What To Look For In A Radiology Residency?
For radiology residency applicants, there is no one perfect radiology residency program and not one size fits all. Each candidate has his/her own needs, wants, and learning style. And, each program has its own positives and negatives. The goal is to match the applicant with the appropriate program so that the positives of the program fit well with the applicant’s needs. The negatives should be minor and not detract from the radiology resident experience.
My goal for today is to discuss the important ingredients for choosing a radiology residency. Some of these factors are not often discussed in a typical online overview of what to look for in a radiology residency program. So, I thought it was important to include them. Included in my discussion will be of greatest importance to least importance: residency culture/hierarchy, location/proximity to family/friends, insider intimate knowledge of a program, rotations/equipment/procedure volume, university vs. community programs, private vs. academic run departments, graduating resident fellowships, conferences, research, mentorship programs, and board passage rates. In the end, it is the entire experience of residency that is most important and will allow you to become a great radiologist. So, I will put it all together at the conclusion to help you to make a final decision. To help you make this decision, I have assigned an individual point score for each factor that you should record for each residency you are considering for ranking. At the end, you can add up the points and compare to the other residencies on your rank list and rank each accordingly.
Residency culture (5 points)
This is probably one of the most important factors to think about when choosing a residency, but it is also one of the most difficult to define. The difference between happiness and misery in a program first and foremost often lies with the colleagues that you have. No matter how great the overall “experiences” of a residency program, if you hate the people you work with, you will not want to come to work. On the other hand, if the program is marginal, but the people you work with are fantastic, the radiology residency will not be so bad.
The problem with using this factor for choosing a residency is that it is a moving target. From year to year, new residents are chosen and old ones leave. So, the residency culture that is there today may not be present tomorrow. However, the attending, technologist, and coordinator support structures of the residency often remain fairly similar. So, it is important to get to know not just the residents you meet, but also the leaders and purveyors of the program.
For that reason, in addition to getting a sense of the “happiness” of the residents, you will want to determine the structure of the residency leadership style. Some programs have prescribed processes for everything that happens at the program. Other programs have a more laissez-faire attitude. Some programs have one or two leaders at the top that act as “benevolent dictators”. Others have each of the attendings with equal say over residency issues.
No one structure is “correct”. If you are the type of person that needs a well-defined structure at all times, the hierarchical structure would be a better fit. On the other hand, if you like to create your own path where you define your own schedule, you may rather be in a program where all have an equal footing.
Location and Proximity to Friends/Relatives (4 points)
Over my years as associate program director, I have found how important it is for residents to have a social outlet. Although not a “resident related experience” per se, this factor can be just as important. Being near loved ones, family, and/or friends can make the difference between a terrible residency experience and a great one. A support structure can be just as important as the residency program itself. I find that the best residents have a healthy support structure outside of residency. Therefore, the location and proximity to loved ones can be an important factor as the residency quality itself. For instance, who would want to be in Manhattan, if your children/spouse are located in California? If asked by medical students, I will usually mention that they need to take location into serious consideration.
Insider/Intimate Knowledge of a Program (4 Points)
As a medical student, it can be extremely helpful to rotate through the department of a radiology residency program that you may want to attend. If you know the residents and attendings prior to starting a program, you likely already know many of the upsides and downsides of the residency programs and where “the skeletons are hidden” even prior to beginning. This can be worth its weight in gold. It can be very difficult to tell what the true nature of a residency program is like prior to starting a program. Therefore, having insider knowledge can really help you when you begin your residency because “you know what you are getting into”. These residents often are some of the most successful because they have a distinct advantage of knowing the attendings, residents, and the hospital system, even prior to beginning their residency. This is a factor that should certainly not be dismissed.
Rotations/Equipment/Procedure Volumes (4 points)
I am lumping these factors into one conglomerate because it is important that the residency has all the resources that you will need to be comfortable at practicing radiology. If you are in a program where diversity of patients and patient volumes are sorely lacking, you are also going to be at a loss when you are out in practice and have not seen those cases in your area of practice. Likewise, if the radiologists in a program do not perform procedures such as arthrograms or your program doesn’t have a 64 or 256 multidetector CT scanner for the interpretation of cardiac CTAs, you will certainly not feel comfortable performing these procedures when you are an attending.
So, it is really important that you make sure to search for a program that has all the necessary resources to allow you to learn all the imaging and procedure skills you will need to become a competent radiologist. Furthermore, as summarized another post, Best Radiology Electives for the Senior Resident, it is really important that you have the ability to do rotations in areas of weakness or interest during your residency because hiring practices are looking for residents that can do a subspecialty but also are competent in most areas of general radiology practice. So when you are on interviews or looking up information on the web, make sure to look into these factors. Once you have started a residency program without all the important resources to make a great radiology resident, there is no going back!!!
Community vs. University Programs (3 points)
The incoming medical student tends to put more weight on attending a “university program” rather than a “community” program than is probably warranted. There are distinct advantages to both that many medical students do not realize prior to choosing a residency program. A large academic university program is not the right fit for all. So, what are the advantages and disadvantages of each?
The large academic university program tends to have a depth of resources in specific subspecialties and have several attendings that just practice in one specific subspecialty. The smaller community programs, on the other hand, tend to have more general radiologists that cross cover multiple specialty areas. So, as a resident attending a university program, you will get a more in-depth experience focusing on individual areas. As a community program resident, you will tend to get a more private practice and “real world” hands-on experience. So these programs should attract different types of radiology residents.
In addition, at community programs, you tend to have more accessibility to your attendings and will more likely work one on one with that individual. Also, if you have a specific need, it is more likely that it will be addressed personally without having to go through “bureaucracy” to get there.
At a large university program, there are more physicians that will intercede with direct attending teachings such as senior residents, visiting fellows, fellows, and junior attendings. There also may be larger bureaucracies that you may need to get through in order to obtain specific resources within your program. However, there may be certain electives and rotations that may not be available at a smaller community program, such as connections for abroad electives or other opportunities.
So, this factor should play a role in your decision. But, it really depends on the practice you want to have when you leave the system. One is not better than the other for all.
Private vs. Academic Run Departments (3 points)
This factor is often not mentioned or included as a factor in making a residency program decision. But having worked at private, hybrid, and academic programs, I really think it should be an important factor.
I completed my residency in the private/academic hybrid model and I found there were some real distinct advantages to this sort of residency program. We had to get through a specific number of cases each day to meet the appropriate caseload. In fact, it was a more “real world” experience that allowed me to hit the ground running when I started my first job. I was dictating loads of cases from the very beginning and had tons of experience by the time I graduated. This was very different from some of my more academic run department trained colleagues that I knew. Some of them had more difficulty with getting through lots of cases during the day and felt a bit more uncomfortable at their first community radiology job. It really made a difference in the long run for me, as it allowed me to become a more efficient general radiologist.
Academic run departments with attendings hired by the hospital emphasize different qualities. These departments may have more resources dedicated to teaching on a daily basis. For the resident interest in a pure academic job, it may be heaven!!! But, they may not simulate the real world. They can perseverate on a few cases for a long period of time. So, for the radiology resident that is interested in private practice, a residency such as this may not be the right fit.
Conferences (3 points)
All residencies are theoretically required by the ACGME to have at least one daily conference. But, not all conferences are created equal. Some programs have additional morning conferences. Others have the resident prepare for and present at interdisciplinary conferences. And, even others have residents prepare medical student teaching conferences. The styles and types of conferences can vary widely at each individual program.
Additionally, it is important to ask if the attendings regularly show up to give their conferences. Beware the program that has many sorts of conferences on paper, but in reality, does not actually have the number of conferences that they suggest.
The importance of the number and type of conference depends on the individual resident. Some residents learn better with didactic conferences and others benefit by hands-on direct radiology experience. So, the importance of this factor will vary with the individual applying.
Graduating Resident Fellowships (3 points)
It is very important to check where the former residents have gone to fellowships. Are the residents not able to get into competitive subspecialties? Are they going to “no name” programs? Do the attendings at the institution have connections and networks with other fellowship programs throughout the country? These are questions that you should ask when you get to your residency interview or you should check online for this information. This can be crucial for getting your fellowship in an area and subspecialty that you are interested.
Research (2 points)
For the academically oriented, research can be an important factor for selecting a radiology residency. For the community oriented, it is less so. But, when you look for jobs, having done some research implies an interest and commitment to radiology. So, it is important to have had some experience on your resume to get both the academic and private practice job. Therefore, research within an institution should play some role in your decision.
To make this assessment, it helps to get a list of the resident research output over the past 5 years. You can see what kinds of studies have been completed. Are there retrospective studies, case reports, or large prospective trials? Is each resident completing lots of projects? Does the program have research conferences to support the resident? These findings should help you decide if the residency has a serious program that encourages residency research.
Mentorship Programs (2 points)
Some residency programs have a dedicated teaching program that helps out first-year residents and gives didactic lectures. Others assign an attending mentor to the resident that is the “go to” person for all issues during their 4 years of residency. These are nice perks that when added to the other factors can be used to make a final decision.
Board Passage Rates (1 point)
I am going to include board pass rates last because I believe that studying for the new core exam is more of an individual responsibility. Of course, you need to pass your boards, but I think that the overall residency experience is more important in the process of making you into a great radiologist than the board passage statistics. On the other hand, a radiology residency program should have the basic resources so that the applicant should be able to pass the exam. They should have learning materials and books as well as board reviews. There are many great residencies that have had lower board pass rates over the past few years, both large academic institutions and small programs. In the end, the examination is very different from the practice of radiology, but it is another hurdle to overcome.
Putting It All Together
There is no one factor that should make your decision to go to a specific program. But rather, the different factors should be weighed based on the individual applicant’s needs and wants. So, add up the numerical point totals for each program next to each section and come up with a final score to create a final rank list for every residency program.
To summarize though, for most residents, I sincerely believe that you really need to take the residency culture to be one of the most important conditions for ranking a program in the residency match. And, location can have a great effect upon your happiness or misery during those 4 years. But, a great culture and location without adequate resources for training would certainly not be enough. So, be careful when you take each factor into consideration.
A great radiologist is the sum of one’s experiences that often stems from radiology residency as the initial building block. Make sure that the foundation will provide you with the training you need to become the best you can be. It can be a difficult choice, but I hope I have been able to provide you with the tools you need to make that decision. Good luck with the match!!!