Following talks between the Vascular Society (VS) and the British Society of Interventional Radiology (BSIR), a new joint training programme that aims to enhance the cooperation between both disciplines and achieve a closer working relationship, is close to being agreed.
Mr John Wolfe, vascular surgeon and current President of the VS, is keen to establish such training programmes (as he explains in his interview on page 16) and has pointed out that the VS are working very closely with the College of Radiology on a curriculum for interventional vascular radiologists and vascular surgeons, combining a programme for the two specialties. If that is achieved, Wolfe believes it would be “fantastic outcome” because he does not think any country in the world has been able to get full cooperation between radiologists and surgeons. “We are all trying, but it is a difficult problem to crack for obvious reasons,” he commented. “We are coming at the problem from different angles and I think we both have a lot to offer each other”.
A close cooperation between the two disciplines could lead to a more seamless management of open or endovascular treatment, and therefore a better outcome for the patients. Wolfe believes that great strides in the last year have been made in that there now is a letter going to the Postgraduate Medical Education and Training Board (PMETB) from the three Royal Colleges of Surgery, the Royal Colleges of Radiology and the Vascular Society suggesting that there needs to be a initial generic training of two years in interventional radiology and surgery and that, according to Wolfe, is an encouraging step in the right direction.
The proposed training programme would be divided into an initial co-operative two years following on FY 1/2 (+/- one to two years post foundation training). Entrants should have either a radiological or surgical NTN and the co-operative years will have equal emphasis on imaging, interventional radiology (vascular and non-vascular), emergency and elective surgery.
Assessment may lead to MRCS/FRCR one equivalent examinations, and would then advance into years three to four focusing on core training. This would be competency based and include diagnostic and clinical care and basic surgical and endovascular skills. Following this, years five to six will focus on additional modules to hone surgical or interventional skills. The exit qualification would depend on the modules undertaken and reflect this bias. Training will be assessed by the RCR/RCS and be competency based around the knowledge, skills and attitudes required by this group of professionals.
This intensive training would hopefully lead to a format applicable to other areas of post-graduate medical education, be competency based and allow flexible entry and cross over in keeping with the ethos on MMC. It will provide potential exits into the combined training scheme or surgery or radiology as required by the individual/service requirements.
The final result of the training programme is anticipated to produce teams whose members between them acquire the fundamental skills to manage all aspects of diagnosis and management of vascular disease and have a broad grounding in endovascular and open surgery. Those with endovascular skills will be able to provide interventional services across a range of specialities and those with surgical skills will be able to provide for the increasingly complex nature of modern vascular surgery. The teams will be able to deliver robust and resilient elective and emergency care with a common ability to assess, diagnose and plan management in the outpatient and ward context.
Joint training programme
Professor Anthony Watkinson, President of the BSIR, recently commented on the need for a joint-training programme, its structure and the benefits such a programme will bring to the patient, interventional radiology and vascular surgery. “The establishment of a joint training programme will aim to train specialists who can work in teams with complimentary skills and mutual respect. This will enable provision of high quality patient care in the elective and emergency setting in a small speciality in an area that is likely to lead to centralisation of services. This acknowledges the likelihood of centralisation of services in small specialities to support service provision,” added Watkinson.
“These proposals benefit the patient, interventional radiology and vascular surgery. The patient benefits by having access to a team with the wide range of skills to provide high quality care 24/7 and the vascular specialist and interventional radiologist can focus earlier in their career pathways and not waste time in areas of unrelated surgery and diagnostic radiology that just serves to pass the current exams,” he said.
Workforce planning
Watkinson explained that the individual must possess a wide range of skills to be able to work in teams and offer a high standard of performance. These skills, according to Watkinson, must include clinical, diagnostic, interventional and surgical. There is likely to be overlap and different emphasis although the new person, whilst having special interests, must have a broad range of skills including non-vascular to support the other services that interventional radiology currently supports and provide cover 24 hours a day, seven days a week.
Training the right numbers of people to do the right things along a training pathway that is fit for purpose, shares common skills of knowledge and trains appropriate numbers. Watkinson commented that the PMETB needs to approve the proposals and to this aim the development has been along a pathway through syllabus/curriculum from the education committees of both the BSIR and Vascular Society. The IR syllabus has been approved by the IR subcommittee, the Education Board and the Faculty Board of the RCR. All this has had a close eye on what PMETB will require, he added.
With well-renown figures like Wolfe and Watkinson expressing their strong interest in establishing closer liaisons between interventional radiologists and vascular surgeons, it seems that the distance between the two specialties will gradually shorten and the combined knowledge and skills acquired by both interventional radiologists and surgeons will result in improved patient care and clinical outcomes.
