Saumya Gurbani, G1, MD/PhD Program, Emory University, and Mithil B. Pandhi, MS4, Midwestern University Chicago College of Osteopathic Medicine
Interventional Radiology (IR), the innovative specialty that dates to the pioneering procedures of Charles Dotter, is undergoing exciting new changes in resident training. Over the past decade, it has been recognized that IR is a unique field at the intersection of diagnostic imaging, minimally-invasive procedures, and patient-centered clinical care; consequently, the American Board of Medical Specialists (ABMS) has approved a new pathway for IR resident training that will be introduced in the next couple of years. If you are unacquainted with this transition to the IR residency, there are some excellent resources to be found on this website (such as the “Pathways in IR” page). It is important to remember that as we make this transition, there will be multiple options available to graduating medical students over the next few years. This article is intended to expound on the IR Residency pathways that will become available, with particular focus on the Early Specialization in Interventional Radiology (ESIR) – a program that will help residents move laterally from DR to IR.
Integrated IR Residency
Currently, IR training entails 6 years of postgraduate medical education; specifically, a 1 year internship (surgical, medicine, or other ACGME approved internship), 4 years of Diagnostic Radiology (DR) residency (PGY2 – 5), and one year of an IR fellowship. This 1-4-1 model will ultimately be replaced by the new Integrated IR Residency—taking effect in 2016. The Integrated IR Residency also entails 6 years of postgraduate education. Diagnostic radiology will remain an integral component of the training, as graduates of the IR residency will become dual-certified in IR and DR. In fact, the PGY2 – 4 years of the Integrated IR Residency function similar to current training and will be primarily comprised of DR rotations, though there will be IR and clinical rotations built into each academic year. The ABR Core Exam is unchanged and will be taken at the end of the PGY4 year with other diagnostic residents. However, the last two years of residency (PGY 5-6) will be devoted to Interventional Radiology and include procedural rotations, an ICU rotation, and clinical care experience (in-patient care, consult service and outpatient clinic). Table I below shows the timelines for the current and new pathways, particularly highlighting how IR rotations are scheduled during the PGY2-6 years. As the new IR residency goes into effect, the current paradigm will eventually be phased out with no more IR fellowships offered beginning in 2020.
For residents not in the Integrated IR Residency, there are two other options that will ultimately be introduced: the Independent IR Residency and Early Specialization in Interventional Radiology (ESIR).
Independent IR Residency
The Independent IR Residency is a distinct two-year program to be tentatively implemented in 2020, replacing the current IR Fellowship. In this pathway, residents that complete a Diagnostic Radiology residency can thereafter enter into the Independent IR Residency (PGY6-7). These two years are comprised of the components of the PGY5-6 years of the Integrated IR Residency, with IR procedural rotations, an ICU rotation, and clinical care experience (in-patient care, consult service, and outpatient clinic). Via the NRMP Match, qualified graduates of Diagnostic Radiology residency can enter into an Independent IR Residency.
Early Specialization in Interventional Radiology (ESIR)
The purpose of ESIR is to provide an alternative path for DR residents who identify an early desire to enter into IR. ESIR is a modification of the curriculum in a DR residency. The establishment of a uniform ESIR curriculum at participating DR residency programs will ensure that these residents obtain adequate IR training. ESIR training requires residents to rotate in 12 IR or IR-related rotations during PGY2-5 with documentation of 500 IR or IR-related procedures. DR residents that complete the prescribed ESIR training and satisfy the IR procedural requirements will be eligible to receive credit for the first year of the Independent IR Residency and enter directly into the second year the Independent IR Residency program at their institution or another institution, thus still being able to complete training within 6 years. These residents will enter via the NRMP independent residency Match. The independent residency programs can chose from a pool of ESIR qualified DR or conventional DR candidates. Critically, the DR residency program must be pre-approved to support ESIR based on their ability to provide a suitable IR curriculum. When looking at DR programs to apply to, we highly recommend reaching out to the residency director and discussing if the program offers ESIR and, if so, what the schedule will be like.
Table I. Comparison of the current DR+IR Fellowship pathway, new IR residency, and ESIR pathway.
IR*: IR or IR-related rotations, including procedural-based rotations such as ICU or critical care.
If you’re a current medical student set on pursuing interventional radiology as your medical specialty of choice, what are your options? We’ve outlined them below in Table II, based on the year you will be graduating from medical school and entering internship.
Table II. Residency options for medical students interested in pursuing IR, broken down by year of medical school graduation.
We would like to thank Drs. Geogy Vatakencherry, Saher Sabri, Jeanne Laberge, Mamdouh Khayat, and Kyle Cooper for their kind guidance and feedback in writing this article.