Category: Applicant Advice

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The One Phrase You Should Ask For In All Your Letters Of Recommendation

letters of recommendation

ERAS season has recently begun. And, with applications to radiology residency and fellowships on the system now available, medical students and residents are scurrying about trying to find letters of recommendation from their faculty and mentors. On that note, if you are applying now, I would advise you to read one of my previous blogs (Cracking The Radiology Residency Application Code).  Previously, I have mentioned that references are one of the less significant discriminators in getting an interview for radiology. However, that statement only applies to decent letters of recommendation. It does not mean that you should find the wrong ones.  That can become a disaster. Remember. Program directors have so many excellent applications from which to choose. So, one lousy recommendation can lead yours into the DNR (Do Not Rank) pile. In the case of a horrible reference, it becomes a great discriminator!

In any event, as always, I want to distill the essentials of applying in the world of radiology into a few simplistic nuggets. Therefore, I am going to let you in on a little secret about what you should be looking for in a recommendation writer not only to avoid this situation but instead, I want to make your recommendation into the reason you may have success getting into your program of choice.

So, here it is, a simple phrase strategically placed within the recommendation, preferably at the end. And it is this, “Your name is the type of student that we want to take at our radiology residency program.” As an application reviewer, that phrase gives me more confidence about an applicant than any other.  If your mentor wants to take you into his program, especially another program director, then why wouldn’t I? So, how do you get that person to write that into your recommendation? I will give you some simple instructions on how to do so to achieve the results you want.

Perform Well On Rotations With Potential Reference Writers

OK. Performing well on rotation may seem obvious. But, on occasion, some residents will ask attendings to write a recommendation when their performance was marginal. Why does this happen? Well, usually, the resident feels more comfortable with obtaining this written reference due to the mentor’s easy-going personality. Don’t let that fool you! When a mentor has many other applicants to write for, your recommendation will not be of the same quality as his favorites!

Befriend Your Mentors

For many medical students, befriending your mentor is a tall order. Often, he may be twice or even three times your age. Or, your interests may significantly differ. However, make that attempt to get to know that person well before asking for a recommendation. Then, when you finally request one from this person, he will feel much more comfortable with writing one. I can’t tell you how many times a medical student or resident will come up to me and ask me for a recommendation when we have barely spoken. It reflects in the written letter!

Tell Them What To Write!

Lastly, this step can be the most critical. At this point, you know your mentor well, feel comfortable with her as a reference, and you know she feels the same about you. And, she is more than likely willing to help you out in any way she can. But, many reference writers do not know what program directors are looking for in a recommendation. So, it is your job to help them out. Ask them if they can slip the key phrase into their letter- “I want you in my program.” (Of course not that verbiage exactly but you get the point!)

Even better, some writers will ask you to make a version of the reference letter. Guess what, slip that phrase or something similar into the end. It has the potential to make your application stand out from the pile!

Capturing The Magic Phrase On Your Letters Of Recommendation

Now you know precisely how to proceed to get the best possible recommendation from your mentors to help you get into the spot you want. It does take a bit of work, forethought, and, most importantly, personal interaction. So, make sure to ask mentors on rotations where you have performed well. And, only request them from those that know you well enough to write you one. Only then will you be able to obtain a recommendation with the phrase that will significantly increase your chances of admission!

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

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

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

Too Detail Oriented

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

Decision Paralysis Because They Know Too Much

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

Question Everything

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

Out Of Clinical Practice

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

Different Knowledge Base During Medical School Training

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

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

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

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

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

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

 

 

 

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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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2018-2019 More Competitive For Radiology? A Midyear Perspective

At our program, we have completed a little more than half the radiology residency interviews through this season so far. And in the midst of interview season, many of you, applicants and radiologists alike, are wondering has radiology become more competitive this year compared to years past? To answer that question, I will analyze the current facts and give you a preliminary conclusion. And then, I will provide you with a little summary of what to do with all this information.

The Hard Evidence

So, which individual pieces of evidence highly suggest increasing competitiveness? First and foremost, we need to look at board scores. Overall, applicants to our institution have had a significant increase in the USMLE board scores year over year. Based on the current candidates, I would say overall, USMLE scores have increased by 5 to 10 points compared to the previous year.

What else? Our institution looks at the Caribbean, American Osteopathic, and American Allopathic medical students. Noticeably, when the numbers of American Allopathic and Osteopathic applicants increase compared the Caribbean applicants, that is a hard sign that the competitiveness of our program has climbed. We see exactly that.

The Soft Evidence 

This year, the applicants have more numerous and exciting extracurricular activities. Typically, I notice this trend when the applicant pool expands. Likewise, we tend to interview more of these applicants instead of the bread-and-butter type. I believe we are following this pattern.

Moreover, applicants have stated that they have heard that the landscape has become more competitive. To support this theory, on interviews, many have indicated that they understand more than usual are applying to radiology from their medical school.

Interestingly, many applicants have explicitly stated that they are no longer worried about artificial intelligence (AI) taking over the world (or the radiologist’s job!). A few years back, many more interviewees had expressed this fear. I believe that the more accurate information about how AI will function as a tool to assist the radiologist has worked its way to the applicants versus the message of replacing radiologists from Silicon Valley. 

And finally/most propitiously, interviewees are well aware of the improved job market in radiology. Usually, the applicants follow the money!

So What Does More Competitive Mean For Applicants This Year?

OK. What to do about it is the critical point. We are pretty sure that applications have become very competitive. But, that must mean something for the applicant, right?

Well, yes. I am going to make a short list of the critical tasks that you should complete. For many of you, make sure that you rank enough programs on the list. Occasionally, some of you may feel that you are likely to match at your first few choices and that’s it. So, some folks will make a short list. Instead, make sure to rank a few more than you may think you need.

Also, you should write thank you letters to all programs of interest. Some programs will use them as a way to bump up your application in the rank list a tad. It does show interest in the program. And, some use it as a marker of a possible good match. It can make the smallest difference between ranking and not ranking. 

Then, for some of you, make sure to take a second look at the programs that interest you, if you can. Like the thank-you letter, coming back for a second look expresses that you are serious about a program. Occasionally, it can help your chances.

Lastly, be prepared for the possibility of having to scramble in the SOAP. What will you do if you do not match? You will need to collect your thoughts and get it to together rapidly if the process does not go the way you wanted.

Are you going to be willing to do a prelim year in medicine or surgery and reapply again next year? Or, are you going to try to match in a different specialty entirely. You should think about these possibilities just in case it does not work out.

Summary

So, there you have it, a review of my thoughts about the competitive environment for the radiology residency applications of 2018-2019. My final piece of advice- make sure to remain humble throughout this process. Unfortunately, as much as we do not like to admit, there is an element of chance in the application. Therefore all applicants should hope for the best, but plan for any eventuality. Good luck!

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The Dean’s Letter Dilemma: A Rogue Evaluation

dean's letter

Within the application, few sources give as much information to the residency application committees as the Dean’s Letter. Yet, the Dean’s Letter also exposes a large crack in our system for deciding upon applicants. And today, I will talk about one of them- the rogue evaluation.

Here is an example of the sort of rotations comments that you may come across in a Deans Letter with a rogue evaluation:

Evaluations

Surgery- A, Excellent. Received glowing evaluations from all residents and attendings.

Psychiatry- A, Fantastic student, Able to empathize well with patients, acts as an intern (above his level of training!)

Family Medicine- A, Actively participated and gave excellent concise, and helpful histories

Radiology- A. Incredible eye, Great talk on Histiocytosis X/eosinophilic granuloma.

Medicine- A-, Worked hard, good scores on the shelf exam.

Ob/Gyn- B, Unable to do an appropriate pelvic exam, forgot to take a good history on several patients, and would not scrub in on many of the cases because he didn’t think it was necessary.

The Dilemma

Whoa. Look at that last rotation. Notice how it does not fit in with all the others. So, what are the possibilities behind the poor Ob/Gyn Deans Letter evaluation? What do admission committees do with this information? And, how does a Deans letter such as this one affect the applicant?

Why Did This Student Get Such A Horrible OB/GYN Evaluation?

Well, it could have been the medical student’s first rotation. Sometimes, in this situation, you have a medical student who initially had no clue how clinical rotations worked and just messed up. Or, maybe, one resident or attending had a vendetta against this medical student and wanted to stick it to him. And finally, perhaps, this medical student indeed did not function well in a rotation that did not interest him.

Regardless of the cause, this resident has been screwed (for lack of a better term!). What do you do when you have scores of applications without a significant blemish, and then you run into this one rogue Deans Letter? Well, you run it by your team, the admissions committee!

The Next Step: The Admissions Committee

So, how does the Admissions Committee deal with a Deans letter like this? And let’s assume that all the other factors, such as board scores, recommendations, personal statements, and extracurricular activities, were just fine.

Well, you can probably imagine the discussions at an admissions committee meeting. First, half the committee says we should give this candidate a shot at an interview because everything else on the applications sounded OK. And the other half wants to dump this application since it has a blemish. Moreover, this year has such stiff competition. In the real world, these are the discussions that take place.

As a program director, if the candidate makes it to the interview process, then the interview needs to proceed with this issue in mind. Typically, we need to press the medical student on this question. If he responds to the problem with a reasonable answer, we will then place the application in a separate pile where we need to confirm the candidate with another well-placed phone call to some of the faculty. On the other hand, if he evades the question or gives a vague answer, we put the application in the DNR (Do Not Rank) pile. The whole process can hinge on this one comment.

The Moral Of The Deans Letter

All this brings us back to the double point of this blog. First of all, as you can see, some schools do not filter the Dean’s Letter at all. And its comments can change the whole disposition of the applicant because often it is the only negative piece of information on the entire application. Is it fair? Sometimes, the alleged student misconduct is actual. But, often, a poorly edited/written Deans Letter is merely a function of the negligence of the institution delivering it. Vengeful comments do not belong in a Deans Letter. Truthful and objective statements do. But, most institutions will allow any old phrase to go into the Dean’s Letter. I see that as a significant issue with the system.

And lastly, all medical students must look at their Deans letter if they can. For one, they should try to edit it if they can. Or, at the very least, they need to know to address it if they make it to the interview stage. You are better off learning about the issues on the Dean’s Letter before starting your first interviews (if you are fortunate enough to get one).

Deans Letter Woes

My relationship with the Dean’s Letter is a love/hate one. Why? Primarily because it does help to ferret out differences among the candidates so that you can rank residents appropriately. At the same time, I am aware that it is an imperfect evaluation tool that can cause the demise of many applications of suitable candidates—bottom line. We need to find a better way to evaluate our medical students. Medical schools should take a second look to re-evaluate how they create the Dean’s Letter. It may lead to better selection criteria and improved treatment of their students!

 

 

 

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A Rarely Utilized But Effective Tool To Make Sure A Residency Program Is Reputable

residency program

Recommendations for “good” residency programs about where to apply are a “dime a dozen.” Residents and attendings often give you their opinions about programs based on previous reputations. Or, perhaps, they attended or have friends within the residency. Rarely a faculty member knows the current residency program well enough to tell you if the perceived residency quality matches its current status.

Additionally, any program’s directors, chairpersons, faculty, and residents continuously change. So, these folks may know much about the residency from many years ago but not much about the current status.

So, how do you confirm whether a radiology residency program is reputable once you arrive on the interview day? To do just that, it takes one straightforward but rarely performed step: Ask residents and attendings from other departments within the same hospital about the residency program at the interview site.

Why Does The Opinion Of Other Department Physicians About The Residency Program Matter So Much?

Remember. When you apply for a residency, the residency has a vested interest in selling you a spot. The residency director, residents, and faculty want all applicants, regardless of rank, to select their program to get “the best residents.” So, asking a radiology resident or residency director whether she likes his residency is like asking a car salesperson if he loves the car he is selling.

On the other hand, other department members may work directly with the radiology residency. However, they do not have the same filter. They can say whatever they want about the program without being directly affected by the repercussions. Therefore, asking these fellow physicians can give you a more truthful answer.

Moreover, physicians within most other departments often work directly with radiology residents and attendings. So, they have great insight into the quality of the radiology department as a whole.

Why Do Applicants Rarely Perform This Step?

First and foremost, most residents never consider the option. Interview days are so chock full of activities that asking other departments would never cross your consciousness. You may also think you do not have the time to bother.

For others, however, it may involve stepping outside your comfort zone. It would help if you asked other physicians you don’t know about another residency. You may worry if they will even respond. But, you will likely find that most physicians will be happy to talk.

What Kind Of Information Can You Find?

Well, the information you may discover can be invaluable. What about a question to an emergency department physician like: Do you trust the reads of the residents in this program? This question can give you a lot of information about the quality of a training program. You will get a much more truthful answer than asking the program director about the program’s quality.

Or, how about asking the oncologists, do you get along well with your radiology colleagues? This question can tell you more about a radiology program’s culture than any pointed question you may ask the radiology residents or faculty.

My advice is to consider some pointed questions to ask after the interviews. And, then, try to find a few residents and attendings in another department to ask about these questions.

Making Sure A Residency Program Is Reputable

If a particular residency seriously interests you and you want to confirm its reputation, then you want to consider taking the extra time to step out of your comfort zone. Ask a few random attendings from different departments about the program. It’s a great way to ensure that the residency matches your expectations. You may find that all is not as it seems!

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Radiology Residency Rank Lists: Are They More Than Just Entertainment?

rank lists

Like many, I enjoy browsing the U.S. News And World Report Medical School rank lists yearly to see which programs are top. (Usually in a line at the supermarket!) Even more so, I enjoy reading the Aunt Minnie and Doximity radiology residency rank lists each year. And I love reading and writing about them as much as the next guy. But, we need to be careful when we rank schools, residencies, and other educational institutions. So, why am I such a “Debbie Downer” when it comes to ranking residencies and educational institutions, and in our case, specifically radiology residency? (And no, it’s not related to my role as an associate residency director at a small radiology residency program). Well, as you guessed, I will give you my reasons for our topic for today!

One Size Does Not Fit All

When you rank multiple programs in one list, you cannot consider all the variables that would make one program great for a particular type of personality and terrible for another. Moreover, looking at the rankings, you will see categories like best teaching, research, and clinical experiences. Some folks learn best on the job, and others retain better in a lecture format. How do you rank that? Or, you want to become a great clinician and don’t take a research interest. Would a Mass General work well for you? It doesn’t do justice to the individual.

A Majority Of Residents Want To Work In Private Practice

Many of the rank lists assume that applicants want the same thing: a high-powered research and teaching program. But, 90% of all radiology residents go into private practice. So, the rank lists usually do not follow the end career results of its participants.

Development of Vicious/Virtuous Circle

Rank lists tend to have a pile-on effect. If a program is ranked highly, it sticks in all the readers’ minds. They will say to their colleagues, “Oh, XYZ school is great.” Likewise, if an article ranks a residency low on the list, that remains in the mind of its readers. I call it a “self-fulfilling proposition,” not based on the truth.

Emphasis On Larger Programs

The larger the program, the more graduates know about it. Therefore, the lists show bias toward bigger residencies just by the sheer numbers. So, if you have a program that contains 20 residents per year, these residents will tend to vote for their programs, right?

Each Site Within A Residency Program Can Be Different

Even within a program, experiences can vary widely. Sometimes, residents barely see each other and do not rotate through all the sites within a system. And one resident may spend more time at the V.A. hospital versus the academic center. So, what may be an excellent experience for one resident may not even resemble the reality for the remainder of the residents within the program.

Residency Experience Is So Dependent On Individual Colleagues/Faculty Members/Mentors

I always like to say the following: if you go to an OK residency program, but like the folks you work with, it will seem excellent. On the other hand, if you attend a program that by all the rankings is fantastic but hate working with all your colleagues, it will become terrible. So, how do you measure one person’s experience versus another when the program’s culture varies widely in any given year?

Do Residency Rank Lists Have Any Merit At All?

Based on these legitimate reasons, residency ranking tends to have very little relevance for the average radiology resident to choose his rank list. Instead, like the U.S. News Report Annual rankings of colleges, it primarily serves as a great way to grab the attention of its readers and create a bit of buzz. Therefore, it performs an essential purpose, but the goal is not necessarily to help out the audience that reads it. So, what is my conclusion based on the evidence? I’m not saying that you shouldn’t read a rank list of the best programs. Instead, take the results with a grain of salt and realize that a “top program” may not be top for you!

 

 

 

 

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How I Made My Decision To Go Into Radiology

decision

This post is different from most. I am going to discuss my start in this field. By writing about my beginnings, I hope to either help you with your specialty decision or keep you going in your residency if you are still unsure once you have started.

Unlike what you might have thought by reading my blogs, I was not initially gung-ho about radiology from day one. In fact, like many medical students, when I first began, I had no clue. As a student, I planned on going into internal medicine after a stimulating rotation in medical school during my third year. I loved my instructors, the academic discussions, the grand rounds, and the camaraderie of it all. I like to say that if you associate with the right people, any task or job could be fun. And that was what happened during that third-year rotation. The stars aligned. Perhaps, I would complete a residency in internal medicine and become a cardiologist.

My Subinternship

And then, wham! I started my subinternship in medicine, a fourth-year rotation at my medical school. On day one, my resident micromanaged everything. And, attendings loved her because her notes were over three pages long. On the other hand, if you worked under her as an intern or fourth-year medical student, you entered an alternate reality. She could not decide what to do next on the simplest of matters. It could be the difference between Tylenol or generic acetaminophen in a healthy patient. No matter. She could not handle the small decisions. We left unnecessarily late every single day.

Moreover, if you did something on your own, exhibited any independence in a decision, she would stare at you with a frown on her face. And, later that same day, she would go to her attendings complaining about her underlings. So, you would hear about what you did wrong. Ahh, the pain.

But, if that was all, I noticed that I spent more time spending hours on the phone with insurance companies and burnt out attendings than any patient-related matters. Additionally, the patient matters that I did take care of were not intellectually challenging. Instead, I worked with the mundane issues of uncompliant patients or patients complaining about the same problems over and over again (obesity, diabetes) but not doing anything to improve their status. Between my team and the actual work, I realized I could not do this for the rest of my life.

Enter The Radiology Rotation

So, I completed my subinternship depressed that my initial career choice did not fit my requirements for what I wanted to do for the rest of my life. Luckily, I had the opportunity to begin my radiology rotation next early in my fourth year. No, there were no epiphanies/signs from above to let me know that radiology was right for me. (although you would never know that from my personal statement!) Instead, I mildly enjoyed my rotation. Looking at images and making interpretations seemed to be the better option than a life of hell in internal medicine. And, what else was there that I wanted to do at the time? So, I started with the ERAS process to create an application for a residency in radiology. A few months later, I matched at Beth Israel Medicine for preliminary medicine and Brown University for radiology. I was mildly enthusiastic.

Prelim Medicine Year- Second Thoughts

Like many of you out there, as I started my internship year in preliminary medicine, I began to question my original decision to go into the field of medicine in general. As the year progressed, I became even more disenchanted with medicine. My disenchantment eventually bled over to my initial thoughts about becoming a radiologist. Was I making the right decision?

Once again, in the dead of winter, I can remember being in a rotation in infectious disease with another crazed medical resident as my supervisor. This time, he was exceptionally aggressive and irritating. He had reported me to the program director for insubordination. Fortunately, that complaint did not go anywhere. But, it left a bad taste in my mouth. After that situation, I thought about interviewing for financial jobs and even completed one. However, I realized that with the excessive debt that I had from medical school, it would probably not end well. So, I stuck it out and made it through to my first year of radiology residency.

Radiology Residency- A Hellish First Year

Again, you would think that I started radiology, and everything became as smooth as a diamond. But, you would be entirely wrong. I began my residency reading a lot. But, it did not show during noon conferences. Nor did it manifest itself on rotation. As I like to say in some of my other posts, I committed the cardinal sin of reading as a first-year in radiology. I did not emphasize the pictures but instead read through mostly text without the images. So, when it came time to interpret pictures, I was somewhat clueless.

Also, I was not so “procedurally inclined.” One of my instructors (who shall remain nameless!) made sure to make that well-known. He would talk about me behind my back. Instead of helping me to become better, for the first time, I found out about this on an evaluation six months later. To this day, it left a bad taste in my mouth.

As the year progressed, I can remember the faculty’s pressures, not believing that I would be able to perform well on call. Should they even let me? Fortunately, I barely passed the precall quiz. And, my adventures in the second year would subsequently begin.

The Rest Of Radiology Residency- I Could Do This As A Career!

So, when did my outlook on radiology change? My new world order started once I began taking calls at the start of my second year. For the first time, I had some control over the environment. I could make my own decision, and it mattered. Every night, I found that I became more intellectually challenged. With each call, I discovered difficult cases. Even the attendings were unsure about them. And I would enjoy looking at the images and arriving at appropriate differential diagnoses. Finally, I gained the respect of my faculty as a decision-maker and a colleague. I felt part of the team. The rest was history.

So, What Was The Point Of Telling You How I Made My Decision?

Well, I think it is critical that every one of you, whether in medical school, internship, or the start of residency, should realize that you will find a light at the end of the dark tunnel of medical training. Don’t expect that the long road will match your expectations along the way. Having doubts during the process of residency is OK. Nevertheless, try to give radiology a chance and stick it out for the long run. I think that most of you have probably made the right decision for your career. It was an excellent fit for me. And, I believe that if you can persevere, you will find that radiology as a career will reward you as well! Until next time…

 

 

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Radiology As A Backup Specialty: Should Radiologists Be Offended?

backup

During the AUR meeting a few years ago, one of the speakers announced that more medical students than ever used radiology as a backup specialty. Well, how can that be? I mean, radiology is a fantastic specialty, right? Yet, our medical students have chewed us up and spit us out. At that point, you could just about hear the moans and groans in the background of the lecture hall. But then, I thought about it and felt a bit differently. Why? Well, that is what I would like to delve into today.

Most Applicants Don’t Know What They Want

Over the years, I have found that most radiology applicants, like other specialties, think they know what they want. However, when you dig a bit deeper, you find out they are not sure. Hell, I had no clue when I entered the specialty. When you ask applicants why they want to join specialty X, many have difficulty verbalizing their true motivations. Often you hear, “I like using my hands” or” I like coming up with differential diagnoses.”

Truthfully, however, these reasons are, at best nonspecific. And, if you dissect what these residents are saying, you would recognize that the reasons why an applicant claims to have applied to a specialty have no bearing upon what he wants. You can apply to surgery, interventional radiology, urology, and other specialties because you want to use your hands. Or, you can come up with differential diagnoses in almost any specialty in the medical field.

Often, applicants bury the real reason for applying to a specific specialty deep within their psyche. Perhaps, they want to say it’s the lifestyle, the culture, or the money. So, how can we become offended by medical students that don’t know what they want?

Our Specialty Is Getting Noticed!

For applicants to apply to our specialty, even as a backup, it means that they must have some foreknowledge about us, to begin with. That means we are doing something right. Maybe, we are training more medical students about imaging in medical school. Or, perhaps, they hear about an improving job market. In either case, residents have found reasons to apply to us, even though it may not be their first choice!

A Badge Of Honor

Only a few years ago, the radiology applications had dropped precipitously. In addition, the quality of applications had significantly decreased as well. Instead, today, we have become respectable enough to apply to! We are returning to the old norm. So, we should feel excited that qualified applicants are again considering our specialty.

So, We Are A Backup Specialty. Should We Be Offended?

Back to the original question again… Let’s look at radiology for what it is. It’s one of few specialties that allow physicians the flexibility to pursue so many avenues and satisfy the academic and clinical wants of most. And now, if we dissect why residents perceive us as a backup, I think we should not become offended. Instead, we should give the new applicants some credit. They are beginning once again to recognize the specialty of radiology for what it is: an excellent choice for a great career!

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How Important Is Level One Trauma To My Radiology Training?

level one trauma

Bullet wounds, stabbings, motorcycle accidents, falls, and blunt trauma from severe car accidents. These are some of the incidents that comprise most of the trauma at a level-one trauma center. But, let’s say you attend a program that does not have a level one trauma center, and you don’t see as many of these cases. Are you at a loss compared to your colleagues who do? And, what are the consequences for your future practice of radiology? Will you be a second-class radiologist? For many of you that have to decide on a residency with or without a significant trauma component, these questions cast doubts on some training programs. As I have trained at a level one trauma center and have been operating a residency without one, we will go through the training from a level one trauma you might “miss” during training.

Trauma Resident Checklists

Do you like to have multiple residents in other subspecialties waiting for you to check off the boxes? That situation is what you will experience at a level-one trauma center precisely. You will find that many exhausted nighttime residents are keenly interested in only finding out if you have read all those films yet, not worrying about the final diagnosis. Yes, it reminds you of all the images you need to see with each trauma. But ensuring the specialists have checked all the boxes does not add much to one’s training!

Limited Four Quadrant Ultrasounds

Are you interested in looking for free fluid at all night hours? Well, this is your opportunity. And unfortunately, the limited four-quadrant ultrasound is the tool of choice. Guess who wields the probe? You do!!! I can guarantee that you will be scanning everyone with a horrible accident that comes through the pearly gates of the emergency department. Is it worth all those additional sleepless nights so that you can find the free fluid? I’ll let you make that choice.

Repetitive Injury Patterns

Do you like variety? Trauma comes in so many fewer flavors than other interesting disease entities. Knife wounds exhibit most of the same findings over and over again. After your 15th splenic laceration, it gets old. And it’s not just the knife wounds. Blunt trauma, bullet wounds, and severe falls work the same way. I prefer a little more variety in my life!

Fewer Bread And Butter Cases

What does trauma experience usually replace? Typically, you will see many fewer bread-and-butter cases. And the time spent working up trauma cases has to substitute for something else. What do I mean by that? Level-one trauma centers may divert some diverticulitis, appendicitis, oncology, and renal stone patients down the street. I mean, who wants to go to an emergency department with all that bloody trauma when you can go to a much less hectic hospital. Unfortunately, for that reason, you get less experience with the diseases that most emergency departments always see. And these diseases are the ones that residents need to learn the most; the more common entities you will be working up the most in practice.

Level One Trauma- A Necessity For Training?

Yes, I will admit that level-one trauma centers provide a specialized experience. But for the most part, radiologists can learn what they need to know from the standard trauma they encounter at a hospital without completing a residency with a level-one trauma program. In addition, it is not hard for the resident to supplement their training with trauma reading. So, if you find a great program without a level one trauma center that otherwise matches what you want, by all means, still consider it. The absence of level-one trauma does not imply a significant gap in your radiology education!