Tag: resident advice

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What Kind Of Technology Background Is Critical For The Radiology Resident?

technology background

Ever been frustrated watching your nuclear medicine attendings use their proprietary software adeptly, while you do not understand how they manipulate the images? Or, do you notice that some of your faculty can look at a whole series with a slice by slice comparison by setting them with a point, but you can’t? Although hospital and corporate information technology should create systems easy and intuitive for every radiologist to use, in the real world, it is not the case. And, even though you may know your radiology and anatomy cold, there are serious ramifications if you do not know what I like to call technology background or “buttonology” knowledge to operate the systems.

So, first, I am going to elucidate why “buttonology” and some radiology technology background can become so critical to your skills and practices. And, then I will tell you what computer features you should expect to learn during your residency and why.

Reasons For Learning “Buttonology” And Getting A Technology Background

Helps Us With Our Job

In general, most of the technology that we use make our lives easier. It may not seem so at the beginning. But, when you do get to know how to manipulate images and information the right way, it can increase efficiency. Heck, what was life like before Picture Archiving And Communication Systems (PACs)? We read half the amount of films in double the time!

Can’t Function Without It!

I cannot even imagine how I would function without knowing how to make measurements or to get to the next case on the queue. So, it requires us to make time for learning at least the bare minimum of what we need to know to get us through the day whether we like it or not!

May Use It After You Leave Residency!

Believe it or not, yes, life exists after residency. And, many of the same hated technologies that you use during your residency, you will likely need to know later as well. I can still remember learning Penrad (a mammo text-based dictation system) that I could not stand during my residency. It took hours to learn how to use it properly. And, I thought it was a waste of time. But, you know what? It has become a regular part of my day as an attending who reads some mammography. You never know what you will need to grasp after you finish.

Clinicians May Ask For It

In our practice, clinicians ask for the use of specific technologies and documentation in our reports. So, it behooves us to learn them to stay in business. Yes, it took some time to learn how to use the DATquant software to determine the likelihood of Parkinson’s disease in patients. But, now we have cornered the market. It was well worth the effort!

Technological Features You Need To Know

OK. We need to learn these technologies even though it is a time sink and may seem distasteful. So, what are the tools that we need to look out for and take time to learn? We will go through some of the basics here.

Tools To Function Daily

This first category would be the most obvious. It would be the technology background that you need to get through the day as a radiology resident. So, which are the essential tools that residents should take time to learn? You should acquire mastery of measurement tools (distance, Hounsfield units, angles, etc.) Each resident should also be able to scroll, pan, window, link cases, and perform necessary reconstructions in a pinch.

You also need to operate any computer system that you will need to make it through a night of call. These include the general nuclear medicine imaging readers, CT perfusion technologies, and so on.

And then finally, you need to know some of the other functions that if you do not remember, you cannot read the cases. These technologies would include the dictation software and sending images to the correct workstation or software.

Tools You May Need After Residency

In your hospital and departments, you will most likely not need to know all of the technologies available. However, you may find some of them will pay off in spades later on when you begin your first job. You never know. RIS systems, complex nuclear medicine applications, mammography software, etc. are only some of the technologies that you may encounter. You may not “need” them now, but it may be worth it to put the time in upfront to learn them if you think there is a chance you may use them. If possible, you do not want to learn them at your first job where you will waste a lot more time. And, more importantly, you will seem a lot less efficient when you begin as an attending.

“Buttonology” And Your Technology Background Can Make Or Break You

Knowing the “buttonology” of radiology systems can be critical for your professional development and future career. Without the tools that you will need, at best, you may make yourself inefficient. And, at worst, you may not last at your first or second job. So, during residency, take the time to learn the basics of PACs functionality and hospital systems. Think of it as an investment in your future. I promise that it will pay off big time!

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Five Dictation Styles To Avoid At Your Own Peril!

dictation styles

As you get along in your career, you will see thousands upon thousands of dictations. And as you would imagine, most reports are useful to clinicians and fellow radiologists.  However, others should never make it to the medical record. To top it off, some of these dictation styles make me bonkers. Often, they waste my time and increase my workload. Therefore, I can only imagine how the clinicians feel that order these studies!

So, in the interest of altruism, I have decided this week to give you five examples of different dictation styles to avoid and one format to use. Some of these dictation styles are too wordy. Others are non-objective. And, others are merely careless. To show you different ways of creating the same report, I have made each dictation similar with a history of shortness of breath (So, you won’t see it at the beginning), and with the same overall findings of right lower lobe pneumonia. Now, you will know how you can get that information across the easy way or the hard way!

The Five Dictation Styles To Avoid!

Style 1- The Cut And Paster (It’s A Struggle To Figure Out What You’re Thinking!)

Comments:

PA and lateral views of the chest demonstrate right lower airspace disease that obscures the right hemidiaphragm. Follow up to resolution is recommended. Cardiac silhouette is within normal limits. Skeletal structures are intact.

Impression:

PA and lateral views of the chest demonstrate right lower airspace disease that obscures the right hemidiaphragm. Follow up to resolution is recommended. Cardiac silhouette is within normal limits. Skeletal structures are intact.

Style 2- The Emotional Dictation (It’s Not A Novel Guys!)

Comments:

PA and lateral views of the chest show patchy opacities at the right base that are compelling for either the diagnosis of atelectasis or pneumonia. I believe that a mass in the right lower lobe is unlikely. However, I would desire to follow up in 6 weeks to make sure it resolves.

The cardiac silhouette is within normal limits. Skeletal structures are unremarkable.

Impression:

Findings compelling for right lower lobe pneumonia or atelectasis

Desire follow up study in 6 weeks to check for resolution.

Style 3- The Indecisive Dictation (All Things Being Equal!)

Comments:

PA and lateral views of the chest demonstrate probable right lower lobe airspace disease. The differential can include pneumonia, atelectasis, pulmonary edema, pulmonary infarct, sequestrum, drug-induced inflammatory changes, fungal infection, atypical lymphoma, or other neoplastic entities. Followup to resolution. The cardiac silhouette is within normal limits. Skeletal structures are intact.

Impression:

Probable right lower lobe pulmonary parenchymal disease.

Consider pneumonia, atelectasis, pulmonary edema, pulmonary infarct, sequestrum, drug-induced inflammatory changes, fungal infection, atypical lymphoma, or other neoplastic entities.

Followup to resolution

Style 4- The Overly Technical Dictation (No one cares and what a waste of words!)

Comments:

PA and lateral views show slight underpenetration of the film with minimal patient rotation rightward.  At the right lung base, the right hemidiaphragm is partially obscured by patchy airspace opacities. It encompasses a segment of the right lower lobe measuring 2 cm and overlies the right 6th through 8th posterior ribs. The airspace opacities extend to the right heart border but does not obscure the silhouette. These findings are most consistent with right lower lobe pneumonia. Followup to resolution is recommended.

Cardiac silhouette is within normal limits. Osseous structures are intact.

Impression:

Right lower lobe pneumonia
Follow up to resolution.

Style 5- The Unchecked Dictation (If you like phone calls, this one is for you!)

Comments:

PA and lateral views dem straights right lower lobe air space disease consistent with pneumonia. Folloup to resolution is recommended. Cardiac silhouette is normal. Osseous structures are intact.

Impression:

Left lower lobe pneumonia.

Followup to resolution.

One Style That Works For Me!

Comments:

PA and lateral views of the chest demonstrates right lower lobe air space disease consistent with pneumonia. Followup to resolution is recommended. Cardiac silhouette is normal. Skeletal and soft tissue structures are intact.

Impression:

Right lower lobe pneumonia.

Followup to resolution.

Summary

So, there you have it: five of the some of the more common annoying dictation styles that you will see and one that works for me. Please, please, please… Try to avoid the usage of these horrible styles. Regardless of whether you create them or read them, they will waste your time and efforts. At least, consider trying to develop good dictation habits before it is too late!

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A Dangerous Personality Trait: “Never in Doubt But Sometimes Wrong”

dangerous personality

This week I thought it was essential to discuss a dangerous personality trait that can lead to disaster when beginning a radiology residency. Coming from different programs, some residents start with bad habits formed from their preliminary year. I like to call this dangerous personality type “Never in Doubt But Sometimes Wrong.” More often than not, these residents trained for their prelim year in surgery (But not always!) and developed this personality trait during the internship. They would have formed skills like talking with strength and charisma. And, usually, this is a good thing. However, this is not the case when this resident does not have the knowledge and experience to back up their overconfidence.

This personality tends to persuade her audience, attendings, and residents, regardless of the evidence. Accessory staff follows these physicians to the ends of the earth based upon the sure command of her words. However, these residents (and other physicians) know the same or less than their colleagues. Moreover, they have not developed the experience to make the most critical decisions as a first-year radiology resident.

Why do I bring this up today? Well, I thought it was necessary to be aware of its consequences if you have developed these tendencies. Alternatively, for other residents, I want you to recognize this personality trait so that you do not go down with the proverbial “ship” as well. Also, what better time than at the beginning of residency?

Why is this so crucial? Well, I go through the three main reasons these beginning radiology residents need to alter their ways: Danger to the resident, increased liability, and potential for harm to the staff.

Danger To The Residents

Being sure of oneself is essential to becoming an excellent radiologist. However, not when the radiologist has not read up on the subject or understands the case. Especially for the first years, this is a danger to their career. Every once in a while, we hear these new residents telling the clinician the wrong diagnosis and management.

Moreover, since these residents have such charismatic personalities, they can often sway their opinion about the case. Unfortunately, the clinician listens and begins working up the patient incorrectly. In the end, the program directors hear about the mismanagement, and the resident can suffer from probation or even worse.

However, the danger is not only for the resident with the personality trait. Also, the followers can suffer just as much. You probably have seen attendings in other specialties that espouse facts with such enthusiasm, only to realize when you look them up that they are entirely incorrect. These attendings tend to be well respected by the hospital administration (but not so much by their colleagues) and wield much power due to their charisma. So, check everything twice before following one of these strong personalities.

Increased Liability

Not only is “Never in Doubt But Sometimes Wrong” a dangerous personality trait that can lead to bad medicine, but also it can significantly increase your medical liability. They can report whatever you communicate to the ER in the medical record. And guess what? You can be liable for the damages incurred to the patient if wrong.

For example, this sort of dangerous personality may confidently state that the patient does not have appendicitis on a CT scan as a first-year resident, even though having never seen a case. Subsequently, he convinces the ER doctor that the study is negative. Finally, unfortunately, the patient incurs harm. The medical license of this resident is potentially on the line.

Dangerous Personality Can Cause Potential Harm To Staff

In our profession, we must remember that the world is not always just about the physician. Instead, the rest of the team can play just as essential a role. Confidently knowing wrong information places our nurses, technologists, and aids in dangerous situations. Instructing a nurse to use the wrong needle can lead to injuries. Convincing a technologist that a patient with an ear implant can safely go in the MRI without knowing can cause a technologist to lose his job. These are potential situations that stem from a resident with misplaced confidence.

The “Never In Doubt But Sometimes Wrong” Dangerous Personality

In radiology, there is no space for overconfidence. According to the Hippocratic oath, our role, like other physicians, is to “do no harm.” And you can see the significant danger a resident can cause to themselves and others when they become overbearing without the accompanying knowledge and experience. So, I beg you. If you are not sure of something, maintain your humility. Let your colleagues, staff, and fellow faculty know. It is OK not to understand. However, it is not OK to let others think you do when you don’t.

 

 

 

 

 

 

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Dealing With The Abusive Nighttime Physician: Rules Of The Road

abusive

Picture this scenario. A Napoleon-like 5 foot 2 verbally abusive surgeon enters the reading room. He begins to yell at you for not performing an intussusception reduction the way he likes. Moreover, a team of surgical residents stand behind him, each member turning red with embarrassment as he continues with his tirade. His verbal abusiveness becomes more and more aggressive. He uses terms such as “idiot” and “moron” to describe you as you attempt to get a word in edgewise. You feel like you want to strike your fist in his face. Does this situation sound vaguely familiar? How would you deal with this everyday but unfortunate situation when you are alone at nighttime?

#MeToo

First, no one should have to contend with harassment such as this. I don’t care if you are a resident, nurse, janitor, or attending. Unfortunately, although society has finally come to terms with refusing such abusive behavior and isolating these individuals, many hospitals still silently condone it. How and why? Perhaps, the hospital is understaffed and would rather have someone to fill the gaps even though he has an abusive personality. Or, the hospital may hire an inappropriate physician because she has a good reputation and brings many patients into the system. Regardless, the behavior is unacceptable and needs to be dealt with accordingly. So, let’s go through some of the processes you need to complete to prevent this harassment again.

Engage Softly With Team Response

The last thing you want to do as a resident is fight fire with fire. If you continue to raise your voice and tussle with this attending, you are making a containable situation into a nuclear bomb! Instead, what is the appropriate course of action?

You can say to this individual quietly, “I am just trying to help you care for your patients appropriately. We are in this together. I will talk to you again when you speak to me professionally so we can help your patient together.” Usually, the raving physician calms down if you maintain a quiet and calm demeanor. At this point, the situation usually de-escalates. Who knows? You may even receive an apology. But that may or may not be the case.

Document, Document, Document

So, what next, assuming the situation does not calm down? If the surgeon has been harassing you, it is most likely a long-standing observable pattern of inappropriate behavior. And this physician has likely affected many other employees within the hospital as well. Therefore, you should document the behavior in written form. State the time, place, and situation as objectively as you can. Then, place the document on the side for further use, if necessary.

Next, you may want to ask other observers, if present, to create a supporting document. This report lends credence to your inappropriate interaction. You are better off gathering multiple documents to establish a pattern of behavior.

And finally, for each time you encounter these behaviors with this individual, you create another document. You are making a paper trail that will help remedy this situation.

Speak To Your Supervisor

As for the next step, you must contact your residency director or associate residency director first thing in the morning. Speak to them and give them the documentation. If possible, leave the wheeling and dealing in the hands of the local administration. Why? Well, often, the lowly resident does not have the influence upon human resources or senior administration like a long-standing faculty member does. And, the administration can turn back the blame on you.

Last Resort- Human Resources

OK. So, your supervisor has not yet fixed the situation. Or, maybe she settled it for that one time, but the abuse is recurrent. Where do you go next? Sometimes you have to go right for the horse’s mouth. You may need to talk directly to human resources and hand in the documentation yourself. Usually, this will begin a full investigation into the matter. Of course, hopefully, you can avoid this situation. Unfortunately, on occasion, you need to act to protect yourself in this way.

Final Thoughts About The Abusive Physician

We all went to medical school and began training to become consummate professionals. Along the way, unfortunately, you will encounter abusive physicians that do not follow these rules of professionalism. Often they have issues of their own. But that does not excuse the actions of these individuals. We, as clinicians, should act according to the rules of civil behavior. And if these abusive physicians cannot play by the rules, either they need to change their ways, or they should not be able to practice medicine. So, we serve all by taking action and not remaining silent.

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Creating Great Radiology Teaching Conferences: Think Like A Soloist In A Jazz Ensemble

conferences

Have you ever listened to a great jazz ensemble live? When each soloist takes his turn, he plays in tune with the melody’s key. Also, he stays with the main elements of the general theme. If the soloist deviates from the key and doesn’t maintain some semblance of the original tune, the solo sounds bizarre and out of place. Even though he must play within a particular framework, a soloist also plays a unique melody, creating something new and innovative as he goes along. Sound interesting… But what does this have to do with radiology conferences? Well, let’s get to that next.

What makes a great teaching conference? Great conferences need some general theme, similar to the melody’s key. Maybe, the conference will address adrenal masses. But, if you talk about adrenal lesions and then, on a whim, deviate by discussing brain tumors, the conference will not reinforce essential concepts about the adrenal mass. And, the trainees will not remember the important points.

At the same time, residents or faculty that give great conferences also add some unique flavor that allows the participants to make the experience memorable, just like the unique melody. Perhaps, it is an unconventional thought process or a funny joke that reinforces a concept. Maybe, the direction that the audience moves with unforeseen swerves takes them to new places. The bottom line is that teaching conferences also need spontaneity.

So, let us discuss a few simple principles about how you, too, can create a conference that maintains your audience’s attention. Based on the same principles as a jazz ensemble, we will divide the remainder of the discussion about creating great talks into two parts: how to create a theme and then learn the art of spontaneity.

Creating A General Theme

As we discussed above, the key to aiding retention is to make an overarching theme. So, how do we decide on that? There are many ways to do this. One way, take a specific organ and then divide that subject into individual topics. For example, if you are talking about adrenal masses, introduce each adrenal tumor type and find individual cases to demonstrate the appearance and pathophysiology of each adrenal lesion.

Or, you can find a pathophysiological mechanism and present cases that conform to that diagnosis. In this situation, we can take masses that cause mechanical renal obstruction. Whether you take a general subject area or pathophysiological mechanism, ensure all the cases tie into the theme. This way, you will reinforce the retention of your audience.

Learning The Techniques Of Conference Spontaneity

Just as important as creating a great theme for a lecture topic, residents and faculty all need to learn how to be spontaneous to maintain our audience’s interest. But most of us never learn the art of spontaneity at a conference. So, how can we take our talk to the next level and become more than a droning speaker?

First of all, don’t use PowerPoint as a crutch. Slides are guideposts for an idea, not a source of exactly what to say. I can guarantee that if you read your slides word for word, most of your audience will drift away. (especially residents who had a long call the night before!) Instead, talk about the general ideas behind why you created the slide as if you were conversing with a friend.

Second, let your audience actively participate in the conference. What do I mean by that? Perhaps, you want to have the audience answer multiple-choice questions. Or, have the listeners take cases under your direction. Either way, you will not allow your audience to nod off and feel like they are only passively observing.

Finally, I recommend adding relevant analogies, jokes, or stories to enliven the conference. When you think about some of the best talks, something in the lecture clicked with you to make you remember a concept or theme. Usually, one of these techniques would have helped you to retain the new knowledge.

Creating Great Conferences

Unfortunately, quality varies widely among residents and faculty when giving conferences. Often, it is not the fault of the individual that gives the lecture. Instead, faculty and residents have never learned the basic tenets of providing a great conference. So instead, think like a jazz ensemble and use the basic principles of creating a general theme and utilizing my techniques to become more spontaneous. With these tenets, you will give conferences extra spice to keep the audience engaged and increase retention of the information you present.