Tag: residency program

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Great Expectations For The Radiology Resident

great expectations

The wait has finally arrived. After years of biding your time in medical school and residency, you are finally en route to what you want to do: begin training as a radiologist. And radiology residency begins. But, is it all that you had expected after all these years? Are you getting unadulterated teaching from your faculty as you had hoped? Is the learning at noon conferences with enthusiastic and engaging staff? Do the fellow residents live up to the great expectations that you had in the first place?

Well, there is a good chance that any residency program that you choose will not entirely live up to your great expectations. So, coming from an associate program director, what are reasonable expectations for your residency program when you start? And what are some unreasonable expectations for your newfound position? Let’s discuss these expectations by expounding on what is reasonable and limited. Then we will summarize the best way to treat these expectations overall.

Reasonable Anticipation

Reading Alongside Attendings

Any program worth its salt needs to have some time dedicated to having residents listening and reading along with attendings. At the beginning of the residency, the only way to know radiology is to listen to how your mentors interpret films and dictate. And this means some dedicated time to watch, listen, and learn the ropes in real-time with a radiology faculty member. A residency cannot survive for long without this factor.

Ability To Ask Questions

If your faculty shuts you down or insults you whenever you ask a question, you cannot thrive in residency. We learn by asking questions. And in the beginning, there is no such thing as a stupid question. Heck, you don’t even know what to ask! But, if your faculty scolds you for asking questions from your mentors, this would be an example of a malicious program to residents and learning!

Monitoring Your Dictations

Any residency should ensure that its residents are dictating and interpreting films appropriately. It is the currency of radiology. The only way to do that is to assess the outcome of the radiology process. And that is the final report or dictation. All residencies should have a system for attendings to review resident dictations. This process is an essential factor for learning.

Feeling Safe

If you feel like faculty members threaten you or fear for your sanity (or life!), you have a real problem. No person can go through such a stressful learning situation in addition to the stresses of radiology residency (and yes, radiology training is considered stressful!). Nor should any resident have to encounter a problem such as this.

Unreasonable Expectations

Unadulterated Attention From Attendings At All Times

Whether you are in a research institution, University program, University-affiliated program, or community/private practice residency, you will not be the priority of most faculty. Most have research to publish, work to complete, and families to come home to. So, if you are too idealistic that you will receive the attention of all the faculty all the time, you will never feel satisfied.

Expectations That Everything Will Be Taught

Yes. For some concepts, it does help to have a teacher. But, no matter what anyone says, most radiology is self-taught. We need to see 100 cases of appendicitis, thousands of routine chest x-rays, and perform hundreds of paracenteses before we get it all right. No one but yourself can do that for you. And, that does not include all the concepts you need to reinforce and remember by reading in every area that radiology covers.

All Teachers And Colleagues WIll Be Your Friend

Just because we are all radiologists does not mean everyone will be your buddy. Similar to the “real” world, we all have different personalities and desires. And, not all people mesh well together, no matter how much we want that to happen. On the other hand, we all can learn from one another. If you apply every person in your program to this concept, regardless of how they feel about you, you will begin to appreciate them for who they are.

Great Expectations

We all come into new situations with great expectations. But, check for yourself. Are these expectations realistic or not? Any program should fulfill the basic requirements, such as working directly with attendings in a safe environment. But, you can’t expect any program to pull all the challenging weights for you. There is just some work you need to do for yourself. It’s the only way to become an excellent radiologist!

 

 

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Active Administrative Management: The Key For A Successful Training Program?

active administrative management

As many of you know, residency reputation and quality throughout the country vary widely. Sure, the Radiology Residency Committee (RRC) and the American College of Graduate Medical Education (ACGME) has set out specific guidelines for all radiology residencies to follow. However, over the years, I have discovered these instructions are merely a tool for individual programs to interpret as they will. As much as these organizations would like to have you believe, the current product is not standardized at all.  So, how can a hospital or system convert a program into the best it can be? It’s straightforward. Treat it like any other significant patient care initiative, whether it be a renal transplant program or oncology center of excellence. And what do they all have in common? Active administrative management!

How Successful Programs Model Their Residencies

Take a look at the most successful programs, ones that are rated highly on Doximity and Aunt Minnie. First of all, management takes residency education seriously. Unlike many administrations who only pay lip service, saying that they take residency education as their prime mission, these few do. They treat a residency like a renal transplant program or a multiple sclerosis center of excellence. They build a program with an initial plan to provide the best training possible.

The Plan

So, how do they do all this? First of all, they communicate with all the stakeholders, not just a few select administrators and high-up faculty onto themselves. They involve medical students, residents, fellows, section chiefs, chairs, residency coordinators, engineers, physicists, program directors, c-suite executives, managers, and more. Everyone plays a role, and everyone is aware of their educational role within the mission. They structure meetings with clear goals. Everyone knows the names of those folks in charge. It should not be that murky person with a cigarette in tow pulling all the strings like the nameless, faceless ones in charge of the government in the X-Files!

Second, these hospitals provide the resources that programs need to succeed. A renal transplant team cannot function without technical support from the surgical technologist or nurse. Nor could they survive without the highest quality equipment and tools for surgical intervention. Likewise, an excellent program cannot exist without the educational tools, numbers of involved faculty, and equipment.

And then finally, they establish buy-in from all members. And, I mean all members. Whether it is the CEO of the hospital or the janitors who need to take of the department, all are active participants. When a hospital establishes any other quality initiative, they all feed into a joint mission, and everyone wants it to succeed because they know their role within the system. That is how an organization does it!

An All-Too-Common Residency Model That Doesn’t Work

Unfortunately, this model contrasts markedly with the other all-too-common model. Many of you have seen these residencies on your interview trail or in your own experience. In this situation, orders arrive from a vague administrator whose command is to save money for a hospital or a system. These bureaucrats tell all the affected parties that they are going to have a great program. But, they establish no buy-in from the involved parties. And, they muzzle or fire individuals who seek to improve the system. This model would never work with a broad patient care initiative.

Moreover, these administrators do not communicate an effective mission statement to any of the players. In effect, they say they want an “Ivy League” program, but they do not provide any organization or structure to those that are on the front lines. They manage the world from thirty thousand feet in the air, hands-off, never uttering a word about their plans. And, then they cut the resources that a program would need to improve the education of its residents instead of facilitating improvements. These “saved” funds go back into the system to pad the pockets of the administration, instead of improving the education of what should be its targeted goal, the residents, and the residency program.

The Upshot Of Poor Planning In The Health Care System

Now, imagine the same happened to a formerly successful oncology program. It would have a short half-life. Eventually, it would dissolve due to the best oncologists, surgeons, primary care docs, nurses, and others wanting to leave the program for other better health care programs and facilities.

In this model of health care education, where entities want to save a buck or two,  administrators reap most of the rewards. However, in the long run, it is a losing formula for the residency and the hospital system. Education does not improve. And the residency/health care system deteriorates over time.

What Are The Returns Of Doing It The Right Way?

When you approach a radiology program the right way, first and foremost, you elevate the quality of the residents that graduate. These are the sorts of folks that you would eventually want to hire in your practice. And, they stick around long after they graduate.

Next, you stimulate more dollars to come back into the system. How do you do that? First, the quality of care increases because you have provided an excellent education. And, these are the folks that take care of patients. Then, more patients come to your facility because they are aware of the quality. It first happens locally, then nationally, and then internationally.

And finally, you receive more support. It may be from research dollars from grants for doing incredible research. Or, it may come in the form of additional donations to the cause of education. Regardless, the program has established a virtuous cycle, a continuing formula that supports the hospital and residency throughout the ages. Administrators and all healthcare-related staff win.

The Sad Truth About Residency Program Management

Not all administrations are created equal. And, not all have the primary goal of establishing residency education as a primary mission as much as they like to imply. And, there are many factors involved, whether it be poor planning, greed, declining reimbursements, and more. But, in the end, it is only those administrators that have the foresight to make education priority number one that will create training programs that will stand the test of time. So, when you decide on your residency, choose carefully. Management matters!