IR JUNIORS | The Future of Interventional Radiology
Career Pathway
Recruitment to Clinical Radiology Training
Interventional radiology (IR) is a dynamic speciality which is developing at a rapid pace worldwide. While IR is now becoming an independent speciality in other countries such as the USA, the current training pathway in the UK remains linked closely with diagnostic radiology. Those interested in pursuing a career in IR in the UK thus apply for a clinical radiology training place (overseen by the Royal College of Radiology). However, discussions are currently in place to develop direct entry IR run through positions.
Trainees who want to train in IR first complete medical school and foundation training. National selection occurs for Clinical Radiology at the ST1 level. After 3 years of core radiology training (ST1-ST3; predominantly diagnostic radiology with varying levels of IR exposure to obtain core IR skills), trainees decide to either continue with diagnostic training for 2 years (ST4-ST5) or undertake dedicated IR training for 3 years (ST4-ST6).
From 2022, a handful of national recruitment posts have been dedicated to IR (with the option of switching back to diagnostic radiology)
Sometimes, local arrangements allow trainees to undertake 2 years of higher IR training (until ST5) - at this point, trainees can finish training and practice IR (depending on what job opportunities available), or undertake a further year of training to complete their CCT with interventional radiology sub-specialisation.
IR Subspecialisation
IR, while continuously growing, is already a vast field and thus trainees undertaking ST4-ST6 in IR will generally chose a sub-specialty area:
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Vascular IR
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Non-vascular IR
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A combination of vascular and non-vascular IR
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Interventional neuroradiology (INR) (with diagnostic neuroradiology)
The exact sub-specialisation opportunities within each training programme depends on local services and expertise. While there is no formal national selection process for IR training, training programmes have advertised posts nationally in the past (for example INR training).
Other IR subspecialisation areas gaining increasing traction and that will look set for almost certain expansion are paediatric interventional radiology and interventional oncology.
Exams and Further Training
At the end of clinical radiology ST1, trainees take the First FRCR Exam which focuses on anatomy (image viewing assessment) and physics (MCQ). The Final FRCR Exam is split into Part A and Part B and is undertaken later in clinical radiology training (ST3 and after). Part A is a single best answer (SBA) format examination paper and Part B consists of 3 sections: reporting, rapid reporting and an oral examination. These examinations are common to all clinical radiology trainees and thus emphases the need for those following an IR pathway from ST4-ST6 to maintain diagnostic radiology skills whilst developing advanced IR skills.
IR is recognised as a subspecialty under clinical radiology. Upon satisfactory completion of the IR training pathway (ST4-ST6) a certificate of completion of training (CCT) in clinical radiology with IR subspecialisation. In the current context it is not possible to obtain a dedicated CCT in interventional radiology in the UK.
The European Board of Interventional Radiology (EBIR) is a supplemental exam overseen by the Cardiovascular and Interventional Society of Europe (CIRSE). The EBIR has existed since 2010 and allows those who have completed training to gain further internationally recognised competency in IR. The EBIR is becoming an important step in IR career development both for UK-trained interventional radiologists and those across the world.
Many UK-trained interventional radiologists choose to undertake a year of further training after ST6. This ST7 year is referred to as a fellowship year and often allows the development of refining of knowledge and skills in a specific IR area or image-guided procedure. This can be within the UK or internationally.
While beyond the scope of the current article, opportunities for less-than-full-time (LTFT) IR training and academic IR training also exist.