Tag: teaching

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Should Teaching Programs Hire Non-Teaching Faculty?

non-teaching faculty

At almost any hospital residency program, you will have a mix of faculty with all different interests. Some like to teach and spend concerted time with the residents. In some more academic hospitals with residencies, other faculty want to pursue research areas. And then there is the final group that wants to put their energies into completing the day as quickly as possible and returning home to family without wasting time on other endeavors. So, today’s question is: should hospitals and practices with residency programs hire these non-teaching faculty if they have a residency program dedicated to teaching? To answer this question, let’s talk a little about the current hiring environment in radiology. And, then let’s discuss the advantages and disadvantages practices and hospitals face when hiring non-teaching radiologists in the current climate. And finally, we will come up with a feasible conclusion.

The Current Hiring Background For Radiologists

We are in the midst of one of the most acute shortages for radiologists in 2022 as it stands right now. Even residents that have not completed their training receive solicitations for work. It is not uncommon for practice owners to cover unwanted shifts to ensure their practices run smoothly due to a lack of personnel. And, starting offers for new radiologists are robust. A “warm body” that can read and catch up on all studies is a treat for many sites. So, many practices can prevent a practice crisis if they hire radiologists to do the work but do not want to teach, but at what price?

Disadvantages To Hiring Non-Teaching Faculty At A Teaching Site

If They Don’t Have To Teach, Why Should I?

The biggest fear for a practice of mixed radiologists is the impression of inequity. When radiologists see that they can get away with less responsibility, you may hear the phrase “it’s not fair” bandied about. This unfairness leads to decreasing morale and radiologists thinking about leaving practice for greener fields elsewhere. This environment can be toxic even if you compensate faculty members for teaching.

Does Not Foster A Culture Of Inquiry

To create an excellent residency program, I like to say you need a culture of “why.” I love when my residents ask why about the reports, procedures, or protocols they see. It forces me to rethink my training and beliefs to analyze what we do “by rote’. And, it’s a great way to reinforce and learn new knowledge for attendings and residents. Disinterested attendings who do not participate can spoil this excellent learning environment.

 Advantages To Hiring Non-Teaching Faculty At A Teaching Site

Free Up Teaching Faculty Who Want To Teach

If you can isolate the non-teaching faculty to rotations that do not involve teaching, you can allow the teaching radiologists to teach without the hindrance of backed-up work. Freeing faculty members who want to teach can theoretically improve the teaching faculty’s morale. However, the practice would need to decide on a protocol for which it will not degrade residency training.

Can Get More Work Done

You may have heard the adage, “a resident will slow you down.” Yes. There is some truth to that. It takes time to explain and go over dictations and give lectures. If you do not have these responsibilities, it is possible to plow through extra work throughout the day (perhaps with a headache!). Practices with some attendings that work without residents can theoretically accomplish more RVUs during the day.

Should Your Teaching Practice/Residency Program Hire Non-Teaching Faculty?

There is always more to a decision that might be easy at face value in a typical environment. New radiologists that do not teach can cause inequities and do not foster a teaching culture. Nevertheless, freeing up teaching faculty and getting the practice work completed is critical. So, if you see a new grumpy radiology hire that does not want to teach residents and is plowing through the cases, there is a good reason for that. Many practices are under duress to hire a body to fulfill the work of the business, not just to teach residents. However, programs that employ these radiologists must ensure they are not on teaching rotations to minimize conflicts. Instead, programs should make a concerted effort to plug in those attendings that want to teach to the divisions with the most exposure to residents. It may take a bit of adjustment on the part of the resident and the faculty until the radiology shortage resolves!

 

 

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Making Silly Mistakes- Not The End Of The World!

silly mistakes

As I sit here writing late at night, my silly mistakes on radiology reports cross my mind. I can laugh about them now. But, when you first hear about them, they feel somewhat awkward. And I’m sure that you know what I mean. That prostate gland can become a uterus. Or, you pronounce a pregnancy on a patient with ascites. Maybe you say you saw a gallbladder in a patient with a prior cholecystectomy. It’s just a matter of time before it happens to you. If it doesn’t, you probably have not read enough scans! So, how can you make this experience a bit more comfortable? Here are some of my main words of advice to prevent you from being too hard on yourself.

Don’t Take Yourself Too Seriously

In the medical profession, many physicians tie their identities to perfection. Many of us encounter these physicians in medical school and our residency training. They tend to be miserable people. However, self-aware physicians will never make this mistake. We have to be able to admit that we will have our errors. And, if you do not make your identity perfect, you will look back and figure out how you made the silly errors you made. You might even laugh about them and enjoy the irony!

Realize Mistakes Will Happen

It’s not just a perfection issue. When you interpret enough films or perform more than your fair share of procedures, statistics say you will make a silly mistake. We can’t beat the numbers. And, the sooner we get through that notion, the happier we will be.

Silly Mistakes Are Learning Experiences

I found that each mistake is a learning experience, silly or not. When I think about how, when, and where I made a mistake, I understand the conditions that caused the problem. Did I go through a case too fast because it was the end of the day? Under what circumstances did I forget to look at the patient’s sex? Was I interrupted or too tired? Did I miss a finding because I neglected my search pattern, or was it a lack of knowledge in a particular area? Each of these questions allows us to delve deeper into the circumstances of an error and forces us to confront the truths so that it won’t happen again.

Silly Mistakes Can Be Teaching Tools!

Instead of covering up my silly mistakes, I use them as teaching points for others. These moments can be some of the most fun teaching tools. Moreover, they can make great stories. Who doesn’t like an excellent allegory to make that point stick? I would have been much less likely to do the same if I heard one of these ridiculous errors.

Yes, You Are Allowed To Talk About Your Silly Mistakes!

We are all human. When you dictate 10,000 reports containing 100 words, that’s a million. Just by sheer statistics alone, it’s only a matter of time before you say something ridiculous in one of those million words. So, get off your high horse and own your silly mistakes. At least make them into something useful!

 

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Teaching In Radiology: How Can Residencies Help To Prepare?

teaching in radiology

Question About Teaching In Radiology

Hi Dr. Julius,

I am an MS3 who is planning on going into radiology, have always loved teaching, and want to make it a large part of my career. I was hoping to hear your take on how radiologists can teach and any tips to shape my career with this goal in mind.

 

Answer

“What kind of teaching opportunities do you have?” is a common question that I get from my interview candidates for residency every year. Teaching is a large part of learning in most radiology programs. Almost all programs have some form of teaching opportunities. These may manifest as teaching medical students, junior residents from different specialties rotating through your department, or interdepartmental tumor boards. Regardless, you will find many opportunities to teach.

Community Vs. Academic Teaching In Radiology

So what is the difference between programs and the different teaching opportunities? Well, it comes down to the sort of teaching. More community programs tend to give you less opportunity to teach students because they may not be affiliated with a medical school. Instead, you will have more opportunities to teach technologists, nurses, and fellow physicians. And, the options tend to be less formal. 

On the other hand, academic programs give you more formal opportunities to teach and mentor research projects and other academic members within your residency, such as students, observers, fellows, and more that you would not get at a community program. And, teaching can be in larger forums. The bottom line is that teaching opportunities are not unique to one type of program or another. The styles just depend on your inclinations and your choice of program. 

Stop And Smell The Roses (And Teach!)

I believe that each resident that comes through a program should stop and take the opportunity to teach others. Teaching others reinforces what you know and helps your fellow man or woman. Plus, you wind up hearing or asking questions that you may never have thought about in the first place. These questions make for promising research projects or take you to places that will make you understand ideas more deeply than you ever thought possible. The rewards are invaluable, and the time it takes to do so is relatively negligible. 

Then, when you finish your residency, you can decide for yourself if you want to take more opportunities to teach either in academic or private practice. They are all around you. It’s a matter of what you want to pursue in your career. 

 

My forty-three cents on teaching,

Barry Julius, MD

 

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What Might Happen With A Residency Merger?

residency merger

Throughout the country, businesses grow to keep costs down. One of the ways that they accomplish this task is by merging. And, if you think that residencies are any different, you would be wrong! Similar to many businesses, you may have noticed that residencies have grown bigger and bigger over the years. While it was once rare to hold ten residents per year per class 30 years ago, a radiology training program of that size is no longer unusual. So, what happens if you begin a radiology residency program and it merges during your four years? Will the residency approach you like a second-class citizen? Or, would you notice some fringe benefits from the process? We will treat these issues and more as we summarize the benefits and downsides of a residency merger!

Benefits Of A Residency Merger

More Residency Resources

First and foremost, you may notice that soon after a residency merger, you may be able to rotate through new departments. Or, you may have access to a simulation center that you did not have before. Furthermore, you may find new grants for residents to start research projects. And you may have at your fingertips a more extensive staff to choose from as your mentor or research partner. That doesn’t sound too bad.

Increased Prestige Of The Residency Merger

Before the merger, you might be in a small community program without “name recognition.” Now that you are part of a larger entity, you may find that hiring practices that want graduates from high-powered programs may be willing to look at your resume for your first job. There is more to a name than you might think!

Faculty With More Time To Teach

Sometimes, faculty at a hospital may no longer have the responsibilities to run their program as they did before. You may find that the staff can now dedicate more time to teaching and residency responsibilities.

Downsides Of A Residency Merger

Loss of Special Programs

As programs grow, they relook at areas in the budget that they can cut so that the senior administration can save some dollars. Perhaps, your residency may have had different outside rotations that you no longer “need” since the entity provides the same service. Or, you may have had a foreign travel program that the original institution sponsored. You know what they say in business: “Cut the fat!”

One Program Director For Many Sites

No longer, you can go to the same program director in charge of everything at your one site. Now, you have one program director for an entire system. What does that mean for you? The program director may have less time to focus on individual residents. Instead, they have multiple sites to “keep in line.” So, you may find that the director caters less toward you.

More Bureaucracy In The Residency Merger

On that same note, now that you have a more extensive system, you may find it more unwieldy for the Institutional Review Board (IRB) approval for research projects. Or, you may have more difficulty getting reimbursed by the system for expenses. With a larger institution, you exponentially multiply the “red tape.”

Increased Traveling Distances

Now that you have multiple sites within a more extensive system, you will likely need to travel to each location. If you live in the city, you may need to go to work via subway, train, or bus. You may need a new car if you live in the suburbs across from your original hospital. Unfortunately, you have a new budget item!

Some Disgruntled Attendings

At most hospitals, the faculty does not like change. Moving around resident call schedules and increasing the responsibilities of the staff can induce resentment among the mix. So they may be less willing to participate in the residency process. Or depending on how the system arranges coverage, attendings may have less time to teach. No change is perfect!

Less Intimacy

Remember that three-person class you had before when you learned each member’s quirks and foibles? Well, that is no longer the case. Now, you will have to contend with colleagues and attendings you will not get to know during your remaining years of residency. When your program touted a small program feel during your interview, they didn’t meet your expectations!

Dilution Of Resources

You remember what your teacher taught you in kindergarten- you need to learn to share! Perhaps, you had a fantastic faculty teacher on service. Or, your program had a one-of-a-kind pathology rotation within the institution. Now that you have a more significant residency, you may have less opportunity to use these resources because they need to be utilized by a larger body of residents.

Change And Residency Mergers

Change is hard. There is no way around it. And, when you enter a residency, some alterations from a merger are beyond your control. But, as you might initially think, a residency merger is usually not all bad or good. Instead, it will afford you some new opportunities and come with some additional palpable downsides. So, what is my advice? Make the most of a changing situation. Learn about the new lay of the land. You never know. Now that your program has included you in a more extensive system, you need to know it well. And make the most of its new opportunities even though they may have some downsides!

 

 

 

 

 

 

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Should First Year Residents Give Interdisciplinary Conferences?

interdisciplinary conferences

Interdisciplinary meetings at many hospitals tend to be working clinical conferences. Ultimately, the primary clinical physician will decide on patient treatment based on the conclusions at one of these meetings. So, we better be careful in choosing which radiology team members prepare for interdisciplinary conferences to get the best possible patient care.

Therefore, this begs the question. Should a first-year resident claim responsibility for presenting at one of these interdisciplinary conferences? Or should the program delegate the senior resident or attending to give the conference? We will discuss why the more senior radiology resident or attending should take this critical responsibility.

Preparation Time

When a first-year prepares for one of his first few conferences, the time is very long. Why? First, the first-year resident needs to figure out what is essential. Then, they must ask a senior resident or attending which images are most relevant to the case. And finally, the resident must figure out the clinical significance of each finding.

On the other hand, a more senior resident or attending will experientially know what is most important. A more senior radiologist can perform almost all the legwork by himself. And, of course, he will understand the clinical ramifications of his findings and conclusions. The amount of time the preparer and the attending staff saves is enormous. It is the time that the junior resident or attending could have used for more critical activities.

Experience/Knowledge Level

A first-year radiology resident may find answering questions thrown at them during a conference difficult. A question can derail a junior resident’s presentation simply because he has not experienced that subject matter or modality. More importantly, it is also possible that the first-year resident may spout misleading information to the clinicians. This pitfall could theoretically influence patient management in the wrong direction.

For the more senior radiologist, she will be able to respond to clinical radiological inquiries with a backstop of years of experience to guide the clinician appropriately. In addition, the senior radiologist is more likely to nudge the clinician toward the appropriate treatment of his patients. Experience counts.

Conference Savvy

Years of conference experience “under one’s belt” also let the presenter know when to chime in, and when to stay silent. This skill only comes from years of practice. Although some junior residents may have this skill, you cannot expect all first-year residents to be adept at giving conferences. Eventually, all first-year residents will develop the art of presenting by observing and participating in many conferences. But, it is not appropriate to expect the first year to know the rules when they start.

Seniority

Even though there is a steeper learning curve for a first-year resident than a more senior resident, the experience of giving a conference is usually more valuable for the more senior resident. Why is that? For the most part, this resident will graduate from the program sooner and will need the experience of presenting for fellowship and beyond. The last year of residency should be a time to hone your presentation skills for the next career phase.

Interdisciplinary Conferences And The Presenter

Preparing and giving an interdisciplinary conference is crucial to the radiology residency experience. In deciding who should provide this conference, we must consider factors such as time, experience, skills, and seniority. Based on these factors, the more senior resident or attending is the right person to play this role.

 

 

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Curriculum/Teaching Issues In The United States And Abroad

curriculum

Question About Curriculum And Teaching In United States And Abroad:

Hello Barry,

Thank you for your outstanding posts and the constant stream of current topics promoting the dissemination of Radiology as both a profession and a collective guild. I’ve been hanging on every word you’ve written, and it’s almost as if you anticipate my questions in advance. So, I am very much encouraged by the relevancy of your blogs and posts.

I am a Canadian who is a first-year diagnostic radiology resident in Targu Mures, Romania. Here, we follow a five-year path outlined by the EU and the European Society of Radiology (ESR). The problem is that the actual ” teaching ” element is virtually non-existent, and the program expects us to follow or shadow senior residents all day and read on our own. I am lost and overwhelmed by all the modalities I see here daily. For example, a typical day involves spending a few hours in an ultrasonography clinic, seeing conventional or plain film radiography cases, and a CT or MRI following a patient scan.

Most often, the radiologists on staff consult with other physicians, and it’s not like they have the time to point out things. I’ve decided to follow a structured plan and would appreciate your curriculum. What should I cover in my first two years? I know I’m asking a lot of you. Perhaps you can abbreviate your own institution’s plan for me? The first thing I’ve begun to do is revisit skeletal anatomy, including the head and neck. I don’t have a lot of textbooks here (in English, that is), but I have a ton of PDF books on my PC. This lack of physical textbooks is another problem because I miss the tactile experience of actual texts, and looking at a laptop all day is tiring. I will digress and hope to hear from you. Take your time 🙂

Sincerely,

A Tired Romanian Resident

 

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Answer:

 

Thanks for the great compliments. It is much appreciated and makes writing these posts all worth it!

Teaching Differences

Interestingly, you mention that teaching is “non-existent” in Romania. It’s almost the opposite problem in the United States, where everything seems regulated by the government. We need to have x number of noon conferences, etc. I almost wish we had a model for teaching somewhere between the Romanian and the United States models. Residents seem to get bogged down by the regulations and spend less time learning by reading films. (It’s an essential ingredient for radiology!!!!) So, in a sense, you can consider yourself lucky, but you are also missing out on some types of the more didactic teachings.

Curriculum

Regarding the curriculum, the plain vanilla answer is that residents study all the material on the ABR website under the core study guide. It would help if you looked at that to understand everything you theoretically need to know. However, I find it a bit overwhelming, and you need to focus on studying for your time as a resident. So, in the real world, I recommend reading some of the basic overall books in each modality when you begin a rotation each month, such as Mettler for nuclear medicine and the requisite series for some other subjects. You can check out some of the curriculum and books on the web in U.S. Residency programs to get an idea of what you need to know and the books they use. You can also look at some of the books my residents like in the book links section of radsresident.

Most importantly, emphasize the pictures and captions and then secondarily look at the text to understand the images and captions. And keep in mind the ABR blueprints and core material when you are studying. Subsequently, go through the case review series to learn how to go through cases once you have the fundamental knowledge of each primary modality. This process will reinforce all that you studied.

You also make an essential point about missing the tactile experience of textbooks and looking at laptops. It happens to be the subject matter of my next article!!! PDF articles are great because you can download them easily. On the other hand, retention rates for PDFs are probably not as high as reading directly from a printed textbook.

I hope this helps a bit,

Barry Julius