Location: Yashoda Hospital, Secunderabad, Telangana

Number of seats: 4 (2 seats every 6 months)

Duration: Post MD/DNB Radiology à 18months, Post DM à 12months

Course director : Dr. Suresh Giragani, Senior consultant interventional Radiologist

Fellowship application process and selection criteria: The application is out every year in the month of May/June. Candidates need to mail their CVs. Formal one-to-one interview of the potential candidate is conducted wherein a clinical and imaging approach to diagnosis on in-house DICOM cases (two long and two short cases) will be analyzed, and 20 spotters of vascular and nonvascular intervention cases will be shown.

Tips on how to secure the fellowship: Good knowledge of general radiology, theoretical aspects of nonvascular, peripheral vascular, neuro interventions, latest trends in interventional radiology, and passion towards clinical patient care.

Exam: Single final fellowship exit exam at the end of tenure. At the end of the fellowship, all fellows are conferred FVIR (Fellowship in Vascular Interventional Radiology) certification.

Working hours and on-call duties: 8 am to 8 pm. However, since it is a dedicated interventional radiology fellowship, fixed duty hours are unlikely to apply, and we are expected to be available all time.

Accommodation: One has to arrange their accommodation. Lots of convenient options are available near the hospital. It will be preferable to get a nearby accommodation, to commute easily for multiple on-call emergencies which is usually the scenario every day.

Fees, stipend, and leaves: As of now there is no fellowship joining fees. Stipend for Post MD/DNB candidates is 60,000/- and for Post DM candidates, it is as per the experience. Six leaves are granted per year.

Interventions and hands-on experience: As the name goes by, it is a purely 24×7 intervention fellowship program. All vascular and non-vascular interventions from head-to-toe are performed. Fellows get excellent primary hands-on experience in both peripheral vascular and non-vascular interventions. All neurointerventions are performed primarily by the consultant and fellows will be a compulsory secondary operator in all the cases performed by faculty.

Description of department: During my training period, Philips Allura Exper FD 20 single plane cathlab was present wherein the predominant vascular interventions were performed. Currently the department has a dedicated IR suite consisting of biplane cathlab, nonvascular procedure room, OP consultation room, and a counseling room.  All the neuro and peripheral vascular interventions are currently performed on the latest state-of-the-art Philips Azurion B20/15 biplane cathlab suite. The department also has two dedicated high-end standalone and portable ultrasound machines and a designated room for performing all the non-vascular interventions beside the cathlab suite, making them all under one roof.

Postings: Initial 14 days of the fellowship programme will be a probation period, wherein the fellow is expected to observe the departmental workflow, get acclimated to the hospital environment, long working hours, and multiple night calls, get familiarized with the logistics in patient management and the routinely used IR equipment in the Cathlab and bedside procedures. No hands-on is provided during the probation period. At the end of the probation period, it is up to the discretion of the fellow to continue the complete fellowship program.

After the probation period, the official postings cycle (each cycle lasts for 2 months) is as follows

1. Vascular Intervention posting for 1 month
2. Nonvascular Intervention posting for 15 days.
3. Academic posting for 15 days (The fellows will be posted in academic posting in every 2 months)

Workflow in vascular postings: The day in vascular postings starts with rounds in ICU followed by wards. Follow-up of all the patients who have undergone interventions is done. Advice for medications and further investigations, including discharge summary for all respective patients is completed during morning rounds. Next, the check list of all patients posted for interventions on the current day is reviewed. The elective vascular cases start at around 8-9 am. The fellows play a crucial role in every step of patient care including history taking, preoperative workup, fitness for the procedure, planning pertinent hardware, patient counseling and writing consent forms, being primary operator or secondary operator in the respective case, post operative ICU monitoring and early detection of any minor or major complications post procedure and initiating immediate intervention. In addition, the fellow also handles the referrals from ICU and wards. The hospital has an excellent workflow for stroke patients. ‘Stroke Code’ is announced to the entire hospital via the audio system. The fellow in the vascular posting rushes to the ER, assesses the patient in the casualty and if amenable to thrombectomy, Cathlab is prepared by the time patient is shifted to the Cathlab suite. On an average, 90-100 neuro and peripheral vascular interventions are performed in the month.

Workflow in non-vascular posting: The day starts with going through all the request forms for the non-vascular procedures. All the non-vascular procedures are performed predominantly by the fellows, including USG guided, CT guided and bedside ICU procedures. On an average 100-150 non-vascular interventions are performed in the month.

Workflow in academic posting: Fellows posted in the academic posting have to prepare a compiled digital record of all the vascular interventions performed in the form of a ppt, including case history, pre and post procedure cross sectional imaging, and intervention procedure. In this way, the fellows in the non-vascular posting don’t miss the opportunity to see the neuro and peripheral vascular interventions and trust me, though it’s a laborious task, it is very fruitful. Fellows are also given the opportunity to research and publish scientific papers during the posting.

Academics: Every Friday at 8am, the fellows in the academic postings must present a topic assigned by the mentor. Presentations topics include interesting cases, Journal club, seminars and How I do It pertaining to individual intervention procedure.

Publication and presenting opportunities: Due to the high case load and systematic collection of all intervention cases, there is ample opportunity to write original research publications. Fellows are expected to publish at least one original publication in an indexed journal and present at least two scientific presentations at either national or international interventional radiology conferences.

My personal experience: I was skeptical at first when I heard about the fellowship program at Yashoda Hospitals. It being a purely corporate setup, I expected a low case load. However, my entire perspective changed after joining the fellowship program. It is an extremely rewarding fellowship program with an overwhelming case load all throughout the year. I have been exposed to almost all the kinds of Head to Toe vascular and non-vascular interventions in the short duration of one year. The hands-on experience is also excellent, and each procedure is monitored and supervised by the consultant when the fellow is the primary operator. As days go by, depending upon one’s confidence and skill level, we get to perform more complex cases as the primary operator. All the nursing staff and cathlab technicians are cordial and work in harmony for the benefit of the patient. This fellowship program has made me feel confident and able to practice individually in any IR setup. All the previous fellows who have completed the fellowship have established successful independent practices.  

Pros: Excellent hand on experience and exposure to head-to-toe neuro and peripheral vascular interventions. The fellowship program makes be more of a clinician rather than a proceduralist and prepares you to evaluate your patient with a holistic approach.

Cons: Being a dedicated IR fellowship and a hospital with an extensive case load, the duty hours are prolonged. We have to compromise on family time, and family support is truly needed. The hospital does not have a 24×7 canteen. Nonetheless, all these are secondary when compared to the extensive IR training benefits the fellowship program offers.

Dr. Sreenivasa Narayana Raju, MD, DM (AIIMS Delhi), FVIR

Consultant, Valluvanad Hospital, Ottapalam, Kerala