Tag: medical school

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What Are The Best Extracurriculars For Radiology?

extracurriculars

Question About The Best Extracurriculars:

 Hello Dr. Julius. I am an incoming MS1 interested in radiology, and I wondered if you had any recommendations for medical school extracurriculars that radiology residency directors highly value. Having talked to several medical students about their extracurriculars, there seems to be a wide variety of options. I know that I will be swamped in medical school and only have time for a few activities. I would love to know if any extracurriculars would be particularly helpful in preparing me for radiology. Thank you!

 

Answer:

Radiology Relevant Extracurriculars

There are two types of extracurricular activities that radiology program directors like to see. The first are those that are relevant to radiology. These would include research, participating in national radiology specialty conferences, etc. These show a depth of interest in radiology and not just taking a two or 4-week rotation.

Non-Radiology Relevant Extracurriculars 

The second of those extracurriculars that you do that may have nothing whatsoever to do radiology but are something that you have explored profoundly and have been successful performing. It could be music but not just strumming a guitar. Maybe you have played in Carnegie Hall or were doing vocals for a cover band. Or, if it is astronomy, you don’t just look at stars at nighttime. But maybe you are actively involved in searching for new planets and found one that has your name!

I am trying to point out that we like to see that you have other interests outside of radiology that make you not just another number but also an interesting person. And that you want to do things, not just superficially, but will work at it to get better and better. These second sorts of interests are so important because we can sit with you for hours at a time. And, we want to make sure that we will like the person that is by our side and have a person there that will work hard for the residency program. 

The Crux Of The Matter 

So, get involved in some radiology-specific research or organizations if you can. But, also explore things that interest you like to do on the side. Doing too much and mastering nothing does not mean much. But, someone that pursues their interests to the nth degree, now that is special.

Even after all this discussion, more important than all the extracurriculars in the world, is doing well in your medical school and getting good grades for the Dean’s letter and good board scores (correlated with passing the core radiology examination). So, don’t forget about the basics!

 

Good luck,

Barry Julius, MD

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Radiology Should No Longer Be Just An Elective: Get With The Times, Medical Schools!

elective

As the 2020 interview season begins to wane, I have noticed a continued pattern among many medical schools. They still consider radiology to be just an “elective.” So, why do medical schools not take the specialty of radiology seriously enough to make it a requirement? Well, I have a few theories. Maybe, they want to limit exposure to medical students to shunt them toward the primary care track. (Yes, they do get government and private funds for doing so!) Perhaps, it’s a bit of inertia that schools don’t like to change. Or, it may take the place of education in other specialties since there is only so much time.

Regardless, they are making a big mistake for several reasons.  First, of course, radiology insinuates itself into almost every medical specialty. And then, let’s face it, all students should learn a bit of radiology to be a well-rounded clinician. But, most importantly for society, however, radiology is one of the most expensive cost centers in health care for patients.  So, let me give you a few good reasons for why medical schools should make radiology into a requirement instead of an elective and how it increases the cost of patient care.

Incorrect Orders

As a radiologist, if you haven’t noticed all the incorrect orders that flow through the system, you are probably living under a rock! Daily in breast imaging alone, I see at least a few ordering mistakes come through the department. For instance, the doctor orders a bilateral breast ultrasound when the patient only needs a unilateral breast ultrasound. Or, a clinician requests an ultrasound of the breast when a mammogram is in order. Sometimes, I can catch these mistakes before the imaging ensues. But other times, the study is completed before I even had time to decide on appropriateness. And, yes, doctors sometimes order these studies incorrectly because they have not had experienced a radiology rotation! Imagine the decreased costs of getting these orders correct?

Repeat Tests

Along with the theme of incorrect orders, clinicians wind up reduplicating their efforts because some don’t know what they are ordering. Let me go back to the example of breast imaging. Typically, we do a mammogram first in older patients when they say they feel a lump.  If you do the ultrasound first before a mammogram, you are more likely to have to do two ultrasound exams instead of one. Why? Because you are more likely to find other findings on the mammogram that you will need to image with ultrasound. If the ordering clinician knew this, he would have been much more likely to save the extra test. And, this is just one example among many!

Wrong Disease Pathways

Then, of course, ordering the incorrect test leads to working up incidental findings. You gotta love those incidental findings! Noninvasive imaging is not benign. Why? Because it can lead to invasive procedures. How about that thyroid nodule that you incidentally detect on an unindicated MRI of the cervical spine? Or, you find a benign lung nodule on a CT chest that the doctor should have ordered as a regular chest film. You now need to work it up! All these incidental findings add undue costs to the system!

Lack Of Understanding of Reports

And finally, without adequate training in radiology, you can blow the significance of findings out of proportion or shove them under the rug. For instance, I have reported on a Schmorl’s node in the lumbar spine (intravertebral disc herniation) with little clinical significance. And I have received phone calls asking what to do for the patient with this diagnosis, biopsy, or not! (Absolutely nothing, of course!) Likewise, I have seen patients with new cortically active bone lesions that a clinician may ignore due to a lack of understanding of its significance. Nevertheless, in both situations, the costs of acting or being inactive incorrectly can rapidly add up for the patient and the system!

For The Sake Of Society- Make Radiology A Requirement, Not An Elective!

Unfortunately, these examples are just the tip of the iceberg. Inadequate radiology education as only an elective allows physicians to skip out on radiology in medical school.  And, since radiologists do not control the flow of imaging exams, incorrect orders from poorly trained physicians will continually slip under the radar.  So, the solution is simple yet bold. Make sure that all medical students receive a basic education about radiology and ordering radiological tests.  We will markedly decrease the cost to the health care system and improve patient care. You got that, medical school administrators!

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What Is This Hang Up About Ivy League Applicants?

ivy league

Hovering over the shoulders of program directors throughout the country right after the NRMP match, sponsoring hospital and medical school administration eagerly monitor the match results and statistics from each radiology residency. And, what excites these bureaucrats?

First and foremost, they love it when you’ve matched all your spots, a legitimate achievement. Second, these administrators want to see how far down the rank list you went. Now, I believe this to be a bogus statistic because many of our best residents have been ranked farther down the rank list. But, OK, I will give them that statistic willingly (although I think it’s silly!)

And, finally, they ask to see how many residents came from “Ivy League” institutions. Now, this arena is where I have a real problem. It shows a lack of insight into the residency selection process and medical school training, as well as demonstrates a hubris undeserved of the sponsoring institution. And, let me tell you why.

Medical School Selection Bias

With all this talk about Lori Loughlin and the unfair practices of the university selection process and knowing what I know about the university selection process, I believe that university selection biases also apply to many medical schools. In particular, these issues tend to affect “Ivy League” medical schools more than most because of the aggressive pursuit of applicants (and snowplow Moms!) to get in. Between legacy favoritism and the eternal quest for diversity (not necessarily having to do with the making of a quality physician), these institutions do not necessarily select for the best candidates at our radiology program. Now, don’t get me wrong. There are some great students at these institutions. But, great students sit on the rosters of almost any medical school.

Poor Fit For The Institution?

Many of the candidates that come from “Ivy League” medical school  (not all) want to work in radiology residency programs that have a preference for getting grants and bench research. And, not all programs offer this sort of work. Instead, some residencies provide a solid clinical experience without in-depth bench research. Why would these candidates fit in well with the philosophy of these programs? They do not!

No Difference In Resident Performance

In this realm, I am a bit biased. But, in a look back of all the residents that we have had over the years, our best residents ironically have often come from Caribbean medical schools or have been D.O. candidates. Not to say that the “Ivy League” graduates have been terrible. But, I have not seen standouts of increased performance compared to the other residents in our program.

And this same idea you can also see in the top 20 CEOs in this country. Take a look at the Crain’s Chicago Business article called No One Asks Where The Top 20 CEOs Went To College. (Hint: Only one went to an Ivy League institution) So, why make an increased effort to recruit these applicants when these residents have not performed any better?

Possible Attitude Issues

And finally, as an associate residency director, what is one of the worst things I can do? Well, naturally, recruit residents that do not want to be here. If we are a profoundly clinical residency without that hardcore research component, why would I want to hire an applicant who intends to apply for research grants? These sorts of residents can develop the wrong attitude for a residency program without these resources and will regret being there. Discontented residents make for a miserable residency experience.

The “Ivy League” Applicant

Now, I am not saying that programs should avoid taking applicants from these prestigious medical schools. Indeed, many will make excellent residents. My point is that great residents can come from any medical school. To make accepting these residents into your program as a badge of honor neglects the right reason for the application process in the first place. And what is that reason? It is to find a candidate who thrives and performs successfully over the four years of training!

 

 

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Physician Burn Out- Is An Inadequate Medical Education System The Fundamental Cause?

We read article after article about the complete dissatisfaction of physicians throughout the United States and how it affects patient care.  Since it makes a good story to cover the woes of physicians, the general press seems to covers this topic as dogma. But it is not just the general news. Even Medscape, one of my favorite radiology news/blog sites, has multiple articles and surveys on this topic.

Many different reasons are espoused for the cause of physician burnout. But, I believe there is one major factor that is not addressed. It all has to do with our medical school system and how the system is not made for the student/trainee but rather to support the folks running the schools.

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