Hospital/Imaging Centre and City: HealthCare Global Enterprises Ltd. (HCG Hospital), Bangalore, India.

Duration: One year

No. of seats: Two seats per year

Accreditation: This is not a university accredited fellowship. However, HCG does provide a certificate of fellowship at the end of the program.

Eligibility: MD/DNB Radio-diagnosis. Fresh candidates are usually given preference.

Fees, salary and leaves: 80,000/- INR per year is the fee. Each fellow is paid a stipend of 45,000/- INR per month. Leaves are usually at the discretion of the head of department.

Thesis/Paper publication: Compulsory.

Exit exam: There are no exit exams. The fellowship is granted on completion of the course period and submission of the thesis.

Duty hours and emergencies/on call duties: The day usually starts at 9 with clinical rounds where the patient’s from the previous day’s procedures are reviewed in the wards and discharges arranged for. These are patients who are admitted under the charge of IR department and also those who have been referred to IR for management.

There is an exclusive IR ward/recovery area for managing patients. For patients who are directly under our charge, we are responsible for pre-procedure evaluation, arranging the requisite consultations, arranging blood for emergency, titrating medications and post procedure. Outpatient appointments are then attended to; this happens as and when an appointment is made.

Cases scheduled for the IR suite are then taken up; there are usually 3-4 elective vascular cases scheduled in a day. This can last up to 3-4 pm in the afternoon. Simultaneously, any non-vascular IR work such as biopsies, tumor ablations, drainages, etc are scheduled in the afternoons in the US/CT rooms. Fellows are expected to take turns alternatively to shuffle among vascular & non vascular IR.

The hospital is a tertiary care oncology institute, so the instances of emergency on call duties during the nights is quite rare. Most emergencies are usually a post-operative patient who is bleeding or an emergency bronchial artery embolization or an emergency biliary drainage in a septic patient.

Intervention and hands on exposure: This is a purely IR fellowship with not much diagnostic reporting involved, except for what is needed to handle IR cases. There is a single uniplanar GE Innova DSA system. The 2 fellows are expected to alternatively scrub up for the vascular cases. There are ample opportunities for gaining hands-on approach.

Considering that the institute is a tertiary care oncology hospital, the usual IR case mix involves TACE, TARE, PTBD & biliary stenting, pre-operative tumour embolization, uterine fibroid embolization, SVC stenting, trans-jugular liver biopsies, TIPS, bronchial artery embolization, post-operative GI bleeds, etc. Non oncological vascular work usually, although rare, involves treatment of vascular malformations, diagnostic neuro-angiograms, etc.

Non vascular IR includes US/CT guided drains, biopsies, FNAs, fiducial marker placements and thermal tumour ablations. These are usually scheduled for the afternoons and occur simultaneously. Fellows are expected to take turns to attend vascular and non-vascular work every day.

Each fellow is also deputed for a month at Jain Institute of Vascular Sciences at the Bhagwan Mahavir Jain Hospital, Bangalore for exposure to peripheral arterial / venous IR. This is usually more observatory in nature as the institute itself has its own DNB trainees. However, getting hands-on experience is up to the fellow and his/her personal equations with the staff/trainees at the institute. The institute provides endovascular treatment for supra and infra-popliteal PAD and varicose veins.

Academic activities and multi-disciplinary meets: All fellows are expected to participate in the tumour board meetings on Tuesday mornings. Also, various MDT meetings are scheduled on various days of the week; attendance to these meetings is voluntary and is quite useful to derive a holistic approach to patient management. Weekly seminars are scheduled; fellows are expected to take turns to present on topics concerning IR. Attendances to national & international conferences with poster/paper presentation are actively encouraged.

Accommodation: Not provided. There are residential areas with studio apartments available for rent close to the hospital.

Tips on how to secure the fellowship: Applications are usually called for in the month of June every year. Candidates are then invited for a preliminary qualifying exam which is usually held in July/August. The exam is usually MCQ based and covers the spectrum of diagnostic as well as basic interventional radiology.

My personal experience at the fellowship: I undertook the fellowship from 2016 to 2017. I had no prior experience with IR during my radiology training and was quite keen to be an active participant in patient care and management. It can be quite a change in the nature of work when a trainee switches from a predominant diagnostic radiology based MD/DNB training program to a more physically taxing IR training program. For all practical purposes, IR is like surgery; it involves all the running around that you see your surgical colleagues do, only with better outcomes and lower morbidity.

Whilst your diagnostic colleagues can probably work 9-5, you may be called at odd hours for procedures; having to stay up managing a patient and have bad days with failed procedures or complications. But at the end of the day, it’s worth the effort when you are satisfied with having directly contributed to patient care. IR is an upcoming sub speciality and has a lot of new avenues to offer for career development.

Personally, I enjoyed being back in the “clinical environment” after 3 years of training in diagnostic radiology. The personal interaction with patients is something to cherish. The fellowship helps envisage a holistic approach to IR with the consultants encouraging a sound clinical background to enable independent patient management. In addition, publications and presentations at conferences/symposiums are actively encouraged with emphasis on research and academic work. The opportunities are plenty for those willing to make use of them. The staffs are extremely friendly and encouraging to the new entrants.

Pros & Cons: As I have already mentioned, the training provides extensive hands-on opportunities to help a trainee practice independently after the fellowship. Also, the training program underlines the importance of clinical management of the patients, right from out-patient clinics to post procedural management and discharge. Research & publications are actively encouraged, as is regular presentation of clinical work at various academic fora.

As far as the shortcomings are concerned, personally I feel the training could have been for two years instead of one. This would ensure better competence in complex vascular procedures like TIPS, BRTO, AVM embolization etc. Considering that the institute is a tertiary care oncology hospital, the exposure to non-oncology vascular work is limited. Although, those skills can be built upon easily, it can be a small gap in your training for the initial period of your post fellowship practice.

Any additional comments/ does it add value over MD /DNB degree: More than adding value over your degrees, the training program imparts essential skills in IR which helps you practice independently. Although it is not recognized by any university, it definitely adds to the CV and opens up avenues for further training or independent practice as the case maybe.

 Dr.Pannag Desai. MD, FRCR

Fellowship in IR (HCG Hospital), Clinical Fellowship in IR (Liverpool University Hospitals)

Currently Consultant Interventional Radiologist, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom