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DO Friendly Programs- Should I Bother To Apply?

do friendly

Question About DO Friendly Programs!

 

Hello! Thank you so much for this website; it has helped me out immensely. What is your take on small community programs with lots of DO residents? They seem to have a pretty good fellowship match (IR in some top programs, a pretty good mix of fellowships overall).

 

Thanks a bunch,

Low Tier

 

Answer:

 

I am somewhat biased as our program has welcomed both DO and Caribbean medical school graduates for years. And, yes, folks consider us a “community” program. (although that will change with our impeding merger)

 

My philosophy on radiology education is that a residency is only as good as what you put into it. Regardless of the name, if you work hard and read a lot, you will come out of your residency as a great radiologist. The big difference some of the more popular programs afford is additional subspecialty work that you might not get elsewhere and hardcore research that you may or may not want. However, all is not lost if your residency does not fit this category. Indeed, you can get some of these experiences during your fellowship. And, most residents complete a fellowship after residency.

 

In terms of being a DO friendly program, I have no problem with that. As long as education is of high quality and the program’s resources are adequate, it should not matter if the residents are Caribbean, foreign, or DO. In our residency, some of our best residents tend to be Caribbean grads, for one reason or another. That should not dissuade you from applying to a program if you know that the program’s quality is high, and you will receive the training you want. We have had excellent residents from American, Caribbean, and DO residencies alike.

 

Hope that helps,

Barry Julius, MD

 

 

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Do CAQ Fellowships Add Any Additional Benefits?

caq

Have you ever wondered why some subspecialties have a separate certificate of added qualification (CAQ) while others don’t? Are there any advantages to getting these added certificates? Or is it just another degree? If you hate taking additional tests, why would you even bother with another examination to get one? I know that these are some of the questions that I have thought about a bit. And this is a great forum to answer them!

The Main Subspecialty Certificates Of Added Qualification

What are the officially recognized CAQ specialties by the American Board of Radiology (ABR) certificate of added qualification? As listed in the link above, the three most common that radiologists typically complete (from most popular to least popular) are neuroradiology, pediatric radiology, and nuclear medicine. The ABR also lists Vascular and Interventional radiology as a CAQ specialty. But, in reality, it is now a distinct full-blown specialty with a separate board and residency program. And then finally, it also lists hospice and palliative medicine as well as pain medicine as two more options. I don’t know of any radiology residents who have completed these subspecialties CAQ after a radiology residency. But, I am sure there are a few out there somewhere.

How Did Some Subspecialties Become CAQ Subspecialties And Others Did Not?

For the CAQ subspecialties, an academic cohort of individuals decided to make specific qualifications for their subspecialties. Sometimes, it was to limit encroachment from other specialties upon their turf. Or, it was to protect the subspecialty’s interest and maintain minimum standards.

Other subspecialties that do not have a CAQ, never had enough members to put in the effort to create a CAQ. It takes a bit of work and money to create an entirely new CAQ exam and all the bureaucracy that accompanies it!

What Are The Privileges/Disadvantages That CAQs Provide?

Financial/Job Advantages?

Sometimes, practices and hospitals ask to have certain subspecialists on their staff. And, in particular, they often want CAQ subspecialists. Why? Well, because frequently, other physicians or hospital administrators demand them. This demand may give you a slight advantage when you eventually go out into the job market. You may find that these subspecialties can add a few dollars to your starting salary when you begin to look. For instance, interventional radiologists and mammographers have commanded a higher salary in the recent past out of the starting gate.

Moreover, some hospitals require credentialing in specific subspecialties for their staff members. You can often see these in job board descriptions if you look at any online radiology job site. If you don’t have these credentials, you will be unlikely to get that job!

Legal Advantages (Or Disadvantage)

As a CAQ holder, you have the privilege (or disadvantage!) of the legal world considering you an expert in these fields. What does that mean? First of all, the courts hold your reads to a higher standard than other Joe Shmo general radiologists out there. In a positive sense, your subspecialty read will carry more weight in the court of law. On the downside, it also means that there will be a lower threshold for misdiagnosis than a typical diagnostician.

Additionally, the CAQ will allow you to have some “street cred” if you decide at some point to go ahead and perform expert legal work. Lawyers love having subspecialists on their payroll to convince jurors one way or another in malpractice lawsuits.

Pigeon Holing

If you are neuroradiologist and hold a CAQ, you are more likely to work at the facility, and complete neuro reads. Of course, this work can be great if it is the lot that you have chosen in life and you are happy doing it. However, it may pigeon hole you into becoming a neuroradiologist even if you are not so fond of the subspecialty work. So, beware of the subspecialties that you choose!

Surveys

If you like making some extra dough on the side, becoming a CAQ subspecialist opens up a few doors to get these subspecialty surveys. Typically, these surveys pay a little bit better than more general ones because of the laws of supply and demand. You are now less one of a fewer number, so you are needed more!

Bragging Rights

And, then, of course, you have the added benefit of bragging rights. If you happen to work at an academic facility, these bragging rights become more important to maintain your status in the field. And these institutions base promotions on their credentials. And, yes, the CAQ counts as another hoop in this game!

Testing

Finally, you will need to pass a qualifying exam in whatever CAQ subspecialty that you choose. For those of you who have had enough testing over the years, this added test may be more than you can bear.

Do Non-CAQ Specialties Have Any Meaning?

With all these inherent characteristics of CAQ specialties, do fellowship specialties without any CAQ have any meaning? Of course, they do! The point of any added subspecialty training, regardless of subtype, is to get additional training in areas of interest. And if you are telling me that a fellowship in Cardiac MRI holds no value because there is no ABR CAQ, you are suffering from CAQ delusions of grandeur. Fellowship training with CAQ or not is only as useful as what you learn during your fellowship. And, there are lots of imaging procedures to learn with or without an official CAQ!

My Whirlwind Tour Of The CAQ World

So, there you have it. Now you know what you need to know about the basics of the CAQ subspecialties. Being CAQed certainly has its privileges and its downsides as well. Make sure to enter this data into your choices when/if you decide upon a fellowship!

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Which Radiologists Will Have The Hardest Financial Impact From The Pandemic?

financial

Based on the individual circumstance, the pandemic has affected radiologists very differently. Financially speaking, some radiologists have barely felt any impact whatsoever from the epidemic. Maybe they practice farther from the pandemic epicenters. Or perhaps, they work directly for hospitals that have longer-term contracts and can weather the financial storm. Others are residents or V.A. employees that receive a fixed salary from the government. But that leaves out a good-sized chunk of the total radiologist population.

So, which subgroups has the Covid pandemic affected the most financially and will most likely have a lasting impact on their financial well-being? Let’s go through two clusters that I believe will have the most economic impact from the pandemic. Logically, these would be those newly-minted radiologists from their fellowships in hard-hit areas, just recently hired (or possibly furloughed!). Also, of course, those recent retirees that unluckily retired just as the pandemic hit. How significant will these losses be? How can they recover? And what are the critical lessons that we need to learn from this episode in our history?

New Radiologists Just Finishing Fellowship

New radiologists are getting hit by a double whammy. First, they are potentially losing out on initial income due to less than expected initial revenue. For some, this may come in the form of a leave or salary cut. For others, it may be a loss of a job. In many of these cases, this initial loss of income comes when loans are typically first due, and even worse, when debt loads from medical school are at their highest. For some, inevitably, this can cause a bit more financial suffering as these radiologists need to make ends meet.

Furthermore, the first few years of retirement savings are the most critical due to the geometric rate of return of invested savings. Think about it. If pensions and retirement contributions are delayed or canceled, these are the dollars that have the most power.

Suppose you are fortunate to have a 10 percent annual interest rate and work for thirty-five years. These initial dollars can be worth as much as 28 times what you put into it when you retire at 67 years old. If you delay merely one year, the same dollar only is worth 25.5 times what you put into it. Compare that to the same savings of a 50-year-old radiologist who has to delay savings by a year. If there are 15 years left in his career at 10 percent interest, each dollar will be worth 4.2 times the initial value. If this same radiologist delays their pension by a year, that same dollar will be worth 3.8 times what they put in. Those additional dollars have much less significance.

Newly Retired Radiologists

When you first begin retirement, you often need a wad of cash to pay for daily expenses. And, many of these radiologists may have cashed out their stash from the stock market. If you were unfortunate to cash out a large amount of your savings at the time of the crash and had not slowly converted your holding to less risky assets, you may have cashed out at the time of the twenty to thirty percent loss in the stock market in March. This loss could have severely decreased your overall net worth and the ability to have a comfortable retirement. Additionally, for those retiring radiologists who were planning to go part-time, many practices were unwilling to hire back some of these radiologists as the volumes had precipitously declined. Again, this could have made for the perfect financial storm!

How To Bounce Back From A Covid Economic Disaster

Keep Those Expenses Down

For many of us, this episode may have been the first time we have had to dip into an emergency fund. It goes to show you that radiologists are not immune from financial hardships (as lucky as we have been in the past!). So, make sure not to spend your savings quickly. Avoid old spending habits, and make sure to tighten your belts. Simple acts such as going through your credit card statements and reducing unneeded expenses can help enormously. And canceling luxury and unnecessary purchases can also assist. None of us can be sure when we will return to a more “normal” baseline.

Return To Work As Soon As Possible

For those younger radiologists that have been furloughed or let go, don’t stop searching for full-time employment as soon as possible. Time is of the essence as a dollar earned today is much more powerful.

And, for those radiologists that were about to retire, you may reconsider complete retirement. Part-time work allows you to make a reasonable salary, when available, and can help defray some of the financial hardship losses.

What Are The Take-Home Lessons About Radiologist Financial Well-Being?

Like any other profession, we are not immune to the whims of the economy and “black swan” events. All of us need emergency funds, regardless of our perceived safety nets at our jobs. And, all of us should continue to save and invest throughout our careers to prevent us from the potential losses of a sudden downfall. As the old boy scout motto reminds us, be prepared!

 

 

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Didn’t Take The USMLE And Still Want To Apply To Radiology Residency!

USMLE

Question About Applying Without The USMLE

Hello,

Currently, I am starting the intern year as a categorical surgery resident. I know I would be happier as a radiologist, but now I am in a tricky situation. I am a D.O. with decent scores. Unfortunately, I did not take the USMLE (I entered medical school thinking of pediatrics, and my advisor told me to focus on just one examination). Even though I have not taken the USMLE, I have published research from undergrad in pediatrics from an excellent medical school. Moreover, I was a part of the medical honor society, a tutor during medical school, had prior work experiences, and plenty of volunteering/club involvement. I know the radiologist I worked with would be willing to write me a persuasive letter of recommendation.

As a student, I initially applied for general surgery due to a passion for anatomy, and because I enjoyed working with breast cancer patients. I thought I wanted to be a breast surgeon. However, I had the pleasure of working with a radiologist working in breast/women’s imaging. I loved it. Being able to detect subtle changes in breast tissue was fascinating. From the mammograms, stereotactic biopsies, and needle localizations, the days would seem to fly by. I couldn’t get enough of it. Never did I think I would be so interested in radiology, but without any prior exposure in the field, I would have never known. 

I guess at this point I am unsure what to do. The current hospital I am at does not offer a radiology residency but is a part of a healthcare system that is about an hour away. What is the best advice you have for someone in my position? Any help would be much appreciated.

Thank you for your time!

What To Do?

 

Answer

Dear Applicant,

As an intern in surgery, you are well within the window to change specialties from the standpoint of government medicare funding. But, if you make your decision to enter radiology too late, that may no longer be the case. Applying later will reduce the number of residencies that will give you an interview. So, there is no better time than now to apply for radiology, as that is your area of interest.

Also, you may not want to hear this. The best way to ensure that you will get a spot in radiology would be to take the USMLE Step I and II exams. Many residencies disregard the COMLEX scores. Now that the AOA has merged with the ACGME, the USMLE tests are the standard throughout the country. A good score on the USMLE Step I would go a long way to giving your application some more “street cred.” (Eventually, in 2022 the USMLE Step II will be more critical exam since Step I will be a pass/fail test only). 

If you only have the COMLEX exam, you will be limiting the number of residencies that will seriously examine your application. I would try to take these exams as soon as possible so that the residency programs will have your scores. (Not sure if you can fit it in before this application cycle ends, but if you can, that would be great!)

All the other stuff that you have done, such as research, tutoring, and volunteering, is excellent. But, everyone else applying for radiology residency has done the same. So, although you need to add it to your ERAS application, it’s not going to differentiate you.

A recommendation from a radiologist within a health care system that has a residency can still support your application. Even if there are no other residency programs within the healthcare system, it will still help a little bit (but not as much).

The bottom line is that all is not lost. It will take a bit of work to study for the USMLE Step I and start your application soon. If you can’t get those USMLE scores before the application cycle, you can try to apply regardless. However, the chances of getting into radiology residency will be a little bit less. I think it is still worth a shot because you don’t want to lose out on government funding. Alternatively, you can take off a year of residency and find a job in research. That would potentially postpone the medicare funding issue and allow more time to study for the USMLE. When there’s a will, there is a way!

Good luck,

Barry Julius, MD

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Is The Radiology Home Workstation Becoming Too Good?

home workstation

At the home of most radiologists nowadays, you will find a computer remotely hooked up to a Picture Archiving And Communication System (PACS) where they can look at films and dictate cases. As I sit typing this blog, I am staring at a home workstation across the room myself. It enables me to read studies from home with all the comforts thereof. Additionally, I find that the chair here is comfier, the mouse works a bit better, and there are fewer glitches on it than the ones at work. But this presents an issue that even I have felt a few times. Why go into the hospital when I can do some of the same things with one home’s amenities and work even more efficiently? Is there any role for reading from an on-site computer?

Well, if you do read in the reading room at your facility, gone are the days when most specialists would come down often to the department to read over a film in your reading room. Instead, you are lucky to get a few stragglers-by, usually, a resident who wants to learn a bit, or maybe a physician with a family member that needs a read on a film. Yes, the din of conversation of colleagues has continued to melt away slowly. But, with decreasing clinical interactions, even on-site, do our comfy home workstations represent the final nail in the coffin for working at the hospital? And what do we lose by being able to do our work at home more efficiently than from the workplace? Let’s summarize some of the most significant losses and problems in this new world as we work at our home workstations instead of on-site.

Future Colleagues And Friends (Outside of Radiology)

Some of the most excellent docs that I have encountered; I have only met because they stopped by the reading room to look at a film with me. And, slowly, over time, I got to know them better. Eventually, we might have lunch together on occasion or see each other at some staff meetings. It’s just not the same when you get a ring from a doctor to look at a film. And even with fewer interactions at work, these new potential connections are lost.

Meaningful Interactions And Learning Opportunities

When a fellow specialist walks into the reading room to look at a study, they will typically talk about their work. And, usually, I will learn something new about their specialty. Maybe, it’s a new technique that the surgeon uses or a new technology that the gastroenterologist operates. Regardless, fewer interactions at home without our colleagues means fewer opportunities to learn about other areas in medicine.

Teaching Opportunities

Likewise, sometimes I want to bring home an essential point to a clinician that came down to check out a study. Perhaps, it’s when to use contrast on a CT scan. Or, maybe it’s when they should order a V/Q scan. These were teachable moments to make sure that clinicians used imaging appropriately. Now, some of these focused teaching opportunities to improve care are lost.

Increasing Burn-Out (For Some)

Then, of course, with the complete loss of foot traffic at home instead of work, we lose some sense of connection to others. This disconnect can lead to a loss of meaning in our work. On-site, you are more likely to hear about what happened in the operating room or the patient on the floor. Working from home can distort your sense of reality. And, us results-oriented radiologists can lose a sense of meaning in our work, causing burnout.

So, Is The Home Workstation Too Good?

I have to admit. Sometimes, it is pleasant to be able to read studies from the comfort of home. And, there are certainly moments to take advantage of that. But, I believe that there is still a time and a place to spend some time at the hospital workstation. The home workstation will never be too good to replace the imaging center environment entirely. Although we may not realize it at any given moment as we work from the hospital, most of us still receive fringe benefits. I don’t think the home workstations will ever entirely replace on-site work!

 

 

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Forgot To Look At The Priors? Disasters Can Happen!

priors

There are a few tenets in radiology that are unbreakable. One of these doctrines is to always look for priors. So, what are some real stories about what can happen to you if you forget them? To bring home this point, I will give you four examples of what can happen if you leave out the prior exam. The results speak for themselves. And these are just the tip of the iceberg!

The Phlebolith That Just Gets In The Way

New radiologists, especially, will often have a disease called happy eye syndrome. They make a diagnosis and forget about everything else. One of these critical steps they forget is remembering to look at priors. And, one such resident happened to do just that. One night, a resident saw a calcification probably in line with the ureter. And the urinary tract collecting system was slightly prominent. And, she called it an obstructing 6 mm stone.

The next day, the overnight attending looked at the case and saw the same calcification at the same location four years ago on a previous with and without contrast CT scan. And, it was not even associated with the ureter!

So, what happened to the patient? The surgeon sent the patient for surgery. But fortunately for the patient, they never got to operating suite. A well-placed phone call from the morning attending prevented an unnecessary operation. But, that was surely a close one!

The Overnight V/Q Scan- Not Just A Harmless Test!

Very commonly, the resident at nighttime use the V/Q scan as a means to sharpen their skills. But, it is not necessarily a safe test if not used the right way. One night, a resident called multiple mismatches at both lungs with a negative chest x-ray as a study highly suspicious for pulmonary embolus. And, correctly so, of course, if they didn’t have the priors!

So, the overnight physician started the patient on a course of coumadin. Guess what? The next day before the attending came into the hospital; this patient developed a change in mental status. And, the CT scan showed a focal hemorrhage. Now, whether the cause of the bleed was this coumadin dosage is debatable. But, once again, it demonstrates the power of the prior!

The Angry Oncologist (And Patient)

Typically, oncologists order studies to decide whether or not their patients should get a change in chemotherapy. In one such case, one attending read a lung cancer oncology chest, abdomen, and pelvis. There were lesions in the bone, liver, and lung. He reported the results, never bothering to check the script and the request for comparison to priors.

It turns out this patient was on an experimental protocol that demanded precise timepoint interpretations compared to the previous study. Due to the lack of description of change on the CT scan compared to the priors, the oncologist could not determine what to do next. Since the new results did not come back until after the deadlines, the study removed the patient from the treatment protocol! Bye-bye successful therapy!

The Thyroid Nodule From Hell

Thyroid nodules seem to be a common indication for a thyroid ultrasound. And, many of us consider ultrasound to be a relatively benign informative examination. But, so not so much for this next unfortunate bloke.

One radiologist interpreted an ultrasound thyroid examination as a suspicious 1.5 cm nodule at the right lower pole of the thyroid. And, he decided to recommend a biopsy. Of course, in small letters at the bottom of the technologist’s report, the technologist said the patient has two different MR numbers, and please compare these to the priors. Unfortunately, the radiologist missed this statement.

So, the endocrinologist sent the patient for a biopsy. Also, unbeknownst to the interventional radiologist, the patient never knew that the patient had priors. Well, what happened? Of course, the radiologist completed the biopsy, and the patient developed a large hematoma in the neck with associated complications. And, only afterward, the referring physician realized that the patient did have another study. Guess what, the nodule was stable all along and didn’t need a biopsy. The patient was stuck with a needless nasty hematoma!

Priors: Don’t Forget Them!

I think you get the point. But as painful as it may be to hear the same recommendation again, it is worth repeating over and over, don’t forget the priors. These are just a few of the potential disasters that lie in wait for you if you break this tenet of radiology. And, it’s a great way to disrupt the chain of excellent patient care!

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Do IR-DR Programs Hold Grudges Against DR Applicants?

grudge

Question About IR-DR Program Grudges Against DR Applicants:

Hi, Dr. Julius!

Thank you so much for creating such an excellent resource for students who are interested in Radiology as a profession. I am interested in applying to Interventional-Diagnostic Radiology (IR-DR) as my preferred specialty this Fall. I am still confused by applying to IR-DR and Diagnostic Radiology (DR) at the same time. To give some context, I currently live in the United States, and my husband is an Orthopedics resident who will complete his training in 2023. We have a young son, and so location is very high on my considerations as it pertains to different programs. I love IR and want to pursue an integrated residency. However, since you can still get into IR-DR from DR, location is more important to me than an integrated program.

I guess my real question is that specific DR programs will hold it against you that you applied to their attached IR-DR program and will not grant you an interview. Considering that the match rate for IR-DR is only around 50-60%, I cannot risk applying only IR, but will program A’s DR program still consider me if they know that I have sent applications to residency A’s IR-DR program as well? Thank you so much for your input!

Sincerely,
Future Interventionalist

 

Answer:

Dear Future Interventionalist,

According to my experience over the past few AUR meetings, unfortunately, some residency programs hold grudges against residents who apply to both DR and IR-DR programs. However, most don’t. For those that do, from what I gather, they will often take residents that apply to IR-DR programs if they believe that they are good anyway. So, I would not let that stop you from sending applications to both sorts of residencies simultaneously. As you have stated, IR-DR is competitive, and you are better off applying to both programs. DR programs still have a pathway to get into IR-DR. The numbers game makes it not worth your while to worry about individual programs’ grudges!

Good luck!

Barry Julius, MD

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Top Eight Radiology Residency Changes Since The Pandemic

radiology residency changes

Covid-19 has changed the face of radiology residencies throughout the country in a matter of months. But, what are some of the most significant differences compared to life before all of this started? Let’s go through the top eight most significant radiology residency changes since the pandemic began.

Noon Conferences

Before

Rows and rows of residents and students would gather in the conference room to listen to the faculty member lecturing. Attendings would call on the folks to answer questions.

After

Who would have ever thought that you would receive your lectures on a computer screen in any location of your choosing? That has precisely happened over the past several months—no more in-person lectures at many institutions. And, you are much less likely to get called on in the middle of a conference!

Empty Reading Rooms

Before

Reading rooms were much quieter than they were twenty years ago since the advent of PACS, reducing the number of physicians visiting the reading rooms. But, you could still find some activity with residents and faculty present, discussing cases.

After

Now more and more faculty are not showing up at all. They are working from home. In many cases, all you have is a resident fielding occasional phone calls. But, for the most part, you can hear a pin drop!

Learning To Dictate With A Mask

Before

You would pick up a microphone and start dictating. And, that was hard enough as a first-year radiology resident.

After

Now first-year residents no longer only need to learn to dictate. They also need to learn with an encumbrance on their face, making sure a mask does not stifle their voices. They will become the most articulate class ever!

Extensive Cleaning Procedures

Before

You would enter a reading room and pick up a microphone. Only a minority of physicians would come in and wipe down the desk, microphone, and computer. And, many folks thought these doctors were crazy neat freaks!

After

Instead, you now come in with an arsenal of cleaning supplies to ensure you don’t get Covid-19. Those faculty members that don’t use all those cleaning supplies are considered nuts!

Less Residency Social Events

Before

Not that we considered radiology residency to be party central, but residents and faculty would get to know each other well on the outside of work. Or, at least you would have a few arranged meet and greet sessions.

After

Residents are lucky if they get to know the new first-year residents’ names! And, attendings are even having a harder time. It’s much more challenging to get to know your colleagues when you need to stay away.

Less Elective Cases/Decreased Volumes

Before

Patients would get mammograms, thyroid screening, DEXA scans, virtual colonoscopies, and more with impunity. Residents and attendings needed to read tons and tons of these scans all times.

After

We have seen a noticeable drop in elective volumes. Patients think twice about completing their screening or low-impact studies because of the inherent risk of personal interaction.

Less Free Food

Before

The hospital was a food fiesta of sorts. On any given day, you could find attendings purchasing pizza for residents, resident appreciation day festivities, and corporate-sponsored lunches.

After

It has become much harder to find free food in the hospital. Although occasionally available, far fewer purchasers and employees want to risk having physicians to dive into a free sandwich!

Easier Commutes

Before

Traffic may catch you on a bridge, a tunnel, or a highway for hours if you have a terrible morning while you were driving to work. You were not the only working soul!

After

Both unemployment and more remote working have taken a toll on the number of cars on the road. You can now enjoy speeding into your rotations in the morning. It is harder to blame being late on the traffic. See, there are one or two benefits to this unfortunate pandemic!

Radiology Residency Changes- A New Way Of Life

It’s remarkable to see the myriad of radiology residency changes in our daily lives. Only four or five months ago, Covid-19 was barely an afterthought. Now, it encompasses our whole way of being. And radiology residency is affected just like everything else!

 

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Passed The Radexam Precall Quiz? You May Still Not Be Ready To Take Call!

radexam precall quiz

Ask ten different program directors on how they decide if their residents are ready to take calls and place them in the same room. You will most likely get ten different answers, plus a heated debate (maybe a fistfight or two!) But, I have witnessed some residents who have passed the Radexam precall quiz perform poorly on call. Likewise, I have seen residents with borderline or failing scores on Radexam make a stellar performance when they start overnights. So, what is it that the exam is missing? I think I have it all figured out!

When we look at the skills that you need to succeed at nighttime, there are three general categories: reading, picking up findings, and professionalism. The Radexam tests the first part, knowledge, and I believe it is acceptable for this purpose. But, it leaves out the other two essential categories. Fortunately, most residents are professional, and you can observe their professionalism during their first year, so that category is not usually difficult to assess. However, the ability to pick up findings is a whole other kettle of fish. Some residents can have a vast knowledge base, yet have a tough time making the calls on a film. If you don’t test for it or observe it, you may miss these prospective call-takers. Houston, there may be a problem!

What Can You Do To Improve Your Finding Skills?

If you think you might be in this boat, what can you do to improve your finding skills? Well, several different techniques can help to improve your skills. The first and most obvious way to improve this skill is to read through lots of cases without knowing the answer beforehand. In today’s environment, in some programs, it is effortless for some residents to slide by without having to make any decisions on their own during the first year. These residents will typically either sit by the attending and watch them make all the findings. Or, they will continue to read books during the day without being an active participant in the case. If you want to learn the skill of making findings, passive learning techniques such as these don’t cut it. You need to flip through the cases on your own!

Additionally, you need to use materials that use lots of images. Now, this is a widespread first-year mistake. Many first-year residents continue to study like interns and read lots of materials without looking at the pictures. In radiology, you need to do the opposite. You need to look at lots of pictures and then read the content. To find appendicitis, you should see at least a hundred different cases before you can readily identify it. Some instances are subtle, and others not so much. Looking at all different sorts of examples of a particular disease entity will eventually get you to the point where you can easily make the findings without as much mental effort.

And finally, there is a subgroup of residents who have not read one lick during their first year. If you don’t know what the different disease entities are, how will you find them? However, this group overlaps with the lack of professionalism and lack of knowledge groups. Most residency directors can pick these folks out. And then, it’s a natural remedy. Read more!

How Should Program Directors Test For This Skill?

Direct observation is the key. Just utilizing a test like Radexam only tests the knowledge component and cannot substitute for observing a resident taking real cases.

Now, at some programs, the faculty may not have much time. But that is not an excuse. Testing residents before overnights is the moral and ethical thing to do. How can you allow a resident without the proper tools to take care of patients? It is unjustifiable!

To test residents for finding skills, I typically take a series of 10 reasonable overnight sorts of cases and watch how they perform when looking for the findings. Usually, I make sure that the residents can get about 2/3 of them right. I’m sure there are other ways to do the same thing, but I have found it reasonably simple to find a group of typical on-call cases.

Also, in the real world, you do not have the luxury of infinite time. So, we make sure to limit the amount of time per case. This simple process can quickly identify residents that are falling off the bell curve because they take to long to look at a case.

Are You Ready To Take Call After Passing The Radexam Precall Quiz?

Well, for those of you that are finishing up their first year, right about now, make sure that you continue to go through cases even after taking the Radexam Precall Quiz. If you don’t have a formal method to check whether you are ready in your residency, please make sure to ask your faculty or a senior resident to observe you. Sometimes you need a second set of eyes to ensure you are on the right path. If you want to get an idea of some of the cases for testing in our residency program, I will refer you to the previous years’ pre-call quizzes on this website for a nominal fee. Check them out! Otherwise, make sure to go through your institution’s classic cases without knowing the diagnoses beforehand. This process works to make you a better on-call radiologist!

 

 

 

 

 

 

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Now USMLE Step I Is Pass-Fail, What Do I Need To Do?

pass-fail

Question About Pass-Fail Step I USMLE:

Hello,

I’m going to be starting medical school this coming August and was interested in DR. Still, with Step 1 becoming Pass-Fail, I am not sure how to strengthen my application to Radiology Residencies. Do program directors value research/community research more than other metrics? Step 2 will likely become the new objective score by which program directors may filter applicants. I was looking for any other advice you might have for applying to a Radiology Residency once Step 1 becomes Pass/Fail. 

Thank you!

Answer:

First of all, I will direct you to my article on this topic called USMLE Step 1 New Pass/Fail Grading-Winners and Losers From A Program Director’s Perspective! – RadsResident

That should give you a bit of background on what I think will happen over the next few years. But, in your particular case, for a typical applicant from a regular U.S. Medical School, the most important criteria for acceptance to a program is and will continue to be the dean’s letter. So, anything that you can do to boost your performance in medical school will help the most.

As you have alluded to, the USMLE step II will continue to be important as long as there is a significant correlation between testing scores and the core examination. So, programs will most likely continue to use USMLE step II scores because they will most likely have some relationship with test-taking abilities. That will ensure that the residents in the program are more likely to pass the core exam. (Not that I like either the USMLE or the core exams in particular!)

Once you have taken these factors out of the equation, research becomes essential. Why? Because it shows that you are interested in radiology and took the time to complete a project to prove it. And, then all the other tangible and intangible factors play a role in our decision for acceptance (recommendations, other extracurriculars, interviews). And lastly, the personal statement is the least powerful of the admissions criteria.

The bottom line: Other than the test criteria changing from USMLE I to II, I don’t see much else changing in the selection process at the current time.

Good luck!

Barry Julius, MD.