Maggie Chung, MS4, Warren Alpert Medical School Jemianne Bautista, PGY1, Kaiser Permanente Los Angeles
For students considering a career in IR, a dedicated elective is a valuable way to learn more about this field. Because IR electives present students with terminology and procedures not often covered during core third-year clerkships, the Medical Student Council offers the following suggestions for how to excel during your elective.
Consider an Away Rotation: Doing an away rotation allows you the opportunity to show commitment to a particular institution or region and gives you a firsthand look into specific programs so that you can determine whether or not a program is a good “fit” for you. Before selecting an away rotation, please take a look at this article for tips on timing, program selection, applying and expectations of visiting students.
Prepare before the Rotation:
Before the start of your rotation, review anatomy, particularly relevant vasculature (e.g. branches of the celiac trunk, tributaries to portal vein, lower extremity arteries and veins). A firm grasp of the vascular anatomy is essential for understanding procedural approaches and reading angiograms. There are tools and terminology in IR that may be foreign to those entering the field. Familiarize yourself with these common tools and terms to have a productive start to the rotation and to be an active member during procedures. Know the basics of common procedures (causes of disease, procedure indications and contraindications). This knowledge will prepare you for any pimping during procedures, and serve as a crucial knowledge base for your future in IR. Study these videos to learn the steps of common IR procedures, so that when you’re assisting the procedure, you will be able to anticipate the next step, and be in a better position to contribute during the procedure. One of the videos even demonstrates how to perform percutaneous femoral access, a skill that will come in handy should you have the opportunity during your elective.
During the Rotation
There are several ways you can contribute throughout the day and find learning opportunities. In the morning, you can help your team by measuring drain outputs and trending relevant labs. Be proactive in following and presenting patients. Your presentations are a great opportunity to demonstrate a solid grasp of patients’ diseases and the procedures’ broader clinical context.
While preferences for student presentations vary, we suggest the following format:
- A one-sentence description of the patient that includes the patient’s age, gender, pertinent disease process, what procedure will be performed.
- Relevant history to serve as background to why the patient is receiving the procedure. Mention any previous IR procedures and when they were performed. If the patient is here for a fistulogram or declot, mention his/her dialysis schedule.
- Medications: note any anticoagulants.
- Allergies: only mention if pertinent.
- Labs: PT, PTT, INR.
Include total bilirubin for hepatic procedures. BUN and creatinine for renal procedures. If the patient is febrile or an infectious process is involved, include white blood cell count.
- Imaging: note any pertinent findings and when imaging was performed.
Example: Mr. Doe is a 30-year-old male with alcoholic cirrhosis complicated by HCC here for chemoembolization.
The patient has had 3 previous chemoembolization treatments here with Dr. ________, the last one being 1/1/15 of segment 4a.
The patient is not on any anticoagulants.
PT is __, PTT is ___, INR is ___, and T bili is ___.
The patient’s most recent CT abdomen was 1/1/15 and showed interval increase in size of his segment 4a lesion.
During the procedure, you can help with the following tasks:
- Label syringes
- Refill syringes (contrast and saline)
- Anticipate next step and hand non-sharp instruments preemptively
- Flush catheters and sheaths before use
- Coil wires
- Gently hold the back of the wire so it does not fall off the table and get contaminated
- Help save images on US or fluoroscopy
- Take biopsy specimen slides from procedure room to pathologist
- Help dress drains
- After the procedure, take sharps to sharp container and then roll up table drape and throw into the trash
You can also help with consults by calling the consulting team to inquire about the reason for consult, patient history, and if the patient is on anticoagulants.
Before you leave each day, you can round on patients who have received arterial procedures (check peripheral pulses and puncture sites for hematomas) or drainage. You should let your team know which patients you plan on following or presenting the next day.
As with any rotation, being enthusiastic and showing eagerness to help is key. The IR service is often hectic; helping out your team gives your fellows and attendings the flexibility to teach. The more motivated you are, the more you will reap from your elective. Stay late and take advantage of all that the experience can teach you. Reading every evening about your patients and their procedures will help you build an impressive fund of knowledge throughout your rotation. We hope you succeed with these tips as you explore the excitement and innovation the field of IR has to offer.