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Most Common Stereotypical Generation Radiologist Differences

generation

 

Millennial
Generation X
Baby Boomer

 

 

 

 

 

 

Although not every radiologist fits the particular stereotype for their generation, some generational stereotypes ring true. On the whole, the baby boomers, Generation X, and Millennials perform better and worse in some parts of the radiology workforce and have their own particular needs. When you work with these individuals, it is vital to keep this in mind. Sometimes, we need to change the way we operate to accommodate these differences. So, today I would like to go through some areas where radiologist generations differ, arranged by different topics. I hope you enjoy it!

PACS And Social Media

Baby Boomers: These folks tend to be less comfortable with PACS system changes. So, beware of the PACS upgrade! It can wreak havoc on their lives. Social media can be somewhat foreign to these radiologists. Many of these radiologists do not have Facebook, Linkedin, or Instagram accounts. So, sending out messages via these media may be a waste of your time.

Generation X: For these radiologists, PACS utility issues tend to be a mixed bag. Some of the less tech-savvy radiologists fall into a similar category as a Baby Boomer. Others are more adept with PACS systems. On the other hand, social media outlets are generally much more native to the Generation X radiologist with broader and more frequent use. Although not all of these radiologists use social media, you will be more likely to find these folks more comfortable.

Millennials: On the whole, these radiologists cope well with PACS updates and changes as long as the network runs correctly. Their technology knowledge enables these individuals to learn quickly and grasp the most efficient ways to learn PACS. Social media is not just a tool for many of these individuals; it can be a way of life. Their online persona can become just as important as their offline interactions. They tend to engross themselves in the online world.

Barium Work/General X-rays

Baby Boomers: This group of individuals has, by far, the most expansive repertoire of experiences with both barium work and plain films. Since it was the mainstay of radiology initially, they often pick things up that their more junior colleagues will miss. They can work wonders with barium and grasp the nuances of a good barium examination.

Generation X: They can read plain films rather adeptly and efficiently. Although not as seasoned as a Baby Boomer, they can read an x-ray reasonably well and are comfortable with most barium work. During residency, they have had lots of experience with films and barium slinging.

Millennials: Since they spend a lot more time with CT and MRI than plain film work during the residency, overall, they are less comfortable with plain film interpretation. As residents, hardcore barium studies experience such as barium enemas can be minimal. So, the performance and interpretation of these studies can be a bit more challenging.

MRI

Baby Boomers: It is much less likely for the Baby Boomer to feel comfortable in this modality since they may have completed MRI training after their residency. Most Baby Boomers will avoid MRI if possible.

Generation X: Plus or minus. Depending on the experiences during residency, some feel very comfortable with general MRI work and others less so.

Millennials: Most Millenials are comfortable with all MRI since it has become “bread and butter” radiology, just as standard as all the other modalities out there. I would certainly put a lot of faith in their excellent reads!

Vacation Time

Baby Boomers: This generation believes in the adage “live to work.” Overall, they tend to take less vacation than given (although they get more vacation time than the rest of the generations!)

Generation X: They have a similar work ethic to the Baby Boomers than Millenials, although they can straddle both sides. Vacation time is essential, and they fully take advantage of their time off the job.

Millennials: Everyone needs to work around the Millennials’ schedule. Their motto is “work to live, not live to work.” They like flexibility in their schedule and will do whatever they can to get to the lifestyle they want. Every day a practice gives vacation time, these radiologists will take the day. They do not spare a moment that they can use to bolster their lifestyle.

Money

Baby Boomers: For the most part, these radiologists sit on a large nest egg, having worked through radiology during its most lucrative years. Debt load tends to be nonexistent. They have the most flexibility and can leave the workforce whenever they want. Many of these radiologists perform their job solely for the “love.”

Generation X: Most of these radiologists have paid off their debts and have done relatively well in their specialty. Money is still important to these folks because they still do not have enough to retire. But, they have good jobs and will do well overall since they have been working during the “good years.”

Millennials: Severe student debt weighs down these radiologists and can limit their opportunities to places and jobs that this generation does not want. It almost runs counter to their ideal lifestyle philosophy. These radiologists also started to work in the field during lean radiology years and are more likely to have had less opportunity to make money. Hence, there is some bitterness when it comes to discussing the topic of money!

Interpersonal Relationships

Baby Boomers: Overall, this group develops solid interpersonal relationships with their colleagues and staff. They never had the opportunity to rely on social media or other forms of technological communication, so they deal well with others. In addition, they have the least need for external approval.

Generation X: These radiologists probably have more in common with the Baby Boomers than the Millenials since they grew up in a world without social media. They were allowed to fail just like the Baby Boomers but were more protected than them. But, they do develop strong interpersonal relationships with their colleagues.

Millennials: Since many of these folks were not allowed to fail growing up, they need to be outwardly appreciated by their colleagues much more than the other generation. They spend a lot of time on their mobile devices, garnering relationships with others. Since online life can be just as important as their offline persona, some can seem outwardly unfriendly because of the time they spend on their devices.

Teaching Expectations:

Baby Boomers: They love a great lecturer and taking cases. However, after completing a teaching episode, the Baby Boomer will research and read the topic to reinforce learning. Overall, the Baby Boomer does not care about electronic media, but some will use it. Old-fashioned books instead of ebooks work better for the Baby Boomer.

Generation X: The typical generation Xer fits somewhere between the Baby Boomer and the Millenial. They will do their research and not expect the lecturer to tell them everything they need to know but understand the practicalities of ebooks and electronic resources.

Millennials: They traditionally have been spoon-fed information in lectures. And, they expect everything to be spelled out for them when others teach them. Overall, they expect the teacher to know everything about a topic and point them toward all the resources they need to read. Most Millennials use ebooks exclusively and will utilize electronic media to reinforce all learning.

Summary

I repeat, “These stereotypes certainly do not apply to all radiologists out there!” However, I think there is an overall tendency for individuals of each generation to fit some of the stereotypes. Knowing the strengths and weaknesses of each generation allows us to schedule accordingly, allocate appropriate resources, and understand what each generation needs. For instance, since the Millennial tends to have a higher debt load, allow for more moonlighting opportunities or extra work. Or, make sure to incorporate additional training with new electronic PACS system upgrades for the Baby Boomer. Bottom line- it pays to understand each generation!!!

 

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Ten Of The Most Frustrating Radiologist Phone Calls

phone calls

As radiologists, we speak with ornery physicians, upset patients, uninformed technologists, and headstrong nurses on the phone. Daily, the phone calls we take are not all peaches and cream. Sometimes these phone calls can get the best of us. So, I thought this would be an educational opportunity for those just beginning their residency or considering a career as a radiologist to understand what goes on in daily practice. Here is a list of some of the most distasteful and frustrating phone calls you may encounter when working as a radiologist. It’s part of our life. Expect the worst but hope for the best!!!

Missing The Diagnosis

You’ve been going through films and feel like you are accomplishing significant work today. For the 3rd time today, you hear the phone ring loudly. As you pick up this phone call after a decent day… WHAM… everything changes, your heart sinks. That patient with pancreatitis has pyelonephritis, and you can hear the physician’s upset but pleasant tone. Can things get worse?

Any Call For Barium Study After 12 AM

Your eyes are watery, and you are barely staying awake in the reading room. Suddenly, the phone rings. “We need a barium swallow to look for a stuck chicken bone in my patient’s throat.” Now I’m never going to get any shuteye. Ugh, the pain won’t stop!

Bad Timing

You have a patient with unsuspected metastases on a thoracic spine MRI, and you attempt to reach out to the physician who ordered the study. “Hi. Is this Dr.______?” Next thing you know, he starts yelling at you, “How dare you to call me while I am at my father’s funeral!!!” He bluntly hangs up the phone. So much for good physician communication!

Contrast Stupidity

You arrive at your workstation and receive a requisition for an abdomen and pelvic CT scan with contrast for a patient with symptoms of flank pain and urinary tract stones. So, you call up the physician and tell her, “I think that you made a mistake with the order. You meant without contrast, right?” The next thing you know, she is arguing with you how contrast studies are better for patients to diagnose an obstructive stone. The conversation goes on for what seems like hours. It’s like talking to a piece of cheese. Oh, My God!!!!

Fellow Physician With Positive Findings

A physician friend comes down from his department and asks you to give him a call when you get a chance to look at his chest x-ray. He has a mild cough. So you oblige and say, “OK.” Ten minutes later… You look at his film, and he has sclerotic bone lesions and pulmonary nodules everywhere. Looks like mets. Gulp. You pick up the phone, not quite sure what to say. Finally, your voice cracks, “Can you come down here. I need to speak to you in person.” Poor guy. How am I going to break the news to him?

Misplaced Anger

As part of your typical protocol, you call in the results of a normal V/Q scan. Suddenly you hear a booming voice on the other end, “HOW DARE YOU CALL ME FOR A NORMAL STUDY DURING REGULAR BUSINESS HOURS!!!!!!!!” You hear a loud click. So much for congeniality…

Demand For Incorrect Protocols

You are going through a knee MRI and notice that the tech did not include the coronal images even though they are essential to evaluate the collateral ligaments. So, you call the technologist to determine why the MRI does not include the appropriate imaging after the patient recently had a motor vehicle accident. The technologist says smugly, “Oh, we didn’t need these images because the clinician said they don’t need the coronal images.” What?

Clinicians That Expect You To Make Their Clinical Decisions

On the queue, a film pops up, and you look at the images. At the left base, overlying the cardiac silhouette, there is an airspace opacity obscuring the diaphragm. So, you decide to call the Emergency Department, and you get through to the Nurse Practitioner. You tell her, “The patient has a left lower lobe pneumonia.” Surprisingly, she asks you, “How do I treat this patient? What kind of antibiotics should I administer?” Listen, buddy- this is above my pay grade. That’s your job!!!

Request For Stats But No One Is Home

At the outpatient center, you see an abdominal and pelvic CT scan with a prescription that says STAT, needs a prompt phone call to the doctor. So, you look at the study at 4 PM and find mild diverticulitis of the sigmoid colon. So, you call the number and receive a message prompt; please dial _______ number to get through to the doctor. Next, you call the number and talk to the secretary. She casually says, “The doctor is not around and there is no one covering.” But, you respond, “But it says STAT!”. She then retorts, “But no one his here.” The phone hangs up abruptly with deafening silence…

The Need To Call The Patient Directly

The patient has abdominal free air on a random CT scan of the chest for pneumonia. So, you call the clinician for the 3rd time after leaving multiple messages with the answering service. No response. The only next available option is to contact the patient directly to come into the emergency room to get checked out. So, you find the number and speak to the husband of the patient, who is 90 years old. He says, “What are you talking about? You need to call my doctor. I don’t understand why my wife has to go to the emergency room.” You spend about 45 minutes on the phone trying to convince him to get her wife to the hospital because you can’t get through to the doctor. Finally, you get the husband to take her wife to the emergency room. Fifteen minutes later, after this long-winded conversation, you get a phone call from the patient’s doctor. What a waste of time!

Phone Calls Can Be Painful!

Although many phone calls are positive and rewarding, these are just some of the phone calls that will frustrate you as a radiologist. So be prepared to have some pretty painful phone conversations with your fellow clinicians, colleagues, and friends. It’s part of the job!!!

 

 

 

 

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USMLE Step III- An Impediment For Radiologists?

Over the past few years, we have been witnessing a new phenomenon that I don’t think is unique to our diagnostic radiology residency program. Incoming residents are either delaying or failing their USMLE Step III examinations. Some of this new reality may be related to the decreased competitiveness of radiology. However, what is interesting is that some of the residents that fail or delay the examination are not toward the bottom of their respective classes but rather are high performing residents with a good fund of background knowledge in radiology. That got me thinking. What is going on with the new USMLE Step III examination? And, should the examination be a prequalifying factor for obtaining medical licensure prior to becoming a radiologist?

According to the USMLE Step III website, “Step 3 content reflects a data-based model of generalist medical practice in the United States. The test items and cases reflect the clinical situations that a general, as-yet undifferentiated, physician might encounter within the context of a specific setting. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care.”

If you actually take apart the content of this summary statement of the Step III boards, you will see that the goal of the examination is in no way applicable to the intellectual goals/medical knowledge necessary for being a good radiologist. Based on the responses of many of my residents that have already taken the test, the questions, and content of the test have limited applicability to the practice of radiology. Very few questions are radiology related and have clinical scenarios that would ever be useful background information for a radiology resident/radiologist. So, is it really warranted to have radiology residents pass such an exam in order to practice their specialty? What is its utility?

Furthermore, the concept of having an intern that trains for one year and practices independent medicine is outdated, to say the least. Almost no hospital or clinic would ever hire a physician without some sort of complete residency training in a specialty whether it be internal medicine, psychiatry, or radiation oncology, let alone radiology. The liability of a hiring physician without this training would be enormous. I, for one, would never let any of my family members see a physician with one year of internship training who had merely passed the Step III USMLE examination.

More relevant to us, radiologists and other subspecialists never practice independent general medical care. The clinical situations that undifferentiated physicians encounter is very different from the needs of subspecialist radiologists. So, why prepare a physician for an end goal that he or she is never going to realize?

All these issues, bring me to this final conclusion. Maybe we consider creating a new examination that is actually going to be relevant to the goals of the subspecialist and not the general practitioner. Perhaps, we should create two separate exams, one with a general pathway and the other with the subspecialty pathway in mind. At least, you would create a test with increased relevancy and with a practical end goal for the individual subspecialist that would help with their future career requirements.

It is time to rethink the requirements for resident physicians obtaining medical licensure since the present concept of practicing independent care as a physician after one year is outdated and dangerous. And, subspecialists have different needs from general practitioners. With that, the Step III examination should change accordingly.

 

 

 

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Should I Sell Out To The Legal Profession?

legal

Often radiologists deliberately take advantage of the opportunity to do legal consultation work for a fee. These services include expert witness work and legal brief consultations. Their colleagues deride some of these radiologists. Other physicians call this “selling out” to the lawyers. But is it? Today I will discuss why I think that radiologists who perform legal work provide some benefit not only to their financial well-being but also contribute to their own clinical and professional skills as a radiologist.

Better Understanding Of Radiology Malpractice

Nowadays, in the United States, radiologists encounter so many pitfalls that can potentially envelop them in a lawsuit. Sometimes the only way to avoid one is to observe others’ mistakes. Participating in legal work provides this window to see other radiologists’ errors and to understand how to prevent these hazards. We are only a hair’s width away from being involved in a lawsuit for our actions and vocabulary daily. Why not work to distance yourself from being the next lawsuit victim?

Improved Reports

Contrary to popular belief, involving oneself in legal work improves the readability of most radiologists’ reports instead of detracting from them. Those who do legal work are much less likely to leave grammar errors, typos, and other blunders in their reports. They tend to take the radiology report’s structure and final appearance much more seriously. Since they understand the ramifications of an unclear dictation, they are much less likely to confound their fellow clinicians with poor dictation.

Physicians participating in legal work are also more likely to know the jargon to not place in a report. Sometimes the wrong word choice can increase the chance of a lawsuit. Why not decrease the likelihood of it happening to you?

In addition, these radiologists tend to create differentials that consider the clinical situation because they know that subtleties can vastly change the outcomes of the patient’s management based on the malpractice outcomes of other radiologists. The final impression is more likely to consider these clinical issues, providing more benefit to the ordering clinicians.

More Thorough Documentation

Some radiologists do not take the documentation of conversations with clinicians seriously. Understanding the mechanics of malpractice increases the likelihood that a radiologist will document the critical findings and discussions with other doctors and patients. This information is vital not just for the attorneys but also crucial for the timeline of the medical record to allow for better treatment and an understanding of the events during a patient’s clinical stay.

Improved Communication With Fellow Physicians

Knowing what has happened in other malpractice situations also forces us to be more careful to communicate the results of a report on the phone or “in person” with other clinicians. Those that have completed malpractice work have a much lower threshold to trigger a phone call to their colleagues so that the report and the patient do not “slip through the cracks.” This understanding is only to the final benefit of patient care.

Is Legal Work Selling Out?

Based upon these tangible benefits of malpractice work, I think I make a case that participating in legal consultation is not “selling out.” Of course, some physicians abuse the legal system to make a quick buck and never learn from the mistakes of other radiologists. However, most radiologists that work with attorneys genuinely want to help their radiology colleagues and improve their clinical and professional skills as a radiologist. Maybe we should all consider doing some malpractice work at one time or another!

 

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Radiology Residency Chain of Command

radiology residency

No, we are not the military, but there is a radiology residency chain of command! Lots of different entities in radiology residency are responsible for your day-to-day activities and training. It is more than your faculty and program directors. It is a whole hierarchy. And, it is was not until later on in my career that I understood the roles that each of these entities played in managing a residency program. But, it would have been nice to understand it all from the very beginning and know who to address for each radiology residency issue. To that end, in today’s post, I am going to define each of the different titles and offices in charge of your radiology residency training and describe the parts that they play. For fun, each role I will associate with a military position! Let’s start at the bottom and work our way up.

Radiology Resident (Private)

A radiology resident is the “lowest” but the most integral part of the chain of command. It is his/her responsibility to be trained in the art and science of diagnostic radiology during the four years of residency. To become a member of this club, he/she needs to graduate from medical school and complete one year of clinical training. After that, he/she answers to all the other “higher” positions listed next!

Radiology Chief Resident (Corporal)

Typically selected by the residents and program directors, this person is the first rung in the ladder of the radiology residency command (also previously discussed in a prior post). When there is a fundamental residency level issue or problem, he/she rises to the occasion. The chief resident is often responsible for scheduling, board reviews, interclass conflict, drinks with peers, performance issues, and noon conferences. In addition, any residency program issue that does not need to go to the attending is under the purview of the chief resident. And, the chief resident is also responsible for communicating faculty-related issues to the residents.

Radiology Residency Coordinator (2nd Lieutenant)

He or she is responsible for the day-to-day running of a residency program but is typically an administrator and not a physician. Most residency coordinators make phone calls, transcribe letters of recommendation, report issues to the faculty, send out evaluations, deal with class conflicts, ensure that the learning portfolios are complete, arrange end-of-the-year parties, and more. Some play a significant role in admissions committee screening. And, the coordinator is often the first-line resource for radiology residents when they have issues with colleagues or attendings. The radiology residency coordinator is an integral part of a radiology residency. (I think of this person like the Class Mom/Dad)

Radiology Faculty (Captain)

Full-time faculty members are responsible for the direct and indirect supervision of residents. The ACGME guidelines require all faculty members to teach. In addition, there are specific minimum numbers of faculty members that are necessary to run a residency program. Teaching involvement, however, varies widely by each faculty member. Residency programs expect all residents to follow the faculty lead when it comes to reading, procedures, and training in any of its forms.

Radiology Section Chiefs (Major)

This designation can be a bit technical. Theoretically, the radiology section chief for a radiology residency program can be different from the head of the section in a department. However, these individuals run the individual subspecialty rotations for a radiology residency. Individual faculty members answer to their respective section chiefs in one of many academic areas. The section chief may also perform many other duties such as setting up protocols for technologists, introducing new procedures, signing off on resident competencies and curriculums, ensuring that the subspecialty curriculum is appropriate, and more.

Associate Program Director (Colonel)

Although not an official designation by the ACGME, the Associate Program Director is the second in command for running the residency program. Suppose there are issues that the radiology chief resident, faculty, coordinator, or section chief cannot take care of. In that case, these problems fall into the lap of the Associate Program Director. He/she is also responsible for curriculum planning, enforcement of residency rules and regulations, maintaining education quality, dealing with residency conflicts, answering both the program director and the residents, and more. The Associate Program Director shares these responsibilities with the Program Director.

Program Director (1 Star General)

The ACGME designates this individual as director in charge of the residency program. He/she is ultimately responsible for most issues that occur during a radiology residency. In addition, the radiology Residency Program Director signs off on each resident that he/she is competent to practice diagnostic radiology after graduation. Clinical activity for this individual varies widely depending upon the program’s size, but most have some clinical duties. However, all Program Directors are responsible for monitoring the clinical teaching in the residency program and administering the radiology residency. So, this person is ultimately accountable for a radiology resident’s training.

Radiology Department Chairman (2 Star General)

The Radiology Department Chairman is the head of the entire radiology department. This person is responsible for dealing with all faculty issues and indirectly will usually help with radiology residency administration issues. When there are complaints about individual faculty members, new radiologists to hire, budgeting, and high-level resident problems, this person steps in to help manage the situation. Frequently, the program directors will consult with the chairman before making important decisions. The chairman sometimes holds the purse strings for some residency programs.

Designated Institutional Official (DIO) And The Graduate Educational Committee (GME) (4 Star General)

The DIO is the head of the hospital GME Committee. The radiology residency program director answers to the DIO for program-level issues and high-level resident issues. The types of problems that a DIO will often work with include accrediting residency programs, monitoring pass rates for programs, dealing with probation and suspension of individual residents, checking residency action plans, adding complements to residency programs, and more. In addition, he/she often gets involved in legal residency issues. And, this is just the tip of the iceberg. Typically, this is a full-time administrative position that is very busy! Individual programs bring many of these issues to the DIO’s attention, and they are subsequently voted upon by the GME Committee for approval.

American Board of Radiology (ABR) (Military Service Chiefs)

The ABR is a private organization in charge of testing for minimum competency for the individual radiology resident. All radiology residents need to pass the boards administered by the ABR to become board-certified radiologists. Although they are not directly in charge of residency issues, they play an essential role in determining the curriculum for the individual radiology residency program since they create the board exams (the core and certifying examinations more specifically).

Accreditation Council For Graduate Medical Education (ACGME) (Chairman of the Joint Chiefs of Staff)

Now we are talking high-level!!! The ACGME is a governmental-run body that is the watchdog of residency programs, a diagnostic radiology residency program. This organization accredits each radiology residency program. They have the power to put a residency on probation or suspension. As part of the ACGME, other committees, such as the Radiology Review Committee (RRC), are responsible for setting up the individual radiology residency guidelines and requirements. They are responsible for making the maximum duty hours, faculty requirements, and more. Overall, most residents do not have direct contact with this organization. However, it is crucial to follow the ACGME rules for the individual radiology resident to graduate from an accredited residency.

Now You Know The Hierarchy

That just about covers the basics of the different levels of responsible parties for a radiology residency program. Even though some institutions have additional positions that also play a role in managing a radiology residency, the ones I described are usually the most important. (Just don’t tell that to the research manager or the radiology liaison!) Of course, additional levels can get quite complicated. But at least you have the basics of who to turn to when you have a specific issue or question. So now you know your ABCs of the chain of the radiology residency command!!!

 

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Best Professional Societies For The New Radiology Resident And New Residency Graduate

professional societies

Student debts are mounting rapidly or you are just starting out in radiology residency. You have limited funds to join professional societies. Is it worth it to join multiple professional organizations? Which ones should they be?

This article will address these issues since they usually arise around this time of year. First, I will discuss why it is crucial to join a few of the professional societies. And then, I will talk about which organizations are essential to participating in from both a junior radiology resident and senior resident/fellow perspective and which ones are not so necessary. Let’s start…

Importance of Joining Radiology Professional Societies

Why even bother signing up? Many professional societies offer benefits to the individual and the specialty of radiology. For the individual, you may gain access to journal articles, CME credits, discounts on annual meetings, access to scholarships, discounts on insurance rates, and more. As for the betterment of the specialty, some societies support the ingredients needed to maintain our livelihood. For instance, some organizations support political action in Washington, D.C, to prevent reimbursement cuts, radiology research activities, the creation of appropriateness criteria, radiology residency boards, and more. It is straightforward to justify joining at least a few of the societies. So, let’s talk about the meat of this article- which ones to join?

Which Professional Societies To Join?

American College of Radiology

New residents: This one is a no-brainer. It is free to join for new residents, and you can quickly become a card-carrying resident member of the ACR. And, you get all the benefits of joining the essential radiological society while supporting the specialty of radiology. Why wouldn’t you want to join?

Senior Residents/Fellows: You have to start shelling out some cash to join the organization. Is it still worth it? Well, the first year out, it is not much to join. At a rate of 70 dollars for the first year, it pays to join. Furthermore, you support your livelihood since the ACR is the leading organization that lobbies for our specialty. As a more senior radiologist, joining rates become steeper- as high as 900 dollars per year! Even so, this is the primary organization that “has our backs” when it comes to all the political stuff. It makes sense.

American Roentgen Ray Society

New residents: This is society is another freebie during radiology residency. You get the benefit of a reputable journal (AJR) and support academic radiology. What is there not to like? Go for it!

Senior Residents/Fellows: At a rate of 350 dollars per year for the online subscription for a senior radiologist, I have mixed feelings about joining this society. Although CME credit opportunities abound when you enter this society, other institutions such as the RSNA duplicate the same education component but more extensive resources. Given plenty of dues shelled out to other institutions, I am on the fence about joining this one. I did not renew my subscription for a while. But I may decide to do so at some point!

Radiological Society Of North America

New Residents: Again, no money for online subscription means go for it! I find this society to have the best resources for education. Specifically, residents get access to Radiographics. This society is a great education tool for learning radiology. Plus, you get free access to the RSNA meeting if you choose to go. Why not join?

Senior Residents/Fellows: Though this society is relatively expensive for annual dues (currently $525/year), it is the best for CME credits and educational activities. For the senior radiologist, you have the opportunity to participate in great online lectures and cases. Plus, you get access to Radiographics and the gray journal (Radiology). Although I begrudgingly pay the dues, it is a crucial society for most seasoned radiologists to join.

Specialty Societies

New residents: I believe that as soon as you know what fellowship you want to pursue, you should immediately join that specialty society. Most of the time, the rates for resident members are significantly discounted. Plus, you are supporting the academic mission and advocacy for your prospective organization. Some of these societies have invaluable career resources. And, you typically get discounts at the annual meeting. Sign up!

Senior Residents/Fellows: Although not cheap, if you are a specialist in a particular area (I pay $510/year to join the SNMMI), you should feel some obligation to support your specialty. And, most specialty organizations give CME credits and discounts to annual meetings. I think, in the long run, it usually pays to keep up membership in your specialty society.

American Medical Association

New residents: Think twice about continuing membership in this society. Many of the positions espoused by the organization are counter to the missions of the radiology societies politically and educationally. Plus, you need to spend money on membership (1st year- 45 dollars, 2nd year- 80 dollars, 3rd year 120 dollars, and 4th year- 160 dollars). It’s probably not worth your while!

Senior Residents/Fellows: I find it hard to justify membership in this society. In addition to lobbying for primary care specialties over radiology, there is little benefit to joining. The articles from the prominent journal JAMA are usually not relevant to the daily practice of radiology, and you can always read the abstracts online if need be. I let my AMA membership lapse many years ago!!!

Final Thoughts

Maintaining membership in societies as a resident in most radiology and radiology specialty societies is a no-brainer because it is free or extremely cheap. In addition, you get the benefits of joining the organizations. However, before becoming an attending, you need to think about which ones to participate in since the dues can be significant, and the benefits may or may not be worth the additional funds. Now that you have to start paying down your debts, every dollar counts. But for the most part, I think most of you starting in the real radiology world should at least join the ACR, RSNA, and your specialty society. It just makes sense…

 

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The American Board of Radiology- Shame On You

Has the American Board of Radiology (ABR) finally thrown up its hands and said it can no longer do its job? That was the take home message from my recent excursion to the AUR meeting. The explicit role of the American Board of Radiology is to standardize the quality of trained radiologists throughout the country. In fact, if you read the mission statement of the ABR website you will read verbatim- “Our mission- to certify that our diplomates demonstrate the requisite knowledge, skill, and understanding of their disciplines to the benefit of patients.” What are the most crucial skills in order to become a radiologist? Well, two of the most important pillars for creation of a competent radiologist is medical knowledge and communication. For the first time at this meeting, the ABR explicitly stated that they will abandon the role of testing radiology resident communication skills and will leave this responsibility for maintaining minimum standards to the individual programs while continuing to standardize testing of medical knowledge. What???????

If you leave the responsibility of testing and maintaining communication skills to individual programs, you are certainly not ensuring the baseline quality of our future radiologists. There are no accrediting bodies out there that can ensure the outcome of training as well as a governing/testing body such as the ABR. Without the lead of an accrediting board such as the ABR, I can see wide variability among different programs in the ability of residents to dictate and communicate results to their fellow clinicians. Some residencies will shine and produce a resident product that will competently communicate results to clinicians and others will no longer create residents with the minimum level of communications skills since there is no impetus to do so. We no longer have an oral board exam that can assess some basic communication competencies. How can the ABR accrediting body support such a position?

Government funding for medical education is at an all time low and hampers the ability of regulating bodies to do their job. Now we are leaving the responsibility of the ACGME/RRC with less teeth and funding to regulate these competencies? On the other hand, the ABR is funded by private radiology resident and radiologist dollars. Each of us spends thousands of dollars on getting and maintaining board accreditation during our lifetimes. And with all this money being spent, the ABR is saying that they cannot ensure a minimum communication competency. This is absurd.

Other licensing boards are actually moving in the opposite direction because they know it is the right thing to do for patient care. For instance, the USMLE has added on a clinical skills section to their test because creating doctors that can’t assess and communicate results to patients makes no sense. Why should testing by the ABR in the field of radiology be any different?

Please ABR… Step back and think about your position on testing communication skills. If you want to stay relevant in today’s day and age, there are other accrediting bodies out their that may take on the role of maintaining standards if you can’t do so yourself. Rethink your position statement and honestly reassess if it is in the best interest of the radiology community to forgo testing of minimum competency in communication skills. I don’t think so.

 

 

 

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Top 10 Common And Silly Mistakes Of Neophyte Radiology Residents

radiology residents

Each year, new radiologist residents repeat the same mistakes as their previous counterparts. These mistakes often make radiology residents feel ridiculous and appear ignorant to the emergency department physicians and hospital staff. I thought it was high time to get these common mistakes out in the open to avoid them, so you don’t have to feel ridiculous. Here we go!!!

Uterus Vs. Prostate Gland

No one ever seems to tell the neophyte radiology residents that, on occasion, enlarged prostate glands can look like uteri and vice versa. Invariably, we get a call from the downstairs physician- “How can this patient have a uterus? He is a male!!!” It happens every year. How can you prevent this from happening to you? Just look at the sex in the patient description region, silly!

Hydronephrosis Vs. Obstruction

Toward the beginning of every year, there is usually at least one resident who does not understand that hydronephrosis does not equate to urinary tract obstruction. You can get hydronephrosis (dilatation of the renal collecting system) from other causes such as reflux or congenital enlargement. So please, do not tell the physician that a patient with a dilated renal collecting system is obstructed if you see it on ultrasound. You need to do another test (renal scan or Whitaker test) to determine if hydronephrosis is related to actual mechanical urinary tract obstruction!!!

Calling A Kidney A Testicle

Often, the resident briefly looks at an ultrasound, and the images may be very nondescript- easily mistaking a kidney for a testicle. You may have no idea what the technologist is looking at unless you make a concerted effort to read the ultrasound technologist captions/notes. I can’t tell you how many times a resident breaks this cardinal rule, especially as a first-year resident. Don’t leave the clinician up in the air wondering what kind of radiologist you are. Always read the fine print!

Overcalling Plain Film Artifacts As Radiology Residents

I can’t tell you how many times I’ve seen first-year residents intricately describe plain film findings that seem to appear on film after film. Mainly, I remember one cartridge with the same ring-like finding producing film findings time after time. Some residents thought the patient ate something strange, and others thought there was a foreign body. If you see the same markings on many films in a row, think artifact!

Not Doing A Rectal Exam Before A Barium Enema

Not performing a rectal exam is a cardinal embarrassing and uncomfortable mistake that also seems to recur every few years. Invariably, one resident forgets to do a rectal exam before inserting a rectal tube and pushes barium into the patient without checking. If you want to get yourself into trouble and perform a “vaginogram” instead of a barium enema, this is the way. Be careful!!!

Radiology Residents Calling Aortic Rupture Vs. Aneurysm Vs. Dissection

For some reason, this is a simple but important distinction that frequently seems to confuse junior/neophyte radiology residents with potentially dire consequences. Remember… Aortic rupture is a surgical emergency characterized by a breakdown of the entire wall of the aorta with free-flowing blood. An aortic aneurysm is an enlarged aorta (sometimes with increased risk of rupture) with intact walls. And, aortic dissection is a tear in the intima of the aorta with a true and false lumen. This diagnosis can sometimes be a surgical emergency, depending upon its location. Get your facts straight!!!

Calvarial Suture Vs. Fracture Confusion

The first time you are a radiology resident on call, there is a 50-50 chance you will get a pediatric head CT scan. And, you will see linear defects all over the place. I can’t tell you how many times I have seen residents overcall fractures on these studies. A. Make sure to look for symmetry of the defects… B. Look for adjacent hemorrhage C. Refer to A! If there is symmetry at the calvarial defect, it is doubtful to be a fracture. Be careful and don’t overcall!

Transverse Sinus Bleeds

Many times, neophyte residents report a dense curvilinear region to another clinician deep to the posterior calvarium and call it a subdural hemorrhage. Well, sometimes, the transverse sinus is the culprit. Look for the other sinuses and see if they merge into this region. Don’t keep the patient overnight for normal anatomy!!!

Appendix Vs. Terminal Ileum Confusion For New Radiology Residents

This is a big one. So many new radiology residents have a hard time differentiating between these two normal anatomical structures. Unfortunately, not making this distinction can sometimes be dire! An appendix is a blind-ending tube extending from the cecum. The terminal ileum is the end of the small bowel, and you can continue to follow it down to the remainder of the small bowel proximally. Don’t confuse appendicitis for terminal ileitis!!!

Calling Flow Artifact Vs. SVC Thrombus

Depending on the timing of the contrast bolus, this timing issue can lead you into trouble! Usually, where the azygous vein meets the SVC, you will get an intraluminal filling defect due to the contrast within the SVC and the non opacified blood entering the SVC from the azygous vein. A few times a year, I see residents call this defect a thrombus. This “pseudo-finding” has significant treatment implications. Don’t let that be you!!!

Establishing Credibility As Radiology Residents

These ten mistakes may seem silly or something that you might never do as a budding neophyte radiologist, but they happen every year. Avoid these ten mistakes, and you will certainly enhance your credibility. If you do not heed these ten pearls, you are doomed to repeat these cardinal mistakes lest your referring physicians will never take you seriously!

 

 

 

 

 

 

 

 

 

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The 2017 Annual AUR Meeting- A Radiology Residency Status Report

Each year in the heart of spring in the United States, academic/teaching radiologists get together at a different part of the country to discuss the newest teaching methods, radiology residency issues, and hot academic topics at a meeting called the annual Association of University Radiologists (AUR) meeting. For new applicants and radiology residents, this meeting is extremely important as it outlines significant changes to the training of radiologists throughout the country. This year is the first annual update from Hollywood, Florida. I am going to go over what I think are the most relevant and important topics at this conference for radiology trainees.

Increasing Competitiveness of Radiology Residency

Traditionally, it is somewhat difficult to measure competitiveness of radiology residency compared to other specialties. One of the more accurate methods is the United States senior U.S. fill rate. Since 2014, there has been a gradual uptick in the senior U.S. fill rate to 72% (last year 68%). In addition, the applicant pool is up 31 percent over the past 4 years. So, it appears that all this talk about artificial intelligence has not yet dampened the enthusiasm of radiology candidates!

There are always two sides to every story, however. Since U.S applicants usually get first priority, it is a bit more difficult for international medical graduates (IMGs) to get radiology residency slots. In fact, on a survey at the AUR meeting, it stated that only 64 percent of programs are willing to take international medical graduates. That number tends to go down as radiology becomes more competitive. Furthermore, programs are no longer able to accept foreign non-ACGME accredited preliminary year internships to satisfy the requirements of the clinical year.

Improving Radiology Job Market

According to the recent AUR survey, practices are increasing both new and current radiology job hires. In fact, projections show an increasing number of available jobs numbering about 2000 today (vs. 1300-1500 jobs a few years ago). The most popular specialties are body imaging, interventional radiology, and neuroradiology.  However, practices need breast imagers, interventional radiologists, and neuroradiologists the most. And, the majority of jobs are in private practice. That being said, large corporate practices do continue to increase hiring radiologists the most.

IR/DR and ESIR

Now that IR/DR is its own distinct specialty, it commanded a fairly competitive match this year. For this subspecialty, the fill rate with U.S. seniors was 85% versus 72% for diagnostic radiology. So by all accounts, the match was fairly successful. In addition, many new residency programs are applying to start up both IR/DR and ESIR programs. Both of these programs allow a resident to complete his/her entire training in 6 years. Unlike radiology residencies willing to add on these programs, residencies that do not start up IR/DR and ESIR programs will force their residents to have to complete a total of 7 years of residency/fellowship for interventional radiology trained subspecialists. Accordingly, those residencies not willing to add either ESIR or IR/DR programs are likely going to have difficulty recruiting new residents.

Rad Exam

The current in-service examinations do not correlate well with resident performance. In fact, many residencies (including my own) cannot utilize the test as a determiner of residency performance given the wide variability. In addition, there is no distinction in the testing questions between different residency levels. To remedy this issue, a new crowd sourced examination call Rad Exam is being created with institutional benchmarks and a large database. Time will tell if it becomes a useful examination to replace our current in-service examination, but it sounds very promising!

Simulation

Although not a discussed in conference at the AUR meeting, a vendor called Simulation was present and had an interesting solution for programs that want a structured precall examination. This company created an excellent standardized test that assesses finding and interpretive skills using a simulated PACS system to help define if a resident is ready to partake in independent call. Additionally, the test is benchmarked to other programs. It seems like it may be significant improvement over the current precall testing options.

ABR Core Examination Frustrations

Interestingly, according to faculty surveys, most faculty members reflect fondly upon the old oral board examination and give low marks to the new core examination as a means of  testing residents to meet basic radiology requirements at the end of their 3rd year. However, even more disappointing to me, the American Board of Radiology (ABR) now takes a new formalized position that they have no role in testing communication skills. In fact, they explicitly stated that their only role is the testing of medical knowledge. According to them, communication skills should be taught at the local residency level.

Call me crazy, but radiology is a specialty of communication, both written and oral, and not just a specialty of medical knowledge. If that is the case, does it make sense that the ABR as an accrediting body is not willing to standardize testing for communication skills as well as medical knowledge to establish a baseline level of competency? I think not. Academic radiologists need to push the board to change their stance regarding communication competency standardization with oral/written board testing!!!

Increasing Required Administration Time For Program Directors

And finally, on July 1, 2018, the ACGME will likely approve an increase in the minimum administration time requirements for program and associate program directors. Presently, program directors at small programs in the United States can have a few as 0.2 FTE time dedicated to radiology residency administration. That number is ridiculously small compared to other medical subspecialties. Now, that number is going to increase based on a sliding scale corresponding to size of programs in July, 2018 assuming approval by the ACGME. How is that going to affect incoming radiology residents? I believe it will significantly increase the productivity and efficiency of residency programs on issues as wide ranging as educational conferences, evaluations/assessments, milestones, and more… It has been long since overdue.

Summary

As I see it, these are some of the most pressing issues tackled at the AUR conference. There are certainly other issues faced by academic radiology programs. Some of them mentioned at the conference and others largely ignored. There is a bit of good and bad news from this conference for everyone involved in radiology residencies throughout the country. Until next year at the AUR meeting in Nashville, Tennessee!!!

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Curriculum/Teaching Issues In The United States And Abroad

curriculum

Question About Curriculum And Teaching In United States And Abroad:

Hello Barry,

Thank you for your outstanding posts and the constant stream of current topics promoting the dissemination of Radiology as both a profession and a collective guild. I’ve been hanging on every word you’ve written, and it’s almost as if you anticipate my questions in advance. So, I am very much encouraged by the relevancy of your blogs and posts.

I am a Canadian who is a first-year diagnostic radiology resident in Targu Mures, Romania. Here, we follow a five-year path outlined by the EU and the European Society of Radiology (ESR). The problem is that the actual ” teaching ” element is virtually non-existent, and the program expects us to follow or shadow senior residents all day and read on our own. I am lost and overwhelmed by all the modalities I see here daily. For example, a typical day involves spending a few hours in an ultrasonography clinic, seeing conventional or plain film radiography cases, and a CT or MRI following a patient scan.

Most often, the radiologists on staff consult with other physicians, and it’s not like they have the time to point out things. I’ve decided to follow a structured plan and would appreciate your curriculum. What should I cover in my first two years? I know I’m asking a lot of you. Perhaps you can abbreviate your own institution’s plan for me? The first thing I’ve begun to do is revisit skeletal anatomy, including the head and neck. I don’t have a lot of textbooks here (in English, that is), but I have a ton of PDF books on my PC. This lack of physical textbooks is another problem because I miss the tactile experience of actual texts, and looking at a laptop all day is tiring. I will digress and hope to hear from you. Take your time 🙂

Sincerely,

A Tired Romanian Resident

 

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Answer:

 

Thanks for the great compliments. It is much appreciated and makes writing these posts all worth it!

Teaching Differences

Interestingly, you mention that teaching is “non-existent” in Romania. It’s almost the opposite problem in the United States, where everything seems regulated by the government. We need to have x number of noon conferences, etc. I almost wish we had a model for teaching somewhere between the Romanian and the United States models. Residents seem to get bogged down by the regulations and spend less time learning by reading films. (It’s an essential ingredient for radiology!!!!) So, in a sense, you can consider yourself lucky, but you are also missing out on some types of the more didactic teachings.

Curriculum

Regarding the curriculum, the plain vanilla answer is that residents study all the material on the ABR website under the core study guide. It would help if you looked at that to understand everything you theoretically need to know. However, I find it a bit overwhelming, and you need to focus on studying for your time as a resident. So, in the real world, I recommend reading some of the basic overall books in each modality when you begin a rotation each month, such as Mettler for nuclear medicine and the requisite series for some other subjects. You can check out some of the curriculum and books on the web in U.S. Residency programs to get an idea of what you need to know and the books they use. You can also look at some of the books my residents like in the book links section of radsresident.

Most importantly, emphasize the pictures and captions and then secondarily look at the text to understand the images and captions. And keep in mind the ABR blueprints and core material when you are studying. Subsequently, go through the case review series to learn how to go through cases once you have the fundamental knowledge of each primary modality. This process will reinforce all that you studied.

You also make an essential point about missing the tactile experience of textbooks and looking at laptops. It happens to be the subject matter of my next article!!! PDF articles are great because you can download them easily. On the other hand, retention rates for PDFs are probably not as high as reading directly from a printed textbook.

I hope this helps a bit,

Barry Julius