International IR
By Anthony Ryan, MD, Raman Uberoi, MD, Gregory Makris, MD, Justin Guan, MD
IR training across the pond A status update and comparison
I
nterventional radiology training and specialty status varies across the globe. In recent years, several countries have amended their
training pathways, but there remains no uniform approach to education. In this article, we discuss the status of training efforts in the United Kingdom, Europe and the United States, to showcase the similarities and differences in how international IRs are educated.
Training in the United Kingdom In the United Kingdom, interventional radiology has been a subspecialty under the Royal College of Radiology since 2011 with a structured training pathway that lasts 6 years (figure 1). Doctors can apply for radiology training in their second post-graduate (foundation) year, having spent time rotating through various non-radiology specialties. Radiology training is normally of 5 years duration for diagnostic trainees and 6 for IR trainees. Until very recently, 3 years of diagnostic training were required before one could apply for an IR fellowship and an additional 3 years of training; however, starting in 2022, trainees will be able to apply for an IR post from year one. This is seen as a major step in the right direction and will remove the previous uncertainty around securing an IR training post. IR trainees will still be required to complete 3 years of dedicated IR training, but their first 3 years will contain more IR and clinical training, so they may enter their dedicated coursework ready to perfect these skills.
The current intention is to maintain flexibility in the system to allow crossover, so that if trainees decide to change their path from IR or DR, they will have the ability to transfer. How this will work in practice remains to be seen and only time will tell. The IR curriculum will not change significantly since it was recently updated by the Royal college of Radiology with the support of the British Society of Interventional Radiology (BSIR) to ensure adequate coverage of vascular and non-vascular IR.1
All trainees,
regardless of their final subspecialty intentions will still need to sit the final
18 IRQ | SPRING 2022
fellowship of the Royal College of Radiologists (FRCR) examination.
Training in Europe Across Europe, there is wide variation in IR training. CIRSE’s European Trainee Forum (ETF) recently reviewed and mapped IR training in the various training systems via questionnaire, obtaining responses from the representatives of 24 European countries which confirmed this heterogeneity. IR has gained official subspecialty status in only 9 of 24 (37.5%) of the countries; however, structured IR training programs are available in 15 of 24 (62.5%). Great heterogeneity was reported in terms of duration of IR training, with 9 countries offering up to a 1 year, 10 countries offering up to 2 years and only 5 offering more than 2 years. In only 11 out of the 24 countries, was there an official IR certification examination post completion of training. Clinical training was only included as part of the IR curriculum in 7 countries, where it ranged from 2–6 months of vascular surgery or intensive care.2,3
In order to
harmonize, support and certify training, CIRSE developed the European Board of Interventional Radiology examination (EBIR) in 2010 which has gradually evolved to become a highly professional and internationally recognized examination. This has been taken by candidates from within and without Europe (42 different countries) with > 850 holders at the time of writing.
A recent trainee survey performed by the BSIR trainee committee in collaboration with CIRSE’s ETF and SIR Residents showed that despite the heterogeneity of training, the vast majority of trainees in Europe are happy
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