Response to letter regarding article, “training of future interventional neuroradiologists: the European approach.

To the Editor: We read with concern the paper by Flodmark et al 1 entitled " Training of future Interventional Neuroradiologists, the European Approach. " The authors have produced a training charter for interventional neuroradiology (INR) based on assumptions of a training deficit, an insufficiency of INR recruits and widespread representation and approval from other medical speciality stake-holders. Unfortunately, these assumptions are seriously flawed. The assertion that " Training in INR has been a matter between trainee and teacher and thus the result has often been less than suboptimal training with a long learning curve, with patients paying a high price " is an affront to the many excellent training programmes in INR throughout Europe, which produce highly skilled and competent INRs. This statement by the authors is anecdotal and without evidence. The authors' assumption that there is an insufficiency of INR recruits is not supported by evidence. In fact, there is no mapping of the numbers or distribution of INRs throughout Europe. For a training charter of this kind, mapping of the proposed deficiency of INRs is extremely important and a glaring omission of this training charter. In fact, Ferella et al 2 , in the Journal of Neurointerventional Surgery, have suggested that there are too many trained INRs in the United States for the proposed work-load, and that training programmes for INRs should be suspended. This is because the numbers of patients with cerebral aneurysms and arteriovenous malformations are relatively constant and the expected explosion in intra-arterial stroke treatments is dependent on the results of randomized controlled trials that have not all finished. Another glaring omission is the fact that interventional radiologists are not mentioned at all in this inclusive charter. Interventional radiologists are a highly trained and skilled group of interventionalists who are already performing many INR treatments throughout Europe, including stroke treatments, aneu-rysm coiling, and arteriovenous malformation treatments. The CardioVascular Interventional Radiology Association of Europe (CIRSE) represents interventional radiologists throughout Europe and was not consulted with regard to this training charter. The authors claim that the European Society of Neuroradiology (ESNR) was one of the scientific European societies that was kept continuously informed of the progress of this project. Different versions of the training charter were discussed within the Executive Committee of the ESNR, but no consensus was ever reached on the document. Moreover, the final draft of the document was never formally submitted for approval …