Tag: residency

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Ten Reasons Why Service Jobs Are Important Preparation For Your Radiology Career!

service jobs

For those out there who worked at Taco Bell during high school or the local Target (1) for a year while in college, these kinds of service jobs may seem irrelevant to your radiology resume. But for program directors and residency selection committees, we find these “real-world” experiences invaluable in creating a picture of a well-rounded person. Here is a list of ten reasons service jobs are crucial to your career!

People Skills

Ever had to get someone to make a final decision because they were unsure if they wanted the Dell or Acer Computer at Best Buy? Or perhaps, you had to take someone’s order at the local Denny’s. These skills are immediately translatable to situations we encounter with people daily in our field. Perhaps, you need to convince a patient to get an interventional procedure completed. Or maybe, you must soothe a patient before getting their barium enema? These people skills will come in handy!

Managerial Skills

Need the technologist to work with you when you are doing fluoroscopy? Well, those years managing the local Subway shop will serve you well. If you can get your employees to clean the restaurant floor, it is not a giant leap to having the technologist prepare everything before your next fluoroscopy the way you like!

Ability To Deal With The Real-World

Is your head in the clouds because you’ve been only thinking about abstractions your entire life? Or do you have some fundamental translatable practical skills? A few months working at your local supermarket will certainly cure you of living in a dream world! We, as radiologists, constantly have to manage real-world situations, not just the anecdotes we read in books!

Practical Problem Solving

Perhaps you worked as a waiter at a restaurant and spilled tomato sauce on your client. Or maybe the deli slicer stopped working? How do you deal with these situations on the fly? As we practice medicine, we need to have the same ability to think on our feet and “outside the box.” Working in service jobs is excellent practice!

Workplace Diversity

When you work at the local McDonald’s, you encounter all races, socioeconomic classes, and cultures. What do we do as radiologists? Well, we also need to take into account these factors for our patients and staff. If you have never had the experience of working with a diverse population, you will not understand the nuances of daily radiology work!

Teamwork

Have you only experienced the artificial environment of working with others at school? Or, have you needed to work as a team to make those sales at the Gap? Working in service jobs is a fantastic way to get this experience!

Understanding of Business Bottom Line

Ever had to run a business to pay your employees and make ends meet? You don’t get that experience by reading books! Instead, it would help if you involved yourself firsthand. And you know what? Radiology is a service business like any other. We need to meet the bottom line too. Now, we know you can empathize with our work!

Conflict Resolution

For those of you that never held a real service job, it is difficult to comprehend how to solve conflicts among your staff. A little practice at your local drug store routinely calming your clientele as they wait to fill their prescription goes a long way toward solving conflicts with your patients and staff as a radiologist!

Ability To Handle New Technology

Maybe, you had to learn an entirely new register at the local hardware store. Or, perhaps, the engraving tools changed. You need to know these new tools very quickly. Guess what? Changes happen in radiology all the time. See, these service jobs are an introduction to our world!

Service Jobs And The Bottom Line

Working in the service industry before beginning a radiology residency is no joke. We, as program directors, truly value the efforts that you have made to work a real job. Whether it is conflict resolution, problem-solving, or learning how to be part of a team, your experience in the service industry will help prepare you for our line of work. So, go forth, don’t be embarrassed, and add that job to your resume. It can only help your cause!

(1) Target is an affiliate of this website

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How Important Is My Radiology Interview Really?

radiology interview

Picture this: It’s more than halfway through radiology interview season. And you’ve already traveled through much of the United States to meet all sorts of radiologists. You’re a bit weary from all the work (Imagine how your interviewers feel!) So, with all that time and effort you have put into the radiology interview process, did the interviews make a significant difference? I mean, this is only radiology, right? A specialty that does not value human interactions as much as internal medicine let’s say? And what happens if some interviews went well and others stunk up the joint? Does it significantly change how the programs rank you on the rank list? Well, today, you are in for a treat. You are going to get an insider’s view of the process!

The Power Of The Radiology Interview

Even in radiology, if I were to say that the interview held no weight whatsoever, I would be lying! A radiology interviewee with good interviewing skills can potentially increase his chances of matching. On the other hand, the interviewee that fails miserably can detract from their application. So much so that occasionally the interviewer can give you the dreaded acronym DNR (Do Not Rank!). But let’s go into some more specifics here.

The Interviewing Maven

Are you one of those medical students who always sound intelligent to everyone you meet? Or, perhaps, your charisma infects the entire room? Let’s say your interviewers have a 10-point scale that considers all the information, including your Dean’s letter, recommendations, personal statement, research, experiences, and board scores. I have seen certain applicants bump themselves up to 3 points. So what does that mean? A lot! Most candidates drift around the middle of the rank list or in the 4-6 range. When you add three points to your application, that can place your application in a rarified atmosphere. It can almost ensure your acceptance to a program.

The Interviewing Wall-Flower

Are you shy or uncomfortable during interview situations? Or maybe, you always appear depressed and lethargic? Hmm… Perhaps, you have a bizarre schizoid appearance? How do these interviewer qualities affect your application? Let’s see. In my experience, an applicant that should be somewhere in the middle or top of the pack can go down to (drum roll please…), the land of nowhere. And where is that may you ask? DNR (Do Not Rank)!!!

On the other hand, the average poor interviewee who is not quite hitting the answers to questions well or making a few flubs usually gets detracted by a few points. However, that can still make an enormous difference in a competitive application process.

My Final Point

So, if you consider these calculations, which radiology interview has the power to change the status of your application the most, the good or the bad? It’s simple. A bad radiology interview trumps the potential positive effects of someone with a great one.

What is my final point of this exercise? Make sure to take the interview very seriously. Please, please, please. Practice before you come in. Tape yourself on your cell phone. Do whatever you must before arriving or showing up on Zoom. A radiology interview is critical. Your future livelihood is at stake!!!

 

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The Program Director Interview Welcome Presentation: More Than Meets The Eye?

welcome presentation

 

 

As part of the radiology residency interview trail, most interviews begin with a welcome presentation delivered by the program directors. I know. Your eyes may start to glaze over as you think about these presentations. All of them blur together by the time you have reached your second or third interview.

But wait… Maybe there is more to these conferences than meets the eye. Although sometimes painful, these presentations are chock full of information that will become very important once you begin the radiology residency. And, believe it or not, the initial program director lecture content usually does summarize the residency programs well. So, try your best to maintain awareness instead of falling asleep in that comfy chair in a warm room with the program director droning on about the program. Listen very carefully and take notes. Your future career is on the line. Ignore it at your peril!

To summarize for today, my goal is to cue you on what you should tune into when you hear these lectures. Most quality presentations contain wide-ranging information, from residency rotations to information about ancillary staff and even imaging equipment. But what do you need to get out of the production? I’ve divided some of the most important themes you may not find elsewhere with the following subheadings: program theme, staff availability, teaching methods, program stability, and fellowship connections. We will go into all of these in more detail.

Program Theme

Every program has a general theme. Some programs are academic. Others produce community radiologists. And even others gear themselves to the interventional radiologist. Usually, the presentation develops one or more of these general themes. Most of the time, you will not find this information on the website or paper. For instance, I can tell you that when I gave the welcome presentation, I emphasized how our program runs as a private practice in an academic community setting. It doesn’t say that anywhere on the website or in the packets we give the applicants. You will be hard-pressed to find this information elsewhere. So, you need to take notes and write down the kind of program you are interviewing.

Staff Availability

Often, the welcome lecture summarizes how open the program is to input from the residents. Can you ask the attending a question on the fly? Or do you have to make an appointment month in advance to get the program director’s ear? You can derive a sense of the general communication between the residents and the attendings from the interaction with the program director and residents during the welcome session. Again, you won’t receive this information quickly from other sources.

Teaching Methods

Most presentations mention the styles that attendings utilize to teach the residents. Does the program emphasize multiple-choice questions at conferences? Do they like to use the Socratic method of teaching how to read films? Or maybe, the residents are taught chiefly by total immersion in the rotation. For some residents, this may be a crucial determiner of the effectiveness of their learning over four years. I’m unsure how you begin to find this information unless you know the other residents or the program director well.

Program Stability

If you listen carefully, the program director may talk about the attending staff at the institution. Are they all young? (Usually, that means there has been a recent collapse of the residency program) Or, as I like to say, do all the staff members stay around until they are in a “proverbial box.” The average age of the staff is 70. (If you see a residency program like this, maybe they churn their young attendings) This information can also be hard to come by using other means.

Fellowship Connections

Usually, you can find out where the former residents went to their fellowships after residency online. However, the program director may drop hints about getting their residents into these fellowships. That is just as important. Do the attendings have deep seeded connections at other institutions? Or rather, the program director may not talk about staff connections at all (A red flag!). Typically, the welcome presentation will divulge some additional information about these connections.

The Welcome Presentation- More Than Meets The Eye

As you can see, a welcome presentation is more than just a summary of all the information everyone already knows about the program. Typically, it summarizes facts about a residency program that you may not be able to find easily elsewhere. So, I recommend listening (as dull as some of them may be!). You may learn a thing or two that will help you decide where you want to match!

 

 

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When A Disaster Strikes- A Radiology Resident’s Role

disaster

 

 

It’s ironic. A while back, I started to write about disasters and radiology residency in the evening, only to wake up the following day with Las Vegas headlines screaming about a disaster with mass casualties, gunshot wounds, and severe injuries to over 500 people from a crazed gunman. Unfortunately, these poor victims needed immediate care. And we, as radiologists, were in the trenches. It is only a matter of time before we may encounter a horrible situation such as this.

Perhaps, you are on call at the time. Or maybe, you are the only radiologist in the hospital covering this affected population. Again, we are not discussing a bus collision with a few victims. No. I’m talking about a mass casualty such as this one where hundreds or perhaps, thousands get injured at a time—a dirty bomb, a World Trade Tower-like incident. What should you do first? Who would you contact to help? How would you cope? Where would you go? Let’s sort through some general rules and think through these issues together.

Make Sure You Are Safe To Perform Your Duties

It goes without saying. For you to perform your duties as a radiologist, first and foremost, you must ensure that you are safe. Is there an active shooter in the building? Get out. Are you in a place of radioactive fallout? Move further from the epicenter. You cannot do your job unless you are alive and healthy. So, be aware of your surroundings.

OK. So, you feel reasonably safe at your post. But, you are not done with maintaining your safety. Be aware of the mass casualty situation. Is it chemical exposure or radioactive contamination? Perhaps, an airborne illness. Follow the rules to avoid further exposure to provide the most help to the maximum number of victims.

Does Your Department Have Electricity?

This question might sound a bit silly. But, unique to radiologists, we rely almost entirely on the ability of the facility to generate electricity—no electricity and no x-rays, MRIs, CTs, and so forth. If there is no power, you will unlikely be able to help as much as a radiologist. (except for battery-powered ultrasounds) Instead, you may be only able to help as a treating clinical physician.

Take The Time To Call For Backup

Next… When hundreds or thousands of victims require acute medical care, and you have electricity at your facility, one lone radiologist is unlikely to be able to provide imaging services for everyone. Call the covering attending radiologist in a mass casualty such as this one. Now, you can decide if you need more coverage to interpret or perform all these studies rapidly.

Triage, Triage, Triage

Unlike standard operations, you no longer have the luxury of providing any study to anyone. In this situation, all the hospital’s imaging resources will run out. So, you are in a position to ensure that the appropriate victims receive the correct studies (the art of triage!).

The treating physicians are not experts in imaging. You are. So, you need to monitor appropriateness criteria like a hawk. You want to save the most lives. Only the sickest and most needy patients should receive imaging first. And, of course, they need the correct study.

Read Where Help Is Needed

Perhaps, you are dealing with lots of inhalation injuries. Well, then, concentrate on the chest X-rays. Or maybe, tons of gunshot wounds. Read the CT scans. You should read what is most needed.

Assess What Happened And Create An Action Plan

So, you’ve run through all the initial steps of our disaster protocol recommendations. And you’ve made it through the disaster scenario. What do you do next? It’s simple: Assess the disaster situation and create an action plan.

Creating a radiology action plan becomes essential so that if disaster strikes twice, you know the best ways to handle it. Your hospital should have a radiology emergency protocol even before the disaster. (Not all hospitals do!) So, now is your opportunity to contribute to or create your own hospital’s disaster committee. Make the plan as efficient and as practical to implement as possible.

Disaster Management Summary

No matter how you slice it, as a radiologist and a physician, a disaster scenario can be complicated. So, you need to follow some of these general rules to make running a disaster protocol as efficient and safe as possible for you, the radiologist, and the patient. Be safe, call for backup, triage, and use appropriate resources. Finally, remember that assessing the situation is crucial and developing an action plan (hopefully before the incident!). Next time, if it happens, you will be ready as you can be!

 

 

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Gaining Recognition When The Odds Are Stacked Against You

recognition

For medical students and residents, at times, it can be tough to gain recognition for your work. I want to give you a little vignette of one uncomfortable experience with a difficult attending I had as a former medical student. Then we will discuss how to counter a poor evaluation. Although your stories may differ from mine, many of you will experience something similar as you traverse through residency.

The Background Story

I was a fourth-year medical student subintern during a medicine rotation. And my group consisted of myself, a pretty female third-year medical student, an intern, a resident, and a balding senior medicine attending in his late sixties or early seventies. The attending physician assigned us to review compelling cases that presented themselves the prior week. We were then to discuss the medical topics that arose from these cases.

First, the 3rd year medical student began to discuss a patient with severe onset of hypertension. And she went through an appropriate workup of the patient with hypertension and delved into the physiology and management of patients with hypertension. It wasn’t a bad presentation. Unfortunately for me, the attending would not stop affectionately staring at the third medical student. It was a bit creepy.

Next off, it was my turn to present. I had a great case of a patient with Histiocytosis X/eosinophilic granuloma of the spine that I thoroughly researched. I knew the case and the topic cold. Therefore, I rehearsed the presentation many times at home. So, I was excited to present. What could be wrong about presenting a rare, fascinating case I knew well?

So, I began to present the case and then went through the process of coming up with the diagnosis with history and imaging. Again, I noticed the attending continuing to ogle the third-year medical student inappropriately. As soon as I started to discuss the topic, WHAM… He shut me down by saying, “We don’t need to discuss this topic because it rarely occurs, and you will probably never see another case like this in your lifetime. What a waste of everybody’s time!”

Problems With Gaining Recognition In Clinical Education

All too often, something similar to this scenario occurs in clinical medicine, whether you are in radiology or another field. Perhaps, you are a foreign medical student, and the mentor won’t give you the time of day. Or, maybe, you are rough around the edges, and your teacher doesn’t like your personality. In all these situations, favoritism for reasons other than merit and quality often trumps a great job. No matter how you change the grading system to include milestones or different innovative ways of evaluation, bias can interfere with gaining recognition for your work. In the end, the final grade often comes down to the evaluators’ quality. (Don’t take it personally!)

At the same time, there are many positives about the experience of having learned about the topic of eosinophilic granuloma, regardless of my evaluator. First of all, in my line of radiology work, the diagnosis of eosinophilic granuloma has come up in my experience several times. Second, from my studies on the topic, I have used the information from that presentation for the betterment of my patients. And finally, the subject arose on some of my radiology board examinations, and I knew all the answers to the topic cold. So yes, there was something educationally valuable from this experience.

How Can We Align The Evaluator With The Recognition Of A Good Job?

That brings us back to the crux of this post. What can you do to get the attention of your evaluators about your quality work when they don’t want to give you the time of day? I do not claim it is going to be easy. It certainly isn’t. But there are a few workarounds.

Get What Makes The Evaluator Tick

First, ask your evaluator what it is that interests them. Now, I am not asking you to be a brown-noser, but sometimes to garner the attention of our seniors, we have to find out what makes them tick. A person like this is more apt to listen to you when you are on the same wavelength. Admittedly, in my case above, if I had changed my topic, I think it still would have been difficult to change this attending’s opinion of me. But, at least, I would have presented a case that would have been more likely to get his attention.

Defy Expectations

Next, go above and beyond the expectations of the evaluator. For instance, perhaps, I could have begun a quality initiative study to improve the outcomes of patients on his service and put his name on the paper. My story above might not have ended differently, even if I had provided the “ogler” with something distinct and memorable. But, it would have increased my chances of garnering recognition for my work.

The Nuclear Option

And finally, sometimes you need to go to the top. Things can be, on occasion, so bad that you cannot even fathom doing anything that will change the opinion of your senior. But be very careful. Heads of departments will often side with their staff before they side with a resident or medical student. So, if you use the nuclear option, ensure you have objective evidence that this person is unfair to you without trying to get your evaluator into trouble. And, also make sure that the director is willing and able to help. Sometimes, they can pair you up with someone else who can evaluate your work.

Gaining Recognition For Your Work

We all encounter people in positions of authority who may not be “fair” to their subjects. It is part of what we experience in medical school and residency and part of the real world. Most of us are somewhat sheltered from the real world through the beginning of medical school because our teachers’ primary evaluation method is exams. As we enter the clinical years and residency, evaluations become more subjective. So, learning how to successfully interact with difficult attendings who may unfairly evaluate your work is vital. Don’t be another technicality of a poor mentor. Be proactive in your education and obtain the recognition you deserve.

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Should I Take A Leave of Absence During Residency?

leave

 

Sometimes events beyond our control interfere with radiology residency. It may be a personal situation, a new business opportunity, mental illness, or severe burnout. I outlined some of these issues in my previous article called The Struggling Resident. And perhaps, one or many of these reasons have you thinking about taking a leave of absence.

But, what does this option entail? Many residents don’t know the details about taking a leave of absence. So, we will talk about the potential consequences of what can happen after a leave of absence and why you need to take the option only as a last resort. Then, we will discuss what situations merit taking a leave of absence, a circumstance where you might want to think about taking a break (but very carefully!), and finally, situations where it is seldom appropriate to take a leave.

Truth or Consequences

What is so serious about deciding to take a leave of absence from residency for some time? Maybe it’s six months, a year, or more. There are so many reasons why it can become a significant issue.

1. It will potentially take you off schedule for getting into a fellowship. Many fellowships will not consider residents who begin in the middle of the year.

2. You will likely have to start paying your health insurance and benefits. Believe it or not, it can cost tens of thousands of dollars for health insurance for a family. You may pay a few hundred dollars out of pocket per month when you are employed, but it can run over a thousand dollars per month when you are not. Can you cover those expenses?

3. You create a reason for future employers not to hire you. Many employers become very concerned when they see a gap in your employment history without an excellent cause.

4. It can cause irreparable harm to your residency program and classmates. You can no longer take call. Additionally, the rest of the class needs to shoulder the responsibilities. It does not set you in the light of a team player.

5. And finally (and perhaps most importantly!), you may be legally required to start paying off your massive debt load. That can be a real bear!

I Can’t Do My Job

So, when should you unconditionally take that leave of absence? It comes down to one situation: you cannot perform your job duties safely. If you can complete your residency duties, radiology residency is a temporary affair (albeit four years). And, believe it or not, many physicians would love to be in your shoes. So, if you are able and healthy, you should put all your efforts into completing your residency.

That said, if you have a mental illness, severe disability, or significant trauma, by all means, take that leave of absence. You took the Hippocratic oath and may not be able to abide by it in these circumstances. So, these conditions necessitate a departure. My advice: If it is some reason that does not involve breaking the oath, do what you can to pursue other endeavors until after your residency. You will have a great field to fall back on.

A Once In A Lifetime Opportunity

A confluence of events occurs from time to time, leading a resident to consider a job opportunity in another field. Perhaps, you just got that call to anchor a TV show. Maybe you created an invention, and a large company wants to buy out your patent for 5 million dollars; that will take a long time/lots of work to seal the deal. Or, you’ve been dancing for years, and a director in Broadway wants you on his show.

As I began brainstorming about what issues may eventually allow a resident to take a leave without regrets, some of these reasons could potentially cause a resident legitimately to rethink a radiology residency. I get it. Just remember, for those of you with significant debt, if you don’t pay your debts, the IRS can garnish your wages for the rest of your life. And these unique situations are not always a means of securing a lifestyle for years to come. (although occasionally it can be) So, those residents in this unusual situation need to think long and hard about taking a leave of absence.

Situations That Do Not Merit A Leave

If you are thinking of starting a business, quitting medicine, or needing some time off to relax and travel the world, this is not the time. You’ve already been through 4 years of college, four years of medical school, and a year of internship. What is four more years or less in the scheme of things to complete a radiology residency?

So what are some other situations that you should not use to take a leave of absence during residency? These would include taking a break to pursue another subspecialty (why can’t you just wait it out to apply, so you don’t have a gap in employment?) Or, maybe you have mild burnout (better off talking to a coach, colleague, or physician.) Perhaps, you want to start a new business (can you wait until after residency?). Attempting to train for the next Ironman triathlon is not a bad idea (you want to jeopardize your future?), and so on.

Final Thoughts

Taking a leave of absence is a huge deal. Many residents may dream of taking a break at one time or another to go for something they never had a chance to do before. However, think twice, my friends. Often, it sounds good in principle, but the practicalities behind it don’t make much sense!

What do you think? If you have any opinions, please leave a comment below!

 

 

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Residency Just Starting And I Am Panicking!

panicking

Hi Dr. Julius,

I read your article on the struggling radiology resident, and it prompted me to contact you. I am an R1 and just finished my first week on Body CT. After this week, I feel panicked and have been attempting to study almost every chance I get, including all day during the weekend. Still, I think I cannot possibly learn all this information (just the anatomy base I need has worried me). I know it is still early, but my colleagues are way more relaxed and comfortable in their current roles than I am. I would greatly appreciate any suggestions you have for me.

Thank you so much for this article and your help,

A Concerned Resident

 

Answer:

Detailing The Problem

To begin, I want to stress that your colleagues who appear as if they are more relaxed and comfortable may be putting on their best face, but they may be panicking too. It can be challenging to tell how another resident or colleague feels. Regardless of how they appear, it would help if you didn’t worry about them. Instead, you must ensure you are doing your best instead of panicking.

I don’t care what anyone says. The first weeks of the first year of radiology are some of the toughest. Anyone who doesn’t think so is in for a big surprise later. It’s good to have a little bit of fear at the beginning. It can motivate a new resident to become great. Excessive fear, however, is no good. You certainly don’t want a fight or flight response!!! Or, you can burn yourself out before you’ve even started. That will make you make you sick.

Also, I think body CT can be one of the more difficult rotations to feel comfortable with, especially at the beginning. Some of the personalities can often be difficult in that field. And, there is more anatomy to know than you may have imagined. This large amount of anatomical information is more so than other subspecialties like nuclear medicine. Plus, you have to start to get to know the pathologies on top of that. So, I know you are in a tough spot.

Solving The Panicking Problem

But alas, there is a solution. I find that the best way to deal with a challenging situation, like the beginning of the first year of radiology, is to establish a reasonable plan of attack. You and I know you cannot know everything. Albeit, many of your attendings may make you feel that way. (you have to try to tune that nonsense out.) However, you can learn what you need to know to become a trusted first-year resident. The key here is to study smartly. Certain books are geared to the first-year resident. For instance, the Webb Body CT book is a great and short resource to learn the basics of body CT scans. You need to concentrate on these.

In addition, the reading style in radiology differs significantly from what you have been learning. Make sure to read the pictures first, the captions next, and then the text last. This strategy will give you the most bang for your buck when reading radiology. Once you have the basics down of a modality within the first week or two, I would also emphasize reading the case review series. Radiology is about pictures. So, why would you not want to emphasize the images? Memorizing lists is daunting and usually not very fruitful without context. Looking at a bunch of pictures makes a list more relevant and memorable. This technique will leave you less prone to panicking. Try to study in this manner.

Also, I would recommend you look at my article on taking oral cases. Handling cases with oral technique is readily transferable to your day-to-day radiology activities. If you can do that well, your colleagues and attendings will appreciate your intelligent assessments more.

In any case, let me know if there is anything else I can help you with. With a bit of change in the study method and trying not to worry about how others look compared to you during your first year (which can make you crazy), I think you can do just fine.

Barry Julius

_______________________________________________________________

Hi Dr. Julius,

Thank you so much for reaching out to me with your advice. I am doing my best to stay positive and study hard. I will let you know how it goes. Thank you!!!

Best wishes,

A Concerned Resident

————————————————————————————————————-

It takes some time to get into the routine. Good luck with it!!!

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10 Ways to Sabotage Your Radiology Residency Interview

radiology residency interview


As radiology attendings, we need to sit next to our radiology residents for hours at a time. We get to know your quirks, mannerisms, and other personality features for better or for worse. (Kind of like a marriage!) Interviews are a time to let that personality shine through. We want to make sure that you are a living, breathing person with a soul. Can you speak understandably? Can you hold a conversation? Are you funny/witty? What’s your hygiene?

A radiology residency interview can also confirm that you are the person you say you are in the application. Can this person be trusted? Is this person going to lie to his attending about a procedure or history? For these reasons, significant weight is placed on the interview even though the process is imperfect. Furthermore, it does not always weed out the bad from the good.

Even knowing the importance of the radiology residency interview process, many prospective radiology residents enter the interview unprepared and have the perceived emotional/situational IQ of a tomato. If that were you, I recommend you practice your advertising pitch numerous times before beginning the interviews. If you want that residency job, you need to be the greatest of actors/actresses during the interview process. Show us that you can handle the demands of radiology residency!!!

Throughout my interview experience, I have seen all sorts of applicant disasters during the radiology residency interview process, usually related to unprepared applicants. Most can prevent these catastrophes with attention and practice. I am going to go through 10 real interview characters that have sabotaged their application. I hope these scenarios will be instructive in the art of the radiology residency interview. DON’T LET ONE OF THESE CHARACTERS BE YOU!!!

The Liar

Our third radiology residency interview candidate of the day walks into the room and shakes my hand firmly as we sit down to talk. He seems very focused, and I enjoy talking with him. He starts talking about how he developed an organization that hires famous CEO guest speakers to come to his medical school and lecture on business in medicine. Wow, very impressive! The interview ran smoothly, so I preliminarily gave him high marks.

After the interview session, the selection committee convenes to review each of the applicants. It turns out, the application and the other interviewer had different stories. Upon review of the application, it says he was just a member of the organization’s club. The other interviewer said he would only chauffeur the CEO to the meeting. Out of concern for the applicant’s integrity, we put him in the do not rank pile.

Bottom line: Make sure to get your story straight. Your oral presentation and written information should all be aligned. The interviewers regularly reconcile everything together. You need to tell the truth and stick with the same story!!

Smelly Guy At The Radiology Residency Interview

Before the formal interview procedure, we have a social interaction period with the residents to get to know the applicants. After most of the residents leave the room, we begin to hear some grumbling from the residents. So, I walk into the room, and as I walk toward a particular applicant, a stench becomes stronger and stronger. Oh my God!! It smells pungent, and I can almost taste it in my mouth. My impulse is to run, but I have to be cordial due to the circumstances. I am dreading the one on one interview process.

Bottom line: Make sure your hygiene is appropriate before starting your interviews. Appearances and “smells” are essential!!

The Sleepy Man

My introductory lecture to our residency program starts, and the lights begin to dim. I typically look at all the applicants in the room to keep the interest level high. But after 5 minutes of lecturing, I hear a loud freight train-like noise emanating from the back row in the form of an applicant in a suit. My assumption is he is not interested in the residency program: suitable applicant but low-interest level. We rank him toward the bottom of the list.

Bottom line: It is imperative to get a good sleep the night before the interviews. Even if the applicant was only tired but interested in our program, sleeping during the interview shows a lack of interest and respect.

Ms. Robot

I warmly introduce myself to an applicant as she enters the room for the formal interview. Entirely devoid of emotion and empathy, she responds, “Hi” quickly. We sit down, and the applicant immediately launches into this speech about herself without any voice inflection or changes in tone or speed. I have the sense she has done this a thousand times before. There is no “conversation-like” tone to her speech. No interactive quality. Is this the way she will behave when I have to sit with her for hours at a time? Even though her application was excellent, the applicant committee decided to give her a do not rank assessment.

Bottom line: Practice interviewing with others. Pretend you are having a conversation and interacting with your interviewer. Perceived personality is vital!

Shy Radiology Residency Interview Guy

The applicant walks into my interview room and introduces himself, but I can barely hear what he says. He stretches out to shake my hand. His hand feels cold, limp, clammy, and weak. The interview starts, and I try to get him to respond to my questions, but it’s like “pulling teeth.” The answers last 10 seconds at most. I asked the residents sitting next to him in the conference room about the candidate, and they said he didn’t speak a word. No one was able to figure out his personality. Even though his application was OK, we felt we could not put him on the rank list.

Bottom line: You need to get over your fears and act and speak with confidence. It may involve practice, coaching, and psychological evaluation. If we can’t figure out who you are during your interview, we are not sure if we want to sit next to you as a resident!!!

Mrs. Bizarro

Across from me in the interview area sits a pleasant-looking woman dressed appropriately. Everything seems fine until our conversation begins. Her eyes start to bulge out. Smiles and giggles burst out inappropriately in the middle and end of sentences. Even though she answers my questions mostly appropriately, something is off.

After the interview, we meet with the selection committee, and the first thing I ask is: what’s with Mrs. Bizarro? All the committee members look at me and say, “We were thinking the same thing!!!” We quickly took her off the rank list.

Bottom line: Practice your interviewing skills in front of a mirror or tape yourself on an iPhone. You need to know that your expressions are appropriate for the interview context. This lady may have been an excellent radiologist, but we sure would not feel comfortable having her sit next to us!!!

Not Quite Right, Joe

Toward the end of the interview, we start to talk about extracurricular activities and hobbies. The applicant proceeds to say that he was into cow-tipping as a college student. And one time, the college dean reprimanded him for the activity. Automatically, mental bells start ringing. Who would mention something like that in an interview setting? Why would someone want to do that to a cow? Off the rank list, he goes!

Bottom line: We are not your friends in the interview setting. Do not release any information that could jeopardize your application and make you appear strange. We do not want any issues during residency that could cause probation, suspension, or worse!

The Guy all the Residents Hate At The Radiology Residency Interview

I am having a great conversation with one of the applicants. He tells me about some of his exciting research projects and hobbies. He seems to be a straight shooter and is very witty. We end the conversation on a high note with expectations that we will rank the candidate highly.

After our interview, we met with the rest of the admissions committee. The admissions committee consists of the residency director, associate residency director (myself), chief resident, and several other senior residents. We begin to discuss the candidate at hand. Every single resident states something negative like: “This guy was obnoxious”; ‘He was chauvinistic,”; “Really bitingly sarcastic.” The directors are dumbfounded. We place the applicant in the do not rank pile.

Bottom line: You need to play nice with all members of the staff, especially the residents. They have essential input in the residency application process and interviews. The wrong statement can get you kicked off the rank list!!!

The Cell Phone Gal

I started giving the introductory talk to the applicants about the program. Every minute or two, I notice a woman looking down at her lap. Oh well… I continued with my lecture.

An hour later, we meet for an interview, and we shake hands. We sit down, and I start asking questions. The applicant seems a little bit distracted. Again her eyes continue to float down toward her lap every few minutes. All of a sudden, I hear a ring. She picks up the cell phone and says to me, “I need to get this.” She is not interested in our program.

Bottom line: Shut off your cell phone. You are here to interview for a job. It is a sign of disrespect to use your cell phone at any time during the interview process!

Opaque Sam

We parse through an applicant’s resume and ERAS transcript. The package states that the resident had a DUI arrest when he was a college student. So, the interview begins after some ice-breaking small talk. Naturally, a DUI arrest is a big deal. It signifies that the applicant has the potential to be an alcoholic and engage in risky behaviors. So, I anxiously pop the question: Tell me about what happened with your DUI arrest when you were in college? The applicant bluntly states, “It happened. It’s over. I don’t really want to talk about it further…” A moment of silence ensues.

Flash forward to the selection committee meeting. All the interviewers received the same response from the applicant. There was no response of remorse. No explanation for the event. Nothing. Our committee put the applicant in the do not rank pile.

Bottom line: Candidates should address any adverse events upfront, or else an admissions committee may perceive the applicant as hiding something significant, whether true or not. Don’t be like Opaque Sam!!

 

Sabotaging Your Radiology Residency Interview!

Interviewing is often about what not to do as much as it is what you should say. Make sure you prepare for the interview day. And, don’t be like our ten catastrophic characters!!!

 

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Is It Possible To Get Into Radiology Residency With An H1B Visa?

Good evening, I am an MS3 just starting to discover the excitement of radiology on my radiology selective. I am contemplating radiology as a career, but I have low Step 1 score (227) and I am also an international student requiring H1B visa for residency (I attend a top 40 US allopathic school and am not Canadian). Is radiology still an option realistic to consider given my circumstances (I hope to match into a university program)? What can I do now as I start my third year going forward to increase my competitiveness? Thank you for all your help!

Adele

Hi, Adele!

H1B And J1 Visa Issue

The answer to the question of your chance for getting into a program may hinge on the next few questions I am going to ask you. Why is it that you require an H1B vs. a J1 for getting a residency? What kind of visa do you currently have? This may make a big difference because universities are much less likely to support a resident with an H1B visa since it costs the university a lot of legal fees and time to support a candidate to obtain the H1B visa. Also, the federal government limits the numbers of H1B visas. Therefore, you significantly limit the playing field of choices of programs to apply.

Some of the larger academic university programs may allow applicants with an H1B visa. But, many smaller programs like ours do not take applicants with H1B visas for the reasons I mentioned (with a few rare exceptions). When applying, if you can’t get a J1 visa, I would definitely call the individual programs to see which ones would take an H1B visa.

Biggest Positives In Your Application

So, what do you have going for you? First, the fact that you are graduating from an American medical school will help your situation immensely. We, as program directors, selfishly like to get applications from American medical schools. At least we can vouch for the quality of the institution and compare to other applicants. Second, your scores are not bad. Many programs have cutoffs around 220 or 225. So, it should allow you to meet that requirement at many programs.

Other Recommendations

In addition to the recommendations above, I would also consider taking the next USMLE early, studying hard, and perhaps completing a USMLE Step II course so that you can show improvement from your 1st USMLE examination to the next one. Program directors like to see improving scores going in the right direction.

Why The Visa May Be The Biggest Issue

Unfortunately, the visa issue may the biggest impediment to getting a radiology residency slot. I would like to refer you to my article called The Alphabet Soup Of Residency Visas And The Radiology Alternate Pathway: A Guide For The Foreign Radiology Residency Applicant at the link above:

Thanks for the great question. I would be specifically interested in why you need an H1B. Let me know if there is any other information that you think I can help you with. I will post it on the website at some point because I think it would be useful for other applicants in your situation as well.

 

Regards,
Barry Julius, MD

Dear Dr. Julius,

Thank you for your reply and great advice.

I am currently on an F1 student visa and was advised against a J1 visa by my immigration attorney because of the requirement to return to my home country for 2 years. I am Singaporean and have been looking into the H1B1 visa for Singaporeans. It is similar to H1B, but has its own cap that has never been filled historically, can be obtained anytime throughout the year, and only requires the employer to file LCA (I-129 is not needed).

I am under the impression that it would be easier to approach programs that offer H1B already to ask about sponsoring for H1B1 visa, than programs that offer J1, since they may not be familiar with the H type visa. Is this likely to be true?

Also, how and when would you advise me to contact programs and discuss visa-specific issues/requests. Should this be done before I submit my residency application?

Thank you for all your help.

Best regards,
Adele

 

 

Thanks for the additional information. That allows me to understand the issues that you have and why you need an H1B1.

I would definitely make sure to contact the residency programs and the Graduate Medical Education (GME) office prior to applying because many of the programs will not even look at a candidate who has to get an H1B or H1B1 visa for a residency slot. Most programs are set up for the J1 visa. If you need an H1B or H1B1 visa to get into a program, it puts you into a different application pool.

You certainly don’t want to waste your time and money applying to those programs that only take J1s and not H1Bs. It makes sense to contact each of the individual radiology programs and the GME office prior to applying to save you a headache. Typically, the person to speak with would be one of the folks in the GME office who handles visa issues. And, you probably want to speak to the residency coordinator because occasionally the individual program policy can potentially differ from the GME office. ( the program may not take a resident with a visa issue, but the GME office may say it is OK) At our institution, this person is a secretary and is very knowledgeable about all things visa related since she has been doing it for a long time.

Hope that gives you a little bit more insight about when to contact the program and who to contact.

Regards,
Barry Julius, MD

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Cracking the Radiology Residency Application Code

application

Most medical students and residents do not have an insider’s insight into radiology residency and fellowship application and interview processes. Even worse, misleading advice and rumors cloud the process. One needs only to look at the average student or residency forum to see numerous conflicting stories and statements.

Only someone actively involved in the process can understand what you need to know when applying for a radiology residency. So, thankfully, you have come to the right post. I have looked at thousands of applications and interviewed hundreds of residents for positions in our program as associate program director. So, I will help you out by delving into the depths of the radiology residency application process. This article will give you the basics of what you need to know.

The Application

We could go through the application in one of many ways. But, I think the best way is to go through the different parts of the application from most to least important. This way, you will not squander your energy on the small stuff!

The Dean’s Letter

Few sections of the application genuinely differentiate one applicant from another. Dean’s letters happen to be one of those items. The reason for that: you will receive comments from attendings, residents, nurses, technologists, and secretaries that may say something negative. I can’t tell you how often we have parsed an entire application with glowing positives until we arrive at the Dean’s letter. And, then we receive coded messages in the letter, such as: was very shy during the rotation, but did see some improvement. Or, this resident was very independent. However, he did not seek help when presented with a challenging patient care issue. And so forth.

Additionally, the Dean’s letter is the only document (other than the boards) that compares the applicants to their classmates. Most medical schools have buzzwords indicating the residents’ rank in their class. Each one is different, but typically it allows insight into which quartile the resident resides.

Can You Do Anything About The Dean’s Letter?

Ok, so you have your Dean’s letter written in “stone.” And, at some institutions, you may hear that administrators say you cannot change the Dean’s letter. But usually, at the bare minimum, you can check the Dean’s letter. All medical students applying for a residency should scan their Dean’s Letter before sending out the application. I have seen Dean’s letters sent on behalf of medical schools with the wrong applicant’s information!

At other institutions, you can look at your letter before application time and potentially modify the document. If that is the case, you should undoubtedly check it for any hostile or questionable comments. And then, if possible, confront the department/person that wrote the statement. Ask if they could redact or modify it. If the writer is truthful, the person may decide to leave it there. But an attempt should be made, as this one negative comment can make the difference between high, low, or no ranking on a program’s rank list. Not infrequently, the admissions committees will obsess over one questionable comment. They will often spend countless painful hours perseverating over these “minor details.”

The institution may not allow you to look at the Dean’s letter at a few medical schools. But the school may allow your mentor or a faculty member to look at the document and possibly edit it for corrections. I can’t emphasize enough how important it is to increase your odds of being accepted to the residency of your choice.

The Boards/USMLE

Why are the boards important? Well, the boards/USMLE assess the ability of a future resident to pass the radiology certification examinations. We have noticed a strong correlation between lower board scores and difficulty passing the new core exam in our program. So, similar to our program, most programs take the USMLE score very seriously.

In addition, programs use board scores more as a baseline cutoff. Once you score higher than that baseline, it doesn’t factor much into the ranking equations. On the other hand, unless extenuating circumstances exist, failing and low scores usually place the application in the deny pile.

What About COMLEX?

For those of you that are D.O. medical school applicants, I recommend that you take the USMLE in addition to the COMLEX examination. Many radiology programs are unsure of the significance of COMLEX scores and don’t know how to factor the scores into the ranking equations/cutoffs. Applications with COMLEX scores alone may get thrown out of the interview pile entirely.

Gamesmanship

Even with all these factors, you can use some gamesmanship when it comes to the boards. If you have done very well in the step 1 boards, often, you may be able to get away with just sending those scores alone. You may want to delay taking step 2 USMLE. With high USMLE Step 1 scores, USMLE step 2 scores can only hurt you if they are lower. Of course, all this gamesmanship will disappear when the scores no longer exist on Step 1. At that point, Step 2 scores will most likely replace the outcomes on Step 1.

Finally, most programs look for/expect improvement from step 1 to step 2, especially with borderline step 1 scores. So be careful and take the step 2 boards very seriously. Invest in a review course if you need to.

Research

Nowadays, research can become a significant factor in getting an interview in a residency program. What is the reason for that? ACGME guidelines mandate that accredited radiology residencies have specific radiology research requirements for residents before graduating. Knowing that a resident has completed multiple quality research projects means that a resident can work more independently completing research projects. This knowledge of research reduces the burdens upon the department.

Furthermore, radiology research may demonstrate significant interest in the field. And, it provides an avenue for discussion during interviews later on in the process. We often look at an application, saying it’s pretty good, but the resident hasn’t completed any research. That may take the application down a few rungs.

Bottom line, though. It won’t take you entirely out of the running for getting a spot. However, it can be a significant asset in some situations.

Extracurricular activities

We look for two big red flags to avoid on this section of your application: those applicants that emphasize that they have participated in every extracurricular activity under the sun and those applicants who write down almost nothing. A resident who participates in everything suggests that he lacks focus, never investigating or accomplishing tasks in depth. On the other hand, a resident that engages in nothing but school tends not to be well rounded. These residents may not have outlets to disperse their frustrations during their four years of training. A residency director does not like having frustrated residents!

Impressive Extracurriculars

So what are some activities that impress the admission committee? : Interesting extracurriculars that show leadership potential, activities that demonstrate a depth of involvement, and activities that offer an ability to handle stressful situations and function independently. Some of the special extracurriculars that stand out in my mind that meet these criteria would be a student that started a Subway franchise successfully from scratch and made it into a big business, a student that participated in the Olympics, and a student that lobbied for Congress. These are people that tend to climb the rank list higher because their extracurriculars were memorable.

Not So Memorable Extracurriculars

What are some extracurriculars that don’t add much to the application? Those activities that everyone else does and do not suggest leadership potential. In radiology, those would include participating in a radiology club (Big deal!), participating in health fairs (Every medical student does it), and teaching inner-city kids (We see it all the time as part of medical school curricula!) Not that these activities are harmful, but they don’t add much at all to your application. My recommendation to you: find something you enjoy, hopefully, something unique, and stick with it during your four years of medical school training!

Recommendations

Admissions committees like to make a big deal about recommendations. You’ll undoubtedly hear that you need an excellent letter to get into a great program. But honestly, if you ask someone for a recommendation, it is unusual to find someone who will write you a nasty one. Students are going to ask attending physicians that like them. On the other hand, although rare, we see a “bad” recommendation as a significant red flag. It often means the resident that obtained the letter has a poor emotional intelligence quotient. Or she couldn’t find one attending that liked them- both significant issues!!!

Like the rare bad recommendation, great recommendations that raise the application within the pile to a higher rank are also unusual. For the most part, this type of recommendation stems from well-known entities that want the person in their program. Or perhaps, it comes from a close colleague that the radiology admissions committee implicitly trusts.

Recommendations rank relatively low in the application influence equation given the rare ability to change the application disposition.

The Personal Statement

Finally, I would like to talk about the item that medical students often perseverate on the most: the personal statement. The personal statement seldom helps an applicant and can occasionally hurt an applicant. After having read over a thousand of them, there are very few standouts. And, almost all of those that stood out were somewhat disturbing. I still remember an essay that emphasized a dead rabbit. It did not have any correlation to radiology whatsoever. I was concerned about mental illness in that student. We terminated the possibility of acceptance to our program immediately!

If I had to say one thing, I would advise you to be cohesive and relevant to your future career as a radiologist. Also, watch out for typos because typos suggest an inattentive personality, not a characteristic you want in a radiologist. Other than that, don’t fret too much about this part of the application.

Summary

Application for radiology is an arduous process with multiple pitfalls. Make sure you concentrate on those items that give you the most “bang for your buck” to send your application higher on the rank list. In particular, put particular emphasis on the Dean’s letter. Check it if you can. Correct it if need be.

And finally, don’t be that student with marginal board scores, no research, dull or no extracurriculars, poor recommendations, and a personal statement that stands out too much. If you follow my suggestions and try not to rock the boat, you should get into a great residency!