by Kyle Cooper, MD, R-3 at Wexner Medical Center at The Ohio State University

Tyler Green is a radiology resident starting IR fellowship this summer. He sat down with Kyle Cooper to explain how he came to a decision to pursue IR as a career, as well as about various training pathways available.

What sparked your interest in Interventional Radiology, and how did you go about getting involved with IR?
As a third year medical student, I found that I enjoyed surgery. There were a couple of surgical fields that I considered going into, but didn’t feel that any of them was a perfect match. My dad is a radiologist, and he suggested that I might like IR. So when I was home, sometime near the end of my third year of medical school, I spent a day with one of the IR guys in his group, and got to see him do a couple procedures—I thought it was really cool stuff, and I could clearly see he was happy doing IR. When I went back to school, I set up a 4th year elective in IR. I loved the wide variety of procedures, and I was amazed by the things you could accomplish through a tiny nick in the skin. Equally important, I really liked the people in IR, and the work environment. Everyone seemed to be having fun, and working well together. In some ways it was similar to the feel of working in the OR (the pace of work and the space you work in), but the atmosphere was a little lower key. Overall, IR just felt like a really good fit.

Tell us about one of your best experiences in IR?
I’m not sure that I could put my finger on one single best experience in IR. It’s always a great feeling any time you do a procedure for the first time on your own from start to finish; regardless of what the procedure is, it gives you a strong sense that you are making progress in your training. In general, it’s a great experience to be at this stage of my training, and to still feel completely content and excited about the field of medicine I chose to go into—I’m lucky in that way.

What advice do you have for an aspiring medical student?
My general advice to medical students is to be open-minded about the fields you consider—don’t pick your field based on what you thought you would do before med school.

For med students who have decided IR is the field for them: IR currently has several training pathways, all of which lead to the same board certification in radiology by the ABR, and all of which take six years of residency/fellowship to complete. The pathways differ in terms of your time will be distributed between IR, non-IR clinical services, and diagnostic radiology; you can read about these pathways in general on the SIR’s website at http://www.sirweb.org/fellows¬residents-students/pathway-options.shtml. My personal bias is that if you are a person who is going into radiology because you want to do IR, then you should consider doing a Clinical or DIRECT pathway. You can obviously become an excellent interventionalist through the traditional pathway (that is the pathway in which almost all of our current interventionalists trained), but the Clinical and DIRECT pathways make it even easier to become an expert in the diseases we treat, to learn about the other fields of medicine with which we most frequently interface, and to become comfortable evaluating patients and making the types of clinical decisions we make in IR.

Unfortunately, there isn’t currently a single site that contains fully updated information about which programs are currently recruiting people for the various pathways. This makes it difficult for med students interested in IR to identify the best programs for them. The ABR’s website has a list of approved DIRECT pathway programs. The SIR’s website has a list of DIRECT and Clinical pathways, but it isn’t fully updated right now. The SIR resident-fellow section is currently trying to compile an updated list of programs offering Clinical pathways, DIRECT pathways, and programs offering IR mini fellowships —you can link to that document https://docs.google.com/spreadsheet/ccc?key=0Ap-jzNRSzc2XdGJES3gxU2MtRURZRDZrN1VzNXAtWkE#gid=0. These are good starting points, but I would recommend contacting programs you identify from these lists to learn more about their programs, and to see if they are recruiting people at your level of training before you start your applications. Sometime in the next few years, we can expect to see the dual certificate pathway start to replace all of these other pathways, and I think that will simplify the whole process for med students who want to do IR—you may even start to see dual certificate pilot programs in the next couple of years, so keep your eye out for that too.

Tell us about your IR training pathway.
I initially matched in radiology at the University of Wisconsin, and went out there to do my internship in internal medicine. For family reasons, my wife and I decided we needed to come back to Colorado. After we made that decision, I found out the University of Colorado was recruiting for their DIRECT pathway program, which was perfect for me because I knew I wanted to do IR. My PGY2 year was at the University of Colorado, doing the second clinical year that is required in the DIRECT pathway—that year was designed by our IR fellowship director in conjunction with the clinical services he wanted me to rotate through. It was a really useful year—a clinical year tailored to someone going into IR. I rotated with general surgery, vascular surgery, urology, hepatology, gastroenterology, and transplant surgery over the course of that year. My PGY3-5 years have been with the radiology department; in addition to the usual radiology rotations, I will do nine months of IR during these three years. Next year, during my PGY6 year, I will be one of the three IR fellows here at Colorado. It’s been a great experience.