pediatric IR training would be reasonably expected to be able perform at the end of the fellowship.
IRQ: What would that curriculum look like? GC: I think we need to identify core procedures, much as the IR residency does. There are a set of core procedures that everybody coming out of pediatric IR training should be able to perform. For example, you should be able to embolize. Whether you’re working on a vascular malformation or embolizing trauma—you should know how to do both—the main skill is embolization. There are other areas, like some musculoskeletal interventions, that are not necessarily part of core training. If you have to do that as part of your practice, you can learn to do that, but it is not necessarily required that you be able to perform that procedure as soon as you come out of fellowship.
IRQ: Have there been any obstacles or challenges to getting that standardization in place? GC: Quite a lot, actually. Because of the different pathways available to train in pediatric IR and the significant workforce shortage, there has been some reluctance to put in too many guidelines as it may restrict the number of people that can potentially train in pediatric IR or restrict the number of programs that can offer a fellowship. Some people feel there should be more pediatric radiology diagnostic training as part of the fellowship. We think that diagnostic training can be incorporated into a residency program and should not necessarily be a requirement for a pediatric IR fellowship.
I think the most difficult part is just getting everyone on board. It’s difficult because we have a variety of thoughts and pediatric IR is such a broad tent.
IRQ: What does the job landscape look like for pediatric IRs? GC: The main issue is that we don’t train enough people. We currently have around 50 unfilled pediatric IR jobs in the country, and I expect there to be a lot more in the coming years. However, the number of trainees coming out of fellowship is five to 10 per year at the most. Most programs only train one
There are a set of core procedures that everybody coming out of pediatric IR training should be able to perform. For example, you should be able to embolize. Whether that you’re working on a vascular malformation or embolizing trauma— you should know how to do both—the main skill is embolization.
fellow, so the difficulty is keeping up with the current shortage and meeting the future demand.
I think that the IR/DR residency offers us a real opportunity to try and address this, because for the first time we have a stand-alone IR training program. What I’d ideally like to see is early specialization in pediatric IR. The thought of adding 1 more year to 6 years of training can be a real deterrent. If residents have a specific interest in pediatric IR, I would like to see them have 3 months of pediatric diagnostic training and 3 months of pediatric IR within the residency, which would then allow us to reduce the length of post-residency training.
It’s a work in progress, but I think it’s something we need to start discussing. We currently take between eight and 10 residents a year acting as our third pediatric fellow. They’re there for 6 to 8 weeks. Many have expressed an interest in pediatric IR and wished they’d known about it earlier. In fact, one of our current fellows was so interested that he took a year off after finishing his residency and then started the fellowship.
If people had the opportunity to rotate through pediatric IR a bit earlier and knew they would only need another 6 months after early specialization, I think we would be able to increase the number of trainees.
IRQ: Why do you think there’s a shortage? Is it the lack of awareness you mentioned or the idea of an extra year of training? How would you combat that? GC: I think a lot of it is exposure. We have residents coming into their last year and they’re amazed by how much they don’t know in terms of pediatric IR. It’s sometimes difficult to really appreciate the differences until you start doing your training. Ideally, if residents express an interest in pediatric IR, and I do offer that to our local residency programs, they can rotate through our department in PGY-4. That allows them enough time to apply for a pediatric IR fellowship. However, as I mentioned, what would really make a difference is a formal early specialization program of pediatric IR training within the IR/DR residency.
In addition, I think that whenever we have a discussion, program or meeting, we should incorporate pediatric IR into all of them. Even at the annual SIR meeting the pediatric IR sessions are often completely separate. It would be more interesting for both pediatric and adult IR physicians if those lectures were incorporated into the general program. I believe that will increase the awareness of both the kind of conditions we treat and the work that we do.
IRQ: Let’s say you’re in a room of medical students looking to pursue their residency. What do you say to encourage them to consider pediatric IR? GC: I’ve trained as a pediatrician. I’ve done IR, then pediatric IR. It’s probably the most satisfying type of interventional radiology. The patient population and the conditions we treat are so varied. Every day you learn something new. What is really striking about a children’s hospitals is how collaborative we are. There are far fewer turf battles. For example, almost all of our clinics are interdisciplinary. The vascular anomalies clinic typically has four or five different specialties seeing the same patient together. The patient population, the conditions we treat and the working conditions—all of those make it a very pleasant place to work. To be honest, I’ve yet to find somebody who really dislikes doing pediatric IR. It’s not always easy, but it is worth the effort.
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