Category: Resident Advice

Posted on by — 2 Comments

Top 10 Things To Do When The PACS Goes Down

pacs

In 2021, almost every radiology residency in the country operates with a Picture Archiving And Communication System (PACS). It has become essential for the daily functioning of the radiologist and the radiology resident. Even though PACS has made our practices more efficient, we all experience a breakdown at some point. Maybe it’s information overload, an electrical surge, or an internet/cloud outage that causes the problem. Regardless, it will happen at one time or another. Sometimes, it may take a few minutes or hours for the system to come back up. During this time, people usually mull about and complain about the PACS being down. It becomes a handicap. Instead, what if we did something useful with our time? So, I thought I would write an article about the top 10 most valuable things to do when the PACS goes down. Let’s begin!

1. Call Up IT To Fix The PACS

Over the years, I have noticed when the PACS goes down: everyone assumes that someone knows about it and will take care of it. Sometimes that is the case. Other times, no! It never hurts to give IT a call to find out what is going on to make sure they get started fixing the issue. Furthermore, they may be able to tell you a timeframe for when they can complete the repairs. Then, you can have an idea about what you can accomplish during this downtime!

2. Network

What is a better time to network than when everyone has time? Now that the PACS is down, people can talk to you and listen!! This period can be a time to speak to your favorite faculty, technologist, nurse, residency coordinator, or janitor. And, no, it is not a waste of time. It brings goodwill to the entire establishment. In addition, getting to know your fellow employees gives excellent morale to the department. Who knows? The janitor may come to your department to clean up first because he likes you!!!

3. Study For The Boards

While at work, you should not waste a minute. One great way to occupy your time: get cracking on those books that you need to read. Start reading a chapter on what you would be doing if the PACS system were working. Or, maybe go over something that you don’t know. Regardless, this is a freebie. Now you will have less time to read when you get home!!!

4. Talk To Your Referrers Instead Of Staring At A Dead PACS

Maybe you have a burning question you need to ask one of your referring clinicians regarding a finding on a film and what that means for one of your patients. Or perhaps, you need to forward a message about a result. Well, now you have some time to do it. Don’t just sit there and complain about the PACS. Pick up the phone!

5. Arrange Elective Time

Perhaps, you are a 3rd resident and are pondering what you want to do for the following year’s mini-fellowships or electives. Now you have a real opportunity to plan something. Take a walk to your area of interest- perhaps neurosurgery, orthopedics, or pediatrics, and prepare a rotation for the following year. It will add an incredible experience to your training. What better time to do that than the present!

6. Observe Department Processes

The PACS system is down, but that doesn’t mean all patients stop arriving in the department. This time is an excellent opportunity to watch the technologist, secretary, or nurse in action. Learn how they take histories, process the patients, and what they do daily. It never hurts to learn about the processes within your radiology department. You never know when some of these skills will come in handy when you are a radiologist who owns an imaging center!

7. Research Projects

Downtime is a perfect opportunity to process the data on your iPad or research some articles for the following paper you will write. Edit your article. Less time needs you will need to spend in the department or your house on this work!

8. Walking/Exercise

You’ve been slouching on your chair all day until the PACS system went down. What better time than now to prevent a DVT and burn some calories! Climb those stairs. Walk around the grounds. Now is your time to get into shape!

9. Grab Your Lunch

Maybe the PACS went down around lunchtime. This respite is a perfect opportunity to get the lunch that you would have interfered with your day otherwise. Now, this PACS downtime no longer wastes your time!

10. Forget The PACS. Go To Radsresident.com!

Of course, what kind of article would this be if I didn’t add some shameless promotion? Take a look at my articles and learn something about radiology residency lifestyle issues that you may not have ever known otherwise. Enjoy this author’s great sense of humor!!!

 

Now that you know what to do when the PACS system goes down, you will no longer whine and complain. Instead, look forward to this inevitable period. This extra time is a blessing in disguise!!!

 

 

 

Posted on by — 4 Comments

What Clinicians Don’t Want From A Radiologist- The 8 Deadly Sins

clinicians

A few months ago, one of my readers sent me the following message, “I would like you to write about what clinicians want from a radiologist.” That comment initiated some thoughts about the topic since our primary goal, as radiologists, is to answer the clinician’s questions. But let’s take this idea from a different angle. At some point in our careers, we all have made cardinal mistakes that turn off our referring clinicians. What is more interesting than the mistakes that most of us have made in our career to teach us lessons about how we can avoid angering our referring physicians and make things right for them? So, let’s talk about what clinicians don’t want from a radiologist! (The negative tends to be more interesting than the positive!) Let’s give this a whirl…

The Forced Hand

In training and board examinations, our instructors tell us to write recommendations for further management. So, how bad could it be to recommend a biopsy for a thyroid nodule when you see a new one? An angry head and neck surgeon stomps up to the department and looks for you. He yells loudly, “Why are you telling me what to do with my patient. He should not be getting a biopsy in this condition!!!” Bzzzzzzzz… (Buzzer sound)

Pretty darn bad! When you write a recommendation, you have to remember that you often don’t have the full picture of the patient’s situation. In other words, there is an asymmetry of information between the clinician, the radiologist, and the patient. Maybe, the patient can’t lie flat. Perhaps, the patient can’t handle needles. Possibly, the clinician knows about an outside study that you don’t. Or, the clinician is privy to some other issue that you cannot imagine. By recommending a biopsy of a thyroid nodule without a caveat, for instance, you are legally forcing the clinician into having to investigate it further. In contrast, it may not be the correct management protocol for the patient. I have learned to be very gentle with my management recommendations over the years!!! Always leave the clinician a way out…

Indecisiveness

We write a list of 10 items in our differential diagnosis without additional comment- like a laundry list to give a “complete differential.” Days later, you get a phone call from the clinician- “I don’t understand what you are saying- what do you think is going on here?”

How can we avoid this scenario? If you have an extensive differential diagnosis, always state what you think is most likely and why. Avoid delving too far into the 1 in a million diagnosis unless you have a real sneaking suspicion it might be the correct one. Clinicians appreciate when you make your best guess since it often will steer the doctor down the right path. Too much information without direction can be harmful!

The Saucy Radiology Report

You are angry that the referring physician did an inappropriate workup on a patient performing iodine scan as the first test in a workup for a palpable thyroid nodule. In contrast, you know that it should be a thyroid ultrasound instead, so you put in your report the following statement, Make sure to order the ultrasound instead of a thyroid scan in patients with a palpable lump. The doctor comes storming in, “How dare you to talk to me like this in your report. It is a legal document!”

If you have an issue with a clinician, make sure to air your dirty laundry outside of the report. The clinician is correct. You are putting the physician in a potential situation with legal liability. This sort of comment does not belong anywhere inside the report.

The Discrepant Report

You dictate a case from the night before when the overnight resident was on call. In the morning, you find a pulmonary embolus, but you do not look at the additional documentation from the resident or the nighthawk. You do not call the doctors to let them know. Later in the day, the ER doctor walks up to the emergency department and says, “What the hell is going on here?” It turns out the overnight doctors did not call the study positive and sent the patient home. You didn’t notify the doctor!

Discrepant reports between you and other physicians can cause negligent patient care. Be sure to check all the information to make sure that all parties are on the same page. Discrepancies will occur. But make sure to notify all parties!!!

Is It Better, Worse, Or Unchanged?

You are following a patient with breast cancer on a CT scan, and you proudly discover and then mention a subtle liver lesion in your report. Next, you refer to the prior study, but don’t look at it. You also do not document the size of the lesions, nor compare the size of the abnormalities to the previous study. Two days later, you get a phone call from the oncologist, “What is going with my patient? I need to know if I have to change chemotherapy. Are the hepatic masses changed?”

Clinicians always want to know if their patient is improving, unchanged, or progressively worsening. These imaging issues often change clinical management and are of the utmost importance to the clinician. Always make sure to put these findings under the impression of your report!!!

Incomprehensibility

You look at a pelvic MRI on a patient with fibroids. The fibroids seem to be growing over time. However, you don’t check the report and click the sign off button. Before you know it, the dictation goes out to the clinician. Three days later you get a phone call from the doctor, “It says here in the body of the report that there is interval enlargement and in the impression, there is no interval enlargement of the fibroids. Which one is correct?”

Make sure to check for grammatical and logical statements within a completed dictation before signing it off. Very few things piss off a clinician more than having them read an incomprehensible report. An unclear story leads the clinicians down this pathway. Always check your work!!!

The Wrong Diagnosis

You are looking at a hand x-ray with a type of arthritis that you have not seen before. Finally, you decide to dictate the case without confirming the diagnosis via Google or running it by another clinician. You call it osteoarthritis. The patient gets treated based on your report. One year later, the patient is still not getting better, and the doctor sends a new film to another one of your colleagues. He comes up to you later in the day and states, “you dictated a case and called it osteoarthritis. It was a definite case of gout!!!”

If you are not sure about a diagnosis, always make sure to either look it up or run it by someone else. We are in the business of healing others. You should never have too much pride to make guesses when you can get the correct answer!!!

Not Answering The Clinical Question

You dictate a plain film of the chest, and you happen to see a lytic lesion in the middle of the thoracic spine and a pulmonary nodule in the right lower lobe. So, you put in your impression- MRI of the thoracic spine recommended for further characterization. 8 mm right lower lobe pulmonary nodule. A few days later, you get a phone call from the physician- “We already know about the bony lesion, and it is a known hemangioma as seen in previous studies. The history said to compare the lung nodule with the prior study. Please take a look at that!”

It is imperative to scour the history for whatever clinical question the clinician wants you to answer. This way, you can provide a helpful answer to improve patient care. That is the main reason we are here as radiologists!

The Eight Deadly Sins- Lessons Learned

As clinicians, we always need to self-reflect to improve our practice of medicine. There is no room for too much pride. We should continuously look for ways to improve our clinical skills, reports, and communications with our colleagues. I have just given you eight different examples of issues that can arise if you want to cut corners. You can easily avoid further carnage with your reputation, your patients, and your colleagues by remembering these situations. Use these examples as a template to prevent the eight deadly sins of a radiologist!

 

 

 

 

Posted on by

Which Radiology Meeting Should I Attend?

radiology meeting

Residents need to make a big decision. At some programs, each resident can attend one academic conference during the four years of residency without presenting a poster or paper, all expenses paid. It may be toward the end of your tenure as a resident, and time runs out to take advantage of the situation. You can “go big” and attend the largest radiology meeting out there- RSNA. On the other hand, you may want to “go small” and consider a subspecialty meeting to delve into your area of interest. Or, perhaps you want to check out the academic conference and hobnob with the faculty at the most critical educational meeting- the AUR. How do you make this difficult choice? Well, if you are in this enviable situation and need to make a decision, this article is for you!!!

“Going Big”- The RSNA

Plan Ahead

RSNA is the radiology meeting that most radiology residents decide to attend. It is a meeting that has “something for everyone,” literally. Traditionally, the RSNA is the largest of all radiology meetings and covers every subspecialty within radiology. But this also presents a problem: how do you decide what to attend when you are there? Because of the vast conference size, I would recommend following a road map before arriving. Know what meetings, poster presentations, or other areas of interest you will attend before arriving. Suppose you do not outline a plan before arriving. In that case, you will likely miss half of the more relevant, informative, and exciting presentations since the conference is so enormous. The different activities can be far, far away from one another.

Lots Of Activity

In addition, if you are in the process of studying for the core examination and the timing is right to attend a conference, this may be the conference for you. There are usually loads of activities for residents, including review courses that may be helpful for the resident scheduled to take his/her boards. It is possibly even more important than the review course itself. You will also network with other residents in a similar situation, allowing you to learn the best resources to study for examinations and learn about other programs throughout the country. In many practices, at least one attending from your group will be present at this conference. Mingling with the faculty also allows the resident to take advantage of the possibilities of dinners or other engagements scheduled with vendors.

The one significant disadvantage of a conference like this one: it tends to be a bit more impersonal than some of the available smaller meetings. Impersonal may not be an issue for a radiology resident, depending on your fellow attendees and how you schedule your days.

“going small”- The Subspecialty Conference

My preference is this sort of conference. I usually attend the Society of Nuclear Medicine Conference every other year, an example of a particular subspecialty conference. I find that this conference is the best for learning the intimate details of a specific subspecialty. The newest information in subspecialties tends to get presented for the first time in these sorts of conferences.

If a particular subspecialty interests you and you want to choose a fellowship in the conference subject matter, you can utilize these subspecialty meetings to network with the physicians in the subspecialty. These conferences offer this possibility because they are smaller and give more of a “feeling of camaraderie.” Why? Conference members tend to be more involved in specific subspecialty activities with fewer numbers.

AUR Meeting- The Academic Radiology Conference

Every year in our program, the program has funded and allowed the chief resident to participate in this conference. It is a wonderful conference to find out the state of academic radiology throughout the country from a resident perspective as they have specific programs available for the chief residents. As a program director, I also tend to go to this conference once per year to keep up with the changes in radiology academics every year. (although I have not made it the past few because of Covid!)

In addition to the potential relevancy, the conference is not that large. It is hard to get lost at this meeting like you can at the RSNA. You can quickly get to know the players in the academic world. I would highly recommend this conference if you are interested in academics or are the chief resident in your residency program. Residents attending this conference obtain an invaluable source of information about all residency programs throughout the United States that they can share with their resident colleagues when they return.

The “Pure” Board Review/CME Conference

Lastly, there is the board review or CME conference. Usually, these conferences are for board review or a specific topic/selection of topics. In our residency program, many residents attend local board review courses before taking the core exam. It is a good resource as a means to review the information learned from studying.

Other sorts of CME conferences are also widely available throughout the United States and abroad. Typically, the attendees of these conferences are more likely to be fully trained radiologists. And, they want to learn more about a particular area or may want to travel to a specific destination. (I recently went to a conference at Disney World like this to learn about digital breast tomography!) In general, radiology residency daily conferences usually cover similar material. So, the yield of this conference for a radiology resident may be slightly lower. From my experience, most trainees that attend these conferences are at the institution responsible for the meeting.

Best Radiology Meeting To Attend During Residency

Like almost everything else in this world, one size does not fit all when deciding to attend a conference. RSNA is an excellent introduction to the world of conferences as it is the largest and the most general. Subspecialty conferences are great for networking, especially if a particular subspecialty or fellowship interests you. The AUR meeting is an excellent option for academic sorts and chief residents. And finally, board reviews/CME conferences are a great tool to review studies for the boards/core examination. Many decisions to make and so little time… Hopefully, this article will give another perspective on making this big decision!

 

 

Posted on by

How To Prepare For Interdisciplinary Conferences As A Radiology Resident

prepare for interdisciplinary conferences

You get the email… There is a urology interdisciplinary conference on Tuesday at 7 AM, and you are responsible for showing 4 cases with multiple radiological studies. You’ve never done this before! How do you know which images to display to prepare for interdisciplinary conferences? Is there a logical order to the pictures? Will I be able to answer the questions posed by the clinicians in the room? Your heart beats a bit faster as you contemplate the issues.

This situation is common for the beginning radiology resident. Frequently, radiology programs thrust first-year radiology residents into their first interdisciplinary conference without much preparation. However, even though initially nerve-racking as an experience, these conferences are an excellent opportunity to get to know your non-radiological colleagues as well as a way for them to find out about how knowledgeable you are! Learning how to prepare for interdisciplinary conferences pays off big time!

Presenting for interdisciplinary conferences is slightly different from preparing for typical conferences. Your audience will be a bit more sensitive to mistakes that the presenter makes because decisions can often directly affect patient care. Therefore, today I will discuss some of the common questions that arise when you encounter your first interdisciplinary conference to make you feel more comfortable. These topics include how to sort through what is essential, what to discuss, and when to ask for additional help to prepare for your first solo interdisciplinary conference as a radiology resident. So let’s get started…

Selecting Cases To Prepare For Interdisciplinary Conferences

When going through a case, clinicians like to have the relevant initial diagnostic images and the subsequent follow-up images. So, it is imperative to get the correct history for the primary diagnosis. When you check the computerized records, make sure to find all studies that support the principal diagnosis. Then, you will need to look for the earliest studies of this sort. If the diagnosis is breast cancer, find the first mammogram and breast MRI present on the record. If the topic is metastatic colon cancer, look for the first CT scan showing the metastatic disease.

Next, you need to find the first post-treatment studies. So, find the next series of relevant images. If the topic is a retroperitoneal bleed, see the first series of post-intervention cases, such as the post embolization ct scan. These will usually be the second from the beginning.

And, then finally, look for the most recent relevant studies. If this was a case of metastatic colon cancer, find the most recent CT scan of the abdomen and pelvis to show the final consequences of treatment or lack of treatment.

Selecting Individual Images

There are two ways to show images during a presentation for interdisciplinary conferences. First of all, you can go to the source images in the PACs system and flip through the pictures directly. Or, you can select individual images and display them on a PowerPoint presentation. I would recommend doing the latter. Why? , You leave less interpretation by the audience, and you will get a lot fewer questions regarding things that you are not sure about during the presentation.

Additionally, the clinician will less likely ask about information and findings that are irrelevant. For instance, you are less likely to get a question about that borderline enlarged node on the corner of the film that was not mentioned but is present on the PACs display. By choosing the PowerPoint format, you have much more control over what is displayed, and it keeps the discussion centered on the essential topics.

Also, there is less chance for technical issues. PACs tend to go down when you most need it since it relies on an internet connection. A PowerPoint presentation is much more reliable since you do not have to rely upon the internet.

Also, when choosing individual images, make sure to look for the relevant information without the fluff. For instance, if it is a metastatic colon cancer patient, take those pictures only of the liver metastasis without the volume averaging artifact. If the case is a retroperitoneal bleed, show only those images containing the bleed without other distracting findings on the film. And so on…

Discussions

When it is your turn to discuss a case, keep the discussion targeted. You want only to start discussing those issues that are relevant to the clinician’s question. If they need to know if the metastatic colon cancer lesion is better, worse, or unchanged, provide the clinician the relevant information such as the measurements. If they want a differential diagnosis, offer it. But do not go off on a tangential vector! If you go off-topic, clinicians tend to get angry because of the limited time you will have during the morning to discuss patient care and other cases. So, please don’t do it!

Also, try to look up relevant information on the topic during your preparations before participating in the conference. If you want to look like a star, gain additional knowledge on the relevant issues so that you can answer those questions intelligently and with authority. Then, you will establish an excellent reputation for yourself during the conference. Imagine how you will sound describing the features of colon cancer metastasis if asked rather than muddling through and stuttering.

When To Ask For Help?

So, you’ve gathered your studies and selected your images. When is appropriate to ask your attending for some assistance? Here are some specific circumstances: You have never rotated through a particular modality, and you are presenting those images during that case. You are not sure that the report description is the same as the information on the images. You do not understand the disease entity issues they will discuss at the conference.

I always like to know about any questions the resident may have before completing preparations for a conference. Better to be safe than sorry!!!

How To Prepare For Interdisciplinary Conferences!

Preparing for your first interdisciplinary conference can be stressful, especially if you do not have much essential guidance. Hopefully, this summary will allow you to make more sense of the necessary preparations involved. Good luck with your next conference!

 

Posted on by — 1 Comment

Technological Essentials For The Radiology Resident

Technological Essentials For The Radiology Resident
By Daniel Choe

 

In an era of exponential technological growth, it is essential that trainees use the latest technology to improve their educational experience. Demands increase every year for the trainee to remain up to date. Moreover, the resident needs to access information seamlessly. So, let’s talk about a few technological essentials that enhance the graduate training experience for the radiology resident. Different from many articles out there, I have no direct financial disclosures about the products I mention in this article.

 

Smart Phone/Tablet

 

It seems like a no-brainer to have a smartphone/Ipad. However, believe it or not, I once had a colleague who started residency with a blackberry!

Regardless, the Ipad or tablet may serve as a surrogate or mobile substitute for a laptop/notebook. However, it has limited storage and computational power. While upgrading them is easy due to its backup/sync features, it often lacks in ease of use for programs that require hardcore graphics rendition or multi-program use. It is ideal for mobile use of editing online documents, viewing online lectures, storing a limited number of pdf files, and running apps for question banks. Several anatomy learning apps are available and extremely useful for a fee. There is a separate section on apps later on.

 

Cloud Services

 

Most users already have cloud services. In fact, that is often the problem – there seem to be too many online storage services. Google, Amazon, Dropbox, OneDrive to name a few. An elegant solution that helps consolidate all of the different clouds you may use is a service such as odrive. It is free, encrypted, and allows you to automatically sync when you copy files to the odrive folder on your computer. The caveat is that to use the sync feature, you must have enough space on your hard drive.

My suggestion is to invest in a cloud service that offers unlimited space and only the folders that you open most frequently. Obtaining a cloud service is essential for the resident who is continually doing research and keeping tabs on what lectures and videos he watches. Alternatively, if you use a pdf reader, it can keep track of which page you were on in one of the many textbooks you will inevitably read.

 

Computer

 

Regardless of whichever camp you fall into, Mac or PC, your home computer or laptop/notebook should be the workhorse for your education and work. I could write an entirely separate article on this topic. Nevertheless, for the sake of simplicity, a home desktop is not essential, but rather a plus. Because cloud services work seamlessly and storage space is a problem of the past, your desktop is a great way to consolidate your work and use programs that require slightly higher computing power and graphics rendition. For example, I use a remote desktop to do a majority of my preparation for tumor board research, presentations, research projects. Moreover, I have my computer permanently connected to my flat screen TV as a secondary monitor so I can multitask.

Also, I can watch lectures on my TV. Watching them on TV affords greater detail and helps when trying to take cases.

Finally, I recommend swapping out your primary hard drive for a solid state drive (SSD). As well, add a secondary storage drive. They are becoming more affordable these days. Keep in mind, much of the work can be accomplished with a laptop, MacBook, or even tablet/PC as well, at the cost of overall computational power and storage.

 

Universal Password Program

 

I use a password and personal information storage program. Using these tools cuts out approximately 50 hours a year in retyping and resetting passwords. For convenience, I have over 200 passwords stored. Moreover, I can routinely change and generate new complex passwords to maintain security. Password programs also allow you to store credit card information and secured notes for passwords and sensitive information. There are many services out there. I would select the one that suits your needs. It is definitely worth the money.

 

Remote Access

 

Most institutions provide remote access for its residents. If not, it behooves you to suggest that the residents have access to remote PACS and EMR. Remote access is critical not only for learning purposes but effective workflow in preparation for interdisciplinary rounds. Your time is better spent working or studying than having to schlep to the department or stay late (unless you are actively trying to avoid home for a particular reason).

 

Shared Network Storage

 

My institution did not initially provide shared in-network storage. However, since its inception, we have been able to provide essential resources for all residents and staff. More importantly, it serves as the institutional memory for a growing and developing residency program by eliminating the possibility of losing critical learning resources. It is also an excellent way to circumvent the elaborate HIPAA clauses in your IRB research protocol.

 

I also include in this topic the necessity of a secured (password protected) USB drive as a conduit for transferring secure data between machines. Your program or IT department may provide one for you. It will serve you well in the long run as it allows you to transfer sensitive documents from your personal computer to a secured hospital network.

 

Apps

 

There are so many great apps available, but I can only mention a few that are technological essentials for the resident. A document reader is critical. Specifically, it should be one that allows you to maintain a “bookmark” for each document you upload. Also, it should open and save highlights and notes you want to review later. This document reader is worth a few dollars because it allows you to carry your library wherever you go, saves highlights directly onto the document, and remembers your page position. I use Goodereader for my Ipad, because it was one of the best at the time, but there may be new readers out there that suit your preferences.

 

Several of my colleagues purchased a group subscription for e-anatomy. This app is a comprehensive anatomy atlas with corresponding radiology images.
Radiology Assistant has recently developed a new app, which is an adaptation to its website. The app allows you to review all the content on their website while offline if the data is pre-downloaded. If you like the website as a resource, it is an even better tool as an app.

 

The different learning apps available can turn your phone into an instant tutor with quiz programs such as Chegg or Anki to name a few. Also, most of the decks relevant to your training probably already exist. I found over 500 premade CORE exams cards. Use at your own risk since you cannot vet them all throughout your review. You can download and edit them as you go if you find the information is not up to date.

 

Conclusions About Technological Essentials

 

The bottom line is that your training experience relies heavily on how you learn. You may get by without some of the technologies mentioned above, so it’s entirely up to you to decide what you need. The items I have mentioned I recommend so that the resident, from day one, can optimize the use of time with relatively cheap resources (or otherwise covered/subsidized by your program). John Stuart Mill wrote, “there are many truths of which the full meaning cannot be realized until personal experience has brought it home.” Hopefully, my experience with these technological essentials serves its purpose to jump-start your journey through residency.

 

 

Posted on by

The Presidential Executive Order And Foreign National Radiology Residents- Will Life Ever Be The Same?

In a medical resident’s life, he or she is so busy that politics rarely influences day to day work and living circumstances in the United States. But, this is no ordinary year and we are not in ordinary times.  A new presidential executive order has been issued. No longer can residents from the following countries: Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen travel to the United States without the appropriate documentation. But, it turns out that the implications of the executive order run much deeper than just the inability to return to the United States. Resident physicians lives may be altered for many years to come.

On the surface, the executive order makes some sense. Prevent the bad guys from coming into the country by halting travel for all citizens of the designated countries, countries where there have been incidences of terrorist activities. Dig deeper and you realize that most of the foreign born nationals have already been in the United States for years legally, either with a green card or certain visas. A majority of these residents are not terrorists and are in fact, good people, hard working, and excellent physicians. Additionally, many other countries with histories of harboring terrorists were not included in the executive order.

Effects of the Travel Ban On Residency

So what are the potential effects of this executive order if you happen to have been away in another country? Since some of these residents are already abroad and cannot return to the United States, these physicians in training will have their training delayed by at least 90 days since they need to stay in their country of destination. On the surface, that does not sound so bad. But, it can have profound implications. Training will have to be delayed by over 3 months. This means that the resident cannot graduate from the radiology residency program on time at the end of the 4 years. And, he/she will potentially have a difficulty either beginning their chosen fellowship on time if they are scheduled to start at the end of residency. Others will have to delay finding a fellowship potentially for over a year.

Furthermore, many foreign medical students from these targeted countries have recently interviewed for residency positions. Program directors are either ranking these medical students lower on their rank lists or are being placed in the “do not rank” category due to the uncertainty that these prospective residents may not be able to start at their residency on time or perhaps not at all. This year’s residency selection is already being affected by the executive order. In the fact, the NRMP has already submitted a statement on the executive order recognizing these challenges.  (NRMP Statement on Immigration Executive Order)

Also, on top of the general work related issues, these residents can no longer visit their relatives abroad, for the risk of not being able to return to the country, giving them less of a support system during the time of their residency. Residency is time a time of significant emotional and intellectual stresses. It is also possible that the international travel ban can last longer than has already been stated, potentially making the stressors even greater. So, although well intended, the executive order is severely flawed.

What Needs To Be Done To Make The Executive Order More Effective And Reasonable?

First of all, the current blanket executive order needs to be made more targeted. Most of these foreign residents have already had their green cards for many years and have been working in the United States as productive employees for most of that time. If need be, these residents can be reinterviewed by the government, but should not be banned from travel abroad or from returning to the United States during this period of “vetting”. Why prevent these legal workers from contributing to the United States workforce and potentially causing shortage of labor in residency programs? We are only harming ourselves.

Second, those countries chosen by the executive order to be targeted is a random selection of “terrorist harboring” countries. Other countries that have traditionally harbored many of the terrorists were not included. So, if you are going to make an executive order to restrict travel and reinterview these residents, it does not make sense to only target a few of those countries.

And finally, vetting should be more individualized and reason based. If in fact, the vetting that was done was not so thorough upon the initial interviews when these foreign born residents came into the country, then by all means go ahead and do the appropriate procedures to make sure that they are in the United States legitimately. But, make sure to do it in a reasonable manner instead of targeting everyone without cause.

What Should You Do If You Are Specifically Affected By The Executive Order?

There are two groups of residents and resident applicants affected by the executive order: applicants who are already in the country and those who are abroad. For those residents that are in the country, I would recommend to avoid travel abroad until the situation clears- you may have difficulty getting back into the country if you make this decision.

For both groups of residents, I would also pay close attention to posts on the ACGME website if you are a resident and the NRMP if you are a applicant for residency. They are scheduled to have frequent updates with relevant information. Also, make sure to stay in close contact with the hospital, residency program, and program directors to receive any relevant updates or other helpful practical and legal advice.

Unfortunately, if you happen to be abroad since the executive order, depending on whether you have permanent resident status or not, you may or may not be able to return to the United States. I would recommend seeking the help of an immigration attorney to help with the issue of returning to the country.

Difficult Times For Foreign Nationals From the Targeted Countries

It is unfortunate how the executive order was issued without regard to the specific circumstances of the individuals affected. Regrettably, many excellent well trained and talented foreign national residents and applicants may be at least temporarily prevented from completing their training due to no fault of their own. However, I believe that once the flaws of the executive order have been worked out, order will be restored to the medical training process, most qualified residents will be able to return to their positions, and medical students will be able to reapply. Although it is only 90 days until a more logical system can be sorted out, these residents may be affected for a much longer time due to the unintended consequences of the order. Continued patience and perseverance is in order for these residents. Hopefully, this situation will eventually pass.

 

 

 

 

 

 

 

 

Posted on by

Can I Be Sued As A Radiology Resident?

lawsuit

As radiology medical school applicants, radiology residents, and full-fledged radiologists, we all dread the possibility of a lawsuit when we begin to practice radiology. Very rarely discussed, however, is the possibility of being sued during radiology residency. The good news: it is very unusual! One article stated that there were only 15 legal cases and 10 law review papers that addressed physicians in training and standards of care on two large legal databases. And, these cases were not necessarily radiology residency specific. The bad news is that although a remote possibility, it has happened several times in the past. 

So, this makes for a relevant topic that is not frequently addressed but is certainly a possibility. In this article, I analyze a few different sources on the web and literature to understand the conditions you need to meet for a patient to sue a radiology resident. More specifically, we will analyze what standards of care a resident needs to breach. Also, we will go through several ways radiology residents can prevent lawsuits in the future.

The Grounds for a Lawsuit

For a lawsuit to be successful against any physician in general, three requirements need to be satisfied. According to a recent article in Diagnostic Imaging, these are breach, causation, and damages. Breach implies that the physician did not satisfy the requirement of the standard of care. Causation means that the breach of duty caused the malpractice. And, damages indicate that the event produced significant harm. 

In today’s article, I will explicitly discuss the issue of breach without discussing causation and damages. Why? Because the concept of breach makes a malpractice case performed by a resident different from a fully trained attending.

Resident Breach For A Successful Lawsuit

Due to the standard of care being different for a resident, the definition of breach for a resident involved in a malpractice event becomes a little more complicated. In fact, over time, the standards of what breach means for the radiology resident have become blurred. I will discuss several cases with different definitions of what the legal system considers “standard of care,” specifically for a resident in training.

Breach For The Intern

Some cases have involved the medical intern. There was one case where an intern failed to identify retained glass fragments and sewed a wound shut. In this case, the court concluded that the criteria for the standard of care should be based upon the standards for the typical intern’s skills. Subsequent lawsuits have demonstrated that the first-year resident needs to fail to do something that a “physician or surgeon of ordinary skill, care and diligence” would typically do to breach the standard of care rule. In other words, the legal system can require a first-year resident without a full license to meet the standards of a general practitioner physician in terms of standard of care.

Breach For The Subspecialist Trainee

For residents in a subspecialty level training program, breach of the standard of care is even more confusing. Some cases imply that the sub-specialized resident should meet the obligations of a general practitioner. Other instances suggest that residents should meet the demands of a more specialized physician. Adding more confusion to the issue, one relevant article’s author reported a radiology resident-specific case of a misread MRI of a newborn. In this case, the court was unable to determine a specific resident standard of care and ruled in favor of the defendant. So, this case did help to define the “standard of care” for this radiology/specialist. (1)

In another case with a radiology resident, an AJR article discussed an incident during radiology moonlighting. The patient sued the resident for missing an abscess and instead called it a bladder diverticulum on a CT scan. The parties eventually settled the lawsuit, but the court determined that the jury would decide the liability before the settlement. This settlement implies that a standard of care was breached at the level of an attending subspecialist/radiologist.

The Main Source of Confusion About Breach

So, according to the literature, the law sometimes considers residents to have lower than the typical standard of care for attendings. Other times they are considered to be at the standard of care of a general practitioner, and at other times the resident has to meet the standard of the attending in his subspecialty. Confusing, huh?

What Does This All Mean?/Primary Take-home Messages to Reduce Liability For A Lawsuit

So, now that all this information confuses you, what does this mean? 

Precept 1: Regardless of the definition of breach for the radiology resident, make sure to get help if you are unsure, and the case can lead to patient morbidity. Getting help can reduce the odds of getting sued for a questionable interpretation and allows your fellow attending to take responsibility for the case.

Precept 2: If moonlighting, make sure you have malpractice insurance. Misses do happen, and the courts may treat you as a fully trained radiologist. So, don’t catch yourself off guard without proper insurance. You need to make sure that your insurance will specifically cover you for moonlighting mishaps.

Finally, Precept 3: Although it is infrequent, lawsuits do happen to radiology residents, and you are certainly not immune from the ravages of the legal system. So, treat each case as if you are the responsible party and always provide your best effort to make the correct findings, diagnosis, and management.

Lawsuits And Residents

Although unlikely, patients can still sue residents for malpractice. Don’t leave yourself susceptible to the possibility of a lawsuit as a resident!

 

References

Clin Orthop Relat Res. 2012 May; 470(5): 1379–1385.

Published online 2012 Jan 26.

Medical Liability of the Physician in Training

Brian Wegman, MD, James P. Stannard, MD, and B. Sonny Bal, MD, JD, MBAcorresponding author

Radiologists, Expect to Get Sued Mar 03, 2016 | RSNA 2015, Practice Management

By Liza Haar

AJR1998;171:565 Malpractice Issues in Radiology: Liability of the Moonlighting Resident By Leonard Berlin

 

Posted on by

Tackling Research- Basic Issues and Considerations for the Radiology Resident

research

Put an academic radiologist and a general community radiologist in the same room and start a conversation on research and radiology residency. How do you think that conversation would go? I bet there would be bitter debate and sharp words. It would likely be next to impossible to get them both to agree on the merits of radiology research.

The academic radiologist would point out the necessity of research to allow the resident to understand how to delve deeply into an area within radiology, understand the mechanics of making discoveries, and create and advance new areas of knowledge within our specialty. He would espouse the importance of statistically analyzing false positive and negative rates, ROC curves, sensitivities, and specificities, tools invaluable to becoming a good radiologist. Additionally, they would also likely say that without an understanding of the mechanics of the research process, companies can easily mislead you by marketing headlines for new software, contrast agents, radiology hardware, etc., that may, at best, marginally display the truth of an imaging process or at worst can be entirely incorrect.

On the other hand, the community radiologist would say that if you understand the fundamentals, can read films well, and know how to manage patients appropriately, what is the point of doing research? Let others develop new ways of interpreting films, creating protocols, or creating new contrast agents. Or in other words, “leave the research to the academics.” The community radiologist would also utter in the same breath that research is too time-consuming, costly, and incompatible with the day-to-day running of a revenue-generating practice. Why bother?

To What Extent Should You Pursue A Project?

So, given these diametrically opposite points of view, the big question becomes: to what extent should the radiology resident pursue research during residency? Should you make it into an all-consuming process or relegate research to satisfying your residency program’s requirements? Given the potential difficulties of making this decision for some residents, I will go through how to figure out for yourself whether you should follow the advice of the academic or community radiologist. In addition, if you go down the research pathway, I will give some sage advice about how to find a research mentor and what makes the best research projects.

How Much Research Should I Pursue?

Maslow’s Hierarchy of Needs

Ever read about Maslow’s Hierarchy of Needs? If not, I highly recommend you click on the previous Wikipedia link. Instead of Maslow’s Hierarchy of Needs, now picture the Radiology Residency Hierarchy of Needs. You might have to dictate films, study radiology material, and attend lectures at the base. At the apex, you would have radiology research. This point is so important: your own basic needs of a radiology residency must be satisfied before you tackle the research requirement. Therefore, you must answer some questions before starting a research project: Have you been studying enough, attending lectures, and learning the basics of radiology concepts? Are you performing well on your rotations? Do you have to concentrate on other issues, such as the USMLE? In other words, the resident must first focus on becoming a good radiologist and then their research. 

The entire pyramid will collapse without the essential elements of good radiology residency preparation. Why do I make this statement? Suppose the resident concentrates so heavily on research instead of learning all the imaging modalities and vital skills during their residency program. In that case, they will find it very difficult to perform well during residency. You want to ensure that you know the general skills of the radiologist first and foremost. Furthermore, too much emphasis on research can lead the resident to lose focus on other issues, such as passing the core examination. So, make sure not to forget about the main reason you are doing your residency: to become a radiologist.

The Rewards

On the other hand, if you can dedicate time to research because you can comfortably divide your time appropriately, by all means, go for it. The rewards are numerous from both a practical as well as academic standpoint. Significant research becomes essential if you are interested in academic radiology, love to come up with innovative ideas and enjoy writing publications. Publishing several papers and abstracts during residency and fellowship can help you get that first job if you want to pursue an academic career.

Even in private practice, performing research during your residency shows that you are interested in radiology. From a radiology job market perspective (although the community radiologist may not want to admit it!), if you have two equal candidates, one who has accomplished much research and the other who has done none, I believe most practices would choose to hire the former.

The bottom line- yes, research can be rewarding but make sure that it doesn’t interfere with your fundamental mission of becoming a radiologist!

How Do I Find A Research Mentor?

Most radiology programs have some attendings that are almost exclusively clinical and others that are more academic. I recommend you seek out mentors/attending with a decent amount of research experience. Although these clinical-based attendings can be great teachers and mentors for learning radiology, they will likely not be as valuable for understanding how to do research. They may express interest in helping you with research, but they cannot instruct you on completing a project. So, unless you have already had a lot of experience with radiology research, a more clinically based radiologist may not be the best choice for a radiology research mentor. There are a lot of radiology attendings out there that don’t have a clue how to structure a research project. (not that it makes them bad radiologists!)

Although not always possible, depending on the size and structure of your residency program, try to find a mentor in an area/subspecialty of radiology that interests you. It will more likely help you later in your career when you complete a project in your area of interest.

Finally, try to find a mentor that meshes with your personality. In addition to the grunt work of research, part of the research process involves bouncing ideas off one another and brainstorming. Exciting research can begin to seem more of a chore than a genuine passion if you feel you are not an equal participant. It shouldn’t be that way. Personality can become a significant issue.

What Makes The Best Projects?

My favorite research projects are those issues and problems that have constantly nagged at me or annoyed me over the years of practice that you have the itch to solve. In addition, I love research projects in an area of actual interest. These tend to be the best and most satisfying projects. I find that esoteric projects without relevance do not provide that spark to take the research to the next level. It also may dissuade the resident from pursuing other projects down the line.

I recommend that when you are involved in the day-to-day readouts, try to take notice of the issues that bother the attendings or questions that occur in the areas of interest you love. There are few things more satisfying than coming up with a question you thought about and then figuring out how to solve it.

Final Thoughts

Radiology research is an excellent avenue for understanding the mechanics of what we do as radiologists. We take many presumed facts for granted, whereas these facts may not be based on the best evidence available. Performing your projects allows the radiology resident to understand how to determine what information is genuinely facts and what information does not have a basis in science. This process helps the resident to read and interpret studies and critically define the accuracy of the information we use to analyze images daily.

Furthermore, delving into research by completing a project can be a very satisfying professional endeavor and become a capstone on top of our radiology residency training. Few things are more satisfying than answering your question, for which the body of literature did not provide an answer.

However, it is essential to remember that as a radiology resident, you must satisfy the basics of radiology residency first and foremost. Before deciding whether or not to become involved in a project, consider if you have the time and energy to pursue the project to its end. If a research project is very complicated and time-consuming, think twice about the project because your priority should be to become a well-trained radiologist. Radiology research can be rewarding, but only to the extent that you first satisfy the basic requirements of radiology residency training.

 

Posted on by

The Uncooperative Patient- The Radiology Resident’s View

uncooperative

As a radiology resident, the patient experience differs significantly from other specialty services. Typically, they see a patient for a single encounter or, even less commonly, a second or third chance episode. Rarely the radiology resident encounters the same patient more than that. Additionally, they have limited time to interact with the patients, even more so than other clinicians. Therefore, the trainee may not establish deep connections with patients like in other specialties. So, we have to view their experience through a very different lens.

In our “radiology world,” all of us will experience one of these dilemmas: The patient may refuse to drink barium, deny the imaging department the significant second portion of a test, physically combat the staff, refuse procedure consent, move during a study, or be noncompliant with our instructions. We often do not understand why the patient may not cooperate in these situations. So in this discussion, I will go through how you, as radiology residents, establish a rapport with these patients to motivate the patient to complete a test. Also, I will discuss some typical situations with “uncooperative” patients that you may encounter and how you can prevent them from escalating from bad to worse.

Patient Rapport and Motivation

As a human being, I can think of nothing less motivating than doing something for someone that I don’t know and for a reason that I don’t understand. Many times, this is precisely the situation that the patient experiences. Often, the floor will send a patient to our department without knowing what test they are having with people they don’t know. The staff may place the patient in confined quarters with minimal human interaction.

Think about it in your terms. Imagine coming down from one of the floors to have a procedure such as a barium enema. And, you see someone without any identification whatsoever. As a patient, I can picture the thoughts going through her head. Is this person qualified to do the procedure? Is someone going to butcher me that I don’t even know? Patients in this situation can often feel dehumanized and vulnerable. How can we minimize this poor patient experience? The first step is straightforward: introduce ourselves. Who are we, and why are we there? Making an introduction alone can motivate a patient to complete a study.

Second, explain the procedure. I have found that taking time to describe it will often go a long way to diffusing a potentially intense situation. Not only does explaining the procedure make the patient more comfortable and knowledgeable about their care, but it also establishes that you are a competent professional to perform a procedure.

And finally, let the patient know if you will perform the procedure. And, if not, at least you will be around to monitor them when it occurs. What a relief to know that someone in the department has your back!

A Couple of Special Situations

The Combative Uncooperative Patient/Family

The Situation

So, you are working in interventional radiology for the month. You are on your fourth consent for the evening before finishing your work. In the back of your mind, you think you are soon finally going home. You enter the room and introduce yourself to the patient and daughter. Subsequently, you start to discuss a PICC line consent that you have planned for tomorrow’s morning procedures, and you begin to rattle off the risks, alternatives, and benefits. As the discussion ensues, you notice on the room door a sign saying feeding precautions: Severe Risk of Aspiration- Do Not Feed the Patient!

You then look back to the patient/daughter and notice that the daughter is rapidly shoveling food from home into the patient’s mouth. You halt the discussion and tell the daughter, “You shouldn’t be feeding your Mom. She has aspiration precautions and can choke on the food you give her…” The daughter yells back, “How Dare You Tell Me How to Treat My Mom? She Has Not Eaten For Days, And I Will Give Her What She Wants!!!!” The patient then begins to cry, and the daughter gets right up into your face threateningly as if she will punch you.

What To Do

How would you deal with a possible real-world situation such as this? There are several options. But, as a radiology resident with limited knowledge of the uncooperative patient’s case, you need to treat it differently than a primary care doctor or specialist who sees the patient daily.

As a radiology resident, you first need to de-escalate the situation. You do not continue to argue with the patient’s daughter, as it could lead to physical confrontation or worse. Besides, there may be more to this situation than meets the eye. Perhaps, the daughter is responsible for the patient’s care and has an advance directive to feed the patient that the sign does not specify in the front of the room. You merely don’t know.

Second, you may want to reflect and say, “Sorry… I see you are upset. Why don’t I leave the room and get you someone who may know more about the situation and can help you.” You can then temporarily step out of the room and recruit the help of the caring physician or the nurse around the corner.

Your role as a radiology resident is not the patient’s total care. Instead, you become the physician ensuring the patient can undergo a procedure the following day. Therefore, letting the caring physicians and nurses know what is happening is appropriate. In this situation, if there is a potentially life-threatening emergency for the patient, it can be taken care of expeditiously. Do not argue with the uncooperative patient, as it can lead to a more active confrontation!

The Obtunded Uncooperative Patient

On interventional radiology rotations, this is a frequently encountered dilemma. You go upstairs to the floors and begin to consent a patient. And, As you are going through the motions, you realize that the patient doesn’t understand a word you are saying. What do you do???

First thing, check the charts. See if anything confirms that the patient is incompetent to make a decision. If not, what do you do? Make sure to think about whether the patient needs the procedure emergently. The consent can undoubtedly wait if it is not emergent.

On the other hand, if the procedure is essential, step out and ask the primary covering physician- what is the patient’s situation? Has the mental status changed? Is the patient on medications preventing them from understanding/responding to the consent? If you see a temporary change in mental status, you may reconsider consenting at a better time/place.

What is the next step if the procedure is emergent and you must complete it first thing in the morning? It is your responsibility to find the person responsible for the patient’s care when they are obtunded so that you can obtain patient consent. You may see an advanced directive in the chart explaining who is responsible for this patient’s care. Or perhaps, the nurse or physician may know who to contact in this event. In either case, contact the patient’s responsible decision-makers before getting consent. The consequences can be dire if you do a procedure and have “consented” a patient without the mental faculties. Legal action is a possibility! Never allow an obtunded patient to sign off on a procedure!!!

Lessons We Need To Learn About The Uncooperative Patient

The uncooperative patient is usually “uncooperative” for a good reason. As radiology residents, we are often not privy to all the information that may lead to the patient’s attitude or actions before or during a diagnostic or therapeutic radiology procedure. Also, remember that you are not alone in making decisions for the patient. Always get help from other clinicians when needed. And never make assumptions about the patient without getting the facts straight. Not following these guidelines can lead to patient care disasters!!!

 

Posted on by

The Chief Radiology Resident- An Insider’s Perspective

chief radiology resident

Every year around the dead of winter in our program, the program directors sit around a table and discuss who will be the next year’s chief radiology resident. For many of you, this process may seem like a mystery box. Why do we even have a chief resident anyway? What exactly does she do? And, how do we make this decision? These are some of the questions you may be asking.

To enlighten you on the world of the chief radiology resident, I will answer these questions. To do so, I will talk about all the nitty-gritty details such as the myriad roles of a chief resident, the perks and downsides of the job, why some years it can be easy or challenging to decide who should be the chief, and how many programs make a choice.

What is the Role of a Chief Radiology Resident?

Roles and responsibilities may vary slightly from program to program across the country. But the essence of a chief radiology resident usually remains the same. The chief resident is the liaison between the resident program and the program directors/attendings. Residents will bring issues that arise among their classes first to the chief resident and then to the program director or responsible attending. Likewise, faculty will bring problems that occur to the chief resident’s attention first, then disseminating the information to the residents.

The duties of a radiology resident include administrative scheduling of residents, scheduling noon conferences, scheduling board reviews, running review courses for medical students and junior residents, voting as a member of the educational committee, attending chief resident conferences such as the AUR meeting, scheduling guest lecturers, planning budgetary arrangements for the residency, interviewing medical students, and more. The responsibilities are significant, and the chief resident needs to command both the attendings’ and residents’ respect alike.

Downsides and Benefits

Like any role with essential responsibilities, there are significant ups and downs to being the chief resident. Let’s start with the downside. The chief resident is often held responsible for conflicts among the residents and between the attendings and residents. They are front and center in many of these issues. Usually, there are no perfect outcomes. Also, the role of the chief resident can be time-consuming and challenging. The scheduling of residents alone is often fraught with lots of emotion and charged conflicts. Each resident wants the best possible schedule for himself/herself, and many times not everybody can be accommodated. The chief resident may be held accountable.

However, there are some significant perks to the role. First and foremost, it can’t hurt to have the words “chief resident” on your resume when applying for fellowships and later attending radiology positions. Sometimes the chief may get to participate in free conferences or get an additional stipend at some programs. Other times, they benefit from getting inside information about the residency program’s inner workings before any other residents. Occasionally, it may help to get a position within the hospital or private practice where the residency is situated.

What Do We Look For In A Chief?

The first most critical feature of an excellent chief resident is to command respect among fellow residents and attendings. We do not want to pick a resident that shows up late, gets involved in numerous conflicts with other attendings or residents, or who is not a “team player.” Second, we look for a resident who has generally performed well academically and can handle the additional load of chief resident administrative responsibilities. And finally, we look for a chief resident who possesses a calm demeanor and is likable by all.

All these personality traits and features will allow the residency to continue to run smoothly and reduce the potential for significant conflict that can make the program director’s job even more difficult. Also, it gives the program directors an additional “ear to the ground” and an advisor that can be extremely useful to prevent miscommunication.

What Makes The Decision To Find A Chief Resident Easy or Difficult?

Assessing who is to become chief is not a decision that we take lightly. An earnest discussion ensues every year among those that make the final decision. Some residency years, one or two residents have been responsible for organizing the class, settling issues within the program, and are performing well academically. And, you may have several interested parties in performing the role and responsibilities of chief resident. When these stars align, the choice to make chief resident is straightforward.

Other years, you have many interclass conflicts, or there is no clear leader that makes decisions for the class. On occasion, we have a year with no one interested in performing the chief resident’s role, knowing there are additional responsibilities. These factors can make it very difficult to come up with a final choice.

How Do Programs Choose The Chief Radiology Resident?

Different programs have distinct policies regarding the installation of a new chief resident. In our radiology residency, the faculty and program directors choose the chief resident during the third year with attendings’ and residents’ input. The chief resident will typically begin his/her duties when the final year starts in July. Some years we have had both educational and administrative chief radiology residents, and other years we have had a single chief resident that takes care of both responsibilities. 

Other programs have a democratic policy, with the residents forming a voting body that may vote upon individual or multiple chief residents. The bottom line: there is no right or wrong way. But instead, the individual culture and traditions of the residency often determine how they choose the chief resident.

“To Be or Not To Be” A Chief Radiology Resident

The chief resident has a significant role in the smooth running of a residency program. The responsibilities can be overwhelming for some and can be an excellent leadership opportunity for others. If the program chooses you to be a chief resident, it is undoubtedly an honor. But, it also involves a lot of extra work and hard choices. Make sure you are up to the task!!!