In February 2023, the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), in conjunction with the European Union of Medical Specialists (UEMS) Interventional Radiology (IR) division, published a new curriculum and syllabus, an update to the previous version released five years prior. According to the CIRSE website, the society provides interventional radiologists with the curriculum and syllabus so they have access to “a standardised IR training guideline that covers the breadth of clinical and technical skills that are needed to perform safe and effective treatments”.
Different countries have different requirements when it comes to declaring interventional radiologists ‘qualified’, and therefore, there can be variation in knowledge and skill bases from one country to another. However, CIRSE’s European Board of Interventional Radiology (EBIR) qualification is one example of a “voluntary and supplemental” certification that has widespread recognition, and is designed to demonstrate holders’ commitment to, and competency in IR. The updated European Curriculum and Syllabus for Interventional Radiology “serves as the framework for the EBIR examination” and is the basis for the ‘blueprint’ used to create examination questions.
In December 2021, CIRSE created a task force for updating the curriculum, which the website states is “the most comprehensive” of all available IR curricula. Between then and February this year, chairperson Raman Uberoi (Oxford University Hospitals, Oxford, UK) and 17 international task force members have adapted the latest version. Mick Lee (University of Medicine and Health Sciences, Royal College of Surgeons, Dublin, Ireland), who led the European Training Requirements (ETR) group, also succeeded in getting the new version included among the European Training Requirements (ETR) at the UEMS. They did this by rewriting large sections of the document to reflect the advancements in IR that have occurred in the last five years, as well as the new quality standards necessary for modern IR training.
Curriculum task force chairperson on the updates
Speaking to Interventional News, Uberoi provided insight into the importance of the syllabus—“in 2006, the CIRSE board recognised the need to standardise IR training and assessment across Europe so that patients get the best treatments possible regardless of geography by well trained IR clinicians. In other words, this means that no matter where future young IR trainees practice, they would achieve the same fundamental competencies.” He went on to explain that this led to the first European curriculum being published in 2013, with this latest edition the third iteration. In Uberoi’s words, “it sets out the objectives, learning methods, outcomes, supervision and assessment of IR training, forming the basis of the syllabus used to blueprint the EBIR (European Board of Interventional Radiology) examination, a high-level professional global examination of IR competence”. There are now almost 1,500 EBIR holders across the world, he added.
What has changed in this version?
When asked about the major changes from the last version of the curriculum, Uberoi clarified that the amendments and additions as a whole “[ensures] that IR education continues to adapt to the changing environment, work practices and needs of current and future interventional radiologists”. Specifically, the changes include a “greater emphasis on clinical responsibility and training requirements for new procedures,” a more “streamlined format”, and creation of four chapters dedicated to interventional oncology (IO). Uberoi also mentioned that the curriculum specifies the level trainees must have reached in core competencies by different points in their training. Regarding regulatory bodies, the chairperson noted that the curriculum reflects what national IR accreditation boards expect of their interventional radiologists, in addition to the UEMS.
The curriculum goes beyond requirements for trainees, it also sets out the requirements for trainers and training centres too, Uberoi continued, “to ensure that trainers are appropriately qualified to train and that training centres have the right infrastructure to support training”. An example of these requirements is that, depending on the centre, trainees may need to rotate between hospitals to gain sufficient exposure to, and practice in, different procedures.
Finally, Uberoi touched on how the curriculum pertains to EBIR examinations, “the traffic light system has also been updated to make it easier for candidates to focus on the most commonly assessed areas of IR practice” when preparing for assessment. “The objective is always to improve the training and quality of interventional radiologists in Europe and globally, and ultimately patient outcomes and care,” Uberoi concluded.
The importance of inclusion in the ETR
As referred to above, being included in the ETR is a significant achievement. The stringent requirements are set out by the body responsible for standardising medical training across European countries: the UEMS. Recognition by the UEMS represents a “strong recommendation for national medical authorities all over Europe” to adopt these requirements and the corresponding assessment for national IR training pathways. This will increase the likelihood that interventional radiologists in different countries, at least in Europe, will have harmonised training and achieve common standards and competencies, leading to greater uniformity in IR care provisions across the continent.
Lee, the aforementioned leader of the group dedicated to achieving this milestone, and president of the UEMS’s IR division, weighed in on why UEMS endorsement matters: “For the first time, the Division of IR of the UEMS Radiology section and CIRSE collaborated to produce this third edition of the curriculum and syllabus. The IR curriculum underwent a rigorous appraisal by all of the other UEMS medical specialties and was eventually approved by the UEMS Council in October 2022 with universal support. This is a landmark achievement for European IR and potentially a potent mechanism for achieving the necessary resources to structure and run competent IR training programmes across Europe.”
The longer-term impact?
Asked to elaborate on the mid- to long-term impact of the UEMS approval, Lee opined that with “this IR training curriculum, and with competency assessment through the EBIR, patients will be treated safely and effectively throughout Europe, and perhaps, in the fullness of time, the putative goal of harmonisation of training across Europe, and the free movement of IR professionals across borders, will become a reality”.
Like Uberoi, Lee emphasised the significance of the curriculum including the resources and requirements for trainers and training institutions, as this has not been done in previous versions. This will enable “robust training”, he added, the product of which will be “doctors who are fit for purpose”. Moreover, Lee underlined how important it is that the curriculum and UEMS endorsement break new ground—“it is another step on the road for interventional radiologists in forging their own destiny”.
Benefits of multilingual curriculum and syllabus “manifold”
Maria Weren, head of certification and accreditation at CIRSE, added her voice to the discussion on the latest curriculum update. She began by outlining how this comprehensive training programme consisting of a curriculum, an examination, an article and structured learning resources can be “easily, fully or partially, adopted by, or integrated into, national training and certification pathways, which will push clinical services in IR and support the further development of IR as an established and growing medical field”. The ultimate goal off the back of this is that, with more trained practitioners, more patients can access IR services, she expanded. Regarding access to the curriculum itself, Weren averred that there are plans to publish it in additional languages, “not least because the [EBIR] examination is offered in German and Spanish through collaboration with national IR societies”.
Probed as to the potential global reach of a multilingual curriculum and EBIR, Weren set out benefits to interventional radiologists in and outside of Europe using them. “All areas of the broad medical field are covered, [meaning] an interventional radiologist [can] expand their general IR knowledge and have this excellent knowledge base attested to through EBIR certification. Widespread recognition also allows greater job mobility and can be a real career boost for young doctors. In countries like Switzerland or Germany, the qualification has found its way into hospital accreditation, which means it is a prerequisite for centres to employ certified interventional radiologists.”
Supplementing this, Weren mentioned that EBIR diploma holders “can also gain advanced certification in the field of endovascular therapy, as CIRSE also offers the European Certification for Endovascular Specialists”. She explained that this is a documented-experience certification that aims to further recognition of interventional radiologists as experts in minimally invasive and image-guided endovascular treatment.
Weren’s final note summarises the importance of the new curriculum and syllabus and its endorsement by over 40 national IR societies, within and outside Europe, “whose common goal is to strengthen IR and help many patients with its minimally invasive therapy options”.
