Category: Ask The Residency Director

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Step II USMLE- When Is The Best Time to Take It?

Dr. Julius,

I’ve planned to take step 2 between late August and early October this year. I’m doing this as I feel my step 1 score in the high 230’s and I’d rather spend time focusing on an away rotation at one of my target institutions and on getting more quality clinical experiences, and therefore LOR’s for my application. Does this seem like a bad idea to you?

Thanks for your input!

First of all, congratulations! High 230’s is a very respectable score. But more importantly, I would say that if you have done well on Step I USMLE, it shows that you can take a test well. It also turns out that with the new radiology core exam, I think there is a much higher correlation between doing well on the USMLE exams and passing the radiology core examination than there was with the old oral board examination. In our program, when we look back at those people that have had trouble with the radiology core exam, they have not done as well on the step I and II USMLE examinations. It makes sense because the style of testing is very similar (multiple choice, matching, etc.) to the current style of the core radiology examination. I think that may be the subject of whole other article!

Getting back to your question, most programs just want to see that you can take a test. So, if you do well on your Step I examination, it is usually acceptable to wait a bit longer to take your Step II USMLE examination and focus on away rotations, clinical experiences, etc. That being said, there may be some programs out there that use both the Step I and II USMLE examination as a screening criteria for getting initial interviews. You may experience a delay in getting interviews at those programs. Many programs, however, will use whatever is submitted at the time and I believe that 230s is usually acceptable for passing that initial screening barrier at most programs assuming the remainder of your application is reasonable.

In particular, you mentioned that you are doing an away rotation at a target institution. Sounds like you might be interested in going there. So, I think it would’t be unreasonable to ask the program coordinator if they require the Step II USMLE examination as an initial screening criterion. If so, then I would take the Step II boards earlier rather than later. Otherwise, it makes sense to get try to get to know the radiologists at the institution of interest rather than hurrying to take the Step II examination. Just remember that when taking an away rotation at a place where you desire to do residency, it is ultra-important to make a decent impression. In some cases, rotating through a desired residency program can be backfire if you make the wrong impression. I’m sure you’ll do great… But, be careful!

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How To Complete The ABR Alternate Pathway As A Foreign Physician

 

dear sir,
I have completed my radiology residency from India in 2015 and I wish to pursue radiology residency in usa.
I am unsure of how alternate pathway for radiology.ABR website says one must have a mix of radiology residency /fellowships/faculty post for four continuous years.If residency itself is for a duration of 5 years ,how would it be possible to have a combination of residency and fellowship for 4 years?
Is it possible to get 4 fellowships consecutively at the same institute?
kindly help me in this regard.

regards,
Fiona

Director1 response:
Radiology residency is for a total of 4 years in the United States. Prior to beginning a radiology residency, you need to have an additional year of clinical internship, usually medicine, surgery, or a transitional year (a year of multiple electives). The expectation from the ABR is that you will either repeat an entire 4 year radiology residency program at the same place (not the initial clinical year). The other possibility is that you have the experience to complete part of a radiology residency program and complete subsequent radiology related fellowships. So, you could theoretically have any combination or permutation of experiences, i.e. 2 residency years and 2 distinct fellowship years, 4 fellowship years, and so on/so forth. As you stated, all the years need to be performed at the same institution.

There are some large institutions that do have more than 4 different types of fellowships. But, if you did attend a United States residency program, more commonly, the foreign resident/fellow would complete a 2 or more year fellowship instead of a typical one year fellowship. (Nuclear medicine, neurointerventional, and neuroradiology fellowships can be 2 or more years) As long as you complete the prescribed 4 years in a radiology related area, you can satisfy the requirement.

Take a look at the following URL:

https://www.theabr.org/diagnostic-radiology/initial-certification/alternate-pathways/international-medical-graduates

 

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ESIR vs IR integrated

ESIR

 

Question:

Hello,

I am an M3 student, most likely applying to radiology next application cycle. I am interested in IR but do not have enough exposure to be dead set on an integrated IR residency. I was wondering about your opinions of applying to diagnostic radiology, specifically at programs with ESIR, and how feasible it is to knock a year off of the independent residency that we seem to be switching to through this option. Could you break down the ESIR pathway and how to transfer from DR to IR? Would this be the best option for someone not dead set on IR, or should I apply to integrated programs and pure diagnostic and rank them as I see fit when the match comes?

Thanks!

Director’s Response:

So, I am going to start by summarizing the three current pathways for interventional radiology at present:

  1. The “old-fashioned’ way involves a 4-year residency. But instead of needing a 1-year fellowship (as it was formerly), you now will require a 2-year fellowship. They call this the independent pathway.
  2. The ESIR pathway that you referred to. In this pathway, you must complete a full year of interventional-related rotations during your residency. At that point, you can then apply for a 1-year independent interventional fellowship.
  3. The DR/IR integrated pathway is an entirely separate five-year residency program.

The DR/IR program has three years of general radiology and two years of interventional-related rotations.

Specifically, regarding your situation, most residents who initially say that interventional radiology interests them usually find another subspecialty fellowship. So, if you aren’t entirely committed to interventional, chances are, you will do something else.

ESIR

If you apply to a program with ESIR, you must tell your residency director reasonably early that you are interested in the ESIR pathway. The reasons for this: A. Multiple residents may be interested in ESIR. B. The residency may only accommodate one or two people because of scheduling requirements. C. The conditions for ESIR can disrupt the schedule of other residents in your class because of the need for additional dedicated IR time and less time on different rotations.

However, the significant advantage of an ESIR program is two-fold. First, it enables the ESIR resident to take the one-year interventional fellowship instead of the two-year fellowship. And second, it makes the ESIR resident more competitive in the fellowship match because they have some experience under his belt. Also, programs have limited their two-year independent fellowships for those not following the ESIR pathway.

More About IR/DR

If you attend a program that has an IR/DR program or an ESIR program, it is possible to transfer in and out of one program or another. However, IR/DR programs give the resident less flexibility. Remember, the IR/DR program maintains independence from radiology residency with its own program director and scheduling. Its sole goal is to create interventional radiologists. (Although it does happen to share the core exam with the radiology program, however). So, it is possible that if you decide to transfer to the DR portion of the program, you may not have enough rotations available to meet the residency requirements. Although unlikely, you theoretically may need to find a residency slot elsewhere.

If you are not entirely sure that interventional radiology interests you, I recommend finding radiology residencies with an ESIR program rather than an IR/DR program. Why? , an IR/DR program commits to you the process of becoming an interventionalist. If you go to an ESIR program, you will more likely have a little more time to decide upon entering into interventional radiology later. (but you should still make a decision as soon as possible). And the ESIR program fits within the confines of the diagnostic program. This program allows more transfer flexibility.

Remember, if all else fails, you can still complete interventional radiology by attending a standard DR program without ESIR. However, you may have a much harder time getting into the fellowship. That may make more sense than applying to an IR/DR program to find out you don’t like it.

So, those are my two cents. I hope that clarifies things a bit. I wish you good luck in the radiology match process!!!

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Radiology Residency Requirements For International Radiology Residents

Question By: Dr.Himansu Shekhar Mohanty

Do you take international radiology residents for your Radiology fellowships/residency? Is it mandatory to pass the USMLE for applying for fellowships? What score ideally do you suggest to have a good chance to get a fellowship in your department?

Best regards

Director’s Response To International Radiology Residents Question:

So to answer your questions, we have taken international radiology residents in the past. But more often, we take residents who are from the United States or residents that go to medical school in the Caribbean and then return to the United States. Nonetheless, some of our best residents have been foreign graduates!!

If you are coming from a foreign program, passing the USMLE is required. Typically, we use the scores as a baseline cutoff. Most importantly for us, we just need to know that you will be likely to pass the new written radiology core exam.  However, the cutoff varies from year to year depending upon the number of applicants and the overall competitiveness of the specialty for any given year. Usually, above 220 is a reasonable level but again that is a moving target. On occasion, we make exceptions if we know the applicant well, there are special circumstances, or the application is so outstanding that the person still merits an interview.

Hope that helps!!

Barry Julius, MD

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Away Rotation in Rads

away rotation

Question By: Nick

Hi there; first of all, great site and info!

So, I’m an MS4 and decided to do an away rotation in IR at a Midwest school which starts in a couple of weeks (I’m at an east coast med school). My wife will be starting vet school at this Midwest school, which is one of my main reasons for wanting to do the rotations. Otherwise, I have performed as an average applicant, and the school that interests me sits in the middle of the pack. My questions: how to approach 1) trying to make the best impression I can in the month (major do’s and don’ts; how to interact with residents/attendings/residency coordinator, etc.); 2) how to approach informing them that my wife will attend school there and that I obviously will want to stay near her for the next four years. I do not precisely know how to “play” this card. Yet, I don’t want to sound desperate even though I feel that way (who wants to live away from their wife!). Thoughts?

Thank You!

-Nick

Director’s Response:

Part 1

First of all, I would like to welcome you to our website. You are the first person to post a question on this page, and it is a great one!!

So, to begin… Let me tell you a story about two trainees that did an away rotation through the interventional radiology department. One did everything right, and the other our department never wanted back again. I will start with the desirable trainee first.

The Desirable Away Rotation Resident

On day one, he got along well with all our interventional attendings. Without fault or complaint, he would share the procedures with the other residents in our department. He would always do his fair share of consent work (even though considered scut). Through the month, he got to know each attending and let them gradually feel comfortable with his work. So by the end of the rotation, each radiologist felt excited to have him participate in almost all the procedures. And he arrived early and stayed late. He went above and beyond when it came to patient care. And, of course, he knew all the pertinent details about each patient. In addition, he befriended everyone and could make a great conversation. Our department wanted to hire him. Unfortunately, however, he would have to live too far away from his family to join our practice.

The Undesirable Away Rotation Resident

On the other hand, we recently had an away rotation trainee who was ultra-aggressive. He refused to do consents and still tried to get in all the cases. All too often, he made many requests from our residency coordinator, which prevented her from getting her residency work done. Finally, he also argued constantly with his fellow medical students and, unbelievably, the residents he worked with. Meanwhile, he had an impressive list of research papers and academic qualifications that dwarfed most other medical students and residents.

Finally, the time came for the medical student to apply to our residency program. And I have to say, I have never seen such an outpouring of violent no votes from attendings, residents, and even technologists! We could not take him into our program, regardless of his academic qualifications.

Part 2

So for the second part of the question, I will assume that your wife will attend veterinary school at the same site as your desired residency. In our residency program, we like our residents to have local family connections such as spouses, parents, or good friends in the area or hospital. Residents with significant ties to the site are happier and less likely to change programs. So, it is a net positive.

I would also tell the program director and attendings at your away rotation that your wife will live nearby. And that you are motivated to stay in their program. Of course, you must also show them that you like the program and the staff. On away rotation, make sure you perform like the resident we wanted to hire, not the student we despised!!!