Hello everyone.. So I just started R1 and have read some posts on the challenges that usually arise during this period in training. However, I cannot help but feel that I'm having more of a difficult time than normal. I go to a small hybrid (private/academic) program. Midwest. My experience with the program so far in what it offers for training and the faculty available along with their backgrounds are all incredible. Having said that, I'm having a rough time progressing and feeling productive. To start, I was a little hesitant on specialty choice and I decided on rads very late during med school. I say this just to express that I wasn't necessarily yearning and craving the idea of reading images, but more so that when it came to the collective of what a specialty entails, I envisioned rads to be the best of both medical involvement and personal life time allotment. Now that I started, I'm having a very hard time studying even just an hour a day. I started on fluoro where I usually get around 7-12 cases per day and after 2-3 weeks am only able to read a handful of abdominal radiographs on top of that with may be 40% accuracy. If I were to somehow come up with an estimate, I feel that I get 2-hours of studying per 3-4 days. I'm worried about not hitting milestones in a timely manner and starting R2 with lots of gaps in knowledge that just get compounded until it's time for the Core exam, which most recently has >10% fail rate among really hard working and extremely smart residents. I definitely think I overestimated my stamina to continue at a high learning pace and this feels like medical school season 2 on steroids with a more intense finale. And being neutral (at best) in enjoying the field makes it even harder, and I admit that thoughts of being useless and counterproductive to the workflow sometimes make it very difficult. Intern year was rough and draining, but I had a much better work social life. Even the nurses were so much more fun to work with than techs, and I've had problems with neither. I came in with the mindset of wanting to do voluntary over time hours and 3 hours of daily studying. Now, weekends are the best thing ever. And I'm catching my shift clock-out time better than I catch easy xray findings. To top things off, I'm a very slow text reader, and for me to remember anything from a text, I have to read it at least twice. Anki never worked for me, grades always went down with it. I honestly worry how I'll get through with little reading. Brent and Helms makes me laugh in sadness. Any advice is appreciated. Also, if anyone was in a similar boat and doesn't normally post, I'd appreciate your time if you can give insight or advice.
Rough Start in Radiology Residency
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It's still early. I still recommend studying 45 mins to 1 hr as an R1. To save time, read around your cases focusing on the pictures and their descriptions e.g. on statdx, radiopedia and case books. Radiology is largely about recognizing normal anatomy and abnormal pathology across imaging modalities. Other aspects of physics and technicalities still apply, but these can be studied later as an R2. Learn normal anatomy and look at pictures of the normal and abnormal in several modalities. Reading textbooks can be challenging, and may not be efficient if you are not a fast reader.
I suggest waking up earlier than usual as this will allow independent study of about 30-35 mins in the AM, and another 30-35 mins after work. This will give you 1 hr/day of studying and a split that lowers the inertia against studying.
I suggest waking up earlier than usual as this will allow independent study of about 30-35 mins in the AM, and another 30-35 mins after work. This will give you 1 hr/day of studying and a split that lowers the inertia against studying.
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That's pretty much what one of my mentors in residency recommended. He was against powering through textbooks as you won't retain much. But if you read material pertaining to cases you see in real life or from case books/question banks, you are much more emotionally invested. And your ability to retain information is significantly boosted when you're emotionally invested.
That's true. I used both approaches as a resident--brute force textbook studying and casebook review. I studied 2 hrs nightly as an R1, but even I (as a textbook reader) would admit that I remembered more from reading around cases and looking at casebooks than reading prose in a textbook.
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As someone who despised studying, I agree with the above… read up things on a case by case basis when you can. Things stick better when you’re putting them into your report to convey to a referring provider.
I’d use the Core Radiology book by Mandell to get you started with each topic/rotation. It’s pretty easy to get through.
Supplement that with radiographics articles and “what the radiologist needs to know” type articles.
Also… I was significantly happier during my internship than during any year of radiology training. It was just a job. Without the pressure to go home and do more of it. And the social life was better.
But now, as a radiology attending, I have zero regrets. I cannot imagine doing any other field in medicine.
Hang in there.
I’d use the Core Radiology book by Mandell to get you started with each topic/rotation. It’s pretty easy to get through.
Supplement that with radiographics articles and “what the radiologist needs to know” type articles.
Also… I was significantly happier during my internship than during any year of radiology training. It was just a job. Without the pressure to go home and do more of it. And the social life was better.
But now, as a radiology attending, I have zero regrets. I cannot imagine doing any other field in medicine.
Hang in there.
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I think you're being too hard on yourself. the only thing those are good for is tube positions, large amounts of free air, and bowel obstruction. one hour a day studying is plenty if you can swing it.
try to study little bits during the day. see a case of HCC...look it up on radiopedia real quick. it makes u look diligent and you learn on the job
By and large, textbooks suck. I couldn’t stand B&H and did the vast majority of my studying the first two years via radprimer, review articles, and google. I only started reading books when I figured out my specialty interest and wanted to learn more.
UPDATE:
It’s been a couple of months now, and while I know more, I recognize a lot more that I don’t. I’ll be honest, at this point, radiology is nothing more than a job to me. I wish I can get euphoric at every little new thing I see or crazy case I come across. This lack of euphoria makes me have to put in double the work that I see others put in just to remember the same amount, or at least that’s how it feels. Forgetfulness is crushing me. I still forget all the features of FNH even though I’ve watched specific lectures and read up multiple times on this. I have been putting in more hours (approx efficient 5hrs spread out) of studying per week, but I still have a lot more room to improve and I’m working on it. However, I’m nervous because I feel like my level is way behind what it should be before going up to R2 soon. If I can get to the competence level that would be on track to get me to where I see my attendings are at, I would be very happy. But, with my progression, and comparing to others, I worry a lot. To the point where I don’t know if I should jump ship and switch to something like IM or even FM just to save face and eventually have a job. Because I don’t know if with so many studious and passionate residents in the field, and again a fail rate as high as 15% on the boards, if I will end up wasting three years as a resident only to find out that I cannot continue because I have not reached appropriate milestones. I haven’t been told of any major concerns and no red flags as of yet. Still, this is giving me daily anxiety. I just feel out of place amongst robots.
I feel like everyone on here is a high-achiever. On the off-chance that there were some who struggled similarly, or knew of people that did, if you can offer insight I’d highly appreciate.
It’s been a couple of months now, and while I know more, I recognize a lot more that I don’t. I’ll be honest, at this point, radiology is nothing more than a job to me. I wish I can get euphoric at every little new thing I see or crazy case I come across. This lack of euphoria makes me have to put in double the work that I see others put in just to remember the same amount, or at least that’s how it feels. Forgetfulness is crushing me. I still forget all the features of FNH even though I’ve watched specific lectures and read up multiple times on this. I have been putting in more hours (approx efficient 5hrs spread out) of studying per week, but I still have a lot more room to improve and I’m working on it. However, I’m nervous because I feel like my level is way behind what it should be before going up to R2 soon. If I can get to the competence level that would be on track to get me to where I see my attendings are at, I would be very happy. But, with my progression, and comparing to others, I worry a lot. To the point where I don’t know if I should jump ship and switch to something like IM or even FM just to save face and eventually have a job. Because I don’t know if with so many studious and passionate residents in the field, and again a fail rate as high as 15% on the boards, if I will end up wasting three years as a resident only to find out that I cannot continue because I have not reached appropriate milestones. I haven’t been told of any major concerns and no red flags as of yet. Still, this is giving me daily anxiety. I just feel out of place amongst robots.
I feel like everyone on here is a high-achiever. On the off-chance that there were some who struggled similarly, or knew of people that did, if you can offer insight I’d highly appreciate.
If none of your attendings have approached you about being behind, and you are not missing catastrophic things on routine studies at this point, I would at least think you are competent to your level. Comfort, and then eventually confidence comes with a lot more time. The fact that you worry is in some ways a good thing, at least you are trying to do well. A lot comes with repetition. You're still learning to walk in terms of radiology. Maybe ask your faculty for feedback in terms of how you are doing. Most things are jobs at the end. I don't think the vast majority of IM or FM residents feel much differently.
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The last thing you described sounds like classic 'imposter syndrome'. That's very common. From a more experienced perspective I'm not worried about that and in fact see it as an overall positive for you. It means you care and you're concerned with your performance. I saw plenty of people in training who a) had no worries about their job performance and b) no insight into how they were actually doing. If you're not somewhat overwhelmed by R1 year, you're probably not trying hard enough. Radiology is a tough job to learn and learning it is often referred to as "drinking from the firehose".
My presumption, if you haven't heard of any major concerns, is that you're doing just fine (aka level appropriate). Believe me, in most programs/cases, the struggling people are identified early and counseled appropriately. Your program (hopefully) next year will not let you take call if you aren't safe to do so.
As for forgetfulness... it happens. I think its unreasonable to expect full comprehension and retention of subspecialty level information when you're an R1. Both of those will come over time as you see those cases in real time and study for the boards (so the studying has some stakes). Also, keep in mind that adult learning is an ongoing process. I still look up things 3-5x a day. It's the reason StatDx and Radiopedia exist. There's no expectation that you read a textbook once and know it by heart for the rest of time.
Finally, this is somewhat cynical but I happen to think residency shouldn't be easy. Not pathologic or anything but its the most formative years of your career and you should be pushing yourself. The people I trained with who just half-assed their way through residency were and ended up being mediocre. You sound like a rad who will end up being pretty strong, cuz you know there's a high bar and you're putting in the work.
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Make a notecard with one thing to remember each day. Then review the cards at the end of the week. After 4 years, you'll be a genius.
I read about 1 hour every night in bed (first year was Brant and Helms). R1 everyone feels like they know nothing. But for me, the stress of taking cases in conference made me study like a madman so I wouldn't look like a *****. This is a marathon to pass your boards. If you don't study now, you're gonna have to sprint eventually...
I read about 1 hour every night in bed (first year was Brant and Helms). R1 everyone feels like they know nothing. But for me, the stress of taking cases in conference made me study like a madman so I wouldn't look like a *****. This is a marathon to pass your boards. If you don't study now, you're gonna have to sprint eventually...
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Old attendings had such funny ways of studying. I seriously applaud and get truly amazed by how smart the older generation of radiologists must have been to retain tidbits and facts from textbooks using these methods which would now be considered archaic by many
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Hey, I felt the same as you as an R1 - stupid and not enjoying radiology very much as a job. I enjoyed my intern year a lot more, which I thought wasa really bad sign that maybe I chose the wrong specialty. I feel the knowledge comes with time so wouldn't worry too much about it, even if you did horrible on your in service exam. As someone said above, it would've brought to the attention of your program director if they thought you were actually stupid. You are probably just struggling with the newness of radiology still, which is normal. This point in R1 year I'm not sure I had ever even opened an MRI. I really hate any time I am doing a modailty for the first time - whethere it was my first PET, my first mammo, my first MRCP, etc. I hated all of these experiences. Knowledge definitely correlates to how much you study unfortunately, which was a tough pill to swallow since I really really wanted to be done with studying. Comfort level also correlates to how many reps you have, and at this point you are probably still at the bottom of your comfort level with most modalities except maybe body/neuro CT. If by the end of next year you absolutely hate radiology still, worst case scenario you jump ship to something like anesthesia which usually has several opening for PGY2 and you will still have a good work/life balance. And given it's a 3 year residency you wouldn't even lose time compared to what you would've done as a radiologist. This is not the end of the world even if it feels like it right now.
I am an R3, I can't say I 'love' radiology by any means but I tolerate it enough to think I can have a satisfying career. I also think things will keep getting better given how much it has already gotten better in two eyars. I also think it's still better than most other alternatives in medicine. I think you would really regret jumping ship to a different specialty at this point. I have also reached out to many people who switched from radiology to other things. Many of them are happy in whatever they switched to, but a say also they prob would've stayed in radiology if they could go back in time.
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I don’t fully understand what you’re trying to insinuate by your concluding statement. Are you saying, now that you are an attending, you can say it ended up not being worth the decision of staying in rads when you came close to switching and that you should have followed through with the switch?
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It’s tough in radiology, but it’s tough everywhere, and arguably less so on this side of the pond. FM gets out of left field patient presentations, and IM gets trainwreck floor admissions.
It’s pretty clear you’re anxious which is fine, but only if it’s not to the point of it being crippling. I can tell you that you wouldn’t have less anxiety in another field. When you’re the on call senior resident in IM on an ICU rotation and a patient is unresponsive with rising pressor requirements and you have no idea why because all of the data is unremarkable or equivocal, and you can’t reach your attending, you’ll miss rads.
You’re a physician. You were able to muster up enough mettle to pass through two day long, grueling board examinations after years of mountains of studying and rapidly changing, harsh expectations. You’re stronger than you think you are. You’re strong enough to meet your expectations. It’s tough, but so are you. Or you wouldn’t be here.
You’ll do fine.
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@SeisK thank you for the all that you wrote, it truly means a lot. You are spot on with the anxiety. I’ve never been this anxious until rads. And this may be also stems from the program I’m in, realizing over time that there may be really important academic components that I’m missing out on because they are not really emphasized where I train. For example, there has been only a handful of times where my program did case conferences this entire year and we barely have any lectures may be 1-2x per week. When I go to work it’s basically me being told to do whatever I can. So I could do 6 CT chests and 10 cxr for the day for example, and then I go home. And I get told good job. And my volume when comparing to others really makes me panic, especially when I compare to residents from other institutions. I like having a goal for tasks to complete vs freestyling my own education every day. The attendings are all nice and supportive. But it feels like I have to teach myself everything without much structure. Sure I’ll do radprimer for each system. But is that really enough..? I’m not studious in nature unfortunately, and it takes a lot for me to get stuff done outside of work. And, admittedly, there are times where I could go on four day stretch without studying at all, and that then precipitates severe anxiety.
Again, you hit the nail right on the head. I’ve gotten anxious and frankly may be getting close to it being crippling unfortunately. Primarily because I also have family responsibilities as well and I cannot fathom this not working out God forbid. I wish I knew where I stood exactly. And if I was not on par with were a soon to be R2 resident should be, do I have a chance to make up for it during R2 year or has that ship sailed.
Again, you hit the nail right on the head. I’ve gotten anxious and frankly may be getting close to it being crippling unfortunately. Primarily because I also have family responsibilities as well and I cannot fathom this not working out God forbid. I wish I knew where I stood exactly. And if I was not on par with were a soon to be R2 resident should be, do I have a chance to make up for it during R2 year or has that ship sailed.
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Are there only 6 CT and 10 CXR available each day? Or that is the number you are able to finish?
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Overall, no I wouldn't say you're in deep trouble. Being below-avg speed as a first year has a way of not being a problem later on in residency. On an individual resident basis, progression is usually not linear. Particularly in first year, when you're seeing completely new stuff on a month-by-month basis, the progression can be really irregular. You go from day 1 on a new rotation not knowing how to even look through a study (much less dictate a good report) to the end of the rotation semi-comfortably opening a study/making the findings/producing a report.
6 CT/10 CXR - is this your first chest rotation or 2nd/3rd? Could you push yourself harder if you had to? Are your reports *relatively* polished or are you slinging poorly edited crap at your attendings? Obviously we can't tell how good your reports are on an anonymous forum, but several attendings have told me they'd much rather than a small amount of clear/concise/correct reports from a resident than a larger number of reports with incorrect findings, dictation errors, etc... I.e. if you were doing 15 CT's a day and those were terrible reports, that would be a bigger red flag to the faculty.
With regards to resident progression, one of my attendings was fond of saying "it all comes out in the wash". Meaning, people eventually figure it out. Some residents "get it" as first years. Some will figure it out as 2nd years when they've taken a crap ton of call. Some don't get it until they study for the boards as 3rd years. But usually by 4th year, most people have figured it out. Another attending who'd been at my residency program for 20 years said in that time, there was really only a handful of people who never "got it" and were fired/voluntarily switched out for incompetency. Most people do figure it out.
Basically, unless there's something big you're leaving out, I'd classify your situation as "within normal limits".
UPDATE:
I'll admit that rads has gotten a little more interesting esp when you pay more attention and start catching little things even as little as misplaced wires on an XR in the span of few min, etc. Unfortunately, this fun is taken away when you stress about volume. During non-call shifts, there's kind of an expectation to read a certain amount but no real expectation to help clear the list at my program at least. Nonetheless, there is still that pressure to read more and more. And unfortunately, when I come across a mess of a case and spend like 25min on it, and then you have conference and sign out x2 during the day, I end up being really stressed about catching up on volume. The other thing that bothers me, is that for example now switching back to MSK, I forget some really simple dumb things. For example, when I got back, I had to check to make sure I get the greater trochanter vs greater tuberosity right. This is making me question whether I'll ever have all the systems solid in my head when for CORE and after residency is over. Nearly all the applicants we are interviewing are >250 on both steps. So, I sometimes question if I need more synapses than I have. If I can get competent, honestly, if it weren't for the volume, it's not that bad of a job. But I do miss being able to do things as opposed to just say what's wrong and what needs to be done. I do think the diagnostic skill is very powerful in medicine in general, but I would love to lessen the degree of cerebral involvement/day and shift into more of executing tasks, even if it comes at the cost of longer work hours. I found that the fatigue from diagnostics weighs really heavy on me after some time and this makes me fearful of call in private practice. With call right now, we are staffed and my shifts are scattered so I get to recover in between, but even then it's quite exhausting and I'm dreading the next weekend I'll be on. I can only imagine how much worse it gets after residency. I'll try to keep updating this as a I go. I think I've spoken to many people who feel similarly but never voice it. So may be it helps some out there.
I'll admit that rads has gotten a little more interesting esp when you pay more attention and start catching little things even as little as misplaced wires on an XR in the span of few min, etc. Unfortunately, this fun is taken away when you stress about volume. During non-call shifts, there's kind of an expectation to read a certain amount but no real expectation to help clear the list at my program at least. Nonetheless, there is still that pressure to read more and more. And unfortunately, when I come across a mess of a case and spend like 25min on it, and then you have conference and sign out x2 during the day, I end up being really stressed about catching up on volume. The other thing that bothers me, is that for example now switching back to MSK, I forget some really simple dumb things. For example, when I got back, I had to check to make sure I get the greater trochanter vs greater tuberosity right. This is making me question whether I'll ever have all the systems solid in my head when for CORE and after residency is over. Nearly all the applicants we are interviewing are >250 on both steps. So, I sometimes question if I need more synapses than I have. If I can get competent, honestly, if it weren't for the volume, it's not that bad of a job. But I do miss being able to do things as opposed to just say what's wrong and what needs to be done. I do think the diagnostic skill is very powerful in medicine in general, but I would love to lessen the degree of cerebral involvement/day and shift into more of executing tasks, even if it comes at the cost of longer work hours. I found that the fatigue from diagnostics weighs really heavy on me after some time and this makes me fearful of call in private practice. With call right now, we are staffed and my shifts are scattered so I get to recover in between, but even then it's quite exhausting and I'm dreading the next weekend I'll be on. I can only imagine how much worse it gets after residency. I'll try to keep updating this as a I go. I think I've spoken to many people who feel similarly but never voice it. So may be it helps some out there.
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Sounds like you're progressing appropriately....
TBH, just last week I googled tuberosity/trochanter while i was on call. It happens. Trust me when I say your concerns about remembering enough at XYZ time point probably aren't going to be a problem when the time comes. Re: the core you will over-study; that's your personality. Re: forgetting stuff as an attending, it takes only a few moments to look up names/disease processes and refresh yourself. And you should be doing that continually, as that's adult learning.
Honestly the most notable thing you've said is that you may strongly prefer clinical work. It's not highly concerning but there are people that do end up switching back to clinical medicine even if they could have made it in radiology. That'll take more time to sort out. I think a lot of your apprehension will end up being laid to rest after you go through all your 2nd year call and/or pass the core. Those are peaks on the Dunning Kruger curve where you feel like a million bucks and that you can read anything and know everything.
Your concerns about call are somewhat valid, insofar that call sucks. DR call is generally awful and is only getting worse at most places. Most clinical jobs have call too though. Worst case though, there are no-call options in both radiology and clinical medicine.
TBH, just last week I googled tuberosity/trochanter while i was on call. It happens. Trust me when I say your concerns about remembering enough at XYZ time point probably aren't going to be a problem when the time comes. Re: the core you will over-study; that's your personality. Re: forgetting stuff as an attending, it takes only a few moments to look up names/disease processes and refresh yourself. And you should be doing that continually, as that's adult learning.
Honestly the most notable thing you've said is that you may strongly prefer clinical work. It's not highly concerning but there are people that do end up switching back to clinical medicine even if they could have made it in radiology. That'll take more time to sort out. I think a lot of your apprehension will end up being laid to rest after you go through all your 2nd year call and/or pass the core. Those are peaks on the Dunning Kruger curve where you feel like a million bucks and that you can read anything and know everything.
Your concerns about call are somewhat valid, insofar that call sucks. DR call is generally awful and is only getting worse at most places. Most clinical jobs have call too though. Worst case though, there are no-call options in both radiology and clinical medicine.
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I am just a lowly MS4 interested in rads, but if you stress out about forgetting the tiny little details, I recommend trying Anki. You could get involved with AnKore or when you look up greater trochanter vs tuberosity, make 2 quick Anki cards differentiating the two, and you will never forget the difference after repeating them for a couple months, which only takes literally a few seconds a day. Memorizing small details is all about repetition imo. Also definitely include pictures on your flashcards if you can, really helps solidify things (at least for myself).
