Month: June 2020

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Passed The Radexam Precall Quiz? You May Still Not Be Ready To Take Call!

radexam precall quiz

Ask ten different program directors on how they decide if their residents are ready to take calls and place them in the same room. You will most likely get ten different answers, plus a heated debate (maybe a fistfight or two!) But, I have witnessed some residents who have passed the Radexam precall quiz perform poorly on call. Likewise, I have seen residents with borderline or failing scores on Radexam make a stellar performance when they start overnights. So, what is it that the exam is missing? I think I have it all figured out!

When we look at the skills that you need to succeed at nighttime, there are three general categories: reading, picking up findings, and professionalism. The Radexam tests the first part, knowledge, and I believe it is acceptable for this purpose. But, it leaves out the other two essential categories. Fortunately, most residents are professional, and you can observe their professionalism during their first year, so that category is not usually difficult to assess. However, the ability to pick up findings is a whole other kettle of fish. Some residents can have a vast knowledge base, yet have a tough time making the calls on a film. If you don’t test for it or observe it, you may miss these prospective call-takers. Houston, there may be a problem!

What Can You Do To Improve Your Finding Skills?

If you think you might be in this boat, what can you do to improve your finding skills? Well, several different techniques can help to improve your skills. The first and most obvious way to improve this skill is to read through lots of cases without knowing the answer beforehand. In today’s environment, in some programs, it is effortless for some residents to slide by without having to make any decisions on their own during the first year. These residents will typically either sit by the attending and watch them make all the findings. Or, they will continue to read books during the day without being an active participant in the case. If you want to learn the skill of making findings, passive learning techniques such as these don’t cut it. You need to flip through the cases on your own!

Additionally, you need to use materials that use lots of images. Now, this is a widespread first-year mistake. Many first-year residents continue to study like interns and read lots of materials without looking at the pictures. In radiology, you need to do the opposite. You need to look at lots of pictures and then read the content. To find appendicitis, you should see at least a hundred different cases before you can readily identify it. Some instances are subtle, and others not so much. Looking at all different sorts of examples of a particular disease entity will eventually get you to the point where you can easily make the findings without as much mental effort.

And finally, there is a subgroup of residents who have not read one lick during their first year. If you don’t know what the different disease entities are, how will you find them? However, this group overlaps with the lack of professionalism and lack of knowledge groups. Most residency directors can pick these folks out. And then, it’s a natural remedy. Read more!

How Should Program Directors Test For This Skill?

Direct observation is the key. Just utilizing a test like Radexam only tests the knowledge component and cannot substitute for observing a resident taking real cases.

Now, at some programs, the faculty may not have much time. But that is not an excuse. Testing residents before overnights is the moral and ethical thing to do. How can you allow a resident without the proper tools to take care of patients? It is unjustifiable!

To test residents for finding skills, I typically take a series of 10 reasonable overnight sorts of cases and watch how they perform when looking for the findings. Usually, I make sure that the residents can get about 2/3 of them right. I’m sure there are other ways to do the same thing, but I have found it reasonably simple to find a group of typical on-call cases.

Also, in the real world, you do not have the luxury of infinite time. So, we make sure to limit the amount of time per case. This simple process can quickly identify residents that are falling off the bell curve because they take to long to look at a case.

Are You Ready To Take Call After Passing The Radexam Precall Quiz?

Well, for those of you that are finishing up their first year, right about now, make sure that you continue to go through cases even after taking the Radexam Precall Quiz. If you don’t have a formal method to check whether you are ready in your residency, please make sure to ask your faculty or a senior resident to observe you. Sometimes you need a second set of eyes to ensure you are on the right path. If you want to get an idea of some of the cases for testing in our residency program, I will refer you to the previous years’ pre-call quizzes on this website for a nominal fee. Check them out! Otherwise, make sure to go through your institution’s classic cases without knowing the diagnoses beforehand. This process works to make you a better on-call radiologist!

 

 

 

 

 

 

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Now USMLE Step I Is Pass-Fail, What Do I Need To Do?

pass-fail

Question About Pass-Fail Step I USMLE:

Hello,

I’m going to be starting medical school this coming August and was interested in DR. Still, with Step 1 becoming Pass-Fail, I am not sure how to strengthen my application to Radiology Residencies. Do program directors value research/community research more than other metrics? Step 2 will likely become the new objective score by which program directors may filter applicants. I was looking for any other advice you might have for applying to a Radiology Residency once Step 1 becomes Pass/Fail. 

Thank you!

Answer:

First of all, I will direct you to my article on this topic called USMLE Step 1 New Pass/Fail Grading-Winners and Losers From A Program Director’s Perspective! – RadsResident

That should give you a bit of background on what I think will happen over the next few years. But, in your particular case, for a typical applicant from a regular U.S. Medical School, the most important criteria for acceptance to a program is and will continue to be the dean’s letter. So, anything that you can do to boost your performance in medical school will help the most.

As you have alluded to, the USMLE step II will continue to be important as long as there is a significant correlation between testing scores and the core examination. So, programs will most likely continue to use USMLE step II scores because they will most likely have some relationship with test-taking abilities. That will ensure that the residents in the program are more likely to pass the core exam. (Not that I like either the USMLE or the core exams in particular!)

Once you have taken these factors out of the equation, research becomes essential. Why? Because it shows that you are interested in radiology and took the time to complete a project to prove it. And, then all the other tangible and intangible factors play a role in our decision for acceptance (recommendations, other extracurriculars, interviews). And lastly, the personal statement is the least powerful of the admissions criteria.

The bottom line: Other than the test criteria changing from USMLE I to II, I don’t see much else changing in the selection process at the current time.

Good luck!

Barry Julius, MD.

 

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How To Do Remote Learning The Right Way

remote learning

Not all programs are alike. Some have advanced IT departments that will create whatever materials the faculty wants. Others have barely entered the digital era. Regardless of how far along the curve your program or hospital sits, we’ve all been thrust into this brave new world, now that residency programs and radiologists demand social distancing.   So, let’s look at the requirements that remote learning tools should satisfy to be successful.

If you are looking to apply to programs, ask whether the residency has these tools. Or, if you are a resident or faculty member in a residency program, try to push the residency to get them. Residencies that do not have most of these remote learning tools are way behind the times!

What Do Programs Need  For A Successful Remote Environment?

HIPAA Compliant Online Meeting Places

As much as I am a fan of Zoom, it  does not allow for safe discussions about sensitive subjects. Just take a look at this Forbes article from the end of April 2020. We certainly cannot entrust private conversations about patient cases in this environment. Residents and attendings alike need to discuss patients in a setting where they don’t have to worry about hackers entering a meeting. If your hospital or imaging center insists on your radiologists using Zoom or other insecure remote viewing tools to look at patient images and information, it can put the patients and radiologists at risk.

Remote Application With Ease Of Use

What good is a remote tool if it takes you 2 hours to get on the network? We need to be able to reach our intended colleagues and fellow residents rapidly. Sitting in front of a computer and waiting a half hour to get past the initial page is not acceptable. All the remote tools must be quick  use for anyone to logon.

Also, remote access tools need to be turnkey. We should be able to rapidly learn how to use them and have our colleagues respond accordingly. Moreover, hospitals should have networks to enable easy access to these resources.

Attendings and residents alike should use these online tools to go over cases and procedures together. Any faculty member or resident should contact each other with them at any time during the workday for learning.

Online Radiology Library

We are no longer in an era where we should need to have one resident wait for someone else to finish reading a radiology text from the library. All residents should have immediate access to both standard textbooks and relevant radiological periodicals online. Any hospital that does not allow for this needs to get with the times. A well-read resident should have all the reading materials that she needs.

Remote Noon Conferences/Scheduling

In addition to HIPAA compliant meeting places, all residencies should have their attendings ready to give noon conferences on the remote access tools. And, that implies all faculty members that provide lectures. It is no longer acceptable to have lecturers unable to give a noon conference because they do not know how to access or utilize the remote meeting applications.

Remote Attendance/Check-ins

Many programs have their residents digitally check-in in the morning or at the start of a noon conference to document that they have attended. Additionally, programs should have the online logs of cases that residents have performed or watched, not just for the six-month resident evaluations, but also for the program itself. This documentation helps with compliance to show that the residents have completed the appropriate requirements of residency. If public schools throughout the country can utilize remote attendance, radiology programs can undoubtedly do the same!

Acceptance Of The Remote Learning Environment

Finally, and probably most critically, all programs need to create a culture where we embed these tools into the fabric of the daily work. All attendings and residents alike should feel comfortable using these remote learning tools. And, they should make use of them whenever possible. There should be no excuses as to why the players within a residency program can’t work with the remote learning tools!

Remote Learning: The Way Of The World

Remote learning is no longer just a fancy accoutrement or add-on to a residency program. It has become a requirement that all residencies should  satisfy to maintain the health and welfare of the residents and faculty alike. These factors should be the bare minimum for a successful residency experience. My advice: make sure your program takes remote learning seriously. It is a necessity for radiology learning today!

 

 

 

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Get Back To Work Now, Will You!

work

Many of us have experienced a recent hiatus from our regular radiology activities related to decreasing imaging volumes. It has been not uncommon to work one, two, or more days less per week than before. Although you may not have wanted this pathway to less work, it has had some positive effects. We have more time at home. Many of you have restarted long begone projects unrelated to the radiology world. Others have begun to re-experience their family life after years of being pulled this way or that.

But now, if your practice or hospital is anything like mine, we have begun increasing our workload. For some, this may be a bitter pill to swallow. We have experienced a taste of an alternative life, the life we could have had if we had an alternate career, or have worked part-time. And, I have a sneaking suspicion that for some radiologists out there, this change may eventually become permanent. But, most of us want to get back into the swing of things. How can we get back to a more regular working existence in radiology after such a long break in the action? Here are some suggestions.

Remember Why You Went Into The Field

Most of us, residents and attendings alike, can think of a time that we made a finding or came up with a differential diagnosis that changed a patient’s life. Or maybe, you can remember a time when you put that stent into a patient’s leg, and the patient could walk without pain afterward. Picture how these moments felt. Think about how they had attracted you to the field of radiology.

Find Some Great Cases And Discuss With Colleagues

Maybe we are no longer on top of one another in the reading room. But, there is always room to pick up an unusual case and share it with some of your colleagues, residents, and attendings. Nothing sparks more interest in the field than a great imaging dilemma with twists and turns.

Read About Areas That Interest You

It’s not an unreasonable time to start picking up a book or two to learn a new area in radiology that you have not studied recently. Or, brush up on some other topic areas that interest you. As we start to become busier again, you will become more versatile. And, you may save time in the long run. Moreover, learning something new can rekindle your interests in radiology.

Teach Others

Although you may not have the option to do close one-on-one teaching at the same reading station nowadays, there are many opportunities to teach others. It could be remote, on the phone, or across the room. Regardless of the method, get involved. I can think of no better way of sparking interest in yourself and others.

The Hiatus Is Over. Get Back To Work!

It’s time to start up again. And, we need to get our heads back in the game. Make the most of the time you currently have. Whether it is reminiscing about our greatness, going over fascinating cases with others, learning about new areas in our field, or imparting our knowledge, we all need to latch on to those aspects of our field that we enjoy. It is mission-critical to be excited and mentally prepared to get back to a full day’s worth of work once again!

 

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How To Prepare For Radiology Residency, Starting In High School!

high school

Question From High School Student

Hello!
I’m a 14-year-old 9th-grade student, very interested in becoming a radiologist! I’m aware that this is more of a university-level website, but would you, by any chance, be able to give some tips on courses you recommend and what to do in high school to help me to get accepted to medical school. Also, what courses will allow me to do well there?

Thank you so much for your time!
Young But Interested In Radiology

Answer/Advice

Glad to hear that you are enjoying radsresident.com. It’s never too early to start thinking about your career options in life! So, I will give a few of my recommendations to you. First of all, of course, you will need to perform very well in school in all your classes. But, if you are writing this email to me, I have a sneaking suspicion that you are doing that already! You have a slightly better chance of getting into medical school from some of the name brand colleges. However, we get lots of applicants from smaller schools as well. So, if you don’t get into Man’s Greatest University, all is not over. Doing well in your college classes is even more important than high school, regardless of which school you attend.

So, what types of courses are best? I don’t think it matters that much at any stage of the game, except to ensure that you meet the typical medical school requirements- Bio, chemistry, physics, etc. Schools like to see that you have varied interests.

Forgetting about grades and courses, what else should you do? Do a few extracurricular activities that you like and do them well. What do I mean by that? If you love music and you are good at it, take it to a high level. Play for All-State band or at other performance venues. If you are an athlete and like baseball, do it well. Play for college sports and work hard. Or, if you are into student government, make sure that you start small in your school and eventually become proactive in national organizations. Regardless of what you do, please do your best, and do it to its utmost. Don’t be one of those folks that do two hundred different things, is not that interested in any of them, and performs them only superficially. Too many applicants get caught in this trap.

Those folks that get into medical school, ironically, have other interests other than medicine. It’s what admissions counselors like to call the “well-rounded” applicant. So, make sure to enjoy and participate in other activities other than school. And do them to their fullest extent. I would shoot for these goals, not just in radiology, but in whatever goals you decide to pursue.

My two cents,
Barry Julius, MD

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Online Interviews: A Waste Of Time Or An Effective Screening Tool?

online interviews

We are not the first. Many industries have been using online interviews for candidate screening for a while now. Yet, we, in the medical field, have shunned using these technologies for resident interviews for years. As physicians, we have felt the interpersonal connection of a live in-person interview was critical for candidate selection. Now, for the first time this year, the pandemic will force radiology residencies, like all other medical subspecialty training programs, to follow suit.

But, what do we gain and what do we lose by ending the in-person interview process? Are residencies going to recruit a higher percentage of unprofessional or incompetent residents? Or, are we going to discover that the format of the interview matters less than we ever thought in the first place? Lots of questions remain up in the air for this year. So, let’s talk about some of these issues by discussing some of the benefits and disadvantages of the online interview process. Then, we will end off by coming up with some hints for prospective interviewers and predictions for this interview season.

Advantages Of Online Interviews

Saves Tons of Cash

Fourth-year medical students are some of the most debt-laden medical professionals out there. By this time, many have accrued hundreds of thousands of dollars in debt. In the past, programs expected them to shell out umpteen more dollars to attend an interview. No longer. Save on your travel and interview expenses, rapidly adding up to thousands of dollars.

Time Savings

All that time that went into travel before, now you can use it for other purposes. Whether you desire to catch up on Netflix  or study a bit more for exams, additional “me” time is always useful.

“Decreased Pressure” For The Interview Candidates

Indeed, in previous years, live in-person interview situations were a bit more nerve-racking. Of course, with the new online changes, lack of this direct pressure can lead to false comfort levels in the online setting. However, there will be no more sitting and chatting with colleagues in the seats next to you, drumming up your anxieties before your interview!

Disadvantages Of Online Interviews

More Difficult To Get A Feel For The Program

Residency directors and chief residents will now have a tighter grip on the interview process. They will be able to show you more what they want you to see- no more wandering around the premises to figure out what happens in the hospital. You will only get online tours, carefully curated to ignore all the negatives. Moreover, you won’t get a chance to talk to that disgruntled resident in the corner. It will make it that much more challenging to make a final choice!

Also, you will miss meeting anyone in the program, not on the Zoom meeting. These include other physicians, residents, program coordinators, technologists, and more. From my experience, critical staff such as these can also make your residency a delight or a misery.

Harder For Programs To Get At The Real Candidate

The longer you stay in an interview situation, the more likely your real personality will shine. If you get bored quickly and are at the live program director’s lecture, you are much more likely to start using your cellphone. Now, with only a few online interviews for 15 minutes apiece, it will be easier to maintain your cool without lapsing. And, you can have the program director only see what you want! But on the other end for the interviewers, it will be harder to catch the nuances of both candidate and program director personalities alike. That sidewards glance or frown can be much more difficult to detect in a Zoom meeting. Or, we can no longer detect an unkempt smell. It is just not the same. Programs may not get what they bargained for when they match prospective candidates for the following year.

So What Should You Do To Make Online Interviews Worthwhile? (Hints For Online Interviewers)

You need to treat the interview as you would if you were going to an on-site interview. Maintain the same dignity and decorum as you have otherwise. A lapse in judgment or the wrong statement can throw a wrench in the process just as it would have done in years past. By that same token, I would recommend you take a look at some of my previous blogs on this subject, such as Ten Ways To Sabotage Your Radiology Interview and How Important Is My Radiology Interview, Really?  And don’t wear a fancy top or suit and forget to wear pants even though you are online. You never know. You may accidentally stand up and show your briefs!

Predictions For This Interview Season. Will These New Radiology Residents Be Better Or Worse?

In general, interviews are sometimes helpful to weed out candidates that don’t fit the mold of a particular residency. For the most part, I believe that these online interviews will mostly give the same information about candidates as in years past. Candidates will usually put on their best airs regardless of the interview forum.

However, this year, we may see a candidate or two slip through the cracks that would not have made it past the interview process in the past. We may miss some subtle hints, more evident in an in-person forum. But, I believe this to be a very, very small percentage of the total candidate pool. Most likely, this will be hearsay and conjecture anyway, because it is complicated to measure the quality of the candidates in any given year to the previous ones. Nevertheless, I will wait and see this year’s results. The truth will eventually come out!

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