The Struggling Radiology Resident
In any profession or career, some employees lag the performance of their peers. It turns out that radiology residency is no different from any other job in this respect. The key, however, is for either the employer to be able to identify the struggling worker or for the employee to recognize that he or she is struggling. It is only when this process happens that interventions can occur. In addition, it is important for this process of identification to be early and effective. The goal of the radiology program is to help these residents along as soon as possible to allow early and more effective remediation. Early remediation can prevent the further downward spiral of a struggling resident that could lead to probation, suspension, or even worse, job loss. On occasion, there is no effective remediation for certain individuals, but that is rather the exception rather than the rule. No matter how you slice it, loss of a resident is devastating for both the radiology program and the radiology resident alike. So, my goal for today’s discussion is geared toward the individual struggling radiology resident in order to prevent him/her from going down this pathway. We will discuss how to identify oneself as struggling, what you can do to intervene prior to more serious repercussions, and how to deal with your attendings and colleagues when you are the “struggling resident”.
As is said, a problem cannot be fixed unless you know a problem exists. So, self identification of oneself as struggling becomes crucial. Some residents know from the very beginning that they are having difficulties and have good insight into their situation. Others may be having difficulties but are not aware. In addition, sometimes the feedback that residents get from attendings, technologists, nurses, and administrators can be different from the truth and outright misleading. Given that radiology residents tend to have limited responsibilities during their first year of residency, this issue is more likely to go unnoticed during this first formative year of residency. So, we will first talk briefly about what may be some of the indicators that you are struggling during your residency.
I am also going to classify the reasons for the struggling resident as either academic or professional in order to simplify and organize the discussion. Let’s first start by talking about some of the indicators that a resident may be struggling in academics.
How to Know If You Are Struggling Academically
Noon conference can be an excellent time to discover your position relative to your colleagues. If you notice that you are unable to answer questions that are easily identified by your colleagues on a consistent basis, that can be a red flag. If you have a hard time describing or making a finding on studies geared to the first year resident most of the time, you may be struggling. If the different attendings giving the noon conference consistently becomes frustrated with your answers, you may want to consider that you are struggling.
Readouts with your attending may help to make a self determination of whether you are struggling. Are you able to answer routine questions appropriately? Is an attending that typically accepts resident dictations redictating everything you write? Is there a sense of frustration from your supervisor? Do your attendings provide you with some sense of independence during procedures similar to others in your program? These are some hints that all may not be quite right.
Next, think about your experiences on “buddy call”. Do you feel comfortable going over films with your colleagues, attendings, and other clinicians? Is there a sense of frustration from these people with your reads? Are attendings not really satisfied when they find out they are on call with you?
How about feedback and evaluations? Is the feedback you receive from attendings routinely negative. Are milestone evaluations always below par? Do you receive comments from attendings that are always negative?
You might think that the inservice exam would also be a good metric of resident performance. But, it turns out as associate program director, I put much less faith in academic evaluations based upon the inservice examination. I have found a poor correlation with resident academic performance. So as a resident, I would put less stake in this form of self assessment. However, in combination with the inservice exam, if you are underperforming in other residency based quizzes or examinations, this can be an indicator of true academic issues.
How to Know If You Are Struggling Professionally
This area can be harder to recognize for the struggling resident. Many don’t realize they have a problem until it’s too late. But, we will go through some examples that you may be able to self identify.
Absence in its many forms is a leading indicator of professionalism based struggles. Are you routinely late to conferences and readouts and d to you sense frustration in others? Do your colleagues too often have to cover for you because you are not available? Have you been cited multiple times for missing conferences or required meetings?
Conflicts with classmates and colleagues can be a prominent indicator of professionalism struggles. Are there routine yelling matches with your fellow residents? Do your colleagues not want to help you out with call coverage,studying, or other routine residency issues? Are you routinely fighting with the secretaries, nurses, technologists, or even attendings?
Substance abuse is all too common a cause for having a difficult residency. Take a serious look at your habits and if they may be truly affecting your performance. Are you routinely using alcohol or other illicit substances?
Chronic disease can be a cause for day to day residency struggles. Cancer, hepatitis, infectious diseases are all problems that can cause fatigue and difficulty with concentrating on a long shift.
And of course, there are psychological issues such as depression, anxiety, schizophrenia, and more. These issues are more likely to go unnoticed by the afflicted resident. But some residents, already diagnosed with these disorders, may have better insight. These residents need to take a hard look and see if these problems are affecting their residency performance.
So, the next step in the process is to figure out how to remedy the situation prior to bigger repercussions. If you know your issues are academic or professional, you can certainly take measures to stem the riptide. We will go through several of these avenues.
You’ve decided that your struggling academically. What do you do? The next step is take make a realistic assessment of why you are struggling. For some people, it make be the quantity and for other it may be the quality of their studies.
1. Quantity of Learning
Having been through the residency process and supervised many residents over the years, I have learned that radiology is a reading intensive specialty and in order to increase ones knowledge base, a resident really needs to create a means to be able to cover all the important and relevant topics within the residency program. So, the first question is: what do you base your study schedule on? Some residents will use the curriculum guidelines from their residency program. Others will split the ABR core exam topics into bits of information that they can review. Even others, may use STATDx/Radprimer to guide their studying. The bottom line is that you need to find some guideline that will allow you to cover all the topics that you need to know.
The second question: have you created a schedule for yourself that will allow you to cover the necessary topics during residency and what are some options for the resident? Many residents don’t realize the amount they need to learn in order to become a proficient radiologist. A schedule therefore becomes very important for the struggling resident. The schedule can vary from one person to the next. Some people do better with studying for short blocks of time. Others prefer to slog it out for a long block at once. It doesn’t matter how you complete the necessary work, whether you take 2,3,or 4, topics per evening, but the work needs to get completed. A regimented schedule will allow you to get through the appropriate information for each rotation.
2. Quality of Learning
The next step is to assess if it is how you are studying that is the problem. Some residents study for hours every night, only to find that their knowledge base is not up to par. You would think that by the time one gets into the radiology specialty, they would have a method for studying well. But, that is certainly not the case for many residents. Studying and reading for the radiology resident is very different from studying for medical school classes and the boards. Radiology emphasizes pictures. Medical school emphasize words.
So, if you are truly studying for hours at nighttime without result, try studying differently. I would recommend emphasizing reading the pictures and captions within a book over the general text. Many residents do not realize they need to do this in order to be a more effective radiology student.
You may also want to explore case review series over general text reading. Again pictures are the center of the radiologist’s world. I find that a general text helps more when you have experienced a case firsthand during the daytime and you want to find out more. On the other hand, a case image with text is more similar to the day to day work of the radiologist and will allow many residents to digest the information better.
There is one last item that I want to bring to light. On occasion, a radiology residency may make a learning disability evident. Because radiology is different than other subspecialties and the methods for studying differ from other areas as well, some residents have problems with the transition. Some residents have problems looking at a picture and translating the picture into findings and conclusions. It is not something that is usually tested prior to beginning radiology. If you think that this may be your situation, it behooves these residents to consider psychological testing to better find a more effective means of studying. Dollars spent to solve this issue now if you do have a learning disability may pay back itself in spades later on.
Professional issues and their solutions can vary widely. For the absentee resident, it may be as simple as creating and sticking to a schedule to make sure you attend all the necessary events on time. If you are in constant conflict with your colleagues, you may need to learn to relate to others better and that may involve sharing more or not taking everything to heart. On the other hand, maybe the conflicts are related to other more serious issues such as substance abuse or health problems. The important thing to remember: there are many sources of help for the radiology resident. Whether it is your colleagues, attendings, program directors, chairman, the Physician Assistance Program, a psychiatrist, or other interventions, there is someone at your program that can support you. It is very important to talk to someone if there is a professionalism issue that needs to be addressed. And, there is always help if the situation becomes unbearable.
How to Deal With Attendings and Colleagues If You Are Struggling
OK. So you have identified that you are struggling and you have created the means to effectively remedy the issues. The next problem is that you may have created an environment where the expectations of your colleagues is so low that it may be very difficult to defy their expectations. I like to describe this as the “vicious circle”. Everything that you do is now going to be much more scrutinized than your colleagues. Even though your performance may improve to the level of you colleagues, it may not be recognized and may even still be perceived as below par. This is probably the most difficult part of being an underperforming resident. So, what do you do at this point?
I would recommend to continue with the remediation program at hand. Healing a reputation takes not a few days or months. Rather, it can take years. Eventually, your effort will be recognized, but it is not without a lot of work and effort. You will have to suffer through some of the expectations of your attendings and colleagues until they realize you are a capable resident. This process takes grit and determination. You are going to have ignore the expectations of others and create your own expectations for yourself. Eventually, you will notice a change in how you are treated, but remember, it will not happen overnight.
Radiology residency is a big transition for most residents, and some may really struggle at the beginning academically or professionally. If you are struggling at this time in your life, don’t let these shortcomings define you. The measure of greatness is how you overcome obstacles such as completing a radiology residency, a major achievement. Struggling radiology residents often become radiology attendings with greater empathy for the struggles of others and can become the most successful radiologists.