The need for skilled vascular specialists to manage the growing number of patients in the United States (not to mention globally) exceeds the number currently available. Most IR graduates will join nonacademic practices that serve communities in need of vascular specialists. That is, the patients are there, but we need to train our residents in how to care for them.
Over the past 2 decades it has become clear that the greatest variation among training programs lies in their ability to provide training in peripheral arterial disease management. This inconsistency in training has resulted in a generation of IRs with varying levels of expertise in managing PAD. While individual training programs will have their own strengths and expertise, many academic programs training future IRs can identify PAD as a strength. However, all IR residents are required to learn about the disease states germane to IR; PAD is clearly one of them.
Now is the time for renewed focus on PAD training. The launch of the IR residency programs was accompanied by ACGME-mandated training requirements, including specific education and training in the fundamentals of PAD management. Furthermore, PAD intervention has long been considered within the domain of disease states that all IRs are skilled and capable of performing.
Beyond the technical skillset, the clinical knowledge may be the most important aspect of this training. Knowledge of the assessment, management and treatment of patients with PAD is the key to building a longstanding practice within an IR’s career.
In examining the changing educational paradigm, we must reframe the goal of PAD training. We must become disease experts rather than lesion experts. In this way, an IR may skillfully treat any patient who presents to their clinic or consultative practice. Now more than ever, the new integrated and independent IR residency pathways mandate this experience.
Didactic solution: Residency Essentials
In support of the ACGME’s new program requirements and the training needs of all IR residencies, SIR has developed the Residency Essentials Program (sirweb.org/essentials). This web-based educational curriculum covers the full spectrum of disease states fundamental to any IR residency training. The content is delivered according to specific learning objectives within disease-specific modules.
The PAD content consists of seven modules that will be released sequentially this fall to all IR residents who are enrolled in the program. SIR will release a new module every 2 weeks, thereby providing a structured program with digestible content, in a cadence that can be managed during a busy training year.
Each module contains before and after assessment questions, suggested and required reading content, and pre-recorded video lectures. Program directors will receive progress reports on their trainees. Residency Essentials fulfills the ACGME requirement for a didactic curriculum. Over the course of a 14-week period, the program addresses fundamental knowledge related to initial assessment, staging, and pre-, peri- and postprocedure management.
There is clearly a strong desire among trainees for training in this space. A recent SIR Resident Fellow Student (RFS)-sponsored PAD boot camp webinar garnered significant interest with over 750 registrations and over 400 attendees logging in live to attend a nuts-and-bolts introduction to PAD. Fundamental education within PAD via didactics and recommended reading, such as through Residency Essentials, can help develop the foundational knowledge within this space.
Practical solution: PAD Champions
However, this training opportunity does not eliminate the need for technical hands-on experience and the actual clinical management/endovascular treatment of these patients. Partnering with our local IR colleagues who exist outside the traditional academic setting may be a viable option for providing meaningful hands-on experience.
Some programs may offer training with local vascular experts, often relying on education and experiences provided by other specialties. While a collaborative multidisciplinary training program can be very beneficial, it is not always feasible. Furthermore, I think it is problematic to rely solely on and/or expect another specialty to provide the entirety of meaningful and thoughtful hands-on education in this space. Potential turf wars and competition aside, these other operators are generally more committed to the training of their own residents and fellows.
Ultimately, it would be ideal for this training experience to occur within the home of the training program itself. To that end, SIR supports local practice development through such efforts as the new PAD Champions program. In this program, a faculty member within a training program, designated as the PAD Champion, builds their local PAD practice and education with the support of SIR and the PAD Service Line content experts. As private and academic health systems consolidate, community hospital practices might be the best sites for developing a local PAD practice. The hope is that as local PAD practices evolve and grow, the clinical and hands-on experience in treating these patients continues throughout the IR residency with the local faculty.
Supporting PAD training
In conclusion, the IR Residency Essentials curriculum will provide the foundational knowledge for our residents, while the PAD Champions project will help nurture academic faculty in developing a local PAD practice. This in turn provides the valuable patient interaction and treatment experience that rounds out PAD training.
It is incumbent on our IR division and section chiefs to remain supportive of these efforts to grow PAD within their practice. Furthermore, chairs of radiology departments must support the requisite clinical experiences required of all IRs. We must support the development of longitudinal clinics and disease content experts despite the concern of local turf battles.
We cannot hide behind invisible agreements to no longer touch a particular disease state. There is no endovascular procedure that is owned by any one specialty. The clinician who provides the care will ultimately treat the patient.
We are recruiting the brightest in medicine into our specialty. Let’s train them on the clinical skills and practice-building content that allow these future stars to shine brightest. They have the ability—we need to provide them with the know-how and with meaningful experiences.
The entirety of our future workforce will pass through the new IR Residency training programs. They deserve to be trained in the full gamut of clinical IR so they can join any practice they choose and provide this care. I believe that, within 10 years, we can witness a major shift in our stake within the treatment of PAD ... but the work to make that happen must begin now.
