Advice for R1

[jknolls]

I'm an R1 at a good university program. I had a different career before going back to med school. I studied hard in med school and had excellent grades and Step scores and never really had any trouble with study material/tests/clerkships. I also did quite well during internship. But I'm having a very tough time in radiology so far. I constantly feel extremely overwhelmed and quite stupid most of the time. It's almost as if whatever I've achieved so far in med school and internship has not prepared me one bit for this. I especially have a tough time with anatomy (my weakest subject in med school) and visuospatial perception. Most of the times I'm still trying to figure what I'm looking at during case conferences while the seniors (even the second years) seem like they're zipping through and trying to narrow down to a few differentials. I've been trying to study almost everyday but am not getting too far with that since it takes me forever to go through even a few pages. I know this is a long four year process but it just feels like a monumental and almost an impossible task. This is getting to a point where I'm starting to doubt my decision to go into radiology and find myself coming up with reasons to apply for another residency next year or even quit medicine altogether. Can upper levels/practicing radiologists please provide some advice? Is this normal? Any tips or suggestions? Thanks in advance.

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[DrBowtie]

I'm an R1 at a good university program. I had a different career before going back to med school. I studied hard in med school and had excellent grades and Step scores and never really had any trouble with study material/tests/clerkships. I also did quite well during internship. But I'm having a very tough time in radiology so far. I constantly feel extremely overwhelmed and quite stupid most of the time. It's almost as if whatever I've achieved so far in med school and internship has not prepared me one bit for this. I especially have a tough time with anatomy (my weakest subject in med school) and visuospatial perception. Most of the times I'm still trying to figure what I'm looking at during case conferences while the seniors (even the second years) seem like they're zipping through and trying to narrow down to a few differentials. I've been trying to study almost everyday but am not getting too far with that since it takes me forever to go through even a few pages. I know this is a long four year process but it just feels like a monumental and almost an impossible task. This is getting to a point where I'm starting to doubt my decision to go into radiology and find myself coming up with reasons to apply for another residency next year or even quit medicine altogether. Can upper levels/practicing radiologists please provide some advice? Is this normal? Any tips or suggestions? Thanks in advance.

What rotations have you done and what have you been studying?

Also what are you doing during your workday in terms of # of cases, reading etc?

 

[jknolls]

So far I had few weeks each of MSK, ultrasound, chest, and Body CT. I try to do as many cases I can during the day, progressively increasing the number of studies throughout each rotation but I feel like I never spot any important findings and rely on readouts to figure out what I need to say. I would have a zillion basic questions which tend to slow down the workflow so I usually wind up don't asking all of them. I've been studying mainly from B & H as that was recommended for the first year by a multiple senior residents.

 

[DrBowtie]

So far I had few weeks each of MSK, ultrasound, chest, and Body CT. I try to do as many cases I can during the day, progressively increasing the number of studies throughout each rotation but I feel like I never spot any important findings and rely on readouts to figure out what I need to say. I would have a zillion basic questions which tend to slow down the workflow so I usually wind up don't asking all of them. I've been studying mainly from B & H as that was recommended for the first year by a multiple senior residents.

IMO B&H is too wordy to digest when just starting out. If it's not working for you, switch it up.

MSK - B&H is fine or alternatively fundamentals of skeletal radiology is the same material just repackaged a bit. I think more readable.

Chest - Felsons and Fundamentals of body CT by Webb

Body CT - fundamentals of body CT

US - Requisites US.

It seems like you switch too often to really get the hang of a rotation (not your fault).

You should have statdx always open at this point.

You'll learn with case conference that there is a certain art to taking a case, much of it is fluff giving yourself time to think.

Hang in there.

 

[colbgw02]

It's only a slight exaggeration to say you know as much about radiology as a new R1 as you knew about medicine as a new MS1. You're in good company in feeling stupid and inadequate.

Give it time. Your brain needs time to adjust its thinking and its eye to radiology. The learning curve is steep during R1.

 

[deleted116380]

Hang in there. I'm an R1 as well and finding the learning curve steep, too. Med school and intern year (medicine prelim) didn't really prepare me much for this. Maybe a surgery intern year would have, but no way would I have done one of those in hindsight.

As said earlier, your rotations look very short...2 weeks each? Ours are 4 weeks, which I think is good as it allows the first 2 weeks go through a book (for the most part) and reinforce it the second half.

I haven't used B&H at all this first year and would recommend Felsons and Body CT for sure for chest and body rotations, respectively. Try to come up with a system in going through chest radiographs and CTs so you don't miss stuff and can go through things quicker with time.

 

[qxrt]

Another R1 here. B&H thus far has been a terrible way for me to learn the basics of my rotations. Once I figured this out and started looking at other recommended textbooks (e.g. Requisites for ultrasound, fundamentals of body CT, etc), I started to do really well on my rotations.

Also, if your rotations are only a few weeks long each, that's hardly enough time to really start to understand any single subspecialty in radiology. I only started becoming comfortable with my reads after at least 3 weeks on each rotation.

This early on, don't worry. It's normal to feel completely lost. Just keep up with your reading, and while at work, volume is much more important than dictating! The more you see, the more you'll learn.

 

[Zweihander]

I'm an R1 at a good university program. I had a different career before going back to med school. I studied hard in med school and had excellent grades and Step scores and never really had any trouble with study material/tests/clerkships. I also did quite well during internship. But I'm having a very tough time in radiology so far. I constantly feel extremely overwhelmed and quite stupid most of the time. It's almost as if whatever I've achieved so far in med school and internship has not prepared me one bit for this. I especially have a tough time with anatomy (my weakest subject in med school) and visuospatial perception. Most of the times I'm still trying to figure what I'm looking at during case conferences while the seniors (even the second years) seem like they're zipping through and trying to narrow down to a few differentials. I've been trying to study almost everyday but am not getting too far with that since it takes me forever to go through even a few pages. I know this is a long four year process but it just feels like a monumental and almost an impossible task. This is getting to a point where I'm starting to doubt my decision to go into radiology and find myself coming up with reasons to apply for another residency next year or even quit medicine altogether. Can upper levels/practicing radiologists please provide some advice? Is this normal? Any tips or suggestions? Thanks in advance.

One bit of advice I found very useful was, when you have the time to spare, go through the previous night's already read-out call cases. Take them as you would a new case at your reading station, go as fast as you can while maintaining your search pattern and disciplined approach, and then compare your findings with those of the attending and resident.

Especially for people who don't learn certain kinds of information well through books, this is a great way to try and simulate the call experience a bit and get used to seeing real life cases. Then you can use this as a jumping point to do more focused reading about anatomy or differentials you aren't familiar with.

 

[cbtk18]

One bit of advice I found very useful was, when you have the time to spare, go through the previous night's already read-out call cases. Take them as you would a new case at your reading station, go as fast as you can while maintaining your search pattern and disciplined approach, and then compare your findings with those of the attending and resident.

Especially for people who don't learn certain kinds of information well through books, this is a great way to try and simulate the call experience a bit and get used to seeing real life cases. Then you can use this as a jumping point to do more focused reading about anatomy or differentials you aren't familiar with.

No way I'd have time for that

 

[greg1184]

My program has mandastory book reviews of Brant and Helms every week so I been reading that I'm addition to my rotation books. I try to take in as much information as I can and treat knowledge as radiation..... It's a cumulative effect. When you go through your rotation again and have to go through the material again it will get easier.

Books I used for rotation:
- nucs: Mettler
-flouro: pink GI Book and the Mayo GI review
- MSK: Requisites.... Awesome book
- Neuro: I'm currently using Osbourne's brain book. Excellent text.

Already started taking cases in case conference, particularly the chief resident case conference where he encourages R1 to take cases.

 

[Zweihander]

No way I'd have time for that

Well, the idea is to make this part of the studying you'd be doing anyway. My residency hospital is in a small town so people would just wander in and study sometimes using the resident library and just doing cases, but I can imagine that wouldn't be practical for everyone. We also were given unstructured study time as residents, which I know is true for a lot of places but obviously not all.

 

[MossPoh]

It is somewhat comforting knowing that I'm not alone with that feeling. I started on Nucs and then neuro where I was learning a different PACS and blitzed with questions about MRIs and various lesions from our assigned reading. I was in a full depression and demoralized. I came home so beat down every night what little reading I did wouldn't stick.

Sometimes I feel they have unrealistic expectations with reading assignments. I started reading the helms MSK fundamentals book and was told that it was not good enough and I was expected to read all Greenspan in 4 weeks. I get home by 5:30 or 6. Have to walk the dog, make dinner and then decide between reading or exercise because I have to wake up at 5:30 am the next morning. I'm so tired it never feels like it sticks. I do a lot of indirect learning now by looking up stuff on statdx, pulling up priors and mentally going through it before checking the report by the other person, etc. MSK is much easier for me due to my personal interests than neuro, but it can still be frustrating.

Regardless, the best decision I made was admitting I needed help, that I was depressed and getting treatment...and adopting my dog. That has helped retention and getting through the grind more than anything else.

Just try to pick up stuff every day. Read what you can but don't beat yourself up if it doesn't happen. You aren't a machine and what seems astronomical now will come. Every day you increase that knowledge base just a little.

 

[greg1184]

It is somewhat comforting knowing that I'm not alone with that feeling. I started on Nucs and then neuro where I was learning a different PACS and blitzed with questions about MRIs and various lesions from our assigned reading. I was in a full depression and demoralized. I came home so beat down every night what little reading I did wouldn't stick.

Sometimes I feel they have unrealistic expectations with reading assignments. I started reading the helms MSK fundamentals book and was told that it was not good enough and I was expected to read all Greenspan in 4 weeks. I get home by 5:30 or 6. Have to walk the dog, make dinner and then decide between reading or exercise because I have to wake up at 5:30 am the next morning. I'm so tired it never feels like it sticks. I do a lot of indirect learning now by looking up stuff on statdx, pulling up priors and mentally going through it before checking the report by the other person, etc. MSK is much easier for me due to my personal interests than neuro, but it can still be frustrating.

Seriously? That is nonsense. Requisites is all you need for MSK as an R1. My chief resident, who got 99s on every single in house exam (he is a machine), did Requisites. Whoever told you to read a reference book in 4 weeks is full or crap. I had Greenspan in my workstation in case I had to look up something. I mainly did plain films to prepare for call.

You have to wake up at 5:30? What time does your day start?

Radiology is 4 years for a reason. Hang in there. Each time you come back to the same rotation a 2nd, 3rd, you get better.

 

[Zweihander]

There is a lot to learn in radiology, and the main thing to understand I think is that it will not come all at once nor will all of the information you learn always make sense as you're learning it.

The knowledge and understanding come in layers, and I think it helps to have an understanding of what sorts of things you *ought* to know at the various levels of training.

I think of first year as a long preparation for call -- really emphasize learning the things that are dangerous which could significantly injure or kill the patient between the time you miss it and the time you get read out. Everyone misses things, but if you can avoid making the "big misses" that represent a severe acute process then you're going to be in good shape.

You layer on more complex disease processes that are less common, congenital diseases, less likely things that would go lower in a given differential for your average setting, etc.

You don't need to understand the temporal bone as a first year, for example, but by your fourth you should have a grasp of it. And so on.

Specific things to get good at in first year are general cross-sectional anatomy, following bowel (getting good at following bowel has saved me now more times than I can count), identifying the appendix, recognizing grey-white differentiation loss in the brain, subtle intracranial bleeds, and PEs and dissections. This is not an exhaustive list but does represent some of the early skills it helps to develop. Add in evaluating for free air and pneumothorax on plain films.

 

[mrad1225]

It is somewhat comforting knowing that I'm not alone with that feeling. I started on Nucs and then neuro where I was learning a different PACS and blitzed with questions about MRIs and various lesions from our assigned reading. I was in a full depression and demoralized. I came home so beat down every night what little reading I did wouldn't stick.

Sometimes I feel they have unrealistic expectations with reading assignments. I started reading the helms MSK fundamentals book and was told that it was not good enough and I was expected to read all Greenspan in 4 weeks. I get home by 5:30 or 6. Have to walk the dog, make dinner and then decide between reading or exercise because I have to wake up at 5:30 am the next morning. I'm so tired it never feels like it sticks. I do a lot of indirect learning now by looking up stuff on statdx, pulling up priors and mentally going through it before checking the report by the other person, etc. MSK is much easier for me due to my personal interests than neuro, but it can still be frustrating.

Regardless, the best decision I made was admitting I needed help, that I was depressed and getting treatment...and adopting my dog. That has helped retention and getting through the grind more than anything else.

Just try to pick up stuff every day. Read what you can but don't beat yourself up if it doesn't happen. You aren't a machine and what seems astronomical now will come. Every day you increase that knowledge base just a little.

Where do you attend residency (if you don't mind sharing)? I understand if you do not want to share.

 

[tartrate]

I've been studying mainly from B & H as that was recommended for the first year by a multiple senior residents.

I wonder what is the disconnect, that your seniors are recommending this book but from this thread it seems like it's not such a good resource starting out. I would never recommend any first year to just sit down and start reading Robbins and would leave it at "leisurely" reading that's not even close to necessary to be a stellar medical student.