Best Radiology Electives for the Senior Resident
It’s getting toward the end of your 3rd year and you are studying intensely for your core examination. All of a sudden, you get a phone call from your chief resident. He says, ” We are making the schedule for next year. What would you like to do for your senior year electives?” You realize you haven’t really thought this through and you are not sure what to do. He just assigns you to a standard fourth year schedule.
Believe it or not, this is a situation that often happens to most residents. Choosing your fourth year electives is not a decision you should take lightly. You should not have the choice made for you, nor should you make a choice without really thinking deeply about what you want. Your senior year elective choices can have repercussions upon your comfort zones in private practice and also your practice patterns for years to come. So, today we are going to discuss what not to do when you decide upon your senior schedule, which standard rotations are the best for senior electives, and some innovative ideas for creating rotations on your fourth year schedule that will really enhance your residency education and your career.
Which Fourth Year Electives Should You Avoid?
When you create a schedule for your fourth year, I would highly recommend to avoid adding scheduled rotations that duplicate your fellowship. Several times as associate residency director, I have had requests from residents to do a half a year in mammography when the resident has already been selected for a mammography fellowship. What’s the point in that? In our residency program and many residency programs throughout the country, it is important to remember that 90 percent of residents eventually do private practice and only 10 percent work in academia. So, chances are you will not be working only within your specialty. In fact, according to many articles (1,2,3), most radiology job descriptions want the new radiologist to not only practice in one subspecialty, but also to cover other areas within radiology. So, if you decide to do a half year in the subspecialty of your fellowship, you are also decreasing the opportunity to learn subspecialties outside of your comfort zone. And, you are also decreasing your desirability for being hired by a private practice.
For instance, if there are two candidates, one that wants to do only mammography, and another that feels comfortable in reading MSK MRI as well as being sub specialized in mammography, which candidate is going to be chosen by a private practice? It’s rather simple. It’s almost always the one that can do both. You are missing out on a potential opportunity if you choose to duplicate your fellowship.
Also, I would also avoid choosing fellowships that are within your comfort zone. If you feel like you are a great musculoskeletal MRI reader, it doesn’t make sense to do too many additional rotations in the same subspecialty. In private practice, you generally do not want to pigeon hole yourself into only a few areas of a subspecialty. A series of fourth year electives or “mini-fellowships” in only areas that you are well versed will limit your ability to learn other subjects and will ultimately prevent you from being comfortable in these modalities when you are a practicing radiologist.
The Conventional Fourth Year Elective Approach
If you are going down the conventional route of fourth year electives, there are two routes I would choose. First, it would be reasonable to select an emphasis in an area that you are interested but in which you are not doing your fellowship. Since you will be completing these electives fairly close in time to looking for full time radiologist work, this will allow you to have a second area of subspecialty confidence and diversify your competencies when you are looking for work.
Second, I would choose electives in areas of weakness. Residency is the time to get to know the different subspecialties and get your hands dirty. The more competent you are in all aspects of radiology, the more desirable you will be for private practices. It behooves the budding radiologist to get to the point of basic competency in as many areas as possible.
The Unconventional Fourth Year Elective Choice
What is the difference between a good and a great radiologist? It’s pretty simple. A good radiologist can generally make the correct imaging calls. A great radiologist can make the correct call, understands the deep clinical significance of the call, and can predict the subsequent patient outcomes. If I had to redo my residency over again, I would choose the unconventional radiology elective approach to correlate the imaging with the practical to further deepen these great clinical radiology qualities.
So, how do you arrange an elective choice such as this? It definitely will take a bit more work on the part of the radiology resident and you will have to go out of your way to communicate with other specialty directors, but it really pays to arrange a few weeks or a month rotating on a medical or surgical rotation with correlative imaging. For example, if you are interested in musculoskeletal radiology, I would highly recommend calling the surgical director of orthopedics and ask him/her if you can watch and participate in the clinical workup of patients, orthopedic surgeries, and the subsequent followup of patients. Then, when you a workup a patient that has had a medial meniscal tear, you will have seen the surgery and the after care follow up of these patients. You will really understand how the imaging fits into the equation and the significance of your imaging calls. I guarantee the learning that you get from an elective such as this will stick with you for the rest of your radiology career.
I would also recommend to wash, rinse, and repeat. If you can arrange this sort of elective in multiple subspecialties, whether in orthopedics, neurosurgery/neurology, breast surgery, oncology, cardiothoracic surgery, pulmonology, vascular surgery, ob/gyn, or whatever other clinical subspecialty you are interested, it would be a highly effective way to have a great diverse overall fourth year experience that will last a lifetime. In addition, you will have a clinical knowledge of the imaged patient, that most other radiologists do not have.
Final Thoughts About Fourth Year Electives
Fourth year of radiology residency is a time to explore in more depth the subspecialties that you have encountered during your first three years. Because you are so close to becoming a board certified practicing radiologist, the fourth year elective takes on a particularly important significance where the subjects that are learned will make a difference in your clinical practice. So, please pay attention to creating a great fourth year elective experience. Don’t squander the opportunity!!!