Nov 19, 2020
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  1. Medical Student
I've been going back and forth regarding specialty choices for quite a while now after finishing the clinical clerkship year. Due to the COVID situation, many of the electives and Sub-I's at my school got cancelled so I am currently on a research gap year before re-entering 4th year next June and applying the following cycle, which gives me some more time to figure things out. I found that during my clerkships neurology stood out as the most interesting rotation for me. Wouldn't say I am a huge fan of early morning rounds in general, but did find myself much more engaged for neuro than other medical subspecialties. I appreciate that a lot of the thinking and diagnosis is rather logical, follows a well defined anatomical approach, cool disease process, imaging, relatively slower outpatient pacing, and enjoy the careful observation involved in the physical exam as well. I also feel like I can easily integrate with the specialty's culture. However, I do have some reservations given a number of attendings I've come across do seem really burnt out, and it is hard to ignore the fact that neuro is deemed to be one of the field with the highest burn out in the long run. I enjoyed most of my experiences during the few weeks on service, but I didn't work anywhere near resident/attending hours to know what the realistic picture will be like once finished with training. I also didn't happen to come across as much GBM/ALS diagnoses, and do wonder if working with a conditions that have little treatment would be difficult to do in the long run.

For rads, I had a short subspecialty rotation. It was a very different experience from any other clerkship given it was purely analyzing images, which is just so different than formulating differentials from reading/listening to a full patient history. To be honest it took the majority of the rotation to get used to the way of thinking, and it was rather passive in nature since I was just watching over the attending/fellow's shoulders for a handful of cases (2-3 hours) and they'd send me home to do independent reading. I have little clue what it would be like to read cases independently for a full 12 hour non stop night shift as one would do residency or on the job. I'd imagine it would be a lot more engaging/interesting after one gets past the learning curve? Is it really stressful or fun to be fully focused and crunching through studies non stop in the real world? What does draw me to the specialty is that while I appreciate aspects of one on one patient care, I am still rather introverted by nature and do feel kind of sapped of energy after long rounds, writing extensive notes, and working through ton of SW calls on the inpatient context. I think I'd be pretty happy reading through studies all day, relaying information to other providers, doing small procedures (I've always liked fields that afford procedures w/o having to take on a surgical career), and just focusing more on the medicine/diagnosis, even though it wasn't what I imagined myself going into at the beginning of med school.

There is also the related question of interest in the content. I am conflicted because I find myself enjoying reading about neurology and even the research side of neuro more than reading about imaging search patterns or how CT/MRI works or the imaging research (I attend a very research heavy school, so it's kind of required to do projects and overall it has skewed my impression that you have to be passionate about learning the book content). I suppose the question is, does it make sense to go into the field that you are more interested in to learn/research in or pursue the field where you feel like the nature of the day to day job is more consistent with your personality. People have often told me to focus more on the latter, but the purist in me is conditioned to think the former lol. (I'm pretty open to either academics or non-academics at this point).

I'm currently choosing a research project that'll lead up to to sub I's next year. The literature in rads is really dense (lol have little familiarity with any of it, so it's hard to get engaged compare to neuro literature). Is this a bad sign if I like the clinical side of reading studies in rads more than managing an inpatient ward, but haven't developed that much interested reading rads literature?

Steps1/2 are ~240 (eh ck didn't turn out too good, not sure if it'd cut it well for DR). Honored rotations, ~10 pubs in various basic/clinical projects (basic science, some neuro, other subspecialties, no rads), top 10 school. I think with these stats, I'd have a decent chance for academic program in major city for neuro, but much less likely for rads (maybe mid tier or community?). Would finding a project specifically in rads make that much difference at this point if steps can't be changed I have already published in other fields (doesn't seem like rads care about research nearly as much as step1/2).

Any sort of insight would be greatly appreciated. Thanks!
 
Jan 4, 2014
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It is hard to be excited about rads as a med student. As you’ve stated, it is very passive because you need a solid foundation of imaging anatomy and a baseline for what “normal” looks like. This takes months of seeing studies everyday all day. After you have that foundation, things get much more interesting. To some extent, radiology is a much more objective field.( E.g. there are kidney stones or there aren’t. There is an inflamed appy or there isn’t.) With most other clinical specialties like neuro, if you don’t ask the right question or you don’t do the right exam maneuver or order the right lab then you may miss the diagnosis. As far as personality, radiology is more suited to introverts for obvious reasons. My experience with neurology is limited, but if you do radiology, you can specialize in neurorads or even neuro IR (if you're insane). At the very heart of this decision is whether you prefer to mainly interact with other doctors or patients. I prefer to talk shop with other doctors (the conversations are quick and to the point since I can use medical jargon).

You didn't mention lifestyle or income, but these are things to think about as well. In neurology you "own" your patients and may feel guilty taking long vacations or even handing off to another clinician during off hours. Excepting IR, radiology is shift work and there are rarely such issues.
 

Cognovi

Knowledge worker
Feb 10, 2016
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Status
  1. Resident [Any Field]
I appreciate that a lot of the thinking and diagnosis is rather logical, follows a well defined anatomical approach, cool disease process, imaging
These aspects that you liked about neurology are well suited for radiology.
I have little clue what it would be like to read cases independently for a full 12 hour non stop night shift as one would do residency or on the job. I'd imagine it would be a lot more engaging/interesting after one gets past the learning curve? Is it really stressful or fun to be fully focused and crunching through studies non stop in the real world?
First imagine the cognitive engagement it takes doing 1000 Anki cards nonstop. Now imagine the added pressure given that other doctors are judging you on your performance and your answers will change patient care. Now add in distractions like phone calls. Overall it's a stimulating experience.
I am conflicted because I find myself enjoying reading about neurology and even the research side of neuro more than reading about imaging search patterns or how CT/MRI works or the imaging research (I attend a very research heavy school, so it's kind of required to do projects and overall it has skewed my impression that you have to be passionate about learning the book content). I suppose the question is, does it make sense to go into the field that you are more interested in to learn/research in or pursue the field where you feel like the nature of the day to day job is more consistent with your personality.
Absolutely you should judge the job of a clinical radiologist by the nature of the day to day work, not the research literature, especially if you're not set on academics. Nobody wants to read about imaging search patterns; you come up with your own and refine it over time. Nobody wants to read about how CT/MRI works; we learn just enough to pass the physics part of our boards, blow off artifacts, and troubleshoot protocols.

You do have to be broadly curious about medicine, because radiologists have to know a little about a lot of diseases. If you are only interested in neurological diseases, you could always become a neuroradiologist and spend most of your time reading neuroimaging (even outside of academics). But you have to first learn enough general to get through residency. Avoid the research papers for now. You have to learn the basics. Try picking up a textbook, review article (eg, in RadioGraphics), article on Radiopaedia (or video on Youtube called "Radiology Channel"), or follow radiologists on Twitter and see what excites them.

If you remain convinced that you have to like the research in a field, and you find radiology research inaccessible, I recommend checking out Radiology In Training https://pubs.rsna.org/page/radiology/radintraining where trainees like myself put together short videos and tweetorials summarizing the more accessible articles in our field's flagship journal, Radiology.

Steps1/2 are ~240 (eh ck didn't turn out too good, not sure if it'd cut it well for DR). Honored rotations, ~10 pubs in various basic/clinical projects (basic science, some neuro, other subspecialties, no rads), top 10 school. I think with these stats, I'd have a decent chance for academic program in major city for neuro, but much less likely for rads (maybe mid tier or community?).
If by 'honored rotations' means you honored all your rotations, you are well within range for an academic program in a major city for radiology.
 
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