Category: Resident Advice

Posted on by

How To Be Successful In Breast Imaging

successful in breast imaging

In the second part of the “how to be successful” series, we will walk you through the ins and outs of the breast imaging rotation. Breast imaging, in general, is much different than almost any other area in radiology. (except for some interventional radiology) Why? Because the whole subspecialty hinges on management instead of differential diagnosis. Differentials are usually relatively limited and easy to remember. The challenging part of becoming successful in breast imaging is deciding what to do next. (As long as you don’t miss the finding!)

Also, there are multiple shades of gray in this area of radiology about how to manage patients appropriately. And, it takes a whole heck of a lot of experience to get good at it.

In any event, just like last week, let’s run through what you should read, what and when you should study the appropriate topics, and then finally how you should tackle learning for each year that you are on the breast imaging rotation.

Reading

First of all, I would highly recommend that you check out the free material from the ACR BIRADS atlas on the web. Here, you will get the most up-to-date resource to understand how we dictate breast imaging cases. Additionally, you will learn the appropriate semantics for all sorts of calcifications, masses, etc. I would also advise you to look for a copy of the paid atlas to see each of the different descriptors and associated findings. (see if you can find one lying around in your residency program because they cost 250 dollars!) These sources are the best way to understand the mechanics of reporting breast imaging modalities.

Furthermore, you should also have a supplemental reading to understand the rest of the gritty details about breast imaging. My residents have recommended Breast Imaging, the Requisites (I am an affiliate of Amazon for purchases when you click on the link) to do just that. Although reading during this rotation is required, it is a little less critical to function as well than some of the other radiology areas because it is so “experience-based.”

When To Study Topics In Breast Imaging

First-year

During the first year of breast imaging, I would recommend that you stick to reading out mostly screening and diagnostic breast imaging cases while reading the above resources. Why? It would help if you got acquainted with the basics of breast imaging. The basics include positioning/views, artifacts, searching for findings, and breast imaging’s basic mechanics. Try to hold off on doing too much interventional breast procedures until you are well acquainted with the imaging. You can check out a few to get your feet wet. However, the interventions may not make as much sense because most radiologists make the initial screening and diagnostic imaging findings to get to the intervention point. And, you need to understand these modalities first. You will benefit a lot more from understanding all the interventions better later on.

Second-year

Toward the end of your first rotation or beginning of your second rotation, try to be the initial reader on diagnostic mammography cases. Be in the position of deciding on the additional views and then run it by your attending. In mammography, the only way to learn is to handle parts of the cases yourself. If you don’t take charge, you will miss a good portion of the key to breast imaging- management. Also, be sure to enter the ultrasound room for all the breast ultrasound cases possible. Scanning patients will help you learn how to find lesions and what to look for when you find a mammography lesion.

Final residency years

For your subsequent months of mammography, you should make sure to learn how to perform stereotactic breast biopsies, needle localizations, and ultrasound guide breast biopsies. Also, this is the appropriate time to learn the basics of breast MRI. Breast MRI has become an integral part of imaging in the breast imagers arsenal. You need to understand its place and the basics of how to read them. Again, check out the ACR-BIRADS book for the reporting of MRI findings.

Finally, during your last year of mammography, learn all the new “fancy-schmancy delancy” add-ons. Learn about breast MRI biopsies, PEM imaging, or other modalities that may be unique to your institution. At this point, you want to fill in the blanks. Also, make sure that you have a mammography rotation during your fourth year of residency because the mammograms you read count toward MQSA requirements when you start reading mammograms after a one-year fellowship.

How You Should Learn Breast Imaging As A First Through Fourth Year Resident

More so than other specialties, breast imaging is not a “spectator sport” (a quote from my former chairman during my residency!). It involves being proactive in getting the experience that you need. Moreover, there have been a host of studies, specifically for mammography, that show you need to read tons of images to become an expert in breast imaging. So, you will have to be aggressive to get the numbers that you need to be successful in breast imaging. Not all residencies provide the same training in mammography, and some have significantly fewer cases than others. Therefore, this is a critical piece of the pie that you will need to become a consummate breast imager.

The Basics Of Being Successful In Breast Imaging 

To summarize, what are the critical factors in learning how to become an excellent breast imaging resident and future attending? Ensure that you read the BIRADS atlas and a supplemental book such as Breast imaging, the Requisites. Start with reading screenings, ultrasounds, and diagnostic mammography. Then, when you are ready, take charge of your cases independently. Perform and learn about interventional procedures a little later. Then finally, fill in the blanks during the final years. 

Also, I cannot repeat enough how important experience is for the breast imager. Writing down that you have seen “x” number of cases is not enough in the world of mammography. Make sure that you are looking carefully at each breast image. It is only with experience that you will feel competent enough to become a breast imager when you complete your residency. And, the best breast imagers have seen tens of thousands of cases!

 

Posted on by

How To Be Successful In Nuclear Medicine

successful in nuclear medicine

For the next several weeks (and possibly months), we will start with a new theme: how to be successful in each of your subspecialty rotations. (and of course, today how to be successful in nuclear medicine!) Why should I even bother to tackle this theme? I mean, most residency programs have some guidelines about what residents need to do each month. Well, I can tell you that most of the time, these guidelines are only set up as a way to satisfy the needs of the ACGME and may not be all that relevant to what you need to know. Often, they are very boilerplate and merely copied from one institution to the next. Moreover, these summaries are “oh-so-boring” to read and likely outdated. Additionally, I aim to give this a bit more entertainment value (as I usually do!) and provide some more relevancy to what you actually should do on your rotations. 

To organize this series, I am going to mirror the subspecialty rotations at our institution. At Barnabas (my humble program), we have a mix of modality and organ-based rotations. Now, you may ask, how can this be relevant to your situation if your program arranges your month slightly differently? Well, regardless of how it’s sliced and diced, you can infer many of the same themes at your institution. The information is still here to help you out. These include the books you need to read, how you should learn the material during each year of residency, and the actions to succeed in your rotations.

So, why start with nuclear medicine? Well, for one, it is my area of expertise. And, of course, what better place to start than my home base?

What You Should Read

Hands down, there is one resource that I like the most. It used to be Nuclear Medicine, The Requisites (which is OK). But all that has changed since the newest version of Mettler. (I am an affiliate of Amazon if you decide to click on the links and buy them!) I found Mettler to be comprehensive and reasonable to tackle. It was straightforward to read when I had to study for my recertification examination in nuclear medicine/radiology. Also, it covers most of the nuclear medicine topics. And I believe that is an excellent way to go.

When To Study Topics In Nuclear Medicine

During that first year of nuclear medicine, you need to first start by concentrating on the studies that can kill patients or cause severe morbidity if you miss something. What are these sorts of cases? These include V/Q scans (you don’t want to miss pulmonary emboli). Then, check out myocardial perfusion scans (you don’t want to miss ischemia from a left main coronary artery widow-maker lesion). Go through GI bleeding scans (you don’t want your patients exsanguinating). And finally, read about renal transplant scans (missing dying kidneys).

Then, next, you need to study what is most common when you’ve covered these bases. Of course, what occurs frequently can vary somewhat from institution to institution. But, for the most part, we are talking about bone scans, hepatobiliary scans, infection detection studies (gallium, indium-WBC, and Ceretec-WBC), and iodine scans for thyroid disease. Or perhaps, your institution may specialize in procedures such as parathyroid adenomas (as we do at ours). The bottom line is that you should study what you see most often to communicate intelligently with your attending.

Finally, you should study everything else. And, in nuclear medicine, that can be a lot. But, the core exam will pretty much cover most of nuclear medicine. That includes anything from PET-CTs of all types to DAT SPECT studies to evaluate Parkinson’s disease (or even the rare salivagram!) This order should allow you to be successful in your successive nuclear medicine rotations.

How You Should Learn Nuclear Medicine As A First Through Fourth Year Resident

First Year

Try to sit with your attending as much as possible at the beginning. Get a feel for what your faculty dictates and why. Then, without much further ado, be aggressive and ask to dictate cases as soon as possible on your own. Why? Because you want to convert what your attendings are thinking into a viable and logical report. That is what we do as radiologists. Without this skill, all your learning with be for naught!

Also, try to spend a little bit of time with the technologists. See how they operate the machinery. Check out how the patients undergo stress tests. Watch how the cameras work. All this observation is essential for understanding how technology translates into clinical operations and patient care.

Second and Third Years

During these years, you need to become a bit more independent. Now that you know some of the basics, you should try to pre-dictate cases even before the nuclear medicine attending arrives on the scene. Grab that bone scan and give it a whirl. What’s the worst that can happen? You will miss a few findings and learn something!

Fourth Year

Instead of only concentrating on the less complicated material, try learning the nuts and bolts of some more esoteric studies. Also, be sure to understand how the software works. You might need it at your first job. For instance, ask how your attendings process the PET-FDG brains for quantification. Or, maybe you should try to interpret some of the more arcane PET scans like Amyvid, Axumin, and Dotatate. Bottom line: this is your last chance to learn nuclear medicine before starting your fellowship. Maximize what you know before it is too late. You don’t want to be struggling with nuclear medicine’s nuances when you take your first job if they assign you to tackle that specialty.

The Basics Of How To Be Successful In Nuclear Medicine

Let’s be honest. Nuclear medicine is not the most formidable rotation of all. (A little biased coming from a nuclear guy!) Or, what I mean is that you are usually not worked to the bone. However, it certainly has its challenges.

To summarize, I would concentrate on those studies that have the most clinical impact first, dictate soon after starting, spend some time with the technologists, and be somewhat aggressive and attempt to preview and dictate studies when you are ready. This targeted approach is how I would proceed if I were starting anew. These guidelines can give you a bit of a boost when starting out and give you the tools to be successful in nuclear medicine. Go for it!

Posted on by

What Are The Consequences Of Postponing The Core Exam?

postponing the core exam

It’s no surprise that the ABR decided to delay the core exam. For years, they were unwilling to go virtual, even before Covid, claiming they needed their computers at the RSNA to give an appropriate “image-rich” examination. And, then, of course, they were not prepared at all when the Covid disaster struck. How do you force over a thousand residents to go to Tuscon or Chicago to take an exam amid Covid? In any case, now, this is water under the bridge. So, what are the real consequences to the current fourth-year residents of postponing the core exam? Will the damage be permanent? Here are some of my thoughts on this issue.

Less Time For Mini-Fellowship Studies

Mini-fellowships have been all the rage since the conversion from the oral boards to the core exam. One reason for this change was more time for residents to dedicate toward more independent learning during the final year. No longer did they need to study for a board exam at the end of the fourth year. Well, now this has mostly changed. Since the examination will be in February, you lose most of your fourth year for studying for the core exam again. (almost like the good old days of the oral boards.) Likewise, the time residents can concentrate on subspecialization without worrying about an exam will suffer.

More Time Spent On Learning Facts Of Equivocal Utility

It’s taken eons to get to the point I am today. I have spent years trimming the useless radiology facts from my brain and concentrating on what is critical. Now, the residents will begin this process a bit later than before. They will regurgitate some of the less useful information at the expense of the critical information needed to become a practical radiologist for several additional months. It’s having completed the core exam that would have allowed this process to begin earlier.

Postponing The Core Exam Will Cause A More Anxiety Filled Year

Residents will continue to spend the majority of this year in the “what-if” phase. What do I mean? They will continuously think about what will happen if they don’t pass the examination. A clear, calm head is much more conducive to enjoying the experience of residency. Test-taking prevents the settling down process.

Less Time For Gearing Up For Fellowship

Some residents like to begin to get ready for their next phase of training. That may mean reading a bit extra on their favorite subspecialty. Or, they may spend time practicing the nuances of bone biopsies if they are going into MSK. Now, residents will be less apt to increase their experiences in their future areas of interest. It’s much harder to concentrate on other topics when a test looms ahead of you.

Missing Out On The Full Fourth Year Experience (It’s Now A Four-Month Experience)

Finally, residents no longer receive the authentic fourth-year experience (However, I never had that as I studied for the oral boards!). It was kind of like an unwritten promise that you will have a great last year if you complete and pass the core examination. Now, it is back to the grind for the majority of the year.

Postponing The Core Exam: Is It The End Of The World?

The short one-word answer to this question is NO! However, for every action, there is a consequence. And postponement of the exam is no exception. After a tough three years, it is a bit of a slap in the face for residents. Many of you have paid to have a great fourth year of residency with blood, tears, and sweat (literally!), working diligently during your training. “Fourth-year” will now only last a few months after the exam.  

Nevertheless, remember, in the end, all of you will still become radiologists. Life always throws a few curveballs. And, your residency will become no more than distant memory soon enough!

 

 

Posted on by

One Additional Dictation Can Make All The Difference

additional dictation

For those of you thinking about working in a radiology practice, working as a team is the key to survival. And part of that team effort is work ethic. If some radiologists have different work ethic levels than others, it becomes a nidus for discontent. I believe that this varying culture of employees/owners is one of the biggest downfalls of individual practices. For example, an owner interested in maximizing income will not mix very well with an employee who took the job for lifestyle. And vice versa. However, when starting, you need to assume more responsibility, not less, regardless of the practice culture. So, what does it take to improve your practice environment?  It’s pretty simple. Be willing to take that extra case or dictate that study without a fuss at the end of the day. One additional dictation can make all the difference.

If you think this is a ridiculous statement with no relevance to you, take a look at your fellow residents or employees. Who are the folks that are the most successful at your level? It’s rarely the person that complains that he has too much work and cannot bear to read another study. And, it’s certainly not the person who always leaves over work for their colleagues. Instead, it’s that radiologist who completes that extra case at the end of the day to ensure that the next person is not swamped. So, what are the ways that dictating one additional study can make all the difference?

How Can One Additional Dictation Improve The Practice?

Builds Goodwill Among Fellow Physicians

If your colleagues notice that you are helping them out, they are much more likely to reciprocate for you. Therein begins the virtuous circle. And reading that one more case at the end of the day can start the whole process. It can have a snowball effect on the practice. You never know when you may have to leave in the middle of the day for an errand. Now, you have colleagues that are willing to cover and support you.

Builds Goodwill Among The Referrers

Sometimes that extra case can come at the end of the day. Most of you probably know of that 5 PM abdominal CT scan for abdominal pain. It may be the responsibility of the person on the next shift. But, by reading that case and calling the referrer, you have established a connection. That ordering physician will be much more likely to send future patients your way when they need a quick read.

Builds Goodwill Among Staff

Then, of course, most staff members hate to have extra cases lying around. Reading that additional case may allow them not to chase someone down to read the case later on that evening or the next day. Who wants the lead technologist to continually nag the radiologists to take care of that extra case? That employee will most likely put a positive word about you to your colleagues.

Increases Overall Revenue

The more cases that the practice reads promptly, the more revenue streams can come in quickly. It may sound silly that one dictation should make such a difference. But, rinse, wash, and repeat. Day after day, you can significantly prompt cash flow for the practice by reading that one extra case. That’s 365 cases per year if someone reads that case every day. Do the math and figure how much that is. That can only benefit you and your practice in the long run.

See, One Additional Dictation Can Make All The Difference!

I think you catch my drift. It’s not just about the one case itself. Instead, it is about the goodwill and economics that you bring to the practice over the long run by improving the work environment’s culture. Imagine if everyone does the same. That is called practice building, my friends. And it is the first step to creating an excellent environment to practice radiology!

 

 

Posted on by

The Frustrations Of Starting Residency With Nuclear Medicine

nuclear medicine

Order matters. And when you are starting in a radiology residency, it makes the most sense to learn subjects logically to get the most out of your first year. First, start with rotations that overlap most radiology topics. Then, afterward, get a bit more specific and esoteric. Right? However, as often is the case, many chief residents and program directors only have so many open slots to fill the rotation schedule. And all of them need to get filled. One of those residents has to begin with nuclear medicine. Maybe that person is you.

So, from the mouth of a nuclear radiologist to you, why can beginning with nuclear medicine be such a frustrating specialty rotation? Well, let me give you some reasons why starting with this subspecialty can be formidable. And, then I will provide you with the information you need to resolve the issue!

Reasons Why Starting With This Subspecialty Can Be So Frustrating 

Some Nuclear Medicine Attendings Are Not Radiologists

Sometimes, especially in highly academic facilities, nuclear medicine attendings are strictly nuclear medicine trained. These attendings live and breathe a different world than the nuclear radiologist. They can’t take an overnight call as a typical radiologist would do. And, their perspective is very different from a radiologist. Not to say that they are not good doctors. But instead, you may not learn on that first rotation what you need to know to succeed in a radiology residency. Starting off the block in this situation can make your transition to radiology residency that much more difficult.

Lots of Cases Are Off the Beaten Path

In many nuclear medicine departments, most studies have less to do with the rest of radiology. For instance, many facilities perform an overwhelming number of cardiac myocardial perfusion scans. Sure, there is critical information on these studies. But, on-call, you may be very unlikely to see a cardiac perfusion case at nighttime. Or, you will catch lots of other more esoteric sorts of studies like gastric emptying to salivagrams. Although essential, learning these studies do not help much when you are taking cases at noon conference.

Need To Study Information Only Relevant To Nuclear Medicine

Finally, in nuclear medicine, you will need to learn lots of information only applicable to nuclear medicine. Learning about the dosage of radiopharmaceuticals will probably not help you much elsewhere in radiology. And, understanding radiopharmaceutical biodistribution, although critical to grasp the pathophysiology of a disease, in reality, will not go a long way toward helping you read a CT scan. This information takes time to learn and may replace the time you could discover other radiology topics. 

How To Resolve The Issues That Come With Starting With Nuclear Medicine

When starting residency on a nuclear medicine rotation, regardless of whether your faculty is nuclear medicine only or a radiologist, make sure to look at nuclear medicine with the lens of how what you see on rotation does overlap with other subspecialties. Even the lowly salivagram has some features that you may find on other imaging modalities. In this case, look at the neck CT and MRI. Check out the anatomy of what you see on the salivagram, such as parotid atrophy, inflammation, or stones. Or, for the cardiac studies, make sure to learn about the angiograms, the cardiac MRI, and the CT scan findings as well. If you stay isolated in your learning and thinking, you will find nuclear medicine more frustrating.

Also, make sure to start learning those areas that you need to know for an independent call. Understanding the relevancy will make it seem like what you are learning has more real-world applications. Check out hepatobiliary scans, V/Q scans, and GI bleeding studies first to increase relevancy. Learning to interpret these studies will have easily observable influences upon patient management. It will make you feel all the more relevant when you are first starting.

Finally, seek mentors and fellow residents who have been in a similar boat to you when you are starting. You are not the one who has had this issue. Other residents have done very well even after starting with nuclear medicine as a first rotation.

Nuclear Medicine Doesn’t Have To Be So Frustrating On That First Rotation!

Well, there you have it. You may not be starting as central to all of radiology as you might have liked. But, you can create an experience that is worthy of a great month. Just follow some of the steps I listed and above, and you will learn a lot and have an excellent experience!

Posted on by

Independent Call: Which Radiology Residency Year Should Take The Most?

independent call

Call burdens can vary widely in residency programs throughout the country. You have those programs with the dreaded 2nd-year crush. Others distribute calls more equally. Some have the third and fourth years taking the majority of overnights. Whatever the case, each program weighs its independent call schedule slightly differently by residency year. Any program can choose to structure the burdens however appropriate. (as long as 1st years are not taking independent calls as per the ACGME guidelines.) However, educationally speaking, who should bear the brunt of coverage and why? Let’s go through some of the more common call structures and the advantages and disadvantages of the call’s different weightings.

Front Loaded Independent Call For R2 Residents

Although not the most desired distribution of calls by emergency room physicians, residents get the most experience early on in their residency with this structure. It allows the R2 resident to build the radiologist’s confidence early on to practice as a radiologist. This resident can take this experience and apply the rules to the remainder of their residency. As I always have said, you are not an actual radiologist until you have had a call, a venue where you can make independent decisions. Until then, you will always be a student.

Moreover, it allows the current 2nd years to have a cushier future R4 year filled with electives and mini-fellowships (assuming they have passed the core exam). It also gives the resident extra time to study for the core exam at the end of the R3 year. And it allows for time at the AIRP during the R3 year.

Back Weighting For R3 and R4 Residents

Theoretically, weighing the call to the R3 and R4 years gives residency programs the advantage of having their more experienced residents take the most overnights. But, there is a catch-22 to this philosophy. If you want more experienced residents, you must give them independence earlier! Just because you put more senior residents on call does not mean you are getting more experienced reads. Call itself is the most critical experience for building practical knowledge, not studying from a book or reading a faculty radiologist’s final reads.

Whatever the case may be regarding back weighting and experience, the experience of having more calls toward the end of the residency sets the resident up better for independent work and moonlighting in their fellowship or as a full-fledged radiologist. The recency of critical training prepares residents better for the practice of radiology. When you finish the fellowship, it is possible to complete all your calls during your R2 year and not work independently as a radiologist three or four years later. That situation might put you in dire straits for making independent decisions at your first job. By backweighting the call, this issue is no longer a threat.

Even Distributions of R2, R3, R4 Calls (As Much As Possible)

Of course, an even distribution is the least burdensome of call distributions. It allows the resident to experience calls without the burdens of doing them all at once. Moreover, an even distribution gives the resident some experience early on. And it allows the resident to maintain skills throughout the residency. Finally, it even gives the resident the confidence to know that she has the experience to function as faculty when done.

Although it is impossible to make any call exactly, even given the constraints of studying for the core exam and the AIRP, this distribution can benefit from early experience and late reinforcement.

A Program Director’s Perspective of Independent Call Weighting In Today’s Environment

As program directors, we have political and educational concerns when a chief resident gives us a sample schedule for overnight coverage. The program directors and the chief resident often do not have complete control over distributing calls throughout the residency. Sometimes, the emergency department requires more senior residents. Other times, individual rotations such as interventional radiology prohibit residents from taking calls. So, giving the resident the perfect “educational” call weighting during residency is not always possible.

Nevertheless, some call throughout residency seems to give the most balanced education. As much as the ABR leaders say the core exam shouldn’t interfere with this training, the core exam does. A poorly thought-out core exam strikes again! Until we develop a better system than the core examination to test residents, it will always prevent programs from having the optimal mix!

 

 

Posted on by

Do Board Review Companies Help With The USMLE?

board review

Not all students learn the same way. And, each method of studying has different pitfalls and benefits. For a distractible student, you need an isolated organized environment to study. And, a large group may not benefit this individual. As a kinetic learner, the action of performing a lab or dancing while reciting study material may allow you to absorb the material better. But, sitting in one place staring at a book may not work as well. My point is that board review is not a “one size fits all” activity. And I recognize that.

Moreover, in my experience, I have seen board review companies giving an unqualified boost to some test-takers in question. And, others who have not taken a board review course do just fine So, to answer the question posed on this post, do board review companies help medical students and residents with the USMLE, I will have to be a little wishy-washy and give you an unqualified maybe!

But if you are reading this post, what you are asking is will a board review company help me. And, perhaps, even more importantly, is the course a waste of money and time? So, another way to word the question would be, what types of medical professionals would and would not benefit from using a board review company? And, those are just the questions that I will answer!

Students That Benefit From Using Board Review

Residents Without Organizational Skills

What board review companies do best is to provide you with a routine and a defined way to study for the examination. They give you the material that you will need to make sure that you will pass the exam. For some students and residents, the course leaders’ material and the demands provide a bit more structure. Of course, a system and a routine can allow these test-takers to focus on studying for the exam.

Poor Test Takers

Some residents and ‘medical school students either develop anxiety or think too deeply about a question and perseverate for a half hour. Board review companies are good at making sure you understand the how’s and why’s of taking tests to improve your test-taking skills. What’s interesting about many poor test-takers is that they don’t necessarily translate into bad radiologists. In this situation, a board review company can provide a bit of a boost to your scores. It is most likely worth your time and money for that extra help if you consider how much more you will make in your lifetime.

Previous USMLE Low Board Scores Failures

They say that the definition of crazy is expecting a different outcome after doing the same thing again. Well, anyone that has not done well on a board exam beforehand should utilize the extra help to get you over the hump to increase your chances of acceptance into the radiology fold! Board review companies can help to change the way you study the next time around.

Students/Residents With Borderline Credentials For Acceptance

If you are a resident toward the middle or bottom of your medical school class, a higher score on Step I (Or now Step II USMLE with the new changes) can make all the difference between acceptance to residency/fellowship and rejection. Many residencies (and to a lesser extent fellowships) will use cutoffs in Radiology to ensure that the accepted class will pass the core exam. Why? Because there is a correlation between doing well on the USMLE exams and passing the core exam. And, a boost of only 5 points on your exam can make all the difference between capturing that interview and total rejection. It’s probably worth it to shell out that extra dough.

Foreign Applicants

Finally, if you are coming from another country, the programs will scrutinize your application more. Any advantage can help your case. If you have reached this far, you are better off taking a course even if it only increases your score by a few points. It may make all the difference!

Students That Don’t Need The Extra Help

Natural Born Test Takers

Yes. Some students and residents can take almost any test and pass it with flying colors. (Aren’t you jealous?) They have just mastered the art of examination to a tee. Based on the question itself, regardless of the information at hand, they can almost sniff the right answer. If that is you, then forget about board review. Save your money!

Honors in Every Course With Twenty Papers Already Completed

Check. Some folks have had an incredible academic record, and no matter what will get into the residency of their choice with or without excellent board scores. If this person is you, why bother to pay up for another exam?

You Get The Point!

I think you see what I am getting at here. Some folks don’t need to pay for that extra boost of a few points. It may not be worth the extra outlay of cash for those folks.

Board Review Companies Work Well For The Right Fit!

I know how painful it can be to shell out a bit more money when you already have umpteen gazillions of dollars of debt. But, sometimes, it is worth it to pay up for the additional help, especially if it may mean the difference between having a long career in the specialty you want. Having a guide that can get you through the pitfalls of studying for these tests is invaluable for the right sort of test-taker. So, consider where you stand and decide if it is right for you. Here are some of the more frequently used board review companies below that my residents have used to help you along with your decision. You can click on them if you are interested. I am an affiliate of both! (Princeton Review currently has a discount that expires on September 3!)

 

 

 

 

 

 

 

 

 

 

 

Academic Tutor LOL (24 hrs) – $180 Off!

Posted on by

How Can I Prevent Low Imaging Volumes From Causing Me To Lose My First Job?

low imaging volumes

Question About Low Imaging Volumes:

Hi. I am an R2. I’ll most likely do a fellowship in body imaging (mostly because I haven’t felt a click with any particular specialty). I keep reading about practices firing radiologists because of low imaging volumes due to COVID. I’m concerned that this will affect me when I apply for jobs because I am only interested in private practice. I want to position myself with some advantages, and I need your advice on how to do this. I particularly enjoy the IT aspects of radiology (troubleshooting PACS, EMR, making software more efficient, automation, computer hardware). In my residency, there is a faculty member who is the “Director of IT.” And, I might be interested in a role like this.

My question is, do you think this is something that is even an advantage if you are seeking private practice? If so, how can I enter this space? Is there a course? Do I do research? If this is a bad idea, are there other things I can do during residency to give myself an advantage when it comes time to apply for a job in private practice? 

What should I do?

 

Answer:

Armaments To Prevent Job Loss

These are excellent questions, and I have a few answers! Let’s start with the first one about practices firing employees because of low imaging volumes. First of all, this Covid situation will most likely all but disappear by the time you graduate residency. Nevertheless, one of the best protection against getting canned is to become invaluable in whatever area that you practice. That niche can be informatics/IT. However, it all depends on the type of practice where you work.

If you aim to work at a small private practice somewhere, it will probably not help all that much. If you work for a larger institution or an academic center, it can help a lot, depending on what you do. In an educational sort of setting, if you are pumping out tons of papers and creating lots of programs/IT solutions for your colleagues, no one will want to let you go. Alternatively, if you are in charge of a massive corporate IT program, and the business cannot function well without your knowledge, they will not fire you. On the other hand, if the IT services you provide are just a little help, and the clinical work that you provide to the practice is not so much. Well, then you will not have the same job security.

At this stage of your career, work hard, and perform well in residency regardless of your fellowship. Learn about all aspects of radiology as much as you can so that you can establish a niche for yourself when you leave your residency. To repeat, most folks that are good at what they do will be the last to be fired.

How To Get Into Information Technology

Next, how can you enter this IT space? Well, some of it depends on how much experience you have in IT already. If you don’t have the knowledge that you would need to take over the IT at a practice, you would probably want to look into the Informatics fellowship. This fellowship will give you the basics of what you will need to know about IT for radiology practices. There, you can establish connections that you would need to find a career. Additionally, research in your area of specialty is never a bad idea during residency or fellowship, especially if you want to follow the more academic path.

Final Advice

So, there you have it. Work hard, learn as much as you can about radiology, consider an informatics fellowship (if that is what you want), and perform a niche in a practice that others have a hard time filling. These are the ingredients that will keep you in practice regardless of the Covid or any other unfortunate situation that may arise to lower imaging volumes for radiologists.

Good luck,

Barry Julius, MD

Posted on by

Going Through A Covid Surge? It May Help Your Career!

surge

Yes. Covid-19 has been an epic disaster. But, in any emergency, opportunities arise. And a new Covid surge is no exception. Sure, the hospital may curtail or delay some of your training in radiology. However, this pandemic affords you other chances to establish a reputation for yourself in your hospital and community. And, you will learn other clinical skills that are just as critical as radiology. Demonstrating your prowess in these dark times can lead to unforeseen possibilities in the future. These opportunities can prove themselves more valuable for your future than you might think at first glance.

So, what are these potentialities that I am referring to? Your experiences and performance during the Covid era can lead to job openings, better recommendations, networking, improved clinical skills, better awareness of the community, and more if you play your cards right. Let’s talk about how.

Increased Contact With Hospital Administration

In a typical environment, most residents have very little to do with the hospital administration. At the beginning of the first year, they may hear a few words from the executives to introduce them to the hospital. And at the end of the last year, they help to hand out the diplomas. That’s about it. But, in many departments, this paradigm has shifted.

Now that you are providing a service for the hospital under extenuating circumstances, you are more likely to have the ear of the administration. If you ever want to start looking for a job in the hospital and perform well, they will more likely remember you when the time comes to search. Even better, if you ever want to look for a career in hospital administration, there is no better time to prove your worth and team-building skills than now.

Better Recommendations

Tough times call for more teamwork. And, what better way to get to know your attendings than a stressful situation such as this? In actuality, faculty are more likely to get to know their residents when you are in close contact. You are no longer just another resident! And, this will show in the recommendations that you receive.

Increased Intra-Departmental Networking/Learning

Since you will most likely work with different teams of subspecialty physicians throughout the hospital during a covid surge, you will get to know your colleagues better. Believe it or not, cross-currents of learning and insights into other specialties also help with becoming a better radiologist. It could be pulmonary, cardiology, or pathology. All subspecialties overlap with ours!

Just as critical, establishing relationships with other physicians that you would never have seen as a radiology resident, will make you more valuable. Who would other physicians instead refer patients, a radiologist that they know well, or someone else?

More Awareness Of Clinical Medicine

Sometimes in radiology, we can grow farther away from the real reason why we went into medicine in the first place, to help patients. Having more direct interaction with patients, even in an unforeseen emergency such as this one, can lead us back to our clinical roots and remind us why we are radiologists in the first place. It allows us to rehone our clinical skills that will come in handy later on as an attending.

Getting To Know The Community

Some residents go to residencies based on the quality of the program alone, ignoring the community. However, you also serve a community, and sometimes getting into the clinical nitty-gritty can allow you to understand the patient populations for which you work. If you doubt the importance of your role in helping out the community, look at the media presentation of healthcare workers. Typically, they present all of us (even radiologist residents) serving the hospital as heroes. Heck, in our community, the leaders hosted a parade for the folks at the hospital to demonstrate their appreciation. So, if you think that you do not influence the community, you are dead wrong. Getting back to these roots will allow you to appreciate once again where you work!

Time To Prove Your Mettle During A Covid Surge!

I know. You may not have bargained for these circumstances. However, there are always a few golden nuggets that we can take away in almost any bad situation. So, even though you think there is no value to having work other roles in a surge, it may be more helpful to your career growth than you think!

 

Posted on by

Check With Your Faculty Before Letting A Barium Patient Go!

barium patient

Barium slinging is harmless, right? I mean, what’s the big deal about letting a patient go after you complete a standard esophagram or barium enema? How often have you, as a resident, completed one of these studies without checking the results with your attending, only to let the patient go home right afterward? I bet most of you have done so at one point or another. If there is any complexity in the case whatsoever, I would think twice before letting the barium patient leave before checking it. Why? Well, for lots of reasons. And I will divide them into the following broad categories, legal, lack of experience, extra scrutiny, patient-related issues, and lack of insight into history. Let’s go through them one by one.

Legal Issues

Residents are not the final interpreters of any study, whether it be a plain film, CT scan, or ultrasound. Additionally, distinct from most other imaging modalities (except for ultrasound), the resident is responsible for showing and carefully examining the findings. If she does not technically demonstrate the findings based on history, the study becomes useless to the ordering physician. Consider the resident not spotting the terminal ileum in a small bowel series for inflammatory bowel disease. Or, maybe he doesn’t complete a cine of the upper esophagus in a patient with dysphagia. Who is responsible for the lack of information targeted to patient history? The attending, of course! Just read this AJR article about barium enemas and malpractice, and you will think again. Radiologists are liable for the missed interpretation based on resident imaging!

Relative Lack Of Training

When barium slinging was more common years ago, it used to be one of the more litigious radiology areas. Just like mammography, you could easily miss all sorts of colon cancers, ulcers, and more. Typically, it would take years of experience to develop the trained eye to find these abnormalities. Don’t think that barium work is easy, so much so that you can blow it off as a low tech waste of time. On the contrary, one inexperienced resident may not be enough to catch the pathology that you will need to find. There is hubris in thinking you know more than you do! Moreover, think of this opportunity to go over the case as an additional learning opportunity to become better.

Second Set Of Eyes

On that same notion, having a second set of eyes can be a critical adjunct to making the finding. It’s like breast imaging. Often, the ultrasound technologist cannot find a blessed thing corresponding to the patient’s lump. But, as soon as you, the physician, walk into the room, WHAM! It’s right in front of your face as clear as day. Sometimes, you need that second set of eyes to get you out a particular mindset. It’s worth it.

It’s A Big Deal To Bring The Patient Back

Finally, if you miss looking for a finding on the study, the patient may not return so quickly, especially as an outpatient. For instance, in the patient population with dysphagia, many of these patients may come from rehabilitation facilities or nursing homes. Did you ever think about how hard it was to get the patient to the study in the first place? Or, maybe the person has a hectic job and made special arrangements to complete the procedure. Now, you need to bring the patient back. You may not think so, but it can become a huge issue!

Check With Your Faculty Before Letting The Barium Patient Go!

Don’t take these studies for granted. Allowing for these studies to go unchecked can cause all sorts of trouble, including legal dilemmas, missing findings, and having to bring unavailable patients back for more imaging. So, please, if you are on the fence, think twice before sending that patient home without having your attending check it. It could be lousy patient care!