Michael D. Darcy, MD, FSIR, said interventional radiology leaders must be passionate and innovative when training the next generation of IR experts in this new era of the IR Residency and physician reimbursement.
Dr. Darcy delivered the 33rd annual Charles T. Dotter Lecture as part of Sunday’s plenary session. Each year, the presenter is selected by the SIR president based on extraordinary contributions to the field, dedicated service to the society and distinguished career achievements.
“Now, more than ever, I think it’s going to be critical that we produce trainees who are able to achieve the absolute best technical results with their procedures,” said Dr. Darcy, a former SIR president. “This is directly going to affect how they get paid and how many referrals they get.”
The Medicare Access and Chip Reauthorization Act (MACRA) will significantly alter physician payment, Dr. Darcy said during his lecture, “IR and the pursuit of excellence.” Under MACRA, CMS now will reimburse providers based on quality rather than quantity, which emphasizes the need to develop knowledgeable and detail-oriented experts.
“We have had many great leaders in IR, who have done a fabulous job of being innovative while creating new techniques and tools,” Dr. Darcy said. “I think as we move forward with this new paradigm of training, we need to be equally innovative and passionate as we train the IRs of the future.”
Dr. Darcy, professor and chief of vascular and interventional radiology at the Mallinckrodt Institute of Radiology at Washington University in St. Louis, explored several concepts to help trainees master their skills.
The 10,000-hours theory suggests practicing a skill for 10,000 hours to achieve mastery.
“The new IR Residency is going to be an opportunity for some increased practice,” Dr. Darcy said. “First of all, for the current fellowships we have to log 500 procedures, but in the new residency, the residents will be required to log 1,000 procedures.”
Regardless of how much time IR residents spend practicing, it’s not enough to become an expert. Dr. Darcy explained the theory of deliberate practice, identifying specific areas of weakness and focusing on those areas in training. Deliberate practice comes into play in clinical settings by steering trainees to specific cases that challenge those areas of weakness or using models and simulators.
“We have used simulators to some extent in IR, but I think we need to incorporate them to a greater extent and in a more organized fashion,” he said. “As we move into an era where virtual reality is becoming more sophisticated, I fully anticipate that it is going to be an important part of our training.”
Dr. Darcy emphasized the importance of mentoring and coaching trainees through hands-on meetings or workshops as opposed to passive lecturing.
“I think we need to recognize that teaching is a unique skill,” he said. “We possibly need to think about finding ways to free up the people who have the skill to teach. One of the other problems we have is that most of us have never been educated on how to teach … I would challenge SIR to develop some programs to teach us teachers how to teach.”
Dr. Darcy closed out the lecture by sharing some of the “pet topics” he teaches trainees, including the basic fundamentals of IR procedures, proper ergonomics, and having an attitude and passion to improve the specialty.
“If we are passionate and really force our trainees to strive for excellence and be the very best they can be, who knows? Maybe one of our trainees will be the next Dotter who totally transforms medicine again,” he said.