Tag: residency

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Inheriting Other Program’s Problems – The Lateral Residency Transfer

lateral residency transfer

Every once in a while, a program will lose a resident for various reasons. It could be to move closer to family, poor performance, or a gazillion other reasons. When this unfortunate event occurs, a program is stuck trying to fill a spot. And, you would think at first glance that it would be pretty straightforward. I mean, radiology is pretty competitive nowadays. Instead, only a fixed small number of residents can transfer from one PGY3, PGY4, or PGY5 spot to another. And, programs need to be very careful when they recruit these positions. A lateral residency transfer from another residency program can become more problematic than having one less resident in the program.

So, what are the issues that residency programs face when recruiting residents from other programs? And, what kind of transfers are programs looking for? Here are some of my thoughts on these situations.

Lateral Residency Transfer: A Minefield Of Problems

Professionalism Issues

Many applicants from other institutions leave because their former residency program does not want to renew their contracts. Out of those reasons, one of the most common is the professionalism violation. It could be any one of thousands of professionalism infractions, including ethical, moral, and legal issues. Moreover, programs suffer from a lack of information about the resident’s former residency. Frequently, the former site of the applicant doesn’t release “all the information.” So, poor professionalism behaviors can quickly arise again when the resident enters your program.

Academic Issues

In addition to the professionalism issue, many lateral transfer residents cannot academically make it through their current program. Perhaps, it is related to test-taking skills, dictations, or inability to make the findings. If you hire them without knowing the real issues, these same issues will eventually surface when they transfer to your program.

Medical/Mental Health Issues That Can Interfere With Training

We also have to worry about medical and mental health problems interfering with resident training. Notably, this information can be complicated to retrieve because it is a HIPAA violation for a program to give this information out to another freely. And although programs make every attempt to overcome these issues, it can lead to all sorts of problems for both the incoming resident and their colleagues who need to cover them.

The Fickle Resident

Finally, some residents leave because they spontaneously want to abandon their former program for various unstable reasons. These include dating scenes, being in a warmer climate, or myriad other miscellaneous reasons. This sort of resident can decide to do the same when entering your program. Not a great situation!

What Programs Want From A Lateral Residency Transfer

Residents That Need To Leave To Be Closer To Family

Sometimes residents will have a sick relative, and they need to care for them. Or, they have a wife and children who live in a different country than their current residency program. These reasons are legitimate. And, they make for a happier resident that will be more likely to complete the radiology residency.

Particular Interests That The Former Residency Cannot Satisfy

Other times residents discover they have different interests that one residency cannot meet. Perhaps, they are interested in participating in bench research not available to them at their current site. Or, maybe the new site has a PET-MRI, which is the resident’s area of interest. Regardless, these reasons can be valid as to why the resident may want to come to your program.

Legitimate Medical Issues That Will Not Interfere With Training

Some residents need to be closer to certain cities/hospitals to get their treatment. And, perhaps, it is not available at the current institution/town. Or they need the care of family members to help them with health issues. These residents can potentially become a great asset to a new program if they meet its demands.

A Real Change Of Heart For The Lateral Residency Transfer

In medicine, it is effortless to make a mistake. We don’t necessarily know what we want to do when we get out of medical school. Medical schools do not give the best sampling of what life is like post-medical school in all specialties. And, many residents realize they made a mistake early on. Sometimes nuclear medicine residents or emergency medicine residents who have completed imaging rotations can qualify for these more advanced positions. Well, these sorts of residents can become the best trainees because of their dedication to doing something they want to do instead.

The Lateral Residency Transfer Can Be A Tough Situation!

Due to all the pitfalls and possibilities that a lateral transfer can offer, it can be challenging to cull residents that will fit the new program’s culture and meet the demands and rigorous tests of residency. Selecting residents with professional/academic violations, medical issues, or the fickle resident can throw a wrench in the new residency program when similar problems arise in the new program. And this situation can be worse than not recruiting any radiology resident. But, many residents have valid reasons for changing programs as well. So, residency programs, just like the residents, need to do their due diligence. The consequences of picking the wrong resident can be dire!

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Should Radiology Residents Have Workstations At Home?

workstations

One of the most significant changes in radiology in the post-Covid age is the ability for radiologists to “telecommute” to work. The pandemic has hastened the adoption of these technologies, not just for teleradiologists but for almost every practicing radiologist. Nevertheless, most radiology residents still cannot read from home workstations (although I have heard of a few).

So, is it a good idea for residents to have workstations at home? Well, I will go through some of the pros and cons of home workstations for residents. And, then I will give you my conclusion for which if any residents should have workstations from home.

Reasons For Residents To Not Have Workstations

Need Real-Time Consultations To Learn

My best teaching situations are routine phone calls and visits from our physician colleagues at the workstation. And when a resident takes these consults, they are most likely to learn how to practice and communicate in radiology. Working from home decreases these potential connections to the daily consultations that radiology residents will receive.

“No Real Time Teaching”

Especially for first-year residents, there is no substitute for sitting with an attending at a workstation for a bit to learn radiology. Yes, it is possible to make phone calls to your faculty to go over the images. But, usually, only after you have seen the case and without a faculty member by your side. So, you lose out on many teachable moments to learn about normal findings or ask miscellaneous questions on all the cases you see. These questions can be the most thought-provoking.

Reading In A Bubble

Yes. You need to make independent decisions and read by yourself eventually. But, when you are at the institution reading, you can more easily recruit the help of nurses, technologists, faculty, and more. It is much easier to talk to the ultrasound technologists about patients’ histories in person who just completed a case than to catch staff on the phone somewhere. Ancillary staff and fellow physicians add critical information to your findings and interpretations.

Expense

It is a significant additional expense for institutions to allow residents to read from home. Workstations can run in price from thousands to tens of thousands of dollars. And Medicare only indirectly reimburses for resident dictations, so it has low perceived value for the institutions. Therefore, resident workstations can theoretically increase the cost of healthcare.

Reasons To Have Workstations

Sick Residents

Residents get sick just like everyone else. And, sometimes, it’s a mild bug (or even Covid!). Most residents don’t want to infect everyone else. Yet, they still may have the ability and desire to work. Well, with a home workstation, that is still possible. Having a workstation from home opens the possibility of continuing to learn and read without having to take a day off!

Looking Up And Reading Cases Off-Hours

Sometimes, you just want to look at actual cases at any hour. Maybe, it was an interesting case from the day. Or, you just want to learn more about a particular subspecialty, say MR MSK. For that matter, residents (and faculty) are much more likely to learn about these cases and subjects on off hours if they can look them up quickly at home. That power can undoubtedly add to resident education.

More Accessible To Prepare Interdisciplinary Presentations

We often see residents scrambling to get all the cases they need for the next tumor board during the day. This process can often interfere with daily work. If you have a workstation at home, there is no excuse for doing these activities off-hours when you are home. It’s much easier to complete when you don’t have to go to the hospital.

Is It Worth It For Radiology Residents To Get Workstations?

I am certainly one of the biggest proponents for onsite learning as a faculty member. Based on the many reasons above, such as real-time teaching, I tend to learn more when sitting at the hospital surrounded by colleagues instead of reading cases from home. Something about being present with others enhances the learning process. And that is one of the main reasons residents do a radiology residency, to learn.

Nevertheless, there is no denying that the flexibility of home workstations can also help when a “traditional” learning environment is unavailable, whether due to sickness or after-hours work. So, I am not against residents having home workstations if the institution can afford to pay for it. But, home workstations should not replace the residency experience. Instead, workstations can supplement the learning environment for the resident. As an add-on tool, it’s not a bad idea!

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Inflation And Residency- Not A Winning Combination!

inflation

Many of you have probably noticed the headlines about high inflation rates. Over the past year, inflation has risen by over 7 percent. It may only seem like a number that the talking heads on TV and youtube espouse. And, maybe, you have noticed some increased dollar costs at the end of the trip at the supermarket. Or, perhaps take-out from the restaurants that you like the most are a bit more expensive. Then, of course, your gas tank is a lot more costly to fill. 

Taken individually, it may not seem like much. But it is probably more than you think when you add it all up. So, let’s discuss why folks with fixed, regular incomes like you tend to get battered the most. And then let’s talk about how you can potentially prevent the year from eating up your entire salary.

Why Inflation Significantly Impacts Residents

Annual Incomes Are Already Set For The Year

Often, hospitals create residency salaries before calculating the following year’s cost of living. Therefore, you may notice that your income does not meet the increase in the cost of living for this year. This relative decrease in salary can undoubtedly give you far less room to squeak by.

Most Residents Are Not Asset Owners

People who own assets such as houses don’t have to worry about rent increases because their mortgages don’t change. But unfortunately, most residents are not in that boat. Additionally, trainees do not have as many stocks, cryptocurrency, or other hard assets that rise with inflation. So, you are at a distinct disadvantage.

Increase In Prices Eat Into A Regular Salary Without Much Room For Discretionary Income

First of all, your salary is typical for the United States workforce. But, the ordinary person in the United States lives paycheck to paycheck. So, this increase in prices will take a significant bite out of your annual budget, especially when you have very little room for discretionary income, to begin with.

What To Do To Prevent More Pain!

Moonlighting

Not everyone has this opportunity available. But, if your residency has this option, you may want to think about participating. In-house moonlighting can help defray the additional costs of a high inflation rate, perhaps at the current inflation rate or even more. Plus, it will also allow you to sharpen your independent radiological skills. 

Sharing Apartments/House Hacks

Did you not want to share an apartment with colleagues when we had a more normal inflation rate of two percent? Well, maybe it may make more sense now. Overall, rentals will sharply increase in price this year for much of this year. And so, sharing the entire bill may make a lot of sense.

Or if you are fortunate to already own a property in the area. Maybe, you would want to rent part of it out this year to decrease your costs. This move can also significantly reduce the cost of inflation in your regular salary!

Strict Budgeting For Times Of Inflation

Lastly, if you are a prodigious spender, you may want to rethink this lifestyle, especially this year. Budgeting and tracking expenses closely can help decrease your annual costs and prevent the paycheck-to-paycheck lifestyle with high credit card debt. Use a spreadsheet or an application. Either way, this method may help to avoid overspending related to inflation!

Inflation And Residency

More than any other time in your career, inflation can eat away at a higher percentage of your annual income since your residency salary is relatively lower than what you will make eventually. Also, most residents don’t have the assets to decrease the influence of an inflationary world. Therefore, it can be tougher to make ends meet than a typical year.

Nevertheless, you can use some of these tools to prevent inflation from impacting too much. And hopefully, we will see some improvement in the following years and get back to a baseline lower inflation status!

 

 

 

 

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Radiology Residency Makeover: What Can Make A Truly Excellent Program!

radiology residency makeover

Everyone has a different vision of what residency should be when they start. And some discover that residency is nothing as expected. Perhaps, you thought that you would get more lectures, but you are not receiving enough. Or, maybe you thought you would receive more thorough assessments by the faculty every week, but no one is checking up on you. Every residency has its sore points. But let’s say you could construct a radiology residency from scratch; what are some of the most critical elements you would like to fix? From an associate program director’s perspective, here are some essential items for a radiology residency makeover from the beginning!

Filling Out Evaluations- Seriously

In many residencies, evaluations get placed on the back-burner because attendings are busy and barely have time to do their work. But, what if faculty took these assessments seriously and took the time to give you real constructive criticism? I mean the type of analysis that would help fix your dictations or make you better at performing procedures. That takes a bit of time. But, receiving constructive criticism such as this would be well worth the price.

Formalized Guideposts For Applicants

Yes, most residencies claim to use milestones to ensure that residents are well on their way toward becoming independent radiologists. However, it’s more of a checkbox that most residencies place in residents’ portfolios to document progress. However, wouldn’t it be nice to have a radiology residency makeover so that you have specific achievable requirements to meet the goals and expectations of the program. I am talking about the type of thing such as the ability to read x numbers of chest films in a day by year two or having a formal standardized assessment for performing paracenteses that everyone needs to complete before allowing residents to do them independently. These guideposts are helpful and will enable you to know where you are at any given moment!

Lectures- Quality And Quantity

Some residencies promise lectures to all residents but do not deliver. Lecturers regularly cancel noon conferences due to other work obligations that they need to meet. Other residences give talks, but they are not of sufficient quality for residents to learn the material. Wouldn’t it be nice to have a residency that consistently provides the material you need to know with excellent lectures? And, lecturers that cancel permanently have a backup on deck—furthermore, all lessons are of homogeneously excellent quality.

A Radiology Residency Makeover So That All Faculty Care About Resident Welfare

Every program has some knowledgeable faculty. Nevertheless, it is another thing to care about resident well-being. Wouldn’t it be nice to have all faculty on board looking out for residents’ self-interest? It only takes a few caring attendings to help their residents along so that they can achieve great things. Whether it is helping pass the boards or having an interested soul to talk to, caring faculty can make all the difference in the residency experience.

Residents Running The Show

In the end, we need to be able to train residents to work competently and independently. On the other hand, some residencies don’t give the residents enough independence on all the rotations to truly get the experience they need to take charge of their service. Maybe they have needy patients that want attendings performing all the procedures. Or the faculty does all the work. Perhaps, an attending on-call overreads all your dictations. Wouldn’t it be nice if you could show that you could run the rotation at some point during your four years?

Residency Makeover: What Can Make A Truly Excellent Program!

As an associate program director, taking evaluations seriously, formalized guideposts, quality lectures, caring faculty, and allowing residents to take charge are some features that can transform a mediocre program into an excellent one. If you are lucky, your program follows these descriptions to a tee. But, life is not perfect, and neither are residency programs nor their faculty. Nevertheless, now you know, in an ideal world, this is probably your residency director’s dream!

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What To Do If You Have A Blemish On Your Radiology Application!

blemish

Some of you are applying for radiology this year with a blemish. Maybe, it’s a course or two in medical school that you initially failed but later retook it and did fine. Or maybe, you had a tough time in one of your clinical rotations because of an errant resident or attending. Regardless, now is the time you need to deal with these issues. Why? Because radiology has become more competitive, many program directors toss aside many applications with a blemish since there are many without them. This problem can also be the case, even though you would be an excellent candidate for radiology. So, what can you do?

Own The Blemish

First of all, don’t disregard the facts. Own your blemish. Yes, you may get fewer interviews than others. But, if you play your cards right, you can increase your chances of acceptance at sites where you interview.

By owning the blemish, you need to have insight into what caused it in the first place and use it to make you stronger. Yes, it will affect you. But, you need to address the issue. The program director will ask you about it. So, explain in your personal statement. Show what you learned from your blemish and why it can be a strength rather than a weakness. No radiologist is perfect,  Don’t go hiding it or sweeping it under the rug. Most programs will know or find out!

Complete Radiology Research

Radiology research is the grand equalizer. It shows that you are interested in radiology even while busy with an internship or senior-level courses. And, it allows you to succeed even though other parts of your application are subpar. It is not a cure-all, but it can compensate for some faults elsewhere. Heck, a paper of yours that gets into the New England Journal of Medicine will undoubtedly elevate your application to a much higher level!

Ace Your Internship/ Senior Level Courses

This statement goes without saying. However, many applicants concentrate so much on the blemish that they don’t get the grades in their most recent courses or internship that will give them that needed boost. Don’t forget that your current courses can count just as much as the blemish. If you don’t perform well on your current rotations, all may be lost!

Do Well On Your Remaining USMLE Exams

All is not lost if you did not ace Step I or even II. Yes, it will make it a bit harder since many programs screen those exams. But, whether it is step II or III USMLE that you need to take, they can still matter a lot if you do very well, especially while you are busy with other endeavors. It shows you can handle stress well and have the potential to pass the radiology core exam.

 And remember, for those of you who have not yet graduated, USMLE step I is no longer going to be scored in the future. So, the Step I exam will become less of an issue (unless you fail, of course!)

Get To A Know A Radiology Residency Program

Finally, try to get to know the faculty in a radiology residency near you. Maybe, you are in medical school and have access to the folks in a residency program. Or you are amid an internship. In any case, attempt to get to know the staff in the local residency program. Ask to meet with the faculty or participate in projects. These connections can help get them to know you as a person and not just as an application with a blemish!

Applications With A Blemish: All Is Not Lost!

I cannot give you a money-back guarantee that you will find a spot in a residency with an application blemish, especially as radiology has become a bit more competitive. However, in most cases, all is not lost. If you own the blemish, complete research projects, do well at your current level, ace the following USMLE exams, and get familiar with a radiology residency faculty, you can surely up your chances of getting accepted!

 

 

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The Radiology Residency Exit Interview- Why Should You Care?

exit interview

You’re finally about to hang in the towel. You’ve taken and passed your core exam, completed all your overnights, given your last tumor board, and finished your final residency dictation. Suddenly, you receive a call from the program coordinator. He says the residency program director wants you to come to her office for your last exit interview. Why even bother? What’s the point of a final discussion when heading out of Dodge anyway? Well, let me give you some reasons why this interview is the most important of your residency from a program director’s perspective.

Want A Recommendation?

Believe it or not, even after you leave your residency, faculty still receive phone calls from your employers if you are looking for a job or decide to change to a new one. And the last thing that you want your residency program director to say is, “That darn resident, he didn’t even care to give an exit interview.”

These folks that call for you from your subsequent practices are serious. And any bit of bad news about you can derail your next great job. Especially when the job market may or may not be the same as it is now!

No Holds Barred Summary Of Residency Issues

After residency, you feel you have no more obligations to the program. Anything you say now is not encumbered by your desire to impress or achieve. You can now have a heart-to-heart with your program director without any of the “BS.” It’s a great time to give the real lowdown on the residency, both good and bad. This interview is the best time to get a reality check on your program from the program director’s perspective.

The Exit Interview– A Last Chance For Great Residency Advice

For the resident, now is the time to ask any burning questions about how the world works, what you need to do to become great, or other residency-based training tidbits you can use for the rest of your career. So, residents will usually ask excellent questions at this time, right before they leave. Residency is usually a once-in-a-lifetime experience. And becoming an attending is so different. Subsequently, residents will often ask inspired questions to learn what they need to succeed in their next radiology life!

Maintaining Contact Information

Not everyone will remain in the same institution forever, and the same goes for your residency faculty. This interview is an excellent last opportunity to cull the contacts from your residency. Get those phone numbers, linked-in addresses, and social media connections finalized. You never know when you will need to contact your faculty again. It may be to consult on an interesting case, recommend a new job, or just to say hi. In any case, keeping this information safe and sound is critical!

Making Sure Everything Is In Order For Future Jobs- They Do Check!

Procedure logs, iodine treatments, and the number of cases completed are critical statistics that your next employer may need. So, ensure you have all the information you will require before you leave. To get hired, you need to back up your previous experiences. Also, make sure that your learning portfolio is all squared away and that you have records of all the academic research, presentations, and posters safe and sound. Often, you will continue to need all this information well into the future. This interview is your last shot at getting all of this straight!

The Radiology Exit Interview- A Critical Component

Between all these factors, including recommendations, giving the real low down on residency, getting some quality advice, garnering contacts, and ensuring everything is in order for your future career, the radiology exit interview is an integral but final component of the residency process. So, it has many more uses than you may have thought. You are not just paying homage to your residency program. Instead, you are providing a genuine service to your future career and helping out your program director. Therefore, you should take the interview seriously. During residency, it is your last chance to help out your program and ensure a great future for yourself in your radiology career!

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Don’t Forget To Learn How To Make The Findings!

make the findings

In a few more weeks, most first-year residents will begin to take call and metamorphose from a student into a valuable member of the radiology team. Nightime independent call is what separates the radiology child from the adult. But, as always, most residents have a few hurdles to overcome before they begin. They need to be able to make the findings.

One of the hurdles is the precall quiz—a test before the start of the new year. And, not all first-year residents are ready for the task. Why is that? And what can residents and programs do to equip radiology residents for their newfound role?

Knowledge Versus Search: Two Separate Skills.

Most radiology residents concentrate on the information side of the equation. It’s a much more familiar task. From time and memoriam, including medical school and internship, residents have been studying from books. So, reading books is what they know how to do best. They can remember the names of the disease entities and perhaps some descriptions associated with them. But, radiology is a lot more than recall and picking out a few disease entities from your memory. Instead, it is also the process of making the finding while scrolling through many images on a PACs system. This skill is entirely different. If you don’t believe me, have your average fairly knowledgeable internal medicine physician attempt to read a CT scan and make the findings. It doesn’t tend to work out too well! (There are exceptions to every rule, however!)

How Not To Be Just A Bastion Of Knowledge And Also Make The Findings

Practice

Just like another task in life, you need to put the time in to become proficient—the same works in radiology. You need to spend hours at the workstations scrolling through images in addition to reading the books (as you have been doing for years). If you don’t spend the time with the mouse and the computer on the PACs, your brain will not be ready to pick out the findings when the time comes.

Study Checklists

Whether they admit it or not, every radiologist uses some form of checklist to make sure they have looked at all the parts of the study. And every resident needs to create the same. If you don’t create a checklist, you will never know what is missing. Why? Because residents and non-radiology physicians tend to make positive findings. But, the negative findings can be just as important to figure out history and disposition. Splenectomies, adrenalectomies, and appendectomies are some of the discoveries you will miss on a CT scan if you do not have a checklist for every organ system. And if you miss these, some of your impressions will sound silly or meaningless.,

Look At Pictures

Finally, residents also need to read. And reading differs from the standard physician resident. Internal medicine residents, surgical residents, and ob/GYN residents can get away with reading only the text or reading the text first. But, we radiologists have to do things a bit backward. We need to look at the pictures first, then the captions, and then the text. Why? Because we are an imaging-based specialty, and if we don’t see the findings on an image, we will never know what to find!

Make The Findings!

Remember. Radiologists read a ton because we cross over so many different specialties. But, in the end, we are primarily an imaging specialty. So, we have to learn how to make the findings, not just be an information bank for consultation with our colleagues. Don’t forget to practice a lot by reading lots of films on PACs, utilizing checklists to avoid missing critical findings, and reading the pictures first when reading textbooks. Practicing these skills will enable you to become an excellent radiology resident and a great radiologist. It’s not all about just reading books!

 

 

 

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Should You Take A Phone Call From A Physician Outside Your Residency System?

phone call

Picture this scenario. It is 2 a.m., and you get a phone call from a doctor at an outside hospital not associated with your residency. The doctor asks about a patient previously admitted under one of the radiology faculty at your institution. This faculty member also has privileges at another site, but your residency program is not affiliated with this other imaging center. He prompts you to try to contact the faculty member to do the procedure at the other hospital. If you comply with the phone call demands, it will take time away from reading cases while you take call. What do you do?

Many of you may have encountered a situation such as this one. And, you might think there is a simple answer. Of course, you should help out a fellow clinician in need, right? But, in fact, many issues should come into play before making this final decision. So, let’s go through these factors and come up with a balanced answer to this question. Let’s tackle this problem from three different angles: patient care, the hospital/residency perspective, and the financial/legal perspective. Then, we will come up with a final conclusion on how to deal with this scenario.

The Patient Care Perspective

From a patient care perspective, as long as you can verify that the physician calling is truly a physician, helping out a fellow clinician could potentially benefit the patient the clinician is calling about. However, while trying to get in touch with your radiologist, you are distracted from the work you have at hand. You may be delaying all the CT scans, ultrasounds, and more that need to get read at nighttime. So, in terms of patient care, answering the phone call may at best be a wash in terms of fulfilling your duties.

The Hospital/Residency Perspective

On the other hand, you are also providing a service to an outside doctor, not in your job description. You are supposed to be taking care of patients at your institution, not other sites. Moreover, the hospital and the federal government pays you to take care of patients at this site. Answering the phone call for the convenience of an outside attending is outside your job purview.

Additionally, from the residency perspective, taking extraneous phone calls is not helping you in your training. Nor does this phone call count as service duty. Therefore, taking this phone and performing this service runs counter to what you should be doing at nighttime.

The Financial/Legal Perspective

Your malpractice insurance does not cover you if you are taking care of patients outside the institution. Let’s say you can’t get in touch with the faculty member to take care of this patient. But, you have promised to get in touch with him. Now, in a sense, you are taking responsibility for a case outside your institution. You have some obligation toward the doctor that called, the patient that needs care, and the faculty member that you need to call. If something goes wrong with these entities’ connections, the law can hold you partially liable theoretically. And, the residency does not insure you for that!

What To Do With The Outside Phone Call?

You have one reason to respond to this outside physician’s request (“to be helpful”), and you have multiple additional patient care, residency, and financial/legal reasons not to get involved. So, what is the best course of action? Based on these reasons, you need to make it the hospital’s responsibility to get the doctor’s information. Refer the doctor to the operator or the help desk!

In a perfect world, we can help out everyone. But, there are costs and benefits to everything we do. Sometimes, initially, the seemingly most logical and straightforward answers are not the best!

 

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Should Residencies Ever Rehire A Resident That Previously Left?

rehire

What is so special about the radiology resident when it comes to rehiring? Moreover, if a resident finds himself in a situation where he leaves and subsequently wants to go back, is it ever appropriate for a residency to rehire this individual? To answer these questions, let’s first discuss why residencies are so different from a regular job when rehiring.  

Why Rehiring Is So Different For Residencies?

Rehiring at a typical job and residency is not the same. For residencies, each post-graduate year has a distinct service role and responsibility that the program needs to fill, different from most jobs. Additionally, since residency is not just service (unlike a typical job), the resident also needs to meet educational qualifications in any given year. For some programs, that might mean passing specific procedural and cognitive activities. Finally, residents may need to fulfill designated milestones of differing responsibilities at each institution. So, residents are not easily interchangeable, and rehiring during residency can be challenging.

Additionally, when one leaves and wants to come back later, your program may not have the educational or financial resources to compensate the resident. For example, if you complete a different residency year and then return to radiology residency, Medicare may no longer fund your position. Or educationally speaking, a first-year most often cannot substitute for a third-year resident spot that might be open and vice versa. All these issues can also stand in the way of a rehire.

When Can A Residency Program Rehire A Former Resident?

Now that you can understand why rehiring might be so tricky, let’s discuss some of the situations that residencies might encounter that would enable the residency program to rehire a former resident. Three of these circumstances are a coincidental fortune, grants and opportunities, and institutional policies. We will go through each one of these in particular.

Coincidental Fortune

Sometimes all the stars align that allow a program to rehire a resident. Let’s take the example of a resident that was let go because of failing the Step III USMLE. At some institutions, residents need to pass the test before they reach their PGY-3 year. So, hospitals are not obligated to rehire individuals who do not pass their Step III boards after starting their PGY 3 year. 

But, let’s say the resident who failed initially was in good standing up until the boards and then passed their boards well into their PGY-3 year. Then, suppose the residency program has not filled that spot, and the former resident applied to it again after passing. In that case, the resident could be fortunate enough to retake their place (albeit possibly graduate later.) The story could have also ended without the resident able to retake their spot if it was no longer available. It was luck that enables the resident to get their job back again.

Grants And Opportunities

Other times, different programs have opportunities built into them to rehire residents after a specified amount of time. Perhaps, it is a year of international volunteering as a radiologist. Or, a resident may take off a year to complete a permissible research project in the institution. In these specific situations, programs can rehire their residents after they fulfill their time.

Institutional Policies

Finally, some institutions may have specific policies that forbid a resident from being fired. Perhaps, a residency suspends a resident but has done so without the appropriate documentation to do so. Other by-laws may force due process before termination (as long as it does not jeopardize patient care!) Specific policies in place at the hospital such as these can cause the rehiring of a resident.

To Rehire Former Residents: Not So Simple!

Residencies are much more than a typical job because of their education as well as service requirements. Therefore, rehiring former residents can present multiple obstacles due to the nuances of radiology residencies. Given these obstacles, don’t expect to regain your former position unless you do your due diligence to ensure that you still have a spot. Rehiring at a residency program is not the norm!

 

 

 

 

 

 

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How To Succeed In Interventional Radiology

interventional radiology

No. I am not an interventionist by any stretch of the imagination. But I do have a clue about how best for you to succeed in this rotation. Let’s call it years of experience and intuition based on our interventional radiology rotations’ best residents. On this note, we will return to the How To Succeed series this week again, this time in Interventional Radiology.

When we compare interventional radiology to other subspecialties, it has less in common with other radiology areas. Why? Because it overlaps more with many of the features of other surgical subspecialties. So, it would help if you changed your mentality to succeed on this rotation. Let’s delve into what you need to succeed on this rotation and how you can adapt to the new expectations. First, we will discuss reading materials and the basic mechanics of what you must do. Then, we’ll talk about when you should learn the different aspects of interventional radiology.

Reading Materials 

Fortunately for some and unfortunately for others, reading plays a little bit less of a role in this subspecialty rotation in the traditional sense. Of course, you must read about cases and how to perform them. But, most of what you need to know for this rotation is experiential. For example, using the wires for a fistulogram is the best way to learn about them. The most salient way to understand the angle you need to use to approach a liver biopsy is to do it.

No amount of reading will allow you to translate everything you need to know to a successful procedure. You need to watch, perform with guidance, and finally complete a technique independently. There is almost no way around it. Therefore, your goal on this rotation should be to get into as many cases as possible.

Background Reading

Even though reading is not the central focus of this rotation, I will give you some background reading resources that some of my successful interventional residents have used. These include readings in the newly written book Vascular Interventional Radiology- A Core Review. Our residents also use Core Radiology and the Vascular and Interventional Case Review Series. Finally, one of my former residents (now an interventional resident) recommended looking at a book called Image-Guided Interventions. This book would be more for the gung-ho budding interventional radiologist, but it is another option. You can click on any of these Amazon links to purchase these books (I am an Amazon Affiliate and get a small percentage).

Other successful residents will google all the devices, wires, and other hardware every time they use one. All successful residents will look up information on significant cases the day before they perform them if they can!

Fundamental Doctrines Of Interventional Radiology

Here are some general guidelines for interventional radiology residents to maximize their interventional radiology experience.

Consent All Patients Early

Every single one of my successful interventional residents has said the same thing, “You need to make sure to consent patients as early as possible before a procedure!” If you cannot consent your patients before the procedure, you will not have the appropriate history that you will need. And your prep time will be taken by having to consent these patients. This consenting process will interfere with your getting into other procedures during the day. And a vicious cycle ensues. What does this mean? It would help if you got up early to start the process before the day’s procedures begin. There is no way around this!

Build Trust With Your Attendings

In interventional radiology, you will need to build trust with your faculty more than in almost any other specialty. And the reason is self-evident and straightforward. These radiologists are the key to allowing you to do more and get more “hands-on” experience. If a faculty member does not trust you, you cannot perform procedures. So, listen carefully to what your attendings have to say. And follow their instructions. Most importantly, do not forget to do something that they ask. I guarantee that being lackadaisical will ruin your entire experience!

Get Into As Many Interventional Radiology Cases As Possible

If you want to perform well in interventional radiology, your days will be non-stop. You will need to get involved in almost all the procedures you can. The experience counts, and there is no way around it. Why? Because to understand how to complete cases, you need to see and do them. You do not want to become an attending and perform a manual procedure you have never seen or performed!  

Therefore, you may not want to pause in the break room for too long for this rotation. There is time for that when and if you become an interventionist. Now is the time, however, to keep the department moving so that you can get into the next case! So, help get patients in and out of the department, take histories, and get consents. It’s the only way to maximize your case time!

Read The Night Before

Finally, any interventionist worth their salt will tell you that you must read about the procedure and the disease entities the night before. Look up the disease entity, the history you need from the patient, the technique, the wires required to complete the procedure, and how to finish it. You will enjoy what the interventionist is doing more the next day because you will understand the whole process. Furthermore, your attendings will be impressed with all that you learned. Even though you may be exhausted the night before, you should never skip this step!

Guidelines For Each Year Of Interventional Radiology

Year One

Just like surgical interns, you need to know the basics before getting heavily involved in the procedural aspects of interventional radiology. The first year is the best year to learn how to consent, take an appropriate interventional history, make orders, do tube rounds, and discharge patients. You need this background to get to the next step! 

Of course, many of you will get to start doing some procedures, but there is a lot more to interventional that you need to know. As a background for the rest of your time in interventional radiology, you should learn all these other tasks in your first year. Reading about procedures or learning about cases the night before is also vital, even though you may not get to help out as much with the manual techniques this year.

Years Two And Three

You should learn the “bread-and-butter” interventional radiology procedures during these two years. Get involved in biopsies, PICC lines, catheter placements, and nephrostomies. These are the procedures your attendings will allow you to do more, especially if you have established their trust. And you will build up your repertoire slowly. You should be able to perform these procedures as a general radiologist when you leave residency. Make sure to learn them well and execute them many times!

Year Four And Beyond

Year four is the time to get involved in the bizarre, complex, and engaging. Help with oncology cases, stent placements, uterine fibroid embolizations, and neurointerventional procedures. Get a sense of some of the more intricate techniques. These rotations may be the last time you will see the more esoteric aspects of interventional radiology. But the experience will be invaluable!

Completing Your Interventional Radiology Rotations Successfully

Anyone who says their interventional experience was easy will probably not maximize their opportunities to learn the subspecialty. To understand what you need to know and be successful, you should be busy in interventional radiology. You should actively take histories, consent patients for procedures, read up on patients/diseases, and get into as many cases as possible. There is no way around it. Experience is the crucial element of this subspecialty, and you desperately need it to succeed. You can not get ahead by sitting back on this rotation. So, take advantage of the opportunities that your residency affords you. Regardless of whether you go into interventional radiology as a career, this experience will go a long way in making you a well-rounded radiologist!