The Interventional Radiology Residency: Is It Time Saudi Radiology Residency Programs Contemplate the Idea?

Abstract

It would be an understatement to say that interventional radiology (IR) is advancing at an exponential rate. The minimally invasive nature of procedures provided by IR has proven to be cost-effective, favored by patients, and an excellent alternative to conventional surgery. This has led to higher demand for the services provided by IR by many medical specialties. Despite this, ambiguity and confusion still loom large when it comes to the perception and awareness of IR among medical faculty and medical students, respectively. This could be attributed to many factors.1,2 In Saudi Arabia, the inaugural IR fellowship training program had begun in the year 2000. It was structured as a 1-year fellowship program after the completion of a 4-year Diagnostic Radiology (DR) residency. Four years later, the Saudi Commission for Health Specialties (SCFHS) had approved a 2-year fellowship program for IR after the prior single year program was met with much criticism.3 Today, there are a total of 8 IR fellowship training centers in the Kingdom and 24 fellows practicing IR. Other neighboring countries such as Egypt4 also offer a 2-year IR fellowship program. IR has yet to achieve specialty independence in the Kingdom. In a recent study, Makris et.al had found considerable heterogeneity both in exposure during IR training and training satisfaction on a global scale.5 The United States no longer offers a classic IR fellowship post DR residency. Instead, there exists three separate pathways to becoming an IRs in the United States.6 The “integrated” IR residency is a 5-year program that includes 3 initial years of DR followed by 2 years of IR. The “independent” IR residency is a 2-year residency that is independent and taken after the DR residency. The independent pathway also has its own matching process after the completion of a DR residency. The third pathway is known as “Early Specialization in IR” (ESIR). Here, DR residents who develop an early desire to specialize in IR can join the ESIR program. The ESIR resident would naturally have a different residency structure to his DR peers. Theminimum requirements to graduate as an ESIR resident are 12 IR or IR-related rotations during the postgraduate year (PGY) 2–5; and one intensive care unit rotation. During said rotations, the ESIR residentmust complete a minimum of 500 procedures and is required to maintain a logbook of such cases. ESIR residents are then eligible to match for the second year of the independent residency, lowering the number of years in training to 6. An extraordinary amount of effort was put in place when considering this drastic shift in training.7 Ultimately, the rationale behind it stems from a few important factors: First, although DR and IR share similar competencies in imaging and procedures, postprocedural patient care is a unique competency to IR. Second, the complexity of procedures offered by IR is increasing, necessitating more years of training. And third, more focused training in IR will prove beneficial to patients and patient care in the long run. Current DR residency structure in Saudi Arabia permits a minimum of three and a maximum of six IR rotations during PGY-2–5.8 This consists of threemandatory “core” IR rotations takenduring clinical years, and threenonmandatory “elective” rotations, from which a resident can choose IR. Some DR residencies in Saudi Arabia reserve one elective rotation for the American Institute for Radiologic Pathology course. This is in stark contrast to the United States, where the pivotal PGY-5 year is, on average, composed of nine elective rotations alone.