The information below is current as of August 1, 2015. 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 2016 radiology match, few (if any) Integrated IR Residency programs will be available. You will most likely have transition to an Integrated IR Residency at your radiology program internally or apply for an Independent IR Residency program during your radiology residency to begin during your PGY-6 year (2021).
Please visit our dedicated ‘IR Residency and Training Pathway FAQ’ page for further details.
Currently there are several VIR training pathways, each of which qualifies the trainee for the diagnostic radiology boards. The traditional pathway involves a one year internship, four years of radiology residency, and a one year VIR fellowship. A recent change in the format of the diagnostic radiology boards examinations allows greater flexibility in radiology residency curricula, and as a result, many residency programs have developed IR tracks that allow opportunities for earlier subspecialization in VIR. The Clinical and DIRECT pathways are designed to offer participants a substantial amount of time on the interventional radiology service and key clinical rotations.
Recently, the American Board of Medical Specialties approved a new IR/DR Certificate in interventional radiology and diagnostic radiology and new IR residency programs are being established to ultimately phase out the old pathways. While the dust hasn’t quite settled from this momentous change, the IR residency is likely to resemble the IR clinical pathway, already available at several institutions.
The SIR is currently recommending the IR Clinical Pathway to medical students who know they want to go into interventional radiology. This pathway and the new IR residency are meant to place a greater emphasis on clinical experience by giving trainees more time in related clinical services such as surgery, internal medicine, and intensive care. Ideally, the new IR residencies are meant to provide sufficient training in imaging, procedural care, and longitudinal patient care. Below we have highlighted four of the IR Clinical Pathway programs leading the transition to the IR/DR dual certificate. For more information regarding the new IR residency, be sure to visit our ‘FAQ page’.
University of Colorado*
University of Michigan
University of Virginia
Ohio State University
Kaiser (Los Angeles)
|Number of Positions||1||2||2||1-2||1-3|
|PGY1||Surgery||Internship (2 mo ICU)||Surgery (2 mo ICU)||Medicine or Surgery Internship||Medicine (1 ICU, 1 CCU)|
|PGY2||10 DR / 2 IR||10 DR / 2 IR / 1 Clin||9.5 DR / 1.5 IR / 1 ICU||11 DR / 1 IR||11DR / 2IR|
|PGY3||10 DR / 2 IR||10 DR / 1 IR / 2 Clin||7.5 DR / 1.5 IR / 2 VS / Clin / 1 Research||10 DR / 1 IR / 1 Clin||11DR / 2IR|
|PGY4||10 DR / 2 IR||12 DR / 1 Clin||11 DR / 1 IR||10 DR / 1 IR / 1 Clin||10DR / 2IR / 1 AIRP Review|
|PGY5||IR Focus + DR / Clin||4 DR / 6 IR / 3 Clin||3 DR / 6 IR / 2 Clin / 1 Research||2 DR / 9 IR (mini-fellowship) / 1 ICU||3DR / 8IR / 1 VS / 1 Misc. Clin (Podiatry, Wound Clinic, Dialysis)|
|PGY6||IR Fellowship||IR Fellowship||IR Fellowship||IR Fellowship (not categorical)||IR Fellowship (not categorical)|
Table I. Timelines for post-graduate education at the indicated institutions.
VS=Vascular Surgery; Clin=Clinical rotation (including IR clinic, hepatology, GYN clinic, inpatient cardiology, etc.)
*Not offered for 2015 application cycle
PGY1: Surgery (2 mo ICU)
PGY2: 9.5 DR / 1.5 IR / 1 ICU
PGY3: 7.5 DR / 1.5 IR / 2 VS / 1 Research
PGY4: 11 DR / 1 IR
PGY5: 3 DR / 6 IR (mini-fellowship) / 2 Clinical / 1 Research
PGY6: IR FellowshipIn addition:
– IR clinic one day per week (rotating among 8 residents – PGY2-4)
– Extra IR call on weekends
– One month less night float than DR residents
The Importance of Clinical Training During Residency- A Fellow’s Perspective
Rob Freed, MD
Graduate of Kaiser Permanente Southern California (Los Angeles) Vascular & Interventional Radiology Clinical Pathway
Fellow, Massachusetts General Hospital
A one-year IR fellowship is simply not enough training. Sure, learning the technical aspects of IR procedures may take a year, but understanding the clinical management of a diverse patient population an Interventionalist will encounter (oncology, hepatology, nephrology, pathology, arterial disease, venous disease, etc.), takes much longer.
Fortunately, this was recently recognized and addressed with the development of the IR residency. This pathway ensures that IR residents will become board certified in diagnostic radiology and have a dedicated IR curriculum with a sufficient amount of time spent on both IR and relevant clinical rotations (vascular surgery, oncology, critical care, etc.). However, this pathway will roll-out slowly over the next 7 years and leaves those IR-interested medical students entering the Traditional IR pathway via Radiology residency and an inconsistent and perhaps deficient IR curriculum.
There are, however, many Radiology residency programs already achieving the goal of the IR residendy in terms of the time spent in IR and its relevant clinical specialties. To briefly break it down, the IR residency will include 14 rotation blocks (4-week rotations) of IR and IR-related specialties by the end of the PGY-5 year. If you include the PGY-6 year, it will total to 27 rotations blocks.
As an example of a Radiology residency already achieving the IR residency’s goal of time spent on IR and IR-related specialties, we can take my experience. I was fortunate to have matched at a residency that was liberal enough to allow me to customize my curriculum. By the end of my PGY-5 year, I was able to rotate on 16 blocks of IR and its related specialties. If you add my PGY-6 year (fellowship year), it will total to 29 blocks. Having this much time on IR not only improves my clinical acumen, but also gives me the competitive edge to grow and sustain a clinical IR practice after training.
Finding a Radiology residency that allows this customization depends on a multitude of factors. First and foremost, the Residency program director must be progressive and on board. There are many programs out there that are accustomed to the Traditional IR pathway (3 rotation blocks in IR prior to fellowship) and would rather have your helping hand on the wheel of a mouse.
As a medical student who is interested in IR and interviewing at Radiology residency programs, the first step would be to ask the program’s current residents interested in IR how their curriculum is arranged. Then ask the program directors themselves. I was able to do two IR rotations each of my first three years (PGY 2, 3, 4), followed by 10 IR and IR-related blocks my fourth year (PGY 5). Having an uninterrupted continuous block of IR rotations my final year gave me the opportunity to setup my own clinic, see consults, post-procedure follow-ups, and have a convenient outlet to refer patients when reading diagnostic studies and speaking to fellow services (AAA, PAD, IVC filter retrieval, etc.).
In conclusion, the IR residency is a great step for Interventional Radiology. It will dedicate more time to IR in Radiology residency, provide a more well-rounded clinical curriculum, ultimately improve patient care, and provide a trainee with the tools to sustain and grow a competitive practice. However, the residency program is still years away, and until then the current trainee is at risk of being undertrained and steps behind their future colleagues. Current medical students interested in IR need to seek a Radiology residency that gives them the flexibility to spend more time in IR and it’s related specialties. Fortunately, they’re out there.
My residency curriculum:
– Internal Medicine Internship (1 ICU rotation, 1 CCU rotation)
– 2 Blocks Clinical VIR
– 11 Blocks Diagnostic Radiology
– 3 Conferences Attended (RSNA, ISET, SIR)
– 2 Blocks Clinical VIR
– 11 Blocks Diagnostic Radiology
– 4 Conferences Attended (RSNA, ISET, SIR, AUR)
– 2 Blocks Clinical VIR
– 10 Blocks Diagnostic Radiology
– 1 Block AIRP Review Course
– 2 Conferences Attended (ISET, SIR)
– 8 Blocks Clinical VIR (weekly resident clinic)
– 1 Block Vascular Surgery
– 1 Block Misc. Clinical Rotations (Podiatry, Wound Clinic, Dialysis)
– 3 Blocks Diagnostic Radiology
– 2 Conference Attended (Young Guns IR, SIR)TOTAL:
– Vascular & Interventional Radiology – 14 Blocks
– Vascular Surgery – 1 Block
– Misc . Clinical Rotations – 1 BlockRobert Freed, MD – Kaiser Permanente Case Log
Traditional PathwayIn addition to the other non-traditional pathways (DIRECT, Clinical and the new IR/DR Certificate), many Diagnostic Radiology residencies offer IR track and mini-fellowship curriculums, which allow for tailoring of residency towards IR.
The ABR currently allows diagnostic radiology residents to spend up to 16 months in any one subspecialty. With the new board structure of exams being taken during the third year of residency, many programs are developing mini-fellowships. The following is a list of radiology residencies offering these IR tracks/mini-fellowships. At a minimum, these programs offer nine months in IR and/or clinical rotations during the PGY 2-5 years.
IR ResidencyThe IR Residency is a pathway only recently approved by the American Board of Medical Specialties. This pathway is designed to provide a direct, and clinically based pathway for training of Interventional Radiologists.
Please proceed to the following link for more detailed information about the new IR Residency:
DIRECT PathwayThe Diagnostic and Interventional Radiology Enhanced Clinical Training (DIRECT) Pathway allows up to two years of clinical training to count toward the Diagnostic Radiology certificate and subspecialty VIR certificate. Never before has the ABR permitted more than one year of credit for non-radiology clinical years. This effectively decreases a barrier of “lost time” for those residents who become interested in the IR specialty, but have already completed clinical time in another specialty. Some DIRECT pathway programs accept residents who have already completed one or more years of post-graduate clinical residency training, while others are available to medical student applicants who desire a more robust clinical experience than that afforded by traditional diagnostic radiology residencies. Click here for a description of the DIRECT pathway, and a list of ABR-approved DIRECT pathway programs.Christina Care
Number of Positions 1 PGY1 Medicine Internship (2 ICU) PGY2 10 Surgery (1 ICU) / 2 DR PGY3 10 DR / 2 IR PGY4 9 DR / 3 IR PGY5 8 DR / 4 IR PGY6 IR Fellowship
Table I. Timeline for featured DIRECT pathway
Clinical Training PathwayThe primary intent of the Clinical Pathway is to provide a broader and more in-depth experience in the clinical diagnosis and care of patients with diseases commonly treated by interventional radiologists. The secondary intent of the pathway is to allow the trainee an opportunity to participate in research to advance the field of interventional radiology. Unlike the DIRECT pathway, the Clinical pathway fits within the curriculum requirements of a traditional radiology residency, and can therefore be developed in any residency program, without the need for special ABR approval.
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