Are We Ready for Subspecialty Training in IO?

The Association of Program Directors in Interventional Radiology (APDIR) had their annual meeting this week. There was a huge turnout, largely to hear about the new Diagnostic-Interventional Radiology residency pathway recently approved by the ABMS. Discussion of this new IR residency and its implications occupied most of the first day. Speakers included representatives of the Radiology Review Commission of the ACGME, Society of Interventional Radiology, and the American Board of Radiology. 

For a separate agenda item, APDIR president Kevin Kim (editor of the IO-Central Case of the Week) invited several academic interventional oncologists to discuss subspecialty training in interventional oncology. Fortunately, most of the rotten tomatoes had been launched during the first session, but nonetheless a lively discussion ensued.  

Collaborating on the IO proposal were faculty from U Penn, Thomas Jefferson University, Johns Hopkins, Emory, MD Anderson Cancer Center, Dotter Institute, Stanford, and Northwestern. The existing ACGME program requirements for DR, IR, and the oncology specialties were integrated into a draft proposal. The essential elements of the proposal were:

  1. An IO training curriculum would include all the required elements for certification in DR and IR, and could be completed within the current 6-year post-graduate structure, with a possible 7th year if a substantial research experience were included. 
  2. IO subspecialty training would encompass 24 months, including the equivalent of 6 months of clinical oncology (medical, surgical, radiation, pathology, medical subspecialties); 6 months of imaging, nuclear medicine and therapy focused on oncology; a dedicated IO research project; and 12 months of IR including longitudinal outpatient and inpatient oncologic care and a long list of technical and clinical competencies.

Ken Kolbeck, MD PhD, from Dotter Institute and Riad Salem, MD MBA, from Northwestern University presented their existing IO Fellowships programs. Memorial Sloan-Kettering Cancer Center has one as well. 

Comments from the experienced leaders from the ABR and RRC were practical and measured. What are the desired outcomes of such training? How will they be measured? How will such training be certified or credentialed - the programs and the trainees? Comments from the program directors in the audience spanned the delusional spectrum from “we don’t need to do this -- my fellows are already competent to practice IO” to “we don’t need to do this -- tumor boards decide how patients should be managed and we just do what they tell us”.  Gag me with a spoon.

Some IR training programs have independently approached WCIO asking for some sort of certification for their IO training program. Interestingly, the surgical oncology ACGME guidelines permit the Society of Surgical Oncology to approve training programs, so there is a precedent for a professional organization outside of the ACGME to serve as the credentialing agency.

Subspecialty training in IR opens a huge can of worms with more questions than answers. These questions and answers will be different among the varying healthcare training systems around the world. If we want IO to become the fourth pillar of cancer care, we must create a standardized training scheme to provide competent practitioners in this complex and multidisciplinary field, who are ready to take their seat at the table. WCIO looks forward to working with the global IO community to further IO training. Post your thoughts on IO subspecialty training on IO-Central.

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