By Matthew Krosin, PGY-3, University of Pittsburgh Medical Center
Presently, a preliminary surgery PGY-1 year is the standard internship for the new six-year Integrated IR Residency. This article shares my own experience-based, dissenting opinion on this training paradigm.
As a current PGY-3 Diagnostic Radiology Resident who intends to pursue an IR Fellowship, I politely argue that a purely surgical internship (or a purely medical internship, for that matter) is suboptimal in molding future IRs. This is based on two facts I came to acknowledge while completing a competitive transitional internship year (TY) at Presbyterian Hospital at the University of Pittsburgh Medical Center (UPMC), also my current institution. First, internship in surgery alone imposes a narrow scope of patient exposure for the PGY-1. Second, by limiting exposure to just surgical divisions, we are short-changing radiology as a whole to the extensive opportunities for hospital-wide practice building through interaction with non-surgical services.
Prior to starting internship, I had already decided that IR was my goal. I met with my TY program director to discuss rotation options in order to tailor my clinical experience for a career in IR. I wanted exposure to as many different patients as possible, much like a practicing interventional radiologist does. I valued the benefits of a surgery internship such as gaining procedural skills and learning peri-procedural management, but was also seeking other clinical skills that would not be developed through an exclusively surgical PGY-1 experience. I also feared circumstances where the educational value would be compromised.
In any field, diminishing returns eventually occur with repeated exposure to similar cases. The first three or four times admitting a bowel obstruction or a COPD exacerbation, plenty of learning is afforded. Eventually, this learning can become stagnant. Extra time is spent doing mundane tasks such as discharging the fifty-ninth SBO admission of the month, at the expense of new educational opportunities elsewhere in the hospital.
My TY curriculum allowed months in both surgical and medical subspecialties, avoiding diminishing returns. I completed blocks in in-patient medicine, general surgery, medical intensive care, cardiac intensive care, cardiology consults, infectious disease consults, outpatient medical clinic, pathology, in-patient night float, and interventional radiology. While many TY programs are considered “cushy,” without significant day-to-day demands or anything close to an 80-hour work week, my TY did not fit this mold. Review of my duty hours revealed an average of close to 80 hours/week as a PGY-1. I used the flexibility of a TY program to customize a challenging and educational experience that would best prepare me for the demands of a future career in IR.
In addition to varied patient exposure, the opportunity to work with all departments in a hospital provides an invaluable foundation for future participation in an interdisciplinary environment. Interventional radiologists receive referrals from all specialists in both medicine and surgery. To build strong practices, interventional radiologists must be known to and trusted by the other clinicians in a hospital—not just from surgery, but from every department. A customized, diverse TY experience with both surgery and medicine rotations for Integrated IR residents would establish and promote the rapport between IR and other departments. Because I worked with trauma surgeons, internists, oncologists, cardiologists, pulmonologists, infectious disease specialists, pathologists, and other radiologists as an intern, I am on a first-name basis with many of them. I receive calls on my personal cell phone from attending surgeons and internists because they trust me with their questions or problems. When they walk into the reading room or angiography lab, they recognize me. This rapport has allowed for better communication about alternative imaging options, appropriateness of requested procedures, and post-procedural care of our co-managed patients.
As the Integrated IR Residency evolves, the internship curriculum should be optimized for a career in IR. Instead of completing a surgical internship intermixed with other preliminary and categorical surgical interns, IR residents should complete their own specialized internship curriculum that draws the best, most pertinent rotations from medical and surgical subspecialties while allowing development of rapport between IR and these referring clinicians throughout the hospital. Such an experience would ensure success of IR residents in residency and their future careers.