By Andy Moore

How does one become a radiologist in Italy?

Basically, in Italy, you have to undergo 6 years of training in order to obtain a medical degree. Then, you have to pass a licensing exam that gives you the possibility to practice medicine without supervision. It usually  takes 6-9 months between the time that you get your medical degree and the time that you get your license to practice.”

The license to practice is equivalent to taking and passing the USMLE Steps 1-3, which explains the need to study for 6-9 months following graduation from medical school before taking the exam. Once the license to practice is obtained, a physician is then able to sit for the national residency entrance exam, whose score will dictate which specialties/residencies are available (based on how competitive a person’s score is, a stratifier similar to our own Step 1).

At the moment, radiology residency lasts 4 years. During these 4 years, you have an educational program which includes a training period in IR (varying between universities, usually up to 6 months). However, frequently residents interested in IR spend extra time in the angio suite,” he explains, with the training model starting to become familiar, although less structured and lacking the standard pre-radiology intern year.

In Europe, there aren’t any countries where you can attend an interventional radiology residency. In Italy, a resident’s exposure to Interventional Radiology is very dependent on the city and hospital in which they do their radiology residency. Often, even if IR has a strong presence in a given training hospital, the onus is still on the resident to craft their own IR learning experience.

The fact that IR exposure for Italian residents is so hospital/geography dependent begs the question: What if I end up in a diagnostic radiology residency that doesn’t give me the access I need to IR?

Italian residents have the opportunity to spend up to 12 months of residency outside of your university, at the discretion of the department head… So, if you are in a program without an IR department, you have the chance to spend 12 months in a hospital from another country in Europe or the world.

So, at the end of your residency, you have a degree in radiology. With this degree, from a legal point of view, you can do anything. I mean, if you want to become an IR, from a theoretical point of view, the degree in radiology and your residency is enough.

This is where the Italian training path gets a little fuzzy for me. You see, if I apply for a job as an interventional radiologist at a hospital in Italy, I have to prove that I have the skill set of an IR. As of now, there is no formalized method for doing so in Italy, so I just build up my resume with as many training experiences as I can and hope that it’s sufficient. To address this, in the last 2 years the Italian Society of Radiology (SIRM) has developed a master’s degrees of 1 year duration, reserved for those who have completed a radiology residency and want to acquire additional skills in IR. These master’s are divided into Body IR and Neuro IR.

These master’s degrees are unpaid and, in fact, you have to pay for it. I remember when I spoke with Marco Ertreo (IMG resident and RFS member) and I told him these things he was quite surprised (laughs).

Are these prohibitively expensive for people that may want to further their IR training?

Individuals enrolled in the master’s in IR continue working as radiologists since the master’s commitment is not full time. And unlike a fellowship in the United States, the master’s degree – as well as the newly-minted European Board of Interventional Radiology – is not explicitly required to practice in Italy.

For example, I am from Naples (Southern Italy) and moved to Rome for medical school. I obtained my medical degree in 2010 and my license to practice at the beginning of 2011. Then, in July 2011, I started my residency in radiology. I was in a university hospital that only performed interventional oncology, but I also wanted to learn emergency and vascular procedures. Therefore, I spent the last 18 months of my residency back in Naples where there is a big public hospital to learn these additional skills (at the time I was a resident, the Italian residency lasted 5 years and so I could spend 18 months away and not 12 months as nowadays). I completed a master’s in body IR and took a job in Naples. I am scheduled to attend the European Board of IR training (EBIR, administered by CIRSE) in March of 2019.

Given this protracted and somewhat loosely-defined training pathway, I’m curious if a dedicated IR residency is on the horizon for Italy?

It’s something that’s always spoken of at each national and European congress, because nowadays we are very different from diagnostic radiology. For some years now, in Italy and generally in Europe, we are thinking about dedicated training in IR, but, at the moment,  no country in Europe has a dedicated IR residency.

Given the historical exchange of residents between hospitals in Italy, what possibilities exist for similar international exchanges?

European residents can come to the United States strictly in an ‘observership’ role because their license to practice is not recognized in the United States. Legally, this translates to not allowing hands-on participation. American trainees instead, he adds, would not be subject to similar restrictions and would be welcomed for training experiences in Italian hospitals if interested.