Goals and Objectives

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Education | Fellowship Program | Fellowship Manual | Interventional Fellow Handbook | Goals and Objectives

Fellowship Program Educational Goals
and Learning Objectives

Purpose

The purpose of the fellowship program in vascular and interventional radiology (VIR) at Indiana University is to provide rigorous, advanced training in all aspects of vascular and interventional radiology. It is expected that the successful fellow will leave the fellowship program with the ability and desire to practice vascular and interventional radiology in a competent, compassionate, and ethical manner.

Rotations

The VIR fellows rotate through the following hospitals, which are part of the Indiana University Medical Center campus: Indiana University Hospital (IUH), Riley Children's Hospital (Riley), Veteran's Hospital (VA), Wishard Memorial Hospital (WMH), and Methodist Hospital (Meth). The diversity of patients and differences in case mix and case load between the hospitals provides a rich experience for the fellows.

Ideally there are 5 clinical fellows. There are 5 rotations: IUH-1 fellow is the primary fellow at IUH and is responsible for IUH patient workup and presentation, IUH-2 fellow also covers IUH but is the primary fellow for Riley and is responsible for Riley patient workup and presentaion as well as MRA interpretation, IUH-3 also covers IUH but is the primary fellow for IUH Operating Room and Methodist HospitalWMH fellow covers WMH, and VA fellow covers the VA. Therefore, in the course of one-year, each fellow will have spent 7 months at IUH (with occasional cases at Riley), 2-3 months at WMH, and 2-3 months at the VA.

Call

The VIR fellows will be on call every fifth night along with a VIR staff. Radiology residents are also on call at each hospital.

Responsibility

The VIR fellows are expected to participate in all cases performed by the Vascular and Interventional Radiology section. Participation in these cases includes, but is not limited to, pre-procedure workup and orders, performance of the procedure, immediate post-procedure workup and orders, daily rounds and notes on inpatients, admitting patients to the VIR service, and seeing patients for a clinical follow-up visit. The fellows will be supervised by a staff member throughout the year and will be given graded responsibility. It is anticipated that the degree of supervision required will decrease as the fellowship year progresses so that at the beginning of the year the VIR fellows will require heavy staff supervision and by the end of the year the VIR fellows will be able to function with a minimum of supervision to the extent that is allowed by HCFA guidelines.

Evaluation

The VIR fellows will be evaluated by the VIR staff on a quarterly basis. See the Radiology Fellow Evaluation Form. Additionally the fellows will have a formal one-on-one evaluation with the VIR Fellowship director every 6 months.

Curriculum

The fellowship program curriculum includes clinical and didactic training that encompasses the entire field of vascular and interventional radiology. Examples of vascular and nonvascular procedures include, but are not limited to, the following:

Vascular diagnosis and intervention: arteriography; peripheral angioplasty; stent placement; stent-graft placement; atherectomy; embolization; venography; thrombolysis; foreign body removal; selective venous sampling; dialysis access intervention; central venous catheter placement; pulmonary angiography; caval filter placement; transhepatic portography; transjugular liver biopsy; transjugular intrahepatic portosystemic shunt placement.

Nonvascular intervention: percutaneous drainage for abscess and other fluid collections; biliary drainage and stent placement; biliary endoscopy; percutaneous nephrostomy; ureteral stent placement; percutaneous gastrostomy and gastrojejunostomy.

Additionally fellows will obtain clinical training in the performance and interpretation of Doppler ultrasound studies, magnetic resonance angiograms and CT angiograms.

The VIR fellow is expected to develop a wide variety of clinical, technical, and cognitive skills throughout his/her training. Some of these skills include, but are not limited to, the following:

Clinical Skills

Perform a directed history and physical (H&P) examination
Concisely document the H&P in the form of a consultation
Present the H&P in a logical, concise fashion
Obtain written consent, which requires an understanding of complications and success rates associated with a variety of procedures
Write the necessary pre- and post-procedure orders pertaining to each procedure
Pre-medicate patients with contrast allergy
Follow and document progress of patients after VIR procedures both short-term and long-term
Perform a complete vascular physical examination, including Doppler interrogation of blood vessels and measurement of ankle-brachial indices
Logically and concisely dictate the interventional radiology procedure report
Perform a complete H&P and admit and discharge patients as needed
Direct and manage the care of patients with complex disease
Serve as a mentor to the radiology residents, medical students, and allied health students who rotate on the VIR radiology service

Technical Skills

Use Seldinger technique to obtain non-selective arterial access in normal and diseased arteries
Use Seldinger technique to obtain non-selective venous access
Perform selective and super-selective arterial and venous catheterizations
Determine appropriate injection and filming procedures for all selective and non-selective vascular diagnostic examinations
Use basic and advanced guide wire exchange techniques
Administer local anesthesia
Prescribe and monitor the use of conscious sedation
Use appropriate suture technique
Perform the full spectrum of vascular and nonvascular procedures for diagnostic and therapeutic purposes
Manage non-functioning or poorly functioning vascular access devices and drains

Cognitive Skills

Discuss risks, benefits, indications, and contraindications of VIR procedures
Identify and manage the patient having a complication of a VIR procedure
Discuss dosing and reversal of conscious sedation
Discuss the drugs used in VIR procedures including analgesics, anti-anxiety agents, vasodilator drugs, thrombolytic agents, and antibiotics
Review basics of iodinated contrast, including alternatives to standard agents
Review basics of x-ray equipment (generators, intensifiers, DSA, etc) and radiation safety
Outline arterial and venous anatomy, including collateral routes, particularly in the visceral, peripheral, renal and supra aortic circulation
Recognize common and uncommon vascular normal variants
Define biliary and genitourinary anatomy
Discuss pathophysiology of all diseases seen in VIR, particularly peripheral vascular disease, renovascular hypertension, carotid occlusive disease, venous thromboembolic disease, biliary and genitourinary obstruction and abscesses
Discuss indications, basic technique, tools, results, complications and outcomes of percutaneous transluminal angioplasty of arteries and veins
Discuss use of vascular stents including results
Understand the basic principles and utility of vascular ultrasound
Review basic and advanced principles of thrombolysis
Discuss percutaneous biliary and urinary drainage, including strategies for internal drainage using stents
Outline the TIPS procedure, including indications, contraindications and results
Review the roles of thrombolysis and PTA in dialysis access
Discuss principles of venous access including PICCs, tunneled catheters and dialysis catheters
Review basic principles of MRA, CTA, and vascular ultrasound Discuss indications for and contraindications to inferior vena caval filter placement, as well as advantages and disadvantages of various available filters