Hospital/Imaging Centre and City: All India Institute of Medical Sciences (AIIMS), Jodhpur, India.

Duration: One year.

No. Of seats: One seat every 6 months. So there will be two fellows at a time, one 6 months senior than other one.

Accreditation: Being an autonomous institute, AIIMS Jodhpur awards its own post-doctoral fellowship (PDF) degree on “Neuro & Vascular Interventional Radiology”.

Entrance exam pattern: Notifications for entrance examinations are put on the AIIMS Jodhpur website (https://www.aiimsjodhpur.edu.in/courses.php) in the month of June and in December, and exam is held in August and January respectively, twice a year. It’s a two-step process, comprising of a theory paper (MCQ based) followed by an interview session on the same day. A shortlisting of candidates are done in ratio of 1:6 per vacancy for interview, according to marks obtained in written exam. 80% weightage is given to the written Examination (MCQs based) and 20% weightage to the interview.

Tips on how to secure the fellowship: The exam is usually MCQ based written exam followed by viva/interview and covers the spectrum of diagnostic as well as basic interventional radiology. For MCQs, I think FRCR 2A/Grainger & Allison MCQ books are helpful; at least these helped me. Prior knowledge of basic IR will be useful, even in viva, you might be asked about basic IR procedures.

Eligibility: MD/DNB Radio-diagnosis.

Fees : Rs. 50,000/- one time admission fee, no other fees after joining.

Bonds : Yes, Candidates those who are got selected for the PDF will have to execute a bond of Rs. 2,00,000/- (Two Lakh Rupees Only); in other words, if anyone is leaving the course midway, s/he has to pay the said amount. There is no post-tenure additional bond year to serve.

Salary: The salary structure is as per 7th central pay commission (same as other central Govt. institutes); so it comes to around Rs. 90,000 per month in hand currently. Those who are staying outside the campus get HRA of about 11-12K (the exact amount might vary).

Leaves: Officially 30 all-purpose leaves throughout one year tenure which are usually at the discretion of the head of department.

Thesis/Paper publication: Not compulsory, but you will be always encouraged to write/publish papers.

Exit exam: Yes, at the end of your course, you have to appear for your exit exam, which comprises of theory exam (100 marks) followed by practical exam. If you are sincere throughout your tenure, you will definitely clear the exam.

Accommodation: Usually married people get hostel easily, as there is less queue. For unmarried, it takes a lot of time for in-campus hostel accommodation. But there are residential areas with well-furnished apartments available for rent close to the hospital (within 3-4 kms), so accommodation won’t be an issue.

Diagnostic exposure: Being a dedicated IR fellowship, you won’t have to do routine diagnostic works, except for cases which need to be reviewed/worked up for a procedure and follow-ups of patient who have undergone IR procedures.

Duty hours and emergencies/on call duties: Usually day starts with morning rounds at around 8 – 8:30 am, where the admitted patients/ patients from the previous day’s procedures are reviewed in the wards/ICU and plan for further management/discharge summaries are made. These are patients are either admitted directly under IR department or have been referred to IR for management.

For patients who are directly getting admitted under IR, we are solely responsible for their pre-admission evaluation, admission, pre-procedure evaluation, all blood investigations, treatments, post procedure managements and all sorts of works related to patient treatment. Everything from patient admission to discharge has to be done by fellows and JRs posted in IR (usually there is rotational posting of 2-3 JRs/PG residents every month in IR).

After the morning round, we usually start our cath-lab cases. We also have to evaluate our OPD patients (new/follow-up cases) at the same time. Usually we finish up our cath-lab cases by 4-5 pm. Any non-vascular IR work such as biopsies, FNAC, drainages, PCD insertions etc are usually planned in the afternoons in the US/CT rooms either after finishing cath lab cases or as an emergency basis. Fellows are expected to actively manage all these duties starting from pre-admission evaluation and work-up of patients, making admission process, preparing the cases for cath labs, doing/assisting cath-lab cases, post-procedure management, taking morning rounds, attending all OPD patients, seeing all referred cases from other departments and doing other CT/USG guided procedures etc.

As a tertiary care hospital and as a stroke care hospital, we are on-call 24×7. Whenever a stroke case comes to CT for imaging, our job is to evaluate the case for whether mechanical thrombectomy is indicated for that patient.  Other emergencies like active GI bleed, hemoptysis, ruptured cerebral aneurysm, uterine bleed, emergency PCD, PCN etc can come at anytime and we have to attend those calls as well, even at odd times. In pre-covid time, we hardly got free before 10 o’clock at night (you invariably get a few calls for emergency PCD insertion after finishing routine works!!!).   

Intervention and hands on exposure: We have a biplanar Philips AlluraClarity DSA system. Both the fellows are supposed to scrub up for all the cath lab cases. There are ample opportunities for gaining hands-on experience. For 1^st 6 months, you will get only few cases to do in DSA, but you have to be there to assist all cases actively; that’s how you will learn the protocols/approach for each and every cases. For the next 6 months, as the senior fellow you will get the opportunity to do more cath-lab procedures independently, like diagnostic neuro DSA (faculty usually don’t scrub up for diagnostic procedures, unless you are facing difficulties in cannulating), all biliary interventions, PCN, venograms, venoplasty, venous line placement, GI and renal bleeders embolization, BRTO etc. For one year of fellowship without any prior IR exposure, you can’t ask for more. Till now I’m more than happy with what I’ve got as hands-on exposure.

Though the caseloads are comparatively less in number than other premier institutes like AIIMS-D, PGI-C, or TMH, the working hours will remain busy, if not very hectic. The best part is you will be able to get a handle of sorts on both vascular and non-vascular interventions, starting from head to toe. Considering that the institute is a tertiary care hospital and a Neuro IR centre, both neuro & non-neuro vascular cases as well as non-vascular interventions are being done regularly.

The usual cases we do here are Neuro-interventions (Aneurysm coiling, embolization of AVM/DAVF, mechanical thrombectomy, intracranial arterial stenting, carotid/vertebral artery stenting, pre-operative embolization of head-neck tumour), Non-Neuro Vascular Interventions (Bronchial artery embolization, embolization for GI/renal/uterine artery bleeding, Splenic artery embolization, TACE, TIPS/DIPS/Venoplasty, stenting/angioplasty for peripheral artery disease, venous procedure like BRTO, central venous catheter/permacath/chemoport insertion, EVLA/sclerotherapy for varicose vein, Dialysis fistuloplasty, sclerotherapy for vascular malformation) and Non-Vascular Interventions (PTBD, Biliary stenting, PCN, antegrade DJ stenting, US/CT guided drains, biopsies, FNAs, fiducial marker placements and thermal tumour ablations (RFA) of tumour like HCC, hepatic metastatic lesions, osteoid osteoma) etc.

Academic activities and multi-disciplinary meets: Weekly seminars are scheduled every Monday; fellows are expected to present on topics concerning IR. Interesting cases done in cath-lab for every month are presented and discussed on the last Saturday of that month in the DSA grand rounds. Regular seminars/case presentations are done by JRs, which can be attended by fellows if no cases are scheduled in the cath lab. Also, various MDT meetings are scheduled on various days of the week; attendance to these meetings is voluntary and is fairly beneficial to derive a universal approach to patient treatment. Participation to national & international conferences with poster/paper presentation is actively encouraged.

My personal experience at the fellowship: I always consider myself super lucky and blessed to get into this fellowship. I completed my 1 year scheduled tenure and gave my exit exam this July’20; however, it has been extended for 3 more months due to the present Covid situation.

I joined this fellowship in August’19 after finishing my prior fellowship in Oncoradiology in my hometown. I had no prior experience of IR during my PG days; only did few FNACs and ascitic/pleural fluid tapping, so didn’t have a fair idea about IR. But I started liking IR during my Oncoradiology fellowship, when I got my first taste of cath lab.

After joining in AIIMS Jodhpur, it was quite a different experience in the nature of work, that changed dramatically from a largely diagnostic radiology program to a more clinically oriented physically demanding IR training program.  For the first 2-3 months, it appeared to be very hectic to me, starting from morning ward rounds, preparing patient for cath-labs, standing 4 to 5 hours for long neuro cases without understanding most of the important steps, shifting patient back to ward/AICU, post procedure patient management without having any previous clinical experience, getting calls throughout day and night from wards/patient attendants and at the end of the day when you are super stressed, getting a call for an emergency stroke case. I was getting frustrated day by day, but gradually I started liking IR (don’t remember that transit point) as days went on, and at present a day without a case in cath lab make me upset!

Starting from the first femoral puncture to first independent cerebral angiogram or putting microcoils in bleeders or injecting PVA particles, everything has happened over this very short period of my life.

All consultants are super enthusiastic regarding doing IR cases and always encourage you to do more cases. I would say whole department is more of IR oriented, so much so that not even a single case pertaining to IR, will go unnoticed if it is coming to department for imaging; you will invariably get informed.

The whole IR team including consultants, colleague, junior residents and nursing & technical staffs are extremely helpful and at no point of time did I feel dejected/depressed because of the working environment, which can happen at some places. I started with femoral puncture here only, and at the end of one year I did many independent cerebral diagnostic angiogram, confident in doing any kind of diagnostic angiogram and venous procedures/venoplasty, did few coiling independently for abdominal bleeders, angioplasty for peripheral artery disease, preoperative angio-embolisation of head-neck tumours, chemoport placement, numerous PTBD, PCN & laser ablation for varicose veins (EVLA).

Pros: 

1. Stress free working environment.
2. Wide intervention spectrum – you will get to see almost all kind of IR procedures, from head to toe (starting from neuro-intervention to GI procedures to peripheral vascular procedures over just a one year tenure).
3. Maximum hands-on during training.
4. Get to learn the medical part of the treatment as well for all relevant cases, starting from admission to discharge.

Cons :

1. Not much, except for less caseload compare to other premier institute.
2. No cardiac and aortic procedures.

The only setback I faced in my tenure was because of this ongoing Covid situation; caseload has been drastically reduced, there were many days in this lockdown period with no case at all in cath-lab, and this was the period when I was supposed to get most of the cases as a senior fellow. I am hoping to make full use of the 3-month extension period!

Any additional comments/ does it add value over MD /DNB degree: What I feel is that IR is not about having a degree, but having more and more experience, confidence in doing cases, more hands-on and knowing cases thoroughly. I’m really grateful to all my faculty for having confidence in me and letting me to do as many cases as possible independently. Although this one year fellowship is not enough to start work independently, but it definitely adds to the CV, opens up opportunities for further training, and gives you confidence to work somewhere in an IR team.

Best wishes to all the aspiring interventional radiologists, if you have any query/doubts regarding this fellowship, please feel free to contact.

– Dr. Tushar Suvra Ghosh, MBBS, DMRD, DNB, PDF (Oncoradiology & Intervention, TMC Kolkata), Post Doctoral Fellow (PDF) in Neuro and Vascular Interventional Radiology, AIIMS Jodhpur

Email- tusharradio@gmail.com

Mobile – 8826863330