Concerned about my program

[Anonradiology]

I am an R1 who is growing very concerned about the education I'm receiving. We are an extremely busy residency, so busy that we do not do readouts and education is very sparse in the reading room. Basically there are maybe 4 attendings in the entire program that will read out with you. Right now every resident is purely looking at their dictation revisions to learn what they got wrong and how they can improve. Sometimes we are told what we got wrong unsolicited but nothing really more. We all really have to pry to get feedback/teaching. Education has taken a serious back burner since COVID here, apparently.

With my 300k of loans on the line I've been increasingly distressed that I'll be any good when I leave here. This program has about a 90-95% boards pass rate but when talking to the upper levels, the education wasn't always this subpar.


I've got a few questions for everyone. Does any one have any experience with programs like this? Is a program like this even capable of consistently producing good radiologists? Lastly, what can I even do? The program is aware but doesn't seem like they plan on doing anything about improving our education.

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[2brads]

Anonymous ACGME surveys come out each year regarding resident safety and education. I guess you could voice your complaints there. The obvious downside to doing that would be loss of accreditation, which would not serve your purposes. Otherwise, tell your chief residents if you are close with them.

I’ve never heard of “no read outs”. You mean that the attending are just dicatating everything themselves? That’s generally anathema in academic circles. Residents and attendings have a deal: you get taught some stuff during readouts and they get free dictation monkeys. It’s a decades-old symbiosis.

On the plus side, even if you are a horrible radiologist, the job market is hot enough you’ll still find a great position.

 

[Anonradiology]

The PD knows that we're all complaining of poor teaching but basically nothing has changed. The chiefs are not very approachable this year, so unfortunately I don't think that is an option.

By no reads outs I mean one of two things occur after we finish our reads: A. either the attending just tells you what you got wrong about the read itself with very minimal actual teaching (maybe half the time on cross sectional and rarely on plain films) or we look back at the report in our dictation software to see what they changed.

Every other person I know in a radiology program has dedicated sit down read outs. From my understanding the way we do it is very rare. The only program I even know that does it the way we do it is SLU. Which obviously is very concerning.

 

[qwerty89]

Lack of readouts should only happen for an experienced R4, never for an R1. This is terrible education.

My fellowship had dedicated readouts for every study.

As a side note, I remember the neuro PD at Univ of Washington saying emphatically that his program had dedicated readouts for all studies unlike the program he went to (UCLA).

 

[qwerty89]

The PD knows that we're all complaining of poor teaching but basically nothing has changed. The chiefs are not very approachable this year, so unfortunately I don't think that is an option.

By no reads outs I mean one of two things occur after we finish our reads: A. either the attending just tells you what you got wrong about the read itself with very minimal actual teaching (maybe half the time on cross sectional and rarely on plain films) or we look back at the report in our dictation software to see what they changed.

Every other person I know in a radiology program has dedicated sit down read outs. From my understanding the way we do it is very rare. The only program I even know that does it the way we do it is SLU. Which obviously is very concerning.

The only time this happened in my residency was on call.

 

[2brads]

At my residency it was: resident reviews studies, read out with attending, resident dictates and signs prelim, attending finalizes report. For every single study - outpt, inpt, daytime, on call, ER.

 

[Anonradiology]

In my position what would you do?

 

[2brads]

You could try to transfer. But if you’re going to transfer do it sooner rather than later.

 

[CherryRedDracul]

By no reads outs I mean one of two things occur after we finish our reads: A. either the attending just tells you what you got wrong about the read itself with very minimal actual teaching (maybe half the time on cross sectional and rarely on plain films) or we look back at the report in our dictation software to see what they changed.

Every other person I know in a radiology program has dedicated sit down read outs. From my understanding the way we do it is very rare. The only program I even know that does it the way we do it is SLU. Which obviously is very concerning.

This was kind of my residency experience with several attendings, and it became worse post-COVID. Best part was hearing about how my R1 class last year wasn't even getting read out by a subspecialty division for like a week; they were flying blind with no senior. We had to complain to get that fixed.

I'm happy my fellowship is much, much better with attendings who actually want to teach you.

 

[GoPelicans]

haha sounds exactly like my program ever since COVID wonder if this is a systemic issue.

 

[shadowlightfox]

Wow, I thought my program was the only one with this issue.

 

[guytakingboards]

The PD knows that we're all complaining of poor teaching but basically nothing has changed. The chiefs are not very approachable this year, so unfortunately I don't think that is an option.

By no reads outs I mean one of two things occur after we finish our reads: A. either the attending just tells you what you got wrong about the read itself with very minimal actual teaching (maybe half the time on cross sectional and rarely on plain films) or we look back at the report in our dictation software to see what they changed.

Every other person I know in a radiology program has dedicated sit down read outs. From my understanding the way we do it is very rare. The only program I even know that does it the way we do it is SLU. Which obviously is very concerning.

It definitely sounds like a tough situation. Radiology definitely needs some hand-holding and attending-directed teaching at the workstation in the first few years.

Sounds like if the PD knows about the problem and nothing has changed then he/she is not empowered to change things either. Really the PD doesn't have that kind of power to dictate what other attendings do. That power resides in the Vice Chair of Operations and the Chairman. If those two don't support the PD then the PD is powerless to get the attendings to do anything.

The chiefs definitely aren't going to be able to fix that problem. They don't have near enough power to do that. All they can do is hear complaints and pass them up the ladder.

At this point, assuming everyone is vaccinated, in-person readouts should be happening again. If they're not, maybe its due to a staffing shortage. In which case, that problem ain't getting fixed anytime soon.

 

[SeisK]

It definitely sounds like a tough situation. Radiology definitely needs some hand-holding and attending-directed teaching at the workstation in the first few years.

Sounds like if the PD knows about the problem and nothing has changed then he/she is not empowered to change things either. Really the PD doesn't have that kind of power to dictate what other attendings do. That power resides in the Vice Chair of Operations and the Chairman. If those two don't support the PD then the PD is powerless to get the attendings to do anything.

The chiefs definitely aren't going to be able to fix that problem. They don't have near enough power to do that. All they can do is hear complaints and pass them up the ladder.

At this point, assuming everyone is vaccinated, in-person readouts should be happening again. If they're not, maybe its due to a staffing shortage. In which case, that problem ain't getting fixed anytime soon.

Top tier academic programs are listing openings on ACR and Merritt Hawkins for gods sake. You can’t threaten your attending with punitive action if you’re paying them an academic salary for increasingly private-practice workloads, knowing they’re already inches from walking and looking for an excuse. And in this market even highly desirable workplaces are looking.

If you can’t punish your employees, they’re not going to do something they don’t want to do, and an increasing number of academic attendings aren’t there because they want to teach, they’re there because they don’t want to work hard or be bothered. And they’re already being asked to do more for nothing.

Like most everything else going on in medicine, it’s because people are asked (by medicare, ultimately) to do too much with too little.

 

[Dr. USMLE]

I am an R1 who is growing very concerned about the education I'm receiving. We are an extremely busy residency, so busy that we do not do readouts and education is very sparse in the reading room. Basically there are maybe 4 attendings in the entire program that will read out with you. Right now every resident is purely looking at their dictation revisions to learn what they got wrong and how they can improve. Sometimes we are told what we got wrong unsolicited but nothing really more. We all really have to pry to get feedback/teaching. Education has taken a serious back burner since COVID here, apparently.

With my 300k of loans on the line I've been increasingly distressed that I'll be any good when I leave here. This program has about a 90-95% boards pass rate but when talking to the upper levels, the education wasn't always this subpar.


I've got a few questions for everyone. Does any one have any experience with programs like this? Is a program like this even capable of consistently producing good radiologists? Lastly, what can I even do? The program is aware but doesn't seem like they plan on doing anything about improving our education.

While it may seem like this is rare, it is more common than most might expect.

I have quite a few students who are radiology residents with a similar educational experience. This puts a lot of strain on preparation for the core exam, which is a very challenging exam if you are not trained in a truly academic program.

Certain areas of radiology are simply not covered in some programs, such as cardiac MR, coronary CTA, prostate MR, rectal cancer staging MR, high resolution chest CT for ILD; even breast, neuro and MSK MR can be spotty or poorly taught. These areas are commonly tested on the core exam.

One option is to reach out for personalized instruction. You can also form study groups with your resident peers. Perhaps have the sympathetic seniors give more instruction and board reviews.

 

[2brads]

"[MSK/breast/neuro] are commonly tested on the core exam." Understatement of the millennium.

How are programs even being accredited if a.) their residents can't pass the CORE and b.) are not training in essential subject areas?

 

[shadowlightfox]

While it may seem like this is rare, it is more common than most might expect.

I have quite a few students who are radiology residents with a similar educational experience. This puts a lot of strain on preparation for the core exam, which is a very challenging exam if you are not trained in a truly academic program.

Certain areas of radiology are simply not covered in some programs, such as cardiac MR, coronary CTA, prostate MR, rectal cancer staging MR, high resolution chest CT for ILD; even breast, neuro and MSK MR can be spotty or poorly taught. These areas are commonly tested on the core exam.

One option is to reach out for personalized instruction. You can also form study groups with your resident peers. Perhaps have the sympathetic seniors give more instruction and board reviews.

All this is easier said than done.

The problem with personalized instruction is that the attendings are just too focused on just getting the work done instead of teaching. The problem with forming study groups is that some peers (or most, rather) are just too burnt out after spending the day expending their energy in clearing the list. Not to mention some residents prefer to study alone rather than with peers for multitude of understandable reasons.

What are your opinions regarding the current setup though?

 

[Dr. USMLE]

All this is easier said than done.

The problem with personalized instruction is that the attendings are just too focused on just getting the work done instead of teaching. The problem with forming study groups is that some peers (or most, rather) are just too burnt out after spending the day expending their energy in clearing the list. Not to mention some residents prefer to study alone rather than with peers for multitude of understandable reasons.

What are your opinions regarding the current setup though?

Not sure what you mean by "current setup."

By personalized instruction, I meant a tutor.

 

[shadowlightfox]

Not sure what you mean by "current setup."

I mean that education is taking a backseat for "clearing the list" across many residencies. And the justification for it stating that it prepares you for private practice once you graduate anyway.

 

[SeisK]

I mean that education is taking a backseat for "clearing the list" across many residencies. And the justification for it stating that it prepares you for private practice once you graduate anyway.

The justification is whatever it needs to be to be just good enough to get you to stop bothering them. I promise, “we want to prepare you for private practice” is not the reason for that kind of behavior.

They know it. It’s just nobody can challenge them on it.