Category: Resident Advice

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Clinician Interruptions In The Reading Room: A Necessary Evil Or An Avoidable Interaction?

clinician interruptions

For those of you that practice radiology, how often do clinicians interrupt you on a busy rotation? And, what percentage of the time does the clinician provide helpful information without interrupting your train of thought? I know I can only speak for myself, but many clinical interactions prevent me from completing my work, increase my inattention, and should probably occur at another time. How often does a clinician stop by to ask you when you will finish his patient’s report only to lengthen the time to complete the dictation? Assuming my experience is similar to others, I believe those clinician interruptions can overwhelm many positive daily interactions.

 Plus, based on the evidence (check out Should Radiologists Ignore The Phone?), we know that interruptions cause an increase in error rate with our reads. So, therefore, clinician interruptions become much more than an issue of mere convenience. Instead, we need to take clinician interruptions very seriously. To cover this longstanding theme, we will discuss whether clinicians and providers should be allowed to enter the radiology reading room. Then, we will talk about potential solutions to these problems. So, let’s begin!

Reasons To Allow Clinicians To Enter The Reading Room

Knowing that interruptions prevent us from reading cases to the best of our ability, one could make a case that we should nail our reading room doors shut. But fortunately (or unfortunately!), this cannot happen in reality. Moreover, it probably is not such a good idea.

So, what are some legitimate situations when a clinician in the room may enhance the reading of our cases? Well, first of all, we must welcome all good histories that help us to make a diagnosis. A clinician coming into the room with this message can become a lifesaver, literally. The clinician can change the diagnosis and management.

Second, a clinician in the room can help when we need to relay an urgent message. For instance, perhaps you find an impending aortic rupture and need to get in touch with the vascular surgeon. Wouldn’t it be nice if the physician just happened to be standing next to you instead of calling all over the hospital to find him?

And then, sometimes, a clinician can enhance our reads when we are unsure of the best way to manage the patient. For instance, maybe, you recommend an MRI, but unknowingly the patient already has a pacemaker. Yet, if a knowledgeable clinician stood next to you, you would ensure that the patient had received some other test, such as a gallium scan.

Clinician Interactions That You Should Prevent

As I discussed above, clinicians should not ask the radiologist when he will complete the study. An assistant or secretary should handle these requests. Furthermore, the technologist or clinician should mark a study as STAT, priority, or routine. And the radiologists should dictate these cases in an appropriate order from most emergent to least. For this reason, a clinician stopping by the reading room interrupts the workflow and is redundant.

In addition, as much as I like medicine rounds from an educational point of view, having a team of medical physicians interrupting the radiology workflow on initial patient reads does not contribute to good patient care. Educational rounds during live readouts can disrupt search patterns and often warrant inefficient rereads of the same films. Furthermore, these types of interactions can cause other errors. On the other hand, educational rounds at a specified time after the radiologist made the reading would not detract from patient care.

Finally, as much as I like a suitable, quality, friendly conversation, clinicians should not use the reading room as a place for small talk. These sorts of conversations can also act as a nidus for errors!

What Are Some Potential Solutions To Allow Useful Clinical Interactions While Mitigating Interruptions?

Unfortunately, the task is not easy. But here are some logical recommendations:

First of all, having a “1st line triage” can help the process of selecting who can enter the reading room. Like other professionals with secretaries and assistants, radiologists should also have clinical assistants who can manage interactions with our colleagues. Radiology assistants can serve this function. (a more expensive option) Alternatively, junior residents may also help to prevent unwarranted interaction. Rather than interrupting the clinician workflow, the junior resident can field the questions and may interact appropriately with the physician. The junior resident can also learn about clinical medicine from the interaction.

Second, make sure to make it understood that the reading room should exist as a place for reading films and not unwarranted conversations. The placement of signs and a general culture of using the reading room as a workplace can prevent some of these disruptions.

Finally, we should proactively inform and train our clinical colleagues regarding the appropriate questions and times to enter a reading room. Continuing education via interdisciplinary conferences and general interactions can undoubtedly help.

Final Thoughts About Clinician Interruptions In The Reading Room

Clinical interruptions are more than just a nuisance. Instead, they directly impact workflow and increase the error rates of the interpreting radiologist. Therefore, hospitals and imaging centers should create appropriate reading environments for beneficial clinical interactions with radiologists. At the same time, they should create an environment that avoids significant clinician interruptions. Hiring more staff, using residents appropriately to triage, and creating quiet reading rooms can allow uninterrupted workflow. So, next time you are interrupted, be proactive and do not allow these interactions to continue. Politely ask the offending clinician to wait until you complete the reading. And then consider discussing the issue with your residency or hospital. Working to improve the efficiency and quality of clinical interactions can save lives!

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Top 10 Resident Issues That Radiology Faculty Wants You To Know But Can’t Say

Top 10 Resident Issues

Most radiology attendings want their residents to succeed. However, etiquette rules cause many to withhold their feedback about some of the resident issues that they encounter on a daily, weekly, or monthly basis. Unfortunately, for that reason, they keep many of you in the dark. However, please learn from their mistakes and enlighten you all. So, to prevent you from continuing with these resident issues, I thought I would create a top 10 list that the faculty wants you to know but may not say… Here we go!!!

You’re Too Aggressive

Are you overcalling everything or coming down hard on a final diagnosis without any other differential? Are you accustomed to the surgical mentality? No longer can you just nod in agreement, but you push, push, push? Everything is an argument. And, your attending does not have the time to talk back. Gosh darn it, perhaps you are more aggressive than you should be at this stage of the game!

He Misses Everything

When your attending sees that you are missing all the findings during the night, he may not feel so great telling you about all these errors. How will that help anything? And I mean, he doesn’t want you to feel bad about it when he tells you, does he? Unfortunately, you may miss out on some of these learning experiences. But, your attending may not let you know!

She Has Poor Hygiene

Poor hygiene can be just plain embarrassing. But, sometimes, your faculty may become very uncomfortable dealing with malodors or unkempt appearance. It often needs to be said to the resident but doesn’t. And, all the other faculty and residents suffer from this resident’s poor hygiene!

You Just Don’t Listen

The attending keeps on telling the same resident the same old thing. But, time after time, nothing changes. No longer can the attending tell you what to do anymore because it does not seem to work? So, your attending does not bother you anymore. What’s the point of hurting your feelings?

He’s Way Too Enthusiastic

Don’t get me wrong, but it is great to be enthusiastic. And, your attending certainly does want you to become excited about radiology. But, too much of anything is no good. And sometimes too much enthusiasm can be a bit too much. It can wear on your techs, nurses, and attendings. So, temper that enthusiasm just a bit!

You’re Just Plain Dumb

Often, your attending will ask you questions to see if you have been reading enough. And it is OK to get some things wrong. However, on occasion, a resident does not know anything that he should. Is your attending going to tell you that, maybe or maybe not? Who wants to say to the resident that she is just plain dumb?

She’s Getting A Bit Too Chummy For My Liking

On occasion, our residents can become a little too familiar with us if you catch my drift. It can all be a little too “touchy-feely.” So, think about how you communicate with your attending. Is it appropriate? Or are you trying too hard to become his best friend?

He Wants Always To Be Spoon Fed

Most residents want to learn from their attendings. Some residents expect all the learning to come from their attendings with no work on their part. If you desire to breed ill-will, you can do just that. Don’t help out your attending. Instead, just expect them to teach. It can be very irritating!

You’re Always Abandoning Ship When The Work Is Not Done

Excuses, excuses, excuses… You have to get to a wedding. Or, maybe you need to go on a date with that new beau. Well, your attending does not want to be the one to break it to you. He does not want to be the unfeeling guy that ruins the resident’s time. But, is it right that you are always missing all that work?

He’s Preventing Me From Getting Anything Done

Some residents like to talk a lot. And, most attendings like a good conversation as well. But, sometimes, it can interfere with the daily work that needs to get completed. How can your attending break it to you when she likes you a lot. Well, it can be challenging at times!

Final Thoughts About Resident Issues That Faculty Want You To Know But Can’t Say

Rightfully or wrongfully so, many taboos exist that prevent faculty from telling you, the radiology resident, what is going on. And even though attendings are supposed to evaluate and give direct constructive criticism and feedback, that is not the reality of the situation. So, if you think that you may have one of these ten resident issues listed above, try to change it on your own because you may never get the real story!

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A Ridiculous Error In The Radiology Report: Can I Recover My Dignity?

error

At some point in our careers, we all make ridiculous report errors. In fact, I know several radiologists that collect and sort several of these “oopsies” in the hopes that one day they will create the book of their dreams. However, some of these mistakes can feel embarrassing if you are the radiologist writing the report. Worse than that, sometimes your referring clinician or patient will call you on it. It could be a simple error like an obscene typo. (the substitution of the word “fecal” for “fetus”!) Or, it could be a detail you would have never thought to mention but your clinician wanted to know. (He asked to rule out sphenoid sinus disease, and you forgot to mention the sphenoid!) Ultimately, these mistakes go on record for all the patients and clinicians. So, how do you deal with these unfortunate miscalculations? And what do you tell the clinician? As you can tell, we will answer these questions as we dedicate this post to the delicate unforeseen “oopsie” and subsequent attempt to recover your dignity!

The Three-Step Process When You Make An Error

Make A Quick Addendum

First off, luckily, you have discovered the error in the report. Perhaps, you read the old dictation or received a phone call from the secretary. Unfortunately, however, you often make the discovery a long time after signing it off. So, what do you do? Issue an addendum as soon as possible! In most clinical practices, addendums from voice recognition technology software typically get faxed to the clinician, just like the initial report. In this situation, the clinician will receive the addendum with the rest of the dictations for the day.

Guide The Doctor To The Correct Report And Follow-Up

However, issuing an addendum is not enough. Often, the clinician will not expect the fax you give as an addendum. Bottom line: it might not get read. And sometimes, the undiscovered “oopsie” may lead to inadequate follow-up, insurance problems, patient anger, or other subsequent clinical issues. Therefore, the rules of mutual respect obligate you to contact your referring physician directly by phone or in person, if possible. It’s a horrible phone call, but you must close the loop.

Profusely Apologize For The Error

Although a touchy subject, I would recommend apologizing to the clinician (or patient if necessary) for the error. More importantly, let the receiver of the error know that you have made amends by changing the report and following up with the report recommendations. Most clinicians will appreciate your effort to correct the issue with the dictation.

Can You Recover Your Dignity From An Error?

Unfortunately, I can’t give you a better answer than it depends. For ages, some may refer to you as the clinician who added a ridiculous mistake to their patient’s report, potentially giving you an unwarranted reputation. On the other hand, others will realize that you made the error as a “one-off” and will quickly forget. Regardless, we need to negotiate these pitfalls as the hazards of our profession. And most importantly, we are more likely to garner respect from our colleagues by dealing with the consequences of the “oopsie” head-on rather than lurking in the shadows, hoping the error will go away one day. So, don’t just ignore the error, so you don’t draw its attention. Instead, own your mistakes before they own you!

 

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Residency Travel For Presentations: What Are The Steps Involved?

travel

Congratulations!!! The Radiology Society of North America (RSNA) has accepted your poster for presentation at the convention. Or perhaps, the Association of University Radiologists (AUR) has chosen you to make a presentation at the next meeting. When and how do you prepare for the trip? What are the best travel arrangements? How and when do you make your plane flight? I plan to answer these questions and more to make your next trip that much easier!

Notify The Program Coordinator First

Most importantly, before booking the event, ensure that your program coordinator knows first. Why? If you forget to do this, you may find the hospital will reimburse you less than you think. Or, perhaps, the program will not cover certain parts of the trip. The program coordinator also has precious information on how to submit expenses for your trip. You must submit your receipts at many programs first and then get your money back later. In other programs, they may cover your expenses upfront. This information is critical, and your coordinator usually has the answers!

Book The Hotel Next

Booking a hotel is usually the rate-limiting step for residency travel for presentations. Why do I say that? Hotels tend to book up first before the plane, the meeting, etc. Over the past few years, I have known several residents who could not reserve a spot in their first-choice hotel because it was already entirely booked. So, you should check your meeting website before booking. Often, you will find group discounts for hotel stays.

Some other tidbits for booking your hotel: First, stay as close to the conference as possible. You don’t want to worry about damaging your poster or arriving late to the event on the day of your presentation. And you certainly don’t want to get stuck in a downpour! Also, make sure to review the hotel for your needs before booking. So, if you are taking your family, ensure they have the correct size room, etc. Finally, before booking a hotel, also join the hotel club so that you can receive points for rewards for the next time you travel.

Make The Flight Arrangements

Over the years, I have found that it is best to book a direct flight if possible. Worrying about connecting flights can be extremely unsettling. Sometimes, the plane arrives at its destination too late, and then you miss the next connecting flight. The last thing you want to do is arrive late for your conference! It is generally safer and less time-consuming to fly one direct flight instead of many legs. It is not worth the minimal savings.

If you are interested in flying as economically as possible, I recommend several possibilities. You can sign up for multiple price alerts from different airlines. Also, some websites let you know when the airlines have the best deal. These include sites like Hopper and Hipmunk. One article also advised following #airfare #flights on Twitter to get you the best deals. Check out the following article that I thought was extremely helpful: http://www.chicago tribune.com/lifestyples/travel/ct-best-time-to-book-airfare-20170614-story,amp.html

Finally, if you have not done so already, it makes sense to sign up for frequent flier miles at the airline you choose. Most likely, you will fly again and again. So, you may as well try to benefit as much as possible! Also, some credit cards accumulate frequent flier miles and give extra benefits such as free baggage check-in.

Sign Up For The Meeting

Regarding signing up for the event, most meetings for radiology do not fill to the maximum. So, you do have a bit of time. But be careful. Some conferences have early bird specials and discount early bookings. Therefore, don’t perseverate too much. Also, make sure you book the event under the heading of a resident. At some meetings, residents get a discounted rate!

Think About Local Transportation To the Gig

Now, this part gets a little complicated. For most of you, taking a shuttle to the hotel is the most cost-effective and straightforward. However, others may arrive with family members and plan to travel to other sites at the meeting destination. Or, maybe you want to travel a bit near the meeting after your presentation. In that case, consider renting a car. (It’s usually a bit more expensive!) Otherwise, if you want to get in and out of the meeting quickly, stick to using shuttles or sharing a taxi with friends to save a few bucks.

Keep Your Poster/Presentation Safe

Treat your presentation like gold! Make sure it is safely ensconced in a cardboard roll if it is a poster. Or make sure you protect your flash drive well if you need to present. I would recommend having a backup if possible. The last thing you want to do- is to notice you have a broken flash drive when you are about to present your topic!

Don’t Freak Out!

All that hard work has amounted to getting to this point. So, you will do great. Practice your presentation a few times in your room if you think you may be a bit rusty. These few days, you should be enjoying the fruits of your labor, not worrying about your presentation.

Enjoy Your Travel Destination!

OK. You have traveled to such a great destination. Why not try to take advantage of the site? Plan some activities. Try some great restaurants. Tour the area if you can. Have some fun! Who knows if you will get a chance to return soon? Congratulations!

 

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Urgent Case And I Can’t Get In Touch With The Doctor: What Do I Do?

urgent case

Covering physicians should always be available, especially in an urgent case. However, when you begin radiology practice, you will find that 24-hour physician availability is a pipe dream. Once in a while, I encounter situations when I cannot reach a physician, let alone a nurse. Fortunately, most of the time, if I wait a day or two to contact the physician, no harm will come to the patient.

But then, now and again, we read an urgent case that can potentially represent the difference between life and death. Perhaps, you find a spontaneous pneumothorax in a patient with mild chest pain. Or, maybe you see an impending aortic rupture in a patient with heartburn. Regardless, good medicine and the law dictate that we must communicate these urgent results rapidly so the patient can get appropriately treated.

So, what do you do when you cannot get in touch with a physician and have an urgent case? Do you yell down the hallway? Do you stomp your feet? Or do you send smoke signals via the hospital generator? You can do any of these fun activities if you want to. (Sure would release a lot of stress!) But, today, I will go into more effective ways of ensuring that the patient receives the appropriate care when you cannot reach the covering physician. To introduce this topic, I will give you a few real-world scenarios and instruct you on what my colleagues and I would have done.

Call The Patient Or Patient’s Caretaker Directly

These are the sorts of cases that tend to occur at the very end of the day. The last episode I remember happened when I looked at the previous outpatient case of the day at one of our imaging centers. I recall looking at the final abdominal CT scan at about 8:30 PM on a late shift and seeing oral contrast density framing several bowel loops on a CT scan. Then suddenly, the anticipation of going home shifted to dread. I knew I would be lucky if I could reach anyone to let them know this patient had a bowel perforation. And, right, I was…

As expected, I called the physician covering the patient multiple times. But to no avail. All I got back was a ringing telephone. What would you do next? Well, I did the most logical thing. , I called the patient’s house and reached the wife of the patient. I told them to get checked out at the local emergency department immediately.

Fortunately for the patient, everything turned out alright. But, if I had continued to call and wait for a physician to pick up, the patient could have died. Sometimes, you have to contact the patient directly!

Send A Certified Letter

Other times, you may make a significant finding but not quite as urgent. Maybe, you discovered cancer on a mammogram. Again, you try to reach the covering physician. But, it does not work out all too well. At this point, you still need to make sure you directly contact a covering physician or patient. Otherwise, you can be liable if the patient did not follow the appropriate treatment. But you also have another option if you can’t get in touch with the physician or patient. You can send a certified letter to the address on record.

Certified letters indicate that you have made a reasonable effort to reach the patient after the initial communication failed. At least, you can make sure you have performed your due diligence.

Call The Cops/Dial 911

In other situations, the consequences of not getting to the patient in time can be dire. Let’s say you detected a subarachnoid hemorrhage on an outpatient at 9 PM in an imaging facility, but the imaging center completed the case in the early afternoon. And, again, you cannot get through to the doctor or patient. One radical technique to overcome this issue is: Call the police and dial 911. Theoretically, if you suspect that the patient may be at risk of life or limb, the police have the authority to knock down the door and ensure that the patient receives appropriate care. Fortunately for me, I have never had to resort to this option. But I know of other radiologists who have.

Final Thoughts About Communicating An Urgent Case When The Doctor Is Not Available

Usually, when you have the will to get through to a covering physician or patient, there is a way. Sometimes, you need to take more extreme tactics into your own hands. Remember… It’s for quality patient care. So, don’t give up. Instead, make sure to follow through. Because otherwise, you risk not only the patient’s well-being but your career as well!

 

 

 

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About To Start Radiology Residency-What Should I Do To Prepare?

prepare

Here are some scenarios: You’re about to finish medical school, and you’ve matched in radiology.  Or, you are in the middle of your internship year, and you have begun to ponder your next year. If you find yourself in either of these situations, you most likely receive mixed messages on whether or not to prepare for your first year. Some of your “mentors” have probably relayed to you how they readied (if they did anything) for their first year of radiology.

When you hear some of these stories, many of those folks have some hidden motivations. Perhaps, they want to appear like they know it all. Or maybe, they want to make it seem like their decision was the right one. (Even though it may not have been) So, please listen to me. Having seen many incoming waves of medical students and residents coming through the department, I will give you the real lowdown. Here’s what you need to know when you start.

Should You Read Anything Radiology Related Before Starting Radiology Residency?

The short answer is yes. But, of course, I will go into a little bit more detail than that!

So, what do you need to know before beginning? For everyone, if nothing else, I would recommend that you at least relearn basic anatomy. Why is that? Since it is difficult to know what you need to learn in radiology when you have not entered into the field yet and radiology is so “anatomy intensive,” you are better off starting by reinforcing the general anatomy that you learned in medical school. For general anatomy, an anatomy book like Netter that you used during medical school will help you to recall the basics.

However, instead of learning anatomy the same way as your medical school course, I would take more of a cross-sectional anatomy approach. To do so, make sure to find a decent cross-sectional anatomy book to supplement Netter. Not only can you use it to learn cross-sectional anatomy, but this book would also be an invaluable reference source during residency and beyond. Even now, as an “old-timer,” I often use the Atlas of Human Cross-Sectional Anatomy: With CT and MR Images whenever I need a reference. A book such as this almost “pays for itself.”

Why is it so important to have a cross-sectional anatomy book to study? Well, that is how most of us radiologists interpret images. You need to know the anatomy to catch the pathology. So, when you begin, you will have the tools to learn the basics of radiology rapidly (since we are an anatomy intensive specialty!). If you prepare your cross-sectional anatomy before arrival, you will have a certain headstart over your colleagues.

How To Go About Additional Radiology Reading Before Starting Radiology

Fourth Year Medical Students

Since fourth-year medical students typically have a bit more time on their hands, what material would I recommend if you want to learn more than just cross-sectional anatomy? First, you can review the essential medical student texts like Learning Radiology. These sorts of books tend to contain the most basic information like how to read chest films, and so on. Also, they will review the essentials of the primary radiological modalities that you need to know.  However, these texts will not go into enough detail to make you stand out.

But, if you are even more motivated, consider looking at the pictures and captions in a book like Brant and Helms. Then, you can review the subtext to reinforce the images. But beware! It is a long series. And, believe or not, even though it is long, it does not cover enough of the information you need to know to prepare. Most importantly, however, do not get discouraged if you cannot complete it. Any bit that you accomplish before starting residency helps.

Interns

OK. For interns, the first step is to make it through the year. You are probably going to be exhausted and lucky to pick up anything additional to read. So, I would probably stick with reviewing some basic cross-sectional anatomy at this point. In general, lack of time will prevent you from reading through a Brant and Helms type of book. But, if you feel you must go for it, by all means, try to read a little bit. Just don’t push it!

Final Advice On How To Prepare For The Beginning of Radiology Residency

Finally, my last bit of wisdom for the pre-radiology resident is that what you are doing now is very different from your radiology career! So, don’t wrap yourself up in the miseries of your clinical year. Remember… Your life will be very different from your medical colleagues. So, soldier forth, read a little bit if you can, and before you know it, the year will be over. Follow my advice, and you’ll grasp what you need to prepare to start your radiology residency!

 

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Can We Learn Anything From Fast Food Industry Slogans About Radiology Residency?

slogans

We hear many catchy slogans for fast food restaurants on television. Although not so healthy for our waistlines, these restaurants’ advertisements motivate millions to go there in droves and bring in billions of dollars each year. So, if these slogans can stimulate so many customers to buy their food, these same slogans may drive radiology residents to improve. For that reason, I have decided to take it one step further. What can we learn from these slogans that we can apply to radiology residents? Well, I am here: to make connections where you think none have ever existed! So, let us go through some ten famous fast food slogans and see how we can apply them to our daily work!

 

Your Way, Right Away (Burger King)

I think this one is self-explanatory for most of you already in or have completed radiology residency. But, we live in a world where the demands for immediate readings of imaging studies have become intense. So, I think it is fair to say we live at the mercy of the ordering clinicians. And it always seems to be your way right away!

Sometimes You’ve Got To Break The Rules (Burger King)

As radiology residents, we can’t always follow the rule books. And for that reason, we need to tweak protocols and situations for individual patients to ensure they get the proper test. And Burger King has known this fact for years. Therefore, maybe we should follow their advice as well. Burger King, once again, you are wise!

You Deserve A Break Today (McDonald’s)

Radiology residency can lead to severe studying and hard work every time we are on call or every day we work. But, as McDonald’s says, sometimes, you need a break. Maybe, you go on vacation or get lucky as the electricity turns off all the equipment in the middle of the night. Or perhaps, you work on a lovely snow day preventing anyone from arriving at the hospital. Sometimes, we need a break from the difficult work of radiology residency.

I’m Lovin’ It (McDonald’s)

We often don’t appreciate where we are and how we arrived here. Well, we need to sit back and smell the roses. We have picked a great profession with multiple exciting challenges and a decent income. McDonald’s once again has it right. Sometimes, we need to say I’m Loving It!

Where’s The Beef? (Wendy’s)

When we perseverate about our cases, we should heed Wendy’s slogan. What should we focus on in these situations instead of worrying about all the extraneous information? We should concentrate on the matter’s meat (or “the beef”). So, I take Wendy’s slogan to heart. Whenever we look at a case, do what Wendy’s would do. Make sure to think about “Where’s The Beef?”

Makin’ It Great Again And Again (Pizza Hut)

We cannot be great just once. If we make a fantastic call and miss many others, our patients will sue us often. So, we need to be on our best game, not just once but repeatedly. Thanks, Pizza Hut, for allowing us to remember!

Little place, BIG TASTE (Checkers)

On any given day, you may think about our role in the scheme of things as little as you understand your place as a radiology resident. But, when you miss something, the impact can become great. Therefore, although you feel like you play a small role in the clinical world, in reality, you leave a large footprint behind you!

Think Outside The Bun (Taco Bell)

Taco Bell has it right. We can’t always emulate our fellow clinicians, who sometimes merely use a checklist to ensure they have worked up the patient appropriately. Instead, we have to think about our patients differently to give them the most appropriate care. Who knew that Taco Bell was such an excellent example for radiology residents?

Eat Fresh (Subway)

When we come into work, we owe it to ourselves and our patients to work as efficiently as possible. Well, how do we get to that point? On that point, Subway recommends we “eat fresh.” And I can’t agree more. We have to ensure that we provide our bodies with the nutrients that we need to use our brains and get as much sleep so that we can be “fresh” for the next day. Good point, Subway!

We Don’t Make It Until You Order It (Jack In The Box)

Now, this one is crucial. Clinicians, please. You can’t expect us to complete an imaging study for you unless you have ordered it first. Like Jack In The Box, we don’t perform the procedure until you call it. Don’t forget!

Fast Food Slogans And Radiology Residency

See, I bet you can’t believe how prescient these slogans are for the average radiology resident. These slogans send important messages to residents that they should take to heart. So, the next time you hear a fast food restaurant slogan, instead of thinking about running to the restaurant for some food and increasing the size of your waistline, think about how it can make you into a better radiology resident!

 

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How To Avoid The Radiology Comparison Culture (Don’t Become A Victim!)

comparison culture

Type A personalities, typical graduates from medical schools, tend to compare themselves to others in their residency classes. These residents often ask the following questions: Am I performing better than everyone else on the in-service examinations? Do I read films as fast as everyone else? Have I written more papers than my colleagues? These questions asking how you perform relative to your colleagues make up what I call comparison culture.

Do you further your career by joining the comparison culture and comparing yourself in this way to others? Sure, it can stimulate some friendly (or unfriendly!) competition. You can work hard to make sure your in-service score beats all others. And yes, you can write your umpteenth paper to shove it in your colleague’s face. But, these motivations only improve metrics that do not correlate with qualities that make a better radiologist, such as the desire to learn continually. And over the long term, a resident cannot sustain these motivations. I mean, who wants to study for the sake of getting a higher in-service score year in and year out? It’s a recipe for misery and burnout.

So, what motivations should we seek to make ourselves better radiologists who love our chosen profession? Let’s go through some long-term motivators to avoid the pitfalls of the comparison culture.

Love Learning

After years of testing and the comparison culture, many students forget or never learn what it is like to enjoy learning. When I read, I do it because reading helps me in some way with my practice or because a specific topic interests me. Reading and studying should not be about getting one up on our colleagues. Instead, understanding is a reward in and of itself.

Solve Great Questions

Nothing is more rewarding than solving that bizarre case or coming up with a twist that leads the clinicians to take a different direction than they had initially expected. Call me crazy, but there is something special about being that “go-to” person when anyone has a problem that needs to be solved. And solving interesting questions begets more interesting questions from your fellow clinicians.

Work To Improve Patient Care

For many radiologists, the ultimate satisfaction comes from improving our patients’ lives. Even though many of us are in the background, we can feel the difference we make when clinicians treat patients appropriately because of our calls, improving patients’ lives. Many of us derive immense joy from the vital work we perform.

Embrace The Excitement Of New Technologies

Many of us, as radiologists, went into the field because we like more significant and sophisticated toys. Whether it’s that new SPECT-CT or the latest and greatest 7T MRI, we should derive pleasure from learning these technologies’ significance and applying them to patient care. It pays to keep a youthful spirit and keep our eyes wide open in amazement as we conquer the next great technology for the betterment of others. Heck, we can even make a career out of it!

Enjoy Playing Part Of A Team

And finally, many of us enjoy our roles in forming a team and operating flawlessly as a unit. Only through interaction among team members that we come up with our best ideas and perform to our fullest. Working by yourself limits us to boundaries instead of expanding our knowledge. Playing a role in a team defeats the hazards of the radiology comparison culture.

Avoid The Comparison Culture

Ultimately, the comparison culture only gives radiologists and trainees a short-term benefit. Instead, loving to learn, solving our colleagues’ clinical dilemmas, embracing new technologies, and playing an essential role in a team can help us derive long-term happiness from our work. Avoid the comparison culture to love what you do. Radiology is a marathon, not a sprint.

 

 

 

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Top Ten Pitfalls Of The Chief Resident Year

chief resident

Traditionally, the chief resident plays one of the most critical roles in the well-being of the resident community. To that end, the chief resident often becomes responsible for much of what happens in her residency program. Unfortunately, in most programs, however, there is no playbook. And for most, the new chief residents learn their role in a “trial by fire.” Since most chiefs do not arrive as experts in this new role, they make many errors (To be expected!) So, what are the most significant blunders you can make throughout your tenure if you catch yourself in a position as a chief resident? I thought maybe we could all learn from others’ mistakes!

Make Different Promises To Residents And Staff

Before starting, many chief residents commonly will tell their classmates one thing only to realize later that the staff will not accept the change. For instance, when scheduling, a new chief may promise everyone that they will have a night float for only ten days. But, when they sit down and create the schedule, he discovers it is impossible. Now, he puts himself in a bad situation. The residents’ expectations differ from reality, and all the residents become upset. Politics is everything! So, be careful what you say!

Set Bad Examples

Unfortunately, as chief resident, you are constantly under scrutiny. What is the easiest way to lose the respect of the residents and administration? Set a bad example for the rest of your residents. Everything you do serves as a model for everyone else. If you don’t show up, who will? Who else will do the same if you decide not to step in when a resident struggles? Once a chief resident does not fulfill the role of a good leader, the rest of the residents will follow suit.

Create The Schedule And Give Yourself The Most Benefits

Chief residents typically play an essential role in scheduling. Therefore, if the program selects you as a chief resident, you will wield a lot of power over giving yourself the best shifts at the expense of others. If you want to piss off your classmates, take those times everyone else wants or vacation on the best months. That will go over well!

Poor Follow Through

Trust can be complicated to establish in any profession. But, as a chief resident, your word is your bond. Perhaps, you do not follow through on reprimanding a resident because they made a mess in a call room and did not clean up. Or, you let a resident off the hook even though they continue to skip out on noon conferences. If you don’t follow through, you lose the respect of your fellow residents and faculty. So, if you promise, make sure you deliver.

Create Cliques

One of the worst feelings in any job- is to feel left out! So, you need to be even-handed and fair. Invite only half your class to a house party. Or, instigate your fellow residents to hate a fellow resident because you don’t like them. These are surefire ways to reduce your chief resident position to rubble!

Perform Poorly

If you want to have others question your capabilities as chief, what is the simplest way? Here are some possibilities: Don’t read; Perform poorly on quizzes; Or fail your core exam. Once you establish yourself as a chief resident that cannot pass the rigors of a radiology residency, should you be a chief resident?

Poor Attendance After Passing Boards

As a chief resident, you wield a lot of power. But absolute power can corrupt absolutely. Just because you have taken and passed your boards does not give you the right to skip out on conferences or take unscheduled time off. In the end, you are still a resident. So, don’t abuse your status. It can bite you if you ever decide to get a recommendation!

Unwillingness To Help Out Faculty

Since you are stuck between the faculty and residents as a chief resident, your role becomes to appease residents and the faculty. So, what does this mean for you? Make sure to follow at least some of the reasonable demands of the faculty, or else you will fast lose respect. It could be as simple as asking residents to participate in a department-wide research project or ensuring all residents take a resident survey. Neglecting the faculty’s demands can upset your superiors and make your chief resident year miserable!

Inappropriate Relationships Within Class Or Faculty

Nowadays, with the “#metoo” movement, you must watch out for your actions. Beware what you say and how you say it. Other residents and attendings can interpret subtle cues as harassment. So, if you want to ruin your chief resident year and possibly your career, follow the rules!

Final Thoughts About The Chief Resident

As chief resident, you play a significant role in running a residency. And, because a proper leadership position such as chief resident is a new experience for most, I can guarantee you will make some mistakes. Therefore, more than others in the residency program, you need to act like a leader without taking advantage of your colleagues and faculty at their expense. Think of this year as a political learning experience. So, heed these ten warnings of what not to do as a chief resident. If you can avoid these mistakes, you will miss most leadership pitfalls. Like becoming an excellent chief resident, learning to perform a leadership role well will be handy for the rest of your career!

 

 

 

 

 

 

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How To Present A Great Case Conference

case conference

During residency, you must choose a case to present to your colleagues or faculty in a formal setting. Many of you will be flying by the seat of your pants without instruction on how to do so. So, how do you select which case from the past week, month, or year? What features make up an excellent case for discussion at a case conference? And what exactly should you discuss during the presentation? These questions and more I will answer as we discuss how to present a great case conference.

Which Case Should I Choose?

On any given day, you will encounter multiple cases that have the potential to become excellent cases for a conference. Some studies may have confounded you or your faculty. Other times, your attending may love a case for some reason. Then, your attending may want a classic case of a particular disease entity. In these situations, how do you pick among all the possibilities?

Typically, I look for cases on a particular theme I want to address. Even better, the study may have addressed several points that created interesting discussions or controversies. Then, I check to see if the case runs through multiple imaging modalities. What do I mean by that? The best cases show a particular diagnosis in many different ways. For instance, say you are interested in showing lung cancers at this specific time. So, a perfect case would be a lung nodule on plain film that the hilum may partially hide. Then in the same study, you have a CT scan showing the mass abutting the hilum with subtle adenopathy within the mediastinum. And perhaps you also have a PET-CT scan demonstrating additional hypermetabolic nodes present on the scan and a hidden osseous hypermetabolic lesion in a vertebral body. Cases that show a finding or related findings in multiple modalities reinforce the subject matter well.

How To Prepare For The Discussion

So, you’ve found this extraordinary case. First, make sure that you can describe the findings appropriately. If you have less experience, you may want to run it by a faculty member or senior resident to confirm that you are conveying the description correctly.

Next, like any good physician, you should read on the topics extensively. In the case I described above, you need to read about lung cancer diagnosis, staging, and treatment basics. Additionally, you should learn how the radiological diagnosis affects the management of the patient. For instance, how does the presence of hypermetabolic nodes and a vertebral body lesion affect the outcome of the patient? Ultimately, you want the listeners to perceive you as the expert on this topic for the presentation.

Moreover, you want to be able to answer almost any question thrown at you. In other words, go to town! By reviewing the topic extensively, in essence, you are not only going to improve the discussion and your ability to answer questions, but also you are studying for the boards at the same time.

What Should You Discuss At The Case Conference?

The lung nodule example above lends itself well to discussing the findings on each of the modalities, the differential diagnosis, the final diagnoses, and the pathophysiology behind the final diagnoses. Furthermore, the topic will lead to basic management principles like how vertebral lesions change treatment.

I would first review the findings similar to the standard logical approach of taking cases. And then, I would discuss the differential diagnosis and the management in that order, just as if you were taking a case during a faculty presentation. If you want to make the case conference a bit more spicy and controversial, you can discuss whether the case met the ACR appropriateness criteria for the symptoms given. Usually, you will get multiple opinions from different attendings if the ordering physician approaches the workup correctly. It would help if you strived to guide the discussion to ensure it follows an appropriate path. With a case like this, the debate can ensue for a while!

Case Conference As A Tool For Learning

You primarily need to remember the end goal whenever you create a conference. In a typical case conference setting, the presenter should want the audience to learn a few essential points by the end of the discussion. Too much information will overload the learner. Likewise, too little information may not reinforce the concepts. So, try to strike a balance after discussing the specific case.

In the end, you should view case conferences as a tool for learning, not as a burden. They are opportunities to learn a topic in great detail and the art of presenting. Moreover, each presentation you perform builds upon the knowledge that you have. I still remember the case conferences I created when I was a resident. Just like I did, if you prepared appropriately, you will use the strategies and information you learned from your case conferences when you become a faculty member yourself many years from now!