Is radiology like taking a test everyday?

[ItAintEasyBeingCheesy]

Med student interested in radiology. Is a full day of reading scans similar to taking a full-length board exam? Would you say it’s mentally less or more challenging than answering step 1/2ck questions?

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[guytakingboards]

Med student interested in radiology. Is a full day of reading scans similar to taking a full-length board exam? Would you say it’s mentally less or more challenging than answering step 1/2ck questions?

Nothing even close to that.

Allow me a metaphor about what radiology is like. A blurb from the American Board of Radiology's Non-Interpretative Skills document:

A commonly used human error classification
scheme is the “skill-rule-knowledge” (SRK)
model. This model refers to the cognitive mode
in which the individual is operating when he or
she commits an error. Actions that are largely
performed automatically, requiring little
conscious attention, are considered skill-based
actions, such as tying one’s shoes or driving on
the open freeway. Actions that require an
intermediate level of attention are considered
rules-based actions, such as deciding which
clothes to wear or when to proceed at a four-
way stop. Actions that require a high level of
concentration, usually in the setting of
situations that are new to the individual, are
knowledge-based actions, such as playing a
sport for the first time or driving in poor
visibility conditions in an unfamiliar city.

The metaphor is a little strained but the board exams are like that third category.

Day to day radiology typically falls under a similar three category system:
1) skill/pattern recognition - very low level conscious thought. "it's positive or negative".
2) rules based - "uncommon finding, what are the usual differential diagnoses for this finding?"
3) knowledge/critical thinking - "very uncommon constellation of findings --> what do the clinical notes/labs say? is there anything published in the literature/Dr. Google about something like this?"

At least for my PP gig, the overwhelming majority of cases are category 1. Maybe a handful of category 2 cases. There are plenty of days I don't have any category 3 cases.

A regular day with a reasonable volume is not particularly fatiguing. Board exams were mentally like going 10 rounds with the champ.

 

[ItAintEasyBeingCheesy]

Nothing even close to that.

Allow me a metaphor about what radiology is like. A blurb from the American Board of Radiology's Non-Interpretative Skills document:



The metaphor is a little strained but the board exams are like that third category.

Day to day radiology typically falls under a similar three category system:
1) skill/pattern recognition - very low level conscious thought. "it's positive or negative".
2) rules based - "uncommon finding, what are the usual differential diagnoses for this finding?"
3) knowledge/critical thinking - "very uncommon constellation of findings --> what do the clinical notes/labs say? is there anything published in the literature/Dr. Google about something like this?"

At least for my PP gig, the overwhelming majority of cases are category 1. Maybe a handful of category 2 cases. There are plenty of days I don't have any category 3 cases.

A regular day with a reasonable volume is not particularly fatiguing. Board exams were mentally like going 10 rounds with the champ.

Do you think the work is as mentally draining/cognitively tiring as people say it is? Given that most scans require “very low conscious thought”?

 

[guytakingboards]

Do you think the work is as mentally draining/cognitively tiring as people say it is? Given that most scans require “very low conscious thought”?

I feel different about that now, than i did first starting out as an attending..... than I did as a resident.... than i did as a newbie R1.

Plenty of times along the way the work was mentally taxing. When you're in training it's basically tough the entire time cuz everything's new. You haven't formed your search patterns, DDx's or filled out the knowledge base. The longer you go the easier it should become.

The increasing volumes are a whole other issue. That's fatiguing for a different reason. If you have to read 100 cross-section in a shift, even if 98 are negative that's a ton of work to get through. Call sucks.

 

[ItAintEasyBeingCheesy]

I feel different about that now, than i did first starting out as an attending..... than I did as a resident.... than i did as a newbie R1.

Plenty of times along the way the work was mentally taxing. When you're in training it's basically tough the entire time cuz everything's new. You haven't formed your search patterns, DDx's or filled out the knowledge base. The longer you go the easier it should become.

The increasing volumes are a whole other issue. That's fatiguing for a different reason. If you have to read 100 cross-section in a shift, even if 98 are negative that's a ton of work to get through. Call sucks.

In terms of increasing volumes, would you say it's similar to data collection for a retrospective clinical research project? Easy for most cases but tedious. And every so often you get a doozy of a case which is a headache to collect information for (b/c of how complicated or messy their chart might be).

 

[guytakingboards]

In terms of increasing volumes, would you say it's similar to data collection for a retrospective clinical research project? Easy for most cases but tedious. And every so often you get a doozy of a case which is a headache to collect information for (b/c of how complicated or messy their chart might be).

I have no frame of reference for that metaphor.

 

[Rad2013]

Nothing is as tedious as research to me.

 

[Cognovi]

Med student interested in radiology. Is a full day of reading scans similar to taking a full-length board exam? Would you say it’s mentally less or more challenging than answering step 1/2ck questions?

The knowledge content that comes up during a workday in radiology is not quite as varied, new, or difficult as a board exam. On the other hand, the stakes are higher because these are real patients that you are making decisions about, and the extraneous cognitive load is higher because you're also answering phone calls from techs and referrers, reading out with your attending, making chit chat intermittently, going to teaching conference or a multidisciplinary working conference, etc. In terms of cognitive load, particularly during training, I would say radiology is closer to taking a test every day than most other specialties are, but it's not quite a full-length board exam.

 

[2brads]

The difference is that when you get a case on a test, you know there is going to be pathology. In real practice, obviously you don’t know at the time. In some cases you may never know and in others, you’ll know when another rad (or your future self) finds a miss. A big part of stress in radiology is the “not knowing”.

 

[Gadofosveset]

There are a lot of factors at play as to how mentally draining it is. If it’s not somewhat draining then you’re probably not operating at capacity. If you have a boss then they will up your workload until you’re at capacity.

I think guytakingboards hit on an important bias. In PP there are a lot more normals, so you can be more automatic. The trade off is usually that you read more studies. In academics, which is usually a trainee’s initial exposure, the cases tend to be more difficult since it’s a referral center, so you move up a little in that difficulty system. You also have to explicate everything for training purposes. The trade off is that you read fewer cases.

Cognovi also makes a good point. There are a lot of drags on your time and energy which are not apparent. Even if you’re shadowing someone you can’t see the mental energy they’re expending on other quasi-work related stuff.

Radiology is definitely a more cerebrally-taxing faster pace environment than some other specialties. and in that sense it is like a test. If you get complacent it will bite you — that’s like a test. After training you mostly grade yourself (and your peers whoever they are), so that’s a big difference.

 

[Tiger100]

No. It is like playing the same game and doing the same $hit over and over again everyday.