In a few more weeks, most first-year residents will begin to take call and metamorphose from a student into a valuable member of the radiology team. Nightime independent call is what separates the radiology child from the adult. But, as always, most residents have a few hurdles to overcome before they begin. They need to be able to make the findings.
One of the hurdles is the precall quiz—a test before the start of the new year. And, not all first-year residents are ready for the task. Why is that? And what can residents and programs do to equip radiology residents for their newfound role?
Knowledge Versus Search: Two Separate Skills.
Most radiology residents concentrate on the information side of the equation. It’s a much more familiar task. From time and memoriam, including medical school and internship, residents have been studying from books. So, reading books is what they know how to do best. They can remember the names of the disease entities and perhaps some descriptions associated with them. But, radiology is a lot more than recall and picking out a few disease entities from your memory. Instead, it is also the process of making the finding while scrolling through many images on a PACs system. This skill is entirely different. If you don’t believe me, have your average fairly knowledgeable internal medicine physician attempt to read a CT scan and make the findings. It doesn’t tend to work out too well! (There are exceptions to every rule, however!)
How Not To Be Just A Bastion Of Knowledge And Also Make The Findings
Just like another task in life, you need to put the time in to become proficient—the same works in radiology. You need to spend hours at the workstations scrolling through images in addition to reading the books (as you have been doing for years). If you don’t spend the time with the mouse and the computer on the PACs, your brain will not be ready to pick out the findings when the time comes.
Whether they admit it or not, every radiologist uses some form of checklist to make sure they have looked at all the parts of the study. And every resident needs to create the same. If you don’t create a checklist, you will never know what is missing. Why? Because residents and non-radiology physicians tend to make positive findings. But, the negative findings can be just as important to figure out history and disposition. Splenectomies, adrenalectomies, and appendectomies are some of the discoveries you will miss on a CT scan if you do not have a checklist for every organ system. And if you miss these, some of your impressions will sound silly or meaningless.,
Look At Pictures
Finally, residents also need to read. And reading differs from the standard physician resident. Internal medicine residents, surgical residents, and ob/GYN residents can get away with reading only the text or reading the text first. But, we radiologists have to do things a bit backward. We need to look at the pictures first, then the captions, and then the text. Why? Because we are an imaging-based specialty, and if we don’t see the findings on an image, we will never know what to find!
Make The Findings!
Remember. Radiologists read a ton because we cross over so many different specialties. But, in the end, we are primarily an imaging specialty. So, we have to learn how to make the findings, not just be an information bank for consultation with our colleagues. Don’t forget to practice a lot by reading lots of films on PACs, utilizing checklists to avoid missing critical findings, and reading the pictures first when reading textbooks. Practicing these skills will enable you to become an excellent radiology resident and a great radiologist. It’s not all about just reading books!