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Radiology Textbooks Vs. Case Review Books- A Death Match

textbooks

One question that often arises is: what material should I study since there is so much information to learn? But I think a more appropriate question may be: how can I get the most bang for my buck when there are so many reading materials out there? In this post, I will address this issue by talking about when you should be reading textbooks and when you should emphasize case reviews since both play a role in getting up to speed during radiology residency or learning about a new area of interest as an attending. (This is our death match!!!)

Why Textbooks?

Sometimes you lack any understanding of a modality when you begin a residency program, are starting a new rotation, or are attempting to learn a new modality such as MRI, perhaps not covered in your residency. For instance, when they begin, most radiology residents have no clue about ultrasound: how it works, and the images the technologist takes. Therefore, starting to read a case series on ultrasound may not be helpful when beginning.

Instead, a general introductory textbook such as Ultrasound: The Requisites makes more sense at this point to understand the basic principles of ultrasound and the key images that need to be taken and interpreted during a renal ultrasound, Ob/Gynecology ultrasound, etc. Another example would be reading CT scans of the chest. Most residents, when they start, do not have a search pattern for reading chest CT scans. Nor do they know their CT chest anatomy well. An introductory textbook on chest CT scans, such as Computed Tomography and Magnetic Resonance of the Thorax by Webb, would be appropriate before reading a case series.

In addition, good textbooks usually better outline the fundamental knowledge needed to interpret images better than a case review series can. Textbooks are better organized by topics, whereas case review series tend to be more haphazard. For example, it may be more direct and efficient to learn the fundamentals of determining whether an intracranial mass is intra-axial or extra-axial once in a textbook than reading 10 case series on the topic and trying to figure the same approach out.

How To Read Textbooks

When you read a textbook, you should emphasize the images, read the captions, and then read the text to get the most out. Reading in this manner reinforces the information that you need to know better than starting from the text first. This process differs vastly from reading a medical school general medicine textbook, where the text is usually more important than the images. You are now a radiology resident, so you have to think differently!

Why Case Review Series?

In our field, we solely exist because we are image interpreters. So, it makes sense to learn those images and what they mean. What better means to reinforce and understand radiology than with a case series? But, this assumes that the reader has some background knowledge on the topic and can understand the basic principles/fundamentals/meanings behind the images in the case review series.

In addition, case review series tend to have more of a “real word bent.” The images we read daily tend not to follow in an orderly manner by topic. Usually, an almost random distribution of cases comes through our departments. Going through a case review series is usually more similar to going through many images in no particular order.

How To Approach Case Review Series

It would help to start the case review series as soon as you have the fundamental knowledge to understand the modality, anatomy, and primary disease processes on imaging. On each initial rotation, you should aim to start reading at least one case review type of book after you have learned the fundamentals from lectures and textbooks. Do not wait too long to get started, however. Going through the case review series will be more helpful and applicable than most textbooks when you read out cases with attendings and when taking cases at noon conferences. But remember- it often does not summarize the fundamentals of a given subject as well as a textbook.

The Moral Of The Death Match

Both textbooks and case review series are at the beginning resident’s learning armamentarium. Be wary of someone that tells you that you can get through residency by just reading textbooks or case reviews by themselves. Each has its place, and you should use the correct one depending on your level and knowledge base. Now become great radiologists: go forth and read!!!

 

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Top Traits Of Great Radiologists (They Might Not Be What You Expect!)

traits

Over the years, I have discovered that the best radiologists often do not comply with the stereotypical traits of one. For instance, you would think that the best radiologists all embrace technology. However, it is sometimes the opposite. Some of the best radiologists I know are the least technologically adept people you would ever meet, not able to conjure up an email password or conquer a new PACS system.

You would say that they would be masters of video games and spatial puzzles. Well, again, you would be squarely wrong. I know many-a-great-radiologist who find video games distasteful or who have no interest.

You would guess that the best radiologists have an “eye” for radiology from day one of radiology residency. Again, you would be incorrect. Some great radiology residents that I have trained had no clue how to read a film or make a finding on day one of residency.

So what is it that makes up the traits of the best of the best radiologists? Based on my experience, it is the following: enhanced clinical training, grit and determination, extreme organization, singular focus, and the passion for learning and maintaining scientific interest in our field. So, let’s go through each of these traits. Then, I’ll give you examples of how each allows some of the best radiologists to perform above and beyond the average radiologist. Finally, I will go through some recommendations on how you can train to be this great radiologist. Try to incorporate some this additional training or these personality quirks and traits into your daily practice.

Enhanced Clinical Training In Other Medical Fields

Some of the most incredible radiologists that I met had initially trained for a different medical subspecialty. The ones I know have either completed a second residency or participated in a residency in internal medicine or pediatrics for more than the required solitary clinical year. These radiologists have a complete understanding of the clinical issues involved in the patient’s films that they are reading. They take a step past the interpretation of the image and make it relevant for the clinician on the other end. They tend to know how to manage patients to a tee and use their skills to better the patient’s welfare. Excellent clinical management for a radiologist is a rare skill.

How can you add these traits to your practice in radiology? Participate in electives that involve interdisciplinary management. Question your fellow clinicians about the clinical significance of your interpretations. Shadow physicians in other specialties.

Grit and Determination

These excellent radiologists are folks that overcame incredible odds to get to where they are today. By sheer determination of will, they take an interpretation of a film to a new level, farther than the typical radiologist. They look into clinical issues more deeply than others. They don’t just stop at the conventional differential diagnosis. And, they can tell you the hows and the whys of what they find. When a clinician stops by, they are mesmerized by the litany of what these clinicians seem to know.

How can you add these incredible qualities to your arsenal? Don’t stop at the mere interpretation of the film. Look further into clinical history. Read up everything about the disease entity. Find out facts that would be clinically relevant to your patient’s care. Always look at priors that may have relevance to your case. Don’t be lazy with any of your imaging cases!

Incredible Organizational Skills

I have never met a great radiologist who has poor organizational skills. Conversely, the great radiologists I have met all have incredible organizational skills. These radiologists tend to keep track of all the patients they have ever seen. They use this information to interpret images and extrapolate the information to other patient’s circumstances. You can ask them about a case they may have seen a year ago, and they can go into their written or mental records and find it. They use all of this information for the betterment of patient care.

How can you become organized as a radiology resident? Always keep track of your unusual cases. Take pictures of the cases you see. Maintain a written or online notebook of what you learned. All these organizational skills will come in handy when you complete your residency and have questions about challenging cases.

Persistent Focus

Some of the most incredible radiologists have a single-minded focus that allows them to read cases, do research, or teach with such precision that they are best in their fields. They are not distracted by the daily minutia, the irrelevant red herrings, and the rumors of the day. They concentrate on their work and their work alone. These radiologists tend to miss very little. They are the type of radiologists that seem to have very few reports with errors and mistakes.

How can you maintain focus on your daily rotations? Maintain awareness of what you are doing at all times. Keep conversations and distractions to a minimum when you sit or stand to read multiple cases. The patient should be first and foremost on your day’s schedule. That is why we are here- to help people!

Passion For Learning/Maintaining Scientific Interest

Finally, the best radiologists I have encountered have a mission to either teach, research, or learn. They enjoy every minute of these processes and convey their passion to others in the specialty, whether they are fellow attendings, residents, nurses, techs, or patients. Moreover, their enthusiasm is infectious and inspires others to want to be the same. These are a rare breed and help overcome the problem of burnt-out physicians through teaching and personality. These radiologists go a step farther not because they have to, but because they enjoy radiology.

How can you become passionate about radiology? Don’t let the folks that complain all the time get you down. Find your path and what interests you. Don’t look to the negative, as those folks tend not to be the successful ones. People that love their specialty tend to become excellent at what they do. So, find your interests and passions and go with them all the way.

Final Inspiring Words

It is not typical traits such as being a techie, having “an innately good eye,” or being a puzzle master that makes a great radiologist. Instead, it is often those skills that we can work on that make us better than the average radiologist out there. So, go forth and learn about other specialties, keep determined, stay organized, maintain focus, and develop a passion for learning and radiology to become the best radiologist you can be!!!

 

 

 

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Five Reasons Why The First Year Of Radiology Residency Can Be The Most Difficult

first year

Second-year radiology residents become overwhelmed and burdened by call. Third-year radiology residents feel exhausted from studying for their core radiology examination. And, the fourth-year radiology residents fret about all the things they need to know before starting their career. But, what about the plight of the first-year resident? Many non-radiology physicians and some long-practicing radiologists think that these residents have it easy since he does not have many responsibilities. He can merely sit and watch the radiology attending to learn the practice of radiology, right? However, in this post, I am going to dispel that notion. I will go through five reasons why I think the 1st year of radiology residency is usually the most difficult.

Little Medical School Background In Radiology

Unlike internal medicine, surgical, ob/GYN, and psychiatric residents, most beginning first radiology residents have had almost no experience in the mechanics of all things radiology. Sure, they take a few courses during medical school. However, they are usually surveys. Also, they do not provide the vast experiences needed to function as a full-fledged radiology resident.

On the other hand, internal medicine residents have worked up patients with histories during their medical school training. Ob/GYN residents have usually delivered a few babies in medical school before beginning. Surgical residents have assisted in multiple surgeries and have worked the floors before their first day of residency. And psychiatry residents have interacted with numerous patients before starting. These initiated residents can almost entirely function from day one.

Instead, new 1st-year radiology residents cannot dictate, review films to be read, or finish the procedures that we perform daily. Since a first-year radiology resident cannot complete most of the functions to be “of use” to the senior radiologist, many first residents feel inadequate until they can begin call as a second-year. At that point, they can function much more independently. However, the lack of training certainly can make for a problematic initial year.

Incredible Amounts of Reading For The First Year

More so than other specialties, radiology requires a boatload of reading during the first year. You need to understand internal medicine, surgery, obstetrics/gynecology, orthopedics, neurology, and more to become a respectable radiologist. Unlike other specialties, you cannot get away with little reading and learn only from your experience with others. If you do not read for hours every day, you will fall behind and not pass the core examination. Many residents do not know the requirements before starting and take a long time to adjust to the nightly reading regimen, a painful process.

Dictations- A Difficult Road

Imagine your frustration as you first start with never having held a Dictaphone. You click the wrong buttons and feel unsure of yourself as you talk into a stick!!! This routine is typical for the first year that starts to dictate. Not only does the first-year resident have to get the physical mechanics of learning dictation, but they also have to create a report that makes sense. This process often occurs with little instruction or regimentation. It becomes hard to put ourselves in the shoes of the first-year resident. However, as an associate residency director, I regularly recognize how hard it is to start from scratch what we routinely do as radiologists daily.

Frustrated Attendings Who Don’t Want First Years Around

Unlike more independent senior residents, radiologists typically have to take extra time out of their day to teach a first-year radiology resident. Given the increasing workloads of radiologists, many attendings see this as a burden. They would instead get home to their family on time in the evening. Additionally, the attending does not know the first-year resident well. Therefore, he cannot figure out how much responsibility to give. Other radiologists feel forced and have no desire to teach. The frustrations of many attending radiologists reflect in the personal interactions with the first-year resident. Often, the resident gets the sense that he/she is not wanted around. Depressing, huh…

Noon Conferences- A Foreign Language

Have you ever listened to a conversation in a language that you do not understand? That is the feeling that the first-year radiology resident often gets when he/she goes to the first noon conference. Attendings give noon conferences on topics such as ultrasound or MRI. Yet, these radiology residents have never seen these images. On top of that, they use language that is not common vernacular.

Moreover, the findings are incomprehensible to the uninitiated resident. Many attending radiologists do not recall what it is was like to attend these conferences. However, these esoteric conferences are standard for first-year residents.

The Final Upshot For The First Year Resident

Senior radiologists can easily dismiss and forget the challenges that first-year radiology residents face. However, please don’t discount the first-year radiology resident’s frustrations, experiences, and anxieties, as they are genuine. It takes an extended period of adjustment to acclimate to the daily work experienced by radiology residents and attendings. Give the lowly first-year radiology resident a chance!!!

 

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The Precall Quiz: Mechanics of The Test And Preventing Failure

It’s getting to be that time of the year. Spring… Ahhh… Birds chirping, snow melting, and oh yeah… of course… first year resident preparation for the first night of call. Often times this process begins with a bang called the Precall Quiz.  Although it is not a specifically required measure for being able to start call, it is a way that many residencies assess the functioning of the soon-to-be second year in a “real-world” situation. Sometimes the residency program sets up the precall quiz. Other times, the residents create it. Regardless of who prepares the exam, the first year resident needs to prepare the same. Since the contents of the examination are generally limited to call cases, he/she should be able to expect what is going to be present on the quiz and be able to pass it without question. In today’s post, I am first going to go over the mechanics of a proper recall quiz, whether prepared by the chief resident or program director. And then most importantly, we will talk about how a resident should prepare to pass the test and make sure to feel “comfortable” taking his/her call for the first time. Here we go!

For The Residency Program: What Is A Fair Precall Quiz?

A precall quiz should consist of both the material/contents needed for the first night of call as well as be similar to the way that cases are taken on a night call. What does that mean? Emphasized cases should be situations that could “kill or severely injure patients” or are very common. In addition, it should also contain a few normal variants. These components will most simulate a real night on call.

Furthermore, the style of the examination should be given in the same way that call is taken. In other words, it should probably be administered on a PACS workstation in the way that cases are usually evaluated. Some residencies may still use the PowerPoint format. But, I think there is a danger to giving an exam with cases in this style. Giving individual pictures in a PowerPoint presentation format only assesses knowledge base and not the ability to find lesions on imaging modalities. Both of these qualities need to be evaluated prior tuo beginning call. Or else, a resident that passes this sort of examination is not truly assessed on all the fundamental knowledge bases needed to assess call competency. In fact, these residencies may be setting up certain residents for failure without the appropriate learned “finding strategies” when night call begins.

For The Examinee: How To Pass A Precall Quiz?

Studying should theoretically begin when the resident starts residency. However, many times residents will often cram knowledge into a short period of time prior to an exam. Either way, the examinee should really concentrate on ER case studies prior to taking the test. These should be the killer diseases such as aortic ruptures, pnemothoracies, neurological bleeds and infarcts, and so on. Also, you should be looking at lots of cases that are very common with some morbidity such as appendicitis, diverticulitis, cholecystitis, and more. I would recommend the Emergency Radiology Case Review Series as one resource that would be very help for taking the taking quiz. But, of course, it just a starting point. Make sure to look at hundreds of versions of the common disease entities so that there are no surprises on your first call night. It can be as simple as Googling appendicitis and looking at all the ways that this disease entity presents. But, it is just as important to attend your rotations real time so you have the experience of knowing how to use the PACS system to scroll and find these disease entities in a “real word” setting.

How To Feel “Comfortable” On That Dreaded First Night of Call

OK. I lied a bit at the beginning of this post. The truth is that no trainee radiology resident ever truly feels comfortable on their first night of call, unless you were born with the genius gene or you are missing the emotion of fear! So, do not expect to feel entirely in your element. That being said, if you know cold the entities that will kill or severely injure patients, have studied appropriate cased base material, and attend your daily rotations it is very unlikely that you injure anyone. The knowledge that you passed your precall quiz and know the basics should put you in good staid. Remember that most radiologists before you have been through the same situation as you and most have made it through the first night of call unscathed. And if you listen to me,  just like them, you will make it through the process too!

 

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Should A Resident Physician Apply For A Credit Card When Already In Significant Debt?

credit card

Credit is a very touchy subject with resident physicians in all specialties. And it makes sense. Student debt seems to be increasing exponentially over the years. When I graduated, I thought I had a lot of debt from student loans. But that number pales compared to the debt that most current medical residents hold. Confirming this suspicion, I did a miniature survey of almost 100 medical students at my hospital. Student debt sums were as high as 600,000 dollars. These medical students had not yet completed their four years of training. So, the amounts were going to be higher than that. These sums of money are not insignificant. Instead, the debt will be life-altering for many of these future physicians for years. On top of that, add a high-balance credit card, and you may head toward financial ruin!

This enormous debt burden brings me to the next question. Does it make sense for a resident to apply for a credit card after accruing so much debt? This question came up in the past year with a resident who had not started to get credit in his name. It caused all sorts of issues for him at the time they needed it. And it will probably continue to cause problems for years to come until he establishes a good credit record. So, the simple answer is yes. But in this post, I will explain why setting up a few credit card accounts makes sense even with significant debt. And I will briefly discuss how residents should establish credit.

Why Do Resident Physicians Need A Credit Card?

Laying out Money

A radiology resident often must lay out a significant amount of funds for travel or a large purchase such as a car. What do you do if you do not have a credit card or do not have a credit card with enough credit? Nowadays, most travel is booked online with credit cards. For many websites, the only form of payment is a credit card. You are now stuck with either relying on others to book your flight or not going on the flight. Once you reach a resident’s level, these issues arise often.

Establishing a Track Record For Large Future Expenses (Mortgages, Car Loans, Etc.)

To purchase large items such as a house or a car without cash (and most residents don’t have lots of money on hand!!!), you need to obtain a mortgage or a loan. How will some company provide you with a loan if you do not have a long track record of making payments? Sure, you have your student loan as some background. But that is not enough. You must also have at least one revolving credit account (a credit card) to increase your credit score to obtain these large loans. A credit card is an excellent way of establishing this background.

Cash Back Credit Card

Finally, many credit cards offer incentives in the form of airplane miles, gifts, and cash. Cash has the most value out of any of these rewards. When you make a purchase, you can get a certain amount refunded on every purchase. Some cards give you 5% on specific items or 2% on all items you purchase. So, it really can add up over time. If you use credit wisely, it can pay back dividends!

How To Establish Credit Without Breaking The Bank

If you have a poor or no credit history, finding a good credit card company willing to give you a credit card can be challenging. Even with these issues, there are several ways to establish credit. You can apply for cards backed by your savings or find cards with very low maximum balances. Either of these sorts of cards will allow you to occasionally use the card to make small purchases such that you can begin to establish a credit history. And remember to use personal credit hygiene: Pay your balances off monthly and try to use a small percentage of the credit allotted. These small steps will allow you to establish a good history without spending too much.

Summary

Even though resident physicians already have vast amounts of debt, establishing a credit card account becomes very important from both a practicality and utility standpoint. You can do it in a way that does not cause additional debt burdens or hardship. Bottom line: Establish credit now rather than later when you need the credit!

 

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Up To Date Book Reviews For The Radiology Core Examination

Studying for the ABR Core Exam is undoubtedly a daunting task. Not only can the sheer amount of material one needs to learn seem overwhelming, but also the vast amount of resources available can be more of a burden than an asset. I often see my fellow residents scrambling to make time to go over every single review book out there, in an effort to have all of their bases covered. This strategy is not only nearly impossible but is likely counterproductive. Rather, one should focus on one “comprehensive” review book while supplementing with case review books and question banks that work best for them.

 

When asking my peers about their thoughts on different study resources, I could never get a good consensus on what was best. Different people had the same success passing the exam with very different approaches. However, one commonality I did notice amongst those who had success on the exam was that their approach was comprehensive (covered all categories tested) and diligent. With that being said, it is best to first peruse a resource to make sure it is useful for your style of learning before fully committing your time (and money) to it. Also, it should be noted that none of these are substitutes for a comprehensive textbook (such as Brant and Helms or the Requisites series). Review books are most effective when they are, in fact, used as a review and not a primary source of learning.

 

Below are reviews for the resources my colleagues I used, some more than others, to prepare for the ABR Core Exam.

 

COMPREHENSIVE REVIEW BOOKS

 

Core Radiology: A Visual Approach to Diagnostic Imaging

 

This is an excellent review book that can be used as a single source for reference and overview of salient points. It contains lots of good quality images and diagrams (in color!), as well as tables summarizing differential diagnoses with easy ways to differentiate one entity from another. As with any review book, it may not delve into as much depth in any single topic. Supplementation with Brant and Helms, StatDX, or Radiographics articles may be required for certain topics that require more depth or clarity. This book can be easily understood by junior residents throughout their first or second years of residency, not simply just for those reviewing for the Core Exam.

 

One drawback of this textbook is its size. At 895 pages, it can be a pain to lug around. Also, compared to Crack the Core, this text lacks humor and motivational quotes. Rather it’s more of a traditional, no-nonsense, well-organized review.

 

Crack the Core

 

Written under a pen name by “Prometheus Lionheart,” this series includes two main volumes, together encompassing the main sections covered on the Core Exam. In addition to the main two-volume set, Lionheart has also written a separate dedicated physics review book as well as a case review book (which I will cover separately). This two-volume set is another excellent review source. While it covers much of the same material as Core Radiology, this text is geared specifically for passing the Core Exam by incorporating test-taking strategies in addition to providing factual information. Lionheart interjects jokes and motivational phrases to keep the reader entertained while studying (not an easy task!). This book is much more simplified than Core Radiology, but serves as an excellent review for someone with solid background knowledge of the topics included. The physics and non-interpretive skills chapters in Crack the Core is much more robust and comprehensive than in Core Radiology. Additionally, Lionheart has a video lecture series to supplement his books (at an additional cost, of course), which can be useful depending on your style of learning.

 

One of the main drawbacks of the Crack the Core series is the abundance of typos in the text. While the typos generally don’t alter the context, they can be an annoyance. Another downfall of Crack the Core is the image quality and lack of color diagrams. The supplementary video lecture series does have improved image quality and nice color diagrams and animations, however.

 

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CASE REVIEW BOOKS

 

Core Review Series (Thoracic, GU, GI, MSK, Breast, Cardiac, Nuclear Medicine)

 

The newest of the main case review books, the Core Review Series has separate books in Thoracic, Genitourinary, Gastrointestinal, Musculoskeletal, Breast, Cardiac, and Nuclear Medicine. Each book is broken down into chapters, with each chapter covering a specific subcategory (usually starting out with fundamentals of imaging for that category or normal anatomy).

 

The good: The breakdown by chapter and multiple questions per chapter allows you to hone down your studying to a specific topic and to do multiple questions in a relatively short time period. Image quality varies by book but is generally very good. Most books have online access with an easy interface for doing questions (almost feels like a Q bank). The descriptions of the answers are excellent. I feel that these books best prepare you to think the way they want you to think about the test; to understand the process of why an answer is right rather than regurgitate memorized information. Many of the books even have physics concepts integrated into the questions, which is a tactic the ABR often employs on the Core Exam.

 

The bad: When using the physical books, it can be tedious to flip between the questions and the answers (which are located at the end of the chapter). This problem is alleviated with the online versions, where the answers are available immediately after taking the question. Also, because not all subjects are covered, other sources must be used to supplement these areas (such as Interventional, Neuro, and Pediatrics)

 

 

Rad Cases (Cardiac, GI, GU, Interventional, MSK, Neuro, Nuclear Medicine, Pediatrics, Thoracic)

 

Rad Cases offers a case-based approach (rather than the more question/answer format of Core Review Series) with approximately 100 cases per book. Each case shows images and a clinical presentation on the first page. The next page then goes over the imaging findings, differential diagnosis (with brief descriptions of each diagnosis and how it may or may not explain the imaging findings), essential facts about the disease entity, other possible imaging findings, and finally pearls & pitfalls.

 

The good: This series really does a good job of allowing the reader to come up with a systematic approach to a case. The explanations do a good job of highlighting how one may have fallen into a trap or how one should tailor their thought process when approaching a case. All of these are essential aspects of passing the exam, but relate

 

The bad: While learning how to approach an unknown case is necessary to tackling exam questions, this text appears more driven to prepare residents for the old oral boards. One could argue that a more rapid-fire question/answer format is more useful when it comes to preparation for the Core Exam.

 

 

Case Review Series (Neuro, Head and Neck, Spine, Breast, Cardiac, Emergency Medicine, GI, GU, MSK, Nuclear Medicine, Pediatrics, Thoracic, Interventional)

 

CRS is another case based review, with each book separated into three different difficulty levels. The cases at the beginning of the book, “Opening Round,” are easiest, the next level of difficulty in the middle of the book is termed “Fair Game” and the most difficult cases at the end are in the “Challenge” section. Each case shows images and is followed by four questions pertaining to those images.

 

The good: The book offers excellent cases with good image quality. The multiple questions per case really force you to learn several aspects of a case. When it comes to the Core Exam, knowing the diagnosis alone usually does not suffice. Thus, being able to answer questions from several angles about a case is a valuable learning tool.

 

The bad: Similar to Rad Cases, CRS appears to be more driven toward oral board prep. While this may help with expanding one’s knowledge base, it lacks the multiple-choice question/answer that is necessary for the Core Exam. Also, the Challenge sections are often too difficult/esoteric and are often beyond the scope of the exam. It would behoove you to do only the Opening Round and Fair Game sections in order to save precious study time.

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PHYSICS/OTHER

 

Huda’s Review of Radiologic Physics

 

This is the physics review book by Walter Huda, who administers yearly review courses in radiologic physics throughout the country. It is in bullet point form and aligns closely with his course.

 

The good: The book has pretty much everything you need to know for physics for the Core Exam, with review questions at the end of each chapter and online access. It is formatted in bullet point form to be intended for quick review. I used this book while at Huda’s review course and immediately after it in order to reinforce the concepts he taught.

 

The bad: While all the facts you need to know may be in this book, there is very little in the way of explanation. You will have to use other, more thorough sources for a deeper understanding. Also, the questions at the end of the chapter serve to reinforce some basic topics but are unlike anything you will see on the exam.

 

 

Radiologic Physics “War Machine” by Prometheus Lionhart

 

This is the dedicated physics book by the Crack the Core author, with a very similar layout to Crack the Core.

 

The good: This book was a great resource for studying physics. It really simplifies topics and makes them easier to understand, and therefore memorize. He does a good job of explaining what physics is relevant to the test and what is not, which is extremely valuable (the last thing we want to do is study more physics than we need to).

 

The bad: Again, the typos. Also, there is a lot of overlap between this book and the physics section of the Crack the Core book. I have not examined them in detail, but I just studied the section in Crack the Core without using the War Machine book and felt it was more than adequate preparation.

 

 

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QUESTION BANKS

 

RADPrimer

RADPrimer is the question bank associated with StatDx and has an abundance of questions (2,221 Basic and 3,747 Intermediate level questions).

 

The good: Lots of questions with mostly very good explanations. Good image quality. What I found most useful about RADPrimer was the ability to hone the focus to exactly what I wanted to study. For example, if I had just read a section in a review book about CNS Infections, I could create an exam and do those specific questions in order to solidify what I had just read.

 

The bad: Many of the questions are too straightforward for what you will see on the test. Rather it should be used as a learning tool to reinforce recently studied material and not a means to simulate the Core Exam. Also, while there are some physics questions, there are not enough to use this as the sole source of physics practice.

 

 

 

BoardVitals

 

BoardVitals is an online question bank that offers subscriptions based on different time increments ($399 for six months, $229 for three months, $139 for one month). There are 1500 questions broken up by general category.

 

The good: The questions better simulate the real exam than RADPrimer. The explanations on most questions are good. There are more physics questions than on RADPrimer and this bank also includes non-interpretive skills questions (which I found very helpful). What I also found very helpful was that the interface was well-suited for use on mobile devices. Whether I was in a line somewhere, on a train, or on a bus I could bang out a few BoardVitals questions with ease.

 

The bad: Some of the answer explanations were one line without much information. These were once in a while but did occur and could be frustrating at times.

 

 

Face the Core

 

Face the Core is another online question bank, with 35 different modules. Each module has about 75-100 multiple-choice questions. Modules consist of several cases, with each case having approximately 4-5 associated questions. Modules can be purchased individually for $10 each or you can purchase all 35 modules for $250. Modules must be completed in full (all 75-100 questions) before you could go over the answers (no “tutorial” mode).

 

The good: I used this question bank at the end, to brush up on my weaker areas, so I liked that I could purchase just the modules I needed rather than forking over $250. The explanations were pretty good. Some of the modules even had video explanations, which was nice because they would go into more detail. The physics modules on Physics Artifacts and MRI Sequences were very helpful.

 

The bad: The main drawback is the fact that you have to do the entire module before you can go over the questions. This made the process very time consuming (at least 2 hours per module). The image quality was poor and the layout appeared somewhat haphazard. Overall it is a good resource to use at the end, to cover areas of weakness.

 

——–

 

I know it seems daunting with all the resources out there. Don’t be afraid to use many, but use them wisely. Below is a rough plan of how I approached studying for the exam. And it worked for me:

 

My approach:

6-8 months before the test

  • Used Core Radiology early and often as primary source
  • RADPrimer questions (based on exactly what I was studying in Core Radiology)

4-6 months before the test

  • Continued above
  • Started Crack the Core Physics (supplemented by various YouTube videos)
  • Started BoardVitals Questions
  • Core Review Books

2-4 months before

1-2 months before

  • Skimmed Crack the Core to fill any gaps/get different perspective
  • Continued BoardVitals
  • Started Face the Core on weak areas

< 1 month

  • Crammed facts
  • Reviewed notes
  • Questions, questions, questions

 

 

 

 

 

Good luck!!!!

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Top 10 Things To Do When The PACS Goes Down

pacs

In 2021, almost every radiology residency in the country operates with a Picture Archiving And Communication System (PACS). It has become essential for the daily functioning of the radiologist and the radiology resident. Even though PACS has made our practices more efficient, we all experience a breakdown at some point. Maybe it’s information overload, an electrical surge, or an internet/cloud outage that causes the problem. Regardless, it will happen at one time or another. Sometimes, it may take a few minutes or hours for the system to come back up. During this time, people usually mull about and complain about the PACS being down. It becomes a handicap. Instead, what if we did something useful with our time? So, I thought I would write an article about the top 10 most valuable things to do when the PACS goes down. Let’s begin!

1. Call Up IT To Fix The PACS

Over the years, I have noticed when the PACS goes down: everyone assumes that someone knows about it and will take care of it. Sometimes that is the case. Other times, no! It never hurts to give IT a call to find out what is going on to make sure they get started fixing the issue. Furthermore, they may be able to tell you a timeframe for when they can complete the repairs. Then, you can have an idea about what you can accomplish during this downtime!

2. Network

What is a better time to network than when everyone has time? Now that the PACS is down, people can talk to you and listen!! This period can be a time to speak to your favorite faculty, technologist, nurse, residency coordinator, or janitor. And, no, it is not a waste of time. It brings goodwill to the entire establishment. In addition, getting to know your fellow employees gives excellent morale to the department. Who knows? The janitor may come to your department to clean up first because he likes you!!!

3. Study For The Boards

While at work, you should not waste a minute. One great way to occupy your time: get cracking on those books that you need to read. Start reading a chapter on what you would be doing if the PACS system were working. Or, maybe go over something that you don’t know. Regardless, this is a freebie. Now you will have less time to read when you get home!!!

4. Talk To Your Referrers Instead Of Staring At A Dead PACS

Maybe you have a burning question you need to ask one of your referring clinicians regarding a finding on a film and what that means for one of your patients. Or perhaps, you need to forward a message about a result. Well, now you have some time to do it. Don’t just sit there and complain about the PACS. Pick up the phone!

5. Arrange Elective Time

Perhaps, you are a 3rd resident and are pondering what you want to do for the following year’s mini-fellowships or electives. Now you have a real opportunity to plan something. Take a walk to your area of interest- perhaps neurosurgery, orthopedics, or pediatrics, and prepare a rotation for the following year. It will add an incredible experience to your training. What better time to do that than the present!

6. Observe Department Processes

The PACS system is down, but that doesn’t mean all patients stop arriving in the department. This time is an excellent opportunity to watch the technologist, secretary, or nurse in action. Learn how they take histories, process the patients, and what they do daily. It never hurts to learn about the processes within your radiology department. You never know when some of these skills will come in handy when you are a radiologist who owns an imaging center!

7. Research Projects

Downtime is a perfect opportunity to process the data on your iPad or research some articles for the following paper you will write. Edit your article. Less time needs you will need to spend in the department or your house on this work!

8. Walking/Exercise

You’ve been slouching on your chair all day until the PACS system went down. What better time than now to prevent a DVT and burn some calories! Climb those stairs. Walk around the grounds. Now is your time to get into shape!

9. Grab Your Lunch

Maybe the PACS went down around lunchtime. This respite is a perfect opportunity to get the lunch that you would have interfered with your day otherwise. Now, this PACS downtime no longer wastes your time!

10. Forget The PACS. Go To Radsresident.com!

Of course, what kind of article would this be if I didn’t add some shameless promotion? Take a look at my articles and learn something about radiology residency lifestyle issues that you may not have ever known otherwise. Enjoy this author’s great sense of humor!!!

 

Now that you know what to do when the PACS system goes down, you will no longer whine and complain. Instead, look forward to this inevitable period. This extra time is a blessing in disguise!!!

 

 

 

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How Does A DO Degree, COMLEX Score, And USMLE Step I Outcome Affect The Radiology Match?

I have a follow up question to your prior question on the USLME examination.

 

I am currently a 3rd year DO student interested in radiology but I got a USMLE step 1 score that was below where I wanted (227) but a decent COMLEX Level 1 score (591). Do you find that being a DO towards the lower end of board scores for radiology it will be hard to match to a program? I am above most of the cut-offs that I’ve seen (based on FREIDA Online) and am not expecting to go to a big time university. Frankly, I just want to train at a place that will give me a good enough education so I can practice radiology and feel comfortable!

 

I am just nervous about not getting interviews and going unmatched! But, I love radiology and will apply regardless and see what happens and go from there.

 

Thanks,
Alex

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Let me step back a few steps before answering your question specifically about your particular COMLEX Level I and USMLE Step I board scores.

 

First thing you need to know: It is true that there are a few residency programs out there that may not look at DO candidates in general. Those are the minority of programs. If you have a good ERAS application, most schools will want to interview you even though you are a DO.

 

Second item: It is good that you took both the COMLEX and USMLE examinations because some admissions committees don’t really understand what the COMLEX scores really mean, which puts you at a disadvantage from start. (You won’t have to worry about that obviously since you took them both!)

 

Third: DO degrees are being more highly regarded since the AOA and ACGME has begun to merge. The new merged organization has decided to get rid of residency programs for different specialties including radiology that in the past would not accept DO degree graduates. Previously for that reason, a graduate from a DO school was considered a second class applicant since there was a limited number of DO programs. That will no longer be the case due to the merging of the DO and MD residency programs. In fact, you will probably have a slight advantage over Caribbean MD graduates in the future since you are a United States medical school graduate and you do not have to worry about applying to DO specific programs anymore.

 

And finally in your particular situation: there are probably some large high end academic programs that have very high board cut off scores above yours. But, for most programs, both of your scores would be fine and should get you an interview at many places assuming you have a reasonable application and that the radiology specialty does not become significantly more competitive next year (You proved you have the ability to pass the core examination.) Not only that, plenty of high quality programs, programs that create great radiologists, should be willing to take you at “your board score level”.

 

My advice: Don’t be nervous about not matching. Be confident with the knowledge that your board scores are reasonable. That is one less thing to worry about!

Director1

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Radiology Private Practice Versus Other Career Pathways- Is It Worth “The Extra Money”?

private practice

The herculean question up for debate: is a private practice career path worth the extra money? To answer this question, you have to know your career options. Suppose you are talking about standard career options for the radiologist (not the alternative career paths discussed in a prior post). In that case, you can divide it into three main choices: private practice, academic/government, and the hybrid model.

Lucky for you, if you are reading this article and you are now making this decision, you have come to the right place. I have worked in the world of academics as a fellow and dabbled in private practice at my first job out of training at Princeton Radiology. Now, I work at Saint Barnabas Medical Center, where we operate with a hybrid model (I was also formerly a resident at a program with a hybrid model-Brown University). Since I’ve been through it all, I am uniquely qualified to talk about how to decide between each option. So, I am going to do just that!!! (Don’t let other posers fool you!)

Are There Income Differences?

What is the difference in income for an academic practice radiologist versus a private practice radiologist? If you look at the Medscape Radiologist Compensation Report from 2016 (later surveys did not have this information!), the academic radiologist made around 262,000 dollars (in this category also is included the military and government physician). On the other hand, some of the other private practice type radiologists made significantly higher amounts: the office-based solo practitioner- 434,000 dollars; the office-based single-specialty group practitioner – 386,000 dollars; and the typical hospital compensated radiologist- 381,000 dollars. So, suppose you take these debatably inaccurate academic and private practice numbers into account. In that case, a pretty substantial difference exists between the income of private practice and academic radiologists (almost 100-150 thousand dollars per year).

It’s Not Just About The Income Though!

But not so fast! In terms of numbers alone, the actual compensation may not account for other benefits like pension and health care. Employees that work for the government or large institution academic hospitals can sometimes receive substantial fringe benefits such as a pension of 70-80 percent of the final salary. Or, they can get incredible health care insurance that you cannot earn elsewhere. Finally, some have other perks, such as free tuition for children in college.

Moreover, the typical smaller radiology private practice will not give these perks. If you take the pension alone, that could amount to a guaranteed (0.8)(262000 dollars per year) or about 210,000 dollars for the rest of your life based on 2016 salary numbers. You would need to have 5.24 million dollars in the bank to have that kind of money guaranteed annually, assuming a 4 percent relatively risk-free return. So, the difference may not be as substantial as initially thought at first glance.

So, now that I have debunked some of the income-based differences (there are always exceptions to every rule!), let’s talk about the different models and decide which option is the right one for you. Let’s start!

The Academic/Government Model

In the purely academic or government model, the primary goal is not reading films and making money. Instead, you will need to publish, teach, or exist (if you are talking about a place like the VA hospital!). Prestige and promotion results from these activities. For comparison, the typical private practitioner couldn’t give a lick about these job requirements. The philosophy is often: publish or perish!

The typical academic sort writes a lot, obtains grants, and is responsible for his/her residents’ teaching and welfare. He/she typically reads fewer studies and sees fewer patients than a typical private practice radiologist. But, that may vary depending upon the institution for which you work. He/she gives many conferences, travels all over the country/world to give lectures, mingles with other academic sorts on all different types of committees, and plays a significant role in directing the future of radiology. Many of these radiologists have outside ventures and partnerships with various companies and academics centers since they do not only occupy themselves with the standard day-to-day role of reading films. Some of the associations may be based on their research or area of expertise.

The higher-up academic radiologists manage their staff as chairmen. These individuals may be responsible for budgeting, hiring, and firing depending upon the institution. Again, your mileage may vary depending upon the role that you have in the institution. The almighty dollar has less control over your day-to-day work. (Although many would say it still plays a nice-sized role!)

The Pure Private Practice Model

What about private practice? In general, private practice wants to maximize income and the number of patients that go through your system. Of course, excellent radiology businesses have an element of quality. But quality exists to increase profitability, and the almighty dollar tends to rule the day. And, of course, all roads lead back to the almighty dollar. Employees and owners grind out films daily, day in day out. The philosophy: if you do not work, you do not make money.

Now, of course, the private practitioner also accomplishes other activities in trying to make money. These folks may perform some or all of the following practice needs: advertising, buying and selling equipment, strategic partnerships, and mergers, maintaining relationships with hospitals, hiring and firing an army of numerous employees (possibly radiologists, technologists, janitors, nurses, physicists, and so on), maintaining and purchasing real estate, payroll, billing, legal issues, parking, and utilities. On the other hand, academic hospitals/ institutional facilities typically take care of most of these issues. Therefore, you need to enjoy playing many different hats and roles and being a self-motivated entrepreneur.

The Hybrid Private Practice/Academic Model

I currently work in this role. I like to think that I get the best of both the private practice and academic world. (Although some would like to say that is the worst!) The hybrid practitioner’s philosophy: A dabbler who enjoys elements of both private practice and academia, but not in such depth.

So, how does the hybrid model work? First of all, you have a few variations on a theme. In my situation, I am involved in a hospital-based private practice with a residency program and multiple covered hospitals and imaging centers. For another type of system, the hospital may employ you, but the hospital may tie you to the private practice world via output bonuses. In essence, the practice expects you to teach, do a little bit of research, and maximize your work output. Thereby, you create income by grinding through studies. Most of these practices are not involved in purely academic activities such as obtaining grants. And, you will probably not involve yourself in typical pure private practice issues. For instance, you will probably not need to maintain the building utilities.

The hybrid practitioner/dabbler likes to do a little bit of everything without delving into some hardcore academic and pure private practice issues. I was never interested in writing grants, but I certainly wanted to teach. I was not interested in dealing with some of the fundamental problems of private practice, such as hiring/firing technologists. Yet, I was interested in the mechanics of business and private practice. For the sort of person that likes to be a bit more generalist, the hybrid model can be a great career path.

How To Make The Final Choice?

I think the final choice becomes a personality-based thought process, not one based on the different income constructions of each career model. If you hate business in all forms, work for the government or academia. If you hate writing and teaching, a private practice may be for you. On the other hand, if you love doing a little bit of everything, think about the hybrid model. Bottom line: You need to be true to your self. Do what you like, not what others will think you will enjoy. If you follow these precepts, you will make a great choice and have a fantastic career!

Comments are welcome!!!

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A Common Radiology Applicant USMLE Step I Misconception

Ask The Residency Director Step I USMLE Question:

Good evening. My name is Susana, a 3rd-year medical student, very interested in your radiology residency program. I would like to know, if possible, what is the average Step I USMLE score of your PGY1, to know if mine qualifies for your program? Thank you.

Susana

_______________________________________________________________________

Answer To The USMLE Step I Question:

Thanks for the great question! It’s a common misconception about how USMLE Step I board scores are used to rank applicants in the match. The board scores are generally not about the average score, but rather the minimum cutoff. The point of using the board scores to help with the match ranking process is to make sure that the candidate can pass the written core exam taken at the end of the third year. And, that is really the only role of the board scores. Most programs such as ours take into much stronger consideration the Dean’s Letter, interviews, and extracurriculars once the applicant has met that specific cutoff.

At our institution we use a cutoff of 220 for the USMLE Step I. However, we have made multiple exceptions over time. First of all, if you perform poorly on the Step I Boards but do well on the Step II Boards, we will often ignore the Step I board scores or average out the two boards scores. Again, the point of the boards for us is the correlation with passing the core examination. A good step II score proves you can pass the boards. Also, if there are exceptional candidates that have other special activities, have had extenuating circumstances for not doing well on the boards, or have proven themselves already by completing a rotation with us, we will on occasion forgo using the cutoff. As an answer to your specific question, if I was to take the average USMLE Step I score over the past few years, it would probably be somewhere in the 230-240 range. But, again I think the average number is irrelevant.

Hope that answer helps!!! Again, thanks for the great question!

Yours truly,

Director1

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