Category: Ask The Residency Director

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Should Artificial Intelligence Be Feared Or Welcomed?

artificial intelligence

Question:

Hello!

My name is Yasmin Amer, and I’m a producer for WBUR in Boston. I’m working on a segment about machine learning and medicine, and, of course, radiology is part of that discussion. I spoke to a local doctor and machine learning specialist who says artificial intelligence will make the field more exciting. Is this the attitude of many med students and residents interested in radiology? Are they primarily excited about tech in radiology, or is there any nervousness there? I’m happy I came across this blog – I would love your input.

thank you,

Yasmin Ameren

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Answer To The Artificial Intelligence Question:

Yasmin,

Speaking to my residents about the topic, several of them fear the onset of artificial intelligence and its effect on radiology. Therefore, some residents have decided to go into “hands-on” fields like interventional radiology and breast imaging.

However, most others have responded they don’t see how a machine can synthesize the context of a case, the images, and all the patient-related factors to arrive at a final impression that tailors itself directly to a patient. Let me give you an example in the next paragraph.

Sometimes, two similar ultrasound findings can lead to entirely different management scenarios on breast ultrasound. An MRI may be the most appropriate for a noncompliant patient with multiple slightly complex cysts instead of serial follow-up ultrasounds. On the other hand, in a low-risk patient with the same cysts, the most appropriate conclusion may be to follow them every six months. These are slightly different patients with the same images. How would the artificial intelligence judge who is noncompliant? So, it takes more than just pattern recognition to process the information and arrive at a viable conclusion for an individual patient. I don’t think we are quite there yet.

Then, legal barriers prevent easy entry into the independent practice of radiology. Are large companies going to take responsibility if the machines make mistakes? Billions of dollars of losses are potentially at stake.

It is also interesting that applications to the radiology field have dramatically increased over the past few years. Improvement of the job market right now likely contributes to the increasing desirability of radiology. But that cannot be all. If applicants thought artificial intelligence would rob residents of their future 25-30-year radiology careers, we would not receive so many applications for radiological residency programs.

Long story short. Some fears of the unknown consequences of artificial intelligence exist. Overwhelmingly, however, I believe most resident concerns of artificial intelligence encroaching upon the radiologist’s work are less than the expected barriers to independent widespread implementation without supervision by a radiologist.

I hope that helps,

Barry Julius, MD

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Residency Just Starting And I Am Panicking!

panicking

Hi Dr. Julius,

I read your article on the struggling radiology resident, and it prompted me to contact you. I am an R1 and just finished my first week on Body CT. After this week, I feel panicked and have been attempting to study almost every chance I get, including all day during the weekend. Still, I think I cannot possibly learn all this information (just the anatomy base I need has worried me). I know it is still early, but my colleagues are way more relaxed and comfortable in their current roles than I am. I would greatly appreciate any suggestions you have for me.

Thank you so much for this article and your help,

A Concerned Resident

 

Answer:

Detailing The Problem

To begin, I want to stress that your colleagues who appear as if they are more relaxed and comfortable may be putting on their best face, but they may be panicking too. It can be challenging to tell how another resident or colleague feels. Regardless of how they appear, it would help if you didn’t worry about them. Instead, you must ensure you are doing your best instead of panicking.

I don’t care what anyone says. The first weeks of the first year of radiology are some of the toughest. Anyone who doesn’t think so is in for a big surprise later. It’s good to have a little bit of fear at the beginning. It can motivate a new resident to become great. Excessive fear, however, is no good. You certainly don’t want a fight or flight response!!! Or, you can burn yourself out before you’ve even started. That will make you make you sick.

Also, I think body CT can be one of the more difficult rotations to feel comfortable with, especially at the beginning. Some of the personalities can often be difficult in that field. And, there is more anatomy to know than you may have imagined. This large amount of anatomical information is more so than other subspecialties like nuclear medicine. Plus, you have to start to get to know the pathologies on top of that. So, I know you are in a tough spot.

Solving The Panicking Problem

But alas, there is a solution. I find that the best way to deal with a challenging situation, like the beginning of the first year of radiology, is to establish a reasonable plan of attack. You and I know you cannot know everything. Albeit, many of your attendings may make you feel that way. (you have to try to tune that nonsense out.) However, you can learn what you need to know to become a trusted first-year resident. The key here is to study smartly. Certain books are geared to the first-year resident. For instance, the Webb Body CT book is a great and short resource to learn the basics of body CT scans. You need to concentrate on these.

In addition, the reading style in radiology differs significantly from what you have been learning. Make sure to read the pictures first, the captions next, and then the text last. This strategy will give you the most bang for your buck when reading radiology. Once you have the basics down of a modality within the first week or two, I would also emphasize reading the case review series. Radiology is about pictures. So, why would you not want to emphasize the images? Memorizing lists is daunting and usually not very fruitful without context. Looking at a bunch of pictures makes a list more relevant and memorable. This technique will leave you less prone to panicking. Try to study in this manner.

Also, I would recommend you look at my article on taking oral cases. Handling cases with oral technique is readily transferable to your day-to-day radiology activities. If you can do that well, your colleagues and attendings will appreciate your intelligent assessments more.

In any case, let me know if there is anything else I can help you with. With a bit of change in the study method and trying not to worry about how others look compared to you during your first year (which can make you crazy), I think you can do just fine.

Barry Julius

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Hi Dr. Julius,

Thank you so much for reaching out to me with your advice. I am doing my best to stay positive and study hard. I will let you know how it goes. Thank you!!!

Best wishes,

A Concerned Resident

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It takes some time to get into the routine. Good luck with it!!!

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Is It Possible To Get Into Radiology Residency With An H1B Visa?

Good evening, I am an MS3 just starting to discover the excitement of radiology on my radiology selective. I am contemplating radiology as a career, but I have low Step 1 score (227) and I am also an international student requiring H1B visa for residency (I attend a top 40 US allopathic school and am not Canadian). Is radiology still an option realistic to consider given my circumstances (I hope to match into a university program)? What can I do now as I start my third year going forward to increase my competitiveness? Thank you for all your help!

Adele

Hi, Adele!

H1B And J1 Visa Issue

The answer to the question of your chance for getting into a program may hinge on the next few questions I am going to ask you. Why is it that you require an H1B vs. a J1 for getting a residency? What kind of visa do you currently have? This may make a big difference because universities are much less likely to support a resident with an H1B visa since it costs the university a lot of legal fees and time to support a candidate to obtain the H1B visa. Also, the federal government limits the numbers of H1B visas. Therefore, you significantly limit the playing field of choices of programs to apply.

Some of the larger academic university programs may allow applicants with an H1B visa. But, many smaller programs like ours do not take applicants with H1B visas for the reasons I mentioned (with a few rare exceptions). When applying, if you can’t get a J1 visa, I would definitely call the individual programs to see which ones would take an H1B visa.

Biggest Positives In Your Application

So, what do you have going for you? First, the fact that you are graduating from an American medical school will help your situation immensely. We, as program directors, selfishly like to get applications from American medical schools. At least we can vouch for the quality of the institution and compare to other applicants. Second, your scores are not bad. Many programs have cutoffs around 220 or 225. So, it should allow you to meet that requirement at many programs.

Other Recommendations

In addition to the recommendations above, I would also consider taking the next USMLE early, studying hard, and perhaps completing a USMLE Step II course so that you can show improvement from your 1st USMLE examination to the next one. Program directors like to see improving scores going in the right direction.

Why The Visa May Be The Biggest Issue

Unfortunately, the visa issue may the biggest impediment to getting a radiology residency slot. I would like to refer you to my article called The Alphabet Soup Of Residency Visas And The Radiology Alternate Pathway: A Guide For The Foreign Radiology Residency Applicant at the link above:

Thanks for the great question. I would be specifically interested in why you need an H1B. Let me know if there is any other information that you think I can help you with. I will post it on the website at some point because I think it would be useful for other applicants in your situation as well.

 

Regards,
Barry Julius, MD

Dear Dr. Julius,

Thank you for your reply and great advice.

I am currently on an F1 student visa and was advised against a J1 visa by my immigration attorney because of the requirement to return to my home country for 2 years. I am Singaporean and have been looking into the H1B1 visa for Singaporeans. It is similar to H1B, but has its own cap that has never been filled historically, can be obtained anytime throughout the year, and only requires the employer to file LCA (I-129 is not needed).

I am under the impression that it would be easier to approach programs that offer H1B already to ask about sponsoring for H1B1 visa, than programs that offer J1, since they may not be familiar with the H type visa. Is this likely to be true?

Also, how and when would you advise me to contact programs and discuss visa-specific issues/requests. Should this be done before I submit my residency application?

Thank you for all your help.

Best regards,
Adele

 

 

Thanks for the additional information. That allows me to understand the issues that you have and why you need an H1B1.

I would definitely make sure to contact the residency programs and the Graduate Medical Education (GME) office prior to applying because many of the programs will not even look at a candidate who has to get an H1B or H1B1 visa for a residency slot. Most programs are set up for the J1 visa. If you need an H1B or H1B1 visa to get into a program, it puts you into a different application pool.

You certainly don’t want to waste your time and money applying to those programs that only take J1s and not H1Bs. It makes sense to contact each of the individual radiology programs and the GME office prior to applying to save you a headache. Typically, the person to speak with would be one of the folks in the GME office who handles visa issues. And, you probably want to speak to the residency coordinator because occasionally the individual program policy can potentially differ from the GME office. ( the program may not take a resident with a visa issue, but the GME office may say it is OK) At our institution, this person is a secretary and is very knowledgeable about all things visa related since she has been doing it for a long time.

Hope that gives you a little bit more insight about when to contact the program and who to contact.

Regards,
Barry Julius, MD

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Transferring From Another Specialty to Radiology: Will I Be Competitive?

radiology

Question:

Dear Barry,

I will be finishing my categorical surgery intern year. I have decided to reapply this year for radiology, with a strong interest in IR. I am aware of the competitiveness of IR and DR in general. I am leaving in good standing. Also, I have good scores and achieved AOA. My radiology mentors in my hospital have encouraged me and feel I am competitive. I don’t have any published research, but I am working on projects. In terms of gauging my competitiveness and having realistic goals, how may I improve my application before September 2017?

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Answer:

Get To Know The Radiology Program Director

In the past several years, several surgical interns have transferred to our department. Both residents came to speak to me about their interests while they were surgical residents (one was a SOAP match candidate, and the other stopped during the year to ask about interviews). I think speaking to the program directors increased their chances of getting into our program. It shows initiative! So, if I were in your shoes, one of the first things I would do would be to get to know the program director for radiology if there is a radiology training program in your hospital.

Also, sometimes spots can open up before the year begins, and showing interest in the radiology program can’t hurt. Therefore, it would make sense to talk to the program director about applications for this year. The biggest problem is that you probably will have to wait another year to secure a spot in a radiology residency program since applications are not for 2018-2019 but for 2019-2020. But you never know; a position can open up for the 2018-2019 R1 year.

Finally, it would allow you to get a feel for the quality of your application at your institution. The program directors will usually have insight into your chances of admission.

Get on The Radiology Bandwagon Now

If you have the fortitude to go through another surgical year and wait for a 2019-2020 spot after interviewing this year in the regular match, that would be the most likely way to secure a radiology spot. As you said, if you are a categorical surgical resident, you will likely be a competitive applicant for a radiology residency (even though the specialties of radiology and DR/IR have been getting slightly more competitive over the past year or two). Nevertheless, I would certainly get on the application bandwagon now because if you wait another year, you are less likely to be able to get government funding for a radiology resident spot. You snooze, you lose!!!

Is No Radiology Research An Issue?

Regarding research, it certainly can’t hurt to have completed a project or two. If you are interested in academic radiology, that will add to your application. In a clinical program, it probably doesn’t matter as much. In either case, most residency programs do not require research before entering. But, it does confirm interest in our specialty. Regardless of whether you have completed a research project, I think most program directors (especially IR/DR PDs) like to take surgical residents who have performed well at their institution and demonstrate an interest in radiology. Surgical residents who serve well can handle stress!!!

Make Sure to Apply To The Correct Programs

Also, since you are interested in IR, I would send out applications to residencies that are DR programs with an ESIR program and the new DR/IR program. Applying to both programs maximizes the probability of getting into a residency that allows you to complete IR without having to do a 2-year independent fellowship.

Let me know if you have any other questions.

Barry

 

 

 

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Is The New DR-NM Pathway Worthwhile?

DR-NM pathway

Message For The Director
Hi,
Can you kindly comment on the ABR/ABNM 16-month dual pathway? Is it worth it? Can one get a job without another extra year of fellowship?

Interested Resident

 

 

 

 

 

I would love to talk about the DR-NM pathway. I am an ABR and ABNM certified radiologist, so I am interested in this matter.

Reasons To Not Participate In DR-NM Pathway

If you are going into the DR-NM pathway, you may find a job after the 16-month program during your residency. However, for most people, I would probably opt for the more traditional route for several reasons. First, you will have much less training in general radiology. For most radiologists coming out of residency, you want to maximize your experiences in general radiology so that you feel comfortable in most modalities. You are replacing 12 months of general radiology with almost exclusively nucs. If you have less general radiology, you are less likely to be comfortable with modalities other than nuclear medicine when you work as an attending in general practice. Most radiology residents work for private practices, with some general radiology.

Second, it may be slightly less desirable for most private practice employers to hire someone with less “radiology” experience. Since this DR/NM pathway is so new and there is less general radiology training, employers may recognize this pathway as a second tier.

And finally, you are pigeonholing yourself into nuclear medicine from the beginning. Most programs will want to know that you will complete the DR/NM program as early as possible (perhaps even from day one of residency!) since scheduling mandates that you need a specific set of rotations. Unfortunately, most trainees have no idea what they want to do at the start of residency.

One Reason To Participate In DR-NM Pathway

So, who would be suitable for this program? The individual that has known for a very long time that they want to specifically subspecialize in the nuclear medicine field. Also, this person should be interested in a primarily academic job (I think that would be the one area where employers would find candidates completing this pathway most enticing).

Final Thought

I’m not quite sure where you stand. However, I would generally recommend the standard one-year nuclear medicine fellowship for most trainees.

I hope that helps!

Director1

 

Click here for more information on the DR/NM program.

  

 

 

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How Should The ABR Test Communication Skills?

ABR

How should the ABR test communication skills? Isn’t that up to the residency programs? The ACGME maintains six core competencies. Only 1 of those 6 (medical knowledge) can be tested by board exams. Others, like professionalism and interpersonal/communication skills, cannot.

Anonymous Attending

 

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Great Question!

Testing Communication Skills

I believe testing and standardizing some basic communication skills before graduation is necessary. Currently, there is significant variability in the quality of communication teachings in different residencies. We certainly don’t want to create new graduates of residency programs who don’t feel comfortable relaying information expeditiously to clinicians or dictating a case. To that end, there are many ways that the ABR could test communication skills.

First, the resident may be able to answer questions in an appropriate dictation format to demonstrate they understand the mechanics of dictation. (At least that would ensure that graduating residents understand the basics.) Grading would be a bit more challenging, but there is no reason why the ABR cannot create such a scheme for a grading system. Second, the previous oral boards, albeit imperfect, did test residents’ ability to communicate the examination, the findings, the impression/differential, and management.

So, to say that ABR can’t test communication skills does not make sense. I’m sure we could develop a new and improved oral board type of examination to test the skill of communicating radiological findings to clinicians and patients in a much-improved way. Perhaps we could create a part 2 to the core examination. If the USMLE examination can do it, why can’t the ABR test for the same things but direct it toward the needs of radiologists?

Professionalism

I agree that testing professionalism is a more challenging nut to crack. Furthermore, unlike communication, professionalism is not a skill set but a way of acting ethically within the profession. You can’t standardize minimum requirements for professionalism in a test format. As you hinted, let’s leave that to the individual programs. But you can undoubtedly standardize essential minimum competencies for communication skills. And I think that should be the responsibility of the ABR if they want to establish the minimum abilities of a graduating radiology resident.

Final Thoughts

I believe we create excuses for ourselves to say it is impossible to test communication skills. It is certainly possible, and if other professions can do it, radiology can do it, too. To say that it is impossible or too hard is just pure laziness. It would just take time, rededication of funds, and getting together some intelligent radiologists and educators to figure it out. If called upon, I would be happy to give my input!!!

Director1

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Curriculum/Teaching Issues In The United States And Abroad

curriculum

Question About Curriculum And Teaching In United States And Abroad:

Hello Barry,

Thank you for your outstanding posts and the constant stream of current topics promoting the dissemination of Radiology as both a profession and a collective guild. I’ve been hanging on every word you’ve written, and it’s almost as if you anticipate my questions in advance. So, I am very much encouraged by the relevancy of your blogs and posts.

I am a Canadian who is a first-year diagnostic radiology resident in Targu Mures, Romania. Here, we follow a five-year path outlined by the EU and the European Society of Radiology (ESR). The problem is that the actual ” teaching ” element is virtually non-existent, and the program expects us to follow or shadow senior residents all day and read on our own. I am lost and overwhelmed by all the modalities I see here daily. For example, a typical day involves spending a few hours in an ultrasonography clinic, seeing conventional or plain film radiography cases, and a CT or MRI following a patient scan.

Most often, the radiologists on staff consult with other physicians, and it’s not like they have the time to point out things. I’ve decided to follow a structured plan and would appreciate your curriculum. What should I cover in my first two years? I know I’m asking a lot of you. Perhaps you can abbreviate your own institution’s plan for me? The first thing I’ve begun to do is revisit skeletal anatomy, including the head and neck. I don’t have a lot of textbooks here (in English, that is), but I have a ton of PDF books on my PC. This lack of physical textbooks is another problem because I miss the tactile experience of actual texts, and looking at a laptop all day is tiring. I will digress and hope to hear from you. Take your time 🙂

Sincerely,

A Tired Romanian Resident

 

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Answer:

 

Thanks for the great compliments. It is much appreciated and makes writing these posts all worth it!

Teaching Differences

Interestingly, you mention that teaching is “non-existent” in Romania. It’s almost the opposite problem in the United States, where everything seems regulated by the government. We need to have x number of noon conferences, etc. I almost wish we had a model for teaching somewhere between the Romanian and the United States models. Residents seem to get bogged down by the regulations and spend less time learning by reading films. (It’s an essential ingredient for radiology!!!!) So, in a sense, you can consider yourself lucky, but you are also missing out on some types of the more didactic teachings.

Curriculum

Regarding the curriculum, the plain vanilla answer is that residents study all the material on the ABR website under the core study guide. It would help if you looked at that to understand everything you theoretically need to know. However, I find it a bit overwhelming, and you need to focus on studying for your time as a resident. So, in the real world, I recommend reading some of the basic overall books in each modality when you begin a rotation each month, such as Mettler for nuclear medicine and the requisite series for some other subjects. You can check out some of the curriculum and books on the web in U.S. Residency programs to get an idea of what you need to know and the books they use. You can also look at some of the books my residents like in the book links section of radsresident.

Most importantly, emphasize the pictures and captions and then secondarily look at the text to understand the images and captions. And keep in mind the ABR blueprints and core material when you are studying. Subsequently, go through the case review series to learn how to go through cases once you have the fundamental knowledge of each primary modality. This process will reinforce all that you studied.

You also make an essential point about missing the tactile experience of textbooks and looking at laptops. It happens to be the subject matter of my next article!!! PDF articles are great because you can download them easily. On the other hand, retention rates for PDFs are probably not as high as reading directly from a printed textbook.

I hope this helps a bit,

Barry Julius

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Is It Still Possible To Become An ABR Certified Radiologist Through The Alternate Pathway?

Dear Barry,

I am also interested as Fiona in the alternate Pathway. My biggest question here would be, if I have any chances after ABR certification in actually pursuing a career as an independent radiologist in the US. As far as I understand, in many if not all states, you are required to complete a minimum time of postgraduate education, within an ACGME accredited program, before being granted the corresponding state license to practice as a physician. Considering the rule that you are allowed to take a fellow position in an ACGME accredited fellowship program ONLY if you graduated from an ACGME accredited residency program (this because of recent changes); how could any radiologist trained abroad be able to fulfill the state licensing requirement after doing the 4 year alternate pathway. (To my disappointment explained here by the SPR – Society for pediatric radiology – ¨ http://www.pedrad.org/Education/Fellowship-Directors/Pediatric-Radiology-Fellowship-Directors-Library ¨ )

The ABR clarifies that the changes introduced by the ACGME are not affecting the alternate pathway, which I understand and see as no impediment for certification, however I still don’t see clearly the possibility of full licensing. Why would a foreign radiologist be interested in ABR certification if the chances of practicing radiology in the US are so scarce or null in the future.

One last question: wouldn’t a fully trained radiologist from abroad be a good candidate to match through the traditional residency system, under your perspective as a program director?.

(Dear Fiona: Maybe we can get in contact and share our views and findings. Please email me if you are interested).

Thank you for reading this, cheers, Esteban.

 

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Here are answers to your two separate questions here. To refer to the other information about the alternate pathway go to the ask the residency director question at the following link: How To Complete The ABR Alternate Pathway As A Foreign Physician

 

Answer to First Question:

In order to be licensed in a state, you do not get your certification from the ACGME. Rather, the ACGME certifies the program that you attend as a resident, fellow, or attending. So, it is still possible to be certified by the ABR and to get a state license via the alternate pathway. However, as you mentioned in the new addendum in 2015 to the alternate pathway, you will have a difficult time getting into an accredited fellowship via the alternate pathway because of the new requirement (having to get an ACGME fellowship only after completing an ACGME accredited residency).

Regardless, it is still possible to use the alternate pathway to become an ABR board certified radiologist. So, how would that happen?

Two Ways To Satisfy The Alternate Pathway Requirements.

1. An ACGME accredited institution would need to sponsor the foreign radiologist for a junior faculty position for four years. In other words, the institution would be responsible for getting the H1B visa for four years so that you could work in the ACGME accredited institution in the United States. The problem with this- the sponsoring institution will incur lots of legal and immigration fees in order for the applicant to get the H1B visa and the junior faculty position. So, it is unlikely that the institution will take a foreign applicant unless he/she offers something special or is trained in a subspecialty area that is useful to the institution and a United States applicant cannot fill that need. Therefore, it is true that the institution is much more likely to take a United States applicant than a foreign applicant for a faculty position.

2. It is possible to get an unaccredited fellowship in an institution that has an ACGME accredited residency program. This year of unaccredited fellowship would be enough to count toward the requirement of having 4 years of training. You would need four such years as this. Through this pathway, you would potentially only have to deal with the issues of getting a J-1 visa, which is a bit easier than an H1b visa.

Issues For The Alternate Pathway Applicant

For both of these alternate pathways, there is a possible complication of some individual states not recognizing the training of foreign residents who do not complete an ACGME accredited residency/fellowship. This means that the alternate pathway training may limit which states he/she chooses to work.

As you can see, it is possible but a bit complicated to go through the alternate pathway via both methods. The ABR alternate pathway has become a rarely trodden method of obtaining a radiologist position in the United States. (It is not impossible, but very difficult and probably involves lots of connections!!!) In addition, there is a risk that your opportunities as an alternate pathway candidate, could be more limited.

Answer To Second Question:

From an associate program director’s perspective, I would love to take a candidate who has been trained as a full-fledged radiologist in another country. Our job becomes a lot easier since these residents are usually very independent. In fact, one our best residents has been a candidate such as that who attended our program four or five years ago. He was absolutely fantastic!

Again, however, there are several impediments for the foreign radiologist who wants to repeat a United States residency. First of all, many programs do not want to have to deal with the stresses of getting a J-1 visa sponsorship for their foreign applicants, even though a J-1 visa is usually not that difficult to obtain. And, second, there is a prestige issue for many programs. Some high-end university programs take pride in the fact they do not take foreign applicants to their program. (Even though they will not say it on their website or brochures)

Bottom line… It is becoming more and more challenging for the foreign applicant to obtain a spot in a United States training position to eventually become a United States ABR trained radiologist. It’s not impossible but it’s very, very difficult. The applicant that is successful is going to have to be at the apex of the foreign applicant pool and is going to have to be on top of the visa situation.

 

Director1

 

 

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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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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

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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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