Tag: medicine

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Why Artificial Intelligence (AI) Will Not Take Over Radiology!

AI

Artificial intelligence (AI) is still front and center for the layperson when discussing radiology. Family and friends always ask me why AI will not take over my day job. I had one of those “aha” moments in one of those discussions recently. We discussed how many factors will prevent AI from taking over our jobs anytime soon. These included legal, ethical/moral, and financial reasons. As I was droning on, I realized I could argue why AI could overcome these issues. However, one reason not related to these is why we won’t see a blank screen or a computer person from India, China, or any other country for that matter replacing our presence for a very long time. And that is that medicine is local, not universal. 

Medicine Is Local, Not Universal- AI Cannot Account For It!

“Standards”

Why would differing local “standards” be the most critical reason for keeping radiologists busy? Well, every country and every physician has their opinions about the best way to treat patients. Medicine is not universal. It is local. Yes, a few standards are omnipresent, like the Hippocratic Oath not to harm. But, other standards like lung nodule management vary widely among physicians, counties, states, and countries. The Fleishner criteria for managing pulmonary nodules are not standard. Some folks use that criterion; Others use LI-RADS.; And even others use ELCAP. 

I also know some clinicians that modify all these criteria to fit their patient populations. Therefore, it is only possible to standardize standards in an AI computer algorithm when your physician wants to use a different bar from the rest. One great way to lose the radiology business is to make recommendations that run counter to your referrers!

Management Differences Between Places

Different countries have different standards of care. For example, it would not be appropriate to recommend imaging a patient with an MRI of the shoulder in Canada due to lack of availability. Over there, physicians may be more apt to order a musculoskeletal ultrasound. Likewise, a radiologist in Canada may be more likely to recommend a musculoskeletal ultrasound for a possible rotator cuff tear. Yet, an MRI is part of a routine workup in the United States. Why? Because they have a much more significant backlog of patients waiting to get their studies done with fewer MRIs than we do in the United States.

In China, clinicians may regularly recommend “cupping” for different ailments. How can AI programs account for each cultural difference among countries, states, or counties based on availability, preferences, and cultural norms? These obstacles would be exceedingly difficult to overcome.

Differences Between Surgical And Medical Preferences

We work for other physicians. Our role is to make it easier for them to treat patients. And each clinician has specific needs for caring for their population. Oncologists look at assessment criteria differently from surgeons. Neurosurgeons have different interests than internal medicine doctors when they order a study. An AI program needs to consider all these factors when it summarizes findings and makes recommendations. AI is not ready to make different individualized reports for each subspecialist clinician. It would take massive programming power for which it’s not ready!

Differences Among Individual Patients

And finally, even among patients, culturally speaking, some patients want more aggressive workups, and others are more conservative. For instance, I may have a patient who can’t live with a small complex cyst in their breast and wants it drained. Meanwhile, another patient might be more willing to follow it. Some of these differences may be cultural or related to individual differences. How would an AI program account for that? AI is not ready to interpret every patient’s cultural and emotional status to make these decisions. Again, no supercomputer could make these individual recommendations for patients.

A Radiologists Job Is Still Way Too Complex For AI!

Whether it is differing standards, cultural differences, physician preferences, or individual patient preferences, radiology, in particular, is not a one-size-fits-all discipline. No program can consider all of these issues to replace a radiologist within the foreseeable future. The processing power required to figure this out for every clinician’s report would be enormous. Of course, 500 years later, a program may accomplish all these tasks and replace radiologists. But, by then, the same computer will replace every other job, and no trace of humans may exist as the singularity has come and gone! So, for those thinking about entering radiology, keep these issues from dissuading you. Over your career lifetime, you will still have a job!

 

 

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How Do I Choose My Prelim Year? So Many Options!

prelim year

In 1997, I applied for radiology. At the time, I was not quite sure about my future radiology residency career. So, I decided on the best back up plan if I was to bail on radiology. Logically, therefore, I decided to complete a one-year internship at Beth Israel Medical Center in Manhattan in Preliminary Medicine. I considered that at least if I decided to forego the radiology residency, I still had the opportunity to utilize that year as a time that would count toward an internal medicine residency program. In hindsight, it may not have been the best decision for a future radiologist such as myself (although it was an excellent program!). But, it worked for me at the time based on my circumstances back then. Hell, most critically, I got to spend a year in Manhattan!

So, how should you decide on which internship to complete?  Even though I had made a decision one way, and perhaps not the best way, I will give you a few basic concepts that you can use to make that decision. Some of the factors should depend on your goals and desired location. As usual, I will slice and dice the categories to help you, in particular, make the correct decision for your situation.  I will divide it up as follows:

1. Rules for the budding radiologist who is not sure of their future specialty,

2. Guidelines for the future interventional radiologist

3. Advice for the subspecialist radiology.

Additionally, click on this ACGME link for the list of approved PGY-1 years for radiology. (You can’t use pathology to satisfy the requirements anymore!)

What Type Of Internship Should I Chose?

General Radiology (Not Sure What You Want To Do!)

Contrary to what everyone says when they want to start radiology during the interview season, everyone does not want to do interventional radiology. Instead, most folks have no idea what they want to pursue. And that is more “normal” than anything else. So, what is usually the best internship in this situation for the budding radiologist?

Typically, the majority of these folks would benefit the most from a transitional year. Why? It allows you to survey multiple areas within all of medicine. And as most of you already know, radiology also encompasses a good chunk of most medical specialties. So, to see lots of clinical scenarios in different specialties makes the most sense for the average new resident. Plus, these residencies tend not to be as intensive as others (but not always!) Remember, your goal is not to become a practicing internal medicine physician. Instead, you want an excellent overview of the world of medicine.

Interventional Radiology

For those of you that have their heart set on interventional radiology or you think that you will eventually pursue this avenue, I would recommend you to consider a preliminary surgical internship. This internship tends to be the most hours (but not always!). But, it is also the most procedural. And guess what? So is interventional radiology. Therefore, I believe that a surgical internship does prepare you the best for this eventuality. Consider it even though you may need to power through this internship!

Subspecialty Radiology

OK. For the rarer medical student, some of you may have your heart set on pediatric radiology, women’s imaging, or neuroradiology. Well, I can still make a case for the transitional year because of the variety of specialties that will reinforce your radiological education. However, for many of these folks, I believe you could consider a specific prelim year that will support your radiology practice later on in life. For instance, a neurology internship could help with neuroradiology later on. And, ob-gyn could provide a boost to your clinical knowledge if you decide to go into women’s imaging. That’s something to think about if you choose to take this route, and you are sure which subspecialty that you will practice.

Which Location?

As an intern, I will categorize the different sorts of interns into two types — the young and the restless and those that already have a family. And I will advise both.

Young And Restless

For this sort of individual, you should think about not just the type of internship. But also, consider a place where you have can pursue an active lifestyle. Do you want a good dating scene or do you like to go ice climbing in the winter? Try to pick a place where you will have things to do outside the realm of an internship. The prelim year is a nidus for burnout with long hours and occasional irrelevance to a future career in radiology. So, make sure to choose a location where you have a convenient choice of activities to do when you leave work!

Family Oriented

Then, some already have an established family. For these sorts, think about picking a location that would cause you and your significant others to be the happiest during the tough year of internship. Whether it’s excellent schools or finding a place to reduce your chances of repeatedly moving from prelim year to radiology residency, these considerations tend to be different from the “young and the restless”!

Which Should Win Out For Internship- Type Versus Location?

Well, this is the million-dollar question. Often, you can’t have it all. Perhaps, where you want to be where there is no transitional year? Or, the neurology internship is only in specific locales? So, in these more unusual situations, you will make the best of it. You need to make that final decision about what is most important to you in your own life. For me, being in Manhattan was a critical decision for that internship year. But, I can see how the sort of residency could sometimes trump location. It all depends on your life stage and situation.

What Happens If You Make The Wrong Choice?

I have some good news. If you do make the wrong choice, it’s not the end. Remember, it’s only one year (although it can seem like an eternity at the time!). So, if you decide to complete a prelim surgical internship and you choose to work as a diagnostic radiologist instead of an interventionalist, the world will not explode. You will still learn things that you will take into whatever specialty you decide to pursue.

The Prelim Year- All The Options!

So, there you have it, my take on the choices that you should consider for your prelim year. Regardless of what path you select, you will begin anew when you first start radiology. And, eventually, that internship year will become a distant memory. But, at least, you now have the basic guidelines to make the best-informed choice!

 

 

 

 

 

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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!!!