How to be a First Year Radiology Resident

This is a brief companion post to my original post on approaching the radiology R1 year. This is what you need to do to succeed in radiology and life:

Be a decent human being and use common sense.

If that’s not enough to go on, here’s a longer list:

  • Be on time
  • Be excited
  • Be nice
  • Be dressed
  • Take responsibility
  • Do what you’re told
  • Read cases, not just books. Be hungry.
  • But…um, also read books, not just cases. Practical knowledge is often different from book knowledge, but you’ll eventually need both to succeed
  • Be knowledgeable. If you can’t know radiology, then Know the Patients. Know the Histories. Know the Priors.
  • Again, always look at the priors and read the prior reports. Prior reports will teach you more than your attendings will face to face.
  • Proofread. Please, please, please. A report is a radiologist’s will manifested. Who do you want to be?
  • Anatomy is the foundation on which all else is built.
  • Develop a search pattern.

Real expectations for a first-year resident in July: are you ready?

In addition to the important life skills I outlined above, I want to stress that really no one expects you to actually understand radiology at this point, but you are expected to learn fast. What you can do—even on day one, even if you don’t actually know anything—is learn the details of the exams: especially patient history and priors. Look at this before you read out because this is literally your one chance to save your attending time and effort. A junior resident is graded more on attitude and attention to detail than on fund of knowledge.

Anyone who cares about what they’re doing can craft reports (almost) free of transcription errors, template mistakes, missing comparisons.

It’s not uncommon to hear from your chairman or program director during orientation that they want you to have a life and be well-rounded. Like, they’re not asking you to do anything crazy, just an hour or two of reading per night. If you were worried that a deep belly laugh might escape to your great embarrassment, then you are not alone. In an ideal world, you would read every night from textbooks and articles and then rapidly move onto writing your own and contributing to the great growing body of truly meaningful radiology research.

Well, sometimes life happens.

While I like knowing things and doing my job well, I wouldn’t have exactly described myself as a radiologist residency completionist. I didn’t necessarily read as much as some people suggested was prudent, and I’ve certainly never enjoyed and found meaning in trying to memorize long differentials for all the things that can occur in a given area when A) those differentials often include things that are radically different either clinically or by appearance and thus would never be confused and B) I have the ability to, you know, access the internet when I’m stumped by an unusual finding.

Keep in mind, this little list was generated from my own experience (in hindsight) and ruminations. The intrinsic variability across programs and training means that parts of my perspective may not or should not apply to you.

But I suspect if you do all of the above to start each of your rotations you’ll be on the right foot.

The ABR Comes Around

The American Board of Radiology announced earlier this week that they would indeed be joining the civilized medical world and moving to a virtual exam solution for all future exams and maintaining the current proposed February and June dates for next year’s administrations:

We appreciate the constructive feedback regarding our 2020 exam schedule and recognize the significant impact that test postponements have had on our candidates, their loved ones and families, and their training programs. We have seen and heard legitimate concerns from candidates, program directors, department chairs, and other stakeholders, and have considered many options to safely administer our exams in the least disruptive fashion while preserving their integrity. Our deliberations and decisions were largely based on our obligation to accommodate those most affected by the pandemic. The health of candidates, volunteers, staff, and the public is our highest priority. In consideration of these concerns, the ABR is moving all currently unscheduled and future oral and computer-based exams to virtual platforms beginning in the first half of 2021, which is the earliest we can confidently deliver these exams without potential delays.

Good for them.

Seriously, I mean that.


And I don’t want to be needlessly negative (or do I?), but as I argued back in April, have said multiple times since, and was then subsequently joined by the entire field of Radiology and its many member organizations, this outcome was the only defensible choice. Nationwide travel for an exam is simply an untenable position right now. Hell, doing so for a computerized test was barely defensible before the pandemic.

Despite all the hemming and hawing and the repeated stance that virtual solutions were simply “not practicable,” the ABR will be moving forward with one of those unpracticable solutions anyway in 2021. It was inevitable, which makes the drama and delay wholly unnecessary.

If the ABR had read the writing on the wall back in March when the world shut down, they still may have not been able to keep the original June date. But they likely could have salvaged the initial backup November date for which every residency program in the country already planned around. That date was closer to the usual timeline and was likely fairer for the senior residents, who will now be forced to re-study and potentially re-broaden their practice as they return from early IR specialization or mini fellowships.

Despite the ABR’s official stance, the Core Exam is not a test you could just pass on the merits of radiology skill alone. The evaluations practicing rads take, the Certifying Exam and OLA, are both easier.

On the one hand, good on the ABR for at least planning to do the right thing. I look forward to seeing how they decide to accomplish this mission, one they originally said they simply couldn’t do. There are a lot of self-imposed boxes to check because “the inability to adequately control image quality, the testing environment, and security would significantly threaten the fairness, reproducibility, validity, and reliability of the testing instrument across all candidates.”

So, on the other hand, the situation was ridiculous. There was a bonafide revolt before the ABR came around to what should have been an obvious choice in the first place. Now that we’re here, the move away from centralized testing should be permanent.

It goes to show that while the ABR has added responsiveness to its toolbox, they have not yet independently demonstrated sound stewardship of our field. Stakeholders need to be willing to fight for every important issue.

I hope this is a turning point for the ABR and its testing mandate. I know the radiology community stands ready to provide constructive dialogue to help improve initial certification and MOC.

Explanations for the 2020-2021 Official Step 2 CK Practice Questions

The NBME released a completely new set of questions in March 2020, which is the first major update since basically 2015.

Last year’s set, which is completely different, is available and explained here. Due to the pandemic, the practice materials page has reverted back to the 2019 set for now, but you still have access to and can complete both sets. More free questions!

These are in the order of the PDF linked above.


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