IR Residency and Training Pathway FAQs

The FAQ listed below is current as of February 22nd, 2016. Please be aware that the current IR training structure is undergoing a shift towards the IR Residency. On or before July 1, 2020, the ‘old’ IR training pathways (Direct Pathway, Clinical Pathway, Traditional Pathway) will no longer be available, and all future IR trainees will have to go through the IR Residency, of which three separate pathways will exist.

For the traditional fourth year medical student applying for the 2015-2016 radiology match, few Clinical Pathway programs and a DIRECT Pathway program will still be available. 2016-2017 radiology match will be the first time an Integrated IR Residency pathway will be available for direct application. This is explained in detail in the FAQ.

The table below summarizes the probable pathway(s) for medical students planning on pursuing a career as an IR.

MedStudentIRPaths

Click here for currently accredited integrated programs.

 

Click here for currently offer the Early Specialization in Interventional Radiology (ESIR) designation.

 

Can you tell me why Interventional Radiology (IR) is becoming a separate primary medical specialty?

Interventional radiology (IR) began to evolve into a more specialized field since the accreditation of IR fellowships by the ACGME in the 1990s. Although there is a large overlap between IR and Diagnostic Radiology (DR) training, specifically the competence in image interpretation and understanding of the underlying disease processes, IR requires a more comprehensive grasp of complex image-guided procedures and longitudinal patient care. Thus, a need for a different IR training model became increasingly apparent.

Recent advents:

  • 2012, the American Board of Medical Specialties (ABMS) approved interventional radiology as a primary specialty in medicine.
  • 2013, the Accreditation Council for Graduate Medical Education (ACGME) approved the formation of a new residency training program in interventional radiology.

How is the IR Residency different from the previous IR training pathways (clinical, DIRECT, and traditional pathway)?

The movement towards the IR Residency was a multistep one. In addition to the current Traditional Pathway, two distinct integrated IR training models were created by various institutions: the Diagnostic and Interventional Radiology Enhanced Clinical Training (DIRECT) Pathway and the Clinical Pathway. The DIRECT Pathway is active at a single institution and the Clinical Pathway remains active at several institutions. Both pathways will ultimately transition into the new ACGME approved Integrated IR Residency pathway.

Brief Outline of Each Pathway

Direct
Pathway

Clinical
Pathway

Traditional
Pathway

(Will not be ACGME approved after July 1, 2020)

Integrated IR Residency

Independent
IR Residency (non-ESIR)

Independent
IR Residency (ESIR)

PGY-1

2 years of ACGME
approved non-radiology clinical training

1 year of ACGME
approved non-radiology clinical training

PGY-2

3 IR + 3-4 Research
+ 29 DR

Traditional DR
training

3 IR + 33 DR

Traditional DR
training

Completion of 12 IR
or IR related rotations and at least 500 image guided procedures within the
domain of IR during the 5-year radiology residency/ICU

PGY-3

2 IR + 10 DR

PGY-4

3 IR + 9 DR

PGY-5

4 IR + 8 DR

9 IR + 3 DR

9 IR + 3 DR/ICU

PGY-6

IR Fellowship

IR Fellowship

IR Fellowship

12 IR

 

Independent IR/ICU

12 IR

PGY-7

 

 

 

 

Independent IR

 

Direct pathway (in simplest terms: 2 years internship + 3 years DR + 1 year IR fellowship)
The DIRECT Pathway, implemented by several institutions such as Christiana Care and University of Arkansas allowed up to two years of clinical training at an ACGME approved program during PGY-1 and 2 to count toward the DR certificate and subspecialty IR certificate. This pathway required a special approval through the American Board of Radiology (ABR) which previously only permitted no more than one year of credit for non-radiology clinical training. The remaining radiology training will consist of 27 rotations of DR and 9 rotations in IR during PGY-5, instead of during PGY-6 as it is done in a traditional IR fellowship pathway.

Clinical Pathway (in simplest terms: 1 year internship + 4 years DR + 1 year IR fellowship)
The Clinical Pathway, implemented by institutions such as University of Virginia and University of Michigan, better exemplifies the new ACGME approved IR Residency pathway. The Clinical Pathway does not require a special approval by ABR since it fits within the approved curriculum requirements of a traditional radiology residency. Similar to the Traditional Pathway (1-year internship, 5-year DR residency, 1-year IR fellowship), a year of non-radiology clinical training at an ACGME approved program is required during the PGY-1. 7 rotations during PGY-2 to 6 will be dedicated to IR related research and clinical training (i.e. consult service for cardiology, nephrology, vascular surgery, oncology, hepatology, gastroenterology, or other non radiology clinical rotations). Of these 7 rotations, at least 3 rotations must be dedicated to research activities. Residents will be required to complete 32 rotations of DR training during their PGY-2 to 5. 9 rotations during PGY-5 will be dedicated to IR training, which consist of noninvasive peripheral vascular lab, MRA, CTA, neuroangiography, neurointerventions, cardiac MRI or IR. The last PGY-6 year will consist solely of IR fellow level training. This pathway will be phased out in favor of the new IR residency and will be offered for the upcoming 2015-2016 match season only.

Integrated IR Residency Pathway (in simplest terms: 1 year internship + 4 years DR + 1 year IR)
As aforementioned, the Clinical Pathway will serve as the cornerstone of the new 2014 ACGME approved Integrated IR Residency pathway. The reader should note that the unofficial name, IR/DR Dual Certificate Pathway, might be often used synonymously with the IR Residency Pathway until the official name is popularized. The Integrated IR Residency curriculum must consist of five years (PGY-2 to 6) of DR and IR education, of which 36 rotations must be concentrated in DR. During PGY-2 to 4, three rotations must be in IR, and residents must fully participate in research, non-procedural patient care, clinical training similar to that of the Clinical Pathway. The final two years of the program should be focused primarily on IR training (i.e. procedural rotation, ICU, in-patient care, consult, and out-patient clinic), during which DR education will be limited to only 3 rotations.

When will the new Integrated IR residency start?

No Integrated IR Residency has yet been approved by the ACGME as of the 2015-2016 ERAS application cycle. Due to the lengthy process of application submission, processing, site visits, and evaluation, first approval is to occur in 2016-2017. It is anticipated that the approval process will be gradual for most programs and the nationwide adoption may take several years. ACGME will begin accepting applications for individual programs starting in 2015 and a small number of programs will most likely participate in the 2016-2017 match. Some programs such as University of Virginia and University of Michigan have already accepted residents in the past into the Clinical Pathway and these residents will be most likely grandfathered into the new Integrated IR Residency when these programs are approved by ACGME. As new Integrated IR Residencies are approved, their status will be updated in the ACGME database found here. Nationwide implementation of the Integrated IR Residency is projected to take full effect between 2017-2022.

Can you tell me more about the IR Independent Residency?

In addition to the Integrated IR Residency, the Independent IR Residency allows residents to enter IR after the completion of the traditional five-year DR training (1 internship + 4DR). Instead of the traditional one-year IR fellowship, the Independent IR Residency will be a two-year program during PGY-6 and 7. The two years will include components of PGY-5 and 6 of the Integrated IR Residency such as procedural and patient care experience such as ICU, inpatient service, consult service and outpatient clinic. This will serve as the new 2-year ‘IR fellowship option’ for those that do not train under a ESIR program (see below). All independent program applications will be reviewed beginning in 2017, and will have an accreditation effective date of July 1, 2020.

Can you tell me more about the Early Specialization in IR (ESIR)?

Early specialization in IR (ESIR) may be offered at various DR programs, preparing residents with sufficient IR training to qualify for advanced entry into a one-year Independent IR residency. ESIR will allow residents to complete 12 interventional radiology or interventional radiology-related rotations and at least 500 image-guided procedures within the domain of interventional radiology during their 5-year DR residency. The resident could then directly enter the second year of Independent IR Residency, only requiring one additional year of IR training. The ESIR is essentially a ‘mini-fellowship’ in IR during a DR residency.

What is going to happen to the current IR fellowships?

Given the introduction of the Integrated and Independent IR Residencies, ACGME has mandated that the existing one-year vascular and interventional radiology (VIR) fellowship be phased-out. The official sunset date for all VIR fellowships will be June 30, 2020. This coincides with the nationwide launch date of the Independent IR Residency on July 1, 2020.

Important Dates

Last ERAS match season for the Clinical Pathway

2015-2016

First ERAS match season that will have the
Integrated IR Residency Pathway

2016-2017

Nationwide implementation of the Integrated IR
Pathway

2017-2022

Launch of Independent IR Residency

July 1st, 2020

End date for all current VIR Fellowships

June 30th, 2020

If I do not get accepted into the Integrated IR Residency directly from medical school and get accepted into a DR program instead, how can I still pursue IR? What are my options?

The transition into the new ACGME approved IR Residency will be a gradual process and vary from institution to institution. During this monumental shift in the training paradigm, applicants will have several options which will include entering a non-ACGME accredited Clinical Pathway that will eventually become an accredited IR Residency, transfer into an Integrated IR Residency during their DR residency, or apply to an Independent IR Residency after completion of their DR residency.

In addition to the few programs that will be starting the new IR residency in the next few years, which DR programs should I apply to if I want to become an IR physician?

For current applicants hoping to become a IR/DR Dual Certificate physician through an IR Residency, it is strongly recommended that they enter a radiology institution with a strong IR department with plans to become an ACGME accredited IR Residency in the near future and/or has or is working on an ESIR.

Since no program has been approved yet for the new IR Residency, how would I know which institution is planning to start the new IR Residency at their institution in the near future?

The RFS Section is currently actively collecting data from all radiology institutions regarding their plans for adopting the ESIR and IR Residency. However, this information may not be readily available by the 2015-2016 ERAS application cycle. Thus, applicants are encouraged to actively contact their program of interest to obtain this information.

Whom (e.g. program director, coordinator, chair, etc.) at the institution of interest should I reach out to regarding their intentions for the new IR Integrated Residency / Independent Residency / ESIR?

The head of IR (chief of staff or program director) is likely going to be the most informative individual when it comes to their program’s intentions in regards to the new IR Residency. If that individual is unable to help you, they may be able to direct you to the right person. Another possible point-of-contact in a department is the program coordinator. These individuals are usually easy to get in touch with and can be very knowledgeable about the status of residency.

How can I maximize my candidacy for the new IR residency?

There are several valuable articles written by prominent members of the Resident Fellow and Student (RFS) Section of the Society of Interventional Radiology (SIR) regarding maximizing one’s candidacy for IR. These can be found here: Articles

Whom in RFS can I reach out to to obtain more information regarding the new IR Residency?

You can reach out to Dr. Mamdouh Khayat, the current chair of IR Training Pathway, or any of the other active members for more information.

Mamdouh Khayat, MD
Ohio State University Medical Center Clinical Pathway
Email: mmkhayat@gmail.com

Alexandria S. Jo, MD
University of Michigan Clinical Pathway
Email: Alexandria.s.jo@gmail.com

Shantanu Warhadpande
Ohio State University Medical Center
Email: shantanuwarhadpande@gmail.com

Andrew Niekamp, MD
The University of Texas at Houston
Email: aniekamp31@gmail.com

Where can I find the most up to date information regarding the new IR Pathway?

This webpage by SIR is devoted to providing the most up-to-date information about the IR/DR certificate.

Will my DR training be negatively affected if I enter the new IR Residency?

The short answer is: no, your DR training will not be adversely affected. The training that DR residents and IR residents is essentially the same until the end of PGY-4. At that point, both DR and IR residents will take the same radiology board exam at the end of the PGY-4 year. Thereafter, DR residents continue onto PGY-5 in whatever diagnostic (or ESIR) rotations they want. IR residents, on the other hand, continue on to their IR training in PGY-5 and PGY-6 years. In other words, at the end of PGY-4, DR and IR residents would have received more or less the same training in diagnostic imaging. This allows both set of residents (DR and IR) to sit for the radiology board exam. They are both equally adept in core DR at the end of PGY-4, and both sit for the CORE exam offered by the ABR.

Could I still practice DR after graduating from the new IR Residency?

Yes. A graduate of the IR residency will be dual certified in both IR and DR. Thus, an IR resident can practice both IR and DR.

References:
1. Kaufman JA, Laberge J, The IR/DR certificate and New IR Residency. IR Quarterly. Winter 2014; 28-30.

2. Training Pathways in IR. Society of Interventional Radiology Resident and Fellows Section Website [Internet]. [cited 2014 Oct 20]. Available from: http://rfs.sirweb.org/wordpressnstall/training-pathways-in-ir/ 2014.

3. DIRECT Pathway. Society of Interventional Radiology Website [Internet]. [cited 2014 Oct 20]. Available from: http://www.sirweb.org/fellows-residents-students/DIRECTpathway.shtml.

4. DIRECT PATHWAY. American Board of Radiology Website [Internet]. [cited 2014 Oct 20]. Available from: http://theabr.org/ic-special-programs-dr-direct-pathway#approved.

5. IR Pathway Options: Clinical Pathway. Society of Interventional Radiology Website [Internet]. [cited 2014 Oct 20]. Available from: http://www.sirweb.org/fellows-residents-students/IRresidency.doc.

6. ACGME Program requirements for Graduate Medical Education in Interventional Radiology. Accreditation Council for Graduate Medical Education Website [Internet]. [cited 2014 Oct 20]. Available from: https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/415_interventional_radiology_09282014.pdf

7. IR/DR Certificate and New IR Residency: Future Direction of the Specialty: Frequently Asked Questions. Society of Interventional Radiology Website [Internet]. [cited 2014 Oct 20]. Available from: http://www.sirweb.org/misc/IR_Residency_FAQs_10-27-14.pdf.

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