Category: Resident Advice

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How To Switch Gears From Orthopedic Surgery To Radiology As A Medical Student

orthopedic surgery

 

Question About Switching To Radiology From Orthopedic Surgery:

Hi Dr. Julius,

 

I’m a 3rd-yr med student with a growing interest in radiology. I’m in the middle of core clerkships and have come to appreciate how vital radiology is in all fields and how broadly it covers different parts of the body and aspects of medicine.

 My issue is that up till now, I have been pursuing orthopedic surgery, doing research, and making connections exclusively in that field. If I switch to seeking DR (maybe IR), what can I do to improve my ERAS application in the eyes of residency directors when I apply next year?

Background information (in case it helps): BS in engineering, currently at a top 25 med school, Step I – 233

 

 

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Answer:

 

Unfortunately, you can’t change what you’ve already done in orthopedic surgery. However, you still have time to get involved with research opportunities in radiology. Find a radiologist who needs some help with her research. At least, that shows some interest in the field. That is the low-hanging fruit that can help your application a little bit. It will also demonstrate some increased interest in the DR or DR/IR field. Even better, if you are interested in IR, I would find an interventionalist to work with and do research. That way, they could become your “mentor” and give your application even more relevance.

 

 

Suppose you have come from a good school with reasonable grades/Dean’s letter. In that case, you should have an excellent shot at a university program for DR. DR/IR is a little more of a crapshoot since it has become highly competitive. But you should still have a good chance as well. As I’ve mentioned, I highly recommend checking your Dean’s letter for any mistakes or “questionable” references. That is the most likely cause for a surprise for not matching where you want on match day. And it is also straightforward to correct if you can.

 

 

I hope that helps a bit,

 

Barry Julius, MD

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Are Residency-Wide Meetings A Waste Of Time?

meetings

In many radiology residencies, similar to some large private practices, not all residents work at the same site. Perhaps, rarely, if at all, do they remain in the same building simultaneously. Moreover, within the program, individual sites within the residency program may give different lectures to the residents rotating at that particular site. Or maybe, you will have varying experiences in your residency due to the limited spots and rotations. One resident may never even rotate through areas that others do. So, big deal, right? How important can it be to have meetings with all your colleagues in your radiology program? Well, I will convince you today that residency-wide meetings are essential. And we will go through the most critical reasons why!

Uneven Distribution Of Work

For instance, you may work at one location and experience a level I trauma center. At the same time, the colleague you started with spends most of his time in an oncology center. Your fellow resident becomes jealous that he is getting very little on-the-job training in trauma radiology. And, you think that you are not getting enough oncology work. How do you resolve this issue? You may not be able to change the schedule without reaching a consensus. Often, to do that, the only way to address this issue is to meet with your colleagues!

Or, since you are working at a pediatric center with inadequate coverage, you must work night call every 5th night. Meanwhile, your “friend” in the main hospital has plenty of coverage and can work call every two weeks. Now, you can discuss all this with your program director. However, you must lay out the issues first with your fellow residents and faculty at residency meetings so everyone can understand and fix the problem.

Miscommunication

Like the game of telephone, you will likely miss out on the opportunity to communicate on the same wavelength if you do not meet as a whole residency program. Perhaps, separate study groups form, and some residents are not privy to the same information. Or, one group learns a technique for fluoroscopy and never shares it with their colleagues. What happens? The whole residency loses out!

Less Sharing Of Resources Leading To Poor Outcomes

Perhaps, one site has a simulation center for interventional radiology procedures. And the others do not. If the residency does not meet as a whole, how do you know which resources to share? And what happens to those residents that never get a chance to perform procedures on the simulation devices? Well, they lose out on the opportunity to learn interventions. And that is just the tip of the iceberg. Not having regular meetings can lead to poor resident training outcomes!

Lack Of Interresidency Networking

Every person in the residency that you do not know reduces the chances that you will find a great job when you graduate. Why? Maybe, the uncle of one of your fellow residents is a radiologist at a hospital in Walla Walla, Washington. And that is the only place where you want to live. When you lose out on your contacts because you barely meet with colleagues at other sites, you lose another chance to get that next best career opportunity!

Importance Of Residency Meetings

Individual sites cannot remain entirely independent from one another to have a well-functioning residency. Accordingly, resident education will either suffer or, at least, not achieve the best possible outcomes for all its members. Not creating regular meetings for all the residents allows jealousy among residents to fester, uneven work distribution to continue, inadequate sharing of resources, and opportunities lost for resident networking. So, don’t poo-poo the resident meeting. They serve a crucial function!

 

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How To Deal With The Negligent Technologist

negligent technologist

Just like not all physicians make caring clinicians, not all technologists fulfill their obligations to the patient. And unfortunately, at some point in your career, you will likely encounter one of these medical team members. Perhaps, the negligent technologist always leaves at 4:00 PM regardless of whether they are evaluating a patient for a STAT study, like a pelvic ultrasound for a ruptured ectopic. Or, maybe, they see an MRI sequence with many artifacts and decide to do nothing about it. One of these situations will likely occur as a resident or attending. Therefore, it is essential to know what to do. To clarify the rules of the road, I will divide the blog into the four strategies outlined below.

Don’t Beat Around The Bush (Be Direct)

Open communication is one of the essential ingredients to prevent recurrent episodes of negligence. If you discover an issue, why wait to address it when it is no longer fresh in anyone’s mind? Maybe, the tech was not passive-aggressive when he made the error in judgment. Instead, perhaps, he did not realize that neglecting to correct the MAs for body weight would cause a problem with the film. You must talk directly with him to find out. Sometimes confronting the issue head solves the problem permanently. Of course, that does not always happen, which brings us to the next heading!

Talk To Your Program Director

Regrettably, you still have not solved the problem by directly talking with the technologist. So, who better to discuss the issue with than the program director? Perhaps, she can guide you to what you should do next. Or even better, maybe, she can take care of the entire situation for you. Many times this simple action will solve the problem.

Document, Document, Document

Rarely talking to the technologist or the program director does not solve the problem. So, what to do next? Well, if you find that the offenses are recurrent, you must document each of the episodes. Only when you have objective data can you use it to change the situation, primarily as a resident. Why? For the most part, the technologist has likely been working for many more years than you at the institution. Therefore, the technologist’s word will often carry more weight than yours.

Why else is the technologist in a better position than the radiology resident? The institution has more to lose when a negligent technologist leaves instead of a resident because it is more costly. So, you will need to keep a written or electronic log. And be specific. Accurately state what happened, how it occurred, and when it transpired. Make sure that you can confirm the information as quickly as possible.

Discuss With Administration

OK. Direct communication has not worked to change the behavior. Nor was the episode a “one-off” event. So, what do you do next? If you need the behavior to cease, discussing the matter with the administration is imperative. Each hospital may have a different administration member to help with this. Typically, it may be a hospital liaison/radiology manager or the DIO (head of GME).

And what can they do with the documentation that you provide? It can serve as a basis to change the offending behavior of the technologist. Also, the hospital can use it to help decide whether to remediate, train, or fire. Whatever the case, when things become that dangerous, you need to address the event to the “higher-ups.”

Dealing With The Negligent Technologist

Often, the most challenging part of playing the role of the resident is not the technical work. Instead, the hard part usually comes down to how you negotiate with other human beings. So, follow the strategies that I have provided. First, communicate directly. Then, talk to your program directors. And finally, rarely, if all else fails, document everything yourself and speak with the hospital administration. These strategies are a logical approach to dealing with the negligent technologist.

Moreover, it should work to remedy most problems. Most importantly, however, you should never neglect to deal with a negligent technologist. Remember, you took the Hippocratic oath. Patient care comes first!

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How I Made My Decision To Go Into Radiology

decision

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

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

My Subinternship

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

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

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

Enter The Radiology Rotation

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

Prelim Medicine Year- Second Thoughts

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

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

Radiology Residency- A Hellish First Year

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

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

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

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

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

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

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

 

 

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A Dangerous Personality Trait: “Never in Doubt But Sometimes Wrong”

dangerous personality

This week I thought it was essential to discuss a dangerous personality trait that can lead to disaster when beginning a radiology residency. Coming from different programs, some residents start with bad habits formed from their preliminary year. I like to call this dangerous personality type “Never in Doubt But Sometimes Wrong.” More often than not, these residents trained for their prelim year in surgery (But not always!) and developed this personality trait during the internship. They would have formed skills like talking with strength and charisma. And, usually, this is a good thing. However, this is not the case when this resident does not have the knowledge and experience to back up their overconfidence.

This personality tends to persuade her audience, attendings, and residents, regardless of the evidence. Accessory staff follows these physicians to the ends of the earth based upon the sure command of her words. However, these residents (and other physicians) know the same or less than their colleagues. Moreover, they have not developed the experience to make the most critical decisions as a first-year radiology resident.

Why do I bring this up today? Well, I thought it was necessary to be aware of its consequences if you have developed these tendencies. Alternatively, for other residents, I want you to recognize this personality trait so that you do not go down with the proverbial “ship” as well. Also, what better time than at the beginning of residency?

Why is this so crucial? Well, I go through the three main reasons these beginning radiology residents need to alter their ways: Danger to the resident, increased liability, and potential for harm to the staff.

Danger To The Residents

Being sure of oneself is essential to becoming an excellent radiologist. However, not when the radiologist has not read up on the subject or understands the case. Especially for the first years, this is a danger to their career. Every once in a while, we hear these new residents telling the clinician the wrong diagnosis and management.

Moreover, since these residents have such charismatic personalities, they can often sway their opinion about the case. Unfortunately, the clinician listens and begins working up the patient incorrectly. In the end, the program directors hear about the mismanagement, and the resident can suffer from probation or even worse.

However, the danger is not only for the resident with the personality trait. Also, the followers can suffer just as much. You probably have seen attendings in other specialties that espouse facts with such enthusiasm, only to realize when you look them up that they are entirely incorrect. These attendings tend to be well respected by the hospital administration (but not so much by their colleagues) and wield much power due to their charisma. So, check everything twice before following one of these strong personalities.

Increased Liability

Not only is “Never in Doubt But Sometimes Wrong” a dangerous personality trait that can lead to bad medicine, but also it can significantly increase your medical liability. They can report whatever you communicate to the ER in the medical record. And guess what? You can be liable for the damages incurred to the patient if wrong.

For example, this sort of dangerous personality may confidently state that the patient does not have appendicitis on a CT scan as a first-year resident, even though having never seen a case. Subsequently, he convinces the ER doctor that the study is negative. Finally, unfortunately, the patient incurs harm. The medical license of this resident is potentially on the line.

Dangerous Personality Can Cause Potential Harm To Staff

In our profession, we must remember that the world is not always just about the physician. Instead, the rest of the team can play just as essential a role. Confidently knowing wrong information places our nurses, technologists, and aids in dangerous situations. Instructing a nurse to use the wrong needle can lead to injuries. Convincing a technologist that a patient with an ear implant can safely go in the MRI without knowing can cause a technologist to lose his job. These are potential situations that stem from a resident with misplaced confidence.

The “Never In Doubt But Sometimes Wrong” Dangerous Personality

In radiology, there is no space for overconfidence. According to the Hippocratic oath, our role, like other physicians, is to “do no harm.” And you can see the significant danger a resident can cause to themselves and others when they become overbearing without the accompanying knowledge and experience. So, I beg you. If you are not sure of something, maintain your humility. Let your colleagues, staff, and fellow faculty know. It is OK not to understand. However, it is not OK to let others think you do when you don’t.

 

 

 

 

 

 

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ESIR Programs: Let The Buyer Beware

Radiology programs, radiology program directors, Early Specialization In Interventional Radiology (ESIR) directors, and residents interested in interventional radiology are dealing with a mini-crisis. For years, programs have allowed residents to make a choice to start an interventional fellowship several years into residency. Instead today, new residents face the crunch of having to make this decision to join up with ESIR programs right away. And, they should not take this decision lightly. Why? Well, that is exactly what we are going to discuss today!

So, What’s The Urgency, Huh?

Like anything else in the world, when you have limited supply and excess demand, you create bottlenecks. And, unfortunately, in many programs across the country, the number of ESIR spots available does not equal the number of residents interested in the program. Therefore, this problem exists in some programs, right here right now.

So, if a program has two residents interested in this program, but it only has one spot available, the program director needs to make the final decision by either one of two methods. First, the program can decide on a first come first serve policy. But, let’s say that you have two residents that decide they want to join a program at the same time. Well then, that leads us to the other way to decide. And, that would be a long drawn out application process to determine the most “qualified” applicant.

Either way, this puts pressure on the applicant and the program to make a decision pronto. As you now understand, the resident and program need to make rushed decisions together.

Why Can This Decision To Join ESIR Have Permanent Implications?

OK. First, I will mention the positive. ESIR programs allow residents throughout the country to decrease the number of years of a fellowship from two to one. And, these residents will be able to hit the proverbial ground running at their interventional fellowships from the very beginning. But, at what cost?

Problem 1

Here comes the tough part. ESIR programs need to allow residents to complete approximately one year of interventional related activities during radiology residency. So, where does the time come from? It has to come from somewhere, right? Well, here is the rub. Programs need to draw the time allotted to ESIR from the normal diagnostic radiology activities. So, residents that complete an ESIR program have less overall experience in the standard rotations like MRI, ultrasound, etc. And therefore, the training of an ESIR resident is not truly equivalent to a standard diagnostic radiology resident.

So, what are the implications of this? In the workforce still, most practices need radiologists that can perform interventional radiology (IR) but can also help out with some of the general work. Well, residents that start a typical IR job will not have the same experience and comfort level with general radiology practice. As you can see, this creates a serious problem for the ESIR graduate.

Problem 2

Unfortunately, the problems do not end here. Let’s say that you start the ESIR program. And then, you then apply for fellowship toward the end of residency. Due to the changes in allocated slots for interventionalists with new DR/IR programs, ESIR programs, and “independent fellowships”, fewer residents can easily drop out of interventional radiology during residency. So, fewer spaces become available for interventional programs throughout the country. And therefore, you, as an ESIR applicant to fellowship, may have a lower likelihood of gaining admission to an interventional radiology fellowship than residents applying in prior years.

So, who is to say for sure that you can obtain an interventional fellowship after residency as an ESIR applicant? In this case, theoretically, ESIR programs have now doubly screwed this resident. First, they completed a program for which they have a real chance of not completing the required CAQ certification. And second, they have less diagnostic radiology experience.

Problem 3

Many folks that want to do interventional radiology really do not know what they want to do until they have completed several IR rotations. So, what happens if the ESIR program resident decides that they do not like interventional radiology toward the middle or end of their residency? Well, they potentially have prevented another interested applicant from getting a spot. In addition, they have again decreased their own training in diagnostic radiology- a lose-lose situation. They will potentially graduate as a “second-rate” diagnostic radiologist.

Bottom Line For The Applicant To ESIR Programs

For those of you applying to ESIR and know for sure that you want to do interventional radiology, well then, go for it. But, I have a sneaking suspicion that many ESIR applicants are not in this category. So, if the program offers you a choice to apply for an ESIR program, make sure to think twice. The implications of joining this program can be far-reaching for the rest of your career!

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Dealing With The Abusive Nighttime Physician: Rules Of The Road

abusive

Picture this scenario. A Napoleon-like 5 foot 2 verbally abusive surgeon enters the reading room. He begins to yell at you for not performing an intussusception reduction the way he likes. Moreover, a team of surgical residents stand behind him, each member turning red with embarrassment as he continues with his tirade. His verbal abusiveness becomes more and more aggressive. He uses terms such as “idiot” and “moron” to describe you as you attempt to get a word in edgewise. You feel like you want to strike your fist in his face. Does this situation sound vaguely familiar? How would you deal with this everyday but unfortunate situation when you are alone at nighttime?

#MeToo

First, no one should have to contend with harassment such as this. I don’t care if you are a resident, nurse, janitor, or attending. Unfortunately, although society has finally come to terms with refusing such abusive behavior and isolating these individuals, many hospitals still silently condone it. How and why? Perhaps, the hospital is understaffed and would rather have someone to fill the gaps even though he has an abusive personality. Or, the hospital may hire an inappropriate physician because she has a good reputation and brings many patients into the system. Regardless, the behavior is unacceptable and needs to be dealt with accordingly. So, let’s go through some of the processes you need to complete to prevent this harassment again.

Engage Softly With Team Response

The last thing you want to do as a resident is fight fire with fire. If you continue to raise your voice and tussle with this attending, you are making a containable situation into a nuclear bomb! Instead, what is the appropriate course of action?

You can say to this individual quietly, “I am just trying to help you care for your patients appropriately. We are in this together. I will talk to you again when you speak to me professionally so we can help your patient together.” Usually, the raving physician calms down if you maintain a quiet and calm demeanor. At this point, the situation usually de-escalates. Who knows? You may even receive an apology. But that may or may not be the case.

Document, Document, Document

So, what next, assuming the situation does not calm down? If the surgeon has been harassing you, it is most likely a long-standing observable pattern of inappropriate behavior. And this physician has likely affected many other employees within the hospital as well. Therefore, you should document the behavior in written form. State the time, place, and situation as objectively as you can. Then, place the document on the side for further use, if necessary.

Next, you may want to ask other observers, if present, to create a supporting document. This report lends credence to your inappropriate interaction. You are better off gathering multiple documents to establish a pattern of behavior.

And finally, for each time you encounter these behaviors with this individual, you create another document. You are making a paper trail that will help remedy this situation.

Speak To Your Supervisor

As for the next step, you must contact your residency director or associate residency director first thing in the morning. Speak to them and give them the documentation. If possible, leave the wheeling and dealing in the hands of the local administration. Why? Well, often, the lowly resident does not have the influence upon human resources or senior administration like a long-standing faculty member does. And, the administration can turn back the blame on you.

Last Resort- Human Resources

OK. So, your supervisor has not yet fixed the situation. Or, maybe she settled it for that one time, but the abuse is recurrent. Where do you go next? Sometimes you have to go right for the horse’s mouth. You may need to talk directly to human resources and hand in the documentation yourself. Usually, this will begin a full investigation into the matter. Of course, hopefully, you can avoid this situation. Unfortunately, on occasion, you need to act to protect yourself in this way.

Final Thoughts About The Abusive Physician

We all went to medical school and began training to become consummate professionals. Along the way, unfortunately, you will encounter abusive physicians that do not follow these rules of professionalism. Often they have issues of their own. But that does not excuse the actions of these individuals. We, as clinicians, should act according to the rules of civil behavior. And if these abusive physicians cannot play by the rules, either they need to change their ways, or they should not be able to practice medicine. So, we serve all by taking action and not remaining silent.

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Eight Ways To Find Inspiration During Residency

inspiration

You wake up to go to work. Maybe, you grind through what seems like a hundred films with your attending. And then, you arrive home exhausted, only to start reading books and case reviews. The work of a radiology resident never ends. So, how do residents find the inspiration to get through the day, study for the core exam, and get through the entire residency? And, what can residents do to have a fulfilling four years? Unfortunately, very few radiologists have the time to consider the resident’s plight. But I plan to tackle these issues today. Think of this post as chicken soup for the radiology resident, concepts one needs to tough things out for four brutal years.

 

Yes, You Will Save Some Lives

Never forget this fact. Imaging saves lives. And who interprets the images? You! So, get yourself right out of that funk. And, remember, we are not financiers, accountants, or lawyers. We directly prevent significant injuries and death!

Have A Hobby/Life Outside Of Residency

As much as you may love radiology, actively seeking other interests is just as important. I don’t care if it is swimming, stamps, reading, or traveling. Having a hobby enables you to return to work fresh and ready for the next day. Sometimes, studying and working improve when you have an unencumbered mind with the same old studying routine. Studies have shown that creativity and productivity also improve when you pursue activities outside your main interests. Why not let that be you? (1)

Sometimes It’s Not Just About The Work; It’s About You!

Inspiration does not only come from your patients and your films. Instead, feeling inspired stems from your moods and wants. To take care of others, you must also take care of yourself. So, remember… You have a responsibility to yourself to cater to yourself at times. Take a little time to yourself when things become tough studying. Or, if you lose focus during the day, sometimes you need to step away for a few moments. To regain your concentration, you need to refresh yourself!

Maintaining Health

It sounds strange that maintaining health can inspire you to become a great radiologist, right? Well, if you do not eat well, exercise, and sleep, it becomes much more likely for a resident to burn out before finishing residency! So, make sure to treat your body right!

Learning From Mistakes Can Be Inspiring

Mistakes are depressing and ugly, correct? If you continue to think that way, you should not become a radiologist. Expect mistakes. It’s part of the risk profile of our job (Although attorneys would think otherwise!). One study reported a significant error rate that ranges between 2 and 20% of all radiologist reports. (Br J Radiol. 2001 Oct;74(886):949-51.)

So, we need to become inspired to do better. How do we do that? Well, think of each mistake you or others make as an opportunity to prevent significant errors from happening again. If we want to get closer to perfection, we must inspire ourselves to learn from these mistakes, knowing we will not miss that finding or commit that knowledge error again!

Appreciate What You Have Accomplished

Think about the goals you have met to become a radiologist. You have completed college, medical school, and an internship. And remember all those tests that you have aced and passed to get to this point. This successful journey is a real accomplishment! Be proud of what you have achieved. You are not an average Joe. Instead, you have done what many folks can only dream about. And, if you have already gotten this far, imagine how far you can go… If that doesn’t inspire you, I don’t know what will!

Think About The End Goal

Inspiration often does not come from what you are doing right now. Many times, it comes from dreaming about what will be. So, it’s not about repeatedly reading that same paragraph to remember or understand a single concept. Instead, it is about how this pertains to the final goal of becoming a great radiologist. Therefore, don’t get stuck in the minutia. It’s about the big picture!

Education As Fun

Education is about the journey, not the destination. That is because we never really arrive. There is always more to learn and see. And what can be more exciting than discovering new ideas and concepts and applying them to the practical world? As radiologists, that is what we do! So, take each pillar and block of knowledge to form new and exciting structures. This process involves taking new ideas to create research projects or looking at studies in a different way that no one has thought about before. You are only limited by your imagination!

Final Thoughts About Finding Inspiration

Inspiration is what makes us tick. It gives us the passion for completing our dreams and going one step further. However, it does not come from the daily grind. Instead, it comes from our beliefs, hopes, dreams, and goals. So, appreciate what you have accomplished, think about what you do daily (and yes, that includes saving lives!), and remember your goals for the future. It’s all pretty amazing. That should be inspiration enough!

 

(1) http://www.cofcogroup.com/want-more-productivity-get-a-hobby/

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Can You Pass The 2018 Saint Barnabas Precall Quiz?

Due to the popularity of last year’s precall quiz post, I am back at it again. Today, I am posting 10 cases from the real 2018 quiz that we used to ensure our residents are ready prior to beginning call. Of course, we used our PACS system to see if they could not only understand the disease entities but also make the findings as well. Unfortunately, you will not have the same option. However, these cases will help to benchmark where you may stand.

When you go through the test, come up with the findings, diagnosis, and if asked/relevant, management. In order to see how you did, answers are at the bottom of this page. (Don’t peek until you are finished!) One more thing… in order to pass the test without conditioning, you need to get at least 70 percent right. Enjoy!

Precall Quiz

Case 1

 

Case 2

 

 

Case 3

 

 

How would you manage this case?

Case 4

 

 

 

 

 

 

 

 

 

 

 

Case 5

 

What questions do you need to ask?

How do you manage this case?

 

Case 6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case 7

part A

 

 

 

 

 

 

 

 

 

1st film- 2 years ago

2nd film- today

What is the differential diagnosis?

What do you want to do next?

 

part B

 

 

 

Case 8

 

 

 

 

Case 9

 

 

 

Case 10

 

 

 

 

 

 

Answers:

Case 1:

Right thalamic/basal ganglia intraparenchymal bleed with intraventricular extension.

Accompanying early transtentorial herniation. (needs to be mentioned for full credit!)

Case 2:

Right-sided pyelonephritis/early abscess formation. Renal mass/neoplasm can be within differential diagnosis.

Case 3:

Aortic dissection extending from the inferior thoracic cavity to iliac arteries.

Accompanying perivascular fluid and effusion- possibly blood products, consider ruptured dissection

For full credit-need to mention that you would call the vascular surgeons

Case 4:

Ultrasound appendicitis with appendicoliths

Case 5:

You need to ask history. (?B-HCG positive)

Ruptured ectopic pregnancy.

Case 6:

Homolateral Lisfranc fracture dislocation

Case 7:

Part A

New prominent bilateral hila- Interval development of adenopathy or pulmonary arterial hypertension

CT of the chest recommended for further characterization.

Part B

Bilateral chronic pulmonary emboli with pulmonary hypertension

Case 8:

Acute biliary leak with extraluminal radiopharmaceutical.

Focus within the hepatic hila- most likely biloma/origin of the biliary leak

Case 9:

Distal left ureteral stone with left renal hydronephrosis and hydroureter. Accompanying inflammatory change at the left kidney and ureter.

Case 10:

No acute disease. Possible recently ruptured left ovarian cyst.

 

 

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Radiology Residency Day One – How To Start On The Right Foot

residency day one

Last week, I wrote about what to do on the first day on the job as a radiology attending. For those of you about to begin radiology residency, I thought it would be unfair to leave you in the dust. So, today, we will talk about what to do on day one of the radiology residency. For this discussion, we will disregard all the formal introduction courses from the hospital. Mostly, that is a passive activity. Instead, I need you to know what you must do on your first day in the department. So, let’s start!

Get To Work Early

On that first day, I recommend arriving early. Get to know the parking, the bathrooms, and the building. You never know how long things will take until you arrive. And as a resident, impressions become exceedingly important. The last thing you want to do is to arrive late on that first fateful radiology residency day one!

Introductions And Thank You

OK. This one does not differ much from your attending’s first day. Your new colleagues and faculty want to make sure they made the right choice when they selected you. So, do this right. Make sure to thank all the folks who helped to get you into the program. This gratitude goes a long way to building solid relationships for the next four years!

Don’t Stand Out Too Much

When you begin your first rotation, be careful about what you say. You certainly don’t want your attendings tagging you as the class troublemaker. That can lead to undue negative attention later on. So, if you think you may say something that may upset your new employers, I would hold back until they get to know you later!

Ask About Special Programs (If Interested)

Some radiology programs have Early Specialization In Interventional Radiology (ESIR) slots. If you do not inform your program directors early on that you maintain interest in the program, the program may fill up, and the ESIR program may exclude you. So, ask to sign up, if interested, on that residency day one.

Ask About Expectations For The Rotation

Different from starting as an attending, most of you have no clue what you should begin to do on residency day one. On day one of our nuclear medicine program, the technologist showed the residents how myocardial perfusion scans work. But, in the following days, you would sit with an attending to learn the basics. You certainly would not want to miss either of those opportunities. On the other hand, if you start on fluoroscopy, perhaps you need to watch a few esophagrams on the first day. And then, a few days later, the attending may expect you to attempt one on your own. Without these clear expectations, perhaps not in the manual, you will start your rotation at a disadvantage. It is hard to meet expectations you don’t have!

Learn The PACS

Like a new attending, you must learn how to look at cases at your institution. Therefore, it behooves you to play around with the PACS system a bit. Also, make sure to ask for tips from your colleagues and attendings. Many times, if you don’t ask at the beginning, you will only learn much later after you have wasted many hours. Remember: these tips can save significant amounts of time and headaches!

Start Learning How To Dictate

Again and again, you will hear that learning to dictate has a steep learning curve. Therefore, there is no time like the present to learn. Begin with a few simple cases. But start now if you can. As a resident, this activity is one of the most active ways to learn radiology. It reinforces the buttonology of the PACS and the learning of the basics of radiology. In addition, it can help the attending out during the daytime. So, why not start on day one?

Let Your Attending Know The Plans

On that first day, you will often need to attend several activities that are integral to starting but maybe off-rotation. As a courtesy, let your attending for the day know when and what you need to do. This act of doing this establishes a rapport between you and your faculty!

Listen Carefully To The Program Director (Or Associate Program Director) Welcome

Most programs have an early morning or noon conference from the program director or associate program director. This conference is crucial! Most of the time, the program directors will give you their expectations and requirements. Usually, they will not repeat the tips and advice you will get from this session. So, take notes, and don’t miss a beat!

Borrow, Rent, Or Buy Books

By the end of the first day, you should know what you will need to complete your first rotation successfully. Most of the time, you will discover what to purchase, rent, or borrow books from your colleagues in digital or print form. So, make sure to get these necessary resources on day one!

Radiology Residency Day One- Final Thoughts

As with any first day of a new job, the first day of residency can become a nerve-racking experience. But don’t let it be. Instead, try to absorb all the unique experiences that you encounter. So, make sure to take in the new situation, the people, and your place of work. And most importantly, don’t be too hard on yourself. The staff and your colleagues have low expectations for the residents on your first fateful day. Later on, you will have many more days ahead of you to stress about giving that next tumor board or taking the core exam. For today, you can relax and enjoy!