Duration: One year, beginning on 1^st July

Mentor: Dr. JP Singh, FRCR, CCST (London), MSK Fellowship (Oxford)

Accreditation: No

Diagnostic work: After an interview with the program director and head of department, fellows are usually asked to join either as a senior resident or attending consultant in general radiology for a few months prior to beginning of the fellowship. This helps one to get used to the working environment and to get to know the department, which is quite huge.

As for the MSK fellow, he/she is expected to make provisional reports of all the CTs and MRIs (about 15-20 on average) for second look, finalized by the MSK consultant. The workload is quite good and one gets to see all kinds of pathologies one expects in routine, majority being trauma, degeneration, rheumatology and post-op scans.

Then the fellow reports around 100-150 OPD X-rays independently every day and does MSK USG (4-6 cases daily) under supervision and later independently, with more experience. The amount of X-ray reporting however goes down after six months during which time the fellow can report more cross-sectional scans.

Medanta has a robust nuclear medicine department and the fellow is also expected to do at least one PET-CT reporting per day (only the diagnostic CT part), which is rather time consuming but quite enriching, especially for candidates with no previous experience of the same.

Apart from this every fellow has to do general USG for a week, every fifth week.

Interventions: Most of the interventions are USG guided, about 2-3 cases per week, pertaining mostly to injections for pain management, biopsy, and aspirations. Fluoroscopy and CT-guided interventions are few and far in between and bone biopsies and spine interventions are usually done by the intervention radiology team.

Academic activities: There is a weekly Radiology-Rheumatology meet along with seminar presentations by fellows and residents. Regular discussions with orthopedicians for daily scans usually happen at the consultant level. Teaching is more on case-based discussions without formal teaching. Fellows are also expected to teach and help the DNB residents. There is always help with doing research work and publications by Dr. JP Singh, but the onus is really on the fellow to find time for that.

Duty hours: 8 am-5.30 pm. 5-6 very busy 24-hour duties every month with post-duty off. Depending on your initial appointment, you have do to USG if you are SR or CT/MRI if you are attending consultant while you are on this on-call duty. These duties are hectic but help you to be in touch with general radiology as well, and there is a vast variety of cases to learn from.

Fee and Salary: There is provision of a paid as well as unpaid fellowship, one candidate in each. In the regular paid fellowship, the fellows get a salary of INR 90,000- 110,000/month depending on their experience, and are expected to do general diagnostic work in addition to the fellowship work as well as emergency duties. The unpaid fellows do not receive any salary and are not given any additional general diagnostic work or on-call duties. They also don’t have to pay anything to the institute. They work exclusively in cross-sectional reporting to be finalized by consultant and also assist in MSK USG. They normally do not report independently.

Accommodation: Not provided

Leaves: 24 Casual leaves in a year

Tips on how to secure the fellowship: Since there is no exam, candidates usually approach the department with their CVs and have a general interview with the program director and the head of department. It is advisable to visit well in advance as MSK fellowship is usually sought after and there maybe a waiting time of upto an year for the same. Dr. Singh prefers candidates with keen academic interests and its really helps if you have some publications to your name. Previous experience is desirable, but not mandatory.

Pros: Good exposure as far as variety of cases is concerned. MSK USG is coming up in a big way and there is ample opportunity to learn the same. The biggest strength of the program is definitely the guidance by the mentor, Dr. JP Singh, who, having trained from UK, brings that level of experience to the fellowship. Being renowned for his work experience, we get a lot of cases for second opinion as well.

Cons: The biggest drawback of the fellowship is the lack of time the MSK fellow gets for the fellowship, despite spending long hours in the department. One should understand working in a corporate hospital means working first for the needs of the department and getting pulled into general radiology is only a part of it. Add the 6 night duty offs and the five weekly general USG shift, and you spend on an average 15-20 days a month in the actual fellowship. Another con would be the difficulty in getting a lot of intervention experience, partly due to less number of cases and also due the private set-up where patients want only consultants to treat them. Not a lot of arthrograms, oncology and pediatric MSK cases either.

Personal experience: I definitely learnt the correct way to approach any MSK case and have my mentor to thank for the immense patience he showed in teaching me. The need to know clinical details and being able to examine the patient yourself is as important as knowing radiology for reaching a diagnosis especially in MSK, and you do learn that very well during this fellowship. The “Medanta” tag means a lot wherever you go. On the whole, it’s a good learning experience, but can be a whole lot better. Just ensure that you know what you are getting into in terms of the amount of general radiology work you will have to do during the fellowship.

– Dr. Neha Nischal, MD, Musculoskeletal Radiology fellowship at Medanta (2018-2019)