Tag: residency

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Top 10 Resident Issues That Radiology Faculty Wants You To Know But Can’t Say

Top 10 Resident Issues

Most radiology attendings want their residents to succeed. However, etiquette rules cause many to withhold their feedback about some of the resident issues that they encounter on a daily, weekly, or monthly basis. Unfortunately, for that reason, they keep many of you in the dark. However, please learn from their mistakes and enlighten you all. So, to prevent you from continuing with these resident issues, I thought I would create a top 10 list that the faculty wants you to know but may not say… Here we go!!!

You’re Too Aggressive

Are you overcalling everything or coming down hard on a final diagnosis without any other differential? Are you accustomed to the surgical mentality? No longer can you just nod in agreement, but you push, push, push? Everything is an argument. And, your attending does not have the time to talk back. Gosh darn it, perhaps you are more aggressive than you should be at this stage of the game!

He Misses Everything

When your attending sees that you are missing all the findings during the night, he may not feel so great telling you about all these errors. How will that help anything? And I mean, he doesn’t want you to feel bad about it when he tells you, does he? Unfortunately, you may miss out on some of these learning experiences. But, your attending may not let you know!

She Has Poor Hygiene

Poor hygiene can be just plain embarrassing. But, sometimes, your faculty may become very uncomfortable dealing with malodors or unkempt appearance. It often needs to be said to the resident but doesn’t. And, all the other faculty and residents suffer from this resident’s poor hygiene!

You Just Don’t Listen

The attending keeps on telling the same resident the same old thing. But, time after time, nothing changes. No longer can the attending tell you what to do anymore because it does not seem to work? So, your attending does not bother you anymore. What’s the point of hurting your feelings?

He’s Way Too Enthusiastic

Don’t get me wrong, but it is great to be enthusiastic. And, your attending certainly does want you to become excited about radiology. But, too much of anything is no good. And sometimes too much enthusiasm can be a bit too much. It can wear on your techs, nurses, and attendings. So, temper that enthusiasm just a bit!

You’re Just Plain Dumb

Often, your attending will ask you questions to see if you have been reading enough. And it is OK to get some things wrong. However, on occasion, a resident does not know anything that he should. Is your attending going to tell you that, maybe or maybe not? Who wants to say to the resident that she is just plain dumb?

She’s Getting A Bit Too Chummy For My Liking

On occasion, our residents can become a little too familiar with us if you catch my drift. It can all be a little too “touchy-feely.” So, think about how you communicate with your attending. Is it appropriate? Or are you trying too hard to become his best friend?

He Wants Always To Be Spoon Fed

Most residents want to learn from their attendings. Some residents expect all the learning to come from their attendings with no work on their part. If you desire to breed ill-will, you can do just that. Don’t help out your attending. Instead, just expect them to teach. It can be very irritating!

You’re Always Abandoning Ship When The Work Is Not Done

Excuses, excuses, excuses… You have to get to a wedding. Or, maybe you need to go on a date with that new beau. Well, your attending does not want to be the one to break it to you. He does not want to be the unfeeling guy that ruins the resident’s time. But, is it right that you are always missing all that work?

He’s Preventing Me From Getting Anything Done

Some residents like to talk a lot. And, most attendings like a good conversation as well. But, sometimes, it can interfere with the daily work that needs to get completed. How can your attending break it to you when she likes you a lot. Well, it can be challenging at times!

Final Thoughts About Resident Issues That Faculty Want You To Know But Can’t Say

Rightfully or wrongfully so, many taboos exist that prevent faculty from telling you, the radiology resident, what is going on. And even though attendings are supposed to evaluate and give direct constructive criticism and feedback, that is not the reality of the situation. So, if you think that you may have one of these ten resident issues listed above, try to change it on your own because you may never get the real story!

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Residency Travel For Presentations: What Are The Steps Involved?

travel

Congratulations!!! The Radiology Society of North America (RSNA) has accepted your poster for presentation at the convention. Or perhaps, the Association of University Radiologists (AUR) has chosen you to make a presentation at the next meeting. When and how do you prepare for the trip? What are the best travel arrangements? How and when do you make your plane flight? I plan to answer these questions and more to make your next trip that much easier!

Notify The Program Coordinator First

Most importantly, before booking the event, ensure that your program coordinator knows first. Why? If you forget to do this, you may find the hospital will reimburse you less than you think. Or, perhaps, the program will not cover certain parts of the trip. The program coordinator also has precious information on how to submit expenses for your trip. You must submit your receipts at many programs first and then get your money back later. In other programs, they may cover your expenses upfront. This information is critical, and your coordinator usually has the answers!

Book The Hotel Next

Booking a hotel is usually the rate-limiting step for residency travel for presentations. Why do I say that? Hotels tend to book up first before the plane, the meeting, etc. Over the past few years, I have known several residents who could not reserve a spot in their first-choice hotel because it was already entirely booked. So, you should check your meeting website before booking. Often, you will find group discounts for hotel stays.

Some other tidbits for booking your hotel: First, stay as close to the conference as possible. You don’t want to worry about damaging your poster or arriving late to the event on the day of your presentation. And you certainly don’t want to get stuck in a downpour! Also, make sure to review the hotel for your needs before booking. So, if you are taking your family, ensure they have the correct size room, etc. Finally, before booking a hotel, also join the hotel club so that you can receive points for rewards for the next time you travel.

Make The Flight Arrangements

Over the years, I have found that it is best to book a direct flight if possible. Worrying about connecting flights can be extremely unsettling. Sometimes, the plane arrives at its destination too late, and then you miss the next connecting flight. The last thing you want to do is arrive late for your conference! It is generally safer and less time-consuming to fly one direct flight instead of many legs. It is not worth the minimal savings.

If you are interested in flying as economically as possible, I recommend several possibilities. You can sign up for multiple price alerts from different airlines. Also, some websites let you know when the airlines have the best deal. These include sites like Hopper and Hipmunk. One article also advised following #airfare #flights on Twitter to get you the best deals. Check out the following article that I thought was extremely helpful: http://www.chicago tribune.com/lifestyples/travel/ct-best-time-to-book-airfare-20170614-story,amp.html

Finally, if you have not done so already, it makes sense to sign up for frequent flier miles at the airline you choose. Most likely, you will fly again and again. So, you may as well try to benefit as much as possible! Also, some credit cards accumulate frequent flier miles and give extra benefits such as free baggage check-in.

Sign Up For The Meeting

Regarding signing up for the event, most meetings for radiology do not fill to the maximum. So, you do have a bit of time. But be careful. Some conferences have early bird specials and discount early bookings. Therefore, don’t perseverate too much. Also, make sure you book the event under the heading of a resident. At some meetings, residents get a discounted rate!

Think About Local Transportation To the Gig

Now, this part gets a little complicated. For most of you, taking a shuttle to the hotel is the most cost-effective and straightforward. However, others may arrive with family members and plan to travel to other sites at the meeting destination. Or, maybe you want to travel a bit near the meeting after your presentation. In that case, consider renting a car. (It’s usually a bit more expensive!) Otherwise, if you want to get in and out of the meeting quickly, stick to using shuttles or sharing a taxi with friends to save a few bucks.

Keep Your Poster/Presentation Safe

Treat your presentation like gold! Make sure it is safely ensconced in a cardboard roll if it is a poster. Or make sure you protect your flash drive well if you need to present. I would recommend having a backup if possible. The last thing you want to do- is to notice you have a broken flash drive when you are about to present your topic!

Don’t Freak Out!

All that hard work has amounted to getting to this point. So, you will do great. Practice your presentation a few times in your room if you think you may be a bit rusty. These few days, you should be enjoying the fruits of your labor, not worrying about your presentation.

Enjoy Your Travel Destination!

OK. You have traveled to such a great destination. Why not try to take advantage of the site? Plan some activities. Try some great restaurants. Tour the area if you can. Have some fun! Who knows if you will get a chance to return soon? Congratulations!

 

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Can We Learn Anything From Fast Food Industry Slogans About Radiology Residency?

slogans

We hear many catchy slogans for fast food restaurants on television. Although not so healthy for our waistlines, these restaurants’ advertisements motivate millions to go there in droves and bring in billions of dollars each year. So, if these slogans can stimulate so many customers to buy their food, these same slogans may drive radiology residents to improve. For that reason, I have decided to take it one step further. What can we learn from these slogans that we can apply to radiology residents? Well, I am here: to make connections where you think none have ever existed! So, let us go through some ten famous fast food slogans and see how we can apply them to our daily work!

 

Your Way, Right Away (Burger King)

I think this one is self-explanatory for most of you already in or have completed radiology residency. But, we live in a world where the demands for immediate readings of imaging studies have become intense. So, I think it is fair to say we live at the mercy of the ordering clinicians. And it always seems to be your way right away!

Sometimes You’ve Got To Break The Rules (Burger King)

As radiology residents, we can’t always follow the rule books. And for that reason, we need to tweak protocols and situations for individual patients to ensure they get the proper test. And Burger King has known this fact for years. Therefore, maybe we should follow their advice as well. Burger King, once again, you are wise!

You Deserve A Break Today (McDonald’s)

Radiology residency can lead to severe studying and hard work every time we are on call or every day we work. But, as McDonald’s says, sometimes, you need a break. Maybe, you go on vacation or get lucky as the electricity turns off all the equipment in the middle of the night. Or perhaps, you work on a lovely snow day preventing anyone from arriving at the hospital. Sometimes, we need a break from the difficult work of radiology residency.

I’m Lovin’ It (McDonald’s)

We often don’t appreciate where we are and how we arrived here. Well, we need to sit back and smell the roses. We have picked a great profession with multiple exciting challenges and a decent income. McDonald’s once again has it right. Sometimes, we need to say I’m Loving It!

Where’s The Beef? (Wendy’s)

When we perseverate about our cases, we should heed Wendy’s slogan. What should we focus on in these situations instead of worrying about all the extraneous information? We should concentrate on the matter’s meat (or “the beef”). So, I take Wendy’s slogan to heart. Whenever we look at a case, do what Wendy’s would do. Make sure to think about “Where’s The Beef?”

Makin’ It Great Again And Again (Pizza Hut)

We cannot be great just once. If we make a fantastic call and miss many others, our patients will sue us often. So, we need to be on our best game, not just once but repeatedly. Thanks, Pizza Hut, for allowing us to remember!

Little place, BIG TASTE (Checkers)

On any given day, you may think about our role in the scheme of things as little as you understand your place as a radiology resident. But, when you miss something, the impact can become great. Therefore, although you feel like you play a small role in the clinical world, in reality, you leave a large footprint behind you!

Think Outside The Bun (Taco Bell)

Taco Bell has it right. We can’t always emulate our fellow clinicians, who sometimes merely use a checklist to ensure they have worked up the patient appropriately. Instead, we have to think about our patients differently to give them the most appropriate care. Who knew that Taco Bell was such an excellent example for radiology residents?

Eat Fresh (Subway)

When we come into work, we owe it to ourselves and our patients to work as efficiently as possible. Well, how do we get to that point? On that point, Subway recommends we “eat fresh.” And I can’t agree more. We have to ensure that we provide our bodies with the nutrients that we need to use our brains and get as much sleep so that we can be “fresh” for the next day. Good point, Subway!

We Don’t Make It Until You Order It (Jack In The Box)

Now, this one is crucial. Clinicians, please. You can’t expect us to complete an imaging study for you unless you have ordered it first. Like Jack In The Box, we don’t perform the procedure until you call it. Don’t forget!

Fast Food Slogans And Radiology Residency

See, I bet you can’t believe how prescient these slogans are for the average radiology resident. These slogans send important messages to residents that they should take to heart. So, the next time you hear a fast food restaurant slogan, instead of thinking about running to the restaurant for some food and increasing the size of your waistline, think about how it can make you into a better radiology resident!

 

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How To Avoid The Radiology Comparison Culture (Don’t Become A Victim!)

comparison culture

Type A personalities, typical graduates from medical schools, tend to compare themselves to others in their residency classes. These residents often ask the following questions: Am I performing better than everyone else on the in-service examinations? Do I read films as fast as everyone else? Have I written more papers than my colleagues? These questions asking how you perform relative to your colleagues make up what I call comparison culture.

Do you further your career by joining the comparison culture and comparing yourself in this way to others? Sure, it can stimulate some friendly (or unfriendly!) competition. You can work hard to make sure your in-service score beats all others. And yes, you can write your umpteenth paper to shove it in your colleague’s face. But, these motivations only improve metrics that do not correlate with qualities that make a better radiologist, such as the desire to learn continually. And over the long term, a resident cannot sustain these motivations. I mean, who wants to study for the sake of getting a higher in-service score year in and year out? It’s a recipe for misery and burnout.

So, what motivations should we seek to make ourselves better radiologists who love our chosen profession? Let’s go through some long-term motivators to avoid the pitfalls of the comparison culture.

Love Learning

After years of testing and the comparison culture, many students forget or never learn what it is like to enjoy learning. When I read, I do it because reading helps me in some way with my practice or because a specific topic interests me. Reading and studying should not be about getting one up on our colleagues. Instead, understanding is a reward in and of itself.

Solve Great Questions

Nothing is more rewarding than solving that bizarre case or coming up with a twist that leads the clinicians to take a different direction than they had initially expected. Call me crazy, but there is something special about being that “go-to” person when anyone has a problem that needs to be solved. And solving interesting questions begets more interesting questions from your fellow clinicians.

Work To Improve Patient Care

For many radiologists, the ultimate satisfaction comes from improving our patients’ lives. Even though many of us are in the background, we can feel the difference we make when clinicians treat patients appropriately because of our calls, improving patients’ lives. Many of us derive immense joy from the vital work we perform.

Embrace The Excitement Of New Technologies

Many of us, as radiologists, went into the field because we like more significant and sophisticated toys. Whether it’s that new SPECT-CT or the latest and greatest 7T MRI, we should derive pleasure from learning these technologies’ significance and applying them to patient care. It pays to keep a youthful spirit and keep our eyes wide open in amazement as we conquer the next great technology for the betterment of others. Heck, we can even make a career out of it!

Enjoy Playing Part Of A Team

And finally, many of us enjoy our roles in forming a team and operating flawlessly as a unit. Only through interaction among team members that we come up with our best ideas and perform to our fullest. Working by yourself limits us to boundaries instead of expanding our knowledge. Playing a role in a team defeats the hazards of the radiology comparison culture.

Avoid The Comparison Culture

Ultimately, the comparison culture only gives radiologists and trainees a short-term benefit. Instead, loving to learn, solving our colleagues’ clinical dilemmas, embracing new technologies, and playing an essential role in a team can help us derive long-term happiness from our work. Avoid the comparison culture to love what you do. Radiology is a marathon, not a sprint.

 

 

 

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Top Ten Pitfalls Of The Chief Resident Year

chief resident

Traditionally, the chief resident plays one of the most critical roles in the well-being of the resident community. To that end, the chief resident often becomes responsible for much of what happens in her residency program. Unfortunately, in most programs, however, there is no playbook. And for most, the new chief residents learn their role in a “trial by fire.” Since most chiefs do not arrive as experts in this new role, they make many errors (To be expected!) So, what are the most significant blunders you can make throughout your tenure if you catch yourself in a position as a chief resident? I thought maybe we could all learn from others’ mistakes!

Make Different Promises To Residents And Staff

Before starting, many chief residents commonly will tell their classmates one thing only to realize later that the staff will not accept the change. For instance, when scheduling, a new chief may promise everyone that they will have a night float for only ten days. But, when they sit down and create the schedule, he discovers it is impossible. Now, he puts himself in a bad situation. The residents’ expectations differ from reality, and all the residents become upset. Politics is everything! So, be careful what you say!

Set Bad Examples

Unfortunately, as chief resident, you are constantly under scrutiny. What is the easiest way to lose the respect of the residents and administration? Set a bad example for the rest of your residents. Everything you do serves as a model for everyone else. If you don’t show up, who will? Who else will do the same if you decide not to step in when a resident struggles? Once a chief resident does not fulfill the role of a good leader, the rest of the residents will follow suit.

Create The Schedule And Give Yourself The Most Benefits

Chief residents typically play an essential role in scheduling. Therefore, if the program selects you as a chief resident, you will wield a lot of power over giving yourself the best shifts at the expense of others. If you want to piss off your classmates, take those times everyone else wants or vacation on the best months. That will go over well!

Poor Follow Through

Trust can be complicated to establish in any profession. But, as a chief resident, your word is your bond. Perhaps, you do not follow through on reprimanding a resident because they made a mess in a call room and did not clean up. Or, you let a resident off the hook even though they continue to skip out on noon conferences. If you don’t follow through, you lose the respect of your fellow residents and faculty. So, if you promise, make sure you deliver.

Create Cliques

One of the worst feelings in any job- is to feel left out! So, you need to be even-handed and fair. Invite only half your class to a house party. Or, instigate your fellow residents to hate a fellow resident because you don’t like them. These are surefire ways to reduce your chief resident position to rubble!

Perform Poorly

If you want to have others question your capabilities as chief, what is the simplest way? Here are some possibilities: Don’t read; Perform poorly on quizzes; Or fail your core exam. Once you establish yourself as a chief resident that cannot pass the rigors of a radiology residency, should you be a chief resident?

Poor Attendance After Passing Boards

As a chief resident, you wield a lot of power. But absolute power can corrupt absolutely. Just because you have taken and passed your boards does not give you the right to skip out on conferences or take unscheduled time off. In the end, you are still a resident. So, don’t abuse your status. It can bite you if you ever decide to get a recommendation!

Unwillingness To Help Out Faculty

Since you are stuck between the faculty and residents as a chief resident, your role becomes to appease residents and the faculty. So, what does this mean for you? Make sure to follow at least some of the reasonable demands of the faculty, or else you will fast lose respect. It could be as simple as asking residents to participate in a department-wide research project or ensuring all residents take a resident survey. Neglecting the faculty’s demands can upset your superiors and make your chief resident year miserable!

Inappropriate Relationships Within Class Or Faculty

Nowadays, with the “#metoo” movement, you must watch out for your actions. Beware what you say and how you say it. Other residents and attendings can interpret subtle cues as harassment. So, if you want to ruin your chief resident year and possibly your career, follow the rules!

Final Thoughts About The Chief Resident

As chief resident, you play a significant role in running a residency. And, because a proper leadership position such as chief resident is a new experience for most, I can guarantee you will make some mistakes. Therefore, more than others in the residency program, you need to act like a leader without taking advantage of your colleagues and faculty at their expense. Think of this year as a political learning experience. So, heed these ten warnings of what not to do as a chief resident. If you can avoid these mistakes, you will miss most leadership pitfalls. Like becoming an excellent chief resident, learning to perform a leadership role well will be handy for the rest of your career!

 

 

 

 

 

 

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Is Four Years The Right Duration For A Radiology Residency?

years

Since the creation of radiology as a specialty, the duration of radiology residency has slowly increased. When the first “radiologists” began training, a radiology apprenticeship/residency took as little as one year. After the American Board of Radiology (ABR) was formally created, the board decided to increase the number of years in residency to three years in 1940. (1) Finally, in 1982, the ABR set the required years for board certification to 4. (2)

So, what is magical about the “most recent” decision in 1982 to set residency as a 4-year process? And would it make sense to create a different length of time for completion of radiology residency? Using a thought experiment, we will imagine what would happen if the ABR suddenly changed the radiology residency from four years to three or five years. More specifically, we will address the essential benefits and disadvantages of changing the time spent in radiology training if the ABR changes the requirements for a three or five-year residency.

What Would Happen If Radiology Residency Was Three Years?

Biggest Problems

Based on my own experiences, a resident must meet a certain threshold of reads and procedures to establish competency in a given area. In the setting of a three-year residency, I believe that not all the residents will achieve this number in all subjects. Could the job market withstand new trainees with experience? Possibly, if we no longer created general radiologists and only wanted to make subspecialist radiologists. However, the current demand for radiologists seems to be for subspecialists who can practice general radiology. So, the new output of radiologists would theoretically not meet the workforce’s needs.

Furthermore, programs would need to cancel training that we all know as part of radiology residency today. For instance, would residents have the time to structure a one-month rotation at the AIRP if the residency length is only three years? (I found it to be a valuable experience!) Or, how can you substantiate the need for mini-fellowships when you have significantly less time for training? The ABR and residencies would have many of these issues to work out.

And finally, you would create one year when you would have double the number of radiology trainees entering the workforce. You may think that is not a big deal. However, due to the laws of supply and demand, those radiologists that graduated in that year of change would likely have significantly more problems obtaining a job!

Biggest Advantages

With the significant rise in student debt, eliminating a year of residency would considerably impact the lives of new residents. Imagine being able to pay your debts off a year sooner. Furthermore, trainees have already delayed gratification for so many years. Wouldn’t it be nice to start your actual career a year earlier?

From a program director’s perspective, one less year of residency would reduce some bureaucratic burdens upon the residency programs. Naturally, you would need one less year of paperwork to be processed. So, that would reduce some costs on the individual programs. But, this is more of an indirect benefit to residency programs.

 

What Would Happen If Radiology Residency Was Five Years?

Biggest Problems

If we started with five-year residency programs, I think we would first notice increased radiology resident fatigue and burnout. More specifically, this would primarily affect the first class of “outgoing” seniors since they would need to alter their expectations radically. Believe me. An extra year of residency is no minor issue!

On the financial side, residents would increase their debt burdens by an extra year of relatively lower pay. For those without debt, this probably would not impact you as much. But for most residents, an additional year can add to a significantly increased financial burden.

Less specific to individual residents, the extra year would cause a one-year absence of outgoing trained residents into the workforce. Understaffed private practices would become more severely burdened because many imaging businesses would have to freeze hiring for one year until the typical graduating schedule returned to normal. This is no small matter.

Biggest Advantages

Firstly, radiology residents would have increased experience when entering the workforce after a five-year residency. An extra year means significantly more mammograms, CT scans, MRIs, and procedures before beginning a career pathway. Moreover, the fifth-year seniors would easily be able to run academic radiology departments throughout the country. The prominent academic centers would love this. More “free” labor with more academic time for faculty members!

In that same vein, you would also satisfy the current practice’s needs by hiring subspecialists that can also practice general radiology, the most significant current demand in the private practice workforce. And similarly, you would also be creating fewer super subspecialized radiologists that could only read their subspecialties.

Additionally, you could make an argument to return the board exam to the last year of year residency before graduation. For the individual resident, this would mean more time to study during residency instead of preparing for the certification examination after entering the workforce.

 

My Take

Change is never easy. But, change that can lead to significant improvements for the current residents and workforce makes a lot of sense. In this case, I do not see that the advantages outweigh the problems of changing the number of years of radiology residency. Perhaps, later on, the balance may be altered. But, based on current practices, changes in duration would present undue burdens upon residents, faculty, and private practices without enough rewards to make the change worthwhile. Let’s continue monitoring the situation but keep things the way they are for now!

 

 

 

 

 

(1) https://www.theabr.org/about/our-history

(2) http://radiology.yale.edu/about/history/

(3) https://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=110650

 

 

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Vacation During Residency: Not Just A Luxury!

vacation

Have you ever worked in a typical business office setting (like the world of Dilbert(1)!)? Typically, you will see young professionals, some working but others wasting time. They make time to text, check out the internet, meet at the water cooler, or make sure to make time to go out to lunch together. If they forget something or make a mistake, perhaps an order gets delayed. No big deal…

Fortunately or unfortunately (depending on your perspective!), these experiences are foreign to radiology trainees and radiologists. We tend not to have much time for inconsequential social activities in our world. Most days, we spend reading films or performing procedures with real consequences. If we miss a pneumothorax, a patient can die. If we embolize the wrong artery, we can cause a stroke. So, we relegate ourselves to taking everything seriously. And rightfully so. But, all this takes a toll over time.

Have you ever heard the phrase: all work and no play makes Jack a dull boy? (According to Wikipedia(2), it comes from 1659!) Well, this phrase applies just as much to the radiology resident. In fact, with all this talk of burnout, each resident should follow this ancient bit of wisdom. Every person (even radiology residents!) needs some time to play. So, all this banter brings me to today’s blog topic: why vacation should be mandatory for every radiology resident.

Gaining New Perspectives

Often, residents get so caught up in worrying about studying, reading, and taking tests that they forget to appreciate the other important facets of life. Sometimes, you need to step back from the daily grind and spend time with friends/family, by yourself, or accomplish something different. Whether you take a trip to an exotic locale or stay in the comfort of your own home and get some more sleep, a vacation gives you that extra time to accomplish different activities from the usual. What better way to gain a more positive perspective on your work and life?

Improving Concentration And Energy

I don’t know about you. But, after a week or two off, when I return to work, I usually return with renewed vigor. It’s a wonder what an extra little bit of sleep or change of pace can do. And I am not the only one who says so. Study after study (2) has shown that vacation improves productivity when you return. So, don’t feel guilty you are not learning enough. Take that vacation and enjoy!

Remembering What’s Most Important

Yes, the radiology work and studying we do is critical. However, as the old bit of wisdom goes, what do people remember the most at the end of life? It’s not that they wished they could spend an extra day completing an assignment at work. Instead, it tends to be the time that you spent away with your loved ones or friends or the good times you had on vacation. So, don’t fret and take that little extra time off!

Incorporating Different Ideas To Improve Residency Experience

Finally, when you vacation, you see new places, complete projects, or think about life differently. The best ideas often come when you are not at your primary work home. (For me, that’s at 2 AM when I write these articles!) Maybe, you scuba dived in Bora Bora, completed an archeological dig, took the time to finish that extra gardening, or spent more time perusing in bed. Often, you can incorporate these “extraneous” activities into improving the residency experience for yourself when you return.

Vacation And The Radiology Resident

Vacation is not a luxury. Instead, residents especially need to consider vacation as a requirement to recharge and unwind. So, fly far away or stay home. It doesn’t matter. Just take that vacation, and your work life will improve when you return. Let others worry about work when you are on away!

(1) www.dilbert.com

(2) https://en.wikipedia.org/wiki/All_work_and_no_play_makes_Jack_a_dull_boy

 

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When To Say No At Nighttime (A Resident Guide)

no at nighttime

Radiology residents can expect disagreement with a nurse, fellow resident, or attending on any given night. Due to lack of sleep, tempers flare, and we magnify minor problems into large ones. Ultimately, we mostly accommodate our colleagues and perform the study they request as we should! Sometimes, however, saying no at nighttime can be one of the most important yet challenging responsibilities of a radiologist on call that we need to learn. We don’t want to offend our colleagues’ sensibilities or upset the attendings of other clinical services. And we want to ensure that we complete studies promptly to increase ER turnover. Yet, there is a time in all radiologists’ careers when the right thing to do is say no.

But, at what point should you say no, I won’t comply with your request? Let’s explore this issue of when to say no at nighttime. We will discuss some of the most common circumstances for the radiologist to refuse a request appropriately. For each case, we will discuss how you should proceed instead.

Studies That Would Cause Undue Patient Risks

Out of all the reasons to refuse a study, most importantly, we must ensure that we comply with the Hippocratic oath, “First do no harm.” This oath is priority number one. For all of us, a time will come when a resident or attending will ask us to perform a study or procedure that can potentially harm the patient. It could be an unnecessary CT scan on a pregnant woman or a biopsy on a patient with an elevated INR. As a physician, we need to prevent these procedures from getting completed. It is our first and foremost responsibility.

So, how do we stop a study when attendings or residents apply crushing pressure to perform the exam? First, we need to elaborate on the data behind why such a study would harm the patient. And then, most importantly, we need to do it in a way that does not demean or upset the physician. This technique is where the art and science of medicine meet in the middle.

Procedures That Would Jeopardize Your Safety

Not only do we have a responsibility to our patients. But also, we have a responsibility to maintain our safety. To take care of others, one must take care of oneself. So, to put yourself in significant danger, simply put, clearly does not meet the sniff test of practicing good medicine. The test could involve putting yourself in harm’s way with a combative patient or exposing yourself to undue radiation. Make sure to think about your situation first before going ahead.

How do you decide if the procedure would affect your safety for you to say no at nighttime? Always think about the potential consequences of a worst-case scenario. If you can think of a situation when you can get seriously injured from a study, it is probably not the best idea to complete the procedure.

Interpretations Or Procedures That Need An Attending

Sometimes we should not complete a test or procedure unless an attending can be present. You may be able to perform the exam adeptly. But, it is not in your best interest to complete the study for legal or ethical reasons.

How do you judge if the study may not qualify as a resident’s domain? If the procedure can result in significant harm unless performed by the appropriate personnel or a protocol establishes that a resident should not complete the study, hold off and call your attending. Let’s give you an example, such as a brain death study. Although easily interpreted by a resident many times, the consequences of “missing” can result in severe harm. Additionally, many programs have protocols for attendings to read this examination.

Inadequate Resources

This one may seem pretty obvious. However, we should not promise to complete a test if we don’t have the capability of finishing it. Often, residents unknowingly will offer a solution to a problem that may not exist in your institution. Or the institution cannot obtain the resources on the night of your call. For instance, you may promise the clinician that you can perform a V/Q scan, not realizing that the agents are in short supply. Unfortunately, this disrupts management, the timing of testing, and the formation of a patient’s final disposition. So, always make sure to check that you can complete a test before you allow the order. And, make sure to let the ordering doc know!

Nondiagnostic Studies

Occasionally, you find an adamant clinician or resident who demands the immediate performance of a test that will not assist in making a diagnosis. In a huff, these folks can propel you down the wrong road. In this situation, it pays to push back a bit. How? Data is your friend. Perhaps, the clinician insists they need a bleeding scan when the patient has a very slow bleed. Calmly, you need to explain why the test would not change the patient’s situation or add any additional significant information. Usually, the ordering physician will comply.

Things That Take Up Too Much of Your Time At the Expense of Patient Care

Often, students, residents, or even faculty will ask for assistance on all sorts of studies they may need help interpreting. However, your time can be minimal. A typical example: A resident asks for a reinterpretation of a cancer workup performed six months ago. Now, it may be essential to perform at some point. But, if you have 20 trauma cases that you still have not read, is it the correct decision to look at this sort of study? Probably not. So, politely tell the resident your situation. Trust me. This physician will go away and let you interpret your STAT cases.

Repeating Similar Previous Studies Without Good Reason

Finally, it is not uncommon to find orders for a repeat CT scan or fluoroscopic study after someone has recently performed it. Clinicians sometimes make errors in unknowingly repeating studies. I can’t tell you how many times this has happened. As radiologists, we are responsible for checking and finding out if these studies are indeed warranted. Again, you must calmly and politely let the ordering clinician know if this is the case.

Final Thoughts About Saying No At Nighttime

Saying no can take real guts when you are not the “authority.” But, when to say no at nighttime needs to be learned by all residents. It can be an art as well as a science. And the lessons stay with you for the rest of your career. So, if the situation arises that you need to say no at nighttime and it can affect patient care, respond gently and with the data to prove your point. The rewards of saying no can be immense.

 

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Top 10 Radiology Anachronisms Today From 1999

radiology anachronisms

Since I started my radiology residency in 1999 (only 23 years ago!), a whirlwind of changes has morphed the field of radiology into something very different from when I first started. It’s amazing how new modalities, technologies, and techniques creep up on us, gradually replacing the old ways. That got me thinking… Since everyone loves lists, what are the top 10 radiology anachronisms from 1999 that would be out of place today? Don’t worry… I’m not going back to the 1950s when pneumoencephalography reigned king because that was not my time. (And most of yours as well!) Instead, let’s start with some of the significant changes for general radiologists from the more recent past (Hopefully after you were born!). I think you might find this enlightening. Enjoy!

Analog Films/Film Panels

When I first started, I hit upon the end of the physical film era. Fortunately, I was one of the last classes to experience the dusk of its usage. Soon after, I graduated residency and never looked back in the world of film. Boy, did that change how we practice radiology!

Pulmonary Arteriograms and Trauma Aortograms

I will lump these two studies into one category because they are invasive diagnostic studies. For those of you that remember, the experts considered pulmonary angiograms for years to be the “gold standard.” Now, we only use chest CTAs. Wow, did that change in a huff with the newer CT technology! And, what about the trauma aortogram? Do you remember getting woken up at 3 AM to rule out aortic rupture? I certainly do!

Misplaced Imaging Studies

For those of you who experienced the film era, you will remember orthopedics taking a good percentage of studies down for surgery, never crossing the path of the radiologist’s eyes. How often does that happen now? Very rarely do films get lost on PACS!

Double Contrast Barium Enemas

In New Jersey, finding the equipment you need to complete a double contrast barium enema is almost impossible. And many residents have never even seen one performed. Incredible isn’t it?! Almost everyone seems to get a colonoscopy or virtual colonoscopy instead. It’s ironic because double-contrast barium enemas played an essential role in cancer screening. No longer!

Written Prelims

Most newer radiologists and residents can’t even picture writing a prelim, let alone writing anything down. That is just how we used to operate in 1999 as residents. We would hang the CT scan boards and then write our impressions on paper in a binder. How passé?

Clinicians in the Radiology Department

I remember when the radiology department bustled with activity from the surgeons and oncologists. Rarely does that happen anymore? Sure, you still get that occasional straggler that enters the room. But, that is more the exception rather than the rule. Too bad, huh?

PET Scanners Without CT

When I started, the debate about whether PET-CT would provide a significant added benefit over a standard PET scanner raged. Well, that debate ended rather quickly! I don’t think I’ve seen a traditional PET scanner around for a while!

Transcriptionists And Cassette Recorders

It’s next to impossible to forget about the changes in dictation technologies over the past 19 years. Granted, I don’t think that the technologies have gone far enough. However, a lot has still changed. I haven’t spoken to a transcriptionist or dictated into a cassette recorder for eons!

IVPs and Ionized Iodinated Contrast

Who can remember having to inject your patients for IVP with iodinated ionized contrast, no less? I do! The pain from an infiltrated dosage was immense. And, I can remember a lot more untoward allergic reactions. Well, fortunately, this is no more!

Absent Hospital CT Techs After Hours

Absent CT techs certainly would not fly at most hospitals anymore. Hospitals expect CT scanners to run at all hours, no matter the case’s urgency. I almost can’t imagine a hospital without 24-hour CT coverage. It makes me miss the old days!

Final Thoughts on Radiology Anachronisms Today From 1999

These radiology anachronisms are probably just the tip of the iceberg. And, I am sure you have your ideas about what would be an anachronism today from 1999. So much has changed! I would love to hear from you to find out what you think are some of the top radiology anachronisms. If you have a good one, please comment below!

 

 

 

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An Insider’s View Into The Radiology Residency Rank List

rank list

The ranking process and rank list seem like a black box from a medical student’s perspective. But today, we will shed some light on how the process works (at least in our radiology residency!) Of course, I cannot speak for all radiology residency programs. But, many programs do have a similar process.

So, how does this all work? You will be the proverbial fly on the wall in today’s post. More importantly, hopefully, you will gain insight into what we look for when we meet and what the rank list process entails.

The Basics Of The Rank List Process

It all begins a few days before the interviews take place. Each interviewer takes home a pile of applications to review before the interview day. Of course, we consider the usual suspects- the Dean’s Letter, research, experiences, recommendations, and all the other components of the process (See Cracking The Radiology Residency Application Code!) And all of these factors are weighted accordingly, with the Deans Letter weighted the most in the equation.

Then, we add on our impressions of the candidate from the interview. Based on these factors, typically, the interviewers give each candidate an overall grade on the day of the interview. Why? Because the applicants stick freshly in our minds on the interview day.

Most importantly, however, after we give the candidates this initial grade, we confirm our impressions with the residents. We call this meeting the coffee clutch. (Other programs, I’m sure, have other names for this sort of meeting!) Depending on the gestalt of the residents, we may change that final grade to higher, lower, or to do not rank.

Only then, once we have the residents’ input, does each interviewer finalize the overall grade that the applicants receive. And we place the interview candidates into three primary piles. The first batch is the application pile that satisfies our credential and personality requirements. We like to call these applications the “rankables.” Most candidates fall into this grouping.

For the next category, we call this the question pile. Sometimes, we will revisit these candidates at a later juncture after we have obtained additional information. Other times, we must mull over the quality of the rest of the candidates before we decide to rank them finally.

And lastly, the final group of applications is those that do not pass muster. We place these into the Do Not Rank list (informally called DNR/DNI!) To summarize, these applications are from candidates with inadequate credentials, personality flaws, or other issues that we think would not fit our program’s culture and philosophy.

How Do We Create Our Rank List?

If you remember before, I mentioned that each interviewer gives a candidate an overall grade. And, for any given day, we always have two interviewers. Each interviewer provides a score from 1 to 11, with 1, the lowest possible score (except for DNR/DNI!) and 11, the highest possible score. Subsequently, we sum the score of the two interviewers, representing the candidate’s primary grade. (scores range from 2-24) Most applicants assemble somewhere in the middle of the pack (scoring between 10-14)—of which those exceptional scores higher and those weaker trends lower.

However, we did not entirely complete our work yet! Next, we take into account a couple of other factors. First, folks that submit a thank you letter will receive an additional half point. And then, those that come for second looks will also garner a half point. (We only add points if we did not DNR the candidate!) What is our motivation behind this? We like to add a little bit to these folks that take the time to show interest in our program. If you think about it, it makes sense. Candidates who succeed in our program want to be here. And, thank you letters and second looks show additional interest. So, it makes sense to reward these folks.

In the situation of those candidates squarely in the middle of the pack, these minor half points can potentially make a humongous difference. Since most candidates congregate around the mean, it simply puts you above everyone else in your category.

Submission Time

Once we finish our last day of interviews, we check for and add on any extra thank you letters and second look points to all members of the rank pile. In addition, we revisit the question pile, making sure to call who we need to call, get additional information, and decide whether we will rank these applications.

We add the numbers to create a final ranking for each candidate’s application. But, we are still not done. We recheck the applicant rank list several times to ensure that the rank order makes sense and we have not made any other errors. And then finally, we input the numbers directly into the computer on the NRMP website.

Final Thoughts

Well, that’s about it. Nothing earth-shattering! No system is perfect. But in my biased view, the process seems logical and fair. I like to think that we do a decent job with our information.

Most importantly, the proof is in the pudding. When I realize the great residents we have accepted over my tenure as Associate Residency Director using our ranking process, it has paid dividends over time. Our residents have been fantastic!