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The Journal of the Swiss Society of
Minimally Invasive Neurological Therapy
The Journal of the Swiss Society of
Minimally Invasive Neurological Therapy
© Swiss Union of Medical Specialists (www.uems.net)
This document sets out standards and guidelines for training in Interventional neuroradiology (INR) in Europe with the aim to acquire competence and if possible, “particular qualification”, in INR. The aim is that this curriculum in INR will constitute an approved training program in all member, and associated member, countries within UEMS. It is recognised that there are a number of structural and operational differences in the health care systems, appointment procedures and training systems in these different countries.
The purpose of this document is to define a training charter in interventional neuroradiology for trainees wishing to obtain competence in INR.
It is recognised that there are a number of specialists in Europe performing all or some of the INR activities detailed in this Training Charter. These specialists will have the acquired right to continue this practice.
This document provides the basis for the development of a harmonised, comprehensive, structured and balanced training program in INR.
Interventional neuroradiology is using percutaneous and endovascular procedures to treat patients with diseases of the brain, sensory organs, head & neck, spinal cord, vertebral column and adjacent structures and the peripheral nervous system in adults and children.
The purpose of this charter is to define the training needed to safely perform endovascular interventional neuroradiology. Although percutaneous spinal procedures are usually included in interventional neuroradiology, these procedures will not be dealt with in this document but will be defined in a separate charter. In this document the term interventional neuroradiology (INR) refers to endovascular interventional neuroradiology only.
Endovascular approaches represent the most complex and potentially endangering aspects of interventional neuroradiology.
UEMS provides a general program for accreditation of teaching institutions. This is a voluntary procedure aimed at securing high quality and good standard of practice in teaching programs.
Accreditation to train the candidates within a program of INR can only be granted or renewed if the applying program documents a minimum annual activity as defined in paragraph 4.1. Projected activity is permitted during the development phase of a service. An agreed intermediate level of activity may be defined by the accrediting authority for each applying institution.
The teaching program should be established within a clinical neuroscience institution, or network of such institutions, with all the appropriate related specialities represented.
The institution’s patient population must have a diversity of illness (brain, head & neck, spine) from which a broad experience in INR can be obtained.
UEMS accreditation to teach in INR is valid for a limited time only and may be renewed.
Identification, visitation and subsequent recognition of a training program is a procedure, supervised by the UEMS and coordinated by the UEMS Division of Neuroradiology. This procedure is a joint responsibility of neuroradiology, radiology, neurosurgery and neurology.
Applicants must have a valid licence to practice medicine within their respective country; this licence has to be recognised by the country where he/she will train.
The applicant must be a specialist physician with a recognised speciality listed in the directive 2005/36/EV of the Swiss Parliament and of the Council on the recognition of professional qualifications.
Additionally, applicants from Portugal with the nationally recognised speciality of Neuroradiology may be accepted to train in INR according to this charter.
The overall purpose of training in INR is to reach predefined goals set out in this Training Charter.
The education and training needed to become a specialist physician with competence in Interventional neuroradiology is 4 years corresponding to full time study in an INR training program.
The 4 years consist of a core of INR of 24 months, clinical neuroscience for 12 months and diagnostic neuroradiology for 12 months.
Depending on previous training, the training time may be reduced as credit is given for previous training and clinical skills. The assessment of previous training and clinical skills and evaluation of remaining training time is the responsibility of the Director and each of the co-directors of the program after a thorough and careful assessment of documented and proven training and experience.
The assessment of the applicant’s background, and additional training required, will be documented in detail in the training agreement described under 2.1.2
Interventional neuroradiology should ideally be practiced in INR teams where exchange of experience, knowledge and research is possible. Having finished the training program, the specialist physician with competence in INR, will be able to perform endovascular procedures as described in Art 4 in a team with other interventional neuroradiologists. Thus solitary practice of INR is not recommended.
A specialist physician with competence in INR shall
Research should be encouraged and time and facilities made available during training.
Neuroanatomy – including embryology and functional anatomy
Neurobiology - including genetics and an overview of molecular biology
Communications
Selection and interpretation of ancillary tests necessary for establishing diagnosis, indications, treatment plan and follow-up.
Selection of treatment options (indications and contraindications) has to be based on knowledge and communication in a multidisciplinary environment.
Pre- and post procedural management
Clinical neuropharmacology
Knowledge in neurointensive care
to master the physiological, technical, mathematical and statistical principles, strengths and weaknesses of common neuroradiological diagnostic and interventional procedures.
Knowledge about radiation physics
Radiation biology
Radiation protection in diagnostic neuroradiology and INR and have knowledge of the laws governing the use of medical radiation.
Training in clinical neuroradiology should not only focus on the neuroradiology of vascular diseases but also provide a general understanding and overview of indications and interpretation in clinical neuroradiology in its application in common neurological diseases.
Knowledge related to technical aspects of clinical neuroradiology
Selection of optimal diagnostic procedure using knowledge of indications, contraindications and limitations of diagnostic neuroradiology procedures
Be able to perform and interpret diagnostic neuroradiological procedures as they relate to INR
Knowledge and management regarding all aspects of contrast materials, including interactions and complications, as they are used in clinical neuroradiology and INR.
Pre- and post procedural management
Clinical neuro-pharmacology
Per-procedural drug usage including interactions
Acquisition of skills and experience in INR procedures
Establishment of an individual treatment strategy
Technical and strategic components
To be able to make independent and well founded decisions in medical ethical matters within INR
To prioritize and optimize the use of resources
To understand implications and priorities in management of incidentally discovered or associated lesions
To manage medical risks and incidents
To understand medical legal implications pertaining to INR
To participate in regular departmental and interdisciplinary conferences including regular reviews of morbidity and mortality and if developed, critical incident reporting systems (CIRS)
To participate in national or international quality assurance programs in INR is strongly recommended
To participate in national and international courses and meetings (a minimum of 2 weeks/year during the training)
The educational environment should encourage trainees to undertake investigative study in relevant clinical or basic sciences subject areas.
Trainees may participate in research projects conducted by the faculty or other trainees or may undertake a project as principal investigators.
Trainees should have a firm knowledge of the fundamentals of the experimental design, performance and interpretation of results.
Trainees have basic knowledge of medical statistics
Trainees should be encouraged to submit their work for presentation at national or international meetings and to publish in scientific journals.
Trainees should understand ethical aspects and what constitute conflicts of interest
Each trainee must keep a personal Log-book for documentation of procedural experience and skills acquired. The trainee will have to demonstrate that he/she has participated in a wide spectrum of INR procedures (See Addendum # 1) which should include a balance of supervisor assisted and personally performed procedures under supervision. Log-book entries must be monitored by regular inspection and signed off by the appropriate supervisor. The log-book must be available at Board and other summative examinations.
The program director, in consultation with the co-directors and faculty, must evaluate the qualification and progress of each trainee at least twice a year. The evaluation includes an assessment of the trainee's knowledge, technical skills, attitudes and interpersonal relationships as well as decision-making skills and clinical management skills. These evaluations should be documented and provided to and discussed with each trainee. The program director, in agreement with the co-directors, certifies the competence of the trainees at the completion of training.
The optimal training program in INR must take place in a network of institutions/departments operating in accordance with the UEMS and WFITN recommendations for good practice in INR. (Interventional Neuroradiology, 2006, 12:7-8).
An INR training program is organized in a network of institutions/departments in which the unit for INR constitutes the core surrounded by clinical and diagnostic units in neuroscience.
To qualify as a training program the following conditions must be fulfilled.
The INR core must fulfil the following conditions
The director of a training program must be certified according to national regulations.
The program director must be a well experienced and an internationally well respected interventional neuroradiologist also involved in scientific activities.
The program director may have a senior academic appointment or a senior leading position in the non-profit training institution.
The program director is coordinating the network which constitutes the training program.
A co-director in a network must be well experienced and internationally well respected as an interventional neuroradiologist or as a medical specialist in another appropriate specialty, i.e. neurosurgery or neurology.
A director or co-director is obliged to participate in appropriate CME/CPD activities.
The program director and co-directors in agreement are responsible for enforcing the Training Charter, selecting and supervising the trainee and faculty members.
The program director is expected to ensure that the program is of required academic standard.
The program director should seek accreditation of the program by an external authority, e.g. UEMS.
Trainees must be given an opportunity to provide a documented evaluation of the program and faculty at least once annually.
The national or regional medical authority is the responsible body for any official recognition and certification of competence in each country.
The program director is responsible for certification of the training and acquired competence, dependent on a properly executed accreditation and visitation process, being national or provided by UEMS.
UEMS strongly encourages a final board examination. If an examination is offered, coming UEMS guidelines should be considered and followed.
Maintenance of a competence in INR is subject to the general principles of the UEMS Charter on Continuing Professional Development. ’01.
This Charter, including Addendum # 1, was unanimously approved by:
This Charter, including Addendum # 1, was unanimously accepted by the UEMS Council in their meeting 2011-10-08 in Naples.
List of minimum numbers of INR procedures as principle operator:
Absolute numbers | Proportions | |
---|---|---|
Aneurysm | 10 | 20% |
Intracerebral AVM | 5 | 10% |
Dural AV fistula | 5 | 10% |
Interventional stroke prevention and therapy | 15 | 30% |
External carotid artery embolisation | 15 | 30% |