Pediatric Interventional Radiology Fellowship Curriculum

I.     Periprocedural Care
II.    Vascular Procedures - Arterial: ​

1. Arteriography
2. Angioplasty
3. Arterial Embolization
4. Renal Arterial Interventions
5. Pulmonary Arterial Interventions
6. Bronchial Arterial Interventions
7. GI Arterial Interventions
8. Hepatic Arterial Interventions

III.   Vascular Procedures - Venous

1. Central Venous Access
2. Thrombolysis
3. Hepatic Venous Interventions
4. Portal Hypertension Interventions
5. Varicocele / Pelvic Venous Congestion Embolization
6. Venous compression disorders
7. IVC Filters

IV.    Treatment of Vascular Anomalies
V.     Non-Vascular Proced​ures

1. Percutaneous Biopsies
2. Drainage
3. Enteric Access
4. Biliary Interventions
5. Genitourinary Interventions
6. Ablation
7. Spinal interventions
8. Image-guided injections

VI.    Transition from Fellowship to Faculty
VII.   Radiation Safety
VIII. Didactic teaching
IX.    Quality Improvement (Morbidity and Mortality)
X.      Scholarly Activity
XI.    Clinics, multidisciplinary conferences

 
I. Peri-procedural Care (core)

A. Pre-procedural care:

1. Indications and contraindications for requested procedures.
2. Indications for the use of anesthesia/ sedation
3. Principles of fasting status required for anesthesia/sedation.
4. Commonly used medications for sedation in children, side effects, and reversal agents
5. Elements of history and physical in children
6. Age-appropriate estimates of weight, vital signs, and common laboratory values
7. Weight-appropriate fluid maintenance and resuscitation rates
8. Acceptable range of pre-procedure laboratory values – CBC, coagulation profile, and electrolytes
9. Determining the risk of blood loss and assessing transfusion requirements
10. Indications for antibiotic prophylaxis and selection of appropriate procedure-specific antibiotics

 
Informed Consent

1. Written indications, procedure planned, expected benefits, possible complications, and alternatives.
2. Verification of age for consent, legal guardianship, biological parents
3. When and how much to involve a child in the discussion.
4. Awareness of cultural and religious issues.
5. Risks of radiation and contrast agents.
6. Explanation of immediate post-procedural and short-term, mid-term, and long-term follow-up plan.

 
Clinical communication              

1. Review clinical and imaging details with the referring team and formulate a plan, including follow-up.
2. Review planned procedures with IR staff, including technologists, nurses, and APPs.
3. Consider input from other colleagues.

 
B. Intra-procedural care

1. Importance of pre-procedure time out
2. Pediatric dosages of commonly used drugs- heparin, nitroglycerine, glucagon. TPA
3. Commonly used medications for anxiolysis in children, side effects, and reversal agents
4. Techniques to decrease radiation exposure to patients and staff.
5. How to assess blood loss and know what classifies as critical blood loss in pediatric patients.
6. Transfusion principles, blood products, dosage, and expected response.
7. Understand the management of intra-procedural anticoagulation using ACT.
8. Management of intra-procedural fluid input and output
9. Importance of sign-out / debrief / handover.

  
C. Post-procedural care

1. Elements of entering brief procedure notes, detailed procedure reports, and follow-up plans.
2. Importance of signing out to referring clinical services, post-operative care unit, and communication with parents.
3. Importance of post-procedure monitoring of vital signs, labs, and outputs.
4. Role of post-procedure imaging: e.g., chest X-ray post-lung biopsy, ultrasound/CT for post-biopsy bleeding.
5. General postprocedural pain and other medication management
6. Diagnosis, documentation, and management of post-procedure complications.
7. Appropriate follow-up for commonly performed procedures.

 
II. Vascular procedures – Arterial
 
1. Arteriography (core)
 a.       General principles

1. Non-invasive imaging techniques that may obviate the need for catheter-directed angiography
2. Indications and contraindications of catheter-directed angiography
3. Principles of catheterization

b.       Pre-procedure

1. Ways to optimize renal function and laboratory parameters.
2. Normal laboratory values in children.
3. Knowledge of catheter types and their indications.

c.      Technique

1. Risk of vasospasm, thrombosis, and vessel occlusion in children and the need for intra-procedural heparin in children weighing less than 15 kg.
2. Special considerations for fluid management in children.
3. Methods of maintaining infant body temperature - contrast warming, table warming, room temperature.
4. Use of umbilical artery access up to 5 days after birth.
5. Needle sizes and guidewires that are available for access in small children.
6. Use of small caliber sheaths for interventions and techniques for performing interventions using 3 and 4 Fr sheaths and catheters.
7. Weight-based contrast limits for children.
8. Weight-based volume and injection rates for selective arteriography.
9. Methods of minimizing radiation exposure to patient and operator.
10. Methods of avoiding and managing puncture site complications and ensuring hemostasis without the use of closure devices.
11. Prevention and correction of hypoglycemia and hypothermia in infants.
12. Methods of managing contrast nephropathy and volume overload.

 
2. Angioplasty (core)
 a.       General principles

1. Indications and contraindications to balloon angioplasty.
2. Knowledge of types of angioplasty balloons, indications, and contraindications.

b.       Pre-procedure

1. Imaging required, including non-invasive and catheter-based angiography.
2. Acceptable laboratory values in children.

c.      Technique

1. Appropriate access sites, sheath types, and sizes.
2. Selection of appropriately sized angioplasty balloons and the indications and contraindications of cutting balloons.
3. Indications and contraindications of medications, including anticoagulation, antispasmodics, thrombolytic, and weight-based dosages.
4. Weight-based contrast limits for children.
5. Weight-based volume and injection rates for selective arteriography.
6. Methods of avoiding and managing puncture site complications.
7. Methods of avoiding and managing complications at the site of angioplasty, including rupture, thrombosis, and dissection.
8. Post-procedure management and follow-up, including anticoagulation and imaging.

 
3. Arterial Embolization (core)
a.       General principles

1. Indications and contraindications to embolization.
2. Principles of catheterization and embolization.
3. Types of embolic agents with indications and contraindications.

 
b.       Pre-procedure

1. Types of pre-procedure imaging and appropriateness for specific indications.
2. How to assess underlying clinical condition.
3. Techniques to stabilize the patient prior to the procedure.
4. Alternatives to embolization, including medical and surgical options.

 
c.       Technique

1. Techniques, including types of catheters and microcatheters.
2. How to identify sources of hemorrhage.
3. How to determine an appropriate embolic agent.
4. Potential complications, and techniques to avoid and manage.
5. Post-procedure follow-up, including management of pain and inflammatory response (post-embolization syndrome).

 
4. Renal arterial interventions (detail):
a.       General principles

1. Indications and contraindications to renal arterial interventions.

b.       Pre-procedure

1. Pre-procedure imaging required, including ultrasound, MRA, CTA, and nuclear medicine studies.
2. Need for managing anti-hypertensive medications.

 
c.      Technique

1. Access techniques, including minimizing the size of access sheaths and the use of microcatheters.
2. Weight-based loading dose of anticoagulation
3. Projections required for assessment of renal arteries.
4. Selection of appropriately sized angioplasty balloons and the indications and contraindications of cutting balloons.
5. The long-term consequences of stenting in children.
6. Technique of renal embolization and how to determine the appropriate embolic agent.
7. Techniques of avoiding and managing complications, including vessel rupture, thrombosis, and dissection.
8. Doses of antispasmodics, anticoagulants and thrombolytics.
9. Techniques of renin venous sampling and interpretation

 
5. Pulmonary arterial interventions (detail):
a.  General principles

1. Non-invasive imaging techniques and findings for the diagnosis of deep venous thrombosis, pulmonary embolism, and arteriovenous malformations.
2. Clinical findings in children with DVT and pulmonary embolism.

b.  Pre-procedure

1. Systemic therapies including anticoagulation and thrombolysis for treatment of thromboembolism.
2. Indications and contraindications for catheter-directed thrombolysis and embolization.
3. Alternatives to embolization, including surgical options.

c.  Technique

1. Techniques for catheter-directed thrombolysis and mechanical thrombectomy and indications for use in children.
2. Techniques and type of embolic agents for embolization of pulmonary arteriovenous malformations.

 
6. Bronchial arterial interventions (detail):

1. General principles.

1. Common causes of hemoptysis in children.
2. Non-invasive imaging techniques, particularly CTA, for assessment of underlying diagnosis and bronchial arteries.

 

1. Periprocedural.

1. Medical therapy for the treatment of hemoptysis.
2. Indications and contraindications for bronchial artery embolization.

 

1. Technique

1. Techniques for identifying sources of hemorrhage on arteriography, including selective arteriography of bronchial and internal mammary arteries.
2. Knowledge of non-bronchial systemic arteries related to hemoptysis.
3. Embolic agents used for embolization of bronchial arteries.
4. Potential complications of non-target and techniques for avoiding this, particularly the risk of spinal ischemia or stroke.

 
7. GI arterial interventions (detail)

1. General principles

1. Common causes of GI bleeding in children.
2. Non-invasive imaging techniques for identifying the source of hemorrhage.
3. Interdisciplinary management of children with GI hemorrhage.

 

1. Pre-procedure

1. Medical therapy for the treatment of GI hemorrhage.
2. Techniques to stabilize the patient with supportive therapy.
3. Indications and contraindications to catheter-directed embolization.

 

1. Technique

1. Techniques for identifying the source of hemorrhage on arteriography.
2. Embolic agents are used, with risks and benefits of using these in small children.
3. Potential for non-target embolization and techniques to prevent this.

 
8. Hepatic arterial interventions (detail)

1. General principles.

1. Risks of developing hepatic artery stenosis following transplantation, particularly in infants and small children.

 

1. Pre-procedure

1. Medical treatment to optimize graft.
2. Indications and contraindications to hepatic artery angioplasty and stenting.

 

1. Technique

1. Techniques for access and intervention in hepatic arteries, with modifications of techniques required in small children.
2. Techniques for assessing the degree of stenosis.
3. Types and sizes of angioplasty balloons and stents for use in children.
4. Techniques for preventing and treating dissection and thrombosis of the hepatic arteries.

 
9. Management of traumatic arterial injury (core)

1. General principles

1. Mechanisms and types of traumatic arterial injuries.
2. Non-invasive imaging techniques for identifying sources of hemorrhage.
3. Interdisciplinary management of children with arterial trauma.

 

1. Pre-procedure

1. Principles and criteria for conservative management.
2. Techniques to stabilize the patient with supportive therapy.
3. Indications and contraindications to catheter-directed embolization.
4. Indications for direct surgical management.

 

1. Technique

1. Techniques for identifying the source of hemorrhage on arteriography.
2. Embolic agents used, with risks and benefits of using these in small children.
3. Techniques of embolization, including determining the appropriate location and embolic agent.
4. Potential for non-target embolization and techniques to prevent this.

III. Vascular procedures – Venous
1.  Central venous access (core)

• General principles

1. Types of venous access and indications in children of different sizes/ages.
2. Risk factors associated with different types of central venous access.

 

• Pre-procedure

1. Determine venous anatomy/patency.
2. Laboratory parameters for the different types of venous access.

 

• Technique

1. Determine the appropriate size and tip position of central venous devices.
2. Learn how to manage catheter complications: device malfunction, swelling, infection, and bleeding.
3. Learn postprocedural ongoing clinical care.

 
2.  Thrombolysis (core)

• General principles

1. Causes of pediatric thrombosis: iatrogenic (related to vascular access) or secondary to anatomic abnormalities, coagulopathy, or systemic disease.
2. Clinical presentation of thrombosis (most commonly involving the limbs).
3. Imaging and laboratory findings in thrombosis.
4. Medical management of thrombosis.
5. Indications and contraindications to thrombolysis in children.
6. Difference between mechanical thrombectomy and pharmacomechanical thrombolysis and indications for each.
7. Types of thrombolytic agents and indications for each
8. Type of mechanical thrombectomy devices
9. Indications and contraindications to venous stenting

 

• Pre-procedure

1. Imaging of thrombosis and thromboembolic disease.
2. Baseline laboratory parameters.

 

• Technique

1. Indications for IVC filter placement.
2. Doses of thrombolytic and anticoagulant.
3. Techniques for minimizing blood loss.
4. Management complications of thrombolysis, including hemorrhage.
5. Post-procedural care, including laboratory monitoring and follow-up imaging.

 
3. Hepatic venous interventions (detail)

• General principles

1. Approaches to hepatic venous access for venography (transjugular, transfemoral, and transhepatic) and indications for each.
2. Indications for venography in pediatric patients.
3. Knowledge of the different types of congenital portosystemic shunts and general management principles.

 

• Pre-procedure

1. Non-invasive imaging options (ultrasound MRV, CT venogram).
2. Baseline laboratory parameters, correction of coagulopathy as necessary

 

• Technique

1. General steps and technical considerations for hepatic venous interventions.
2. Measurement and interpretation of portosystemic gradient.
3. Performance of transjugular biopsy and indications for such
4. Post-procedural management and ongoing clinical care.

 
4.  Portal hypertension interventions (detail)

• General principles

1. Etiology and classification of portal hypertension (pre-hepatic, intrahepatic, post-hepatic).
2. Clinical presentation of portal hypertension.
3. Medical and surgical management of portal hypertension

 

• Pre-procedure

1. Non-invasive imaging of portal hypertension
2. Baseline laboratory parameters

 

• Technique

1. Approach to endovascular management of acute and chronic portal hypertension- the role of thrombolysis, angioplasty, portal vein recanalization and stenting, variceal embolization, TIPS
2. Clinical and imaging follow-up after interventions for portal hypertension

 
5.  Varicocele/venous congestion embolization (detail)

• General principles

1. Epidemiology of varicoceles in pediatric patients.
2. Common causes of varicocele in children, including congenital anatomic abnormalities
3. Clinical presentation of varicocele.
4. Types of sclerosing and embolic agents used in varicocele treatment.
5. Indications and contraindications for sclerotherapy of varicocele in children.

 

• Pre-procedure

1. Imaging (ultrasound) findings and diagnostic criteria for varicocele.

 

• Technique

1. The technique of venography to identify sources of reflux.
2. Steps and technique of varicocele embolization.
3. Common complications of varicocele embolization
4. Postprocedural management and ongoing clinical care

 
6. Venous compression disorders (detail)

1. Know the various types of venous compression disorders in children, including iliac (May-Thurner), subclavian (thoracic outlet syndrome), popliteal, and renal veins (nutcracker).
2. Know the mechanisms of compression and symptoms.
3. Clinical presentation of varicocele.
4. Know principles of management, including interventional (angioplasty, stenting) and surgical

 
7. IVC Filters (core)

• General principles

1. Risk factors for venous thrombosis in children and clinical presentation.

 

• Pre-procedure

1. Laboratory and imaging findings of venous thromboembolism.
2. Medical management of VTE in children.
3. Indications and contraindications for IVC filter placement.
4. Types of IVC filters and indications for use.

 

• Technique

1. Indications and contraindications for jugular and femoral placement
2. Size and length of IVC required for filter placement
3. Variant anatomy of IVC and SVC.
4. Potential complications and management
5. Follow-up, including timing and technique of IVC filter retrieval.

 

 
IV. Treatment of vascular anomalies (core)

• General principles

1. Correct nomenclature for vascular anomalies as per the ISSVA classification.
2. Imaging appearances of vascular tumors and malformations.
3. Combined vascular anomalies and overgrowth syndromes.
4. Non-interventional treatments for vascular anomalies, including medical and surgical treatments.
5. Common sclerosants used in IR, their indications, contraindications, dose limitations, and potential complications.

 

• Pre-procedure

1. Appropriate imaging of vascular anomalies, particularly ultrasound and MRI.
2. Identify co-morbidities that could affect the outcome of interventional treatments, including hematological and airway compression.

 

•  Technique

1. Techniques of sclerotherapy, embolization, percutaneous ligation, and micro-phlebectomy are used in the treatment of vascular anomalies.
2. Knowledge of malformations treated by cryoablation and technique.

 
V. Non-vascular procedures.
 
1. Percutaneous Biopsies (core)
a.    General principles

1. Indication and contraindications for image-guided percutaneous biopsy
2. Alternatives to percutaneous biopsy, including surgical/excisional biopsy
3. Anatomy and preferred approaches for biopsies
4. Type of biopsy needles and indications.
5. Understand current clinical trials and pathology-specific requirements for biopsy
   
   

b.  Pre-procedure

1. Appropriate imaging of biopsy targets.
2. Identification of safe approaches (including patient positioning).
3. Choose the appropriate imaging modality (or modalities) for the biopsy
4. Confirm appropriate baseline laboratory values, including correction of coagulopathy if necessary.
5. Obtain and/or review appropriate pre-procedure labs (SIR guidelines)
6. Determine the need for anesthesia support

 
c.   Technique

1. Pros/cons of coaxial needles.
2. Selection of appropriate biopsy devices.
3. Selection of appropriate imaging modality
4. Identification of safe approaches.
5. Indication and techniques for tract embolization.
6. Prevention and management of complications.
7. Post-procedure positioning, restrictions, imaging.

 
2. Drainage (non-GU) (core)

•  General principles

1. Indications and contraindications to image-guided percutaneous/transrectal drainage.
2. Alternatives to percutaneous drainage, including surgical drainage or conservative management.

 

• Pre-procedure

1. Appropriate imaging for drainage.
2. Identification of safe approaches (including patient positioning).
3. Choose the appropriate imaging modality for the procedure.
4. Confirm appropriate baseline laboratory values.
5. Determine the requirement for antibiotic prophylaxis and selection of appropriate antibiotics.
6. Selection of appropriate catheter and needle.
7. Determine the need for anesthesia support.

 

• Technique

1. Indications and techniques for different approaches, including percutaneous and transrectal.
2. Prevention and management of complications
3. Post-procedure follow-up, including drain flushing, repeat imaging, and timing of removal.

 
       
3.  Enteric Access – Enteric tube exchange (core)
Primary Gastrostomy, Gastrojejunostomy, and Cecostomy (detail).

•  General principles

1. Indications and contraindications to enteric access
2. Decide between gastrostomy, gastro-jejunostomy, or jejunostomy depending on patient requirements.

 

•   Pre-procedure

1. Review relevant imaging.
2. Determine a safe approach for enteric access.
3. Choose the appropriate imaging modality (or modalities) for the procedure.
4. Obtain and/or review appropriate pre-procedure labs (SIR guidelines)
5. Determine the need for prophylactic antibiotics.
6. Determine the need for anesthesia support.
7. Appropriately prepare the patient for enteric access, including opacification of the bowel (if indicated).

 

• Technique

1. Choice of enteric tube style and size
2. Antegrade vs. retrograde approach
3. Use of glucagon
4. Use of bowel contrast
5. Use of T-fasteners
6. Post-procedure care, including monitoring for complications, initiation of feeds, and timing of exchange.
7. Prevention, identification, and management of complications.

 
4.  Biliary Interventions (core)
 
a. General principles

1. Knowledge of hepatic and biliary anatomy
2. Pathophysiology, diagnostic criteria, and imaging findings of the common indications for biliary intervention in children
3. Contraindications to Biliary Intervention

 
b. Pre-procedure

1. Review relevant imaging.
2. Plan a safe approach for biliary access.
3. Choose the appropriate imaging modality (or modalities) for the procedure.
4. Obtain and/or review appropriate pre-procedure labs (SIR guidelines)
5. Determine the need for prophylactic antibiotics.
6. Determine the need for anesthesia support.

 
c. Technique

1. Percutaneous Transhepatic Cholangiography / Percutaneous Transhepatic Cholecystography.
2. Percutaneous Transhepatic Biliary Drainage
   1. External
   2. Internal-External
3. Biliary Stricture Dilation
4. Biliary Lavage
5. Percutaneous Cholecystostomy
6. Prevention, identification, and treatment of complications, including hemorrhage and biliary leaks.
7. Post-procedure monitoring and care, including tube management (if applicable), repeat imaging, and timing of tube removal.

         
5.  Genitourinary Interventions (core)
a.  General principles

1. Knowledge of conditions that result in urinary obstruction in children.
2. Knowledge of relevant renal anatomy          
3. Indications and contraindications for GU intervention

         
b.  Pre-procedure

1. Review relevant imaging.
2. Plan a safe approach for intervention and understand approaches for PCNL based on stone location.
3. Choose the appropriate imaging modality (or modalities) for the procedure.
4. Obtain and/or review appropriate pre-procedure labs.
5. Determine the need for prophylactic antibiotics.
6. Determine the need for anesthesia support.

 
c.  Technique

1. Percutaneous Nephrostomy (core), suprapubic tube (core)
2. Ureteral stent placement
3. Suprapubic tube placements
4. Drainage of perinephric collections.
5. Prevention, identification, and management of complications, including hemorrhage, urinary leaks, and urosepsis.
6. Post-procedure management, including family education, repeat imaging, and timing of tube removal.

 
6.  Ablation Procedures (detail)
 
a.  General principles

1. Mechanism and physics of various ablation modalities
   1. Radiofrequency ablation
   2. Cryoablation
   3. Microwave ablation
   4. Laser ablation
2. Indications and contraindications for percutaneous ablation
3. Ablation techniques, including a combination of ablation and embolization.
4. Alternatives to ablation, including surgical resection.

b.  Pre-procedure

1. Review relevant imaging.
2. Plan a safe approach for ablation.
3. Choose the appropriate imaging modality (or modalities) for the procedure.
4. Obtain and/or review appropriate pre-procedure labs.
5. Determine the need for prophylactic antibiotics.
6. Determine the need for anesthesia support including possible nerve block.

c.  Technique

1. RFA
   1. Grounding pads
   2. Heat sink
   3. Monopolar vs. bipolar
   4. Ablation zone and probe selection
   5. Intraprocedural data (impedance, temperature, etc)
   6. Burn prevention
2. Cryoablation
   1. Probe selection
   2. Monitoring the iceball
   3. Skin protection
   4. Cryoshock prevention
3. Microwave
   1. Probe selection
   2. Monitoring the ablation zone
   3. Intraprocedural data
4. Laser (endovenous, CO2)
   1. Device selection.
   2. Eye protection.
   3. Burn prevention.
5. Post-procedure monitoring, clinical and imaging follow-up, and need for further intervention.
6. Prevention, identification, and management of complications, including burns and cryo-shock.

 
7. Spinal interventions: Lumbar punctures (core)
Intrathecal injections, myelograms, blood patch, epidural steroid injections (detail)

• General principles
  1. Indications and contraindications to spinal interventions.
• Pre-procedure
  1. Pre-procedure work-up, including indications for imaging,
  2.  Determine the need for sedation/anesthesia.
• Technique
  1. Sonographic and fluoroscopic techniques.
  2. Know appropriate patient positioning, needles, level of entry, and amount of CSF required.
  3. Post-procedural care, including a period of bed rest.
  4. Identification and treatment of complications, including headache, CSF leak, seizures, hemorrhage, and seizures.

 
8. Image-guided injections (core)

• General principles

1. Indications and contraindications to image-guided injections.

• Pre-procedure

1. Pre-procedure work-up, including imaging.
2. Determine the requirement for sedation/anesthesia.

• Technique

1. Sonographic and fluoroscopic techniques.
2. Know appropriate patient positioning, needles, and amount of steroid/toxin to be injected.
3. Post-procedural care, including analgesia.
4. Identification and treatment of complications, including pain, hemorrhage, and nerve injury.

 
VI. Transition from Fellowship to Faculty (core)

1. Establishment of collaborative, transparent relationships with IR colleagues, support staff, administrative team, anesthesia, and all clinical teams.
2. Learning and practicing essential communication skills.
3. Ability to relate to the patient and parents, which may be dependent on age or cultural differences.
4. Importance of recognizing limitations.
5. Ability to realize deficiencies.
6. Ability to seek out assistance from all, particularly senior faculty
7. Ability to be honest and of high integrity in preventing and successfully navigating complications or non-optimal outcomes when they occur.
8. Ability to lead a team, respecting individual roles and accepting feedback.
9. Importance of appreciating the elements of a new practice.
   1. After a relationship is established, the ability to observe current practice and suggest improvements constructively.
10. Ability to prioritize patient safety and quality of care over all other duties.
11. Ability to anticipate risks and take measures to address them with the help of the team.
12. Strategies to maximize the learning and career growth opportunities for all in the team.
13. Learning how to handle complaints from patients, family, co-workers, clinical teams.
14. Ability to synthesize learned lessons into future practice and behavior.
15. Recognizing the importance of diversity, equity inclusion, and cultural sensitivity.
16. Ability to engage and participate in quality improvement initiatives such as Morbidity and Mortality rounds.

 
VII. Radiation Safety (core)
VIII. Didactic teaching (core)
IX. Quality Improvement (Morbidity and Mortality) (core)
X. Scholarly Activity (core)

1. All fellows must engage in a scholarly project under faculty member supervision.
2. All graduating residents should have submitted at least one scholarly work to a national, regional, or local meeting, or for publication.
3. Journal Club

 
XI. Clinics, multidisciplinary conferences (core)
 
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