Pathway to IR: Lessons learned and future training. Brandon Olivieri, R4 Dave Tabriz, R3

Insights from a future IR fellow. Brandon Olivieri TITLE HERE

BRANDON SLIDES START HERE

The IR Training Transition: What medical students need to know. Dave Tabriz R3, University of Florida-Gainesville Chair SIR Resident, Fellow, & Student (RFS) Section

SIR RFS Section Webpage rfs.sirweb.org History Application News Education

History of IR Training Current status (competitiveness) of IR fellowships Future training models What you need to know (and questions to ask) Questions/Answers Outline

History of IR Training Current status (competitiveness) of IR fellowships Future training models What you need to know (and questions to ask) Questions/Answers Outline

Traditional Historic IR Training (After 2020) Medical School 1 year internship 4 year Diagnostic Radiology (DR) residency 1 year Interventional Radiology (IR) fellowship “Subspecialty training”

If my fellow angiographers prove unwilling or unable to accept or secure for their patients the clinical responsibilities attendant on transluminal angioplasty, they will become high-priced plumbers facing forfeiture of territorial rights based solely on imaging equipment others can obtain and skill still others can learn. —Charles Dotter American College of Surgery meeting in 1968 Impetus for change.

Impetus for change Importance of clinical competency in IR »Embracing role as clinicians »Recognizing need to provide supplementary training in nonprocedural patient care Practice of IR is complex »Broad scope of procedures »Inadequacy of 1-year fellowship  Technical Skills  Perioperative care  Clinic

Traditional IR Training – Special Pathways IR Clinical Pathway »29 months in DR »24 months of IR »16 months in patient care specialties »3 months of research DIRECT (Diagnostic and Interventional Radiology Enhanced Clinical Training) Pathway »27 months in DR »21 months in IR »24 months in patient care specialties These pathways were not widely adopted

Proposal Acceptance Approved by ABMS in September 2012 »ABMS mandated development of timeline for transition from IR fellowships to new IR residency  Sunset date on IR fellowships is June 30, 2020 »IR is a PRIMARY medical specialty (e.g. Internal Medicine, Surgery)  No longer a sub-specialty (e.g. Cardiology, Neuroradiology) Approved by ACGME Board of Directors in February 2013 »Naming of training that leads to IR/DR certification: “IR Residency” ACGME approves IR program requirements Sept 2014

Bottom Line. IR ‘fellowships’ will be phased out on July 1, »In stone. After this date, ‘fellowships’ will lose accreditation. »Trainees from non-accredited programs (e.g. ‘fellowships’) will not be able to sit for IR certification.

History of IR Training Current status (competitiveness) of IR fellowships Future training models What you need to know (and questions to ask) Questions/Answers Outline

IR fellowship match: increasingly competitive

History of IR Training Current status (competitiveness) of IR fellowships Future training models What you need to know (and questions to ask) Questions/Answers Outline

Structure of IR Residency Three “paths” »Integrated IR Residency [DR and IR program director]: [6 years total]  1 year Internship  5 years of DR/IR training at one institution (3 years DR + 2 years IR-focused)  Residents enter from medical school »Independent IR Residency [IR program director]: DR Residency + 2 [7 years total]  1 year internship  4 years of DR residency at one institution  2 years of post-DR residency IR training (PGY6-7) – Same or different institution  Think of as a 2 year ‘fellowship.’ – Residents enter post-completion of a DR residency »Early Specialization in IR (ESIR) [DR program director] DR Residency + 1 [6 years total]  1 year internship  DR program pathway (‘mini-fellowship’) that demonstrates IR competency, and allows trainee to bypass 1 year of the Independent IR Residency.  1 year of post-DR residency IR training (PGY6) – Same or different institution  Think of as a way to only need a 1 year ‘fellowship.’ – Residents enter post-completion of a DR residency

Structure of IR Residency

DR and IR Resident Certification Timeline Same timeline. Same Core Exam. DR Certifying Exam »5 modules, all computer based  2 modules: Essentials of DR, Noninterpretive Skills  3 modules: Clinical areas (chosen by examinee) IR Certifying Exam »2 computer based modules, oral component  2 modules: Essentials of DR, Noninterpretive Skills  Oral component in-lieu of ‘3 modules in selected clinical areas.’

History of IR Training Current status (competitiveness) of IR fellowships Future training models What you need to know (and questions to ask on interviews) Questions/Answers Outline

FAQs, updated database of IR residencies, etc. RFS Webpage Resources rfs.sirweb.org

Accredited Integrated IR Residencies Georgetown University University of Kansas University of Michigan Vanderbilt University University of Pennsylvania Massachusetts General Hospital Brigham and Women's Hospital Washington University Total Applied 37 Total Applied [Dec 15 Deadline for upcoming cycle] [Cannot name all at this time] Programs “Ahead of the game”

What would I do? - Join SIR and the Medical Student Council -FREE! (for now…) -SIR Connect (forum akin to AuntMinnie, SDN) - Try to attend the SIR Annual Meeting (Medical Student scholarship) - Start (or become active) in an IR Interest Group What would I ask? (but be careful…) - Does your program have an ESIR (Early Specialization in IR)? - Have you applied for an IR Residency? Integrated, Independent, or both? What would I do? What would I ask?

History of IR Training Current status (competitiveness) of IR fellowships Future training models What you need to know (and questions to ask) Questions/Answers Outline

SIR RFS Section Webpage rfs.sirweb.org History Application News Education