IRQ Articles

Feature: Roads into research 

10-12-2018 09:59

Training strategies for the next generation of clinician-scientists in IR

By Dania Daye, MD, PhD, Giovanni Santoro, DO, and Joshua D. Kuban, MD  Fall 2018

As IR continues to mature as an independent medical specialty, emphasizing scholarly activity and scientific research is essential to further evidence-based practices and to advance the field. Evidence-based practice can refine our techniques, validate therapeutic interventions and, most importantly, improve patient outcomes. Furthermore, it raises the confidence of referring physicians in our ability to effectively manage complex pathology.

Investing in research education for young trainees is essential to support this progress, whether through the recruitment of residency applicants with strong research backgrounds or by formalizing IR research training in integrated IR residencies. In this article, we discuss existing opportunities for research education and highlight several ways to advance research training in IR.

IR research training opportunities for residents and fellows

IR research programs are already underway in several major academic institutions. The Holman pathway1 is designed for residents interested in careers combining research and clinical radiology. It includes 18–21 months of research training during the radiology residency PGY2–5 and adds 1 year to the total length of residency training.

Currently, few programs provide a dedicated track for DR trainees interested in pursuing research training outside the Holman pathway. The University of California–San Diego offers a 5-year clinician-scientist radiology residency program (CSRRP), in which radiology residents pursue a full year of conducting research during their PGY2 with 6 weeks of protected research time in each subsequent year. Other institutions, such as the University of Texas MD Anderson Cancer Center and Massachusetts General Hospital, allow DR residents substantial protected time during their fourth year of residency to pursue research.

In radiology, a limited number of formal independent research-oriented fellowships can be pursued before or after clinical training, including some in pediatric radiology2, computed tomography3 and body imaging4. A few institutions, such as Memorial Sloan Kettering Cancer Center and the University of Washington, offer independent 1- to 2-year IR research fellowship opportunities. These non-ACGME-accredited fellowships allow fellows to gain clinical training in a specific area of IR, such as interventional oncology, while having protected research time during their training (ranging from 30–70 percent of their time). These opportunities require additional training time beyond clinical fellowship; availability of positions remains subject to institutional and NIH funding, primarily through the NIH T32 grant mechanism.

Apart from a few established independent research fellowships, multiyear NIH-funded postdoctoral positions are available in several research labs at larger academic centers. These opportunities are best for those with limited research training who are interested in acquiring skills to develop an independent NIH-funded research program. Very few pursue such positions, currently the mainstay for rigorous research training, since they significantly increase training time.

Establishing an integrated research pathway within residency training is essential, then, to provide a longitudinal formalized research structure for those interested in a career as a physician-scientist in IR.

Pre-residency training in IR research

If someone develops interest in IR research during their undergraduate education or as a medical student, they can seek a longitudinal research experience at their home medical school or summer research program at other institutions.

Many summer research internships are available for medical students interested in IR research. Each year, SIR Foundation offers medical students the opportunity to engage in pre-clinical IR research at an academic site or medical device development at a corporate site during the summer months free from academic coursework. This excellent opportunity provides robust training in research for medical students.

The internships available through this program, which vary from year to year, have included institutions such as Cleveland Clinic, Johns Hopkins, MD Anderson, UCLA, University of Chicago and Yale.5

Research assistant positions or postdoctoral positions are available in select IR laboratories for those who are between degrees or who are taking a year after medical school to seek research training or to increase their competitiveness for residency positions. Available roles vary from molecular bench work and pre-clinical animal research to clinical research positions.

Emerging research training models in IR/DR residencies

Many efforts are currently underway to design residency structures that support the training of residents interested in becoming clinician-scientists. The University of California–San Diego has instituted a CSRRP under the direction of Gerant Rivera-Sanfeliz, MD, and Isabel Newton, MD, PhD. This CSRRP provides integrated IR residents with the opportunity to pursue a research-intensive program through their T32/IR/DR pathway.

Research image
Figure 1: The first IR/DR Research Residency, implemented at the University of California–San Diego, consists of a 7-year program dedicating PGY2 to research training and providing residents with 6 weeks of protected research time each year during the PGY3–6 years. PGY7 is dedicated to advanced IR training. Residents complete up to 3 months of IR training during the PGY3–5 years and up to 21 months of IR training during the PGY6–7 years.

Through this program, trainees complete an internship year followed by a 6-year research IR/DR residency. Participating residents dedicate their first year of radiology training to research followed by 6 weeks of protected research time per year, typically pursued in 2-week intervals, during each of their PGY3-6 years (Fig. 1). In this program, residents satisfy all Accreditation Council for Graduate Medical Education (ACGME) and American Board of Radiology (ABR) requirements including those in breast imaging and nuclear medicine and complete a total of 24 months of IR training.

Supported by an NIH T32 grant, this program:

  • Allows trainees to pursue substantial research, publish results and secure grant support
  • Allows longitudinal integration of research throughout clinical training
  • Maximizes opportunities for research productivity
  • Provides a pathway towards eventual transition to research independence after training

This innovative model offers great potential for training the future generation of clinician-scientists in IR.

Opportunities to strengthen current research training models

Research funding, which is essential to advance IR, is available at every level of training. Foundations including those of SIR, the Radiological Society of North America (RSNA) and the Association of University Radiologists (AUR) provide funding for students, residents and junior IRs interested in pursuing scholarly activity. Increased visibility of these opportunities is essential to allow more trainees and junior faculty protected research time.

The IR community should also strive to train the next generation of IRs in proper research practice, study planning, publication composition and submission of grant funding applications. Institutions with strong academic records should offer courses and seminars in research methods. As a specialty, we should also send more of our trainees and junior faculty to attend the Introduction to Academic Radiology (ITAR) program sponsored by RSNA, AUR and ARRS,6 as well as dedicated courses on grant writing and clinical trial design available through RSNA—programs with a strong track record of positive research outcomes.

Active IR research labs with adequate funding should also make a concerted effort to formalize and advertise research opportunities for medical students and IR/DR residents. For short-term projects, clearly delineated goals will be key for investigators to maximize the productivity of their mentees. It is equally important for trainees to be able to identify research mentors as early as possible during their clinical training as protected time for such pursuits tends to be limited. To this end, the newly established Research and Innovation Committee of the SIR Residents, Fellows and Medical Students Section (RFS) is currently developing a list of available research opportunities for trainees.

Developing a strategy for the future

To ensure our specialty’s future success and maintain its culture of innovation, the IR community should strive to train the next generation of IR clinicians in proper research practice. Moving forward, in addition to capitalizing on available opportunities, we should consider instituting the following steps:

  1. Establish a national formal training structure in IR residencies including integrated longitudinal research training pathways.
  2. Establish a national repository of available research opportunities in IR for medical students and residents.
  3. Provide programming aimed at trainees, such as “introduction to research” workshops, courses in biostatistics, research certification programs and grant writing courses through SIR.
  4. Establish a longitudinal research scholar community within SIR to provide a community for trainees and young investigators interested in research.
  5. Recruit active IR investigators for mentorship roles and create a network for trainees in need of a mentor.
  6. Provide more substantial funding for resident grants, allowing them to secure protected research time to conduct research during clinical training.
  7. Establish benchmarking metrics and a strategy to increase research productivity and the number of physician-scientists in IR over the next decade.

Establishing formalized research training programs to increase the number of clinician-scientists in IR is essential for continued innovation and for the establishment of evidence-based guidelines. If we are to flourish as a specialty, it is important to invest now in training the future generation of interventional radiologist-scientists.

Acknowledgements

We thank Isabel Newton, MD, PHD, Gerant Rivera-Sanfeliz, MD, and Claude Sirlin, MD, for providing information about the UCSD CSRRP and about the IR/DR research residency program they direct.

References

  1. Holman Research Pathway
  2. Pediatric radiology research fellowship
  3. Research fellowship in computed tomography
  4. Body imaging research fellowship
  5. Summer Medical Student Internship Program
  6. RSNA/AUR/ARRS Introduction to Academic Radiology Program

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