Year: 2019

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Can I Practice Radiology With Color Blindness?

color blindness

Question:

Does having partial red-green color vision deficiency hamper the chances of a resident to pursue Interventional Radiology? Or will it even prevent me from applying for the post of a professor after completing MD Radiodiagnosis?

Color Blind Future Radiologist

Answer:

Dear Color Blind Future Radiologist,
Fortunately, most interventional procedures, you can view in black and white. And, that same rule also applies for most of the radiology field, interventional and non-interventional. Usually, we look at images without color overlay when reading CT scans, plain films, MRIs, and fluoroscopy.
Moreover, you can change the color settings on the software of most equipment such that you can avoid the pitfalls of red-green color deficiency. Even color doppler ultrasound and nuclear medicine (the most color driven modalities) usually have different color settings. In these colorful modes, you should be able to set it so that you see the information appropriate for your eyes.  So, you should be able to get around the problem.
However, there is one caveat. It is critical to notify your faculty about your color blindness to ensure that they change the settings on the equipment. Don’t be shy about bringing this issue to their attention. You will only be hurting yourself. If you let them know up front, you can look at the images in a color scheme that you can read. In the end, it is possible to become a full-fledged radiologist with a partial color blindness deficiency!
Instead of worrying about color blindness, most importantly, now you can concentrate on improving your application. Since IR has become so competitive, you can spend your time on what matters, garnering a spot in a field with few positions. And, no longer do you have to worry about how partial color blindness will affect their selection of you as a candidate!
Regards,
Barry Julius, MD

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What Is This Hang Up About Ivy League Applicants?

ivy league

Hovering over the shoulders of program directors throughout the country right after the NRMP match, sponsoring hospital and medical school administration eagerly monitor the match results and statistics from each radiology residency. And, what excites these bureaucrats?

First and foremost, they love it when you’ve matched all your spots, a legitimate achievement. Second, these administrators want to see how far down the rank list you went. Now, I believe this to be a bogus statistic because many of our best residents have been ranked farther down the rank list. But, OK, I will give them that statistic willingly (although I think it’s silly!)

And, finally, they ask to see how many residents came from “Ivy League” institutions. Now, this arena is where I have a real problem. It shows a lack of insight into the residency selection process and medical school training, as well as demonstrates a hubris undeserved of the sponsoring institution. And, let me tell you why.

Medical School Selection Bias

With all this talk about Lori Loughlin and the unfair practices of the university selection process and knowing what I know about the university selection process, I believe that university selection biases also apply to many medical schools. In particular, these issues tend to affect “Ivy League” medical schools more than most because of the aggressive pursuit of applicants (and snowplow Moms!) to get in. Between legacy favoritism and the eternal quest for diversity (not necessarily having to do with the making of a quality physician), these institutions do not necessarily select for the best candidates at our radiology program. Now, don’t get me wrong. There are some great students at these institutions. But, great students sit on the rosters of almost any medical school.

Poor Fit For The Institution?

Many of the candidates that come from “Ivy League” medical school  (not all) want to work in radiology residency programs that have a preference for getting grants and bench research. And, not all programs offer this sort of work. Instead, some residencies provide a solid clinical experience without in-depth bench research. Why would these candidates fit in well with the philosophy of these programs? They do not!

No Difference In Resident Performance

In this realm, I am a bit biased. But, in a look back of all the residents that we have had over the years, our best residents ironically have often come from Caribbean medical schools or have been D.O. candidates. Not to say that the “Ivy League” graduates have been terrible. But, I have not seen standouts of increased performance compared to the other residents in our program.

And this same idea you can also see in the top 20 CEOs in this country. Take a look at the Crain’s Chicago Business article called No One Asks Where The Top 20 CEOs Went To College. (Hint: Only one went to an Ivy League institution) So, why make an increased effort to recruit these applicants when these residents have not performed any better?

Possible Attitude Issues

And finally, as an associate residency director, what is one of the worst things I can do? Well, naturally, recruit residents that do not want to be here. If we are a profoundly clinical residency without that hardcore research component, why would I want to hire an applicant who intends to apply for research grants? These sorts of residents can develop the wrong attitude for a residency program without these resources and will regret being there. Discontented residents make for a miserable residency experience.

The “Ivy League” Applicant

Now, I am not saying that programs should avoid taking applicants from these prestigious medical schools. Indeed, many will make excellent residents. My point is that great residents can come from any medical school. To make accepting these residents into your program as a badge of honor neglects the right reason for the application process in the first place. And what is that reason? It is to find a candidate who thrives and performs successfully over the four years of training!

 

 

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Pregnancy In Radiology Residency

Question:

 

Hi Dr. Julius,

I have a few questions for you about pregnancy during radiology residency that I wanted to know.

Is pregnancy in radiology residency doable?

Are programs supportive of students who expand their family during residency?

Are there radiation exposures that I would need to avoid in a diagnostic radiology residency?

Is there a typical year of residency easier to have a baby than others?

With radiology being a male-dominated specialty does this cause strife between residents during maternity leave? (Is there maternity leave?)

How do you decide if a program is family friendly and future-family friendly?

Thank you!

Sincerely,

Future radiologist

———————————

 

Hi future radiologist,

I have to say I have been getting some great questions from my audience and yours is no exception!

So, let’s start from the beginning… Is radiology residency doable for a pregnant resident? My quick answer is undoubtedly yes. Many have done it before.

But, let me give you a bit of the more detailed response to your inquiry. It’s not whether it’s doable, the question is, do you want to do it at this point in your life? By no means is it a cake walk.

So, what changes? Typically, many pregnant residents will lay off the fluoroscopy and the interventions that involve ionizing radiation. And, depending on how your pregnancy goes, you may feel tired and nauseous at times. But, most get through the residency just fine.

And, of course, you are entitled to pregnancy leave which I believe is usually three months. Depending on how much time off you take, that may extend your residency a few months. Moreover, the additional time can delay the timing of your fellowship.

Then, finally, you will probably need some help with the kids once you do restart your residency after the pregnancy.

Is it easier or harder to have a baby during rads compared to others?

Comparing radiology to other residencies, I believe it is more doable than some and harder than others. Those long nights with a reversal of sleep schedule can be tough on typical residents let alone pregnant ones. The hospital will constantly bombard you with images with no time to sleep. Psychiatry and derm are some specialties that don’t have those tough calls. But then again you are practicing psychiatry and derm, not where I would want to be!

And, perhaps it is not as grueling as surgery. But, it all depends on what you want.

So, what year would be best to have a baby?

If I had to choose within the current system, I would have to say in most programs the 4th year (after you have passed your boards) would be the best time. It is the least demanding in most residencies (but not all!) Usually, you can fill it with mini-fellowships, electives, and less call shifts than other years (although some have 4th-year weighted call).

Does pregnancy cause resentment?

I will say the following; Whenever you have one person with different sets of requirements from the others, you will have some resentment. Call shifts will increase for your classmates in spurts.  You will have to give them back afterward, so it eventually evens out.

But, in the end, this is a personal decision to make and regardless of what others think it is probably not best to put it off too long because of the increased risks of waiting too long.

Which residency should I choose for a possible pregnancy ?

So, if I were looking for a residency for my wife where she would have the best situation while pregnant, I would say, most critically, pick one near family members that can help out. Next, I would want to find one where the call might be a little bit lighter.  Or, one that has a decent 4th year if that is when you want it. And finally, find a program director that you believe will be able to commiserate with and support you during residency.

I hope this answers some of your questions!

Barry Julius, MD

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Why MD-PhDs and Radiology Residency Sometimes Don’t Mix

Getting an MD-PhD is no small achievement. These candidates often take eight, nine, ten or more years to complete their training by the time they apply to medical school. Meanwhile, their friends and colleagues have long since graduated from medical school. And, working on a thesis as a PhD can be brutal. I admire the tenacity it takes to get through this program.

Now, you would think that with all this training, all these applicants would turn into the most incredible radiologist residents. (of course, some are great) However, based on my own experiences and the sentiments of other program directors throughout the country, nothing could be further from the truth. And, let me tell you why.

Too Detail Oriented

MD-PhD training (especially the PhD part) utilizes a whole different philosophy from medicine. These teachers teach with bottoms up approach. You start from all the details and then work your way upward to the whole. On the other hand, in radiology, you start with the general disease or imaging findings and then work your way into the details. These two approaches clash. Concentrating on the features of a hepatic cyst on a CT scan while an aorta actively ruptures can cause real problems for patient care! Imagine the issues misses like this can create when a resident starts his first call.

Decision Paralysis Because They Know Too Much

With some residents in radiology, the problem is they know too little. That is not true for the MD-PhD graduate. Instead, in a way, often, MD-PhD know too much to make a quick decision. They think about cases too profoundly (which of course, is sometimes a good thing). But, sometimes it also leads to decision paralysis. Harping on one imaging study at nighttime for 45 minutes can lead to a backup of cases for the entire call shift. Imagine the constant phone calls from the emergency department when this happens. Getting bogged down in decision making instead of acting can lead to poor outcomes!

Question Everything

In the MD/Ph.D. world, you need to question everything. By doing so, the art of making questions leads to incredible research. But, in the radiology world, we can query some things. However, we do not have the time to question every detail. That doesn’t work well for radiology residents or attendings. We will be working until the cows come home!

Out Of Clinical Practice

Unlike the standard MD pathway, the MD-PhD approach often involves performing their clinical rotations early. So, by the time these residents apply to your program, they have already had three or four years of PhD work without even seeing a patient. It is not uncommon to forget about how to talk to patients and make them happy. Just like PC Richards, customer service is king for radiologists. You need to have the patient skills to be a consummate radiology resident. And, you know what?  If you don’t use your skills, you lose them!

Different Knowledge Base During Medical School Training

A typical MD will emphasize learning about disease processes and pathology during the clinical years. By the time she arrives at the radiology program, she knows the basics about medicine.  On the other hand, MD-PhD grads may have been profoundly learning about focal adhesion kinase enzymes for years before arriving at the radiology residency. Unfortunately, learning about complex biological chemistry is not directly transferable to the clinical duties of a radiologist. And, it shows when these residents first start!

How Can MD-PhD Grad Be Successful In Clinical Radiology When Their Medical School Training Stacks The Odds Against Them? 

Now you can see why some program directors hesitate when they face the decision to accept their next MD-PhD applicant. But, with all of these issues how can you, the average MD/PhD succeed? I mean that is the bottom line, right? If I can’t help out the poor MD-PhD grad than what is the point?

Well, fortunately for the MD-PhD applicant to the clinical radiology program, solving these issues is straightforward. How can you go about making yourself a better candidate? First, you may want to apply to programs that have a bench research component, if that is what you want.

Second, stay connected with clinical medicine. What do I mean by that? Make sure to volunteer to participate in additional clinical rotations when you shift to the PhD portion of your medical school training.

And finally, remember that you need to think a bit differently when you enter your radiology residency program than your PhD training. Creating a connection to the clinical realm will give you an edge!

 

 

 

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I Am A Foreign Grad And Want Interventional Radiology… Help!!!

want interventional radiology

Question For Residency Director

Dear Dr. Julius,

First of all, thank you for writing up this excellent blog. I found the ‘choosing fellowships’ section to be of highly beneficial to me. But even after that beautifully written post, I am still undecided. I am currently a radiology resident in the UK. And, I am keen to apply for a fellowship in the USA(I have completed my USMLE). I like working with my hands. Moreover, I think that I am talented. I understand that the traditional interventional radiology fellowship will no longer be available by the time I am eligible to commence my fellowship (2021).

Now, I am quite interested in neurointerventional radiology. By 2021, I would have completed a five years residency in the UK (3 years in general radiology and two years in neuroradiology). Realistically speaking, what are my chances of getting into a two-year fellowship in neurointerventional radiology being a foreign medical graduate? I understand that it is a competitive fellowship. Also, what kind of interventions do I get to perform by doing a body fellowship?

Many thanks for your help!

 

Answer:

Azygos Lobe,

Unfortunately, all those years in the UK are not directly transferrable to the United States requirements. So, you are stuck with one of two possibilities in the United States. First, you could look to satisfy the alternate pathway requirements. However, interventional fellowships of any sort have become the most competitive of them all in the United States. Even though you may want interventional radiology, getting a slot as a foreign grad may be next to impossible. And, if you were to find one, you may not satisfy the requirements for licensure in many individual states within the U.S. when you completed your fellowship and looked for work here. Therefore, that would be a tough road to choose.

Second, you could theoretically apply to repeat your clinical and radiology residencies in the USA. But, that would mean an additional five years of training.  And, then you could ask for a fellowship in interventional for a year or two (Depending on whether the program has ESIR)

And finally, the most unlikely option, you can apply directly to the IR/DR residencies. But again, only a few accepted applicants were foreigners because it has become one of the most competitive residencies in the match.

To sum up, your options are a bit limited. For your best chances, I would apply to the US residencies and start anew. That would involve many years but would be the most likely scenario to succeed. It would be a tough road to follow.

Body Fellowship For Interventional Practice

In terms of the body fellowship, depending on the location, you may encounter a bit of interventional variability. Some programs do more biopsies and drainages. Others may have a mammo/breast component. And, even others may have a small interventional/vascular element. It comes down to the individual program practice patterns. So, you need to ask around before committing to any particular body fellowship.

Let me know if you have any other questions,
Barry Julius, MD

 

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What Radiology And IR/DR Programs Don’t Tell Applicants About Interventional Radiology!

IR/DR Programs

After all of the hype about the new IR/DR programs, I am not surprised that it has become so attractive for medical students. However, most applicants don’t realize what happens to the typical resident’s desire for interventional radiology after they begin their residency. Of course, these programs don’t tell them that! It’s bad for business. So, I will give you the lowdown.

On the interview trail, at least since when I became a program director, and before the new IR/DR programs existed, a large percentage of medical students have always claimed interventional radiology was their top choice for fellowship. But, as soon as they would arrive at the program, some of these former desires became a wist of memory. And, the other rarified few would make it to their first, second, or third year and then suddenly drop off of the IR bandwagon. Very few who initially wanted interventional would make it to the end of the residency. Why did that happen? Well, I have some theories.

Constant Consents/Too Much Patient Contact

One thing most residents like to complain about (myself included back in the day): scut. And, in the world of interventional radiology, you can find no lack of scut in any corner. Patients need consents. They complain about their symptoms.

Moreover, as a “real” IR doctor, you need to listen. That can become real old quickly if you cannot stand performing these critical patient duties. It’s not why most residents signed up for radiology.

Lifestyle Is Not What They Thought It Would Be

Overall, which radiologist subspecialist awakens the earliest in the morning? Well, that’s easy- the interventionalist. And, who often leaves the latest? The same. Also, some interventionalists may get called in for all hours of the night at any time on their lonesome. Now, radiology may not be the lifestyle specialty that it was years ago in any subsegment of radiology, let alone interventional radiology. Regardless, this sort of long day in interventional does not attract many radiology residents to the field. You may be the only one in your residency!

Risk Of Needlesticks

In any medical field, you will encounter physical dangers. But notably, the interventionalists have a higher likelihood of bodily injury. Most critically, these folks use lots of sharp needles. And, guess what? When you utilize lots of needles, you increase your chances of a needle stick and the good stuff that comes with it- Hepatitis, HIV, and more. Many residents think about this only after they start their residency. And, walla, they make their decision not to enter the field!

You Can Perform Procedures As A DR Graduate

No. Interventionalists are not the only ones that can perform procedures. If you decide to take a rural job or practice as a general radiologist, you will likely be responsible for some of these. I know of many “non-interventionalists” that perform all sorts of biopsies, vascular work, and interventional oncology. So, why bother if you don’t need that extra certificate of qualification?

Not As Glamorous As They First Thought (PICCs and Ports)

Nowadays, most interventionalists perform all sorts of procedures. And, most likely, it will not be many of those stent placements in the neck or embolization of the liver. Most techniques are much more mundane. You will probably have done a lot more PICC lines and Portacaths than any high tech complex procedure out there. Yes, you will be a critical member of the team. But no, you will most likely perform more garden variety interventional procedures than complicated ones.

Heavy Lead

In some “fancy” institutions, they have made sure that each interventionalist needs to wear anti-gravity lead before any procedure. But, more likely than not, you will need to wear a regular lead uniform most of the time. And, unless you maintain yourself in excellent shape, many lead garments tend to cause back and muscle pain. In fact, at a certain age, it is not uncommon for many interventionalists to switch to a DR specialty because of the wear and tear on their bodies. Most new radiology residents do not realize the long term consequences of wearing a heavy uniform until they hear the complaints of their mentors.

 

Bottom Line: What Does This Mean For The Future Of The IR/DR Programs?

After all of these issues, and as much as I like the field of interventional radiology as a profession, I find it fascinating that the IR/DR residency has become one of the most popular and competitive specialties out there. I think many residents have not done their research and have fallen for all the hype.

Now, call me crazy, but I believe that one of two things may happen since residents are signing up early before they get to know the specialty. Either, the attrition rate for these IR/DR residencies may become more significant than the founders realized or the programs will have created lots of disenchanted and unhappy IR/DR clinicians. Only time will tell. I hope I am wrong!

 

 

 

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I Didn’t Match In Radiology! What Do I Do?

match

Question:

Thank you for providing great information. I have been utilizing it throughout my residency application process and have found it to be an invaluable resource. Currently, I am in the process of SOAPing (Supplemental Offer And Acceptance Program) to match into a position and was hoping to get your input on applying for research fellowships in radiology as an alternative to SOAPing into an undesirable program/alternative specialty. I am a US MD 4th year with a 230-240 range for both USMLE1&2 and with previous research experience in genetics and interventional radiology.
Thank you for your time and consideration,
A Worried SOAPer

Answer:

Sorry to hear about having to try to SOAP into a position. I would continue to try to get into a slot in radiology if you can. Getting a residency slot in a marginal program is better than not getting anything if radiology is your chosen field. I believe that you can always make the most of your experience regardless of the residency that accepts you.
However, I would imagine that there are not that many empty slots in the SOAP this year. (Only ten programs did not fill as of the time I am publishing this article). So, if you do not match into an opening, I think doing a radiology research program would be a great way to make yourself more desirable the next time you apply. I would probably opt to find a clinical program this year first as well (if you have not done so already), so you have that clinical year that you need under your belt. But, getting a research year afterward would be an excellent way to stay immersed in the field. It is the closest you can get to remain in radiology without completing a residency year.  It will also demonstrate your interest in the programs when/if you reapply.
Good luck with the SOAP,
Barry Julius, MD
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Can I Discuss Lifestyle On Interviews?

lifestyle

We all want to know about lifestyle when we interview for residency, fellowship, and beyond. But, many of us are afraid we will offend the sensibility of the interviewer. Will he think I’m lazy? Will she believe I will take too much vacation if I work here? I’m sure at one point, or another, these thoughts have crossed your mind.

So, in what context, can you ask these questions? And, is it ever appropriate to grill your interviewer about the lifestyle that she leads in her job? I mean that likely is one of the reasons why you are taking the position there. Or, at least, you don’t want to let on that is the reason why you are taking the job, right?

Once again I aim to please. Accordingly, I am going to delve into the hornet’s nest of the discussion of lifestyle on an interview. At what point should you avoid it at all costs? When is it appropriate to discuss? And, finally, how should you address it and what should you say?

When To Avoid Discussion Of Lifestyle

In general, unless under special circumstances, you should not broach the topic of lifestyle on that initial outing when you interview for an attending job. Think of the first interview as a “get-to-know-you” session. First and foremost, you want to discover if the place of work matches your expectations for what you want. Typically, once you introduce the subject of lifestyle issue during that first interview, you have opened a can of worms. You are saying; essentially, lifestyle is more critical than the working environment. Most likely, you do not want to relay that message on first sight!

Likewise, as a resident, most often it is inappropriate to ask an attending about lifestyle issues as a resident. First, faculty tend to know less about the day-to-day lifestyle issues of residents. So, it shows poor insight when you ask the attending about how and where they live. Try to direct these questions to a more appropriate source, your future colleagues, the residents within a program.

And finally, sometimes, you discover that you are interviewing with a person who does not seem to want to answer questions about lifestyle. Perhaps, this person is awkward or is a bit off. Is that the sort of person, you want to ask about lifestyle anyway?

When Is It Appropriate?

Of course, as an attending interviewing for a job, you need to find out more information. So, wait a bit. Get a feel for the practice. If you have already had your first interview, then you can start thinking about lifestyle questions. Vacation and call issues become more important once you have established that this place may work for you.

Or, perhaps, you are sitting down at the table at lunch with future resident colleagues. This time would be perfect for broaching the topic of lifestyle. Do residents always eat together? That’s certainly an appropriate question at this point in the day.

And then finally, sometimes the interviewer may ask you a question that can lead you into discussing a lifestyle issue. For instance, he may want to know how you tend to enjoy your vacations. That could appropriately stimulate discussion on the topic since the interviewer essentially permitted you to discuss it.

Best Way To Address The Issue

Once you have established that you think that you will fit in with a residency or practice, it pays to be tactfully forthcoming. At that point, you can ask the interviewer if they receive extra “administration” or half days. Or, you can find out about which days may lead to easier rotations. The information that you collect from this place may further inform your decision down the road to choose where you want to work. Use your best judgment. You have gotten this far!

If you feel less comfortable, you can also always sidle your way into the conversation. A statement like the following For instance, after you see a picture of the radiologist in Bora Bora on the reading desk, the following statement would undoubtedly work- “I see that you like to go away to Bora-Bora. How often do you take that trip?” That would be a non-offensive way of beginning to broach the topic. And, it can lead to more detailed information.

Another non-intrusive question that I like and can work to get a feel for the “corporate culture”: “Do the partners/residents like to go to dinners together?”. This question establishes whether or not the partners get along well enough to host events together.

Bottom Line About Discussing Lifestyle On Interviews

Understanding the corporate lifestyle is a critical piece of data that you need to decide whether the radiology practice or residency works for you. Nevertheless, it can become a sensitive topic. Delivered at the wrong time, it can relay a lousy impression that may prevent you from getting that next great position.  So, be sure that you mention the subject at the appropriate time to the correct individual. And phrase these questions non-offensively. Tread lightly, my friends!

 

 

 

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Why Does No One Want To Go Into Mammography?

mammography

Question:

Why Does No One Want To Go Into Mammography?

Hey! Why are so few residents interested in pursuing a breast fellowship? The job market for breast has always been ‘hot’ and the hours and salaries are generally higher than other subspecialty specific jobs. I was an IR resident who dropped to DR because of the discrepancy in lifestyle vs. salary vs. free time. Let me know… thanks!

Answer:

My Four Reasons For Fewer Mammographers Than Expected

Well, I have a few insights for you about the world of breast imaging. Back in the day, eons ago before when I even started practicing, mammography was a no brainer. If you talk to some of the older radiologists, you will be surprised to learn that most will say that they initially felt comfortable reading the films. But, the field slowly became more litigious. And, eventually, the area grew into the most sued specialty in the field of radiology.
However, that is not all. Many radiologists went into the field to “get away” from the day-to-day emotions of the patient encounter. And, what do you do when you work in this field? You work with one of the most touchy subjects known to women, breast cancer. You will serve some crying emotionally charged patients. That is not why many radiologists signed up for radiology.
Additionally, mammography differs from other fields in daily practice themes. Unlike other radiologists, breast imagers mainly work with management issues. Instead, most general radiology practitioners want to solve diagnostic dilemmas rather than management matters. Hence, the name of our field “diagnostic” radiology. That’s very different from the expectations of most radiologists.
Finally, this last thought may be a bit more controversial, but I will stick my head out a bit. Many mammographers tend to work intensely at one time or another just reading one type of study, screening mammograms. You may drown in hundreds of the same sorts of studies all day long. Now, this does not necessarily apply to the radiologists that are consummate all-around breast imagers who do biopsies, read MRIs, and work directly with surgeons. But, some of the older breast imagers do only the straight screening and diagnostic mammography portion of breast imaging. And, for many, this work can become redundant and tiring.

My Final Take On Mammography

Now, taken together, these unique practice issues make a particular sort of person to want to go into mammography. And for that reason, regardless of salary, lifestyle, free time, you will not find as many breast imagers as some of the other specialties in radiology. To each his or her own!
Regards,
Barry Julius, MD
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Minimal Effort And Maximal Gain: A Targeted Residency Approach

minimal effort maximal gain

Radiology residents, especially, are under the gun to complete their work efficiently. I mean, to learn what you need to know for the boards you have to read through umpteen books and a gazillion films, right?  So, who has the time to go through the motions of a bland long-winded study routine to get you through all the material? That would take way too long. Therefore, I want to give you some suggestions to guide you efficiently through all the subjects you need for radiology residency. So, here are some the basics you need to get through residency with minimal effort and maximal gain!

Targeted Reading

I can’t remember the number of times that I have talked about targeted reading in my posts. But, I will repeat it for the ten thousandth time. It’s that important. Every resident should read radiology books differently from other subjects. Remember. Pictures first, then captions, and then text. If you start from the text and go to the images, much less information will stick. So, please do yourselves a favor and do this the right way.

And, just as critically, make sure to emphasize case review series in your review process. Radiology without cases is like peanut butter without the jam (sorry for those of you that are allergic to peanut butter!). It just does not feel right!

Reinforced Reading

How do you get information to stick around in your brain? Well, you need to look at the same item from different angles. What do I mean by that? If you find a meningioma on a CT scan at work, first of all, make sure to look it up that night. Then, look at the same case on multiple imaging modalities. Perhaps, check it out on an MRI, a contrast-enhanced CT scan, or even a skull series if available. The more ways that you look at the same findings, the more likely you will recall the case when you need it!

Lots Of Questions

Don’t let the texts that you are reading become merely a bunch of random words. Just like any other time that you had to study for tests, make sure to phrase the text into the form of questions. And, I have some great ideas to help you along your way. My residents reported using several test question bank companies for study, especially around board time. But, it may not be a bad idea to use these question banks at any time during your studies to emphasize the materials.

The two companies that I hear assist the residents with fairly comprehensive question banks are as follows: Board Vitals and Quevlar. Both of these companies give you some great questions for the Core Examination. Now, you need to make sure to have learned the basics before. But, both Board Vitals and Quevlar will enable to get through the material that much quicker to get you where you need to be before the boards.

Group Learning

You certainly need to read a lot independently to learn the material that you need to know. However, you should also utilize your colleagues to maximize your knowledge. Going over questions or cases in groups with your fellow residents adds new perspectives on the same information. And, by golly, here you have another neural pathway to maximize what you retain!

Board Review Courses

I believe in learning from numerous different angles. And, therefore, I need to put a pitch in for Board Review Courses. Not all program directors believe in this approach. However, sometimes, it helps to step out of your familiar residency conference world and to get a fresh perspective. Different instructors and different points of view create distinct neural pathways for information recall. That is the reason I believe a board review course can work. I think it’s not a bad idea to attend one or two.

Minimal Effort And Maximal Gain

Don’t get me wrong. To be a great radiologist, you need to put in the hours. However, make sure that you utilize your time as effectively as possible. Why spend time that you don’t have? So, follow this approach to get through the material logically and efficiently. Who doesn’t like minimal effort for maximal gain?