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The Other Struggling Radiology Residents

struggling radiology residents

A radiology residency program is like a family. When one person is afflicted academically or professionally, all of its members suffer down the road. Just as important as it is to be aware of and help the struggling radiology resident, it is also important to remember that one struggling resident can have severe repercussions for the remainder of the radiology residency program. It is not just the program director and chairman that reap the consequences of the struggling resident. Often unfairly, the class members take up much of the additional burden. The result be extra call shifts, less time spent on educational rotations, uncomfortable personality conflicts, or spare time spent educating the failing resident. So, I am dedicating this post to the other radiology residents affected by the struggling radiology resident. First, we will explore how other residents can appropriately identify and help the struggling resident and possibly get this person to the program director’s attention. Then we will go through what a resident should and should not do when a resident is academically or professionally struggling. And finally, we will examine how the residency program should commit its resources toward the struggling resident vs. the other radiology residents.

 

Identification of Struggling Residents by Colleagues

Often, the first residency program members to notice that a resident is struggling are not the program director, chairman, or attendings. Instead, it may be the struggling resident’s colleagues. Fellow residents are more likely to interact with struggling residents socially in a more comfortable setting. Here, the struggling resident is more likely to discuss his/her issues. This interaction is an opportunity to learn more about your classmates’ feelings about residency. They may even ask for your help. My advice is to give your classmate whatever assistance is reasonable so they can perform well. Residency is not a competition; it is a team environment. In addition, the help you give your fellow struggling resident will return to you many times. Whether you decide to teach your colleague or help them out with other residency issues, you will find that you will learn more about your material and yourself. Even better, you may be able to stem a progressive downward spiral to probation. Or, even better, prevent your classmates from suffering more dire consequences.

How To Identify The Resident

Sometimes the identification of the struggling resident is a bit more subtle than a simple comment about their struggles. Unlike an attending that sees a resident on a noon conference or a single day, you, as a fellow resident, may notice a pattern of taking cases and missing all the findings each time or multiple absences not recorded by the program. Or you may see bad habits such as drinking too much, something a little bit off, or a strange affect. These signs can be essential sentinel events. And you may want to address the issue with your program faculty to ensure the struggling resident gets the help they need.

In the end, it pays to identify the struggling resident. Remember, it often affects not just that resident but the entire program.

How Can The Residents Help With The Academically Struggling Resident?

The program directors, attendings, and chairman are primarily responsible for handling the academically struggling radiology residents. But, for the struggling resident’s rehabilitation to succeed, the program often needs to have the participation of all. The role of the other residents can be the key to the stability of the program through this trying time as well as increasing the likelihood that the struggling resident will eventually succeed.

Before any remediation, it is critical to determine if the struggling resident is willing to accept the help of the other program members. So, the role of the other residents can only begin when the struggling resident asks for help from their colleagues. You certainly cannot force a struggling resident to participate in remediation efforts if the struggling resident is unwilling or able.

Interventions To Help Academically

If you remember the previous article- The Struggling Radiology Resident, we discussed how the academically struggling radiology resident might have difficulty coping with the quantity or quality of their work. So, I will briefly review how the other residents should attend to these issues.

What should their colleagues do for a struggling resident who cannot schedule an appropriate time for studying? This dilemma becomes a time management issue. It would be fair to help the struggling resident to create a schedule for themselves. Sometimes it helps to sit down with the struggling resident and show them how you schedule your study time and what you have been reading on each rotation.

For a struggling resident with difficulty with the quality of study time, it would make sense to have group study time and present cases to one another to improve their presentation when reviewing studies. Or, it may be a good idea to go over questions with all the residents to practice testing skills. These processes help the struggling resident and may be good practice for the team.

How Can The Residents Help With The Professionally Struggling Resident?

Regarding a professionally struggling resident, fellow residents must be more careful with assisting in interventions. The intervention will depend on the primary cause of professionalism problems.

The Absent Resident

For the resident that is often absent, it may be possible to address this issue by asking the resident where they have been or why they have not been around in a non-confrontational manner. Sometimes the struggling resident may not be aware of the burden they are placing on the other residents. This interaction may make this resident aware of the issues he is causing and take responsibility for his actions. Again, if this does not work, bringing the matter to the program’s attention may just be as essential.

The Personality Dilemma

You must be more careful with the resident with personality issues, whether an abusive or unengaged resident. If you are friendly with this resident, it may pay to find out the cause of the behavior. But be careful not to be overly intrusive, as getting involved much further may be inappropriate. Indeed, if the struggling resident is amenable to helpful suggestions for conflict resolution within the residency, talk to this person about some of these issues in an appropriate setting. Or, it may be relevant to suggest this resident seek professional help if the resident is amenable.

In many programs, some struggling residents will experience psychiatric issues just like the general population. Or, they may get involved with alcohol or illicit drug use. These situations can be extremely touchy. Many of these residents may not have insight into their problems. And, they are likelier to refuse help from colleagues or attendings. Of course, a few may have an understanding. But, if you notice a struggling resident with one of these issues, it is usually best to bring the issue to the attention of the program director or chairperson of the department so that they can get the resident into the appropriate channels for treatment. Of course, there are exceptions to every rule. And occasionally, the struggling resident’s colleagues may have intimate knowledge of the resident. Therefore, they may be more likely to be able to get the resident appropriate help. But, be careful in this situation because there can occasionally be unforeseen legal and professional ramifications to the caring colleague. A resident without insight into their problems may see this helpful resident as antagonistic and can theoretically pursue these channels.

How to Commit the Program’s Resources

Over my tenure as associate residency director, I have learned that dealing with struggling radiology residents’ issues can drain a program’s administration and resources. The time you usually spend toward improving the residency program instead needs to be placed on the problems of the one resident. Especially in smaller programs with less faculty and monetary resources, the extra time can overwhelm the program directors, chairperson, and heads of Graduate Medical Education. While the struggling resident must get the necessary help and remediation, we have to remember that other residents also need to have a functional residency program. It is easy to forget about the other residents in this process. So, it is the residency director and chairman’s role to place additional efforts to concentrate on not just the struggling resident but the other residents at these times and to ensure the residency program continues running smoothly.

Back To The Other Residents

Every program, at one time or another, will have struggling radiology residents. And fellow resident colleagues need to help out, if possible, with identifying and remedying the struggling resident. But, the other residents often suffer the most from the consequences of a struggling resident’s actions. And the residents can be hurt by the administration’s choices to help the struggling resident. So, everyone involved needs to make a concerted effort not to forget about the struggling resident’s colleagues. Or else, these residents can truly become the “other struggling residents.”

 

 

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The Struggling Radiology Resident

struggling

In any profession or career, some employees lag the performance of their peers. It turns out that radiology residency is no different from any other job in this respect. The key, however, is that the employer can identify the struggling worker or that the employee can recognize that he or she is struggling. It is only when this process happens that interventions can occur. Also, this process of identification needs to be early and effective. The radiology program’s goal is to help these residents along as soon as possible to allow rapid and more effective remediation. Early remediation can prevent a struggling resident’s further downward spiral that could lead to probation, suspension, or even worse, job loss. On occasion, there is no effective remediation for specific individuals, but that is instead the exception rather than the rule.

No matter how you slice it, the loss of a resident is devastating for both the radiology program and the radiology resident alike. So, my goal for today’s discussion is to help the individual struggling radiology resident and prevent him from going down this pathway. We will discuss how to identify oneself as struggling, what you can do to intervene before more severe repercussions, and how to deal with your attendings and colleagues when you are the “struggling resident.”

Self Identification

As is said, you cannot fix a problem unless you know a problem exists. So, self-identification of oneself as struggling becomes crucial. Some residents know from the very beginning that they are having difficulties and have good insight into their situation. Others may be having challenges but are not aware. Additionally, sometimes the feedback that residents get from attendings, technologists, nurses, and administrators can be different from the truth and outright misleading. Given that radiology residents tend to have limited responsibilities during their first year of residency, this issue is more likely to go unnoticed during this first formative year of residency. So, we will first talk briefly about some indicators that you are struggling during residency.

I will also classify the reasons for the struggling resident as either academic or professional, to simplify and organize the discussion. Let’s first start by discussing some of the indicators that a resident may be struggling in academics.

How to Know If You Are Struggling Academically

Noon Conference and Readouts

Noon conference can be an excellent time to discover your position relative to your colleagues. If you notice that you are unable to answer questions that your colleagues quickly answer consistently, that can be a red flag. If you have a hard time describing or making a finding on studies geared to the first-year resident, you may be struggling. Or, if different attendings become consistently frustrated with your answers while giving the noon conference, you may want to consider that you are having difficulties.

Readouts with your attending may help to determine whether you are struggling. Are you able to answer routine questions appropriately? Is an attending that typically accepts resident dictations re-dictating everything you write? Is your supervisor frustrated with you? Do your attendings provide you with some sense of independence during procedures similar to others in your program? These are some hints that all may not be quite right.

Call

Next, think about your experiences on “buddy call.” Do you feel comfortable going over films with your colleagues, attendings, and other clinicians? Is there a sense of frustration from these people with your reads? Are attendings not satisfied when they find out they are on call with you?

Feedback and Exams

How about feedback and evaluations? Is the feedback you receive from attendings routinely negative. Are milestone evaluations always below par? Do you receive comments from attendings that are uniformly negative?

You might think that the in-service exam or Radexam would also be a useful metric of resident performance. It turns out that as an associate program director, I put much less faith in academic evaluations based upon the in-service examination as a sole means of assessment. I have found a weak correlation with resident academic performance. So as a resident, I would put less stake in this form of self-assessment. However, in combination with the in-service exam, if you are underperforming in other residency-based quizzes or examinations, this can be an indicator of real academic issues.

How to Know If You Are Struggling Professionally

This area can be harder to recognize for a struggling resident. Many don’t realize they have a problem until it’s too late. But, we will go through some examples that you may be able to self-identify.

Absences

Absences, in its many forms, is a leading indicator of professionalism based struggles. Are you routinely late to conferences and readouts, and do you sense the frustration in others? Do your colleagues too often have to cover for you because you are not available? Have you been cited multiple times for missing conferences or required meetings?

Conflicts

Conflicts with classmates and colleagues can be an indicator of professionalism struggles. Are there routine yelling matches with your fellow residents? Do your colleagues not want to help you out with call coverage, studying, or other everyday residency issues? Are you routinely fighting with the secretaries, nurses, technologists, or even attendings?

Substance abuse

Substance abuse is all too common a cause for having a problematic residency. Take a serious look at your habits and if they may be genuinely affecting your performance. Are you routinely using alcohol or other illicit substances?

Organic causes

Chronic disease can be a cause of day to day residency struggles. Cancer, hepatitis, infectious diseases are all problems that can cause fatigue and difficulty with concentrating on a long shift.

And of course, there are psychological issues such as depression, anxiety, schizophrenia, and more. These issues are more likely to go unnoticed by the afflicted resident. But some residents, already diagnosed with these disorders, may have better insight. These residents need to take a hard look and see if these problems are affecting their residency performance.

Self-interventions

The next step in the process is to figure out how to remedy the situation before more significant repercussions. If you know your issues are academic or professional, you can certainly take measures to stem the riptide. We will go through several of these avenues.

You’ve decided that you are struggling academically. What do you do? The next step is taking a realistic assessment of why you are having difficulties. For some people, it may be the quantity, and for others, it may be the quality of their studies.

Quantity of Learning

Having been through the residency process and supervising many residents over the years, I have learned that radiology is a reading-intensive specialty. Moreover, to increase one’s knowledge base, a resident needs to create a means to cover all the essential and relevant topics within the residency program. So, the first question is: on what do you base your study schedule? Some residents will use the curriculum guidelines from their residency program. Others will split the ABR core exam topics into bits of information that they can review. Even others may use STATDx/Radprimer to guide their studying. The bottom line is that you need to find some guidelines that will allow you to cover all the topics that you need to know.

The second question: have you created a schedule that allows you to cover the critical topics during residency. And what are some options for the resident? Many residents don’t realize the amount they need to learn to become a proficient radiologist. A schedule, therefore, becomes very important for the struggling resident. Plans can vary from one person to the next. Some people do better with studying for short blocks of time. Others prefer to slog it out for a long block at once. It doesn’t matter how you complete the necessary work, whether you take 2,3, or 4 topics per evening, but the work needs to get finished. A regimented schedule will allow you to get through the appropriate information for each rotation.

Quality of Learning

The next step is to assess if it is how you are studying, that is the problem. Some residents read for hours every night, only to find that their knowledge base is not to par. You would think that by the time one gets into the radiology specialty, they would have a method for studying well. But, that is indeed not the case for many residents. Studying and reading for the radiology resident is different from studying for medical school classes and the boards. Radiology emphasizes pictures. Medical schools emphasize words.

So, if you are genuinely studying for hours at nighttime without meaningful results, try learning differently. I would recommend emphasizing reading the pictures and captions within a book over the general text. Many residents do not realize they need to do this to be a more effective radiology student.

Pictures/Case Series

You may also want to explore case review series over general text reading. Again pictures are the center of the radiologist’s world. I find that a general text helps more when you have experienced a case firsthand during the daytime and want to find out more. On the other hand, a case image with text is more similar to the radiologist’s day-to-day work and will allow many residents to digest the information better.

Discovering Learning Disabilities

There is one last item that I want to bring to light. On occasion, a radiology residency may make a learning disability evident. Because radiology is different from other subspecialties and the methods for studying differ from other areas, some residents have problems with the transition. Some residents have issues looking at a picture and translating it into findings and conclusions. Radiologists do not usually test for this before beginning radiology. If you think that this may be your situation, it behooves these residents to consider psychological testing to find a more effective means of studying. Dollars spent to solve this issue now if you do have a learning disability may pay back itself in spades later on.

Fixing Professionalism

Professional issues and their solutions can vary widely. It may be as simple for the absentee resident as creating and sticking to a schedule to make sure you attend all the important events on time. If you are in constant conflict with your colleagues, you may need to learn to relate to others better, and that may involve sharing more or not taking everything to heart. On the other hand, maybe the conflicts are connected to other pressing issues such as substance abuse or health problems.

The critical thing to remember: there are many sources of help for the radiology resident. Whether it’s your colleagues, attendings, program directors, chairman, the Physician Assistance Program, a psychiatrist, or other individuals, there is someone at your program that can support you. It is crucial to talk to someone if there is a professionalism issue that you need to address. And, there is always help if the situation becomes unbearable.

How to Deal With Attendings and Colleagues If You Are Struggling

OK. So you have identified that you are struggling, and you have created the means to remedy the issues effectively. The next problem is that you may have created an environment where your colleagues’ expectations are so low that it may be challenging to defy their expectations. I like to describe this as the “vicious circle.” Your faculty will now scrutinize everything that you do, much more so than your colleagues. And, even though your performance may improve, they may not recognize the improvement. Unfortunately, they may still perceive you as below par. This “vicious circle” is probably the most challenging part of being an underperforming resident. So, what do you do at this point?

I would recommend continuing with the remediation program at hand. Healing a reputation takes not a few days or months. Instead, it can take years. Eventually, your effort will be recognized, but not without a lot of work and effort. You will have to suffer through some of your attendings and colleagues’ expectations until they realize you are a capable resident. This process takes grit and determination. You are going to have to ignore the expectations of others and create expectations for yourself. Eventually, you will notice a change in how they treat you, but remember, it will not happen overnight.

Summary

Radiology residency is a big transition for most residents, and some may struggle at the beginning academically or professionally. If you are struggling at this time in your life, don’t let these shortcomings define you. The measure of greatness is overcoming obstacles such as completing a radiology residency, a significant achievement. Struggling radiology residents often become radiology attendings with greater empathy for others’ struggles and can become the most successful radiologists!