Duration: One year Post-doctoral certificate course (PDCC) in Vascular Intervention Radiology; No bond.

No. of seats: Two seats per year of Vascular IR (Total 6 seats: 2 of vascular, 2 gastro and 2 neuro IR)

Eligibility: MD/DNB Radiodiagnosis

Fees, salary and leaves: 70,000/- INR per year is the fee. A state government salary of 90-95k per month. 30 ELs and 8CLs and 2 RH (Restricted Holiday). (However, the liberty to grant leaves is at the discretion of faculty).

Exit Exams: Exams (Theory & Practical) will be conducted at the end of one year, usually in August/September. Theory exam includes 2 papers on consecutive days, one pertaining to basics and second on recent advances in the field of vascular IR.

Thesis/Paper publication: Not Compulsory.

Duty hours and emergencies/on call duties: So, we are discussing ‘duty hours’ for IR postings! An entity that is alienated when your posted in DSA. Always be prepared to work at any time of the day or night. An emergency won’t inform beforehand (renal, GI bleed, thrombolysis etc); likewise the anticipated time for an elective case cannot be guaranteed. So the concept of ‘duty hours’ should be tossed into the abyss. We have two DSA labs (one uniplanar Philips and one biplanar siemens) which are working throughout the week. Two residents, mostly the PDCC fellows, will be posted at a time along with two MD junior residents. The non-vascular IR is a different suite with its own fluoroscopy machine. So mainly as a vascular PDCC we get around 6-7 months of posting in the DSA. For someone who has no exposure of an IR suite before, the initial one month is for orientation. We have a 20 bed ward, the first of its kind to be managed by interventional radiologists, who admit and discharge their own cases. This leads to tremendous learning. However, as as fascinating as the concept of “radiology IR ward” sounds, we ought to remember that with “more power comes greater responsibility”. Thus, we are responsible for preparing the cases: which means pre-procedure evaluation, looking into their co-morbidities, getting the requisite consultations from respective departments who are primary care givers, arranging blood for emergency, titrating the medications etc. In other words, everything under the roof to prepare the patient prior to the day of OT is to be looked after by the fellow who will be performing/assisting the case; the post procedure management will also remain to be our responsibility. Only getting ‘hands on’ is not the criteria for a good IR training, I truly believe that it’s the holistic approach to the patient that actually trains us to be an ideal interventionist. Broadly speaking 14-16 hours of work on weekdays, with 24 hours call duty on alternate days and 2 Sundays a month. In one year training period we will have 6-7 months of DSA postings, 1 month of doppler, 1 month CT, 1 month of trauma hospital posting and 1 month of ward posting (By lighter postings am referring to the non DSA posting).

Intervention and hands on exposure: The hands-on experience is exorbitant! As the lab is divided system wise e.g. Vascular is on Mon/Tue/Thu/Sat, the vascular fellow will not only get training of vascular cases, but also a good amount of exposure of the gastro interventions like TACE,TARE, DIPS, TIPS, BARTO, PARTO, TJLB, BCS etc. on the other days. SGPGI is a cynosure of all nephrology interventions like haemodialysis or AVF Fistuloplasty and in treating central venous occlusions; all managed by Vascular IR fellow along with the respective IR faculty. Furthermore, we treat cases of DVT, Varicose veins, Sclerotherapy in low flow malformations, PAD, Angioplasty/stenting in Renal artery stenosis, coeliac/SMA stenosis, BAE etc. We have diverse spectrum of diseases being treated by IR which also includes onco-interventions like pre-op tumour embolization, RFA ablations etc. Few cases (~ 6-7/year) of aortic interventions like TEVAR and EVAR have been performed with good technical and clinical success, which helps us to familiarise with the hardware and the procedure techniques.

Academic activities and multi-disciplinary meets: One seminar has to be presented every week by the fellow which will be assigned and moderated by the faculty. It will be a topic of a recent advance or a conventional vascular IR procedure. Not only this, but the fellow will also be a moderator for the various seminars/cases, usually 4 per week, that will be presented by the MD student, which helps us to be in touch with topics of general and diagnostic radiology.

Hostel accommodation: Provided in campus. The campus is an eye tonic; all green and beautiful and has facilities of swimming pool, tennis/badminton/basketball courts which can be enjoyed on off days and during lighter postings (for the sports enthusiasts!)

Tips on how to secure the fellowship: The qualifying exam is usually held in July/August. It is conducted in 2 parts. Part A is FRCR MCQ based pattern and Part B is a spotter exam both covering the spectrum of diagnostic as well as interventional radiology. The post MD general radiology knowledge is usually sufficient to crack the exam. Keep a track of the form in July on the SGPGI website.

Your personal experience at the fellowship: So, I had a my tiny bit of experience in the IR lab as an MD candidate; that’s when the love for the wires and catheters developed!! Towards the end of my MD exam, I already had this feeling to want to work in IR, and to be an active participant in patient care and management. So despite all the negative feedback I got for wanting to work in high radiation zones, I went for it. I don’t remember being so sure of my choices as much as I was about doing this fellowship. For a radiologist, to choose a hectic schedule as a lifestyle choice does come at a price. Whilst most of your diagnostic colleagues (not all) may pack up in the evening, but as an IR fellow we may not be so lucky most days. You may be called at odd hours for procedures, may have to stay up managing a sick patient, may have days where the procedure failed or got complicated; but if you feel the impending need to be a radiologist with a healing touch then this is the way to go!! If watching a patient walk out of the ward healthy after a procedure gives you a sense of gratification then don’t let anything hold you back, the IR fellowship here opens a whole new set of horizons.

Now addressing to the concerns of the prospective applicants: I think I have explicitly highlighted the pros of joining this fellowship in the form of hands on experience, wide case variety, very friendly and approachable faculty, clinical management learning at the wards etc.

As far as the cons are concerned, I think being a non MCI recognised PDCC (although one year SR teaching experience is given) and the fact that I felt the course should have been 2 years (as one year of learning is sufficient for most but not all cases, especially aortic interventions and TIPS etc). There will be no posting in the non-vascular suites in Vascular PDCC which may be disappointing. No sponsored conferences is another disadvantage.

Any additional comments/ does it add value over MD /DNB degree: I definitely think it adds to the CV and peddles the way to enter the field of IR. Although a foreign IR fellowship might hold an upper hand on paper, but as far as hands-on learning is concerned this is the place to be!

– Dr Amrin Israrahmed, MD Radiology, PDCC Vascular Interventional Radiology, SGPGIMS, Lucknow.