Tag: preparation

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Passed The Radexam Precall Quiz? You May Still Not Be Ready To Take Call!

radexam precall quiz

Ask ten different program directors on how they decide if their residents are ready to take calls and place them in the same room. You will most likely get ten different answers, plus a heated debate (maybe a fistfight or two!) But, I have witnessed some residents who have passed the Radexam precall quiz perform poorly on call. Likewise, I have seen residents with borderline or failing scores on Radexam make a stellar performance when they start overnights. So, what is it that the exam is missing? I think I have it all figured out!

When we look at the skills that you need to succeed at nighttime, there are three general categories: reading, picking up findings, and professionalism. The Radexam tests the first part, knowledge, and I believe it is acceptable for this purpose. But, it leaves out the other two essential categories. Fortunately, most residents are professional, and you can observe their professionalism during their first year, so that category is not usually difficult to assess. However, the ability to pick up findings is a whole other kettle of fish. Some residents can have a vast knowledge base, yet have a tough time making the calls on a film. If you don’t test for it or observe it, you may miss these prospective call-takers. Houston, there may be a problem!

What Can You Do To Improve Your Finding Skills?

If you think you might be in this boat, what can you do to improve your finding skills? Well, several different techniques can help to improve your skills. The first and most obvious way to improve this skill is to read through lots of cases without knowing the answer beforehand. In today’s environment, in some programs, it is effortless for some residents to slide by without having to make any decisions on their own during the first year. These residents will typically either sit by the attending and watch them make all the findings. Or, they will continue to read books during the day without being an active participant in the case. If you want to learn the skill of making findings, passive learning techniques such as these don’t cut it. You need to flip through the cases on your own!

Additionally, you need to use materials that use lots of images. Now, this is a widespread first-year mistake. Many first-year residents continue to study like interns and read lots of materials without looking at the pictures. In radiology, you need to do the opposite. You need to look at lots of pictures and then read the content. To find appendicitis, you should see at least a hundred different cases before you can readily identify it. Some instances are subtle, and others not so much. Looking at all different sorts of examples of a particular disease entity will eventually get you to the point where you can easily make the findings without as much mental effort.

And finally, there is a subgroup of residents who have not read one lick during their first year. If you don’t know what the different disease entities are, how will you find them? However, this group overlaps with the lack of professionalism and lack of knowledge groups. Most residency directors can pick these folks out. And then, it’s a natural remedy. Read more!

How Should Program Directors Test For This Skill?

Direct observation is the key. Just utilizing a test like Radexam only tests the knowledge component and cannot substitute for observing a resident taking real cases.

Now, at some programs, the faculty may not have much time. But that is not an excuse. Testing residents before overnights is the moral and ethical thing to do. How can you allow a resident without the proper tools to take care of patients? It is unjustifiable!

To test residents for finding skills, I typically take a series of 10 reasonable overnight sorts of cases and watch how they perform when looking for the findings. Usually, I make sure that the residents can get about 2/3 of them right. I’m sure there are other ways to do the same thing, but I have found it reasonably simple to find a group of typical on-call cases.

Also, in the real world, you do not have the luxury of infinite time. So, we make sure to limit the amount of time per case. This simple process can quickly identify residents that are falling off the bell curve because they take to long to look at a case.

Are You Ready To Take Call After Passing The Radexam Precall Quiz?

Well, for those of you that are finishing up their first year, right about now, make sure that you continue to go through cases even after taking the Radexam Precall Quiz. If you don’t have a formal method to check whether you are ready in your residency, please make sure to ask your faculty or a senior resident to observe you. Sometimes you need a second set of eyes to ensure you are on the right path. If you want to get an idea of some of the cases for testing in our residency program, I will refer you to the previous years’ pre-call quizzes on this website for a nominal fee. Check them out! Otherwise, make sure to go through your institution’s classic cases without knowing the diagnoses beforehand. This process works to make you a better on-call radiologist!

 

 

 

 

 

 

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About To Start Radiology Residency-What Should I Do To Prepare?

prepare

Here are some scenarios: You’re about to finish medical school, and you’ve matched in radiology.  Or, you are in the middle of your internship year, and you have begun to ponder your next year. If you find yourself in either of these situations, you most likely receive mixed messages on whether or not to prepare for your first year. Some of your “mentors” have probably relayed to you how they readied (if they did anything) for their first year of radiology.

When you hear some of these stories, many of those folks have some hidden motivations. Perhaps, they want to appear like they know it all. Or maybe, they want to make it seem like their decision was the right one. (Even though it may not have been) So, please listen to me. Having seen many incoming waves of medical students and residents coming through the department, I will give you the real lowdown. Here’s what you need to know when you start.

Should You Read Anything Radiology Related Before Starting Radiology Residency?

The short answer is yes. But, of course, I will go into a little bit more detail than that!

So, what do you need to know before beginning? For everyone, if nothing else, I would recommend that you at least relearn basic anatomy. Why is that? Since it is difficult to know what you need to learn in radiology when you have not entered into the field yet and radiology is so “anatomy intensive,” you are better off starting by reinforcing the general anatomy that you learned in medical school. For general anatomy, an anatomy book like Netter that you used during medical school will help you to recall the basics.

However, instead of learning anatomy the same way as your medical school course, I would take more of a cross-sectional anatomy approach. To do so, make sure to find a decent cross-sectional anatomy book to supplement Netter. Not only can you use it to learn cross-sectional anatomy, but this book would also be an invaluable reference source during residency and beyond. Even now, as an “old-timer,” I often use the Atlas of Human Cross-Sectional Anatomy: With CT and MR Images whenever I need a reference. A book such as this almost “pays for itself.”

Why is it so important to have a cross-sectional anatomy book to study? Well, that is how most of us radiologists interpret images. You need to know the anatomy to catch the pathology. So, when you begin, you will have the tools to learn the basics of radiology rapidly (since we are an anatomy intensive specialty!). If you prepare your cross-sectional anatomy before arrival, you will have a certain headstart over your colleagues.

How To Go About Additional Radiology Reading Before Starting Radiology

Fourth Year Medical Students

Since fourth-year medical students typically have a bit more time on their hands, what material would I recommend if you want to learn more than just cross-sectional anatomy? First, you can review the essential medical student texts like Learning Radiology. These sorts of books tend to contain the most basic information like how to read chest films, and so on. Also, they will review the essentials of the primary radiological modalities that you need to know.  However, these texts will not go into enough detail to make you stand out.

But, if you are even more motivated, consider looking at the pictures and captions in a book like Brant and Helms. Then, you can review the subtext to reinforce the images. But beware! It is a long series. And, believe or not, even though it is long, it does not cover enough of the information you need to know to prepare. Most importantly, however, do not get discouraged if you cannot complete it. Any bit that you accomplish before starting residency helps.

Interns

OK. For interns, the first step is to make it through the year. You are probably going to be exhausted and lucky to pick up anything additional to read. So, I would probably stick with reviewing some basic cross-sectional anatomy at this point. In general, lack of time will prevent you from reading through a Brant and Helms type of book. But, if you feel you must go for it, by all means, try to read a little bit. Just don’t push it!

Final Advice On How To Prepare For The Beginning of Radiology Residency

Finally, my last bit of wisdom for the pre-radiology resident is that what you are doing now is very different from your radiology career! So, don’t wrap yourself up in the miseries of your clinical year. Remember… Your life will be very different from your medical colleagues. So, soldier forth, read a little bit if you can, and before you know it, the year will be over. Follow my advice, and you’ll grasp what you need to prepare to start your radiology residency!

 

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How To Present A Great Case Conference

case conference

During residency, you must choose a case to present to your colleagues or faculty in a formal setting. Many of you will be flying by the seat of your pants without instruction on how to do so. So, how do you select which case from the past week, month, or year? What features make up an excellent case for discussion at a case conference? And what exactly should you discuss during the presentation? These questions and more I will answer as we discuss how to present a great case conference.

Which Case Should I Choose?

On any given day, you will encounter multiple cases that have the potential to become excellent cases for a conference. Some studies may have confounded you or your faculty. Other times, your attending may love a case for some reason. Then, your attending may want a classic case of a particular disease entity. In these situations, how do you pick among all the possibilities?

Typically, I look for cases on a particular theme I want to address. Even better, the study may have addressed several points that created interesting discussions or controversies. Then, I check to see if the case runs through multiple imaging modalities. What do I mean by that? The best cases show a particular diagnosis in many different ways. For instance, say you are interested in showing lung cancers at this specific time. So, a perfect case would be a lung nodule on plain film that the hilum may partially hide. Then in the same study, you have a CT scan showing the mass abutting the hilum with subtle adenopathy within the mediastinum. And perhaps you also have a PET-CT scan demonstrating additional hypermetabolic nodes present on the scan and a hidden osseous hypermetabolic lesion in a vertebral body. Cases that show a finding or related findings in multiple modalities reinforce the subject matter well.

How To Prepare For The Discussion

So, you’ve found this extraordinary case. First, make sure that you can describe the findings appropriately. If you have less experience, you may want to run it by a faculty member or senior resident to confirm that you are conveying the description correctly.

Next, like any good physician, you should read on the topics extensively. In the case I described above, you need to read about lung cancer diagnosis, staging, and treatment basics. Additionally, you should learn how the radiological diagnosis affects the management of the patient. For instance, how does the presence of hypermetabolic nodes and a vertebral body lesion affect the outcome of the patient? Ultimately, you want the listeners to perceive you as the expert on this topic for the presentation.

Moreover, you want to be able to answer almost any question thrown at you. In other words, go to town! By reviewing the topic extensively, in essence, you are not only going to improve the discussion and your ability to answer questions, but also you are studying for the boards at the same time.

What Should You Discuss At The Case Conference?

The lung nodule example above lends itself well to discussing the findings on each of the modalities, the differential diagnosis, the final diagnoses, and the pathophysiology behind the final diagnoses. Furthermore, the topic will lead to basic management principles like how vertebral lesions change treatment.

I would first review the findings similar to the standard logical approach of taking cases. And then, I would discuss the differential diagnosis and the management in that order, just as if you were taking a case during a faculty presentation. If you want to make the case conference a bit more spicy and controversial, you can discuss whether the case met the ACR appropriateness criteria for the symptoms given. Usually, you will get multiple opinions from different attendings if the ordering physician approaches the workup correctly. It would help if you strived to guide the discussion to ensure it follows an appropriate path. With a case like this, the debate can ensue for a while!

Case Conference As A Tool For Learning

You primarily need to remember the end goal whenever you create a conference. In a typical case conference setting, the presenter should want the audience to learn a few essential points by the end of the discussion. Too much information will overload the learner. Likewise, too little information may not reinforce the concepts. So, try to strike a balance after discussing the specific case.

In the end, you should view case conferences as a tool for learning, not as a burden. They are opportunities to learn a topic in great detail and the art of presenting. Moreover, each presentation you perform builds upon the knowledge that you have. I still remember the case conferences I created when I was a resident. Just like I did, if you prepared appropriately, you will use the strategies and information you learned from your case conferences when you become a faculty member yourself many years from now!