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Great Expectations For The Radiology Resident

great expectations

The wait has finally arrived. After years of biding your time in medical school and residency, you are finally en route to what you want to do: begin training as a radiologist. And radiology residency begins. But, is it all that you had expected after all these years? Are you getting unadulterated teaching from your faculty as you had hoped? Is the learning at noon conferences with enthusiastic and engaging staff? Do the fellow residents live up to the great expectations that you had in the first place?

Well, there is a good chance that any residency program that you choose will not entirely live up to your great expectations. So, coming from an associate program director, what are reasonable expectations for your residency program when you start? And what are some unreasonable expectations for your newfound position? Let’s discuss these expectations by expounding on what is reasonable and limited. Then we will summarize the best way to treat these expectations overall.

Reasonable Anticipation

Reading Alongside Attendings

Any program worth its salt needs to have some time dedicated to having residents listening and reading along with attendings. At the beginning of the residency, the only way to know radiology is to listen to how your mentors interpret films and dictate. And this means some dedicated time to watch, listen, and learn the ropes in real-time with a radiology faculty member. A residency cannot survive for long without this factor.

Ability To Ask Questions

If your faculty shuts you down or insults you whenever you ask a question, you cannot thrive in residency. We learn by asking questions. And in the beginning, there is no such thing as a stupid question. Heck, you don’t even know what to ask! But, if your faculty scolds you for asking questions from your mentors, this would be an example of a malicious program to residents and learning!

Monitoring Your Dictations

Any residency should ensure that its residents are dictating and interpreting films appropriately. It is the currency of radiology. The only way to do that is to assess the outcome of the radiology process. And that is the final report or dictation. All residencies should have a system for attendings to review resident dictations. This process is an essential factor for learning.

Feeling Safe

If you feel like faculty members threaten you or fear for your sanity (or life!), you have a real problem. No person can go through such a stressful learning situation in addition to the stresses of radiology residency (and yes, radiology training is considered stressful!). Nor should any resident have to encounter a problem such as this.

Unreasonable Expectations

Unadulterated Attention From Attendings At All Times

Whether you are in a research institution, University program, University-affiliated program, or community/private practice residency, you will not be the priority of most faculty. Most have research to publish, work to complete, and families to come home to. So, if you are too idealistic that you will receive the attention of all the faculty all the time, you will never feel satisfied.

Expectations That Everything Will Be Taught

Yes. For some concepts, it does help to have a teacher. But, no matter what anyone says, most radiology is self-taught. We need to see 100 cases of appendicitis, thousands of routine chest x-rays, and perform hundreds of paracenteses before we get it all right. No one but yourself can do that for you. And, that does not include all the concepts you need to reinforce and remember by reading in every area that radiology covers.

All Teachers And Colleagues WIll Be Your Friend

Just because we are all radiologists does not mean everyone will be your buddy. Similar to the “real” world, we all have different personalities and desires. And, not all people mesh well together, no matter how much we want that to happen. On the other hand, we all can learn from one another. If you apply every person in your program to this concept, regardless of how they feel about you, you will begin to appreciate them for who they are.

Great Expectations

We all come into new situations with great expectations. But, check for yourself. Are these expectations realistic or not? Any program should fulfill the basic requirements, such as working directly with attendings in a safe environment. But, you can’t expect any program to pull all the challenging weights for you. There is just some work you need to do for yourself. It’s the only way to become an excellent radiologist!

 

 

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Read Like A Speed Demon: Goals To Read Cases Faster!

read cases faster

You are just beginning your residency, and your faculty expects you to dictate all the cases on the CT list, more than twenty. But, you are as slow as molasses, having just recently picked up a dictaphone. Unfortunately, this phenomenon is not uncommon. Faculty often forget what it is like to have recently started. Having the tools to read cases faster at the beginning is just not possible.

However, take heart. You have to begin somewhere. Most of us are not speed demons from day one. So, instead of worrying about this particular situation, it is much more critical to know how to set goals so that you can continually improve your speed. Each successive time you dictate, you need to feel more comfortable reading each case. And, eventually, you can run more adeptly through increasing numbers of cases in a shorter time.

In the past, I have written an article to help you out with increasing your knowledge to pick up speed called: How To Pick Up Speed In Radiology. Check it out to get some essential advice. But today, I am going to give you some guidelines for setting up specific goals to increase your speed. First, I will talk about what to avoid. Then, I will discuss what you should watch for from your experienced faculty. And, finally, I will go through the specifics of creating goals for increasing speed.

Do Not Deviate From The Search Pattern!

What is the worst way you can read cases faster in radiology? Cutting corners. But, I see it in residents all the time. They feel rushed, and what is the first rule that goes? Well, either they no longer search through all the fields of the film, or they skip looking at an organ system. Either way, these residents are destined to miss many critical findings as they begin to pick up speed, but in an unhealthy way. Training yourself to deviate from a search pattern is a recipe for disaster. If you cut corners as a resident, you will continue the same patterns even after you graduate. Learn the right way early on!

Learn The Tricks Of The Pros

Who should you learn from to read cases faster? Medical students rotating through radiology or attendings in other specialties? Of course not! The answer is simple, the radiology pros, of course! Learn from the best, your faculty.

So, you want to make sure to watch the people that already read cases quickly and accurately,  the seasoned radiology veterans. If you are reading CTs, for instance, sit down with the body imagers. You are bound to learn ways to cover organ systems with more accuracy in a shorter amount of time. One example would be to check out how they scroll through the cases. You may discover that running through the bowel is easier if you look at the contiguous intestine on each successive slice rather than randomly looking at the small and large bowel within the abdomen. By watching what the experienced professionals do, you can pick up additional tips such as this one to speed to your reads and search patterns.

Pick A Number And Increase Each Day

For those of you want to be weightlifters, you cannot start by bench pressing 350 lbs. That is a dangerous recipe for hurting yourself. Instead, most weightlifters set a long term goal to lift 350 pounds eventually, but increase little by little, setting daily and weekly goals. Just like that weightlifter, you need to set a long-term goal and then set shorter-term goals to slowly increase the number of cases in a day. Don’t overdo it at the beginning and strain yourself!

Let’s say that you are starting to read mammography. How many studies should you read? Well, try to pick a long term goal of reading the same number of cases that your attendings read in a day. So, say your breast faculty read around 100 mammograms each in a day. But, when you are starting, you can only read ten mammograms reasonably accurately and quickly. Then, each day, aim to complete a few more than the last.  You may not realize it ay first, but you are building mental connections and eye tracing patterns each time you look at a case. And, the more studies that you look at the stronger the connections. Eventually, it will seem effortless as you scroll through the images. However, it takes time to build this skill.

To Read Cases Faster, It’s Not A Sprint. It’s A Marathon!

Given the pressures of daily work in radiology, you need to run through lots of cases in a rapid amount of time. However, it’s not possible to begin to read accurately and quickly without starting slowly and deliberately. And, usually, it involves starting at a crawl, graduating to a walk, moving to a jog, and only then competing in a marathon.

Remember. As a resident, you have time to build up speed. So, don’t rush it. Habits that form today can last a career. Don’t let them be the wrong ones!

 

 

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Want To Improve During Radiology Residency? Think Small!

improve during radiology residency

A few days ago, I had an “aha!” moment that caused me to stay and listen to the radio in the car for an extra 10 minutes in the garage. In the “on-air” discussion, the presenter of the radio show claimed that to create tangible improvements in any skill, we need to learn from our mistakes and set smaller, more reachable defined goals for ourselves. We can’t look at our most impressive role models and realistically say I will be just like them without a plan of action. Instead, we need to create a specific goal with small attainable means to get there. And I believe the same holds for improvement in the field of radiology. I would subscribe to a similar philosophy for all radiology trainees- to improve during radiology residency, you need to “think small.”

Just like we cannot expect to become like George Harrison at the guitar in just a few lessons, we cannot assume that we will practice the highest-quality radiology after a few months of residency or even one year of practice. Improvement and learning occur at a snail’s pace. In radiology, like most complex fields, becoming a consummate professional is a slow incremental process. And, we shouldn’t be so hard on ourselves and our residents for not being perfect. Each one of us started without the complete set of knowledge and skills that we have today.

Allow For Small Imperfections

Residents often beat themselves up for missing an individual finding or misinterpreting a case. And, as polished attendings, some of us lose sympathy for the trials and tribulations of the resident. We emphasize the occasional miss, not the learning experience. Attendings may harp on the small mistake and cajole the resident about reading a film in the wrong way. But are these the appropriate courses of action for residents and attendings? Probably not. Being hard on ourselves because of a miss helps no one. And instead of hounding the resident who missed a finding, radiologists should be helping him realize he should be thankful to make the solitary error in a comfortable learning environment rather than as a final decision-maker.

We all need to understand, residents and attendings alike, that to become a consummate professional, we must make a few mistakes along the way. Radiology trainees are no exception.

Remember, only after correcting many minor mistakes throughout residency can the radiology trainee become an incredible radiologist. Radiology mentors should encourage residents to take those leaps of faith rather than hold back and merely rely on the Nighthawks or in-house attendings. Attendings should not throttle the innate drive of radiology trainees to think and do more. We do that by punishing rather than celebrating the small mistake as a tool for learning.

Setting Achievable Specific Goals

In addition to allowing for imperfection, residents must create learning plans focused on learning “small” individual skills to improve, not generalized goals. What do I mean by that? Outline the specific topic areas you want to learn and the resources you will need to cover the material. Don’t just say I will learn all about nuclear medicine this month. Be specific about the how and what. You will never reach the end goal if you don’t set a plan that emphasizes the small stuff. The ability to build upon small goals block by block eventually creates incredible professionals in any field.

Want To Improve During Radiology Residency: Think Small!

The overall completion of generalized tasks does not make a radiologist great. Instead, it is the sum of learning from our mistakes and completing “small” goals over time. So, let us all celebrate the “small.” Ultimately, the sum of “the small”corrections of imperfection and achieving specific milestones builds great radiologists.