Duration: One year.
Sessions: Two, starting in January and July, respectively.
Number of seats: 03: 2-General category (January session), 1- Sponsored (July session, but in case it is not filled, the seat carries forward to the next session). However, the seats of one category cannot be transferred to the other in any circumstance. The sponsored seat is for candidates in Government service wanting to enhance their skills.
Accreditation: AIIMS is an autonomous body, and awards its own degrees. At the end of the program, you get a certification of your fellowship with a 1-year teaching experience certificate. Also, the name of the fellowship has now been revised to “Diagnostic & Interventional G.I. Radiology’’ from just “G.I. Radiology” to reflect the training in interventional radiology.
Eligibility: Three years of post MD/DNB experience as a senior resident/equivalent is required to be eligible for this fellowship.
Entrance exam pattern: All the information regarding the exam dates and pattern is available on http://www.aiimsexams.org. Application forms for the entrance exam are usually available 3-4 months before the start of the session (February-March and August-September respectively). The entrance exam is usually held a month before the start of the session (Generally in May and November, respectively). It is a 2-step examination with a computer-based test (CBT) comprising 60 questions (60 marks) and an interview (40 marks). The CBT is an MCQ-based exam, with questions pertaining to general radiology, physics, GI radiology as well as basics of intervention. Around 15-20 questions tend to be image-based. The results of the CBT are declared within a week. Brushing up on cancer staging and commonly used scores in interventional radiology (like MELD/Child-Pugh) might help. Otherwise, there is no set pattern or question bank available. 50% marks are required in theory to be eligible for the interview. The number of candidates called for the interview is three times the number of seats available. The interview comprises spotters, two cases, and a table viva. The focus of the case discussion is generally on diagnostic radiology, while the table viva is focused on interventions. Selected candidates get around 14 days to join the Institute after the results are declared.
Interventions and Hands-on experience: The entire course can be broadly classified into diagnostic and interventional work. Generally, there is a day-wise roster of work for fellows. Every fellow is posted in DSA for 2-3 days in a week, while the rest of the days they rotate between ultrasounds, MRI, and CT. There are 2 single plane DSA machines available in the department and a separate fluoroscopy unit for non-vascular procedures.
- These comprise of USG and CT guided drainage of abscesses/ collections/ pleural/ ascitic fluid.
- FNACs and Biopsies: These are generally done by senior residents, however difficult cases and percutaneous plug liver biopsies are done/supervised by fellows
- Biliary drainages: PTBD catheter drainages placement and management
- Biliary stenting and balloon dilatation
- Percutaneous nephrostomy
- DJ stent placement
- Percutaneous gastrostomy
- Nasojejunal tube insertion
- Percutaneous feeding jejunostomy
- Esophageal balloon dilatation
- Microwave ablation
- PAI/PEI for HCC
Apart from fellows, there are around 3-4 senior/junior residents posted in the cath lab on a rotation basis. You get a free hand to do non-vascular procedures, with consultants always available to guide you. After about 6 months or so, you will be thorough enough to be mentoring the residents in doing these. For vascular procedures, the learning curve is generally steeper. If you can build the consultants’ trust and confidence, you will start doing cases independently after 4 to 6 months. In any case, you are encouraged to perform certain steps in every procedure as the first assistant. Depending on your skill, you can go as far in a case as you are able to smoothly. The consultants stay by your side and take over in case of difficulty or mistakes. But you will get enough hands-on experience, to work independently post a year of working in the cath lab. Also, apart from GI cases, peripheral angioplasties, stenting, bronchial artery embolization, peripheral AVMs, JNA embolization, cross circulation, endovenous laser ablation for varicose veins, etc are all done in the same lab. So you can watch and assist, and even perform a few non-GI cases independently. The best part of the fellowship is that the consultants are friendly and helpful. In case of any problem, you can freely discuss it with any of the consultants, who are more than happy to help. The mentoring faculty members involved with the fellowship are internationally renowned, highly experienced and skilled. That I think is very essential while doing a post MD super-speciality course.
Diagnostic Radiology: There are three CT Scanners of which two are dual energy scanners, three MR scanners of which two are 3-Tesla scanners and many high-end ultrasound machines. The fellow is a bridge between residents and consultants and can be made to work in either capacity. So you will end up doing ultrasounds, primary reporting of CT and MRIs as well as countersigning reports of residents. However, practically, ultrasounds done by fellows are second look ultrasounds, for a specific clinical question and not routine diagnostic ultrasounds. During CT and MRI postings, fellows are expected to supervise acquisition, reporting and help residents, wherever needed. The fellow is also expected to perform bedside ultrasounds and procedures. The spectrum of cases is huge and you get to see a lot of interesting cases. You also get exposure to liver transplants, including pre-transplant imaging workup, intra-operative Doppler examination, and post-transplant imaging and interventions.
Academic activities: There are two main case conferences, held with the Gastroenterology department on Mondays and with the GI surgery department on Wednesdays. Cases are provided a day before the conference and around 20-40 interesting cases are discussed. These are immensely helpful in understanding what is expected out of you, as a GI radiologist, beyond just “heterogeneously enhancing masses” and “bowel wall thickening”. You get a keen insight into the point of view of Gastroenterologists and GI surgeons and can freely interact with them. Better still, you can follow up of interesting cases and can plan biopsies/procedures for patients discussed in the conference.
Apart from this, there is a fellow class every Tuesday, where interesting diagnostic/interventional cases are discussed one to one with the faculty. There is a journal club every Wednesday evening where relevant articles are discussed and the current literature is reviewed. These discussions go above and beyond resident classes in terms of the quality of discussion.
There is an IBD multi-department meet held on alternate Wednesdays, where consultants and residents from Gastroenterology, GI surgery, Pathology, and Radiology discuss complex cases of bowel disease to guide the management of patients.
Publications and presentations at conferences are actively encouraged. However, there is no compulsory thesis.
Apart from this, there are post-graduate seminars, case discussions, journal clubs, interesting film sessions, case conferences with various clinical departments, held in the department every day. If you have spare time, you can attend these and stay in touch with general radiology.
Duty hours: 8:30 am to 4:30 pm are the official duty hours. However, you will be coming in earlier and leaving late almost every day. So on average, you’ll spend 8-10 hours in the department, going up to 12 hours on busy days. However, there are no night duties and infrequent emergency calls. There is a Senior Resident who is on call for interventions at night, so the fellow is 2nd on call. About 5 to 10 liver transplants occur at AIIMS in a year. Transplants are done during the night and the fellow is required to go for intra-op assessment after vascular anastomosis.
Fee and Salary: The salary is two increments above that of third year senior residents, which translates to 1.3-1.35 lakhs/month including HRA at present.
Accommodation: No accommodation is provided to fellows by the hospital administration. You will have to arrange for your own accommodation. However, flats on rent are easily available in nearby localities.
Leaves: 24 casual leaves in a year are permitted to fellows, which can be availed as per the exigency and requirement of the department. However, there is generally no real difficulty in taking leaves for genuine reasons.
Pros: The X-factor here is the amiability, warmth and proficiency of the faculty involved with the fellowship. They are not only great teachers but also excellent mentors and friends. After your MD/DNB, you can only learn from people who are not only masters of their subject but are also willing to share their hard-earned expertise. You will get in-depth knowledge, key points to making a diagnosis, and pearls of wisdom from the greats involved in this fellowship. Interventional radiology isn’t just about learning steps of procedures and replicating them. It has a lot to do with the way you approach a case and how you handle situations when things go wrong. At AIIMS, these are taught by consultants who are pioneers in their field. Another advantage of this place is that there is no dearth of cases. You will never have a dull moment. Also, unlike most other places, you are not made to do routine diagnostic reporting for the sake of the department. There are enough residents to handle the day-to- day reporting of diagnostic scans. As a fellow, you are expected to assist in reporting and performing diagnostic scans only in diagnostic dilemmas as a second read.
Cons: This is a diagnostic plus interventional GI radiology fellowship. As the duration of the fellowship is one year, for applicants who have no experience of interventional radiology, this may be too steep a hill to climb. If you are starting from scratch, you will be able to learn a lot but may not feel confident enough to work independently as an interventional radiologist after finishing the fellowship. However, the training is such that most of our alumni are working as successful IRs in hospitals across the country. Also, the fellowship requires 3 years of work experience as a senior resident, which may be a bummer for some.
I had the good fortune of working as a senior resident and as an on call SR for interventions during my tenure in the same institute before joining as a fellow. To be very honest, I was a little apprehensive about joining the course. I saw my seniors slogging it out, spending more than 12 hours in a day at the hospital, getting their weekend plans ruined, so on and so forth. I eventually decided to give it a shot and in retrospect, I am glad that I did.
As of today, although there is still a requirement for general radiologists, I feel that a fellowship gives you an upper hand. Wherever you may join as a consultant, it’s always advantageous to be a jack of all trades, but the master of at least one. This fellowship will hone your skills as a diagnostic GI radiologist while providing you enough hands on experience and confidence to perform independent vascular and non-vascular procedures. The amount of intervention work you do while pursuing the fellowship, will somewhat depend on how motivated you are and the kind of skills you develop, however that would apply to IR fellowships across the board. My co-fellow and I were lucky to have been backed by our seniors and faculty members, getting ample opportunities in the cath lab. Both of us are currently performing IR procedures in our practice, as are most of our seniors.
Though people might feel that there is not too much to learn in diagnostic GI radiology, during the course of this fellowship, I realized that there was just so much to build upon the knowledge I had gathered before joining the fellowship. Learning the soft pointers here and there can help you refine your differentials and be more confident while reading scans. You get to discuss cases not only with arguably the best and most learned radiologists, but also top Gastroenterologists and GI surgeons of the country.
A major factor that helped in my learning was the friendly atmosphere in the department. There was pressure in the cath lab when a procedure was going on, but never outside of it. The consultants are caring, concerned and take pains to make sure you learn new skills, which I think is a huge positive. It was a pleasure working in this department as the senior residents, junior residents, and all other staff members were very friendly, dedicated, and supportive.
I had a fruitful year of fellowship and have no hesitation in recommending it. In case of any queries, please feel free to contact me, I would be happy to help.
– Dr Savinay Kapur, Fellow, Diagnostic and Interventional Gastrointestinal Radiology Fellow, AIIMS, New Delhi (January 2019 Batch)
Currently working as Consultant (Diagnostic and Interventional Radiology), Mahajan Imaging, Pushpawati Singhania Research Institute, Sheikh Sarai, New Delhi
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