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) having completed a medical degree and foundation training.
Clinical radiology training is a run-through training programme, this means interested individuals apply once and, if successful, are recruited for their entire diagnostic radiology/IR training radiology pathway.
The competitive application after 2-3 years of training for higher training (as seen after core medical and core surgical training) does not apply in clinical radiology training.
Doctors can apply in their FY2 year and be recruited directly into clinical radiology training.
Clinical Radiology Training
Competition for clinical radiology training is relatively high in the UK with 3.47 applications for every post in 2019.
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). The growth of IR has failed to meet the exponential increasing demand for IR services in the UK. For this reason, while dedicated IR training places are limited by local resources, up to this point radiology trainees interested in IR have been accommodated on IR training programmes (either locally or nationally).
IR, while continuously growing, is already a vast field and thus trainees undertaking ST4-ST6 in IR will generally chose a sub-specialty area:
A combination of vascular and non-vascular IR
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.
As mentioned at the top of this page, IR is a dynamic speciality – the development of more minimally-invasive image-guided procedures and increasing awareness of IR is leading to massive growth. There is a school of thinking within the IR community that recognition of IR as an independent speciality would allow stakeholders to better deal with this growth. A vote is scheduled to take place on the topic at this year’s British Society of Interventional Radiology (BSIR) ASM in Manchester in November. Regardless of the outcome the training pathway outlined above is unlikely to be drastically changed in the coming years. We’ll aim to keep you updated on developments on this front.
The Future of UK IR Training
As mentioned at the top of this page, IR is a dynamic speciality – the development of more minimally-invasive image-guided procedures and increasing awareness of IR is leading to massive growth. There is a school of thinking within the IR community that recognition of IR as an independent speciality would allow stakeholders to better deal with this growth.
At the British Society of Interventional Radiology (BSIR) ASM 2019 in Manchester, BSIR members voted on the motion 'Should IR become an independent speciality?' With 80% of votes in favour of the establishment of an independent speciality, there is now a clear mandate for the development of the same in coming years. While this was a massive vote which will likely have shape UK IR training in the future, the training pathway outlined in previous sections is unlikely to be drastically changed in the coming years.
IRJ will aim to keep you updated on developments on this front.