So Cuts, how's rads going.

[Whisker Barrel Cortex]

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I was gonna PM you, but thought I'd ask in public instead. After the hell of prelim, how are you enjoying rads residency? First year of radiology is a tough year and a little overwhelming at times. Let us know how your first couple weeks have gone.

 

[Docxter]

First year of radiology is a tough year and a little overwhelming at times.

Really, you think so? I thought the first year was the easiest since your "off the hook" because you don't know anything and don't take any real call for at least six months (or some places for the whole year). Anyhow, I'd like to hear from cuts too. Actually, more than that, I'd like to hear from him next year at this time.

 

[Whisker Barrel Cortex]

Really, you think so? I thought the first year was the easiest since your "off the hook" because you don't know anything and don't take any real call for at least six months (or some places for the whole year). Anyhow, I'd like to hear from cuts too. Actually, more than that, I'd like to hear from him next year at this time.

Actually, it really wasn't that bad for me since I got three months of radiology in my intern year where I met the staff and dictated as the radiology resident. And yes, you do get off the hook because you aren't expected to know that much. What can be hard is getting used to being out of the clinical realm.

 

[Whisker Barrel Cortex]

Hey compandres 🙂!

Sorry for the delay in replying... I've been swamped lately HA!!! Seriously this Rads thing is tough 😱 ... HAHA... tougher than I thought it would be anyway. I'm doing Body/CT right now and the volume at our place is pretty high... so we probably look at 20-25 studies/day. I don't really do much of anything yet... no dictating or any meaningful contributions I mean... mostly just watching, asking questions, and listening... trying to absorb as much as I can. The work day's longer than I had thought it would be -- we usually go from 7:30am to 5-6pm -- that's longer than my medicine days last year! But there's no comparison with the work this year and last... I actually enjoy what I'm doing now and am excited at the start of each day 😀. And without too much active reading (most of my after hours time is spent settling in to my new place/city) on my part I already feel I've aquired some Rads knowledge here and there... and that feels good... like I'm actually learning something that I can contribute to society at some later date.

Admittedly though I do feel a little lost sometimes... the other two R-1 with me both did their PGY-1s at the same place and are both familiar with the staff, HIS, PACS, etc... and they're both off and running with dictations. Me I don't even know how to operate the dictaphone yet. But my seniors (who are great by the way) assure me that it's nothing to worry about and that I will catch up. I am deathly scared of taking call in 6 months though 😱.

I am curious if y'all felt this way too last year??? Any advice for me regarding reading, information/pearl management systems, saving cases, and the "best" way to learn Radiology? I could use all the help I can get. Thanks!

How's it going with you WBC you R-2 badass 😉 ?

Being an R-2 is gonna be interesting. I'm doing interventional now. They expect a lot more from you as you progress in residency. We'll see if I can live up the their expectations.

Our program did a great job of starting us off slow last year and easing into more intensive sections. We are one of those residencies that doesn't start real call until second year (my first one won't be til October). We do short calls where we are responsible for plain films only. I think part of the reason is that, as a tertiary care hospital, a lot of our patients are incredibly complex. We need to read tranplant kidney and liver ultrasounds, CTs of patients with pancreatic tranplants, etc while on call and I just don't think we could learn all of that in 6 months. I think I have dictated maybe 5 normal abdominal CTs in the last year.

As for advice.
- Read about a finding or diagnosis when you see cases.
- Get a standard format of dictation so that you don't leave things out.
- Do not be overly verbose in your dictations. It only wastes the transcriptionists, the clinicians, and your time to use a lot of words when few will suffice. However, in certain complex cases, don't be afraid to explain your interpretation in the dictation.
- Its probably good to read through some basic text regarding the rotation you are on. I'll be the first to admit I was not very good at doing this.
- Saving cases is great if you have to do case conference later or if the case is especially interesting. PACS is a godsend when saving cases.
- Try to really make up your mind about a case before you staff it out. Pretend the staff won't be seing this until tommorrow and the clinicians want and answer NOW.

 

[Apollyon]

- Do not be overly verbose in your dictations. It only wastes the transcriptionists, the clinicians, and your time to use a lot of words when few will suffice. However, in certain complex cases, don't be afraid to explain your interpretation in the dictation.

Powerscribe: normal chest. 😀

Our R2's in "the box" are worth their weight in gold (which wouldn't be so bad, 'cause they're virtually all health nuts). However, with limited PACS (if a department wants it, they have to buy it themselves, to link with Rads), plain films are a PITA, and the box doc HAS to look at every single one.

I do feel your pain, though - ortho gripes about the "age-indeterminate anterior wedging", but, what can you say? Post-MVC, back pain, what else are you going to do? (As an EM doc, with the pt staying in my department, I'm in the same boat.)

 

[Whisker Barrel Cortex]

Powerscribe: normal chest. 😀

Our R2's in "the box" are worth their weight in gold (which wouldn't be so bad, 'cause they're virtually all health nuts). However, with limited PACS (if a department wants it, they have to buy it themselves, to link with Rads), plain films are a PITA, and the box doc HAS to look at every single one.

I do feel your pain, though - ortho gripes about the "age-indeterminate anterior wedging", but, what can you say? Post-MVC, back pain, what else are you going to do? (As an EM doc, with the pt staying in my department, I'm in the same boat.)

Yea, we have Powerscribe now. Just implemented this year. Its got its positives, but most of the time I just wanna drive my fist through the monitor cause it gets so many things wrong.

 

[Goober]

First year was major suckage mostly because you don't know anything. My program put first years on the hot seat during conferences with all the attendings and other residents watching. I remember not even being able to identify what body part was being scanned on an ultrasound hot seat case 🙄

Of course when you get out to private practice you will reailze how easy you had it in residency. In many practices you will read 20-25 CT cases in addition to 15-20 U.S., 50 plain films, 10-15 MRIs, 10-20 mammos and do biopsies, fluoro cases all within your work day. 😎

 

[Docxter]

First year was major suckage mostly because you don't know anything. My program put first years on the hot seat during conferences with all the attendings and other residents watching. I remember not even being able to identify what body part was being scanned on an ultrasound hot seat case 🙄

Of course when you get out to private practice you will reailze how easy you had it in residency. In many practices you will read 20-25 CT cases in addition to 15-20 U.S., 50 plain films, 10-15 MRIs, 10-20 mammos and do biopsies, fluoro cases all within your work day. 😎

Yeah, I too think that 20-25 CTs/day that cuts was saying is not busy at all, especially if you aren't dictating them.

 

[amnesia]

Dr. Cuts you are my hero. I will be in your position in like 10 years lol...

Damn I have a long way to go.

 

[Docxter]

Docxter why is it that you always come off sounding like a know-it-all geek? 🙄

Anyway FOR ME 20-25 CTs/day is a lot... and that private practice example given sounds insane! But I guess it gets easier with experience and aquired knowledge. Any opinions on the "Radiology after Five" series? Of course it's far too rudimentary for the great Docxter... but what about for us mere mortals out there? That's what our morning conferences have been so far... and I really like most of the lectures. Do y'all think it's good prep for call? Any other recommendations for DVD or CD-ROM resources? Thanks!

Sorry abut that. In retrospect, I think I have been a little on your case. Maybe it was because you always have been so oblivious to the hard work of radiologists and go on as touting that you'll someday become like the rest of us radiologists who (apparently) work minmal hours with months and months lot of vacation, hating all patient contact, and making so much more than other specialties who work harder by sitting in a yacht doing teleradiology. Your numerous posts on almost every forum just always taints the picture of us radiologists as "lazy-a.., patient-hating, money-grubbing, pseudo-docs". No, we work very hard with long hours and significantly contribute to the well-being of patients which we don't hate, whether we see them or not. Now that you have just started radiology, you are beginning to realize that radiology actually does involve hard work and is not as cushy as it may have seemed. The reference to the 20-25 CTs which Goober made, was just to show that the work is often much greater than what you see now (and consider a lot, despite the fact that you are not even dictating them). My whole point is that most radiologists work very hard and you haven't seen how bad it can get.

By the way, do you think I didn't struggle in the first two years of my residency? Sure, I did. The volume of work was overwhelming. The volume of text reading was overwhelming. And yes, if you dictate 25 CTs as a R1 in your first month of radiology, it is quite a lot. Later on in your residency, it won't seem too much, let alone in practice. In any case, my apologies, but I'm glad the doors of reality are finally opening to you.

As for preparing for call, I don't know about the "radiology after five" series, but a little handbook called "Radiology On-Call Survival Guide" was helpful for me, though you have to complement it with something that has more pictures. Also a little book that you can finish in one eveining is "Emergency CT Scans of the Head: A Practical Atlas". Know your fractures and also get hold of a few pictorial review articles in emergency abdominal CT, e.g renal stones, obstruction, Appy, trauma. Try reading the three part series of 4-5 page pictorial essays in "Applied Radiology" called "Imaging upper cervical spine injuries". Go to the www.appliedradiology.com website and browse through what they have. You'll benefit a lot by subscribing to it's printed journal (free), since it's the best journal for residents (and even later on) with very useful practical info.

 

[Voxel]

I think 25 c/a/ps CT is a lot in one day. Especially if most of them are tertiary complex type cases and you have to do stat trauma as well. I think if there as mix of head/c/t/l spine, extremity cts then it would be doable. Also, when doing the body ct stuff there are lots of other physicians who bring outside cases or want to review a CT done recently. This makes it difficult to finish your day, especially if you are looking for the attending to staff you out. I am very busy on the body CT rotation. It's probably our busiest rotation outside of VIR.

My advice is to read a little bit everyday faithfully. If you read 10 pages a day, every day, you can get through about 3000 (give or take a couple 100) pages worth of material/yr.

 

[BenHoganFan]

For each rotation I read through the relevant Brant and Helms chapters, then I read the Requisites for the month. At the end of the month, I read Case Review Series for the last week of the rotation.

An excellent subscription to consider is Radiologic Clinics of North America. The past issues that are great for call "Imaging of the Acute Abdomen", "Emergency Ultrasound".

As for Radiology After 5. It is an excellent series but anecdotal. www.CTisUS.com is a good website for CT related issues.
www.mrisafety.com is good for those MR safe hardware questions on call.
www.radquiz.com is nice for reviewing teaching file cases.

Suggestion: Take as many unknowns as a first year. You'll tend to remember the cases that you fumble through. They don't expect much out of the R1s. It's better practice than taking your first cases as an R2 not knowing how to talk your way through a case.