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Half The Battle Of Residency Is Just Showing Up!

showing up

During residency, life will present you with many options. Sometimes you can decide to study for the boards instead of actively seeking to learn new procedures or experiences. Or, there will be times when you can get out of work early in the afternoon because you went to a half-day conference, and no one is taking attendance anyway. But, radiology residency is only four years. And, the time you have to learn new procedures with experienced professionals and make the mistakes you need to make before you go out into the real world is limited. You may not realize now how critical it is to spend extra time learning what you can and taking advantage of each moment you have as a resident to know your future trade. Hopefully, you will have decades to practice and form the basis of this career in these four years. And half the battle of residency is just showing up. Here is why.

Technical Procedure Practice

Every procedure you complete later adds to your work’s cognitive and muscle memory. And, each time you do a technique again, you are adding a body of knowledge that you will eventually refer to you. It can be something simple as the best way to position a patient. Or, it can be a more complex set of wire movements. We become a bit better each time we complete one of these procedures.

Making Mistakes Now Instead Of Blindly Later

Because we are human, we will make mistakes. And the more mistakes you can make in a protected environment, the less likely you will make those same mistakes later in your career. If you miss a pulmonary nodule as a resident, it’s not a big deal. If you miss that same pulmonary nodule as an attending, it could be the beginning of a horrible lung cancer and a potential lawsuit. The more you miss now that your faculty picks up, the more you are likely to concentrate on those same areas later on so that you will never forget them again.

Showing Up To Expose Yourself To More Incidental Findings

In practice, some of the most complex parts of radiology are not necessarily the specific disease entities. Instead, it is those pesky findings that we make that we can’t but see. Some of them, like pulmonary nodules, have defined Fleishner criteria for following them. However, most don’t have particular rules. And, sometimes, you have to rely on your experience to figure out what to do next. That is something that you can only receive by showing up and reading!

New Disease Entities/Presentations

The more times you see cases, the more likely you will see new presentations of diseases that you know and other findings of pathology that you don’t. It’s like a lottery. Eventually, after a certain number of times, your number will come up due to the odds alone. Why not increase those odds by showing up to your training during residency?

Subconscious Identification Of Normal Variants

Finally, sometimes it’s not the material that we know. Instead, it might be the little findings that we don’t pick up. Subtle curves and lines we all pick up each time we look at an image. Sometimes, we are unsure which ones we can disregard and which are critical. It is only through putting through the motions of reading lots of cases that we can get to the point of confidence. All it takes is to show up!

Every Moment Of Showing Up To Residency Is Important!

Those moments you take advantage of instead of sitting back contribute to your overall body of knowledge even though you may not think much about it at the time. So, take the bull by the horns and practice technique, make mistakes now, and expose yourself to incidental findings, new disease entities, and normal variants to become the seasoned radiologist you need to be. Showing up is half the battle!

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Knowing Normal Variants: Experience Vs. Reading Books in Radiology (Doximity Article)

normal variants

A while back, I was looking at a stream of comments on one of the social media outlets. And, as the conversation flowed between residents and attendings, I noticed one significant distinction. The attendings tended to emphasize seeing thousands of cases to understand normal variants. While at the same time, the residents talked much more about books and case review series.

Within my residency program, I also notice a similar discrepancy between the resident and faculty opinions on learning normal variants. Therefore, since both parties vary widely on this topic, this would be the perfect forum to discuss the conflict. Here we go!

How Can You Best Learn Normal In Radiology?

To understand all of the normal variants in the world, you would have to practice radiology for hundreds of years. And as much as I love “thorough” books like Keats (linked to my Amazon affiliate!), they do not cover even half of the normal findings on plain film that you can easily confuse with pathology. Also, Keats does not include CT, ultrasound, MRI, mammography, or nuclear medicine. Since you cannot find all the variants in the literature, reading lots of books alone, in my opinion, does not enable you to learn enough to become proficient.

Additionally, the information inside rarely sticks if you are reading a book without context. If I were to go through the entire Keats book without any real-life images, I probably would not remember all that much.

This point brings me back to the essence of this article. How do you best learn normals? To maximize stickiness, I believe looking at lots of real-time cases within books, like Keats at your side, and having an attending sit next to you allows you to remember and understand normal variants the best. Context is key.

Reading Lots Of Films: Painful But Necessary?

In addition, it is not just about knowing the normals. You also need to read scores of films rapidly to identify the normal variants appropriately. There is no room to perseverate forever on every case you read. Rapid assessment of normals has become critical to thriving in a bustling private practice.

You cannot practice radiology without reading tons of cases with normal variants unless you find yourself shielded from many films within a large academic center or decide on an alternative career path. So, we recognize that you need to start reading early to produce insightful reports that differentiate normal as an attending. And, what better place than residency to learn these skills?

To that end, you may not believe it, but most program directors do not derive pleasure in causing undue pain to the residents by saying you need to spend “x” hours on a rotation. Instead, we seek to make sure that in addition to reading books, you also read enough studies to identify normal versus abnormal sufficiently. We want nothing more than to create an upstanding/quality radiologist.

What Is The Correct Balance To Develop A Feel For Normal Variants?

The perfect balance is difficult to figure out; we need to tweak it for the individual trainee and program. But, I would recommend spending more time at work with your faculty instead of dedicating too much time to study books.

Moreover, the government pays for you to perform clinical services. It’s hard to justify reading books when Medicare pays you to work. And just as importantly, nighttime after work tends to be the best time to reinforce your day’s learning.

The Bottom Line

Remember, you can always look at films by yourself later in your career or while on call. But, you will not always have the advantage of a readout with an experienced radiologist. So, I have to side with the faculty in this situation. Granted, I am biased, but they make the best point!

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Check out the original article at the following Doximity link!!!

https://opmed.doximity.com/articles/knowing-normal-experience-vs-reading-books-in-radiology

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Ten Surefire Ways To Destroy Your Radiology Experience (And Your Colleagues’ Too!!!)

radiology experience

I have seen it all. Some radiology residents make sure to glean every last drop of radiology experience from their residency so that by the time they graduate, they are ready to hit the ground running. But then other radiology residency graduates never quite live up to their full potential during their residency training. Many of these folks are great people, but when they are about to leave, I am not quite sure if they will handle the pressures of radiology practice.

In the end, I have learned some residents are late bloomers and do pull themselves up by the bootstraps once they leave residency, but a large percentage unfortunately constantly shift from job to job. Many of those folks are the same ones who seemed to do whatever they could to destroy their own residency experience during their four years of residency. And yes, we hear about them again when the paperwork comes back to us each time they change jobs when out in practice. Today I figured I would talk about those characteristics that are a surefire way to ruin your residency radiology experience. Don’t make those same awful mistakes!

Sweat The Small Stuff

In the heat of battle, it is effortless to forget the end goal of radiology residency, to be well trained and ready for practice when you leave. Remember… residency is only a 4-year experience. However, some residents get caught up in the moment and forget about the end game. They concern themselves with relatively minor things such as rising prices in the cafeteria, having to do a few extra shifts, or hearing some disheartening comments from one of their annoying colleagues. Sure, there is a place and time to worry about those things. But, it should not become an all-encompassing mission. Some never get over these issues and forget to learn what they need to know when they leave residency. In the process, they also upset their colleagues, distracting everyone from their training. Get over it!!!

Argue With Your Colleagues

Some residency classes always get along. Others have permanent hatred toward one another. The inability to get along spills over to other areas in a radiology residency. Studying suffers because some folks are left behind, and no one seems to care. Tempers flare and prevent classmates from covering each other when they need it. Everyone becomes exhausted and upset. Next thing you know, residency is over, and everyone is worse for the wear. Do whatever it takes to get along! It is not worth four years of frustration!

Sabotage Your Team

Every once in a while, one resident does not play fairly in the sandbox. Perhaps, he/she refuses to help out with a call. Or maybe, this person does not show up to work and constantly needs to have additional coverage. Not playing nicely with others affects the entire team. If you want to ruin the experience for everyone, it is elementary. But in the end, it will haunt you when you need your residency team the most!

Don’t Read

Radiology residency is a marathon, not a sprint. That means you constantly need to keep up with reading books and articles. I can guarantee that you will fall behind your classmates if you do not adequately read enough starting year one. You will not comprehend or perform well at conferences. Likewise, your call and board experiences will suffer. And, your colleagues will not want to have you’ve as a study partner since you are so far behind. You came to radiology residency to become a radiologist. Part of learning radiology is reading a lot. Why would you want to sabotage your training?

Always Compare Yourself To Others

Everybody learns and reads at different rates; and, some residents click with the material earlier than others. That is OK. As long as you are doing your due diligence during radiology residency, you will eventually get to the promised land of radiology competence and graduation. Don’t worry if some of your colleagues always seem to get things right and you don’t. The quickest path to misery is worrying about how everyone else is doing. Undue competition ruins the experience for everyone. Care first and foremost about your progress!

Don’t Show Up To Readouts

There are two main pillars to becoming a great radiologist, knowing the material and experience. If you were going through the hassle of completing a residency, why would you shortchange yourself and not try to get as much experience as possible? You will never understand the context of reading radiology without having the readout experience. Not being at the readout also affects your mentors’ day. Sit down with your residency mentor, and don’t miss the readout. You are only hurting your career and your relationship with your superiors. You never know when you will need their recommendations!

Do Not Improve Upon Your Weaknesses

You have been getting inadequate evaluations in the area of mammography. So, what do you do about it? Nothing. The complaints continue to come streaming in from attendings. But, you persist in not reading the material or studying your misses. Behaviors become habitual and will likely continue even after you graduate if you do not learn from your mistakes. These folks are the same folks that can never keep a job and never improve their lot. Ignoring practice-based improvement hurts you, your patients, and your colleagues. Residency is all about self-improvement to become the best you can so that you can help your patients. Why would you not pursue the same avenues during training?

Procedures Are Not For Me!

Some residents hate procedures and will do whatever they can to avoid them. I understand these folks may not become interventional radiologists. But, they still need to know the basics of specific procedures such as needle localization, arthrograms, and more. Sure, they can get away with this during residency. But, when they try to land their first job, they may have frustrations as they find the only jobs available require “light interventional” work. Not learning procedures may affect your future partners and colleagues. By not trying to feel comfortable with procedures during residency, you are only hurting yourself!

I Am Always Right

Some residents do not accept criticism. Residency is the time to learn and change harmful behaviors before they become ingrained in practice. We are in the game of treating people, not always thinking we are correct. Why would you not want to correct what you are doing wrong? It makes no sense. You are only hurting your patients and colleagues. There is no room for not accepting criticism both during and after residency!

Don’t Take On Extra Responsibilities

Each year of radiology residency, you accrue new responsibilities. Shirking your responsibilities is a surefire way to become a needy radiologist when you graduate. When the technologist comes along to ask a question, please don’t send them to someone else to answer it. Take charge of your situation and section. Those folks that never take on those additional responsibilities never learn to become an independent radiologist!!! Go forth and makes your path.

Avoid Destroying Your Residency Radiology Experience

It is far easier than one might think to destroy your own residency radiology experience. Sometimes you have to put a bit more effort in to get more out of residency. Please, please, don’t succumb to the pitfalls and traps that can prevent you from growing and improving as a person and a radiologist. Get over your issues… It is not worth it!

 

Article Featured on Auntminnie.com!!! Click here for the Auntminnie version.

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Ten Thousand Page Views- The Radsresident Experience

The Radsresident Idea

Sometimes the best ideas come about in the most mundane ways. I remember an uneventful Saturday in the middle of September when I sat down and began to surf the internet. I started to read about financial topics and happened upon a website called the Financial Samurai, a website dedicated to passive income. Most importantly, at the top of the page, there was an article called How To Start Your Own Blog. And so, it got me thinking… I haven’t really seen much organized accurate information on the web dedicated to the day to day issues of the radiology resident. Most sites were dedicated to medical students and board certified radiologists interested in radiology topics, but the radiology resident caught in the middle seemed to be skipped over. That being said, there were a few scattered helpful radiology residency related articles and forums on websites such as Aunt Minnie and Medscape, but it was a really a sparsely covered subject. And much of the information was not always reliable and accurate, not really personalized to the individual radiology resident, and was very technical and dry.

In addition, I always wanted to create a website. And, with all the valuable information I have learned as associate residency director over the past 7 years or so, I thought I could really contribute to the body of knowledge of the unappreciated radiology resident. I would target the day-to-day information that radiology residents, students interested in radiology, and others involved in the radiology residency process need and want to know. So these were the humble origins of this blog/website.

From the beginning of the idea for the radsresident website, I thought it would take a very long time to get viewers to the website and was expecting a long slog. To my surprise, in a little over a month and a half, we have already reached 10000 page views! So, why not write an article about what I have learned about my initial experiences, what I think it means for my loyal viewers, and what are some of the exciting changes to happen in the upcoming months?

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