Miscellaneous Archives - Page 7 of 8

Posted on October 1, 2017January 20, 2022 by Barry Julius — 1 Comment

Ten Things Radiologists Cannot Tell The Ordering Clinician (We Wish We Could!)

As residents and radiologists, we have all experienced frustrations that we cannot verbalize to an ordering clinician for fear of retribution. Perhaps, the ordering clinician may stop referring patients to us. Or, just maybe we will get written up in the middle of the night for performing unprofessionally. That would end badly! Regardless, I have created a list of ten things that all radiologists and radiology residents wish we could tell you, the ordering clinician, but cannot quite get up the nerve to do so. So, here we go.

Examine The Patient First

How frustrating is it that patients get a hepatobiliary scan to rule out cholecystitis, only for us to discover afterward that the patient had a cholecystectomy? Or, we receive a CT scan to rule out appendicitis, only to find out there is no appendix! Come on, guys, do your due diligence, PLEASE!!!

Throw Me A Bone- Give Me Some More History

You ever heard that saying called GIGO- garbage in, garbage out? Well, that certainly applies to us! Please, no more clinical histories with abnormal clinical findings or rule out? What does that exactly mean? If you want your reports to be somewhat valuable, throw us a bone!!!

I Cannot Read Your Handwriting- Write Something Legible Next Time.

Ever consider the amount of time we waste trying to mull over what you wrote on the prescription? Precious time that we could have used to get home earlier lost! Did you write CT w/ for contrast, or does CT w/o mean without contrast? This stuff matters!!!

Get An Answering Service, Bub!

Yes, there are times that we need to contact you. One of the most frustrating things in the world is to make that phone call that your patient has a pneumothorax only to find you, the ordering clinician, are out to lunch without anyone to contact. Please, please, please. If you are not around, find us someone who is covering!!!

Don’t Kill The Messenger

Hey, guys… We are only trying. Don’t get angry with us when we are doing you a service by letting you know that patient has an unforeseen pulmonary mass. Or, maybe we want to tell you that your patient has acute appendicitis. I don’t care if you are on vacation when we get you on the phone. Please show us a little bit of respect!

Just Provide The Relevant Facts, Man, We Don’t Have All Day!!!

We, too, have studies to read and patients to see. Could you not keep us on the phone? We have to hear about all the patient’s irrelevant labs, history, and physical examination. Keep it short and sweet, folks. We have lives that we would like to lead!

Don’t Send Us Your Patients At 4:55 PM!

Why do you like to send us your patients right before we are about to leave? Well, maybe, that patient with a GI bleed that you don’t want to work up because you want to go for the day. So, you send that patient for a GI bleeding scan instead of an endoscopy that you would typically do. The patient gets extra radiation, and then you delay the final diagnosis. Is that good patient care? NO!!!

We Are Not The Hospital Dumping Ground- Take Care Of Your Patients

So, your patient is giving you anxiety because he is combative on the floor. Therefore, you send the patient out to get a test so you can get a breather. Well, if you can’t handle your patients, we certainly can’t control your patient when they need to stay still. We are not the hospital dumping ground. At the very least, give your patient a valium if you send them down to our department!

If You See Us Dictating- Don’t Interrupt Us Until We Are Done!

You wouldn’t stop a surgeon in the middle of surgery. So why the heck would you want to interrupt us in the middle of our dictation? We provide essential information to our clinicians, and studies (1) show that interruption prevents radiologists from making all of the findings. Please… Appreciate what we do!

Give Us A Chance To Look At The Films Before Coming Up With A Final Opinion

So, you came down to our department to talk to us about the study you just ordered. Maybe, it is a CT scan of the abdomen and pelvis. Or perhaps, an MRI of the knee. If you know the nuances of reading these studies and you are telling us all the findings, then why did you come down in the first place? Did you do a 4-year radiology residency already? I think not. Give us a chance to make the correct diagnosis, not the one you want to tell us!

Final Words To The Ordering Clinician

We are clinicians, too, so we appreciate some professional courtesy. Do onto others as they would do to you!

http://www.academicradiology.org/article/S1076-6332(14)00307-9/fulltext?cc=y=

Posted on September 28, 2017August 14, 2020 by Barry Julius

Happy One Year Birthday To Radsresident.com!

My Birthday Balloons!

Personally, I think it is very important to celebrate momentous occasions. And for me, this is certainly one of those times! I am proud to announce that my blog- radsresident.com has survived to its one-year-old birthday. And, there are lots of folks that I would like to thank. Of course, I would like to appreciate all the authors, commenters, critiquers, email writers, and posters who have added immeasurably to the quality of this website. And most importantly, I give my heartfelt thanks to all my loyal readers who have encouraged me to keep this blog afloat.

For this post, I would like to share with you some of the statistics for the year and recount some of the sentinel events. And, I am also going to mention some of the future plans for the website.

Statistics For The Past Year

I am a lover of statistics and if you are into statistics, writing a blog is heaven. Some of you may be curious as to who reads the website, the most popular blogs, and more. So, I will give you the lowdown as of the blog’s first birthday. Let’s start at the beginning.

Over the past year from September 24, 2016, through September 23, 2017, I have had over 68,700 page views and 34,800 individual visitors arrive at my site. Out of the 68,700 page views, about 60 percent of the hits are from the United States. The other countries in the top 5 to visit my site are India (10%), Canada (2.7%), Pakistan (1.6%), and the United Kingdom (1.4%). Most countries throughout the world are also represented.

How do folks find my site? Well, 34% find my site through search engines, 31 % land on my site through social media, 30% arrive at my website directly, and 6% are referred from other sources such as Aunt Minnie.

In total, we have published 105 separate posts as of the blog’s birthday, not including all the additional pages that we have written. Of all these posts, I have authored 83 unique posts; 14 posts have been interesting questions posed by viewers/commenters in the Ask The Residency Director category; guest authors have written 8 posts.

Ten Most Popular Posts Written By Me:

Three Most Popular Ask The Residency Director Posts:

Three Most Popular Guest Author Posts:

Up To Date Book Reviews For The Core Examination by Danny Nahl, MD
Teleradiology, A Risky Business? by Haley Dezendorf
Has Technology Ruined Your Chance Of Employment In Radiology? by John Chung

Whirlwind Birthday Tour Of The Past Year

Not only did we have a prolific year at radsresident.com but we also were honored to have some of our posts published in some great blogs such as Aunt Minnie, Doximity, and PassiveIncomeMD!

Blogs Published In Aunt Minnie

Blogs Published In Doximity

Blog Published In PassiveInvestorMD

Alternate Careers And Supplemental Income For The Radiologist

Plus, we have survived one full website update and I have written a book called Radsresident: A Guidebook For The Radiology Applicant And Radiology Resident, both on Kindle and paperback. And, we have created new features that have been a great success such as Ask The Residency Director and The Case Of The Week. Of course, I am still experimenting and trying to figure out what interests you, the viewer, and what works on the website well so that I can continue to create interest, entertain, and grow the website audience!

Please Continue To Support The Website

Although our website is growing by leaps and bounds from its humble origins, radsresident.com continues to operate at loss. So, if you like this site, please continue to buy books and items through our affiliate Amazon.com in the books and links section.

Also, if you are interested in completing surveys for money, I am an affiliate of both M3 Global Research and GLG Group. I currently use both companies to complete surveys for extra cash. If interested, I highly recommend joining both organizations to maximize your survey dollars.

And finally, I am also an affiliate of grammarly.com. I use this application on a daily basis to help with correcting grammar for the website and find it exceedingly helpful. If you are interested in writing personal statements, papers, or other documents, I highly recommend utilizing it as a grammar check. Joining up is free for the basic version and you will also support the website. Just click the link in this paragraph.

The Future Of Radsresident.com

For now, I plan to continue to write lots of blogs that I hope will be useful and of interest to you, the reader. (I have 4 articles already written in advance and have lots of ideas for new articles!) In addition, recently, Doximity has asked to publish some of my new articles on its website. So, I am excited to announce that you can also expect that Doximity will highlight my articles in the Doximity op-ed section!

As we go along, I also hope to continue to get great questions from my readers to use for the Ask The Residency Director section of the blog. And, we will continue to publish interesting articles by guest authors as they come through. Of course, if you have any interest to participate in any of these ways, don’t hesitate to contact me at director1@radsresident.com!

Gradually, I also plan to experiment with what works best on this website. But, would be happy to entertain any further suggestions from you, the audience. Over the next year, you may notice changes to the website every once in a while as I add on concepts to the website that may be interesting or take away others that I find to be redundant or do not work as well. Please, I would love to know what you think! Thanks for celebrating the blog’s first birthday with me, everyone!

Posted on September 13, 2017March 10, 2022 by Barry Julius — 1 Comment

The Uncomfortable “Screenostic” Breast Ultrasound Imaging Dilemma

For those of you who have completed a mammography rotation or are beginning to practice mammography, you may notice ordering physicians prescribe a diagnostic mammogram along with a diagnostic and screening ultrasound. One example would be the doctor who orders a mammogram for a unilateral breast asymmetry with an accompanying bilateral diagnostic ultrasound. Or other times, the ordering doctor will specify to perform an ultrasound for pain on one breast. Yet they order a bilateral breast ultrasound that the patient expects to get done. One of my former excellent mammographers had called these sorts of situations “screenostic studies.” And I think that is a great descriptive name since these breast ultrasounds encompass both a “diagnostic” and a “screening” component. So, I kind of took to the title, “screenostic.” Now, I use it all the time.

Issues Behind The “Screenostic” Ultrasound

For me, I always find this situation very frustrating. You are never quite sure if the ordering physician means to order the study as a screening ultrasound. Or, did they mean for the case to be diagnostic and accidentally request a bilateral breast ultrasound? Perhaps, they were not thinking about it or did not understand the purpose of the ultrasound. Unfortunately, frequently, you will never know the answer.

So, let me give you an example of what happens when you confront the issue head-on. You call the physician to learn their ordering intentions, taking away precious minutes of your valuable time. Then, when you ask the ordering physician what they wanted, the physician often becomes indignant because it “wastes their time.” On top of this, the patient expects that they will receive a bilateral ultrasound because it is “better” than a one-sided diagnostic ultrasound. Now, they have to wait longer. And if you decide to change the order, you now have to waste additional time to persuade the patient that they need a unilateral breast ultrasound.

Bottom line. All hell breaks loose. It’s ugly. You have a mixture of undecipherable physician expectations. And the patient has unfounded expectations to complete the study. The radiologist is unhappy; the patient is angry, and the ordering physician is upset. It is a lose, lose, lose situation.

So what finally happens? Regardless of the study indication and the true intentions of the ordering physician, the technologist completes the study. It’s just a heck of a lot easier. But, it is all a waste of time and money.

Call To Arms!

I only see two potential ways out of this daily breast imaging mess. First, we need intense education for ordering physicians. In most practices, however, this road is a difficult one. It can be next to impossible to get through to all the referring physicians in a bustling business. And, referrers just want to order and write their scripts without dealing with the implications. It takes too much time to “listen” to the meager radiologist or set up an educational outreach program.

Second (and I may get a lot of backlash for this one), enter clinical decision support systems. If only a system could force the ordering physician to make a clear prescription that makes sense. Clinical decision support systems would do just that.

You may think that I am just whining and complaining. But this issue has real implications for patient well-being and daily workflow. Oh well, in the end, it is just another dilemma that occurs when the clinician controls the ordering of imaging studies instead of the true imaging expert, the radiologist. Let’s take it back!!!

Posted on August 24, 2017December 29, 2021 by Barry Julius

Radiology Jargon That We Would Love To Use But Can’t

Radiology Jargon Defined

Radiology jargon that we use to describe our findings to our fellow clinicians and radiologists differs widely from what we have to put in our reports. If only we could use these words in the final dictation because these words are so much more picturesque and meaningful. In addition, they can replace a long-winded description with a simple phrase. Life would be so much more fun!!! Ohh, to be truly living the moment. But alas, we can’t do it for legal, moral, and ethical reasons. Perhaps, the words are too flippant. Or maybe, they are not grammatically correct. But what if we could? I’ve come up with an excellent glossary of thirteen words that should be in common usage that we do not dictate or write down for these reasons. So, here we go!

Badness/Pure Evil

Some tumors have such an aggressive configuration; these words apply. Usually, these lesions are over 99% likely to be malignant with a high probability of metastases.

Brain Teaser

When you obtain the final diagnosis, you are dying to put this your dictation by complicated, circuitous logic. However, it is just not allowed!

Cheesy Consistency

You know it when you see it. It is slightly higher density than fluid with small foci of air.

Ditzel

A tiny finding that you see of no significant consequence.

Fecally Challenged

It’s what you say when you can’t mention constipation because that is a clinical diagnosis. But yet there is tons of poop everywhere!

Glom

It is usually a proteinaceous mess within the body. The glom can be contained or free! I would love to use this one. It sounds so right…

Gumba

A gumba is an enormous finding that is of paramount importance.

Nightmare Case

It is the perfect descriptor for that case, with a billion findings on a CT scan, usually with no oral and intravenous contrast. The problem is- who wants to be called a nightmare?

Ring Magnet

A patient who has rings in almost every orifice imaginable. I am waiting for the proper case to use this one!

Screenostic

Screenostics are breast studies ordered as a diagnostic for a callback or finding and include the opposite breast for some unknown reason. Hence, the “Screen” part of the word.

Shpiel

It’s the real story, not the long-winded, boring version. It can be a word or phrase to replace the written history or impression. Direct translation from Yiddish

Sweet Pickup

It’s what you like to say when you make a subtle but significant finding. Unfortunately, there is nowhere you can say it in your dictation! You have to rely on hearing it from others.

White Cow In A Snowstorm

It’s what you see when there is so much noise that the findings are impossible to visualize. Usually, it is present on ultrasound in an obese patient, an underpenetrated film, or a study with tons of artifacts.

Posted on June 15, 2017August 19, 2021 by Barry Julius

Most Common Stereotypical Generation Radiologist Differences

Although not every radiologist fits the particular stereotype for their generation, some generational stereotypes ring true. On the whole, the baby boomers, Generation X, and Millennials perform better and worse in some parts of the radiology workforce and have their own particular needs. When you work with these individuals, it is vital to keep this in mind. Sometimes, we need to change the way we operate to accommodate these differences. So, today I would like to go through some areas where radiologist generations differ, arranged by different topics. I hope you enjoy it!

PACS And Social Media

Baby Boomers: These folks tend to be less comfortable with PACS system changes. So, beware of the PACS upgrade! It can wreak havoc on their lives. Social media can be somewhat foreign to these radiologists. Many of these radiologists do not have Facebook, Linkedin, or Instagram accounts. So, sending out messages via these media may be a waste of your time.

Generation X: For these radiologists, PACS utility issues tend to be a mixed bag. Some of the less tech-savvy radiologists fall into a similar category as a Baby Boomer. Others are more adept with PACS systems. On the other hand, social media outlets are generally much more native to the Generation X radiologist with broader and more frequent use. Although not all of these radiologists use social media, you will be more likely to find these folks more comfortable.

Millennials: On the whole, these radiologists cope well with PACS updates and changes as long as the network runs correctly. Their technology knowledge enables these individuals to learn quickly and grasp the most efficient ways to learn PACS. Social media is not just a tool for many of these individuals; it can be a way of life. Their online persona can become just as important as their offline interactions. They tend to engross themselves in the online world.

Barium Work/General X-rays

Baby Boomers: This group of individuals has, by far, the most expansive repertoire of experiences with both barium work and plain films. Since it was the mainstay of radiology initially, they often pick things up that their more junior colleagues will miss. They can work wonders with barium and grasp the nuances of a good barium examination.

Generation X: They can read plain films rather adeptly and efficiently. Although not as seasoned as a Baby Boomer, they can read an x-ray reasonably well and are comfortable with most barium work. During residency, they have had lots of experience with films and barium slinging.

Millennials: Since they spend a lot more time with CT and MRI than plain film work during the residency, overall, they are less comfortable with plain film interpretation. As residents, hardcore barium studies experience such as barium enemas can be minimal. So, the performance and interpretation of these studies can be a bit more challenging.

MRI

Baby Boomers: It is much less likely for the Baby Boomer to feel comfortable in this modality since they may have completed MRI training after their residency. Most Baby Boomers will avoid MRI if possible.

Generation X: Plus or minus. Depending on the experiences during residency, some feel very comfortable with general MRI work and others less so.

Millennials: Most Millenials are comfortable with all MRI since it has become “bread and butter” radiology, just as standard as all the other modalities out there. I would certainly put a lot of faith in their excellent reads!

Vacation Time

Baby Boomers: This generation believes in the adage “live to work.” Overall, they tend to take less vacation than given (although they get more vacation time than the rest of the generations!)

Generation X: They have a similar work ethic to the Baby Boomers than Millenials, although they can straddle both sides. Vacation time is essential, and they fully take advantage of their time off the job.

Millennials: Everyone needs to work around the Millennials’ schedule. Their motto is “work to live, not live to work.” They like flexibility in their schedule and will do whatever they can to get to the lifestyle they want. Every day a practice gives vacation time, these radiologists will take the day. They do not spare a moment that they can use to bolster their lifestyle.

Money

Baby Boomers: For the most part, these radiologists sit on a large nest egg, having worked through radiology during its most lucrative years. Debt load tends to be nonexistent. They have the most flexibility and can leave the workforce whenever they want. Many of these radiologists perform their job solely for the “love.”

Generation X: Most of these radiologists have paid off their debts and have done relatively well in their specialty. Money is still important to these folks because they still do not have enough to retire. But, they have good jobs and will do well overall since they have been working during the “good years.”

Millennials: Severe student debt weighs down these radiologists and can limit their opportunities to places and jobs that this generation does not want. It almost runs counter to their ideal lifestyle philosophy. These radiologists also started to work in the field during lean radiology years and are more likely to have had less opportunity to make money. Hence, there is some bitterness when it comes to discussing the topic of money!

Interpersonal Relationships

Baby Boomers: Overall, this group develops solid interpersonal relationships with their colleagues and staff. They never had the opportunity to rely on social media or other forms of technological communication, so they deal well with others. In addition, they have the least need for external approval.

Generation X: These radiologists probably have more in common with the Baby Boomers than the Millenials since they grew up in a world without social media. They were allowed to fail just like the Baby Boomers but were more protected than them. But, they do develop strong interpersonal relationships with their colleagues.

Millennials: Since many of these folks were not allowed to fail growing up, they need to be outwardly appreciated by their colleagues much more than the other generation. They spend a lot of time on their mobile devices, garnering relationships with others. Since online life can be just as important as their offline persona, some can seem outwardly unfriendly because of the time they spend on their devices.

Teaching Expectations:

Baby Boomers: They love a great lecturer and taking cases. However, after completing a teaching episode, the Baby Boomer will research and read the topic to reinforce learning. Overall, the Baby Boomer does not care about electronic media, but some will use it. Old-fashioned books instead of ebooks work better for the Baby Boomer.

Generation X: The typical generation Xer fits somewhere between the Baby Boomer and the Millenial. They will do their research and not expect the lecturer to tell them everything they need to know but understand the practicalities of ebooks and electronic resources.

Millennials: They traditionally have been spoon-fed information in lectures. And, they expect everything to be spelled out for them when others teach them. Overall, they expect the teacher to know everything about a topic and point them toward all the resources they need to read. Most Millennials use ebooks exclusively and will utilize electronic media to reinforce all learning.

Summary

I repeat, “These stereotypes certainly do not apply to all radiologists out there!” However, I think there is an overall tendency for individuals of each generation to fit some of the stereotypes. Knowing the strengths and weaknesses of each generation allows us to schedule accordingly, allocate appropriate resources, and understand what each generation needs. For instance, since the Millennial tends to have a higher debt load, allow for more moonlighting opportunities or extra work. Or, make sure to incorporate additional training with new electronic PACS system upgrades for the Baby Boomer. Bottom line- it pays to understand each generation!!!

Featured on Aunt Minnie.com!!! Click here for the Aunt Minnie version.

Posted on June 8, 2017 by Barry Julius

USMLE Step III- An Impediment For Radiologists?

Over the past few years, we have been witnessing a new phenomenon that I don’t think is unique to our diagnostic radiology residency program. Incoming residents are either delaying or failing their USMLE Step III examinations. Some of this new reality may be related to the decreased competitiveness of radiology. However, what is interesting is that some of the residents that fail or delay the examination are not toward the bottom of their respective classes but rather are high performing residents with a good fund of background knowledge in radiology. That got me thinking. What is going on with the new USMLE Step III examination? And, should the examination be a prequalifying factor for obtaining medical licensure prior to becoming a radiologist?

According to the USMLE Step III website, “Step 3 content reflects a data-based model of generalist medical practice in the United States. The test items and cases reflect the clinical situations that a general, as-yet undifferentiated, physician might encounter within the context of a specific setting. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care.”

If you actually take apart the content of this summary statement of the Step III boards, you will see that the goal of the examination is in no way applicable to the intellectual goals/medical knowledge necessary for being a good radiologist. Based on the responses of many of my residents that have already taken the test, the questions, and content of the test have limited applicability to the practice of radiology. Very few questions are radiology related and have clinical scenarios that would ever be useful background information for a radiology resident/radiologist. So, is it really warranted to have radiology residents pass such an exam in order to practice their specialty? What is its utility?

Furthermore, the concept of having an intern that trains for one year and practices independent medicine is outdated, to say the least. Almost no hospital or clinic would ever hire a physician without some sort of complete residency training in a specialty whether it be internal medicine, psychiatry, or radiation oncology, let alone radiology. The liability of a hiring physician without this training would be enormous. I, for one, would never let any of my family members see a physician with one year of internship training who had merely passed the Step III USMLE examination.

More relevant to us, radiologists and other subspecialists never practice independent general medical care. The clinical situations that undifferentiated physicians encounter is very different from the needs of subspecialist radiologists. So, why prepare a physician for an end goal that he or she is never going to realize?

All these issues, bring me to this final conclusion. Maybe we consider creating a new examination that is actually going to be relevant to the goals of the subspecialist and not the general practitioner. Perhaps, we should create two separate exams, one with a general pathway and the other with the subspecialty pathway in mind. At least, you would create a test with increased relevancy and with a practical end goal for the individual subspecialist that would help with their future career requirements.

It is time to rethink the requirements for resident physicians obtaining medical licensure since the present concept of practicing independent care as a physician after one year is outdated and dangerous. And, subspecialists have different needs from general practitioners. With that, the Step III examination should change accordingly.

Posted on May 25, 2017August 27, 2023 by Barry Julius

How Should The ABR Test Communication Skills?

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

———————————————

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

Posted on May 21, 2017 by Barry Julius — 4 Comments

The American Board of Radiology- Shame On You

Has the American Board of Radiology (ABR) finally thrown up its hands and said it can no longer do its job? That was the take home message from my recent excursion to the AUR meeting. The explicit role of the American Board of Radiology is to standardize the quality of trained radiologists throughout the country. In fact, if you read the mission statement of the ABR website you will read verbatim- “Our mission- to certify that our diplomates demonstrate the requisite knowledge, skill, and understanding of their disciplines to the benefit of patients.” What are the most crucial skills in order to become a radiologist? Well, two of the most important pillars for creation of a competent radiologist is medical knowledge and communication. For the first time at this meeting, the ABR explicitly stated that they will abandon the role of testing radiology resident communication skills and will leave this responsibility for maintaining minimum standards to the individual programs while continuing to standardize testing of medical knowledge. What???????

If you leave the responsibility of testing and maintaining communication skills to individual programs, you are certainly not ensuring the baseline quality of our future radiologists. There are no accrediting bodies out there that can ensure the outcome of training as well as a governing/testing body such as the ABR. Without the lead of an accrediting board such as the ABR, I can see wide variability among different programs in the ability of residents to dictate and communicate results to their fellow clinicians. Some residencies will shine and produce a resident product that will competently communicate results to clinicians and others will no longer create residents with the minimum level of communications skills since there is no impetus to do so. We no longer have an oral board exam that can assess some basic communication competencies. How can the ABR accrediting body support such a position?

Government funding for medical education is at an all time low and hampers the ability of regulating bodies to do their job. Now we are leaving the responsibility of the ACGME/RRC with less teeth and funding to regulate these competencies? On the other hand, the ABR is funded by private radiology resident and radiologist dollars. Each of us spends thousands of dollars on getting and maintaining board accreditation during our lifetimes. And with all this money being spent, the ABR is saying that they cannot ensure a minimum communication competency. This is absurd.

Other licensing boards are actually moving in the opposite direction because they know it is the right thing to do for patient care. For instance, the USMLE has added on a clinical skills section to their test because creating doctors that can’t assess and communicate results to patients makes no sense. Why should testing by the ABR in the field of radiology be any different?

Please ABR… Step back and think about your position on testing communication skills. If you want to stay relevant in today’s day and age, there are other accrediting bodies out their that may take on the role of maintaining standards if you can’t do so yourself. Rethink your position statement and honestly reassess if it is in the best interest of the radiology community to forgo testing of minimum competency in communication skills. I don’t think so.

Posted on February 19, 2017September 8, 2021 by Barry Julius — 2 Comments

Reading Room Background Music- A Hazard For Patient Care?

Walk into any radiology reading room, and you may see several radiologists with headphones plugged into iPhone music. Others are constantly shushing other residents, chatting amongst themselves in the reading room. These rads hate the moment that excess noise comes their way. This divergence of opinions on the matter is enormous. So, should we concentrate solely on the findings on the film and ban all music/noise from the reading room? Or, does music help radiologists to notice things they may have not as seen otherwise? Let’s look at several relevant articles and weigh the body of evidence to come up with a conclusion.

Music As Potential Benefactor In The Radiology Department

Mood

As I was combing through the internet, I came across several interesting positive articles on noise and productivity. However, overall, the scientific power of the studies was pretty weak. One particular study emphasized radiologists, and it was an interesting article in Science Daily. It summarized an American Roentgen Ray Society abstract. The study took eight radiologists and looked at how baroque, classical music affects mood, concentration, perceived diagnostic accuracy, and work satisfaction. It concluded that the most statistically significant positive effects were upon mood and work satisfaction. One physician even stated that there was a subjective improvement in concentration and interpretative abilities. However, it had a low number of included participants and didn’t look at the actual performance of the radiologists. So, I’m not sure if the results are that relevant.

Performance

One abstract in the literature with a slightly higher number of participants (26 radiologists) looked at acoustic noise within clinical departments and radiology performance. This study concluded that acoustic noise found in most radiology departments is not a distraction from work. However, this is not a direct study about music and reading films. Although a small study, the paper suggests no harm in listening to music and reading chest images.

Another article went through different types of music that are best for immersive tasks but are not specific to radiology. I think you can extrapolate these genres to radiology because radiology reading rooms are an immersive environment. Interestingly, it listed baroque, classical, electronic, video games, and low-volume ambient music as the most helpful. Nevertheless, the scientific literature did not back it up.

The Journal of the Acoustical Society of America released a paper stating that natural sounds may “enhance cognitive functioning, ability to concentrate, and increase worker satisfaction.” I didn’t see the data behind the study, but it would be interesting to arrive at a reading room that sounds like a waterfall or a windy day. That could make me a bit more efficient and relaxed… But perhaps a bit sleepy as well!

A Case Report About Music And Performance

Nototallyrad.blogspot.com had an interesting expose on reading ICU chest films where he spoke specifically about his productivity based on different types of music in an unscientific format. He concluded that he was most efficient when listening to Bach instead of Metallica, White Noise, and Red Stick Ramblers! Call me crazy. But, if I listened to Metallica while reading anything, not only would I have a difficult time reading cases, I may come home with a headache!!!

Music As A Disruptor of Radiologist Concentration

Much of the literature regarding noise/music and adverse effects upon performance is not specific to the radiologist. These articles tend to be a bit more powerful but are certainly not complete. We can try to extrapolate from these articles the relevance to the radiologist. Specifically, if you look at the psychological literature, several negative articles reported on the radiologist regarding noise, music, and performance.

Performance Deterioration

The first one, The Impact of Listening to Music on Cognitive Performance, supported that performance scores were higher in silence than in all types of music conditions. That performance deteriorated as the intensity of the music increased. The kind of music did not affect performance, just the intensity of the music. Again, the sample size was not that large. And other biases were present that could alter the applicability of the results.

Another psychologically-based article called The Effect of Background Music and Background Noise on the Task Performance of Introverts and Extroverts looked at 10 participants and the effect of music with high arousal potential and negative affect, music with low arousal potential and positive affect, and everyday noise on cognitive task performance of introverts and extraverts. Similar to the previous study, performance was worse with background noise compared to silence. There was also differing performance among introverts and extraverts (I’m not sure how relevant that part would be toward radiologists!)

Outside of the psychological literature, a sociological study looked at the relationship between multitasking and academic performance. Although not specific to music, it had a significantly higher number of participants (1839 surveys). Moreover, it could potentially be relevant to the radiologist. The result was that multitasking with social media and academics could lead to a lower GPA. Although there is no direct link in this article between listening to music and radiologist performance, one can conclude that music is multitasking and can just as well interfere with radiology performance.

The Lone Radiology Resident Study- A Mixed Result

Finally, there was an article explicitly dedicated to the radiology resident! It specifically looked at resident detection of rib fractures. They divided eight radiology resident readers into two groups- one accustomed to reading in quiet environments and another group that reported to be unaffected by noise. It turned out that the resident’s attitude toward noise affected the detection of rib fractures. Those residents who usually read in silence had improved performance in silence, and those unaffected by noise had improved performance with noise. Again, not such a robust study, but interesting nonetheless.

So What Is The Preponderance Of Evidence?

Although the higher power studies currently lean toward music as an overall detractor of potential radiologist performance, there are no strict guidelines in either direction. You can still make an argument in some cases that music can help some radiologists get through the day in a better mood if nothing else. However, until there is some more substantial evidence that music has no effect or improved effect upon radiology reads, read films with music at your peril!

Posted on February 16, 2017February 16, 2017 by Barry Julius

Can Clinical Decision Support Systems Help To Improve Radiology Resident Education?

During my residency only a little bit more than 14 years ago, I can still remember grabbing a ream of sheets from the bin to check the day’s CT protocols. We would quickly read through each one to make sure that the appropriate test was indicated as was ordered by the referring physician. Somehow, I think this process is currently an anachronism at many radiology residency programs. The pressure to complete studies in rapid fashion have changed the way things are done. It seems almost all the cases come directly from either the emergency room or from the referring physician directly to the scanner. No longer is the resident an intermediary in the process (a potential delay in the system). Instead, there is a corresponding increase in tests with incorrect indications and/or wrong technique, only to increase radiation dosages and the cost to the system. The ordering physicians, not the imaging experts, have hijacked what should be the domain of the radiologist: to decide if imaging examinations are appropriate.

Why do I bring this topic to our attention? First and foremost, of course, patient care suffers. But also, as today’s topic implies, it also affects the education of the radiology resident. So how do we get control back over the reins of imaging from a standpoint of improving resident education? Initially, we have to understand the role of protocols in the education of the radiology resident. And then, I will briefly discuss what imaging clinical decision support systems are and how clinical decision support systems can potentially enhance the education of residents as well as the appropriate use of imaging.

Protocols And Educational Implications For The Radiology Resident

One of the most important roles of radiologist is to be a consultant for the appropriate use of imaging. As I described above, the process of checking protocols significantly enhanced my knowledge on this topic. What may have seemed at the time as a questionable activity bordering on scut, I now see as invaluable. Related to my prior experience with protocoling CT scan studies, I now understand when contrast should be administered, how certain studies are typically performed, and most importantly, what are good indications for a study to be completed. At many programs, this educational opportunity is no longer available due to financial and political pressures upon radiology departments to get through the system. Any study ordered must get done in a timely fashion, no matter whether the study is indicated or not! It only matters that it was ordered. Correspondingly, resident involvement in this process has significantly decreased over time.

So, how does removing this educational opportunity for radiology residents change the knowledge base of the radiology resident? First of all, you are taking away important practical knowledge that can reduce the value of new radiologists as a consultant for determining appropriateness of individual imaging studies. Second, new radiologists will be less likely to understand how to tailor individual studies to the indications of the ordering physician. And finally, the potential implications of issues like when to use intravenous contrast can be underestimated, both from a contrast complication and an appropriate indication point of view. So herein lies the potential savior to return the educational opportunities of protocoling back to the radiology resident- The Clinical Decision Support System!

The Clinical Decision Support System

Here is the definition of clinical decision support systems according to the government– “Clinical decision support (CDS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. CDS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include computerized alerts and reminders to care providers and patients; clinical guidelines; condition-specific order sets; focused patient data reports and summaries; documentation templates; diagnostic support, and contextually relevant reference information, among other tools.”

In terms of imaging, the potential implications of a clinical decision support system from a cost and educational standpoint are myriad. No longer are all imaging studies going to be ordered without the approval a computerized system. When can this potentially occur? How would the radiology resident role going to be affected by the implementation of such systems? Let’s talk about both of these questions…

Institution of Clinical Decision Support Systems And The Potential Effect Upon The Radiology Resident

At first, institution of electronic clinical decision support systems were going to be mandatory as January 1, 2017. The date was subsequently changed to January 1, 2018. We will see if this date is going to be the finalized implementation deadline.

But let’s say that a good quality clinical decision support system became mandatory at all institutions for ordering imaging studies at the beginning of 2018. How would that affect the residents? First thing that would you notice, bogus indicated studies would all of a sudden significantly decrease dramatically. The system should theoretically block anything that has a questionable indication from getting through from the clinician order to actual practice. Second, there could potentially be a flood of phone calls. Since any study with a questionable indication or a complex protocol would not be able to get through the system, instead, clinicians would be forced to ask the radiologist what kind of protocol should be implemented for these cases. Not only would this be a boon for patient safety (decreased radiation dosages) and appropriateness of imaging, clinical decision support systems can actually bring the control of image ordering back to the radiologist. More specifically, a good quality clinical decision support system can theoretically allow the radiology resident to protocol examinations appropriately in concert with the ordering physician and tailor examinations to the indication that is needed. Resident protocol education can be restored!!!

Interestingly, a clinical decision support system for imaging was actually one of the few parts of the health care bill that actually had the potential to decrease costs and quality of care in addition to improving resident educational experiences. Ironically of course, it may never be implemented depending upon how the political situation in Washington affects health care.

Clinical Decision Support Systems For Imaging Can Be The Resident Radiologist’s Best Friend

In summary, clinical decision support systems have the potential to be one of the true benefits to the health care system, in terms of costs and quality of care. But, one of the most overlooked implications is actually the potential educational benefits to the radiology resident. No longer would ordering be in the hands of untrained ordering physicians. Instead, control will again lie in the hands of the radiology resident allowing him/her to protocol patients once again appropriately and giving the radiology resident the education he/she needs to become a true imaging expert.