Tag: medical student

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Things To Not To Do When Ranking A Program Number One

number one

For those of you involved in an NRMP matching process (radiology residency or fellowship), you only have a few more weeks to finalize the rank list. But, the most significant decision is to rank number one. Why? Well, you have around a fifty-fifty chance of getting that spot if you are thinking about putting it down on your rank list, better than any other place. So, how do you make sure that you are clicking the right program when you finalize it all? Well, to sure ensure your sanity and make sure you have the best likelihood of getting this spot, here are some things that you should not do with your number one ranked program.

Don’t Play Mind Games

It’s not worth thinking about whether or not the program wants you badly. That should play no part in the assessment to rank a position as number one. Only, and I mean only, should you list a program first if you want to go there. It would be best if you only took your assessment of the program into the equation. If the program selected you and you didn’t want the program, where does that leave you? In a matching spot that you don’t like, of course!

Don’t Lie

It is unethical to let a program know that you are going to be ranking a program first unless you mean it. Some programs will use this information to rank you higher if they liked you in the first place. (a residency will not change their rankings if they don’t!) Regardless, if for whatever reason, you decide on a different program than the program that you said was your first choice, and then match with another site, forever hold your peace! Radiology is a small world. And, the ramifications of doing this are myriad. Not to say the least, unbeknownst to you, programs may blackball you in the future if you decide you want a job with one of their faculty. You never know!

Don’t Get Too Invested In Your Number One Choice Before You Match There

There is one guarantee in life: that there is no guarantee! Just because you are confident that a program is going to choose you, don’t buy a condo next door. Until it is official, you never know. I know of several students that had bought all the T-shirts of the presumed institution that they will attend, only to find out that they had not matched at the program. Please. Wait until you have the residency has accepted you before telling your colleagues. You don’t want to look like a fool!

Don’t Psyche Yourself Out Of Your Number One Rank

Your number one choice selected you for an interview for a reason. Regardless of how you may feel now, you do have a chance of getting a spot at your first choice. That chance is probably better than you think!

Don’t Forget To Double Check You Number One Choice

Computers and people’s hands are finicky. You can easily click the wrong button and not realize what you have selected. Or, maybe you changed your mind about your first choice and forgot to choose the program on the match list. In either case, check and recheck that list multiple times before you click submit!

Ranking A Program Number One- Don’t Take It Lightly

The matching process is a headache. But, you’ve already made it through seven-eighths of the ordeal. Don’t screw it all up at the last minute. Make sure to dot your i’s and cross your t’s. Ranking your first choice is a big deal. So be careful and remember: many applicants get their first pick!

 

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The One Phrase You Should Ask For In All Your Letters Of Recommendation

letters of recommendation

ERAS season has recently begun. And, with applications to radiology residency and fellowships on the system now available, medical students and residents are scurrying about trying to find letters of recommendation from their faculty and mentors. On that note, if you are applying now, I would advise you to read one of my previous blogs (Cracking The Radiology Residency Application Code).  Previously, I have mentioned that references are one of the less significant discriminators in getting an interview for radiology. However, that statement only applies to decent letters of recommendation. It does not mean that you should find the wrong ones.  That can become a disaster. Remember. Program directors have so many excellent applications from which to choose. So, one lousy recommendation can lead yours into the DNR (Do Not Rank) pile. In the case of a horrible reference, it becomes a great discriminator!

In any event, as always, I want to distill the essentials of applying in the world of radiology into a few simplistic nuggets. Therefore, I am going to let you in on a little secret about what you should be looking for in a recommendation writer not only to avoid this situation but instead, I want to make your recommendation into the reason you may have success getting into your program of choice.

So, here it is, a simple phrase strategically placed within the recommendation, preferably at the end. And it is this, “Your name is the type of student that we want to take at our radiology residency program.” As an application reviewer, that phrase gives me more confidence about an applicant than any other.  If your mentor wants to take you into his program, especially another program director, then why wouldn’t I? So, how do you get that person to write that into your recommendation? I will give you some simple instructions on how to do so to achieve the results you want.

Perform Well On Rotations With Potential Reference Writers

OK. Performing well on rotation may seem obvious. But, on occasion, some residents will ask attendings to write a recommendation when their performance was marginal. Why does this happen? Well, usually, the resident feels more comfortable with obtaining this written reference due to the mentor’s easy-going personality. Don’t let that fool you! When a mentor has many other applicants to write for, your recommendation will not be of the same quality as his favorites!

Befriend Your Mentors

For many medical students, befriending your mentor is a tall order. Often, he may be twice or even three times your age. Or, your interests may significantly differ. However, make that attempt to get to know that person well before asking for a recommendation. Then, when you finally request one from this person, he will feel much more comfortable with writing one. I can’t tell you how many times a medical student or resident will come up to me and ask me for a recommendation when we have barely spoken. It reflects in the written letter!

Tell Them What To Write!

Lastly, this step can be the most critical. At this point, you know your mentor well, feel comfortable with her as a reference, and you know she feels the same about you. And, she is more than likely willing to help you out in any way she can. But, many reference writers do not know what program directors are looking for in a recommendation. So, it is your job to help them out. Ask them if they can slip the key phrase into their letter- “I want you in my program.” (Of course not that verbiage exactly but you get the point!)

Even better, some writers will ask you to make a version of the reference letter. Guess what, slip that phrase or something similar into the end. It has the potential to make your application stand out from the pile!

Capturing The Magic Phrase On Your Letters Of Recommendation

Now you know precisely how to proceed to get the best possible recommendation from your mentors to help you get into the spot you want. It does take a bit of work, forethought, and, most importantly, personal interaction. So, make sure to ask mentors on rotations where you have performed well. And, only request them from those that know you well enough to write you one. Only then will you be able to obtain a recommendation with the phrase that will significantly increase your chances of admission!

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Radiology As A Backup Specialty: Should Radiologists Be Offended?

backup

During the AUR meeting a few years ago, one of the speakers announced that more medical students than ever used radiology as a backup specialty. Well, how can that be? I mean, radiology is a fantastic specialty, right? Yet, our medical students have chewed us up and spit us out. At that point, you could just about hear the moans and groans in the background of the lecture hall. But then, I thought about it and felt a bit differently. Why? Well, that is what I would like to delve into today.

Most Applicants Don’t Know What They Want

Over the years, I have found that most radiology applicants, like other specialties, think they know what they want. However, when you dig a bit deeper, you find out they are not sure. Hell, I had no clue when I entered the specialty. When you ask applicants why they want to join specialty X, many have difficulty verbalizing their true motivations. Often you hear, “I like using my hands” or” I like coming up with differential diagnoses.”

Truthfully, however, these reasons are, at best nonspecific. And, if you dissect what these residents are saying, you would recognize that the reasons why an applicant claims to have applied to a specialty have no bearing upon what he wants. You can apply to surgery, interventional radiology, urology, and other specialties because you want to use your hands. Or, you can come up with differential diagnoses in almost any specialty in the medical field.

Often, applicants bury the real reason for applying to a specific specialty deep within their psyche. Perhaps, they want to say it’s the lifestyle, the culture, or the money. So, how can we become offended by medical students that don’t know what they want?

Our Specialty Is Getting Noticed!

For applicants to apply to our specialty, even as a backup, it means that they must have some foreknowledge about us, to begin with. That means we are doing something right. Maybe, we are training more medical students about imaging in medical school. Or, perhaps, they hear about an improving job market. In either case, residents have found reasons to apply to us, even though it may not be their first choice!

A Badge Of Honor

Only a few years ago, the radiology applications had dropped precipitously. In addition, the quality of applications had significantly decreased as well. Instead, today, we have become respectable enough to apply to! We are returning to the old norm. So, we should feel excited that qualified applicants are again considering our specialty.

So, We Are A Backup Specialty. Should We Be Offended?

Back to the original question again… Let’s look at radiology for what it is. It’s one of few specialties that allow physicians the flexibility to pursue so many avenues and satisfy the academic and clinical wants of most. And now, if we dissect why residents perceive us as a backup, I think we should not become offended. Instead, we should give the new applicants some credit. They are beginning once again to recognize the specialty of radiology for what it is: an excellent choice for a great career!

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A Student/Resident Guide To Research

 

Introduction:

Participating in research is a great way to contribute to medicine. Well-conducted research and literature reviews help advance both scientific understanding and clinical practice. Additionally, it enables you to develop expertise in a topic, while simultaneously showing dedication to your field. Peer-reviewed publication and presentation of your research should ultimately be your goal. Although you may want to get involved in research, you might not know how to go about it. Beginning a project can often present a challenge for residents and students with a limited research background. Here, I offer some advice and recommendations that I would give anyone just starting. Much of this I have learned through trial and error. Learn from my mistakes!

Identifying research mentors:                               

Your choice in mentorship can dictate whether or not a project will be successful, especially when just beginning your research career. Try to identify a project mentor (usually a physician or Ph.D.) with a proven track record of publication. Even better, if you can find someone with institutional or national grant funding, you can be confident that your research will likely be published. These are not essential, but finding the correct mentor can mean the difference between publication and fruitless pursuit.

First of all you should approach attendings, residents, and students. Ask if there are any ongoing or projects in the department. If you identify something that piques your interest, offer to assist in any way! Offer to carry out a literature or chart review. Attendings and residents are busy, so help them with the work that no one wants to do. The more you do, the higher up on the author list you will be. Make sure you show initiative and interest!

Although clinical research in your dedicated field might help you more as an applicant, any well-conducted research can be a great interview discussion topic, as long as you can speak intelligently about it.

Research takes time and patience:

What many don’t realize is that conducting research takes time, and that manuscript preparation and submission can take equally long. When you read a newly published paper, often the presented data is up to a year or two old. In many cases, a you need to submit a publication to several journals before being accepted. Especially true, if an author is seeking publication in a high-impact journal. My advice: start your research early. Students should seek out research from the first day of medical school, and residents should look for research during the intern year (if they can find the time!). Not to say that you cannot accomplish research in a short timeframe. However, you must be realistic about your goals and recognize that you cannot completed all projects if you are limited on time (i.e., close to residency or fellowship applications).

If you budget your time wisely, you will be able to edit thoroughly and compose a more eloquent article with a comprehensive review of the literature.

How to minimize your time for completing projects

Remember you are legally/ethically obligated to submit your paper to one journal at a time. Some review cycles can take several months for the first decision, so look up their average turnaround time if this might be concerning. Also, if you plan to submit to notable journals, there is always the possibility of rejection. Resubmission to another journal will likely require reformatting and an additional wait period. The time between finishing an experiment and publishing can add up. Remain conscious of this reality.

If you are limited on time, but still want to conduct a small project, one option to consider is a conference abstract. Conference abstracts allow you to showcase your research often through a poster presentation. The beautiful thing about conference submissions is that you can submit an abstract with preliminary findings, and later expand upon these in the full poster if accepted. Certain conferences/societies will even publish your work in their journal afterward.

As a bonus, getting an abstract accepted allows you to attend a conference and network with your colleagues. Most large meetings are held in either the spring or the winter. And, abstracts are generally due approximately six months before the conference. Deadlines may vary so identify these times if you have an ideal meeting in mind.

As a side note, the societies that hold conferences often have student/trainee travel scholarships or discounted conference fees. Any young professionals with funding concerns should apply. Again, be aware of scholarship applications deadlines.

Where to publish:

Everyone should strive for publication in high-quality, peer-reviewed journals. Things to consider are impact factor (IF) and indexing in scientific databases. High IFs are in journals like Nature or Science. However, it is essential to realize that a journal’s audience can impact this number. For instance, Nature has an impact factor of approximately 40, while Radiology has an impact factor of around 6-7, and the Journal of Vascular and Interventional Radiology (JVIR) has an impact of about 3.

If each is an example of a high quality-peer reviewed publication, then why the difference in IF? The reason is the audience and journal scope. Nature covers a wide range of disciplines. And therefore, it has a larger audience. On the other hand the other two have smaller audiences. By sheer readership, this means that fewer people read them and cite their articles.

Although everyone might aim for publication in big-name journals, we often have to settle for lesser-known, lower-impact publications. This is ok, as long as you consider several things. Journal reputation, peer-review, and indexing. Ultimately, we want our research to be visible to the scientific community. Therefore, we want our papers indexed in PubMed, Medline, Web of Science, etc.

Why you should consider open access:

Professional scientists often have a “publish or perish” mentality. For a Ph.D. actively conducting full-time research, publication in large name journals can provide major career and funding opportunities. This is especially true for young postdocs. However, the pressure to get published in major journals like Nature, Science, or the New England Journal of Medicine reflects a major flaw in the scientific community. Scientists often delay submitting their findings until a more thorough narrative can be told. This can involve years of additional experiments, and, unfortunately, deceptive and unethical practices in some cases. Additionally, it also prevents experiments from being repeated and perfected, as the drive to submit “novel” findings fuels these major publications. This also discourages the presentation of negative results, or when an experiment or intervention fails. These findings are equally as important for scientific progress.

Although research output is not as essential for becoming a successful practicing physician, a publication can augment your career opportunities, especially at major academic centers. As physician-scientists, this pressure is not felt as strongly, thus we have a unique opportunity to help change the industry and combat these practices.

One movement in response to the publishing business is open access. This model of publishing promotes freely available, online publications with a quick review turnaround time and lower publishing costs. However, certain concerns over the quality of these publications have been raised. Not every open access journal is created equally. There are certain predatory publishers who will publish anything without peer review as long as a fee is paid.

More information about open access:

Be aware of journal quality when you are considering the submission. One great resource, the Directory of Open Access Journals (www.doaj.org), continuously compiles a list of reputable open access publications organized by specialty and database indexing. Another interesting response to the flaws of the publishing industry takes the form of the publisher, Matters (https://www.sciencematters.io/why-matters). Matters takes the stance that those individual findings should be reported. They suggest that observations should again be the basis of good science, not embellished narratives like major journals tend to favor.

Rapid dissemination of new data could provide the missing piece to a colleague’s research on the other side of the world. Knowledge and its access should be easier in the age of information. Give open access a try, and get your data out there!

Know your reviewer and audience:

Before submitting any publication be sure to edit your content for grammar and spelling. It is not uncommon for a great idea to get rejected because of poor presentation! No matter how groundbreaking your findings may be, sloppy grammar, spelling errors, and disorganization will instantly raise red flags among reviewers. “They were not meticulous with their writing, were they meticulous with their research?”, a reviewer might think. Share your paper with anyone willing to read it. A fresh set of eyes always picks up something you might have missed.

Also, always try to write with your reader in mind. In reality, radiology journals will likely be read by radiologists, but try to consider an extended readership. Think of your reader as a scientific/educated person, but from a field different than your own. You should compose a logical and concise piece, with appropriate references for the majority of your statements. Something that might seem intuitive to you or a radiologist, might not be as clear to another professional. Provide the extra detail, or at the very least, a resource if more information is sought.

Be aware of the publication scope and adhere to manuscript formatting requirements:

Every journal has its own formatting and organizational requirements. These are usually clearly stated online. Read these carefully and make sure every item has been accounted for. You don’t want to wait several weeks for a decision only to get a request to re-upload a version with double-spacing and times new roman 12-point font, and then have to wait again! Also, make sure your paper fits within the journal scope. Again, this is usually clearly stated online. Don’t submit a surgery paper to a radiology journal. Don’t submit a case report to a journal that doesn’t’ publish them. Use your common sense! You can always look up what they have published in previous years to get an idea of the style and types of papers that are accepted.

Important items that are often omitted from the discussion section:

  1. Make sure you have a sound basis for why you carried out your study. If you state a fact, technique, or clinical approach, cite the literature. Even if a statement might seem like common knowledge to you, it might not be to a reviewer or reader. Reference everything!
  2. Do not embellish. You should discuss the limitations of your study. Every study has shortcomings. Be upfront about them. Offer solutions to these limitations for future research. This shows maturity and that the scientist has thought about the holes.
  3. State how you think your findings can advance the literature, science, or clinical practice.

Avoid frustration by using a citation manager from the start:

When you’ve finished your project, and are ready to write, be sure to use a citation manager such as Endnote. Often when writing, you will reorganize your thoughts and shift your references. By using a citation manager like Endnote linked to Microsoft Word, you will save yourself hours of frustration trying to organize citations and manually create a bibliography. You can create a free online account on www.myendnoteweb.com and if you purchase or get a copy of Endnote for Mac or PC, you will be able to “cite while you write.” Trust me! This is a HUGE help! Often your institution will provide you with access to a research database, like Web of Science. You can link this account to your endnote account and export references easily. Alternatively, you can download a citation file from PubMed and upload to your citation manager. Either way, you will save time and avoid frustration! How-to guides can be found online and on YouTube.

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How To Create A Killer Radiology Personal Statement

radiology personal statement

 

Personal statements in the radiology field are the least effective way to bolster your application. (1) Rarely, do they help an applicant. Occasionally, they hurt the applicant’s case. Regardless, I am aware that the personal statement will often become essential to many viewers of this article who apply to radiology regardless of whatever I say.  Therefore, I am creating this blog for anyone that is applying for a radiology related job to learn to create that killer radiology personal statement. And, today I am going to recount some of the basics for creating one. Specifically, I am going to start by explaining the parts of a great radiology personal statement and then give you some general tips that I have learned over the years from blogging and reading many personal statements.

First Paragraph:

The Hook

After having rummaged through thousands of radiology personal statements and writing lots of blogs, I can definitely say that the key paragraph for the reader begins at the beginning. If it is average/boring, I have almost zero desire to read the rest of the statement, especially when you have another 10 more to read that day. Something in the few first few sentences needs to draw the reader in quickly. You are not writing a short story or novel where you can slowly develop your characters and plot. Rather, you need to write using a technique that I like to call the hook. Reel that program director in.

There are several techniques that I have seen over the years. Let’s start by using the writing technique of irony. Notice the irony I chose in the first paragraph of this article. I started by saying personal statements are the least effective way to bolster your application. Whoa, wait a minute! The title of the article is How To Create A Killer Personal Statement. That’s somewhat interesting. The dissonance in that first paragraph draws the reader in.

So, what other techniques can you use to maintain the interest of the reader? Sometimes quotes can certainly help. Once in a while, I come across a quote that really interests me. I tend to like quotes from Albert Einstein. They tend to be witty and have double meanings. But, there are certainly millions to choose from. A good quote can set the tone for the rest of the personal statement.

Finally, you can write about an interesting theatrical description of a life-altering event that caused you to want to go into radiology. Use descriptive novel-like adjectives and adverbs. Go to town. However, be careful. Don’t choose the same events as everyone else. Read my other blog called Radiology Personal Statement Mythbusters to give you some other ideas about what not to choose!

Tell Why You Are Interested In Radiology

The first paragraph is also an important place to tell the reader why you are interested in radiology. Many times I will read a radiology personal statement and say to myself that was kind of interesting, but why does this person want to go into the radiology field? He/she never quite answers the question and I am left feeling that this person does not know why they want to enter the field. Don’t let that be you!

Second Paragraph:

Explain Any Problems/Issues

I like the applicant to be upfront with the reader rather quickly if there was an issue that may cause a program director or resident to discard an application. It could be addressing something as serious as a former conviction for drunk driving when you were young and stupid. Or, it could be something milder like a questionable quotation from a mentor that you found in your Deans Letter. Either way, you need to explain yourself. Otherwise, the problem/issue can declare itself as a red flag. Subsequently, it can prevent you from getting the interview that you really want.

Second and Third Paragraphs

Expand Upon Your Application

Let’s say you don’t really have any red flags in your application. Well then, now you can write about some of the things that you accomplished that you want to bring to the attention of your reader. Typically, these may be items in your application that are partially explained in the experience or research sections of the ERAS application but really deserve further emphasis or explanation.

Show Not Tell

In addition, the meat of any personal statement should contain information about what you did. Do not, instead, describe all the characteristics you had to allow you to do it. This is a cardinal mistake I often see in many personal statements. What do I mean by that? If you have been working at NASA on the Webb Space Telescope, you don’t want to say I was a hard worker and was well liked by everybody. Rather you would want to say I spent 1000 hours building the mirror for the telescope constantly correcting for mistakes to such a fine degree that the engineering societies considered it to be almost perfect. And to show you were well liked by everybody, you can say when you were done completing the telescope, NASA held a ticker tape parade for me!!! (Well, that’s probably not the case. But, hopefully, you get the idea.)

Final Paragraph

Time to Sum Up

This can be the most difficult part of writing a personal statement (and blog too!) How do you tie everything together into a tight knot so that everything comes together and makes sense? Well, one thing you can write about is what you will bring to the table if your residency program selects you based on what you have stated in your radiology personal statement. Back to the Webb telescope example: Given my experience with my successful quest for perfection by creating an almost perfect telescope mirror, similarly, I plan to hone my skills to become an incredible radiologist by always learning from others and my fellow clinicians to get as close to perfection as possible. Bottom line. You want to make sure to apply your experiences to the job that you want to get.

General Issues With Editing

1. I have learned a few things about writing over the past years, whether it is blogs, personal statements, letters, or whatever else you need to write. However, the most important is the obsessive need to review and re-review whatever you are writing for editing. It may take 100 edits to get it right!!!

2. Have a friend or a relative read your personal statement to catch errors you may not see. Your brain is trained to already know what you have written. Many times the only way to catch your own mistakes is to have another person read your writings.

3. Also, make sure to the read the personal statement out loud. Sometimes you can only detect errors by listening to what you have actually written. It happened many times when I edited my book Radsresident: A Guidebook For The Radiology Applicant And Radiology Resident

4. Finally, I recommend the use of grammar correcting programs. The one that I would like to bring to your attention is the program called Grammarly. I am an affiliate of Grammarly. However, that is only because I use the program myself for my blogs all the time. It has saved me from really stupid mistakes. One version is for free and corrects simple critical errors. The other uses more complex grammatical corrections and is a paid service. Regardless, either version will assist you in catching those silly errors. In addition, I usually paste my blogs into the Microsoft Word program to correct any other possible errors. I have found both programs to be complementary.

Other Useful Tidbits

Avoid Too Many I Words

When writing a radiology personal statement, try to reduce the usage of the word I for multiple reasons. First, it begins to sound very redundant. Second, you appear selfish. (It’s always about you, isn’t it?) And finally, you want to create the impression that you are going to be a team player, not in the field of radiology just for yourself.

Active Not Passive Tense

If you want a passage to sound great, make sure to almost always use the active tense, not the passive variety. When using the passive form, the reader has more work to do because he/she has to figure out who is doing the activity. In addition, the environment appears to control you rather than you controlling the environment. And finally, sentences sound more verbose when using the passive tense. Think about the following phrases: The job of creating a computer algorithm was completed over the course of 10 years vs. My colleagues and I created a computer algorithm over the course of 10 years. Which sounds better to you?

Use Sentence Transitions

If you want your personal statement to sound smooth, I find words other than the subject at the beginning of the sentence help to diversify the sound of the individual sentence. Also (notice this transition word!), it allows for a change of idea without being so abrupt.

Don’t Use The Same Word At The Beginning Of Each Sentence

In that same train of thought, try not to use the same word to begin a sentence over and over again. It’s a surefire way to bore the reader!!!

Creating That Perfect Radiology Personal Statement

Now you know some of the rules I would utilize to create an interesting radiology personal statement. Some of these are general rules that I apply to my blog on a weekly basis that I also see in the best personal statements. Therefore, I know that they work well. So, go forth and write that killer radiology personal statement. You now have all the tools you need!!!

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What To Look For In A Radiology Residency?

residency

No perfect radiology residency program exists for radiology residency applicants, and no one size fits all. Each candidate has their own needs, wants, and learning style. And each program has its positives and negatives. Therefore, each applicant should strive to match with the appropriate residency. In doing so, the positives of the program should fit well with the applicant’s needs. And, the negatives should be minor and not detract from the overall radiology resident experience.

My goal for today is to discuss the essential ingredients for choosing a radiology residency. Most online overviews do not address many of these crucial factors to look for in a radiology residency program. So, I thought it was critical to include them. Included in my discussion will be of the highest importance to most minor importance: residency culture/hierarchy, location/proximity to family/friends, intimate insider knowledge of a program, rotations/equipment/procedure volume, university vs. community programs, private vs. academic run departments, graduating resident fellowships, conferences, research, mentorship programs, and board passage rates.

In the end, the overall residency experience will allow you to become a great radiologist. So, I will put it all together at the conclusion to help you to make a final decision. To do this, I have assigned an individual point score for each factor. It would help if you recorded for each residency you are considering for ranking. In the end, add up the points. And then, compare to the other residencies on your rank list. When you finish, rank each accordingly.

Residency culture (5 points)

Residency culture is probably one of the most critical factors to think about when choosing a residency. However, it is also one of the most difficult to define. The difference between happiness and misery in a program first and foremost often lies with the colleagues that you have. No matter how excellent the overall “experiences” of a residency program, you will not want to come to work if you hate the people you work with. On the other hand, if the residency is marginal, but the people you work with are fantastic, the four years of residency will not be so bad.

What To Look For

The problem with using this factor for choosing a residency is that it is a moving target. From year to year, residencies accept new residents, and old ones leave. So, the residency culture today may not be present tomorrow. However, the attending, technologist, and coordinator support structures of the residency often remain relatively similar. So, it would help if you got to know the residents and the leaders and purveyors of the program.

In addition to getting a sense of the “happiness” of the residents, you should determine the residency leadership style. Some programs prescribe processes for everything that happens in the program. Other programs have a more laissez-faire attitude. Some programs have one or two leaders at the top that act as “benevolent dictators.” Others have each of the attendings with equal say over residency issues.

No one structure is “correct.”. If you are the type of person that needs a well-defined structure, the hierarchical culture would fit better. On the other hand, if you like to create your path and define your schedule, you may prefer a program with an equal footing.

Location and Proximity to Friends/Relatives (4 points)

Over my years as an associate program director, I have found how important it is for residents to have a social outlet. Although not a “resident related experience” per se, this factor can be just as important. Being near loved ones can make the difference between a terrible residency experience and a great one. A support structure can be just as crucial as the residency program itself. I find that the best residents have a healthy support structure outside of residency. Therefore, the location and proximity to loved ones can be essential factors, just as the residency quality. For instance, who would want to be in Manhattan if your children/spouse are in California? If asked by medical students, I will usually mention that they need to consider location seriously.

Insider/Intimate Knowledge of a Program (4 Points)

As a medical student, it helps to rotate through the radiology residency program you may want to attend. Suppose you know the residents and attendings before starting a program. In that case, you already know the residency program’s upsides and downsides and where “the skeletons are hidden.” Knowledge can be worth its weight in gold. It can be challenging to tell what the true nature of a residency program is like before starting a program. Therefore, having insider knowledge can help you when you begin your residency because “you know what you are getting into.” These residents often are some of the most successful because they have a distinct advantage of knowing the attendings, residents, and the hospital system, even before beginning their residency. Do not dismiss insider knowledge as a factor for making this big decision.

Rotations/Equipment/Procedure Volumes (4 points)

I am lumping these factors into one conglomerate. Why? Naturally, the residency must have all the resources you will need to be comfortable with to practice radiology. If you are in a program where the diversity of patients and patient volumes are sorely lacking, you will be at a loss when you are out in practice and have not seen those cases in your area of practice. Likewise, if the faculty does not perform procedures such as arthrograms or your program doesn’t have a 64 or 256 multidetector CT scanner for the interpretation of cardiac CTAs, you will certainly not feel comfortable performing these procedures when you are an attending.

So, you must make sure to search for a program that has all the necessary resources to allow you to learn all the imaging and procedure skills you will need to become a competent radiologist. Furthermore, as summarized in another post, Best Radiology Electives for the Senior Resident, it is imperative that you can rotate in areas of weakness or interest during your residency. Why? Because hiring practices are looking for residents who can do a subspecialty and are competent in most areas of general radiology practice. So when you are in interviews or looking up information on the web, make sure to look into these factors. Once you have started a residency program without all the crucial resources to make a great radiology resident, there is no going back!!!

Community vs. University Programs (3 points)

Incoming medical students tend to put more weight on attending a “university program” rather than a “community” program. However, both programs give distinct advantages that applicants do not realize before choosing a residency program. A sizeable academic university program does not fit everyone’s career path. So, what are the advantages and disadvantages of each?

Depth Of Resources

Large academic university programs tend to have resources in specific subspecialties and have several attendings that practice in a particular subspecialty. On the other hand, the smaller community programs tend to have more general radiologists that cross cover multiple specialty areas. So, as a resident attending a university program, you will get a more in-depth experience focusing on individual subspecialties. As a community program resident, you will get a more private practice and “real world” hands-on experience. So these programs should attract different types of radiology residents.

Beauracracy

Also, at community programs, you tend to have more accessibility to your attendings and will more likely work one-on-one with that individual. Also, if you have a specific need, it is more likely to be addressed personally without having to go through “bureaucracy” to get there.

At a sizeable university program, more physicians will intercede with direct attending teachings such as senior residents, visiting fellows, fellows, and junior attendings. You may also need to get through bureaucracies to obtain specific resources within your program. However, some electives and rotations may not be available in a smaller community program, such as connections for abroad electives or other opportunities.

Summary

So, this factor should play a role in your decision. But, it depends on the type of practice you want when you leave the system. One is not better than the other for all.

Private vs. Academic Run Departments (3 points)

This factor is often not mentioned or included as a factor in making a residency program decision. But having worked at private, hybrid, and academic programs, I think it should be essential.

I completed my residency in the private/academic hybrid model, and I found some real advantages to this sort of residency program. We had to get through a specific number of cases each day to meet the appropriate caseload. It was a more “real world” experience that allowed me to hit the ground running when I started my first job. I was dictating loads of cases from the beginning and had tons of experience by the time I graduated. My experience was very different from some of my more academic-run department-trained colleagues that I knew. Some of them had more difficulty getting through lots of cases during the day and felt a bit more uncomfortable at their first community radiology job. It made a difference in the long run for me, as it allowed me to become a more efficient general radiologist.

Academic run departments with attendings hired by the hospital emphasize different qualities. These departments may have more resources dedicated to teaching daily. For the resident interest in a purely academic job, it may be heaven!!! But, they may not simulate the real world. They can perseverate on a few cases for an extended period. So, for the radiology resident interested in private practice, a residency such as this may not be the right fit.

Conferences (3 points)

The ACGME theoretically requires all residencies to have at least a daily conference. But, not all are created equal. Some programs have additional morning conferences, while others have the resident prepare for and present at interdisciplinary conferences. And, even others have residents prepare medical student teaching conferences. The styles and types of meetings can vary widely at each program.

Additionally, you should ask if the attendings regularly show up to give their conferences. Please beware of the program with many on paper, but in reality, it does not have the number they suggest.

The importance of the number and type of conference depends on the individual resident. Some residents learn better with didactic sessions, and others benefit from hands-on direct radiology experience. So, the importance of this factor will vary with the individual applying.

Graduating Resident Fellowships (3 points)

It is critical to check where the former residents have gone to fellowships. Are the residents not able to get into competitive subspecialties? Are they going to “no-name” programs? Do the attendings at the institution have connections and networks with other fellowship programs throughout the country? These are questions that you should ask when you get to your residency interview. Or, you should check online for this information. Knowing where prior residents have attended can show you if they get into competitive subspecialties and fellowships.

Research (2 points)

For the academically oriented, research can be an essential factor in selecting a radiology residency. For the community-oriented, it is less so. But, when you look for jobs, having done some research implies an interest in and commitment to radiology. So, it is essential to have had some experience on your resume to get both the academic and private practice job. Therefore, research within an institution should play some role in your decision.

To make this assessment, it helps to get a list of the resident research output over the past five years. You can see what kinds of studies the current residents have completed. Are there retrospective studies, case reports, or large prospective trials? Is each resident finishing lots of projects? And, does the program have research conferences to support the resident? These findings should help you decide if the residency has a curriculum that encourages residency research.

Mentorship Programs (2 points)

Some residency programs have a dedicated teaching program that helps out first-year residents and gives didactic lectures. Others assign an attending mentor to the resident that is the “go to” person for all issues during their four years of residency. When added to the other factors, applicants can use these perks to help make a final decision.

Board Passage Rates (1 point)

I will include board pass rates last because I believe that studying for the new core exam is more of an individual’s responsibility. Of course, you need to pass your boards. But, I think that the overall residency experience becomes more critical in making you into a great radiologist than the board passage statistics. On the other hand, a radiology residency program should have primary resources for residents to pass the exam. They should have learning materials and books as well as board reviews. Great residencies have had lower board pass rates, large academic institutions, and small programs over the past few years. In the end, the examination is very different from the practice of radiology, but it is another hurdle to overcome.

Putting It All Together

No one factor should make or break your decision to go to a specific program. But instead, the different factors should be weighed based on the individual applicant’s needs and wants. So, add up the numerical point totals for each program next to each section and develop a final score to create a final rank list for every residency program.

To summarize, though, for most residents, I sincerely believe that you need to take the residency culture to be one of the most critical conditions for ranking a program in the residency match. And, location can have a significant effect on your happiness or misery during those four years. But, a quality residency culture and a suitable place without adequate training resources would not be enough. So, be careful when you factor each into consideration.

A great radiologist is the sum of one’s experiences that often stems from radiology residency as the initial building block. Ensure that the foundation will provide you with the training you need to become the best you can be. It can be a difficult choice, but I hope I have provided you with the tools you need to make that decision. Good luck with the match!!!