1 thing I don't understand....

[medlaw06]

hey guys...i am more of an IM person, but something happened recently regarding rads to a good buddy of mine that completely baffleds me...it is quite well known that rads is one of the toughest residencies to get...there are many reasons for that ($, lifestyle, residency hours, etc.) that make rads the envy of a lot of "non-rads" people....along with these "perks" comes the competition since many med student grads want to have those perks (whether they will opnely admit it or not is a different story)...also, there are very few rads spots in the nation...so, taking all of this together, you have those people will did REALLY REALLY well on their USMLEs going into radiology and there are very few spots to deal with....translation, hard core competition that eventually end up going to people who did really well of boards...now, looking at what the USMLEs test, there REALLY isn't alot of "hardcore" radiology since alot of those findings are provided for you in the question stem...so, this just begs the question: what if you did REALLY well on your USMLEs and then get a rads spot and then you are horrible at it because you really don't have a "keen eye" to see the pathology? In other words, you could know 5,000 differentials for something, or know what the "next best management" is for everything, or even know the pathophysiology of something esoteric disease like Kennedy's disease or CHARGE syndrome, but what if you are spatially VERY challenged!?!?!...

the thing that happened to my friend is a little wierd...he is trying to get rads and is massively kissing a** at various places...the thing is that he has REALLY bad board scores (including Step 2)...he has been told by LOTS of programs that they will not look at his application due to his bad board scores (community as well as university hospitals)...the thing is that he is AWESOME at reading x-rays, CT, MR, etc....his explanation for this is that he has a great eye for detail (he used to be a photography "minor" in college)...and he was never really good at all the damn differentials, next best step, etc....ANY ADVICE? Has anything like this happened to others that you may be aware of in your residencies? Why is it that you have to have awesome board scores, when a lot of rads is NOT having to deal with "the next best step?" Lastly, are there rads residents who are definitely brilliant but have had problems with the "nuts and bolts" of rads since they are spatially challenged?

Thanks for your help!!! I hope I have not offended anyone in this forum!!

take care

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[ttumed]

First of all good luck to your friend, however I don't think being poor at gernerating a diferential translates to a good radiologist. I'm doing my 1st 4th year rads rotation now and these guys are mad smart. They are always thinking about the differential. Fortunately all of this can be learned, so all the best for your friend.

 

[hans19]

A couple of things...

First- Radiology and High step scores.
The USMLE is a standardized test. Residencies have to have some measure of the 'quality' of a candidate, no matter how arbitrary or peripherally related that measure is.

The high step score requirement is NOT unique to radiology. The selection committee for any of the other competitive specialties will favor high scores. Why? --Because they can.
Do you think step scores correlate with prospective plastic surgery applicant's aesthetic talent or hand-eye coordination?

Secondly - 20/20 vision alone does not make you an ace fighter pilot.
Maybe your friend has above average visual acuity and has a 'good eye', but I seriously doubt that he is 'good' at reading CTs or MRIs. If he is neither radiologist nor resident how could he possible be adept at the interpretation of plain films, CT and MR? Have you ever seen the myriad of sequences on MRI? As a new resident, I had a really tough time identifying abnormal let alone the normal structures on MRI.

Rendering a useful, let alone 'good' interpretation requires much more than determinine something is abnormal. The clinician not only wants to know what is abnormal, but what does the finding mean for the patient? Is it benign, or is it suspicious for cancer? In order to do this you have to have a broad knowledge of pathology, normal and abnormal anatomy and an understanding of the clinical implications of your impression. This comes only with years of repetition tempered by experience.


Third- if you know you can't swim, don't be a life guard.
Similarly, I would think that if a person knows they are visually or spatially impaired they would not knowingly pursue radiology or surgery.

One of my good friends is blind in one eye and he is very artistic. Though he would have loved to be a plastic surgeon (he certainly had the grades for it) he opted for a nonsurgical field. Similarly, I'm sure you have heard of the blind student who graduated near the top of his med school class. Needless to say he is not doing a residency in radiology or surgery.

At any rate radiology is a wonderful field. If your friend really wants to be a radiologist, I strongly encourage him to apply, regardless of his test scores.
Good luck to your friend.

 

[Docxter]

the thing that happened to my friend is a little wierd...he is trying to get rads and is massively kissing a** at various places...the thing is that he has REALLY bad board scores (including Step 2)...he has been told by LOTS of programs that they will not look at his application due to his bad board scores (community as well as university hospitals)...

Radiology requires a massive amount of medical knowledge. Board scores are the best available standard criterion by which program directors can gauge this.

the thing is that he is AWESOME at reading x-rays, CT, MR, etc....his explanation for this is that he has a great eye for detail (he used to be a photography "minor" in college)

What? He's awesome? How? How do you know? By what criteria? Has he undergone ay standard radiology test? Just because he's a bit better than other med students is "seeing" a finding, doesn't make him Awesome at "reading" imaging studies.

...and he was never really good at all the damn differentials, next best step, etc....ANY ADVICE? Has anything like this happened to others that you may be aware of in your residencies? Why is it that you have to have awesome board scores, when a lot of rads is NOT having to deal with "the next best step?" Lastly, are there rads residents who are definitely brilliant but have had problems with the "nuts and bolts" of rads since they are spatially challenged?

You are obviously very ignorant about what radiology training and practice entails. Radiology is all about differentials (more than any other field, including IM). If your friend is not good with knowledge about diseases or differentials of all organ systems, he can't be a good radiologist. The "visually superior" notion is more of a myth and can be learned with practice. Unless someone has a real pathologic problem in spatial data processing, the spatiovisual relationships useful in radiology can all be learned by practice and experience. The hard part about radiology is it's broad knowlege base requirement and ability to formulate differentials, and even guessing the patient's history and symptoms by extracting information from images.

 

[medlaw06]

You are obviously very ignorant...

ouch

i wouldn't go as far as calling me ignorant (especially OBVIOUSLY) per se...maybe a little less knowledgeable about radiology since i am not a radiologist...as i said earlier, i am an IM person who came to this particular forum to ask a question...in the way you reponded, i guess i can just as easily say that you "obviously" have the social grace of a...well...I'll just leave that one...you ARE going to be a radiologist....


to other radiologists in the house, I mean you no offense....just came in here with a simple question....

have a nice day!

 

[Whisker Barrel Cortex]

ouch

i wouldn't go as far as calling me ignorant (especially OBVIOUSLY) per se...maybe a little less knowledgeable about radiology since i am not a radiologist...as i said earlier, i am an IM person who came to this particular forum to ask a question...in the way you reponded, i guess i can just as easily say that you "obviously" have the social grace of a...well...I'll just leave that one...you ARE going to be a radiologist....

to other radiologists in the house, I mean you no offense....just came in here with a simple question....

have a nice day!

I agree that was a little harsh by Docxter.

The answer to your original post is that being a GOOD radiologist does require a very broad and in depth knowledge base. Decent spatial abilities are obviously a plus, but will not make a good radiologist, in my opinion. Thinking through what you see and deciding what the next best course of action would be is vital. I don't think there are many that will be limited by their spatial ability unless its a very severe lack. However, there are those that will be limited by their lack of knowledge base in becoming a GOOD radiologist.

I am sure you have seen some of these people's reports, which tend to be poorly organized, nebulous, and not very helpful. I'm not talking about the clinical correlation statements that people complain about (there is often a good reason for including this statement). I'm talking about radiologists whose reports have no good recommendations at all.

By the way, the social graces of most radiologists is much better than many of the clinicians I know. I have a lot of internal medicine friends who can talk about nothing but work all the time. Not my idea of a good time.

 

[medlaw06]

By the way, the social graces of most radiologists is much better than many of the clinicians I know. I have a lot of internal medicine friends who can talk about nothing but work all the time. Not my idea of a good time.

thanks Cortex for your input....I am getting a better understanding...i guess my past experiences with radiologists (rotations, etc..) were not the best in terms of learning....taken into consideration that I hear some (THE KEY WORD THERE BEING "SOME") IM docs who complain that the rad report is filled with vagueness that "may or may not" be the cause of what the patient was sent in for....

lastly...I couldn't agree with you more, cortex...while I like IM alot and eventually want to pursue a fellowship (no...not in cards like everyone else), I am VERY aware of the fact that a lot of IM docs sit there and foam at their mouths over how wonderful their practice has been going...

 

[Whisker Barrel Cortex]

thanks Cortex for your input....I am getting a better understanding...i guess my past experiences with radiologists (rotations, etc..) were not the best in terms of learning....taken into consideration that I hear some (THE KEY WORD THERE BEING "SOME") IM docs who complain that the rad report is filled with vagueness that "may or may not" be the cause of what the patient was sent in for....

Many times its just not clear. We are only looking at shadows of the pathology and it can represent a variety of things.

That being said, I have seen some reports from private practice radiologists that are terrible. These are sent to our department for over-reads when the patient is tranferred to our tertiary care hospital. Most are pretty good reports, but I've seen some that are just terrible meandering messes. Our reads can often clarify the situation greatly. The difference between a good radiologist and a bad radiologist in their overall usefullness to patient care can be huge.

I think the practice of radiology is improving everyday. Not only are the med students getting into rads brighter, they are trained in more high tech equipment than before and will continue to increase the importance of imaging in diagnosis. As some of the old timers retire (many of whom are self trained in CT and MRI to varying degrees of ability), the utility of the rads report will continue to improve.

 

[bigfrank]

Another awesome post, WBC.

To the OP, I wouldn't say that Rads spots are extremeily limited. There are about 1,000 per year available. Now Derm, RadOnc, and Integrated Plastics -------- those three fields have severely limited #s of spots.

Good luck to you and your friend.

 

[medlaw06]

Many times its just not clear. We are only looking at shadows of the pathology and it can represent a variety of things..

hey cortex...i really don't mean to beat a dead horse, but this is what i was trying to say in my original post...i guess the thing i don't understand is that shouldn't a radiologist IN GENERAL have a better "visual acuity" (by that I mean ability to pick up these things having a strong background in anatomy) than others...also, are there radiologists that say "i just don't see it...it looks like gray stuff to me" vs. another who'll say "but, see the different shades of gray...that would mean X is going on here whereas Y is going on here."

I REALLY am not explaining myself appropriately!! I hope you can see ( ...ok...ok...so that was a bad joke) what I am trying to say...


big frank...good God man...are your posts everywhere!?!?! Do u ever sleep!?!?!