Tag: radiology residency

Posted on by

Tackling Research- Basic Issues and Considerations for the Radiology Resident

research

Put an academic radiologist and a general community radiologist in the same room and start a conversation on research and radiology residency. How do you think that conversation would go? I bet there would be bitter debate and sharp words. It would likely be next to impossible to get them both to agree on the merits of radiology research.

The academic radiologist would point out the necessity of research to allow the resident to understand how to delve deeply into an area within radiology, understand the mechanics of making discoveries, and create and advance new areas of knowledge within our specialty. He would espouse the importance of statistically analyzing false positive and negative rates, ROC curves, sensitivities, and specificities, tools invaluable to becoming a good radiologist. Additionally, they would also likely say that without an understanding of the mechanics of the research process, companies can easily mislead you by marketing headlines for new software, contrast agents, radiology hardware, etc., that may, at best, marginally display the truth of an imaging process or at worst can be entirely incorrect.

On the other hand, the community radiologist would say that if you understand the fundamentals, can read films well, and know how to manage patients appropriately, what is the point of doing research? Let others develop new ways of interpreting films, creating protocols, or creating new contrast agents. Or in other words, “leave the research to the academics.” The community radiologist would also utter in the same breath that research is too time-consuming, costly, and incompatible with the day-to-day running of a revenue-generating practice. Why bother?

To What Extent Should You Pursue A Project?

So, given these diametrically opposite points of view, the big question becomes: to what extent should the radiology resident pursue research during residency? Should you make it into an all-consuming process or relegate research to satisfying your residency program’s requirements? Given the potential difficulties of making this decision for some residents, I will go through how to figure out for yourself whether you should follow the advice of the academic or community radiologist. In addition, if you go down the research pathway, I will give some sage advice about how to find a research mentor and what makes the best research projects.

How Much Research Should I Pursue?

Maslow’s Hierarchy of Needs

Ever read about Maslow’s Hierarchy of Needs? If not, I highly recommend you click on the previous Wikipedia link. Instead of Maslow’s Hierarchy of Needs, now picture the Radiology Residency Hierarchy of Needs. You might have to dictate films, study radiology material, and attend lectures at the base. At the apex, you would have radiology research. This point is so important: your own basic needs of a radiology residency must be satisfied before you tackle the research requirement. Therefore, you must answer some questions before starting a research project: Have you been studying enough, attending lectures, and learning the basics of radiology concepts? Are you performing well on your rotations? Do you have to concentrate on other issues, such as the USMLE? In other words, the resident must first focus on becoming a good radiologist and then their research. 

The entire pyramid will collapse without the essential elements of good radiology residency preparation. Why do I make this statement? Suppose the resident concentrates so heavily on research instead of learning all the imaging modalities and vital skills during their residency program. In that case, they will find it very difficult to perform well during residency. You want to ensure that you know the general skills of the radiologist first and foremost. Furthermore, too much emphasis on research can lead the resident to lose focus on other issues, such as passing the core examination. So, make sure not to forget about the main reason you are doing your residency: to become a radiologist.

The Rewards

On the other hand, if you can dedicate time to research because you can comfortably divide your time appropriately, by all means, go for it. The rewards are numerous from both a practical as well as academic standpoint. Significant research becomes essential if you are interested in academic radiology, love to come up with innovative ideas and enjoy writing publications. Publishing several papers and abstracts during residency and fellowship can help you get that first job if you want to pursue an academic career.

Even in private practice, performing research during your residency shows that you are interested in radiology. From a radiology job market perspective (although the community radiologist may not want to admit it!), if you have two equal candidates, one who has accomplished much research and the other who has done none, I believe most practices would choose to hire the former.

The bottom line- yes, research can be rewarding but make sure that it doesn’t interfere with your fundamental mission of becoming a radiologist!

How Do I Find A Research Mentor?

Most radiology programs have some attendings that are almost exclusively clinical and others that are more academic. I recommend you seek out mentors/attending with a decent amount of research experience. Although these clinical-based attendings can be great teachers and mentors for learning radiology, they will likely not be as valuable for understanding how to do research. They may express interest in helping you with research, but they cannot instruct you on completing a project. So, unless you have already had a lot of experience with radiology research, a more clinically based radiologist may not be the best choice for a radiology research mentor. There are a lot of radiology attendings out there that don’t have a clue how to structure a research project. (not that it makes them bad radiologists!)

Although not always possible, depending on the size and structure of your residency program, try to find a mentor in an area/subspecialty of radiology that interests you. It will more likely help you later in your career when you complete a project in your area of interest.

Finally, try to find a mentor that meshes with your personality. In addition to the grunt work of research, part of the research process involves bouncing ideas off one another and brainstorming. Exciting research can begin to seem more of a chore than a genuine passion if you feel you are not an equal participant. It shouldn’t be that way. Personality can become a significant issue.

What Makes The Best Projects?

My favorite research projects are those issues and problems that have constantly nagged at me or annoyed me over the years of practice that you have the itch to solve. In addition, I love research projects in an area of actual interest. These tend to be the best and most satisfying projects. I find that esoteric projects without relevance do not provide that spark to take the research to the next level. It also may dissuade the resident from pursuing other projects down the line.

I recommend that when you are involved in the day-to-day readouts, try to take notice of the issues that bother the attendings or questions that occur in the areas of interest you love. There are few things more satisfying than coming up with a question you thought about and then figuring out how to solve it.

Final Thoughts

Radiology research is an excellent avenue for understanding the mechanics of what we do as radiologists. We take many presumed facts for granted, whereas these facts may not be based on the best evidence available. Performing your projects allows the radiology resident to understand how to determine what information is genuinely facts and what information does not have a basis in science. This process helps the resident to read and interpret studies and critically define the accuracy of the information we use to analyze images daily.

Furthermore, delving into research by completing a project can be a very satisfying professional endeavor and become a capstone on top of our radiology residency training. Few things are more satisfying than answering your question, for which the body of literature did not provide an answer.

However, it is essential to remember that as a radiology resident, you must satisfy the basics of radiology residency first and foremost. Before deciding whether or not to become involved in a project, consider if you have the time and energy to pursue the project to its end. If a research project is very complicated and time-consuming, think twice about the project because your priority should be to become a well-trained radiologist. Radiology research can be rewarding, but only to the extent that you first satisfy the basic requirements of radiology residency training.

 

Posted on by

The Post Interview Second Look – Is It Worth My Time?

second look

Every year after interview season ends, there is a brief interlude until the rank selection list is submitted. And now, during the life and times of covid, it may be more challenging to arrange a second look. However, with vaccines available to health care team members, students, and attendings alike, you may be able to schedule one. 

So, you may wonder at this time- Does it make sense to go back to a radiology program to take a second look? It may be a complicated decision and can depend on numerous factors. Therefore, I am going to take a look at this issue from a program director’s perspective. We will approach the problem by tackling a series of questions that will help you make this critical decision. Hopefully, it will be of some benefit to those of you that are involved in this process.

Who Is Most Likely To Benefit From a Second Look?

From a residency director’s perspective, the ideal candidate for a second look at a residency program is a student that has already interviewed, for which the admissions committee was unsure of its final disposition. For example, every once in a while, an application/prospective resident interview causes a stir among the committee. The interview may have gone well, but the application quality didn’t sync with the interview. Or, the application was excellent, but the applicant’s personality was questionable on interview day. Usually, it is some conflict in the committee evaluation process. These applicants can benefit the most from a second look because it may sway the admissions committee one way or another after the candidate returns.

Second, the marginal/below average candidate that has been ranked but did not have many interviews would also be an ideal candidate to return for a second look. Some programs will rank their returning applicants slightly higher for just showing interest by returning to the program. Usually, candidates don’t return unless they are earnest about a program. A slight increase in the rank list can make the difference between matching and not matching.

Finally, the other ideal candidate would be the interviewee who felt he/she didn’t get the best impression of a program and wants to make a more informed decision on the day he/she will submit the rank list. Maybe the program director was absent. Perhaps you have a spouse that wants to remain in the area, and you didn’t get the best impression on the interview, but the location would be ideal. Or, maybe you like the people you met, but you felt you didn’t meet the residency program’s key players on the day you interviewed. Whatever the case may be, the second look can help to reinforce that decision.

How Do You Know You Should Come For a Second Look?

Let’s first begin by stating: The worst situation for the residency applicant and the program is to have an applicant that has already been placed into the “Do Not Rank” pile return for a second look. It wastes the applicant’s time and money and the resources of the program director and staff. Also, it may not make sense for the individual applicant to return depending upon other applicant factors. So, here are some criteria that may help you to decide if you are in either of these situations:

  1. Did the interviewer suggest you come back for a second look? The program director will usually recommend to return for a second look if he/she is potentially interested in a candidate and think it may be of some benefit.
  2. Did you get the cold shoulder during the interview process? Some interviews don’t go well for multiple reasons. That will happen from time to time. Your instinct is probably correct if you feel that is the case. In this situation, it is perhaps not worthwhile to return for the second look.
  3. How far down is the program on your rank list? If the program is very low on the order of your rank list and you are a reliable candidate, it is probably not worth the effort to return for the second look.
  4. Is it reasonable to travel to the interview site? Some candidates live very far away from the prospective residency program. Suppose it will be disruptive to return to the program due to travel costs or significant inconvenience (maybe you are amid your medicine sub-internship and can’t miss a few days). In that case, it is probably not worth your effort.

 

How Should You Behave/Present Yourself On The Day Of The Second Look?

The program director or interviewer that asks you to return for a second look will often tell the candidate, “we would love to have you return for an informal second look.” It is important to remember that there is no such thing as an “informal” second look. A second look is a second interview day, and you need to treat it as such. Wear your best interview clothes as you would have worn for your first interview. Be on your best behavior and be friendly to all staff members, just as you would have done for the initial interview. Remember, you still have not been admitted to the program, and you are certainly not yet “one of the residents.”

What Should You Tell The Program Director Before You Leave?

Certain buzz words have significance to the program director when meeting at the end of the second look day. The program directors and admissions committees take these words very seriously. So, be careful what you say. If you say the wrong thing, it may cause a different result than intended.

If you are genuinely interested in the program, you can say, “I will rank the program first.” This phrase is specific and demonstrates your genuine intention to the interviewers. The program can verify this fact on match day when you either match the program or do not match it. So, your action will back up the facts. This truth will follow you from this point forward. If you ever decide you want to return to the community as an attending and you did not abide by your word, the program can blacklist you!!!

On the other hand, the phrase “I will rank your program highly” is a buzzword that means your program is nowhere near their first choice, and you will probably match elsewhere. Some applicants do not realize this. So, be careful!

If you are still not sure after the interview day, it is appropriate to say, “I really enjoyed my second look at the program, but I am still considering my decisions.” The program director/interviewer will usually understand. When/if you decide to rank the program first, you can always contact the program and let them know.

Final Thoughts About The Second Look

The second look can be an essential part of the residency interview process. It can provide a slight edge to your candidacy and may be worthwhile if approached the right way. On the other hand, it may not be the right move for all applicants. So, weigh the facts and make a final decision. The interview process will be over before you know it!!!

Posted on by

The New Core Exam- An Associate Program Director’s Lament

What are the essential ingredients of a successful radiologist? – the art of oral and written communication,  being able to distinguish one study from another, the ability to successfully analyze the findings, the masterful arrival at a reasonable differential diagnosis, and the creation of insightful management recommendations.

The oral boards enabled residents for years to learn these essential skills of a good radiologist. As much as we had heard horror stories of the trials and tribulations of the test takers in Louisville, Kentucky, it lit a fire under all of us. By the end of our fourth year and completion of our oral board at the last month of residency, all of us were artful in the realm of oral and written communications and powerhouses of essential radiological knowledge. We were immediately able to practice competently as radiologists on day one after completing our radiology residencies. This bygone era is no more…

Instead, what does the new core examination teach radiology residents? It forces residents to learn some radiological knowledge. But, more importantly it reinforces the strategies of multiple choice and matching format questions. As a radiologist, I never have options a,b,c,d, or e on a piece of paper or a computer screen. I need to have a baseline sum of knowledge to make my own assessments. On occasion, I will google a question. But, the only reason I know what question to ask is: I know the fundamentals of radiology. The fundamentals are no longer emphasized.

The style of a test can be just as important as the content because it reinforces the process of learning and communication. Now, instead of concentrating on practicing the most common methods of disseminating information to others, radiology residents are now concentrating on methods that are never used by radiologists in practice. Think about it…  A good oral test that actually forced residents to study the essence of radiology has been converted to an examination that reinforces the learning of the art of testing taking. Is that what we really want to be teaching residents?

In the latter half of every academic year, we encounter nervous third year residents fretting about the mechanics of a test that are not even utilized in daily practice at the expense of learning the fundamentals of radiology. I can understand their stresses because their role as studying residents is split twofold: to study for a test that does not directly correlate with what we do on a daily basis as well as study the fundamentals of becoming a good radiologist. There is conflict between the two. Residents waste time and energy devoting themselves to two divergent causes. It shouldn’t be like this.

So why has the ABR decided to resort to computerized multiple choice testing and changing the timing of the examinations?  I have a couple of theories.

Cost Cutting/Increased ABR Income

What are some of the biggest advantages of converting an oral examination to a written test? No longer do you have supply the manpower to meet the demand on the days of the boards. It can be extremely expensive and time consuming to host tens of seasoned radiologists at a hotel anywhere to provide the services needed for creating an oral board exam. The costs saved in the short term are enormous. In addition, you don’t need to rent out a space to accommodate these radiologists for many days. Instead, the ABR can create fixed computers in a fixed site that can be used year after year in a few sites with less manpower to run the annual examinations. The cost savings can be significant.

Annual income from the dues can still be increased without a concomitant increase in annual expenses, significantly increasing the income of the “nonprofit” organization of the ABR. Salaries within the organization can be buttressed and maintained, a possible incentive for changing the examination.

Creating More Subspecialized Radiologists Working in Academic Radiology

Notice the change in timing of the general examination from the end of fourth year to the end of third year of residency. Why would an organization want to do this? If you think about it, radiology residents study most intensely prior to taking an examination, oral or computerized/written. Before, residents would go out to their first job with a significant body of knowledge fresh in mind on day one. Now residents have a full year to forget about the information that they learned for the core examination. Sure, they take a specialty certification examination after they finish fellowship. But, the studying and content is not the same. It is instead mostly dedicated toward the individual specialty What does that mean for the first year employee? These new radiologists are less capable to practice general radiology because their general radiology knowledge is more remote and they are less comfortable with “bread and butter” radiology imaging studies. This idea matches in practice what we are experiencing with new hires. They are more likely to stick to subspecialty work and less likely to want to practice general radiology.

This outcome is even more harmful for private practices throughout the United States. According to the AUR meetings and multiple papers on the subject (1,2,3), most practices need new radiologists that are sub specialized but can also cover generalize radiology work. Because  of the new core examination timing and the content of the core exam, the needs of private practices continue to be unmet and do not match with the newly minted workforce.

So, where are more new radiologists, less competent in general radiology, forced to work? These new residents either need to work at academic facilities that can afford to harbor a highly subspecialized workforce or very large private practices and teleradiology companies that can divide the subspecialty work among its employees, providing benefits mostly to the chairmen of academic departments and the heads of very large private practices.

Who was most responsible for the decision of creating the test? It is the same representative body- chairmen of large academic departments and the largest of the private radiology practices that most likely will benefit from these changes. This represents a conflict of interest between the creators of the examination and the needs of radiology practices throughout the entire spectrum of radiology.

Final Thoughts

Examinations are important not just because it should establish a baseline of competency in a particular subject matter, but also just as importantly because it guides how the student learns. This process can change the landscape of a profession for years to come.   In addition, prior to the creation of any examination, the foreseen outcomes should be match the needs of the specialty. In my opinion, the core examination has failed on all of these accounts. It deemphasizes the fundamentals of radiology, guides the radiology resident to learn information in ways that are not relevant, and leads to the outcome of weakening private practices by causing a mismatch between the needs of radiology practices and the differing abilities of the newly minted radiologist.

Unfortunately, the core examination has already become embedded in the radiology residency process and culture. Since so much time, effort, and expense has been dedicated to changing the examination and timing, it is very difficult to navigate back to a different format that will better match the needs of the radiology specialty. But, it is something that we should consider to make a better prepared radiology resident for the job market and to sustain our specialty for years to come. We are better than that.