Tag: radiology residency

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DO Or Foreign MD- Which One Is Better For Radiology?

foreign md

Each specialty looks for different skill sets and activities when selecting candidates for residency. As part of an admissions committee, institutions scour dean’s letters, recommendations, board scores, volunteer activities, and more to ensure that the candidate makes it through rigorous residencies. However, one of the most “in-your-face” factors that most residencies cannot overlook is the degree applicants have completed. Yes, it is a soft criterion because a suitable candidate can graduate from most foreign MD programs or DO institutions in the United States. Nevertheless, it can become an issue, especially when the committee is not sure of the quality of the medical school.

So, for radiology residency specifically, which degree stands out as the best for applicants? And, which one gives them the best chance of getting into a radiology residency program? I will break down the different degrees into Caribbean MD, Other Foreign MD, and DO schools to accomplish this feat. For each, I will give you the insider advantages and disadvantages. Then, I will provide you with my opinion of the rank order based on the objective facts of each degree.

Top Tier Caribbean MD Schools

Within the Caribbean MD schools, there are undoubtedly several tiers. First of all, we know the quality of St George’s institution since we have had a relationship with them in the past. And, we know that a top student from this school performs at the level of most United States medical schools as we see in our program. Moreover, many other program directors feel the same way from what I have heard. Unfortunately, many medical schools nowadays are biased against Caribbean graduates, even St. George. Many large prestigious academic institutions won’t even touch one of these applications unless the applicant is an exception to the rule.

Furthermore, with the AOA (American Osteopathic Association) combination with the ACGME (Accreditation College For Graduate Medical Education), having a DO degree is no longer a disadvantage for getting a residency. DO residents no longer have to complete separate osteopathic internships and osteopathic accredited residencies. So, Caribbean residents have more competition than ever before to get into ACGME accredited residencies. But, at least, the Caribbean schools with a known reputation can help these applicants secure a spot.

And then finally, the new Step I board pass/fail non-scoring criteria will prevent radiology residency programs from assessing incoming students’ test-taking acumen, which correlates with passing the radiology boards. Therefore, residencies will be more wary of accepting a Caribbean student, even from a top-tier program, especially without knowing if they are a good test taker.

Other Foreign MD Schools

For other foreign MD programs, residencies have the same problems. It’s a problem of familiarity. What does a degree from a Taiwanese, Indian, or Iranian institution mean? This problem is even more complicated than the top-tier Caribbean schools (where we are more familiar). How do we know how students compare to United States schools that graduate? Perhaps, a few institutions do break this mold. But for the most part, we cannot figure out where a candidate stands. Nor do we have the time and energy to tease that out. Primarily, we don’t need to when programs have so many excellent United States candidates to choose from nowadays.

Additionally, the ACGME combining the AOA and the new Step I board pass-fail criteria will make it much more difficult for these students to secure a radiology residency slot due to the increased competition.

DO Schools

Today, many MD radiology residency programs still have a bias against DO candidates, especially at larger academic institutions. Nevertheless, all DO schools must meet the same criteria as MD schools since the AOA and the ACGME have combined into one organization. Therefore, even at the most questionable United States DO institution, theoretically, we should know the baseline training of the medical student applicant. We cannot receive this same assurance from a foreign graduate school.

Moreover, getting rid of the Step I board scores will have a negligible effect on these applicants. Why? Because we have an idea of the baseline quality of these US accredited schools.

So, What’s The Final Ranking Of DO AND Foreign MD Degrees For 2022?

From best to worst chance of securing a radiology residency spot:

  1. DO Schools
  2. Top Tier Caribbean MD Schools
  3. Other Foreign MD Schools

 Just a few words of advice, because you may have graduated from a lesser-known foreign medical school does not mean you have no shot of acquiring a radiology residency. And, if you are coming from a top-tier United States medical school, it does not mean you are guaranteed a spot. But, the type of program you are coming from influences the chances of getting in. You were wondering about probabilities, right?

 

 

 

 

 

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Should I Address My USMLE Step II Score Drop In My Statement?

score drop

Question:

Hello – I’m actively interested in applying for DR residency, but I was let down yesterday after receiving a Step 2 score which dropped 11 points from my Step 1 (230 –> 219). I’m a DO student, and I’m afraid this will be a red flag that will become detrimental to my application for a radiology residency. I planned to address this score drop in my personal statement, as I’m sure programs will wonder why it happened. I believe my Comlex Level 2 exam went very well. However, I haven’t received that score yet, and I’m not sure PDs even care about it. Do I need to apply to a backup specialty?

A Worried Candidate

 

 

Answer To How To Deal With The Score Drop And More!

I wouldn’t throw in the towel quite yet. You have to remember that there are so many factors other than board scores to add to the equation of getting into a radiology residency. Moreover, many residencies use a cutoff of 220 or higher on the step one exam. So, you will most likely get a decent number of interviews as long as your other application credentials are OK. (not having those I could not tell you where to apply)

Also, you are right about the COMLEX scores. Most programs do not care much for those scores because it is harder to compare to everyone else taking the USMLE examination. So, I don’t believe that it will change your chances of acceptance all that much.

Finally, being a DO does not hurt your application as much as it had in the past. Now, the ACGME and the AOA are one organization, so you are no longer as much of a “second class medical citizen.”

One more critical point about your personal statement that you mentioned: I would not be so keen to address the score drop. (unless there was some major life crisis that could have affected your entire application). It would call more unnecessary attention to your board scores. To begin with, really, your step I score was not so bad. Instead, it shows that you have the potential to pass the core exam. (what most residency directors care about) Your personal statement would better serve you by talking about all the other issues that I discuss in my blog called How To Create A Killer Radiology Residency Personal Statement. Make sure to read or reread it before submitting your residency personal statement.

 

 

Let me know how everything goes,

Barry Julius, MD

 

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Top Ten Differences Between A Senior Resident And Radiology Attending

differences

You may be more than halfway through your residency program or about to graduate residency. And it may feel like you have been through the wringer. Not only have you made it through the call, but you have also studied all the minutia that you need to know to take the core exam. So, can life change that much more when you become an attending? I mean, it’s only a few years or less away. Well, for your education (and entertainment, of course!), we will go through the top ten differences between a senior resident and an attending. Let’s go from least to most noticeable!

Shallower Breadth And Increasing Depth Of Knowledge

Believe it or not, beginning a full-time job still changes what you know. Remember all that detailed information from the case review series and the survey books? And, of course, all that detail you learned from studying for the core examination? Where does it go? Let’s put it this way; your brain begins to trim out what you no longer use. So, that full breadth of knowledge you learned from studying for your core exam? Yes, gone! Instead, one of the biggest differences is that you remember the relevant information you need to know daily for your specific areas of expertise.

You’re Now The Expert

For the first time, you da’ man (or woman!). Regardless of your feelings, your colleagues see you as a guru in your specialty. A very different feel from your previous work as a resident or fellow in training!

Horses First, Then Zebras

As an attending, you know what you see because you have experienced it many times. The zebras only come out when you have exhausted all the horses first. Usually, not the case for residents!

Patients And Doctors Want To See You!

No longer are you an intermediary in the way of your attendings. Patients and doctors ultimately want to hear from the man or woman of final reckoning in the report. And that is you! Feels good to be desired. One of the biggest differences!

Need To Get A Move On!

No longer can you rest on your laurels as you did as a resident during the daytime. You have a job to do, and it must get done. If not you as an attending, then who? A hundred cases? If they do not get read by the end of the day, you hear and see a queue of angry clinicians and patients!

More Vacation But Perhaps Not At The Best Times!

You may notice that you took a vacation during residency, usually at the standard times- Christmas, spring break, or summer. And although the residency required some coverage from one or two of your fellow residents, most could still take off at those times. Well, alas, this is all about to change! And although you may receive more vacation in general, your practice will still need significant coverage during these favorite vacation slots. And who needs to work at these times? You!

Increased Liability

In the end, no longer can a senior cover for your mistakes. You are coming onto a shift in the morning and looking at the night resident’s dictations. Well, you own them. His and your mistakes are your problems! Miss cancer, your reputation, license, and nest egg are on the line!

Loans Come Due

You think all the money you earn as an attending is your own, right? Wrong! On day one, as you start your first job, the loan servicers ask for their due. Forbearance of your loans is no longer an option. Thousands of dollars per month only to service your student loan debt. Welcome to the real world.

Increased Pay

Imagine rolling along for years at a time, garnering biweekly or monthly paychecks, and coming home with a few thousand dollars a pop. And, then suddenly, Whoosh! You notice that the direct deposit fills your account with something more substantial. Feels good, doesn’t it?

Expenses Rise

Now for the bad news. The more significant paycheck comes with more considerable account drainage from those expenses. Those larger paychecks suddenly drain rapidly from your bank account with new costs from a new house, car, loan payments, and child care. Where did all that increased pay go?

 

Final Thoughts About Differences Between A Senior Resident And A Radiology Attending

So, there you go. Perhaps, not what you thought? Or, maybe it was? Regardless, now you know what to expect to change once you graduate!

 

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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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Want To Improve During Radiology Residency? Think Small!

improve during radiology residency

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

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

Allow For Small Imperfections

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

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

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

Setting Achievable Specific Goals

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

Want To Improve During Radiology Residency: Think Small!

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

 

 

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Radiology Residency Chain of Command

radiology residency

No, we are not the military, but there is a radiology residency chain of command! Lots of different entities in radiology residency are responsible for your day-to-day activities and training. It is more than your faculty and program directors. It is a whole hierarchy. And, it is was not until later on in my career that I understood the roles that each of these entities played in managing a residency program. But, it would have been nice to understand it all from the very beginning and know who to address for each radiology residency issue. To that end, in today’s post, I am going to define each of the different titles and offices in charge of your radiology residency training and describe the parts that they play. For fun, each role I will associate with a military position! Let’s start at the bottom and work our way up.

Radiology Resident (Private)

A radiology resident is the “lowest” but the most integral part of the chain of command. It is his/her responsibility to be trained in the art and science of diagnostic radiology during the four years of residency. To become a member of this club, he/she needs to graduate from medical school and complete one year of clinical training. After that, he/she answers to all the other “higher” positions listed next!

Radiology Chief Resident (Corporal)

Typically selected by the residents and program directors, this person is the first rung in the ladder of the radiology residency command (also previously discussed in a prior post). When there is a fundamental residency level issue or problem, he/she rises to the occasion. The chief resident is often responsible for scheduling, board reviews, interclass conflict, drinks with peers, performance issues, and noon conferences. In addition, any residency program issue that does not need to go to the attending is under the purview of the chief resident. And, the chief resident is also responsible for communicating faculty-related issues to the residents.

Radiology Residency Coordinator (2nd Lieutenant)

He or she is responsible for the day-to-day running of a residency program but is typically an administrator and not a physician. Most residency coordinators make phone calls, transcribe letters of recommendation, report issues to the faculty, send out evaluations, deal with class conflicts, ensure that the learning portfolios are complete, arrange end-of-the-year parties, and more. Some play a significant role in admissions committee screening. And, the coordinator is often the first-line resource for radiology residents when they have issues with colleagues or attendings. The radiology residency coordinator is an integral part of a radiology residency. (I think of this person like the Class Mom/Dad)

Radiology Faculty (Captain)

Full-time faculty members are responsible for the direct and indirect supervision of residents. The ACGME guidelines require all faculty members to teach. In addition, there are specific minimum numbers of faculty members that are necessary to run a residency program. Teaching involvement, however, varies widely by each faculty member. Residency programs expect all residents to follow the faculty lead when it comes to reading, procedures, and training in any of its forms.

Radiology Section Chiefs (Major)

This designation can be a bit technical. Theoretically, the radiology section chief for a radiology residency program can be different from the head of the section in a department. However, these individuals run the individual subspecialty rotations for a radiology residency. Individual faculty members answer to their respective section chiefs in one of many academic areas. The section chief may also perform many other duties such as setting up protocols for technologists, introducing new procedures, signing off on resident competencies and curriculums, ensuring that the subspecialty curriculum is appropriate, and more.

Associate Program Director (Colonel)

Although not an official designation by the ACGME, the Associate Program Director is the second in command for running the residency program. Suppose there are issues that the radiology chief resident, faculty, coordinator, or section chief cannot take care of. In that case, these problems fall into the lap of the Associate Program Director. He/she is also responsible for curriculum planning, enforcement of residency rules and regulations, maintaining education quality, dealing with residency conflicts, answering both the program director and the residents, and more. The Associate Program Director shares these responsibilities with the Program Director.

Program Director (1 Star General)

The ACGME designates this individual as director in charge of the residency program. He/she is ultimately responsible for most issues that occur during a radiology residency. In addition, the radiology Residency Program Director signs off on each resident that he/she is competent to practice diagnostic radiology after graduation. Clinical activity for this individual varies widely depending upon the program’s size, but most have some clinical duties. However, all Program Directors are responsible for monitoring the clinical teaching in the residency program and administering the radiology residency. So, this person is ultimately accountable for a radiology resident’s training.

Radiology Department Chairman (2 Star General)

The Radiology Department Chairman is the head of the entire radiology department. This person is responsible for dealing with all faculty issues and indirectly will usually help with radiology residency administration issues. When there are complaints about individual faculty members, new radiologists to hire, budgeting, and high-level resident problems, this person steps in to help manage the situation. Frequently, the program directors will consult with the chairman before making important decisions. The chairman sometimes holds the purse strings for some residency programs.

Designated Institutional Official (DIO) And The Graduate Educational Committee (GME) (4 Star General)

The DIO is the head of the hospital GME Committee. The radiology residency program director answers to the DIO for program-level issues and high-level resident issues. The types of problems that a DIO will often work with include accrediting residency programs, monitoring pass rates for programs, dealing with probation and suspension of individual residents, checking residency action plans, adding complements to residency programs, and more. In addition, he/she often gets involved in legal residency issues. And, this is just the tip of the iceberg. Typically, this is a full-time administrative position that is very busy! Individual programs bring many of these issues to the DIO’s attention, and they are subsequently voted upon by the GME Committee for approval.

American Board of Radiology (ABR) (Military Service Chiefs)

The ABR is a private organization in charge of testing for minimum competency for the individual radiology resident. All radiology residents need to pass the boards administered by the ABR to become board-certified radiologists. Although they are not directly in charge of residency issues, they play an essential role in determining the curriculum for the individual radiology residency program since they create the board exams (the core and certifying examinations more specifically).

Accreditation Council For Graduate Medical Education (ACGME) (Chairman of the Joint Chiefs of Staff)

Now we are talking high-level!!! The ACGME is a governmental-run body that is the watchdog of residency programs, a diagnostic radiology residency program. This organization accredits each radiology residency program. They have the power to put a residency on probation or suspension. As part of the ACGME, other committees, such as the Radiology Review Committee (RRC), are responsible for setting up the individual radiology residency guidelines and requirements. They are responsible for making the maximum duty hours, faculty requirements, and more. Overall, most residents do not have direct contact with this organization. However, it is crucial to follow the ACGME rules for the individual radiology resident to graduate from an accredited residency.

Now You Know The Hierarchy

That just about covers the basics of the different levels of responsible parties for a radiology residency program. Even though some institutions have additional positions that also play a role in managing a radiology residency, the ones I described are usually the most important. (Just don’t tell that to the research manager or the radiology liaison!) Of course, additional levels can get quite complicated. But at least you have the basics of who to turn to when you have a specific issue or question. So now you know your ABCs of the chain of the radiology residency command!!!

 

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The American Board of Radiology- Shame On You

Has the American Board of Radiology (ABR) finally thrown up its hands and said it can no longer do its job? That was the take home message from my recent excursion to the AUR meeting. The explicit role of the American Board of Radiology is to standardize the quality of trained radiologists throughout the country. In fact, if you read the mission statement of the ABR website you will read verbatim- “Our mission- to certify that our diplomates demonstrate the requisite knowledge, skill, and understanding of their disciplines to the benefit of patients.” What are the most crucial skills in order to become a radiologist? Well, two of the most important pillars for creation of a competent radiologist is medical knowledge and communication. For the first time at this meeting, the ABR explicitly stated that they will abandon the role of testing radiology resident communication skills and will leave this responsibility for maintaining minimum standards to the individual programs while continuing to standardize testing of medical knowledge. What???????

If you leave the responsibility of testing and maintaining communication skills to individual programs, you are certainly not ensuring the baseline quality of our future radiologists. There are no accrediting bodies out there that can ensure the outcome of training as well as a governing/testing body such as the ABR. Without the lead of an accrediting board such as the ABR, I can see wide variability among different programs in the ability of residents to dictate and communicate results to their fellow clinicians. Some residencies will shine and produce a resident product that will competently communicate results to clinicians and others will no longer create residents with the minimum level of communications skills since there is no impetus to do so. We no longer have an oral board exam that can assess some basic communication competencies. How can the ABR accrediting body support such a position?

Government funding for medical education is at an all time low and hampers the ability of regulating bodies to do their job. Now we are leaving the responsibility of the ACGME/RRC with less teeth and funding to regulate these competencies? On the other hand, the ABR is funded by private radiology resident and radiologist dollars. Each of us spends thousands of dollars on getting and maintaining board accreditation during our lifetimes. And with all this money being spent, the ABR is saying that they cannot ensure a minimum communication competency. This is absurd.

Other licensing boards are actually moving in the opposite direction because they know it is the right thing to do for patient care. For instance, the USMLE has added on a clinical skills section to their test because creating doctors that can’t assess and communicate results to patients makes no sense. Why should testing by the ABR in the field of radiology be any different?

Please ABR… Step back and think about your position on testing communication skills. If you want to stay relevant in today’s day and age, there are other accrediting bodies out their that may take on the role of maintaining standards if you can’t do so yourself. Rethink your position statement and honestly reassess if it is in the best interest of the radiology community to forgo testing of minimum competency in communication skills. I don’t think so.

 

 

 

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The 2017 Annual AUR Meeting- A Radiology Residency Status Report

Each year in the heart of spring in the United States, academic/teaching radiologists get together at a different part of the country to discuss the newest teaching methods, radiology residency issues, and hot academic topics at a meeting called the annual Association of University Radiologists (AUR) meeting. For new applicants and radiology residents, this meeting is extremely important as it outlines significant changes to the training of radiologists throughout the country. This year is the first annual update from Hollywood, Florida. I am going to go over what I think are the most relevant and important topics at this conference for radiology trainees.

Increasing Competitiveness of Radiology Residency

Traditionally, it is somewhat difficult to measure competitiveness of radiology residency compared to other specialties. One of the more accurate methods is the United States senior U.S. fill rate. Since 2014, there has been a gradual uptick in the senior U.S. fill rate to 72% (last year 68%). In addition, the applicant pool is up 31 percent over the past 4 years. So, it appears that all this talk about artificial intelligence has not yet dampened the enthusiasm of radiology candidates!

There are always two sides to every story, however. Since U.S applicants usually get first priority, it is a bit more difficult for international medical graduates (IMGs) to get radiology residency slots. In fact, on a survey at the AUR meeting, it stated that only 64 percent of programs are willing to take international medical graduates. That number tends to go down as radiology becomes more competitive. Furthermore, programs are no longer able to accept foreign non-ACGME accredited preliminary year internships to satisfy the requirements of the clinical year.

Improving Radiology Job Market

According to the recent AUR survey, practices are increasing both new and current radiology job hires. In fact, projections show an increasing number of available jobs numbering about 2000 today (vs. 1300-1500 jobs a few years ago). The most popular specialties are body imaging, interventional radiology, and neuroradiology.  However, practices need breast imagers, interventional radiologists, and neuroradiologists the most. And, the majority of jobs are in private practice. That being said, large corporate practices do continue to increase hiring radiologists the most.

IR/DR and ESIR

Now that IR/DR is its own distinct specialty, it commanded a fairly competitive match this year. For this subspecialty, the fill rate with U.S. seniors was 85% versus 72% for diagnostic radiology. So by all accounts, the match was fairly successful. In addition, many new residency programs are applying to start up both IR/DR and ESIR programs. Both of these programs allow a resident to complete his/her entire training in 6 years. Unlike radiology residencies willing to add on these programs, residencies that do not start up IR/DR and ESIR programs will force their residents to have to complete a total of 7 years of residency/fellowship for interventional radiology trained subspecialists. Accordingly, those residencies not willing to add either ESIR or IR/DR programs are likely going to have difficulty recruiting new residents.

Rad Exam

The current in-service examinations do not correlate well with resident performance. In fact, many residencies (including my own) cannot utilize the test as a determiner of residency performance given the wide variability. In addition, there is no distinction in the testing questions between different residency levels. To remedy this issue, a new crowd sourced examination call Rad Exam is being created with institutional benchmarks and a large database. Time will tell if it becomes a useful examination to replace our current in-service examination, but it sounds very promising!

Simulation

Although not a discussed in conference at the AUR meeting, a vendor called Simulation was present and had an interesting solution for programs that want a structured precall examination. This company created an excellent standardized test that assesses finding and interpretive skills using a simulated PACS system to help define if a resident is ready to partake in independent call. Additionally, the test is benchmarked to other programs. It seems like it may be significant improvement over the current precall testing options.

ABR Core Examination Frustrations

Interestingly, according to faculty surveys, most faculty members reflect fondly upon the old oral board examination and give low marks to the new core examination as a means of  testing residents to meet basic radiology requirements at the end of their 3rd year. However, even more disappointing to me, the American Board of Radiology (ABR) now takes a new formalized position that they have no role in testing communication skills. In fact, they explicitly stated that their only role is the testing of medical knowledge. According to them, communication skills should be taught at the local residency level.

Call me crazy, but radiology is a specialty of communication, both written and oral, and not just a specialty of medical knowledge. If that is the case, does it make sense that the ABR as an accrediting body is not willing to standardize testing for communication skills as well as medical knowledge to establish a baseline level of competency? I think not. Academic radiologists need to push the board to change their stance regarding communication competency standardization with oral/written board testing!!!

Increasing Required Administration Time For Program Directors

And finally, on July 1, 2018, the ACGME will likely approve an increase in the minimum administration time requirements for program and associate program directors. Presently, program directors at small programs in the United States can have a few as 0.2 FTE time dedicated to radiology residency administration. That number is ridiculously small compared to other medical subspecialties. Now, that number is going to increase based on a sliding scale corresponding to size of programs in July, 2018 assuming approval by the ACGME. How is that going to affect incoming radiology residents? I believe it will significantly increase the productivity and efficiency of residency programs on issues as wide ranging as educational conferences, evaluations/assessments, milestones, and more… It has been long since overdue.

Summary

As I see it, these are some of the most pressing issues tackled at the AUR conference. There are certainly other issues faced by academic radiology programs. Some of them mentioned at the conference and others largely ignored. There is a bit of good and bad news from this conference for everyone involved in radiology residencies throughout the country. Until next year at the AUR meeting in Nashville, Tennessee!!!

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Ten Surefire Ways To Destroy Your Radiology Experience (And Your Colleagues’ Too!!!)

radiology experience

I have seen it all. Some radiology residents make sure to glean every last drop of radiology experience from their residency so that by the time they graduate, they are ready to hit the ground running. But then other radiology residency graduates never quite live up to their full potential during their residency training. Many of these folks are great people, but when they are about to leave, I am not quite sure if they will handle the pressures of radiology practice.

In the end, I have learned some residents are late bloomers and do pull themselves up by the bootstraps once they leave residency, but a large percentage unfortunately constantly shift from job to job. Many of those folks are the same ones who seemed to do whatever they could to destroy their own residency experience during their four years of residency. And yes, we hear about them again when the paperwork comes back to us each time they change jobs when out in practice. Today I figured I would talk about those characteristics that are a surefire way to ruin your residency radiology experience. Don’t make those same awful mistakes!

Sweat The Small Stuff

In the heat of battle, it is effortless to forget the end goal of radiology residency, to be well trained and ready for practice when you leave. Remember… residency is only a 4-year experience. However, some residents get caught up in the moment and forget about the end game. They concern themselves with relatively minor things such as rising prices in the cafeteria, having to do a few extra shifts, or hearing some disheartening comments from one of their annoying colleagues. Sure, there is a place and time to worry about those things. But, it should not become an all-encompassing mission. Some never get over these issues and forget to learn what they need to know when they leave residency. In the process, they also upset their colleagues, distracting everyone from their training. Get over it!!!

Argue With Your Colleagues

Some residency classes always get along. Others have permanent hatred toward one another. The inability to get along spills over to other areas in a radiology residency. Studying suffers because some folks are left behind, and no one seems to care. Tempers flare and prevent classmates from covering each other when they need it. Everyone becomes exhausted and upset. Next thing you know, residency is over, and everyone is worse for the wear. Do whatever it takes to get along! It is not worth four years of frustration!

Sabotage Your Team

Every once in a while, one resident does not play fairly in the sandbox. Perhaps, he/she refuses to help out with a call. Or maybe, this person does not show up to work and constantly needs to have additional coverage. Not playing nicely with others affects the entire team. If you want to ruin the experience for everyone, it is elementary. But in the end, it will haunt you when you need your residency team the most!

Don’t Read

Radiology residency is a marathon, not a sprint. That means you constantly need to keep up with reading books and articles. I can guarantee that you will fall behind your classmates if you do not adequately read enough starting year one. You will not comprehend or perform well at conferences. Likewise, your call and board experiences will suffer. And, your colleagues will not want to have you’ve as a study partner since you are so far behind. You came to radiology residency to become a radiologist. Part of learning radiology is reading a lot. Why would you want to sabotage your training?

Always Compare Yourself To Others

Everybody learns and reads at different rates; and, some residents click with the material earlier than others. That is OK. As long as you are doing your due diligence during radiology residency, you will eventually get to the promised land of radiology competence and graduation. Don’t worry if some of your colleagues always seem to get things right and you don’t. The quickest path to misery is worrying about how everyone else is doing. Undue competition ruins the experience for everyone. Care first and foremost about your progress!

Don’t Show Up To Readouts

There are two main pillars to becoming a great radiologist, knowing the material and experience. If you were going through the hassle of completing a residency, why would you shortchange yourself and not try to get as much experience as possible? You will never understand the context of reading radiology without having the readout experience. Not being at the readout also affects your mentors’ day. Sit down with your residency mentor, and don’t miss the readout. You are only hurting your career and your relationship with your superiors. You never know when you will need their recommendations!

Do Not Improve Upon Your Weaknesses

You have been getting inadequate evaluations in the area of mammography. So, what do you do about it? Nothing. The complaints continue to come streaming in from attendings. But, you persist in not reading the material or studying your misses. Behaviors become habitual and will likely continue even after you graduate if you do not learn from your mistakes. These folks are the same folks that can never keep a job and never improve their lot. Ignoring practice-based improvement hurts you, your patients, and your colleagues. Residency is all about self-improvement to become the best you can so that you can help your patients. Why would you not pursue the same avenues during training?

Procedures Are Not For Me!

Some residents hate procedures and will do whatever they can to avoid them. I understand these folks may not become interventional radiologists. But, they still need to know the basics of specific procedures such as needle localization, arthrograms, and more. Sure, they can get away with this during residency. But, when they try to land their first job, they may have frustrations as they find the only jobs available require “light interventional” work. Not learning procedures may affect your future partners and colleagues. By not trying to feel comfortable with procedures during residency, you are only hurting yourself!

I Am Always Right

Some residents do not accept criticism. Residency is the time to learn and change harmful behaviors before they become ingrained in practice. We are in the game of treating people, not always thinking we are correct. Why would you not want to correct what you are doing wrong? It makes no sense. You are only hurting your patients and colleagues. There is no room for not accepting criticism both during and after residency!

Don’t Take On Extra Responsibilities

Each year of radiology residency, you accrue new responsibilities. Shirking your responsibilities is a surefire way to become a needy radiologist when you graduate. When the technologist comes along to ask a question, please don’t send them to someone else to answer it. Take charge of your situation and section. Those folks that never take on those additional responsibilities never learn to become an independent radiologist!!! Go forth and makes your path.

Avoid Destroying Your Residency Radiology Experience

It is far easier than one might think to destroy your own residency radiology experience. Sometimes you have to put a bit more effort in to get more out of residency. Please, please, don’t succumb to the pitfalls and traps that can prevent you from growing and improving as a person and a radiologist. Get over your issues… It is not worth it!

 

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Five Reasons Why The First Year Of Radiology Residency Can Be The Most Difficult

first year

Second-year radiology residents become overwhelmed and burdened by call. Third-year radiology residents feel exhausted from studying for their core radiology examination. And, the fourth-year radiology residents fret about all the things they need to know before starting their career. But, what about the plight of the first-year resident? Many non-radiology physicians and some long-practicing radiologists think that these residents have it easy since he does not have many responsibilities. He can merely sit and watch the radiology attending to learn the practice of radiology, right? However, in this post, I am going to dispel that notion. I will go through five reasons why I think the 1st year of radiology residency is usually the most difficult.

Little Medical School Background In Radiology

Unlike internal medicine, surgical, ob/GYN, and psychiatric residents, most beginning first radiology residents have had almost no experience in the mechanics of all things radiology. Sure, they take a few courses during medical school. However, they are usually surveys. Also, they do not provide the vast experiences needed to function as a full-fledged radiology resident.

On the other hand, internal medicine residents have worked up patients with histories during their medical school training. Ob/GYN residents have usually delivered a few babies in medical school before beginning. Surgical residents have assisted in multiple surgeries and have worked the floors before their first day of residency. And psychiatry residents have interacted with numerous patients before starting. These initiated residents can almost entirely function from day one.

Instead, new 1st-year radiology residents cannot dictate, review films to be read, or finish the procedures that we perform daily. Since a first-year radiology resident cannot complete most of the functions to be “of use” to the senior radiologist, many first residents feel inadequate until they can begin call as a second-year. At that point, they can function much more independently. However, the lack of training certainly can make for a problematic initial year.

Incredible Amounts of Reading For The First Year

More so than other specialties, radiology requires a boatload of reading during the first year. You need to understand internal medicine, surgery, obstetrics/gynecology, orthopedics, neurology, and more to become a respectable radiologist. Unlike other specialties, you cannot get away with little reading and learn only from your experience with others. If you do not read for hours every day, you will fall behind and not pass the core examination. Many residents do not know the requirements before starting and take a long time to adjust to the nightly reading regimen, a painful process.

Dictations- A Difficult Road

Imagine your frustration as you first start with never having held a Dictaphone. You click the wrong buttons and feel unsure of yourself as you talk into a stick!!! This routine is typical for the first year that starts to dictate. Not only does the first-year resident have to get the physical mechanics of learning dictation, but they also have to create a report that makes sense. This process often occurs with little instruction or regimentation. It becomes hard to put ourselves in the shoes of the first-year resident. However, as an associate residency director, I regularly recognize how hard it is to start from scratch what we routinely do as radiologists daily.

Frustrated Attendings Who Don’t Want First Years Around

Unlike more independent senior residents, radiologists typically have to take extra time out of their day to teach a first-year radiology resident. Given the increasing workloads of radiologists, many attendings see this as a burden. They would instead get home to their family on time in the evening. Additionally, the attending does not know the first-year resident well. Therefore, he cannot figure out how much responsibility to give. Other radiologists feel forced and have no desire to teach. The frustrations of many attending radiologists reflect in the personal interactions with the first-year resident. Often, the resident gets the sense that he/she is not wanted around. Depressing, huh…

Noon Conferences- A Foreign Language

Have you ever listened to a conversation in a language that you do not understand? That is the feeling that the first-year radiology resident often gets when he/she goes to the first noon conference. Attendings give noon conferences on topics such as ultrasound or MRI. Yet, these radiology residents have never seen these images. On top of that, they use language that is not common vernacular.

Moreover, the findings are incomprehensible to the uninitiated resident. Many attending radiologists do not recall what it is was like to attend these conferences. However, these esoteric conferences are standard for first-year residents.

The Final Upshot For The First Year Resident

Senior radiologists can easily dismiss and forget the challenges that first-year radiology residents face. However, please don’t discount the first-year radiology resident’s frustrations, experiences, and anxieties, as they are genuine. It takes an extended period of adjustment to acclimate to the daily work experienced by radiology residents and attendings. Give the lowly first-year radiology resident a chance!!!