We understand that individuals pursue fellowship training in Interventional Radiology in order to gain technical proficiency in the multitude of procedures performed by our specialty. The volume of procedures in our division provides each fellow with an abundance of opportunities to develop and enhance their procedural skills. Our fellows graduate with an enviable proficiency in image-guided procedures and the confidence to bring these abilities to the next step in their careers. However, it is important that our fellows understand and gain proficiency in the entire episode of care surrounding an IR procedure. Success in this field is achieved when as much attention is paid to the patient before and after the procedure as is paid to the patient during the procedure.
When it comes to performance of procedures, we have created a system whereby graded responsibility is given to each fellow. This can be thought of as a "2-4-6" program. By this, we mean that early on in the fellowship year, usually for at least the first 2 months, procedures are performed under direct supervision, with an attending physician in the room, scrubbed into the procedure with the fellow. It is expected that the fellows gain an understanding of the assistant role during procedures and must be proficient with that role before moving onto the role of primary operator. This typically involves understanding the indications for the procedure, the instruments on the table, the table side controls of the equipment, and the role of the nurse and technologist within the procedure room. It is also essential that fellows demonstrate the ability to anticipate the next steps in a procedure before they occur. Fellows should demonstrate these abilities and this knowledge through active interaction with the attendings before, during, and after procedures. As comfort is gained with the procedural skill of each individual fellow, usually for the next 4 months, attendings will begin to permit limited independent performance of all or part of certain procedures. This will be at the discretion of the individual attending responsible for individual procedures and may be different for each of our fellows. It is our hope that our fellows will be able to perform most procedures independently by the midway point of the fellowship and can enhance their skills during the final 6 months of the year. It is also expected that fellows demonstrate an understanding of limiting both radiation exposure and contrast administration with patient safety in mind. Ultimately, it is a combination of technical proficiency and judgement that will enable fellows to gain procedural independence during the fellowship.
In an effort to fairly distribute the clinical responsibilities and procedural volume, there are two roles assigned to our fellows on a daily basis: procedure fellow and clinical fellow. The "procedure fellow" position is meant to be procedural in nature. As a result, this fellow gets to choose the procedures they are going to perform on that day. This position, however, is not limited to simply performing procedures. It is expected that the procedure fellow will manage the entire episode of care surrounding the procedure for each patient they are treating. This means that the procedure fellow is responsible for morning rounds presentations, pre-procedure consultations, post-procedure orders (including admission orders if applicable), and rounding on the patients undergoing procedures he/she performs or intends to perform. It is our intention to have the fellow assigned to this role select the procedures they are going to perform on a given day but this may not be the case periodically in order to balance the experience among the fellows and residents on the IR service. The "clinical fellow" position is primarily responsible for managing the IR clinical service. This means rounding on patients previously seen by IR and evaluating requests for consultations. Other members of the IR team, including our residents, medical students, and nurse practitioners, share these responsibilities. It is expected that the clinical fellow help coordinate the efforts made by all members of the team towards successful completion of these responsibilities. The clinical fellow should participate in procedures at those times during the day when their clinical responsibilities have been completed.