ESIR FAQ

Author
Jason Mitchell, MD, MPH. Assistant Professor at the University of Maryland
 
Editors
Geogy Vatakencherry, MD. Program Director at Kaiser Permanente Southern California 
Minhaj Khaja, MD.  Assistant Program Director at the University of Michigan
 

What is ESIR?

ESIR stands for Early Specialization in Interventional Radiology, and is a pathway offered by some ACGME-approved Diagnostic Radiology (DR) residencies that allows select residents in DR programs to begin their Interventional Radiology (IR) training within their DR residency. Upon completion of the ESIR residency, only a single year of dedicated IR training is needed for board certification as opposed to two additional years for DR residents who did not participate in an ESIR approved program.

What pathways are available for me to take to become an Interventional Radiologist?

There are three paths to become an Interventional Radiologist. They are:

  • The Integrated IR residency: This involves a 1 year internship followed by a 5 year residency (1 + 5). Typically, the residency consists of 3 years of DR and 2 years of IR and IR-related rotations, with at least one month of ICU experience. There is some flexibility for the programs to determine when the IR and IR-related rotations take place during the integrated residency.
  • The Independent IR residency: Although it is called a “residency”, the independent IR residency functions similar to the current fellowship model.  This is either a 2 year IR training program after a conventional radiology residency (7 years total) or a 1 year IR training program after completing an ESIR-approved training program (6 years total).
  • ESIR (Early Specialization in Interventional Radiology) ESIR is completed within a DR residency, which allows residents who have completed a DR residency including the requirements of ESIR to then pursue a 1-year Independent IR residency (1 + 4 + 1) rather than the 2-year Independent IR residency as above (1 + 4 + 2). Effectively, it decreases the total post-graduate training by one year from the DR residency + Independent IR residency (1 + 4 + 1) to the length of an Integrated IR residency (1 + 5).  The ESIR training consists of a total of 12 IR or IR-related rotations during the 4 years of a DR residency, along with 1 month in the ICU.  Most programs will have the bulk of those rotations in the R4 (PGY-5) year, though there is flexibility in designing curricula, and there will be variation between programs as to timing of requirements.

Why would one choose one pathway over the other?

The pathways were designed to offer flexibility in becoming an IR physician

  • The Integrated IR residency is available for medical students who have chosen to pursue a career in IR very early—before the residency application and interview cycle in medical school. It is a total of 6 years of training.
  • The 4-year DR residency + 2-year Independent IR residency is available for trainees who have either:
    • decided to pursue a career in IR later—towards the end of DR residency.

-or-

  • decided to pursue a career in IR as well as further explore other interests in DR during the 4th year of DR residency—typically a period when DR residents pursue additional focuses in diagnostic imaging
  • This is a total of 7 years of training.
  • The 4-year DR residency including ESIR + 1-year Independent IR residency is available for trainees who have:
    • decided to pursue a career in IR later than during medical school, but before the end of DR residency.

-or-

  • decided to “keep career options open,” i.e., a medical student or resident that really enjoys IR, but is not 100% sure of pursuing it as a career. This pathway allows for the same 6-year length residency as an Integrated IR trainee, without having to make the decision to enter an Integrated IR residency, but rather, entering a DR residency instead, and thereby keeping DR career options open.

Is doing ESIR (DR residency with ESIR + 1-year Independent IR residency) going to make me look different than doing an Integrated IR residency?  Does it show less commitment?

No.  In the end, Interventional Radiologists who have completed any of the three above pathways will have the exact same board certification (IR/ DR dual certificate) and will have trained in about the same number of IR rotations.  The only variation between the training of any graduate from any of the pathways will be variation within training programs.  These different pathways have all been designed to allow a trainee the opportunity and flexibility to choose IR as a career path at different times during their training.

How many programs will offer ESIR?  How many total positions will be available?

Programs are continuing to apply for the ESIR designation (as well as for the IR residencies), and the Radiology Residency Review Committee of the ACGME (RRC) is continuing to review all of those applications.  Until that process has been completed, which may take some years, no one really knows the answer to that question.  The best thing to do would be to contact individual programs and ask whether they offer, or plan to offer, ESIR or the IR integrated and independent residencies.  All the integrated and ESIR approved programs are also listed here: http://www.sirweb.org/clinical/IR_DR_cert.shtml

How will residents in DR residencies get ESIR training?  Are there a limited number of positions?

The number of available positions as well as the selection process will vary at each program.  Again, it is best to contact individual programs for those details.

Can residents match directly into ESIR positions in DR programs?

No, the selection process for ESIR residents will happen within DR residency. The selection process will involve the program directors from both DR and IR residencies.

What is the selection process for ESIR?

The selection process within each program for ESIR positions will vary based on the program and available resources.  Once successfully completing the selection process, a resident is determined to have completed ESIR at the end of his or her residency if all requirements for ESIR have been fulfilled.

Can residents switch from a DR residency with ESIR into an Integrated IR residency?

Technically, yes, if there are available positions.  Switching positions within an institution is at the discretion of the program directors and graduate medical education leadership.  Switching positions between institutions is more difficult, but still possible.

However, given the identical length of the two pathways and similarity in training, there may not be any need to do so.  The difference will be that while an Integrated IR Residency resident is guaranteed a PGY-6 position at the same institution, the ESIR resident is not and may have to go through the Match.

How will programs allocate spots between the Integrated IR residency, the DR residency, and ESIR?

Each institution is tackling this differently.  There are institutions that are adding positions to accommodate new trainees in new training programs, institutions that are keeping the number of trainees neutral and allocating spots based on perceived demand or resources, and institutions that will no longer continue to train Interventional Radiologists under all or any of these new models.  In this time of transition between the VIR fellowship and the IR residency, there is no clear pattern of how individual institutions and programs are handling position allocation.  It is best to contact individual programs for these details.

Why would a program offer both Integrated IR positions and ESIR within the residency?

Program directors, the SIR, and the RRC all understand the decision to pursue a career in IR may come at a different point in each individual’s training.  In fact, these pathways have all been designed to allow a trainee the opportunity and flexibility to choose IR as a career path at different times during training, or even beyond primary training.  By offering many different pathway options, programs are allocating resources to train individuals who have decided to pursue IR as a career at different times during their training, and recognizing that the choice to pursue IR is an individual one.

How different is the ESIR curriculum in a DR residency from that of the traditional DR residency curriculum?

In order to complete the ESIR curriculum, one must do a minimum of 12 (and maximum of 16) IR or IR-related rotations (4 week rotation duration) during the 4 years of a DR residency, along with at least 1 month in the intensive care unit.  At least 8 of the 12-16 rotations must be in the IR section under the direct supervision of IR faculty. Within the IR and IR-related rotations, residents must complete and document a minimum of 500 interventional procedures.  Most programs will have the bulk of the IR rotations in the R4 (PGY-5) year, though there is a lot of flexibility in designing curricula, and there will be variation between programs as to timing of requirements.

Traditional DR residents (i.e., those residents who are not ESIR) will utilize the time ESIR residents are on IR and IR-related rotations for other elective interests, such as additional diagnostic rotations or research.

What are IR-related rotations?

IR-related rotations are training rotations in the domain of IR (providing image-guided procedural or medical/surgical skills), but outside of the IR section proper, for example rotations in ultrasound procedures, hepatology, or Vascular Surgery.  There are standards for approved rotations, which are part of each program’s application for ESIR designation, and procedures performed by trainees on IR-related rotations count toward the minimum number of interventional rotations needed to satisfy ESIR requirements.

How can I ensure my DR program gets approved for ESIR?

First, ask the program director whether an application has been submitted to the RRC—while some programs have been approved, many applications are still being processed.  Almost all of the programs that want to be approved for ESIR are applying at the same time, and the RRC can only go so quickly to process and approve the applications!  Second, if an application hasn’t been submitted, discuss with the program director what barriers there are to applying—they may not have resources to support the program, or they may not have had time to apply yet.  They may just need an engaged resident to help with curriculum development, and might welcome the help!

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