Tag: training

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Are You Getting the Outpatient Experience You Need In Your Residency Program?

outpatient experience

Some radiology residency programs throughout the country often claim a great outpatient experience. And others, if you ask, they won’t mention it at all. As an interviewee, you may not think about this segment of radiology. But, as a practicing radiologist, this is where you will spend a good chunk of your time.

So, what are the different sorts of outpatient experiences? And, is this outpatient experience even critical to your training? Or, is it something that you can forego because the hospital covers it? The bottom line, are you getting the outpatient time that you need?

Let’s investigate the world of outpatient radiology and what it all means for the typical radiology resident. To do so, I am going to discuss why it is critical to your training. Then, I will split the categories out outpatient imaging into those that you might encounter. And finally, I will talk about what you genuinely need in radiology residency to make your outpatient experience complete.

Why Is Outpatient Imaging So Important?

They say that about 90 percent of radiologists go into private practice (me included!), and the other 10 percent become hospital academics. And, a large swath of those 90 percent practices some form of outpatient imaging. Moreover, the imaging mix differs in outpatient imaging compared to the standard hospital menu of cases. So, if you want to simulate the real practice of radiology, you need some form of outpatient experience.

Three Different Types Of Outpatient Environments

Hospital Outpatient

Almost all hospitals have nonemergent patients that will show up to receive their imaging. The extent can vary from hospital to hospital depending on the location, patient mix, etc. However, the sort of patient that shows up for nonemergent imaging at a hospital tends to differ from the standard clinic patient that wants imaging. These studies often are more complex. And, they show up to the hospital either because they have some complicating issue that prevents them from getting outpatient center imaging (asthma, contrast reaction, etc.) Or, they may have an appointment at the hospital and may as well get their studies. Finally, less likely, a patient will show up here because he wants to go to a hospital rather than an imaging center.

Regardless, these outpatients will less likely have complaints like osteoarthritis or a superficial lump on the back. Instead, the patients will overall have more complex and involved issues. So, your mix of patients will not be the same.

Hospital Owned Outpatient Center

This experience is a hybrid between private practice imaging and the outpatient hospital experience. Here, you will get complex referrals from a hospital center. But, you will also receive the more typical outpatient type of studies. When you sit down and read, you will find a mix of patients with widely varying difficulty levels of cases.

Private Practice Outpatient

And most likely, private practice is what you think of as the “pure” outpatient experience. Here you get referrals almost exclusively from local doctors. Or, you will get patients who come in independently to receive screening tests like mammograms. Cases tend to be more one complaint sort of issues with more “normals.”

How You Might Experience Outpatient Radiology

Sampling

Depending on how the residency arranges your outpatient experience, you may be an occasional observer. Perhaps, the attendings dictate the outpatient cases because they get paid for them. And, you get to watch them interpret the studies. Or, it may be a random sampling as you are reading hospital outpatients. In either case, this is not the immersive type of outpatient experience.

Immersive

Here, you will be primarily interpreting outpatient cases and having your attendings sign off on them. It is much more similar to the daily workflow you might encounter in any given private practice. You will have a more similar experience as an outpatient private practice radiologist.

What Is The Best Outpatient Experience?

Well, as usual, the answer depends. Though, the key to becoming an excellent radiologist, in general, is to have varied experiences across the board. It is possible to have too much outpatient radiology at the expense of inpatient imaging, especially if you want to become a hardcore academic. So, you need to ask yourself, am I getting a broad enough experience concerning all the other segments of radiology training for my interests?

Nevertheless, I would recommend searching for a program that gives you the capability of reading and interpreting all sorts of “simple” and complex outpatient cases. And, I also believe that immersive experience is better. Why? Well, it allows you to get a feel for private outpatient practice. And, it will enable you to make a more informed choice of practice situations when you ultimately decide to settle on a final path.

Are You Getting What You Need To Become An Excellent Radiologist?

Having all the ingredients available for you to get the training you need to become a radiologist, well, that is the main point of residency. So, if you are in a situation that does not give you the right mix outpatients, look into ways that you can get the appropriate outpatient experience. Take some time and effort on your part to create a custom rotation. Or, push your faculty to allow you to get the proper exposure. In any case, make sure not to skip out on this subsegment of radiology. Without this experience, you will not be the consummate well-trained radiologist you want to be!

 

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What Exactly Is The Specialty Of Body Imaging?

body imaging

Body Imaging Question:

Greetings and salutations,

Thanks so much for your educative content. I have benefited immensely. Please, what is body imaging (Radiology sub-specialty)? What exactly does it mean/entail? How is it different from Abdominal Radiology and Gastrointestinal Radiology subspecialties? And, are body imaging specialists privileged to carry out interventional radiology (vascular and non-vascular) procedures involving the part(s) of the body in which they specialize?

Thanks so much,

Possible future body imager

 

Answer:

 

It’s a great series of questions that you have asked because it is more complicated than what you might think at first glance. First of all, let’s talk about body imaging. Body imaging covers many different areas. To that point, some folks say that practicing this specialty is like saying you will practice all of radiology. That is because radiology covers the whole body!

Defining Body Imaging

But, if you look at most of these fellowships, they cover at least some of the following areas- gastrointestinal, abdominal, MSK, thoracic, cardiac, genitourinary, and breast. Because of this variability, there is no MQSA for these sorts of fellowships. And, if you look under this category or do a google search and see what they include, any one of them may emphasize any of these subspecialties within radiology. So, if you are interested in “body imaging,” you need to look at the fine print. Then, check out what the fellowship covers.
Moreover, a common approach for these advanced specialty programs is to cover six months in one of these areas and another six months in a different subspecialty. Or, it can emphasize more interventional biopsy type of training. Regardless, the topics can vary widely, and what you should look for depends on your interests for practice. As to your other question, abdominal and gastrointestinal radiology are just some of the areas that a fellowship can teach.
To answer your third question, yes, lots of body imagers do perform interventional procedures. And, no, you do not need to be an IR doctor or even a body image trained specialist to do many interventional sorts of procedures. Just make sure you have excellent training during your residency or body imaging fellowship, and that should be adequate for practice!
I hope that helps with your questions!
Barry Julius, MD

 

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How Do I Know Which Cases To Discuss With My Attending In The Morning?

You’ve made it through a typical night of call and the attending for the day is about to arrive. Your mind begins to meltdown from the exhaustion of it all. And, there are too many cases to discuss with your morning radiologist. It’s just going to take too long.

Moreover, you don’t want to waste your attending’s time with the obvious. On the other hand, you are not sure about what you are going to have missed during your shift. And, you want to make sure that you address all the critical issues. So, how do you go about deciding which cases to discuss with your morning attending? And what can you ignore? To increase your efficiency, let’s go over some of the basic guidelines.

All Cases That Can Significantly Change Patient Medical Management

Remember, in the end, every case that you sign off at nighttime, also will have your attending’s name on it too. By default, therefore, you should show every situation to your attending that will significantly change medical management. Now, what exactly does that mean? If your patient has gone to surgery based on your findings for any reason, that would certainly qualify. Or, if the patient needs to stay overnight because of your call, that would be eligible too.

In essence, I would have a low threshold for what constitutes a change in patient management. And, if it meets that criteria, well then, you must show it!

Equivocal Findings

It’s those cases that you hem and haw over. These are the best learning tools. So, make the most of them. Even it’s not the most clinically significant case; I would highly recommend that you try to discuss it with your morning attending. It’s one way that you may never discover that finding to be equivocal again. Think about all that time over your career that you will waste that you could have figured out immediately by just asking your attendings in the morning. Why wouldn’t you bother to do that?

Discrepant Reports With The Nighthawk

If you want to get burned, the best way to do it: Don’t go over discrepant nighthawk reports with your attending. I have been on the receiving end of one or two of these unmitigated disasters. And, the resident could have avoided it by simply telling me about it.

Moreover, even if the resident gets it right, and the nighthawk misses the case, it can still become a problem. Medically, the emergency physician can administer the wrong medication based on the nighthawk read. Or even potentially worse, she may not administer treatment based on his final report. Therefore, please let your attending know about these cases, especially if you made the critical finding, and the nighthawk reader missed the obvious!

Discrepant Reports With The Emergency Physician

Just as often as nighthawk discrepancies, if you forget to go over those cases where your opinion differs from the ED physician, you are potentially asking for trouble. Immediately, these cases should be some of the first that you must discuss in the morning. In addition to increasing the work burden on your morning reader, your attending will likely have to make a whole bunch of unnecessary phone calls if he doesn’t know that there was a discrepancy.  Your goal should be to reduce the amount of work your attending needs to complete, not increase it!

Any Other Cases With Questions

Sometimes, cases bring up fascinating points or other medical management questions. And, what better time to ask questions to reinforce what you have learned at nighttime? After residency, you will not have these opportune moments again. So, take advantage of making inquiries with experts while you can!

Whew, That’s A Lot Of Cases To Discuss!

Well, not necessarily. It sounds like a lot more than it is.  Often, these cases are the minority of what you will experience at nighttime. And, fortunately, most nights, you will encounter many normals and garden variety cases that don’t need to take up a lot of your time in the morning. However, regardless of the number of cases, it always pays to go over those cases that need extra attention and care, whether it’s for medical management issues, equivocal findings, discrepancies, or simple questions. It’s a fantastic tool for learning, and more critically, a moral duty for excellent patient care!

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Job Market Is Booming: Are Fellowships Still A Necessity?

fellowships

Let me clear up the facts for all the radiology residents that are thinking about fellowships in this market:  Just like any other job market, the number of radiology attending positions available is subject to market forces. Moreover, this prolific job market will not last forever. To support these claims, in my medical career, I have seen two job cycles, trough to peak. And we are sure to see others. It’s just a matter of time.

So, how does the changing job market impact the topic for today’s blog, the necessity of fellowships? Well, I have a bit of explaining to do.

Back in the early 2000s, when I completed my residency at the last market peak, great jobs were everywhere. California, New York, and  Florida were no exceptions. The theme of the job market was: “Name your price!” And, I can distinctly remember the heated discussions in the reading room about whether fellowships are necessary.

Well, it’s happening again. All you need to do, go to the recent forums on Aunt Minnie on the topic. Or, you can stop by my residency program. You will hear a few passionate debates on the matter. (We had this discussion during noon conference a week or two ago!) Regardless, I think this is a prescient indicator of a market peak. Not that it means we will experience a sudden downturn. But, we are riding somewhere along the top of the curve.

So, what happened the last time around the market went from peak to trough? Well, if you took a poll of radiologists without a fellowship, I believe a higher percentage of these folks would have had more issues with their career than those with one. Therefore, I am going to throw a bit of proverbial cold water on those of you who are thinking about going down this non-fellowship path by telling you why.

More Likely To Have Work You Don’t Like

For better or for worse, those radiologists without a specialty tend to have less control over their domain of practice. Don’t like mammo and plain films? Well, you can’t say you are an expert in another area that you enjoy more when you are starting your career. So, guess where the practice will want to place you!

Severely Limited Job Market On The Coasts

If you want to have a better chance of securing a job in the more populated portions of the country, you will have a much better shot if you have a fellowship. I can certainly speak for my part of the country, New Jersey. It’s possible, but good luck finding a quality position without one!

Not Considered An Expert In Any Area

Now, this may or may not bother you. But, many radiologists like their colleagues and referrers to perceive them as experts in a particular area. Clinicians know individual radiologists and ask for them by name because of their fellowships. That will be less likely to be you!

Much Harder To Start A New Fellowship Once Established

Once you have already been working as a full-fledged radiologist for a while, it becomes much more traumatic to start anew as a fellow. You may have a family. Or, perhaps you have become accustomed to the lifestyle of a radiologist. It’s hard to go back and do a fellowship once you’ve started your career!

Yes, You Will Have Increased Chance Of Losing Your Job

And finally, you may not want to hear this, but as an employee of a practice, when the reimbursements turn down and the market becomes sour, who is the first to go? Well, it’s not likely to be that expert in neuroradiology who the neurosurgeons love. And, it’s not going to be the nuclear radiologist who performs complicated radiopharmaceutical treatments on the referring physician’s patients that the practice cannot replace so easily. Hmmm. Who can be ousted the most quickly without a significant impact on the business? That person is much more likely to be you!

Booming Job Market: Still Need Fellowships!

I get it. You’ve been out working for so many years. And, you’ve become impatient. Maybe, you have a family and want to earn a real living. But, in the long run, it’s not worth the additional risks that you will take by not completing the additional training. So, think again before you choose to enter the job market without a fellowship now. You may regret your big decision later in life!

 

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Radiology As A Backup Specialty: Should Radiologists Be Offended?

backup

During the AUR meeting a few years ago, one of the speakers announced that more medical students than ever used radiology as a backup specialty. Well, how can that be? I mean, radiology is a fantastic specialty, right? Yet, our medical students have chewed us up and spit us out. At that point, you could just about hear the moans and groans in the background of the lecture hall. But then, I thought about it and felt a bit differently. Why? Well, that is what I would like to delve into today.

Most Applicants Don’t Know What They Want

Over the years, I have found that most radiology applicants, like other specialties, think they know what they want. However, when you dig a bit deeper, you find out they are not sure. Hell, I had no clue when I entered the specialty. When you ask applicants why they want to join specialty X, many have difficulty verbalizing their true motivations. Often you hear, “I like using my hands” or” I like coming up with differential diagnoses.”

Truthfully, however, these reasons are, at best nonspecific. And, if you dissect what these residents are saying, you would recognize that the reasons why an applicant claims to have applied to a specialty have no bearing upon what he wants. You can apply to surgery, interventional radiology, urology, and other specialties because you want to use your hands. Or, you can come up with differential diagnoses in almost any specialty in the medical field.

Often, applicants bury the real reason for applying to a specific specialty deep within their psyche. Perhaps, they want to say it’s the lifestyle, the culture, or the money. So, how can we become offended by medical students that don’t know what they want?

Our Specialty Is Getting Noticed!

For applicants to apply to our specialty, even as a backup, it means that they must have some foreknowledge about us, to begin with. That means we are doing something right. Maybe, we are training more medical students about imaging in medical school. Or, perhaps, they hear about an improving job market. In either case, residents have found reasons to apply to us, even though it may not be their first choice!

A Badge Of Honor

Only a few years ago, the radiology applications had dropped precipitously. In addition, the quality of applications had significantly decreased as well. Instead, today, we have become respectable enough to apply to! We are returning to the old norm. So, we should feel excited that qualified applicants are again considering our specialty.

So, We Are A Backup Specialty. Should We Be Offended?

Back to the original question again… Let’s look at radiology for what it is. It’s one of few specialties that allow physicians the flexibility to pursue so many avenues and satisfy the academic and clinical wants of most. And now, if we dissect why residents perceive us as a backup, I think we should not become offended. Instead, we should give the new applicants some credit. They are beginning once again to recognize the specialty of radiology for what it is: an excellent choice for a great career!

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Is Four Years The Right Duration For A Radiology Residency?

years

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

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

What Would Happen If Radiology Residency Was Three Years?

Biggest Problems

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

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

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

Biggest Advantages

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

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

 

What Would Happen If Radiology Residency Was Five Years?

Biggest Problems

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

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

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

Biggest Advantages

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

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

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

 

My Take

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

 

 

 

 

 

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

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

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

 

 

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Why Radiology Is Better Than Law!

law

For many of you training to become a radiologist (or any physician for that matter), by this point, you may be a bit cranky and tired. When this happens, I often hear residents question their original intentions and ask, “Should I have gone to law school instead?” Typically they follow this question with, “I would have finished my residency and would be rolling in the dough by now if I was an attorney…” But in the website’s style, I will immediately debunk those painful thoughts! So let’s start going through why law school is no replacement for becoming a radiologist!

Attorneys Have Loans, But Are Less Likely To Pay Them Back!

If you think you are alone in your debt, think again. Lawyers also have three years of law school loans that they must pay back. OK… It’s not four years. But, the prospects of having them paid back are more tenuous than yours. Did you know that the median attorney earns 118,160 dollars? (1) You may not be the median lawyer, you may say. Let’s say you are above average. An attorney at the 75th percentile makes 175,580 dollars. More rarely do attorneys bring the astronomical salaries that we hear about as partners in a firm on Wall Street for long periods.

And what is the salary for a radiologist? Hmm… Well, it depends on the survey. But, if you look at the AuntMinnie website, they say that the median compensation is 503,225 dollars. (2) If you don’t like that survey, let’s try another showing a lower average salary. How about Medscape from 2017? (3) We are talking about an average of 396000 dollars. Either way, you split hairs. As a radiologist, you will more likely be making more! And more importantly, even though you may owe a bit more, you are more likely to pay those loans back!!!

Attorneys Have Long Hours Too!

If you think you work many more hours than an equivalent attorney, think again!!! Sure, attorneys spend more time at lunch to make that next deal or to increase connections. However, most hardworking attorneys work until late at night, especially if they want to become a partner in a practice. My former Wall Street attorney friends frequently worked until after 8 pm or even as late as 10 or 11 pm! So, I don’t want to hear that whining!

Attorneys’ Work Is Not As Interesting As Ours

OK… This statement is a bit opinionated. But, in my situation, it is very accurate. I certainly would much prefer to read films or perform procedures than splitting hairs over the definition of a word in court. The prospect of researching cases doesn’t do it for me. And, probably not for you if you have chosen to join the field of radiology!

Radiologists Have More Vacation, Ha!!!

Radiologists are blessed with more vacation time within the field of medicine than most other specialties. On the other hand, I can guarantee that few attorneys have eight or ten weeks off per year. I know we work hard when we are on. But it is sure nice to have those extra weeks of vacation, whether at home or away in Bora Bora!

Radiologist Contributions To Society

I’m not particularly eager to make overarching statements. However, I think this one is mostly true. Most radiologists make essential contributions to society by increasing overall health and well-being. Not to say that attorneys do not contribute to our communities, but I believe a more significant percentage of attorneys make less of a difference to humanity. I’m not sure how much ambulance chasers help the average human being! And many other attorneys serve even less noble purposes. On the other hand, hospitals would falter without the average radiologist working their shifts, and patients would have severe health issues!

Law School Vs. Radiology Training: A New Perspective

If those reasons are not enough to convince you about the benefits of radiology training over law school, maybe you should become an attorney! The grass is always greener on the other side in the throes of residency. But, I have news for you; take a look around. Training to become an attorney is not all that flashy. You are lucky right where you are!!!

 

(1) https://money.usnews.com/careers/best-jobs/lawyer/salary

(2) https://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=117841

(3) https://www.medscape.com/slideshow/compensation-2017-overview-6008547#4

 

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The Mega Five: The Ultimate Resources For The First-Year Radiology Resident

Wow, what a feeling! You did it! You’re officially a first-year Radiology resident! And, you just took your first step toward the rest of your life!! One full year has gone in the blink of an eye and you molded yourself into an unbeatable intern! Your mastery of surgical knots, writing extensive progress notes, rounding, and discharging patients have you feeling like you can tackle the world! In fact, you’re so eager to show off all your skills as a first-year radiology resident to your new Radiology Attendings on your first rotation that you jump right in and introduce yourself. You find a really comfy chair next to him, eagerly waiting to learn.

So, your attending opens the very first case and you already know the answer is pneumonia. Let’s face it on those long ICU rotations when was it not? To your surprise, it’s a head CT. He then gives it a quick scroll and asks those fateful words “Normal or abnormal?” … You sit there in silence… Chills run down your spine…sweat appears on your forehead…What just happened? Uttering the word ”I” a few times, you finally commit to the full sentence “I don’t know”. You have failed. You know nothing and feel like you are nothing… At least that’s how you feel for a short while. But hey, it’s your first day!

Get used to it… In the beginning months of the first year, the phrase “I don’t know” will become all too familiar because let’s face it, you don’t know! Not a thing! As an intern, you haven’t picked up a single book relating to radiology. And, you may have only looked at the impression to relay the information to your higher-ups when needed. You just did not have the time! So? What now? Where do you turn? Who can help you? You feel smaller than an insect. How can you possibly turn this around? Get ready to take all your years of what you learned and flush it down the toilet! You’re about to enter a whole new realm, the world of radiology.

The Mega Five

Enter the Mega Five. What is the Mega Five you say? Only the five most powerful resources at your fingertips for the first-year radiology resident! Sure, there are a ton more but these have been the most help in my experience. So, let’s start!

Case review series, Case review series, Case review series!!!

I cannot say it enough but these reviews are incredible. Most importantly, you don’t need a lot of background in order to learn as you go. And, the series takes excerpts of information from the Requisites (longer and wordier than the case review series!) and summarizes the material. Each case has questions and pictures. In addition, it literally contains every subject with increasingly difficult sections as you progress within each of the books.

Core Radiology

I love this book! It contains high-yield pictures and information, especially the Aunt Minnies. And, the book goes system-by-system, image-by-image. It even gives mini dictations of how you should describe the entity.  I can honestly say Core Radiology has helped bolster all my dictations positively. With all the knowledge you attain during 1st year, this book serves to solidify and maintain a steady foundation.

Radiopedia

I can’t believe I’m saying this but yes…Radiopedia is an incredible resource. First, you get fast information, pictures you can scroll through including CT and MRI studies, differential diagnoses, and links and videos. You can also sign up for these links and videos if you so choose (I did for emergency radiology before taking call). Finally, you can think of it as an underused gem like Wikipedia for radiology but even better!

RADPrimer

Oh, RADPrimer how I love you so… RADPrimer makes the list because let’s face it… What are facts without questions to test yourself? With over 4000 questions, you better just dive in and do 10 a day because it has a UWorld feel to it. And, if you’re like me, UWorld was the Holy Bible for USMLE Step 1, 2, and 3. So, why let this opportunity go to waste? Get cracking now…  Just start RADPrimer and crank out questions. You’ll see how much you really know from your studies.

Radiology Assistant

Last but not least, we have Radiology Assistant. To put it mildly, this website is incredible with detailed information, videos, pictures, and cartoons. You name it and they have it. In fact, I utilize this website as much as possible. There are even lectures to watch that break down hard topics, an amazing bonus.

But Wait There’s More…

In addition to my top five resources, of course, there are a ton more. Some of the other resources that I have used include Felsons Roentgenology,  E-Anatomy (application), headneckbrainspine.com, and Lieberman’s eRadiology. Although I poked fun at it above, I still need to mention the radiology requisites series in a better light. As wordy as they may be, you must read them. Why? Well, I’ve noticed that the question banks gather much of their information from the requisites. And finally, please do not be afraid to use free resources like Google, Google images, and even YouTube!

My Final Thoughts

The Mega Five worked well for me during my as a first-year radiology resident because these resources were readily available and came with a wealth of knowledge. If you take advantage of the Mega Five too,  your hard work, diligence, and dedication will pay off. You too will be saving lives “radiographically” one day at a time (A catchphrase for my dating app. I am a single resident, so don’t take it, it’s mine and copyrighted!) So, best of luck to you. Remember, being a first-year radiology resident is tough but there are lots of quality resources to help you out. So, never give up!

 

 

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How Important Is Level One Trauma To My Radiology Training?

level one trauma

Bullet wounds, stabbings, motorcycle accidents, falls, and blunt trauma from severe car accidents. These are some of the incidents that comprise most of the trauma at a level-one trauma center. But, let’s say you attend a program that does not have a level one trauma center, and you don’t see as many of these cases. Are you at a loss compared to your colleagues who do? And, what are the consequences for your future practice of radiology? Will you be a second-class radiologist? For many of you that have to decide on a residency with or without a significant trauma component, these questions cast doubts on some training programs. As I have trained at a level one trauma center and have been operating a residency without one, we will go through the training from a level one trauma you might “miss” during training.

Trauma Resident Checklists

Do you like to have multiple residents in other subspecialties waiting for you to check off the boxes? That situation is what you will experience at a level-one trauma center precisely. You will find that many exhausted nighttime residents are keenly interested in only finding out if you have read all those films yet, not worrying about the final diagnosis. Yes, it reminds you of all the images you need to see with each trauma. But ensuring the specialists have checked all the boxes does not add much to one’s training!

Limited Four Quadrant Ultrasounds

Are you interested in looking for free fluid at all night hours? Well, this is your opportunity. And unfortunately, the limited four-quadrant ultrasound is the tool of choice. Guess who wields the probe? You do!!! I can guarantee that you will be scanning everyone with a horrible accident that comes through the pearly gates of the emergency department. Is it worth all those additional sleepless nights so that you can find the free fluid? I’ll let you make that choice.

Repetitive Injury Patterns

Do you like variety? Trauma comes in so many fewer flavors than other interesting disease entities. Knife wounds exhibit most of the same findings over and over again. After your 15th splenic laceration, it gets old. And it’s not just the knife wounds. Blunt trauma, bullet wounds, and severe falls work the same way. I prefer a little more variety in my life!

Fewer Bread And Butter Cases

What does trauma experience usually replace? Typically, you will see many fewer bread-and-butter cases. And the time spent working up trauma cases has to substitute for something else. What do I mean by that? Level-one trauma centers may divert some diverticulitis, appendicitis, oncology, and renal stone patients down the street. I mean, who wants to go to an emergency department with all that bloody trauma when you can go to a much less hectic hospital. Unfortunately, for that reason, you get less experience with the diseases that most emergency departments always see. And these diseases are the ones that residents need to learn the most; the more common entities you will be working up the most in practice.

Level One Trauma- A Necessity For Training?

Yes, I will admit that level-one trauma centers provide a specialized experience. But for the most part, radiologists can learn what they need to know from the standard trauma they encounter at a hospital without completing a residency with a level-one trauma program. In addition, it is not hard for the resident to supplement their training with trauma reading. So, if you find a great program without a level one trauma center that otherwise matches what you want, by all means, still consider it. The absence of level-one trauma does not imply a significant gap in your radiology education!