You are a co-founder of two innovative and highly practical courses covering both core and advanced skills in interventional radiology. Why is good training so important?
Excellent outcome of interventional procedures depends on a number of closely related factors. The interventional radiologist needs to have fundamental knowledge of the disease process and of the procedure which he/she is performing. He/she needs to have clinically assessed the patient, studied the imaging, communicated with the patient so they understand and relate their expectations to predicted outcome, have the technical experience and knowledge of equipment to perform the procedure, have the ability to deal with any complications that may develop and also to know how, why and when to follow the patient up. They need to relay confidence to the patient that he/she can deal with the problem they are facing in a calm and efficient manner. He/she also needs to have a highly trained and focused team around them to provide support every step of the way. In order to achieve this utopia of practise, it is necessary to undergo the right training in the right environment. Educate yourself, your team and your clinicians before you perform procedures on patients. Courses can provide excellent grounding and knowledge but must be underpinned by good training centres with inspirational teachers. The expanding role of simulated environments and procedures I am convinced will play an increasing role.
What are the core skills that physicians who want to perform interventional radiology procedures need to have?
Both technical and clinical skills are core. Interventional radiology services many specialities covering procedures in every organ and vessel in the body. Despite this range of procedures, the core skills to perform many of these are similar based on catheter-guidewire technique. As such the knowledge of catheters, guidewires, balloons, stents, coils, embolic agents, etc, is fundamental to the application of these skills. As with any intervention, good clinical skills and judgement is vitally important. When to and when not to do a procedure is fundamental to achieve good outcome and patient satisfaction. These skills need to be imparted and emphasised from an early stage as a building block to produce high quality image guided interventionists.
How can interventional radiologists maintain their skills over time in a changing subspecialty?
By attending one my courses of course! Basic continuing professional development is without doubt very important. Keeping up with the literature, attending courses and watching other interventionists work are clearly important elements.
Acquiring and keeping the required armamentarium of skills is a life-long learning process which starts early in radiological training but often only begins in earnest on appointment as a full staff member/consultant. To stay at the forefront requires commitment, drive and a passion to do what is best for patients. I have always believed in interventional radiologists treating a wide variety of conditions across systems to maintain high throughput of cases to maintain skills. Occasionally “doubling up” with colleagues helps, particularly when the less common conditions are being treated. “Doubling up” in these circumstances is also good for the interventionists and the patient because of the support and extra brain power it provides.
What is the current pathway to train as an interventional radiologist in the UK? In Europe?
In the UK, training is still via diagnostic radiology for three years via The Royal College of Radiologists (FRCR). However, recently with interventional radiology achieving subspeciality status, post FRCR, the trainees can embark on three years dedicated to interventional radiology via an FRCR curriculum which is very similar to the CIRSE curriculum for interventional radiology. This of course is going to be helpful when UK interventionists wish to take the European Board of Interventional Radiology exam which I hope in time will be seen in the UK and around Europe as an exit examination.
How does training and maintenance of skills also help delineate turf and territory?
I have always felt that whoever performs a procedure, from whatever background, should only do so if they have the right training and experience. If someone was to operate on me or a member of my family, that would be a pre-requisite. I am sure that is what happens in a publicly funded system. However, I know that there are countries in the world where fee for service drives a different agenda and this quality control is not always a priority.
In an ideal world, what type of training would you want to see for young physicians entering the specialty?
A training that covered the bases in basic clinical management of patients with experience of the surgical environment and importantly a really good background in imaging—I think people underestimate the importance of being a good diagnostic radiologist as a grounding for being a good interventionist.
In the UK, the drivers behind what we used to call turf battles are not financial as they are in other countries. They are purely professional. This is why we have been able to discuss the best way forward with our surgical colleagues who have displayed great intelligence and understanding in their approach. Of course there are one or two surgeons who practice endovascular treatment in the absence of any training. I doubt they tell their patients this but I believe that this sort of behavior will soon be a thing of the past. I see no reason why future interventionists should not come from radiology and surgery. It is a question of making the time in a training programme—at least three years–—learning and gaining experience in that time and emerging as an accredited clinician and interventionist. Surgeons could enhance their imaging skills during training and interventional radiologists could build on those clinical skills acquired prior to radiology training.
