Institute: Jaipur Institute of Pain and Sports Injuries, Jaipur

Mentors: Dr. Gaurav Kant Sharma

Duration: 6 months

No. of seats: There were 2 seats when I did my fellowship (July-November 2023). I was the second fellow.

Eligibility: MD/DNB/DMRD 

Entrance exam: When I joined, it was an interview-based selection. It is going to be an entrance exam along with an interview soon. 

Fellowship application: We need to regularly check for the openings on the official website or contact at jipsihealth@gmail.com, or call on +919899012822.

Accommodation: No. There is a nice building with flats for rent nearby which is walking distance. That is where I stayed.

Duty hours and emergencies/on call duties and type of work: 

Routine work hours: 10 hours a day. Purely MSK work. You won’t see a single non MSK case here.

Work starts around 9.30 am in morning with MR reporting, and goes on till the patient inflow is there till about 8.00 pm or so. 

Night duties: No night duties   

Fees and salary: Rs 2 lacs fees plus taxes during my tenure. No stipend during my tenure as we are only learning and not bringing any revenue addition to the setup.

Accredited: No

Leaves:  If you have any work or need to visit home for some work, you can request for leave. Sundays are off but if you wish you can come to study or see cases in the database. 

Workflow: There is wide exposure to a huge range of sports injuries, degenerative spectrum and inflammatory pathologies. There is good training in using a methodical approach, history taking, clinical examination, and ultrasound scanning techniques in accordance with patient clinical setting.

Fellows are expected to reach the center by 9 30 am and have to draft all the MRI tele reporting cases. Case load varies from 10 to 25 cases. The faculty cross checks all the drafted reports and gives feedback.

After this, ultrasound work starts by 11 am. Initially a fellow is allowed to take history, examine and perform the ultrasound of each case followed by cross checking of every finding by the faculty. The work goes on till patient inflow is there. On an average 30-50 ultrasound cases and 10-20 image guided procedures happen in a week.

Once every week, the fellow gets a chance to accompany the associated Pain Physician and see outpatient cases, and learn proper methodical approach to patients’ complaint, rationale regarding the evaluation and treatment protocol.

Amount of work and daily schedule: On an average, a fellow would do primary reporting of around 100-150 MSK MRIs, 30-50 MSK USG cases and 10-20 guided interventions in a week (including C-arm interventions).

Intervention and hands on exposure: The intervention procedures commonly performed include ultrasound guided joint, bursal and tendon sheath injections and miscellaneous procedures like calcific tendinosis barbotage, prolotherapy, hydrodilatation for adhesive capsulitis, hydrodissection for entrapment neuropathies etc. Hands-on is given only in the latter half of the training programme, once the fellow develops the skills of inplane technique. The fellow is expected to practice interventions on the jelly phantom for ultrasound, and on a spine model for C-arm guided procedures in the first half of ultrasound training. 

Academic activities and research/publications: A teaching session happens daily during reporting and ultrasound training. Minimum of 2 research publications are expected during the course. A lot of learning happens on case-to-case basis. The fellow is also supposed to take a seminar twice in a month.

Exit Exam: Clearing the exit exam is mandatory for the candidate to get the fellowship. The examination is taken by 2 internal and 1 external examiner. The exam is based only on practical approach and live demos with a few long cases and spotters.

Pros: Fellows learn a lot about all MSK pathologies, especially sports injuries, their diagnosis and management. Having a pain physician as a 2nd mentor gives us good clinical knowledge especially about treatment protocols. We also get to learn rehabilitation protocols with very knowledgeable physiotherapists. One receives regular feedback and follow-ups, learns USG guided and C-arm guided MSK interventions and occasionally CT guided bone biopsies and RFA. A huge set of 1000+ pre-loaded case collection of cross sectional studies in MSK, including even CT Arthrogram studies, gives us an idea of all spectrum of findings of all possible MSK pathologies.

Cons: Relatively limited exposure of pediatric MSK, onco-orthopaedics and post-operative imaging related MSK work during the time I was there. 

Personal experience at the fellowship: The faculty is one of the best teachers of MSK radiology, especially in ultrasound and interventions. My main interest was MSK ultrasound, and am very much happy with the overall training. I in fact got much more than what I was expecting in my ultrasound training. Additionally, the exposure of MSK interventions was unparalleled along with extensive exposure to MSK MRI as well. 

Does it add value over MD /DNB degree:  No doubt about it. You learn many practical things and see a really wide spectrum of cases, most of which are complex and ones which you don’t see in your residency or routine practice.

Dr. Perumandla Mohan Rao

MBBS, MDRD (Osmania Medical college) 

Fellow in Musculoskeletal Radiology, July 2023- November 2023