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Brian Stainken: Editorial opinion September 2023 | Issue 91
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Profile: Farah Gillan Irani
CRLM: Bridging to transplant
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CIRSE curriculum update targets greater harmonisation and improvement in global IR training standards
New report returns to issue of improving UK’s paediatric IR provision
other words, this means that no matter where future young IR trainees practice, they would achieve the same fundamental competencies.” He went on to explain that this led to the first European curriculum being published in 2013, with this latest edition the third iteration. In Uberoi’s words, “it sets out the objectives, learning methods, outcomes, supervision and assessment of IR training, forming the basis of the syllabus used to blueprint the EBIR (European Board of Interventional Radiology) examination, a high-level professional global examination of IR competence”. There are now almost 1,500 EBIR holders across the world, he added.
IN 2010, THE UK ROYAL COLLEGE of Radiologists (RCR) with the Royal College of Paediatrics and Child Health (RCPCH) published a report focused on how to improve paediatric interventional radiology (PIR) services. In June 2023, an updated report was published, this time by the RCR on its own. The purpose of the report is to “identify how PIR services can be expanded and improved” and “suggest solutions” that can be enacted by commissioners, healthcare leaders and hospitals. The conclusion of the 2023 report states that “the 2010 report recognised the value and importance of PIR to the National Health Service (NHS) and made recommendations to grow and support PIR but has not driven change”. In light of this, what do the updated recommendations suggest is needed to drive change successfully this time round? The introduction to the report seeks to clarify that “PIR is more than just IR in children, and requires specific skills, staff and infrastructure to be done right”. In spite of this, according to the latest RCR workforce census, the UK has 743 consultant interventional radiologists, but less than 20 of those are formal PIR posts. The report goes on to state how the majority of these posts are in London, meaning children and families across most of the UK do not have easy access to PIR services. The RCR’s goal in providing an update to the joint report is to finally “bring PIR service provision into the 21st century”.
What has changed in this version?
PIR in the UK in 2023
In February 2023, the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), in conjunction with the European Union of Medical Specialists (UEMS) Interventional Radiology (IR) division, published a new curriculum and syllabus, an update to the previous version released five years prior. According to the CIRSE website, the society provides interventional radiologists with the curriculum and syllabus so they have access to “a standardised IR training guideline that covers the breadth of clinical and technical skills that are needed to perform safe and effective treatments”.
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ifferent countries have different requirements when it comes to declaring interventional radiologists ‘qualified’, and therefore, there can be variation in knowledge and skill bases from one country to another. However, CIRSE’s European Board of Interventional Radiology (EBIR) qualification is one example of a “voluntary and supplemental” certification that has widespread recognition, and is designed to demonstrate holders’ commitment to, and competency in IR. The updated European Curriculum and Syllabus for Interventional Radiology “serves as the framework for the EBIR examination” and is the basis for the ‘blueprint’ used to create examination questions. In December 2021, CIRSE created a task force for updating the curriculum, which the website states is “the most comprehensive” of all available IR curricula. Between then and February this year, chairperson Raman Uberoi (Oxford University Hospitals, Oxford, UK) and 17 international task force members have adapted the latest version. Mick Lee (University of Medicine and Health Sciences, Royal College of Surgeons, Dublin, Ireland), who led the European Training Requirements (ETR) group, also succeeded in getting the new version included among the European Training Requirements (ETR) at the UEMS. They did this by rewriting large sections of the document to reflect the advancements in IR that have occurred in the last five years, as well as the new quality standards necessary for modern IR training.
Curriculum task force chairperson on the updates
Speaking to Interventional News, Uberoi provided insight into the importance of the syllabus—“in 2006, the CIRSE board recognised the need to standardise IR training and assessment across Europe so that patients get the best treatments possible regardless of geography by well trained IR clinicians. In
When asked about the major changes from the last version of the curriculum, Uberoi clarified that the amendments and additions as a whole “[ensures] that IR education continues to adapt to the changing environment, work practices and needs of current and future interventional radiologists”. Specifically, the changes include a “greater emphasis on clinical responsibility and training requirements for new procedures,” a more “streamlined format”, and creation of four chapters dedicated
It is another step on the road for interventional radiologists in forging their own destiny.” Mick Lee
The main body of the report begins by listing the advantages to making PIR services fit for purpose, which will bring about faster recovery times through less invasive procedures, and therefore the use of fewer inpatient beds and other resources, as well as a more manageable experience for the patient and their family. The report further informs readers that there is, roughly, only one paediatric interventional radiologist per million children in the UK, to the USA’s one per 342,000 children. Moreover, it states, there is roughly one adult interventional radiologist per 74,000 adults in the UK, yet even this is jeopardised by the “[worrying]” shortage of radiologists generally. Continued on page 5
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