How Will Today’s Clinically Focused Training Paradigms Shape Tomorrow’s Radiology Workforce?

The landscape around Interventional Radiology (IR) training has evolved rapidly during the last decade. Since IR’s recent recognition as a primary specialty of medicine by the American Board of Medical Specialties (ABMS) and the approval of the IR/DR dual certificate in 2015, there has been a gradual training paradigm shift from IR fellowships to IR residencies. The recruitment pool for IR training programs now includes medical students in addition to Diagnostic Radiology (DR) residents.  The number of approved IR residency positions continues to increase every year, and the match rate for categorical IR positions was 100 percent in the 2018 match.

Today’s medical students have a variety of options for pursuing IR. First, an interested candidate can match directly into an integrated five-year IR/DR residency program spanning three DR years and two IR years in addition to an internship year. This option results in a total of six years of postgraduate residency training. Alternatively, one can match into a four-year DR residency following internship, and subsequently pursue a two-year independent IR residency, which is analogous to IR fellowships in the traditional training paradigm. This route results in seven years of postgraduate residency training. The third option is Early Specialization in IR (ESIR) which is a training pathway that allows trainees in a DR residency to complete additional IR electives during their DR residency and enter directly into the second year of an independent IR residency. The ESIR pathway takes six years total to complete.

Despite the competitiveness and the flexibility of the training options, the question remains as to whether or not current third- and fourth-year medical students will receive enough IR exposure to make an informed career decision. Multiple studies to date demonstrated that medical student awareness of IR is low, particularly in the formative preclinical years of training (1). In a recent study, 74 percent of 82 current and recent IR fellows surveyed nationwide believed that medical students will not be ready to select an integrated IR pathway by third year due to low exposure (2).  While efforts such as regional IR symposia continue to combat this problem and increase awareness, better student access to mentorship and integration of IR into medical school curricula will be vital to help senior medical students make the right career choice. 

In addition to increasing awareness of the specialty and the training pathways, it is also paramount to focus our recruitment efforts on the right candidates for the field. Unlike the traditional training system where the pool of candidates is comprised of DR residents who have a passion for imaging, the prospective candidates in the new paradigm includes medical students who have many interests and are considering a variety of specialties. While IR continues to evolve as a clinically oriented specialty, diagnostic training is key for success in IR, and the understanding of imaging, imaging-guidance, and radiation science is one of the elements that separates interventional radiologists from other proceduralists. Hence, the most successful IR trainees and candidates will be those who are passionate about imaging, procedures, and patient care.

IR’s foundation in DR means that the both fields will benefit from each other. The push for value-based clinical practice in diagnostic imaging continues, leading to improved clinical and patient-centered training for IR trainees entering from DR residency. This relatively recent effort known as “Imaging 3.0” pushes for better allocation of healthcare resources toward a more patient-centered view and parallels IR’s progression towards a more clinical model. IR trainees will be better equipped to use more appropriate imaging and procedures that are ultimately focused on benefitting the patient rather than generating volume. Radiology’s place in clinical patient care will also become more important with both DR and IR physicians playing an important role in the management of each patient. In addition, the perceived lack of direct patient care may no longer remain a deterrent to medical students pursuing either DR or IR training.

Innovation remains fundamental to IR’s natural progression to its own independent specialty and beyond. As procedures evolve to answer more needs, the skilled interventionalist will become an invaluable asset to complex patient care. The increasing numbers of minimally invasive options available will subsequently bring a higher demand for IRs trained in these procedures. The new IR residency pathways will offer two years dedicated to IR rotations as well as clinical rotations in other fields such as vascular surgery, which also employ image-guided interventions. This increased exposure will allow the trainee more time and exposure to more complex procedures, including opportunities to collaborate and learn nuances in technique. With a more robust toolbox, tomorrow’s interventionalist will be highly skilled at meeting the increased demand and expectations set forth by advancing medical technology and our complex patient population.
In summary, there is a broad spectrum in interest and clinical exposure to IR among those who will make the decision to train as interventional radiologists.

As a field, IR continues to rapidly evolve. The procedures of today are different from the ones performed 10 years ago and may even be obsolete 10 years from now. However, there is no doubt that future IRs will be better suited to take responsibility for their patients and more effectively contribute to their clinical well-being. Both DR and IR trainees will benefit from the clinical arcs that radiology has begun to take. The future of radiology training is bright and the time to pursue clinical radiology is now.

References:
1. Commander CW, Pabon-Ramos WM, Isaacson AJ, et al. Assessing medical students’
knowledge of IR at two American medical schools. J Vasc Interv Radiol 2014;25:1801-1806.
2. Hoffmann JC, Singh A, Szaflarski D, et al. Evaluating current and recent fellows' perceptions on the interventional radiology residency: Results of a United States survey. Diagn Interv Imaging. 2018;99(1):9-14.