Year: 2019

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Caribbean Medical School- Is It Still A Legitimate Pathway Into U.S. Medicine?

caribbean medical

The landscape of medical training will monumentally shift over the next several years. According to the American College of Graduate Medical Education(ACGME) and the American Osteopathic Association (AOA), both organizations will merge all residency programs by July 1, 2020. As innocuous as it may seem for U.S. graduates, it should strike some fear into the hearts of current Caribbean medical students that will match after this date. So, why do I say this and what are the implications of this immense change? Well, let’s start at the beginning and then we will discuss the final meaning of all of this.

The Historical Truth Behind The Separate Pathways Of The AOA and ACGME

As many of you may already know, for years, the AOA and ACGME had separate pathways for internship and residency. I liked to think of these pathways as “separate but equal,” kind of like the old segregationist south. ACGME and AOA accredited residencies were undoubtedly separate, but not equal! Most applicants considered AOA residencies to be the second tier. Typically, they did not have the same depth of resources as ACGME accredited residencies. Moreover, the AOA required their residents to participate in AOA accredited residencies which often were not ACGME accredited.

What Will Happen Now?

Well, all of this “separate but equal” business will now become history as of 2020. AOA residents will be able to choose to go to any residency program throughout the country. Likewise, AOA programs across the country will either abide by the ACGME rules and convert or fold. Bureaucracy will no longer hand-tie these U.S. osteopathic students into joining second rate residency programs. Significant numbers of “new” U.S. medical students will enter the NRMP residency match for allopathic spots.

So, how will this sea change of the AOA/ACGME merger affect the typical Caribbean medical student applicant? Well, for the Caribbean medical student applying to radiology, the winds of change from the merger will not be blowing in their direction.

Now, with the merger, you will have more osteopathic residents from the United States competing for the same spots as the foreign medical graduates previously. Additionally, these American osteopathic students will have the advantage of coming from American medical schools. At the same time, most residency programs are biased toward accepting U.S. graduates. And finally, these increasing headwinds do not even include the growing numbers of medical students in Caribbean schools. Nor does it include the more slowly increasing number of residency slots throughout the country compared to applicants. (1)

What Will Happen To The Caribbean Medical School Applicants That Cannot Find A Spot?

In total, these new factors will create the “perfect storm” to decrease the chance of acceptance for a Caribbean applicant. For the more accomplished Caribbean students, they will be forced to enter other less competitive residency programs such as family medicine. Additional subspecialties will become too difficult to match for the foreign grad. But the picture becomes even more worrisome for those Caribbean residents toward the bottom of the class. These students may no longer be able to get into any residency. And, we will begin to see a wave of increasing unemployed Caribbean trained physicians. These unfortunate casualties will be unable to shoulder their enormous student loans without a residency slot. Even worse, some will have their debt garnished from their wages in alternative careers by the IRS because of ballooning debt loads.

What Does This All Mean For Current Medical School Applicants?

Based on the new ACGME/AOA merger and all of its subsequent implications for medical students, a Caribbean medical student applying for a residency slot in 2020 will likely not have the same chances for acceptance as a student from 2019. So, keep that in mind that if you decide to send an application to a Caribbean medical school. The previous statistics that Caribbean schools will show you will no longer apply. Moreover, you cannot count on numbers such as percent acceptance to U.S. graduate schools from the past several years. To confirm my theory, carefully watch the National Residency Matching Program results (NRMP) results. See how the new percent match for foreign and Caribbean graduates change for the 2020 match and beyond. Bottom line. Consider application to alternative United States osteopathic programs instead of Caribbean medical schools as a backup to standard allopathic programs. Caveat emptor. Let the buyer beware!

(1) https://mk0nrmpcikgb8jxyd19h.kinstacdn.com/wp-content/uploads/2018/04/Main-Match-Result-and-Data-2018.pdf

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A Common Rank Order Dilemma For Radiology Applicants

rank order

Question

Hello Dr. Julius,
I am an aspiring Radiologist who is currently preparing for the USMLE exams. In the future, I plan to apply for Radiology residency as well as Internal Medicine as a backup. However, I am a little worried and confused about submitting my NRMP Rank order list when the time comes. Specifically, I would like to ask if it is acceptable to apply for a Radiology position, preliminary position, as well as a full 3-year internal medicine residency position at the same program. How would my rank order list look?

Also, what would be an appropriate response to give interviewers if they know I have applied for both a prelim position and a full three year IM position? I am worried about being in a scenario where I would not match into any program at all due to the improper listing of my Rank Order List.

Thank you for your time,

Concerned applicant

Answer:

How To Rank Order For The Match

Good question! For confirmation about the process, I recently spoke with a few of my residents. Typically, you can tie the preliminary spots to the advanced radiology programs such that you need to match into a combination of the two or none at all. That can leave you with potentially hundreds of combinations and permutations depending on the number of programs you decide to rank. Furthermore, after you rank these tied together programs, you can then list the 3-year internal medicine programs. That way, you will rank any combination of a prelim and radiology programs more highly than a categorical three-year internal medicine slot. As you specified, you need to be careful to make the appropriate order when you create this rank order for the list. You may want to write down (on paper or electronically) the permutations before clicking the submit button!

Prelim Medicine And Three Year IM Programs Rank Issue

I would have to say that the other more controversial question to answer would be what to tell the Prelim and Three Year IM Programs to which you are applying at the same place. In this situation, I firmly believe that honesty is the best policy. Any other tact would make you seem a bit ridiculous since they already will know your motivations.

Make sure to make it known that you enjoy medicine as well as radiology. And, tell the interviewers that you will perform exceptionally no matter which program you attend. Program directors most want to know that the folks beginning in their program will make it through to the completion of their residency. So, this strategy should satisfy the program director’s biggest concerns.

Hope that allays your concerns,

Barry Julius, MD

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Image Wildly!

National organizations that represent technologists, physicists, and radiologists have created programs to decrease radiation dosages called Image Wisely (adult population) and Image Gently (pediatric population). As much as these programs make perfect sense and reduce exposure to patients,  neither program addresses the more pressing radiation dose issue in radiology. Right now, Emergency Departments (EDs) throughout the country have a program that counteracts all of these achievements. I like to call it Image Wildly!

So, what do I mean by that? We, as radiologists, have noticed an epidemic throughout our hospitals. And, no it is not high radiation doses for patients on an exam by exam basis. Instead, we see EDs ordering unnecessary studies indiscriminately. These unwarranted studies significantly increase radiation dose much more steeply than any single exam reduction in radiation dose can achieve. So in today’s rant, I will outline a myriad of factors for the problem. And then, I will identify how we can achieve the goal of reducing radiation dose by decreasing the number of silly studies ordered.

Reasons For Image Wildly

If You Build It, They Will Come

Have you noticed when you either add or replace old imaging equipment with more efficient hardware, the numbers of studies increase accordingly? And, what happened to these patients that didn’t get these studies before the new ED CT scanner arrived? Well, now that the equipment is more readily available to patients, it becomes more convenient for clinicians to order a test instead of waiting to complete an appropriate physical and history to triage patients through the system. But, like many of you, I still believe there is a role for taking a good quality history. It’s the most effective way to reduce exams and also radiation dosage!

Midlevel Providers Automatically Ordering Studies

In some departments, automatic button pushers such as some midlevel providers will sometimes order studies to hasten the final disposition of each patient. The process can become somewhat standardized with any patient labeled with abdominal pain slated for a CT scan. Unfortunately, these formulaic systems do not always work. Not every patient with abdominal pain needs a CT scan. And, the midlevel providers often are just another cog in a wheel run by a larger entity. If only someone would examine the patient well first, the clinician could cancel these unwarranted studies.

CYA (Legal Issues)

Of course, in any discussion of imaging, we need to discuss one of the thousand-pound gorillas, the threat of a lawsuit. Elevated threats of lawsuits lead clinicians to order more studies just to prevent the possibility of “missing” a clinical finding. However, this issue ignores the other complications of imaging- false positives, increased radiation doses, and occasional misdiagnoses. I am a firm believer that the answer often lies in the patient’s history. But, histories are also not perfect. And, how can a clinician transfer the blame from himself? Order a study and make it the radiologist’s problem!

Quantitative ER Parameters (Time To Disposition)

Often, in a busy ED, it takes less time to order a procedure before a patient needs it rather than to have to order a study when she needs it. And, what is the metric that many Emergency Departments use to measure quality? Well, that would be time to disposition! So, what happens? Patients get additional unneeded studies that rack up increased radiation over time in order to minimize ED time. Statistics like this one emphasize time over quality. And, who suffers? The patient, of course!

How To Solve Image Wildly

Unfortunately, I do not have one straightforward answer to solve every problem that leads up to the Image Wildly phenomena. Instead, we need to tackle each reason for the problem individually. Indeed, if you address the legal issues with tort reform that will not correct the reliance of quantitive parameters that many EDs utilize. And, if you prevent the ordering of unnecessary new studies with clinical information systems, you would still have to solve the problem of having mid levels creating formulaic diagnoses of patients so that the hospital can move them through the system more rapidly.

Slowly and deliberately, we need to take a hard look at each of the issues that can cause the problem indiscriminate imaging. Only then, can we significantly reduce radiation dosage of patients and end the problem of Image Wildly!

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Research Fellow Advice For Applying To Radiology

research fellow

Research Fellow Question:

Dear Dr. Julius,

I have recently discovered your website, and I am amazed by your level of empathy and willingness to help. Your effort here is something quite unparalleled. I highly value taking and giving feedback, and after reading tons of your articles, I wanted to express how much I appreciate your work here on this website. Especially the last article gave me extra courage to contact you.

I am an FMG as well, and I am currently working as a full-time research fellow in the United States, and at the same time, I am studying for the steps. If I can take all three (Step I USMLE, CK and CS), I will apply for Match 2019, but I am not sure if I can make it till September. So what would be the latest date to upload my ERAS data to be on the safe side? I am afraid to make a hasty move that can ruin the whole application.

Secondly, how should I spend my time here to increase my chances of matching apart from my research? I truly believe this blog is a treasure so I will probably read all the articles (Yes, believe me!, that is what I usually do when I find something excellent to read) and give you more comprehensive feedback.

Also after reading all, I may find the courage to write an article myself and send it to you for a review but I must disclose that I am not well versed in writing at such a great level. I am looking forward to hearing from you and thanks in advance for your time and consideration.

Answer:

Hi,
Thanks for the compliments. I have created to my blog to help out folks like you who are beginning. It’s tough out there!

Application Timing

Anyway, regarding your questions. First, I would make sure to get your applications in as early as possible. Often, programs will not interview those that have sent their applications in later. So, particularly as an international student, this would be critical. As soon as you get your scores back, I would recommend that you get that application in right away. Of course, don’t forget to edit it and check it over!

Fellowship 101

When you are doing your fellowship, I would make sure to get to know the program director and critical faculty in the radiology department. They often have significant connections that can help you to secure a position, whether in your fellowship institution or other programs as well.

Also, make sure to perform well in your fellowship. No slacking off (not that I believe you would). Put in that extra effort when you are there. Give great presentations and sound knowledgeable. Read a lot. Ask good questions.

Summary For The Research Fellow

These simple tasks will help you to create a good impression. And, any time you have an idea for an article, I would be happy to consider it for the website. I could always use a few more guest posts!

Good luck with the application process!

Barry Julius, MD

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How To Pick Up Speed In Radiology

When starting as either a resident or beginning attending, commonly, radiologists worry about whether they are reading quickly enough to meet the demands of the residency or practice. Sometimes, we self impose this construct of the “truth” about our speed. And, other times the fear may be legitimate. In either case, how can you achieve the point at which you are interpreting cases fast enough to feel like you are producing quality dictations without fumbling too much (everyone misses something no matter how quickly you read!) at a reasonable speed? Well, that is my goal for today!

Read Lots Of Cases

First and foremost, I have never found a substitute for reading tons of cases. When you have seen the same finding for the seven thousand three hundred and forty-sixth time, it will stick. Eventually, as you read it so many times, it becomes part of your autonomic system. It becomes so entirely reflexive that it never quite makes it into your consciousness (which will slow things down!).

Create A Master Checklist

Every great radiologist creates a master checklist. It may get to the point that you subconsciously check everything because you have done it so many times. But, it is still there. If you continue to use the same checklist, time after time, it will become second nature. One day, you will make all the findings and won’t even remember that you have one!

Minimize Interruptions

Sometimes, you have to shut the door and focus on the work ahead. Don’t allow your chatty colleagues to stop you from doing your work. If they need to talk to you and you are in the middle of a study, have them wait until you are done. A few seconds of delay can significantly backtrack the progress you have made on your report!

Use Templates Well

Templates can become a major time saver if used properly. If you are dictating a CT scan, having the technique section automated will save you countless hours throughout your career. But be wary. Make sure to take items out that do not apply to your current case!

Use Your Residents Wisely (If an attending)

If you are fortunate to work for a practice with a residency program, you need to make sure to utilize the residents to your advantage. What do I mean by that? Well, they usually have better access to histories than you do (as long as the resident is good!). So, make sure to copy and paste these into your report. On the other hand, if your resident makes lots of typographical errors, you would want to make sure to redo your own report so that it comes out readable! How you go about utilizing the reports varies on a case by case basis. But, using your resident appropriate can save loads of time!

Listen To Your Attending (If a resident)

Say you are on at nighttime and your attending likes a report a certain way (i.e the impression before the findings), make sure to create reports the way she likes it. Or, if you are sitting next to your attending and he tells you to dictate a case an include a statement about the kidneys, remember to do so. You don’t want to have the report bounce back to you!

Don’t Perseverate On The Small Stuff

We can obsess over liver and renal cysts, pulmonary granulomas, and ovarian follicles. Or, we can learn to minimize the verbiage that we use to describe these findings. At some point, when you get too busy, you have to remember to include only what is truly important. Don’t go crazy with the minutia!

Limit Your Differential

Almost every finding can theoretically have 10 differentials. But, what is really going on in the case? In the real world, you only have time to discuss those differentials that are really likely or dangerous. You don’t have time to discuss the unlikely zebras!

Knowledge Is Speed

Believe it or not, reading lots of radiology books augments your speed. Why? Just because it tends to boost the confidence of the reader. The more you know, the less you perseverate and the quicker you become. Thems are the rules!

Don’t Be Too Speedy!

And finally, a word to the wise. After all this talk about increasing speed, don’t forget that sometimes you need to slow down. Missing findings is bad for patient care, increases the likelihood of lawsuits and will ruin your reputation. Therefore, there is a point of no return. So, back it up a bit, will you?

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Poor Step I USMLE Scores- What Do I Do?

USMLE Step I

Hello Dr. Barry Julius, 

Question About Step I USMLE Scores And Application:

I am a foreign medical graduate that finished Med School in 2016. During this 2 years I’ve been studying and taking the USMLE steps, I took my step I USMLE and got an unsatisfactory score of 209 for multiple reasons. Then, I took my step II CS, passed the first attempt, and received a step II CK score of 250. I have an upcoming paid rotation (very hard to find in radiology) in a large city for 3 months starting in February 2019. Unfortunately, I don’t see myself doing anything else than radiology. Since I grew up with it and came from a family full of radiologists back home, this is what I see myself doing and breathing.

Am I dreaming about getting into a radiology residency? Or, is it possible and should I keep on pursuing it? I have all the upcoming months to make my application stronger and more appealing to apply in 2019. I am thinking about taking the step 3 USMLE if that would help my application. However, I have heard mixed opinions about completing it before applying. Also, I don’t have any research. Moreover, I have also found conflicting information on the importance of research for radiology applications.

I would really love to enter a radiology residency but I want to keep it real. Can I have your professional opinion on whether it will be possible. Also, what should I do this time to improve my chances. Or, should I just wake up and look for another option?

Thank you very much for your response,

Concerned Applicant

Answer:

Honestly, since you are a foreign grad, a score of 209 on Step I USMLE may limit your ability to obtain interviews. However, some programs may still give you one because you did so well on the step II exam. I think it is worthwhile to attempt the application process. You never know. But, I agree that it may be very challenging for you this year. You should temper your expectations for getting into a radiology residency.

In terms of the USMLE series, in your case, I would probably consider taking the USMLE Step III and try to ace the examination. A good score would confirm that the initial Step I exam results were a fluke. But, be careful. If you perform poorly on it, you can ruin your application. So, you need to study hard! (Not that I expect that you wouldn’t do so)

Also, it is often just as competitive to get into a prelim year prior to starting radiology residency. All foreign grads need a clinical year in an ACMGE certified program in the United States. So, make sure that you also apply for this as well. Foreign clinical programs are not a substitute.

Finally, as I’ve told some other foreign grads before, you need to make sure that you get to know the program director at the site of your paid rotation, This will help you get your foot in the door for an interview at least at that site. Also, this person can be a great resource to find a way to get involved in radiology research that can also bolster your application. Potentially, this person can also give you a good recommendation. That would help as well.
Let me know if you have any other questions,

Regards,

Barry Julius , MD

Follow-up Question:

Thank you very much for your answer.  I have to apply to both programs at the same time, meaning the first categorical year and radiology at the same time. Is that correct? Is there a possibility to start a separate IM program and then transfer after the first year to radiology?

I think it’s a little bit easier to get into internal medicine residency for the IMG. And, some programs require a lower Step 1 grade. As per your advice, I will definitely take the step III before applying and try to complete some research. It is hard to find, but hopefully, during my upcoming rotation, I can get my hands on something. 

Finally, I forgot to mention that I have a U.S. residency. So, I think that would improve my chances a little bit since I have seen lots of programs not interested in sponsoring VISAS, is this correct? I just want to make my case as strong as possible when applying to improve my chances, but I’m also considering internal medicine residency as another possibility because of my bad STEP 1 grade. 

Thanks again for your reply,
Concerned Applicant

Follow Up Answer:

It is possible to start a separate internal medicine program and then transfer over to radiology. However, I would recommend applying to both a preliminary clinical year and the categorical program as well as the three-year IM program. But, I would make sure to rank the categorical radiology and prelim clinical year programs first. You should be able to use the IM three year program as a backup if all else fails.

And, I agree. U.S. residency will help you a bit to secure a residency slot. It’s one less problem for the residency programs to worry about when you apply.


Good luck!

Barry Julius, MD

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Great Teachers And Radiologists: Not Always One And The Same!

great teachers

Have you ever heard of the phrase “those that can’t do, teach”? Well, if you think about the words, you can find a modicum of truth. (Not for all radiologists but some!) I’m sure that some of you have worked with a radiologist/former teacher who gave the most terrific lectures on a topic. And then, when you sat down with them for the first time to complete some work, you realized that something was not right? Maybe, they missed all the significant findings. Or perhaps, the dictations they created were so long, to be almost unreadable. I certainly have worked with some of these great teachers in the past. And, you will most likely too.

Does It Matter?

The simple answer is yes. But, why? Well, residents and students tend to follow excellent teachers to the end of the earth (and they fall over the cliffs with them). In essence, they form the same bad habits and eventually perform the same way. If your favorite attending that gives those great lectures lackadaisically ignores the liver windows on a CT scan, you are likely going to follow suit.

Moreover, we tend to give those mentors that we like a pass. In essence, these attendings perpetuate these bad habits because their teaching sways their students to ignore their foibles. And, programs are less apt to remediate these faculty members.

It reminds me of that friendly guy who was not so great at his job but continues to get promoted because he can never complete his work well. Everyone loves him. He eventually becomes the CEO of the company because no one has the guts to fire him!

How To Prevent Yourself From Falling Off The Proverbial Cliff?

Similar to the Reagan era when the United States made agreements with the Soviets to decrease nuclear weapons, all students need to trust but verify. What do I mean by that? We can’t always rely on what our favorite mentors say and do. With even our best teachers, we need to check on what they say. Even the best radiologists and mentors make mistakes. And, you certainly do not want to incorporate these mistakes into your practice.

Also, remember that sometimes your best teachers are not the most charismatic. Many times, that boring lecturer has excellent advice and maybe a better radiologist. You need to listen to all your faculty members to learn how to practice our specialty. I like to say that teaching is a team effort. If you learn from just one individual you will likely miss out on the best way to practice.

And finally, think about how your favorite mentor’s practice affects patient care. Does it make sense to ignore the liver windows on a CT scan when you improve your sensitivity for the detection of metastases in a patient with colon cancer? Probably not. Sometimes, we, as students, need to use some common sense.

Great Teachers And Radiologists: Not Always The Same

We love to ascribe positive sentiments to our favorite mentors and teachers. While true for some, not everyone is great at everything. Sometimes, we have to step back and decide for ourselves if our most entertaining and best lecturers are teaching everything that we need to know for our future. If you want the best experience from residency, learn from all your faculty, whether “charismatic” or “sub-par.” You will be happy that you did!

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Radsresident Book Poll

book poll

So, the results from my informal survey of radsresident readers are back! And, I thought it would be interesting to first compare the results of the Saint Barnabas residency book poll to the Radsresident book poll results today. Here we go!

First-year radiology residents from Saint Barnabas and the Radsresident survey agreed that Felson’s Principles Of Chest Roentgenology, Lawrence R. Goodman, Core Radiology,  Jacob Mandell, and Fundamentals of Body CT, W. Richard Webb, William E. Brant, and Nancy M. Major are the most popular

Second years from both groups agreed that Core Radiology,  Jacob Mandell is the most popular.

Third years from both groups agreed that Core Radiology,  Jacob Mandell is the most popular.

Unfortunately, I did not get enough 4th years to reach statistical significance to compare with the original poll.

Overall, the most popular book is (drum roll please……..) Yes, you guessed it. The top choice for both polls is Core Radiology,  Jacob Mandell.

Lastly, I also added a few more categories for fellows and attending. Why not get their opinions too? At least, they have had some successful experience with residency!

Check out the results from my informal radiology book poll at the bottom of this blog in order of popularity for each residency year.

The Final Results of the Radsresident Book Poll!

So, now I present you a list of the results from my online poll with links to the same books on Amazon (where I am an affiliate!)

Attending

Brant And Helms’ Fundamentals of Diagnostic Radiology, Jeffrey S. Klein, William E. Brant, Clyde A. Helms, and Emily N. Vinson

Fundamentals of Body CT, W. Richard Webb, William E. Brant, and Nancy M. Major

Core Radiology,  Jacob Mandell

Fellow

Thoracic Imaging: Pulmonary and Cardiovascular Radiology, W. Richard Webb and Charles Higgins

Osborn’s Brain, Anne Osborne, Gary Hedlund, and Karen Salzman

Genitourinary Radiology by N. Reed Dunnick, Jeffrey Newhouse, Richard Cohan, et al.

4th Year

Not Enough Results For Statistical Significance

3rd Year

Core Radiology,  Jacob Mandell

Fundamentals of Body CT, W. Richard Webb, William E. Brant, and Nancy M. Major

Crack The Core Exam,  Prometheus Lionhart

Fundamentals Of Body MRI, Christopher Roth and Sandeep Dehmukh

Radiologic Physics War Machine, Prometheus Lionhart

2nd Year

Core Radiology,  Jacob Mandell

Fundamentals of Body CT, W. Richard Webb, William E. Brant, and Nancy M. Major

Duke Review Of MRI Principles, Wells I Mangrum, et al.

Nuclear Medicine and Molecular Imaging: Case Review Series, Lilja B Solnes and Harvey Ziessman

Neuroradiology: The Requisites, David Yousem, Robert Zimmerman, Robert Grossman

1st Year

Core Radiology,  Jacob Mandell

Fundamentals of Body CT, W. Richard Webb, William E. Brant, and Nancy M. Major

Felson’s Principles Of Chest Roentgenology, Lawrence R. Goodman

Crack The Core Exam,  Prometheus Lionhart

Radiology Review Manual, Wolfgang Dahnert

Weir & Abrahams’ Imaging Atlas of Human Anatomy, Jonathan Spratt, Lonie Salkowski, Marios Loukas, et al.

Neuroradiology: The Requisites, David Yousem, Robert Zimmerman, Robert Grossman

Enjoy the list and most importantly, thank you for your participation!!!

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Top Ten Radiology Resident New Year Resolutions

It’s the beginning of another year. And, the average Joe off the street creates a list of new year resolutions. Some of them he will keep, and others he will forget. Perhaps, he will try to begin to clean up the house or start to eat right.

Well, as radiologists in training, you have a different set of wants and desires that would appear foreign to the average chap. (And perhaps, a bit bizarre!) I mean who in their right mind would want to read films, do procedures, and see patients. Shouldn’t we concentrate on living life? In any case, here is a list of the top 10 resolutions I would think are most important for the radiology resident for 2019!!!

The Top Ten Radiology Resident Resolutions

  1. Reading more hours every night- One hour is just not enough!
  2. Completing your study logs on time- Be kind to your program administrators…
  3. Paying off student debt interest- Don’t let those debts rack up as much by the time you graduate!
  4. Reading more films and completing more procedures- You can never know enough normal variants!
  5. Staying awake and listening at noon conference– Who knows? You may remember a few tips for when you are practicing as a radiologist!
  6. Always checking for prior films– Don’t get burned later on in your career. Avoid lawsuits!
  7. Arriving on time to work every day- This can get you in trouble later on in your career and may get you fired!
  8. Traveling when you are off- Seeing new places is crucial for maintaining sanity…
  9. Maintaining calm when you receive unreasonable requests for a study- Losing your temper can lead to adverse outcomes!
  10. Standing up instead of sitting down at readouts- Burn a few extra calories while you are at it!

Let me know if you agree or disagree with these top resolutions. Comment below!

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I Am A Foreign Grad- How Can I Stand Out To Get An Interview?

foreign grad

Question:

Hello, Dr. Julius. I am a foreign medical graduate in my third year of medical school, and I want to apply for a radiology residency after graduation. I wanted to know from your perspective what would make a foreign grad application stand out and prompt you to interview them. 

Thank you for taking the time to answer my question!

Regards,

Want To Stand Out

Answer:

Foreign Grad Categories

To begin with, not all foreign residents are equal. I like to classify foreign medical grads into a few separate categories. First, you have the foreign medical grads who are United States citizens and have passed the USMLE exams. These folks tend to have the most excellent chance of acceptance because they do not have any VISA issues.

The second type of applicant is not a United States citizen but has also graduated from a foreign radiology residency in addition to an international medical school and has passed the USMLE exams. These graduates are usually a bit higher up on the totem pole because they have loads of experience to bring to a radiology residency program.

To categorize the rest, you have the non-US citizen foreign grad who has completed the USMLE series. Finally, the last group is non-US citizen foreign grads who have not completed the USMLE.

Depending on which category, your chances of an interview will vary dramatically. If you are part of the first category, you have the best chance of an interview. Instead, you have almost no chance if you are in the last group.

Regardless of which category, some U.S. radiology programs will not even look at your application if you come from a foreign medical school. So, you cannot expect to have as many interviews as a U.S. graduate. However, if you have U.S. citizenship, the odds are a bit higher.

Oh, and one more thing. Since the ACGME merged with the AOA, a D.O. graduate in the United States has the same options for residency as an M.D. Separate D.O. residencies will no longer exist. So, in effect, unfortunately, the increased pool of these non-MD candidates decreases the chances of obtaining an interview as a foreign grad.

Now That I Know My Chances, What Should I Do?

What can you do as a foreign grad if you are in any of these groups? First, I would recommend getting to know the program director and faculty to get the “inside track.” Often, personally knowing the faculty may be the only way to get an interview as a foreign grad. So, that would be my first strategy. What else? Participating in research or an observership can also help the foreign grad. Finally, the board scores of a foreign grad will often need to be significantly higher than an American grad to receive an interview.

Also, I received a lot of questions about how to apply. Most programs will not even look at your application unless you go through the ERAS system. So, make sure that you are filling out the ERAS application! And, unless it is a unique circumstance, don’t even bother to apply to a program without going through the online system.

 

I hope that answers your question,

Barry Julius, MD