Roundtable sparks audience discussion on the pitfalls and successes in global IR training pathways

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In a roundtable dedicated to comparing training pathways for interventional radiology (IR) in Saudi Arabia, the Middle East and North Africa (MENA), Europe and North America, discussion levelled on the challenges faced by many and heard first-hand experiences of trainees around the globe.

Presenting first on the Sunday of the Pan Arab Interventional Radiology (PAIRS) annual congress (10–13 February, 2024, Dubai, United Arab Emirates), Raman Uberoi (The John Radcliffe Hospital, Oxford, UK) elaborated that interventional radiologists are image-guided surgeons, and on the critical nature of IR assessment worldwide. He noted that in the past, interventional radiologists have no or very minimal exposure to IR in the early years of their training, and have no formal assessment in the quality of training they receive to confirm that they have achieved basic core competencies in IR. “Patients would be shocked if surgeons had no assessment in place to prove their core skills.”

In Europe, Uberoi’s work with the European Board of Interventional Radiology (EBIR) to consolidate a comprehensive examination for training IRs was aimed at “evolving the way [interventional radiologists] work and train, focusing on the critical core skills that future interventionists will need”.

Abdulkader Alkenawi (King Abdulaziz Medical City, Jeddah, Saudi Arabia) explained that the bodies which determine the IR curriculum and examination are entirely separate in Saudi Arabia, but the parties frequently come together to ensure what trainees are being taught aligns with their assessment.

Although important, assessment can only take trainees so far, one audience member stated. He provided that his centre in Jordan sees very limited numbers of complex cases, and queried whether trainees would be accepted to facilities such as Alkenawi’s so that they may gain exposure to a broader range of pathologies. To this, Alkenawi explained that due to Visa constraints and a consistently significant workload for their small IR team this is not yet a possibility, but hopes that in the future they may begin accepting trainees from other countries.

Mamoon H Al-Omari (King Abdullah University Hospital, Ar Ramtha, Jordan) then went on to describe how IR is still yet to be included within diagnostic radiology (DR) training today. At his hospital, those who are interested in IR can take one to two months elective training; however, he stressed the lack of exposure to IR for most trainees generally.

Sparking contention, attendees and speakers turned to IR’s position within the house of DR. Saher Sabri (MedStar Georgetown University Hospital, Washington, DC, USA) asked the audience whether an IR-only residency would be attractive, including one/ two years IR training and a year or so training in DR, but would certify trainees in IR alone.

Taking stock of hands raised, Sabri concluded that most would prefer dual certification and when asked why, an audience member said that this is beneficial as trainees would have something to show for the significant portion of time spent training in DR.

Another audience member opined however, that if IR was selected from the off, there would be more dedicated interventional radiologists who could create better recognition for the specialty. They stated that maintaining a qualification in DR when training in IR acts as a ‘safety net’, enabling trainees to have a field to fall back on, negatively affecting the growth of IR. Yet, another audience member viewed the ‘plan B’ quality of dual certification as positive, and explained that with limited jobs in the MENA region, having the ability to do both DR and IR procedures places interventionists in a better position to secure a place in a competitive job market.

“It’s not an easy path doing IR,” Alkenawi said, airing his concerns that IR has lost “too many battles” with other specialties to date, which Uberoi consolidated, noting the difficulties interventionists can encounter if they are “at the whim” of referring specialities. Sabri, however, in attempts to “uplift a little bit”, brought the discussion back to the positive practice models that are already in action for many centres, to which Alkenawi agreed that IR as a field has shown its capability to adapt to challenges.

Uberoi concluded that “the future is bright, but we must think in a radically different way. The next generation can hold the future of IR in their hands, which will mean [they] must grapple with these issues now, talk to [their] trainers and develop [themselves].”


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