How to Make the Most of Radiology Training

Residency is an intense time in the career for any radiologist. There’s much to learn and practice. Finding ways to do it all well can be an intimidating task. And, doing so can be particularly challenging if you don’t get the right guidance.

At this year’s RSNA, Rachel Nelson, MD, senior radiology resident and former chief resident at the Medical University of South Carolina, had advice for how residents can best navigate – and maximize – their training.

“Residency is daunting and difficult from the moment you first walk through the door,” Nelson said. “You need to know the tools you can use and find the support along the way to make the four-to-six years go smoothly.”

• Foundation: When you begin residency, she said, focus on developing the skills you need that will help you with advanced learning as you progress.

• Anatomy: In many ways, radiology is applied anatomy. Learn what normal – and the variations of normal – look like so you can identify when something is wrong. Focus on understanding how normal outcomes present on each modality.

• Pathology: Once you’ve mastered anatomy, she said, move on to pathology and pathophysiology. It’s important for you to be able to recognize what condition or problem you’re dealing with so you can provide better information to referring physicians and surgeons. Understanding the pathology can also better position you to help the patient achieve his or her “new normal.”

• Physics: You don’t need to be a physics expert, Nelson said, but it’s a field that’s fundamental to radiology. Educate yourself on some of the basics, learn how an X-ray is made, and study the Compton Effect. Not only will this knowledge help you when you’re studying for your board exams, but it will also be useful as you begin working with more advanced modalities.[[{"type":"media","view_mode":"media_crop","fid":"44129","attributes":{"alt":"Rachel Nelson, MD","class":"media-image media-image-right","id":"media_crop_5377709734981","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4916","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"Rachel Nelson, MD","typeof":"foaf:Image"}}]]

• Personalized Learning Style: When you begin residency, it’s likely been at least one or two years since you’ve had to study vigorously. Re-learn your best strategies for taking in information. Do you learn best sitting with your attending physician, asking questions, or do you prefer to find a quiet area and pour over textbooks?

“It’s important to figure out your learning style early so you can connect the dots,” she said. “It gives you a solid foundation as you move forward to more advanced training.”

• Available Resources: During residency, your charge is to take in and retain as much information as possible. Take advantage of every resource you can, Nelson said. Utilize your attending physician – he or she is there to teach you.

“Ask your attending physician questions. It’s okay to not know all the answers,” she said. “It’s worst to pretend you understand what he or she is saying and, then, going home and trying to figure it out by yourself.”

Additionally, familiarize yourself with all available online resources that both you and your referring physicians might use, such as Epocrates, The Radiology Assistant, or UpToDate. Pay particular attention to what your referring physicians are reading because it will give you insight into how they make decisions about which test to order. If you’re knowledgeable, you can guide them to the most appropriate test and, potentially, improve patient care.

Communication
Developing open lines of communication, internal and external, to your department is vital, Nelson said. Focus on creating strong relationships with co-residents, attending physicians, fellows, and other hospital staff, especially anesthesiologists who might work with your pediatric patients or emergency department physicians. In addition, take time to get to know the technologists who complete studies – they have greater patient contact and can provide information about a patient’s true condition, such as pain level or symptoms of illness.

Open lines of communications with other specialties, as well. Attend multi-disciplinary conferences. Talk with pathologists, surgeons, and oncologists to see how radiology can better help them. Demonstrate that you want to be part of the patient care team, she said.

Report
When you can’t meet or talk with another provider face-to-face, your report is your communication to the outside world, she said. Make it as effective as possible. Be clear and concise, stating things in simple terms and limiting minutiae. Be definitive when you can, but if you can’t, provide useful information that can lead the referring physician in the right direction. Have a suggestion about next steps to take, she said.

Mentoring
Anyone can be a mentor, Nelson said, so find someone that resonates with you. Nurture that relationship because it can be beneficial both during your residency and further into your career. Then, be sure to pay your mentor back by paying it forward and mentoring other residents in the future.

Outside the Reading Room
To be the most effective radiologist you can be, you must step outside the reading room and get involved, she said. Join your local American College of Radiology chapter or other state organizations, and take on a leadership position. If you’re interested in research, find a way to get involved in a project. Investigate whether your institution has a program that introduces radiology in the early years of medical school. If so, volunteer to speak about what you do – it could also be a way to attract more talent into the specialty.

Work-Life Balance
Even though workloads are heavy, you can’t spend your entire life in the reading room or working with patients, she said. Find an outlet that helps you decompress, such as gardening, running, or photography.

Most importantly, though, know when enough is enough.

“Know your limits,” Nelson said. “Know when you have to say no and back away.”