Course: Fellowship in Vascular Interventional Radiology (VIR)

Duration: 1 year

No of seats: 2 per year

Eligibility: MD / DNB Radiology. Prior Interventional radiology experience is not a prerequisite.

Fellowship Application & Selection process: As this fellowship course is offered by MUHS (Maharashtra University of Health Sciences), you will get a University degree certificate for this fellowship.

Admission is through centralized admission process from MUHS, Nashik. Detailed admission notification comes on the MUHS website usually around November/December (time can vary a little bit). They will assess all marks right from 12^th, MBBS, MD/DNB, post MD/DNB work experience in teaching institutes or government hospitals, number of attempts for MBBS & MD/DNB and points are given to everything as per their strict criteria. While applying you have to write your sequential choices of colleges, as fellowships are available in multiple institutes in Maharashtra. According to the points, a merit list will be prepared and seats will be allotted accordingly. Those who are Domicile of Maharashtra will get preference. There is a separate quota for in service candidates, who are serving in municipal /  government hospitals of Maharashtra.

Exit exam: Yes, at the end of 1 year of fellowship. Usually only a practical exam.

Fees: Approximately INR 1,00,000 for the duration of fellowship.

Stipend: Approximately INR 54,000 /- per month.

Accommodation: Provided by the institution on sharing basis.

Leaves: 12 CLs.

Academic activities & Multi-disciplinary meets: Fellows are expected to present an intervention topics/ interesting cases every week. Senior fellows / faculties do present too. There is a case of the month published in KEM’s official website every month by VIR department. In addition to this, fellows are free to attend academic sessions going on in KEM, Tata or other nearby institutes if you get time. I used to attend most of the vascular meetings which happen every month, where you can present interesting cases or topics.

Conferences: Fellows are encouraged to attend IR conferences on a rotational basis provided there is enough man power in the department. They will be expected to present a paper / poster and take part in quiz competitions. Besides, you will get to attend quite a few in and around Mumbai throughout the year.

Postings: From day 1 and throughout the fellowship, you are posted in DSA lab. There are no other allied diagnostic or ICU postings.

Duties & Work Pattern:  As this is the most important part of any fellowship, I would like to explain it in details.

Everyday duty starts at 8 am; fellows are expected to reach the department first and leave last. Department has alternate day OPD and OT (cath lab). Many times on OPD days you have to do emergency procedures after you finish OPD, which usually lasts till evening. At least one fellow must scrub in for all procedures with seniors. It is the duty of the fellow to study each and every case thoroughly and present it to the seniors every day, this is where you get to learn about clinical decisions and seniors are happy to answer your queries. Fellows should get all pre-op work-up done before posting the case for OT. They will get the help of junior residents of MD radiology posted in VIR department and by teaching them your concepts get clearer as well. You must know the history, examination findings, relevant investigations, indication for the procedure, consent for the procedure, type of anesthesia to be given, technical aspects of the procedure and inventory required for the procedure. Post procedure monitoring of patients is done in the recovery room beside DSA lab which includes sheath removal also. Fellows are supposed to take ward rounds twice daily of all the patients who undergo interventions till their discharge and a day prior for the patients who are to be posted for procedure next day. All emergency calls and any post procedure complications must be attended immediately. In short fellows are on call 24×7 by rotation.

Hands on work: Fellows are the one who get maximum hands-on work in VIR department. Fellows are scrubbed in all kinds of vascular and non-vascular procedures. KEM being one of the largest government hospitals in Maharashtra with the oldest intervention radiology department, you will get to see all kinds of referrals from all the departments of KEM as also from outside KEM, like body, peripheral vascular, porto-biliary, other gastrointestinal, renal, pulmonary, aortic, onco-interventions, laser and radio-frequency ablations (with regards to oncointervention, usually one TACE and one RFA happen on an average every month, done by the fellows or lecturer). Due to the very heavy case load, you can get enough direct hands-on work as a main operating interventionist in rotations with your co-fellow. Of course it depends on how fast you develop your skills. At the end of the fellowship, you will get confidence in performing most of the vascular and non-vascular interventions independently except for a few complicated procedures with long learning curve for which you naturally have to spend more time.

The exception to what you get to work on is neurological and cardiac interventions (KEM has a separate fellowship for neuro-intervention).

My experience in KEM VIR:

As I am a post graduate from KEM hospital being exposed to IR postings during residency, I had fair idea about this fellowship before applying for it. Before choosing for IR, it should be clear in your mind that why do you want to go for IR because it is a very different and slightly difficult field, at least initially. While doing VIR fellowship in KEM, there were no fixed duty times, and emergencies used to come any time be it day or night; so if you are arranging your own accommodation (although you do get hostel as I mentioned earlier), it should be nearby. Handling patients and relatives from treatment point of view is little difficult initially; they come to you hoping for a complete resolution of their ailments which is often not possible as IR has its own limitations. Many times an IR procedure is just a part of medical or surgical management, so you have to explain that to patients beforehand. Many times cost is the big issue to decide for the type of treatment and type of material to use. It will take time to learn about technical aspects of interventions and inventory. But more importantly it is very satisfactory to treat the patients and seeing them getting discharged in healthy condition.

Pros:

1. Good hands on training.
2. Wide spectrum of Interventions.
3. No allied postings in diagnostic or ICU.
4. Lots of CMEs, conferences, vascular club meetings in and around KEM.
5. Tag of KEM.
6. It’s a MUHS recognized fellowship, so you will get university degree certificate.

Cons:

1. Hectic nature of the fellowship. If you are not willing to work hard, don’t go for it.
2. Lack of much exposure to neuro interventions.
3. Lack of much exposure to minor non vascular (CT/ USG guided) interventions. (these are done by MD Radiology residents)
4. Managing some paper work to help clerical staff for procedure payments related issues and to maintain case records.

Verdict: If you are genuinely interested in IR and ready to work hard for a year, go for it.

– Dr. Vinayak Jedhe, Interventional Radiologist