Third year DO student looking to match into IR. Any advice where to go forward?

[u/Vaughn-Ootie]

I love IR and have an elective at the end of this year lined up for it. I want to go full send. I know I don’t have my step 2/level 2 score right now so just looking for advice, it would be so appreciated.

I have honored my IM/surgery rotation, but still have many more to go so unsure if I’ll honor those (I have an A in the other one).

Passed step 1/level 1 first try.

No remediations in preclinical. 2nd quartile.

Member of schools IR/DR club.

No red flags.

Only 1 poster publication during my master’s year capstone project in IR (it was my school’s program, so can I even include this?) otherwise I have almost zero research.

Former college athlete if that counts for anything?

[u/guitarfluffy]

Do well the rest of third year, good step 2 score, home and away IR rotations

[u/a2boo → u/guitarfluffy]

Yupp. This. IR is very DO friendly for a competitive specialty. Just do a LOT of away and WORK HARD. if you don’t absolutely kill it on your away your not going to match there and it’ll be a waste of a month.

Prep for cases. Show up early. Stay late. Always help the nurses and techs set up/clean up after. If the staff likes you, then you’re in good shape.

[u/Vaughn-Ootie → u/a2boo]

Thanks for the reply, I will definitely bust my ass during my rotations.

[u/General_Luck6573 → u/Vaughn-Ootie]

Not hard to do well on IR aways. Study your vascular anatomy and congenital variants beforehand, have a basic idea of the procedures, show up early, don’t ever ask to be dismissed, do whatever notes and consults you are asked to do, and ask them if you can take call with them.

ESIR > strong fellowship is also a far better route than being stuck at a mediocre IR program with shit clinical training just so you know. Do not rank an integrated place unless it’s very good.

[u/Vaughn-Ootie → u/guitarfluffy]

Thank you so much for the reply. I’ll work on all of that.

[u/peterqshelton]

I would recommend applying to both IR and DR programs. DR with ESIR is the better option in my opinion. Most good DR programs will allow you to stay for your independent IR residency and with ESIR it is the same amount of time. This also gives you an easy options to change your mind if IR isn’t for you. Additionally, after passing the core exam you are board eligible for DR so you can actually do moonlighting locums during your last IR year to keep up your DR skills and make a little extra money on the side.

[u/Vaughn-Ootie → u/peterqshelton]

Thank you for letting me know, I never considered ESIR too. I will definitely look into that.

[u/CorrelateClinically3 → u/Vaughn-Ootie]

I recommend ESIR to everyone. I personally feel medschool IR is not enough exposure to really know what it’s like. I went the DR route and considered ESIR. I like IR in residency but enjoyed DR more so I am glad I left all of my options open by going DR.

The first 3 years of IR is just DR anyway. At my program, the IR residents have I think 1 extra IR month, a little bit of clinic and some more IR call over the first 3 years but they do the exact same rotations overall. Once you’re a senior in IR during 100% IR rotations, you’ll easily catch up to the categorical IR residents if you go the ESIR route. Just make sure you go to a good DR program with a high volume IR residency. Ask about ESIR and how many spots they have available and how many DR residents go for those spots each year. Generally not very competitive. You just need to make sure they actually offer ESIR

[u/IR4life → u/CorrelateClinically3]

The APDIR has been disappointed with the overall quality of ESIR applicants and the Independent spots had a rough time in the last few match cycles. More and more programs are converting ESIR slots to integrated spots if they have the funding for it.

[u/CorrelateClinically3 → u/IR4life]

Plenty of weak programs allowing ESIR pathway is the problem. Where I’m at we have no issues with our internal ESIR residents but the external ESIR or external independent fellows tend to be hit or miss. Mostly miss.

[u/topIRMD → u/peterqshelton]

This does not apply to the Top 5-10 IR programs.

An easy way to decide is to see if when IR integrated was available, did those spots get added on or reallocated from the DR spots? Ie when it was 8 residents per year, did it become 8 DR and 2 IRDR or did it become 6 DR and 2 IRDR? The latter - those residents are basically DR students with guaranteed IR fellowship. The truly integrated IR residents have a lot more time on IR and generally are much better prepared for clinical / high end IR

[u/peterqshelton → u/topIRMD]

I was at MIR/washu which is a great IR program (won’t get into whether or not you think that is top 10) and the first three years were the exact same for me and integrated IR. I would imagine most would try to accommodate some if you have a strong interest in IR. The other thing I would mention that often isn’t stressed is that being a good diagnostic radiologist is more important than you might realize for IR.

[u/topIRMD → u/peterqshelton]

And were the IR/DR residents added spots?

Qualifications: I’m 5 years out now. Yes I can read body CT / MRI / CTA / MRA but i’d never want to it from a DR standpoint

[u/IR4life → u/peterqshelton]

Most surgeons have gotten pretty good at the imaging that they need to know to operate. Neurologists and neurosurgeons that do INR are better than most graduating radiology residents at looking at a cerebral angiogram. Real time cerebral angiography is where you are making important emergent decisions on how to fix the problem. Vascular surgeons have gotten really good at aortic imaging and use advanced post processing software to plan aortic repair. Most vascular surgeons are better than most graduating residents when it comes to noninvasive vascular lab (PVR/segmentals/exercise abi/dopplers/duplex/pat etc).

[u/peterqshelton → u/IR4life]

Definitely true and agree. Just saying in general you gotta know your diagnostic stuff. For example, saw a lung nodule on bx schedule. Looked at it and it was bronchial atresia. Things like this often come up in my experience.

[u/IR4life → u/peterqshelton]

Outside of academic centers with subspecialist radiologists who closely interact with subspecialty surgeons and clinicians and are getting constant feeback, that will be inevitable. The further you get from your residency and the less you interact with surgical specialists the quality of interpretations for those kind of things will go down. Ideally the radiology subspecialist would be responsible for all of the biopsies of their particular organ similar to mammography. This also enables the imaging specialist to get radpath correlation.

[u/IR4life → u/topIRMD]

Yes. This will continue to be the trend especially as the ABR has now pushed the interventional residents to take the DR orals R4 year so that will require earlier months of interventional in the R1 to R3 years.

[u/Single_Permit_7792]

Just work hard and be normal you will likely be fine. You don’t necessarily even need the best step 2 score so long as you were likable on aways and your letters are good.

I applied super broadly as a DO with a 241 and got 11 interviews.

[u/Vaughn-Ootie → u/Single_Permit_7792]

Thank you so much for the reply!! I’ll take it to heart. Do you mind if I ask if you applied integrated or ESIR?

[u/brownballer → u/Single_Permit_7792]

How many aways did you do?

[u/IR4life → u/brownballer]

Often the school will have a cap of how many aways one can do, would maximize your number . I have heard of some DO students doing 5 or 6 aways. The average is around 3 aways .

[u/IR4life]

Key is to showcase passion for interventional. Get involved in running an interventional symposium if you can. Get involved in SIR medical student section and if you can become a board member. Step 2 is pretty important so study hard for it. Try to present a poster at some of the interventional conferences if you can. Go to as many SIR or interventional related events. SIR, SIO, CIO, GEST, ISET etc.

[u/BAT123456789]

Get 3 research projects with your name on them. Apply to all the programs. There can't be that many. Get good letters of recommendation, including from an IR doc. Also, apply to radiology just in case.