Residency Didactics - Importance?

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Apr 6, 2016
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There's a program I really like for residency but I think their didactics are generally quite weak. It doesn't seem like the residents "take cases" post covid during didactics. Curious how much this should influence my decision. In medical school, I thought didactics were generally pretty useless, but that is subject to change in residency.

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Personally wasn't a big fan of 'hot seat' case conference as you're describing. You definitely remember the ones you miss but I didn't appreciate the anxiety of being put on the spot in front of large group of people. Case conference doesn't have to be hot-seat style. My favorite case conferences the faculty opened a folder of cases marked interesting over the prior week and just went through them de novo without looking at the read. I learned a ton from just seeing/hearing their thought processes as they moved through cases. Way better than hearing a group of R1's "um"ing and 'er'ing their way through cases.

There's the whole other half of didactics: formal lecture. That's important too.

The answer to your question, as with almost everything, is 'it depends'. Some people learn a lot from didactics; others barely attend and never pay attention (and do just fine). It's just like medical school in that regard. If you're strongly self-motivated and your program has a large breadth of clinical material, I think you'd get a good foundation regardless if the case conferences were mediocre.
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I think there is some value to hot seat conferences but it shouldn't be the only thing you do. I personally like them and the "anxiety" went away fast for me because you realize everyone else is also in the same boat. Faculty-led didactics are important too, some places had resident run B&H conferences which I found kinda weird cause I can read a book myself and I would want faculty teaching me.

Conferences aren't everything by any means but I think they are a rough benchmark to how much the program is committed to resident education. If conferences are sparse or the residents tell you attendings are rarely present that's a bit of a flag to me. Didactics and education are a key component of our program and faculty are present at even the resident case conferences to drive discussion and point out interesting topics. I think it has helped me a lot. My personal opinion.
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Taking cases in a conference setting is an important aspect of training because it is part of the practice of radiology. When I pick up the phone and a clinician asks for a wet read, I am "taking the case." When I'm presenting at tumor board and the oncologists add on a last minute case that just got scanned, I am "taking the case." You have to be able to quickly look at a case, formulate an opinion, and communicate your thoughts aloud clearly. Part of it is knowing radiology, but part of it is a finesse that comes with practice.

When I have seen radiology people give a bad tumor board, it's because they don't communicate clearly, they drag on without concluding, they speak in jargon or innuendo, they don't understand the clinical question asked, they hedge unnecessarily, or they don't know when to say they don't know.

These are things that should get whipped out of you in case conference. When you're in the hot seat, you are practicing managing your anxiety being put on the spot in front of smart people and you are exercising your mental bandwidth to both process the visual information and articulate your thoughts simultaneously.

When you're not in the hot seat, you are learning by example or counterexample from your peers. When they are 'um'ing and 'er'ing, you are making a mental note that it sucks to listen to that and you should not do that when in that position. When someone gives an awe-inspiring masterful rendition of a read and the differential/pathophysiology/management/etc, you are making a mental note to be more like that and study harder. Radiology residents do not get that many opportunities to see each other really at work (doing the mental work live, not the reports that have been edited by an attending). It is a useful calibrator for how well you are doing.
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The anxiety of hot seats made me study my ass off.