The IR-in-training has a number of options to consider for their internship year. Although most program directors recommend surgery, a significant number of residents pursue a medicine or transitional year internship. We spoke with four residents-in-training about their internship experiences.
Surgery
Brandon Lei, MD, R1 Staten Island University Hospital, N.Y.; Internship: Surgery, UCSF East Bay 2017–2018
My surgical internship included rotations at an inner-city trauma center, a children’s hospital, and a large referral center for thoracic, hepatobiliary and colorectal disease. I look back on that experience with growing fondness not only because of how well it prepared me didactically for a career in interventional radiology, but also because of the values and passion it helped me develop in my first year as a doctor.
Many aspects of surgical training translate well to IR. Surgery exposes you daily to the finer points of human anatomy, focused consultations, procedural skills and periprocedural care—which are also pillars of IR practice. However, one thing that surprised me during my internship was how much direct interaction I had with imaging. When our department met in conference every day, a CT scan would always be on screen, front and center, driving our discussion forward. By the time I started my second thoracic surgery rotation, I was personally reviewing dozens of chest radiographs in the morning to guide management decisions for my patients. After a year of this experience, the transition to radiology residency and IR has felt natural, like a continuation of everything I’ve been working on.
That said, no internship is perfect. I had less exposure than those in medical internships to the broad scope of nonsurgical pathologies. I was usually up earlier in the morning and home later in the evening, though not by much. At some times over the course of the year, I was forced to eat lunch sporadically and my coffee addiction found new depths. To me, those were small prices to pay for an unforgettable (and for the most part really quite fun) experience in which I honed both my skills and my compassion as a physician.
Perhaps most importantly, a surgical internship will teach you about grit, perseverance and the ability to maintain your composure under pressure.
A prelim year in surgery may not be right for everyone, but I really do think it’s one heck of a stepping stone on the path to becoming a great interventional radiologist.
Thomas An, MD, R1 Massachusetts General Hospital, Boston; Internship: Surgery, MGH 2017–2018
The biggest draw of a surgical internship for me was the opportunity to be in the operating room. Aspiring interventional radiologists should enjoy doing procedures and most IR residents have probably considered a career in surgery. Consider: would you rather spend your mornings rounding endlessly on the floor or starting early, staying focused and heading to the operating rooms? Getting patients into the room, prepping, draping, using sterile technique and interacting with anesthesia become your responsibility for the first time and, over the course of a year, all become second nature. This will form the basis of your technique throughout your career in IR.
However, not every surgical internship is created equal in terms of the number of intern operative cases. Make sure that you do your research about the operative experience at programs before ranking your preferences.
Perhaps most importantly, a surgical internship will teach you about grit, perseverance and the ability to maintain your composure under pressure. There will likely be times where you feel overwhelmed, or an operation may go awry, or a senior resident or attending may have harsh and perhaps unfair feedback. It all happens, but by being involved in all of it you will gain the ability to handle and learn from these situations. How will you manage your first hypotensive postoperative patient when you are the resident on call? How will you handle the first consult you receive for a “cold leg” on your vascular surgery rotation? The amazing part of the year is that addressing situations that once seemed frightening soon become normal and you see yourself growing each time. I would be remiss if I didn’t mention the final benefit of surgical intern year—the scrubs! Scrubs all day every day. What could be better than going to work in pajamas for a year?
The major downside of a surgical internship is the number of hours you will spend in the hospital. The 80-hour work week is enforced at most surgery programs, but usually you will not end up much below that number. Every surgery intern also remembers a week (or multiple) during the year that made 80 hours look like a daydream. It will be a grind—there is no other way to put it. On top of the hours, the work is stressful at times and you will be pulled out of your comfort zone early in the year.
At the end of the day, a surgery intern year will not be the easiest path. However, I do believe that it is the internship that will prepare you best for your future as an IR. When I reflect on my surgery intern year, I’m thankful for everything I learned and the experiences I shared with my co-residents (who are now calling me for radiology consults in the reading room and the emergency room). Was it a challenging year mentally and physically? Yes. Am I glad I did it? Definitely.
Transitional year
Daniel Gewolb, MD, TY Internship, Lincoln Medical Center New York, N.Y.; Radiology Albany Medical Center c/o 2023
Perhaps the biggest advantage of choosing transitional year (TY) is its specialty variability. As an aspiring IR, you will be working with a wide range of specialty physicians, including neurosurgeons, Ob/Gyns, ER physicians, pulmonologists, general surgeons, etc. A TY produces interns who are better equipped to communicate with a broader range of specialists.
My transitional year curriculum included one block each of MICU, SICU, Ob/Gyn, ambulatory clinic and general surgery as well as two blocks of emergency medicine and internal medicine. This diversity in rotations has given me the confidence to effectively communicate and understand what the ordering physician expects when their patient leaves for an image, and it’s not all the same.
Another major advantage to a TY is the amount of elective time—for most TYs, it’s one to two blocks. Electives include trauma, surgical oncology, orthopedics, IR and others to bolster clinical skills many of your colleagues will never have. On the flipside, you might choose to incorporate a research elective to improve your writing or bench skills.
This increased elective time generally allows for a less stressful intern year with more free time. There are often far more golden weekends during a transitional year, which becomes more important than ever as an intern. Time to maintain your hobbies, spend more time with family, study for step 3, and even read up on radiology are luxuries other programs might not allow for.
However, frequently changing departments can also be stressful. Most TY residents (including myself) find the first few days of a new rotation difficult since the day-to-day work can be a complete 180 from the month prior. For example, switching from 2 months of emergency medicine straight into Ob/Gyn has an adjustment period before getting comfortable with the workflow. Often TY residents feel like they are restarting their first day of intern year because of that adjustment period. This constant change can also make longitudinal learning more difficult. At the end of each rotation we tend to feel proficient in whichever field we have been working in; TY residents, however, lose the continuity. This creates the “jack of all trades but a master of none” type of scenario.
Another disadvantage is that TY residents generally have slightly less responsibility/expectations from attendings than the categorical residents. This can lead to more scut work and less patient care depending on the department, and I would recommend that you speak with current residents and alumni about the phenomenon.
Overall, I am very happy with my decision to pursue a TY. According to most attending IRs, there is no noticeable difference between those who have completed an intern year in medicine, surgery or a TY. The increased elective time and opportunity is what makes a TY the most competitive internship and the most fun. On those stressful days when you are getting crushed by your pager, you will be happy to have chosen a year that allows you added time with friends and family. Lifestyle is at least part of why most of us have chosen the ROAD to happiness.
e-IRQ bonus: Medicine
Sahir Quraeshi, Medicine Internship, SUNY Upstate Medical University; Radiology SUNY Upstate c/o 2023
For my intern year, I chose to do internal medicine; and I’m glad I did. It gave me a great opportunity to improve my skills as a clinician, learn a ton about management of general floor patients, and pick up some subspecialty pearls. I truly felt like it would give me the biggest advantage and skill set moving forward into the world of IR.
As IM, you are the heartbeat of the hospital. You are on the primary team managing most of the patients. You have the opportunity to see these patients as they get admitted all the way until discharge. As such, you become familiar with taking care of patients with a variety of pathologies/co-morbidities, and you learn what requires a subspecialty assist. Luckily, we get to rotate through most subspecialties and the ICU to learn those subspecialties as well. This gave me insight into how much each team relies on imaging and brought in exposure to a variety of modalities of imaging this year. It gave me an opportunity to see what a clinician is looking for when they order a specific test. Moreover, this entire year has shown me how often IR is consulted in the hospital—whether it’s the simple PICC or port, or the more urgent embolization; every team that I have worked on has had interaction with our IR docs.
I truly enjoy patient interaction, and you get plenty of that in IM. We also get a small understanding of billing, case management and family meetings. To me, this is the education that’s not taught in medical school.
There are negatives. Rounds. So much rounding. Does anything else really need to be said? Yes, there’s as much as you’ve heard and maybe more. And after rounds its putting in orders, calling consults and writing notes rather than doing much hands-on work. Sure, I’ve gained some experience in doing paracenteses and LPs but, other than basic lines, I have almost no hands-on procedure time—which is something I wish I had more of. I became less upset about this as I heard more about friends' varying experiences with operative time in prelim surgery years. Some may say a con to medicine is learning stuff that will not be relevant to our career fields; however, the emphasis on physiology and patient management will undoubtedly be helpful in bringing clinical context to my reads. Lastly, as a prelim, we are just exposed to much more floor time than categorical medicine residents. Floors are fine, but not having golden weekends often can take a toll on you. Overall, it’s fine and I’m happy with my choice. I do feel like it prepares me well for my future and I’m excited to find out for sure soon enough.
