-
What to do? failing residency, better to switch?
I got very low marks on in training exams prior years, below the 3rd percentile. I am not a visual person, so I’m not good at radiology, not good at the day to day work, not on call, not during lectures, not on tests. I’ve missed things.
My program director has told me that I need to do better, but I’m not sure if I can do it, if I have the potential. And I don’t like it either. How do you know if you’ll be a good radiologist and if I should continue or if this was a mistake and look into something else? Radiology is so hard, and it makes me anxious. -
34 Replies
-
What year are you?
i think learning radiology is hard because it is stuff you dont learn in college o medical school. Who knows about hilar lymph nodes or what a density is on a screen.
There are many things that are totally new. Even the basic findings are things that arent really taught in med school. Filling defects, opacity, adenopathy arent things that you pick up in med school, unless you were a geek and sat in the rad reading room all day.
BUT heres the but.. if you keep looking at hundreds of images, you will pick it up. Unless you are way below average (which you shouldnt be if you got into med school), you will learn. It takes time. Sometimes even years. But once youve seen enough cases, they become second nature. You will be able to take 5 seconds and decide there is nothing serious on a negative CXR. 15 seconds to decide a negative head CT. Again it takes time. You have to just see thousands of cases.
And all the testing that they do also dont mean much other years later. Those exams test you for silly things that arent very relevant in day to day stuff. It is good for people who are really good at memory. In real practice, you will be able to look anything up. Google, radio graphics etc.. articles after articles. Lots of examples fill the internet. Initially you may have to look stuff up all the time, but in time it will be easier. After a few years, you will find that there arent that many things in radiology left. It is the same differential and the same recommendation and the same management.
In time, you will come down to the top 3 differential diagnosis. And in most cases it will be obvious and you dont even need to know the 2nd or 3rd differential. Again, this just takes time and looking at lots of cases.
Residency is the time to make mistake but to learn from them/it.
if you really like radiology, stick with it. It will come to you (with time and lots of images).
-
Prior years being pleural would mean you’ve taken multiple before so probably at least a 3rd year. May have difficulty with CORE given those scores.
If you’re not good at it and doing poorly on tests its probably not going to end well unless you radically change something. Could mean a new studying approach or picking a new field. -
Of the hundreds of residents Ive trained over the last few decades there are a handful who just lack the ability to get radiology.
They were all bright people who worked hard. They just lacked a certain type of radiology-specific intelligence that let their eyes tell their brain what the images say. None of those few made it through residency. They all either left voluntarily to pursue other specialties or were removed.
On the other hand, I have known a much larger number of residents who have struggled early, felt overwhelmed, missed things al lot, but who then went on to learn, thrive and have successful radiology careers.
I dont know which one of those people you are. Just playing the odds, probably the latter.
But it is important to figure out which so that if you are in the small first group you can consider making a career switch before you end up unhappy and dangerous in a practice setting for which you are ill suited.
Seek out a few radiologists who you trust to give honest feedback.
-
Agree with Dergon.
Most of us felt, as residents, that learning radiology was overwhelming and that we sucked. The difference from your situation is that our objective performance was not bottom 3 percent, we are generally perceived as doing okay.
If, despite your best efforts, you are objectively perceived by your attendings as being unable to learn the material and you are a third year, then it sounds like it’d be time to switch. Question is, how do you know what field you would be good at?
-
I second this. Out of approximately 100 people that Ive known, two or three just had no idea how to get it.
Another 5 to 8% were incredibly lazy or incredibly arrogant which made them somewhat dangerous.-
Cut your losses and get out. Radiology is not worth it. Its likely youll work a corporate or telerad job with high volume and bad hours if you want to live anywhere decent.
-
To OP. Be selective about the comments you receive here. Non-academia rads, like myself, have only personal experience, and maybe a few more as friends during residency. Academia rads, like dergon, have much more valuable experience in this matter as they work closely with many residents. Their advices are many folds more important than that of my kind in this matter. Good luck.
-
Im having a difficult time believing this is a genuine post, now that I read and reread it.
Seems like everything is a fail. In real life, this is very rarely the case.-
Written test scores dont mean much. How well you will do as a radiologist is whether or not you are making the findings and how fast you are at doing so. Anxiety will only kill you more in doing this. Im not sure why you chose radiology if you are not a visual person. Radiology is all about making visual findings. If your perceptual skills are bottom 25%, you should do something else. If your knowledge is bottom 10%, who cares, you can put in the time and learn it.
-
Marry another radiologist, finish residency, and then retire a year or 2 after starting work.
-
-
Quote from wisdom
Im having a difficult time believing this is a genuine post, now that I read and reread it.
Seems like everything is a fail. In real life, this is very rarely the case.
Or there’s mental health issue, e.g. depression.
I know, I know…. a radiologist spinning a psychiatric diagnosis on an anonymous internet bulletin board. -
This was my immediate thought. I’m not sure of the motivation, but on my first read this seemed fake.
Quote from wisdom
Im having a difficult time believing this is a genuine post, now that I read and reread it.
Seems like everything is a fail. In real life, this is very rarely the case.
-
I think for any of us to be able to help you, we need a better understanding of what your problem is.
So far, all we know is that you did poorly on the exam and that you ” missed some things”. Everybody does the latter. The former doesn’t mean much either.
If someone puts up two images, side by side, of a normal kidney and a kidney with a mass in it, do you see the one with the mass?
Are you able to, with practice, memorize differentials?
Do you have search patterns?I don’t have as much experience with residents as other people here, but unless you go into psych, you will face similar problems in any residency you switch into…
Let me put this another way – if you’re doing poorly on EVERY aspect of residency, it’s not a radiology problem, it’s a YOU problem. There are several different skill sets you have to master as a radiology resident:
reading exams
1. a. learning a search pattern.
b. coming up with differentials.
c. putting those into context and coming upwith a best diagnosis
2. answering phones
3. reviewing cases others have already read (tumor board, when clinicians call / come into the room)
4. studying for exams (which is different than day to day reading and will have to be done regardless of which residency you go into).
5. learning to deal with different attendings.
etc.
Please expand on what specific problems you are facing.-
I was terrible until halfway through third year. Then I was average. I might be above average now, not really sure.
All I know is that it was not a linear progression. I was seriously falling behind by the time I was a second year and it started to show on a rotations. I started getting horrible evaluations. I increased my effort significantly, and got a little bit better, but was still getting terribly evaluations. I stuck it out throughout my second year and first half of third year. By January of my third year, attendings had noticed a huge jump in proficiency, though I wasn’t really doing anything differently. I just kept plugging away and not letting myself get really down about things. It worked.
I essentially took on a “I don’t really care if you think I’m stupid or incompetent” attitude toward everything, but remained civil with the attendings who were my biggest detractors. I would not let them see me hurt or discourage from their words or actions. I would never fire back at their snide remarks or cheap shots after going over cases with them.
Eventually they left me alone, and my reputation started returning to neutral. I’m not saying that’s what will happen with you, and I know it is cliche, but if you can continue to work hard and learn from your mistakes, you won’t have to work harder to get better.
-
-
-
Agree with you.
-
Whether this post is genuine or not, the answers are really helpful
-
-
-
-
-
-
-
-
-
0
-
Why did you go into radiology?
-
Thanks for all who gave encouragement. This is all true unfortunately. I went into it because I liked it in medical school, but I didn’t know how hard it would be or that some people have a knack for it and some don’t. I started not liking it because I see how hard it is for me. I’ve learned that I’m not a visual picture learner. I can pick up an appendicitis or an obvious renal mass, but subtle neuro things are harder. I have a search pattern, but I can still miss things or not recognize that there is something wrong with it. I can’t memorize, so all the tiny parts in the brain or all the MSK parts, just knowing the anatomy is hard. And then knowing all the disorders is difficult but the hardest part is knowing the imaging findings to match all those disorders. Or looking at an image and finding what’s wrong with it. And even if I see something different, knowing the significance or what it is. If something has a limited differential, it’s easier. Knight rider, it’s reading exams and studying for exams out of that list that is hard. Dergon, I don’t know who to ask, because some people are unapproachable and others whom I’ve asked in the past, just say keep studying you’ll get better. How do I figure out which group I’m in. Flounce, I don’t know, but does anyone really know before radiology residency that they’ll be good at it? Striker, I’m not fast and I don’t always make the findings. Sometimes I do, but sometimes I don’t.
-
The thing is, there were times in residency when I felt the same was as the OP. Granted, I was in a top 3 program and my co-residents actually *did* walk on water, but it made me feel more acutely that I was a fake and almost regretted all the shucking and jiving I did to worm my way into the program. Getting the wrong answer in case conference, even mixing up right and left. Having some attending occasionally make fun of a dumb answer during read out. I had the rare good day, too, when I happened to study the right material the night before and the guru of cardiac imaging gave a case conference on pediatric congenital heart conditions and called me to take the hot seat and I knocked that sh*t out of the park and then turned around to bask in glory and imagined applause before taking a bow. But there were times I seriously thought there was something wrong with me. But I never questioned whether I could learn the material, the question was just whether I’d ever perform at the level of my co-residents (spoiler: I did). I think it’s just the nature of radiology training to be very discouraged at some point, but you just “chop the wood in front of you” and take it one day at a time, one page at a time, one lecture at time, one rotation at a time, keep asking the dumb questions, redouble your efforts and vow to do better next time. At some point, it turns out okay for most everyone. The only difference from the OP is this business of being in the bottom 3 percentile, which sounds objective. I wouldn’t even have known what percentile I was in residency, there wasn’t a standardized exam for that, but would not have wanted to hazard a guess.
-
I would say do as many question banks as possible. Rad Primer is an excellent tool in residency as it has many easy and hard cases. Great pictures, thousands of cases. This might be enough.
Radcases are good and pretty quick reads for each specialty. Teaching Atlas also helpful (might be old now).
The point is challenging yourself with cases in non work settings. It will make a difference.
-
Most of the things you describe sound like normal resident stuff except the 3 percentile exam scores. Thats going to correlate with core passage.
No one expects you to make every finding or know everything and everyone probably gives something up somewhere . Most people arent superstars in the reading room and getting 100th percentile . However if you do better on standardized testing or you do better on the reading room it would give you more leeway with the other. Theyre stupid tests with absolutely
Idiotic questions that no actual radiologist in the world knows the answer to, but thats the game you have to play .Would figure out how to do better on dxit and inevitably the core.
-
I knew people who scored sub 10% on the in-service written exam and rocked/aced the oral exams (were obvious superstars when it mattered). YMMV.
-
probably the exception more so than the rule and everyone probably knew they knew what they were doing
-
Doubt is the enemy of your success.
You need to commit to radiology, or something else.
I never doubted radiology was what I was going to do, and forged ahead. Had bad days, and times I felt dumb; but that is life.
So as my chairman used to say when someone was in the hot seat in conference stuttering; sheet or get off the pot.
This sounds somewhat mean, and not my intent; but I do think you have to toughen up a bit and be more aggressive. Success in radiology is not complicated; it is something hard work can conquer for anyone that has made it successfully through medical school.
-
I am struck by one of the OPs comments: He doesn’t like Radiology.
Obviously that could be because he is not doing well and that would make you not like it.
But – on the other hand – things I do not inherently like – things I am not enthused about doing – I am not that good at.so – it may not matter which it is – but if he truly does not like radiology, I doubt he can be successful at it, and he may be setting himself up for a very unhappy life.
OP – what did you REALLY like in medical school?
-
I would say if there is a single sub specialty of radiology that you like, you should stick with it. Body? Breast? If so, then once you finish residency and if you pass your boards your weaknesses in the other areas of radiology can become completely irrelevant. You can choose an academic job or other subspecialized gig.
So, if thats the case, check out one at a time the most concise text book for each sub specialty. Read each over 1-2 weeks followed by doing tons of questions from q bank or whatever. You will gradually get used to the types of questions that are asked and your scores will go up.
All you really have to do is climb from bottom 3% to 20% and pass your boards. It is not a moon launch. You just need to work harder than everybody else.
And assuming you succeed go to a different program for fellowship. Give yourself a fresh start somewhere where the fact that you were bad at neuro as a resident will not haunt you since you will never read neuro again if you dont want to.
If there is no field of rad that you like them do switch. Just make sure it is a rational and not an emotional decision. If you say you dont like radiology as a defense mechanism because you are not doing well that is fixable through hard work.
Remember that if you switch to another field of medicine there will still be minutia and board exams.
-
Quote from fumoney
I would say if there is a single sub specialty of radiology that you like, you should stick with it. Body? Breast? If so, then once you finish residency and if you pass your boards your weaknesses in the other areas of radiology can become completely irrelevant. You can choose an academic job or other subspecialized gig.
So, if thats the case, check out one at a time the most concise text book for each sub specialty. Read each over 1-2 weeks followed by doing tons of questions from q bank or whatever. You will gradually get used to the types of questions that are asked and your scores will go up.
All you really have to do is climb from bottom 3% to 20% and pass your boards. It is not a moon launch. You just need to work harder than everybody else.
And assuming you succeed go to a different program for fellowship. Give yourself a fresh start somewhere where the fact that you were bad at neuro as a resident will not haunt you since you will never read neuro again if you dont want to.
If there is no field of rad that you like them do switch. Just make sure it is a rational and not an emotional decision. If you say you dont like radiology as a defense mechanism because you are not doing well that is fixable through hard work.
Remember that if you switch to another field of medicine there will still be minutia and board exams.
I like this advice.
Do your best to get by, focus on one specialty like breast imaging or IR, and do 100% of that for your career. Yes, your job options will be limited, which means your geographical options may be limited. I am a breast imager – about 50% – and I think you could do a *LOT* worse in medicine that be a 100% breast imager or IR. -
I would also add that you can have a highly successful academic career in radiology without actually being a good radiologist.
The skills of research, publication, service, leadership, quality are all wholly separate from interpretative skills.
-
To add on to that, I would add that one can have a relatively successful private practice career in radiology without actually being a good radiologist.
Heck, just look at my partners. -
To the OP:
Don’t get discouraged. Just keep studying, plugging away and be professional.
It’ll get easier with time. -
One thing that I found really helped a lot early in my training was looking at as many cases as possible in the ACR learning files. I always found it much more interesting to look at cases and read about them rather than doing mostly reading. Back in the early days of my training the ACR learning files was in the form of hard film copies, and you had to stand up, take the films out of their envelopes, throw up them up on the light board, look at them, take out the blurb about them in the case envelope, shove everything back in the envelop, then repeat for another case, case after case after case. I think all this helped the brain circulation and kept me from falling asleep. And discussing the cases with other residents really helped to keep things interesting, too. All this helped to make studying more fun and interesting. These days there are no hard copies, but you can still look at cases on as big a screen as you can. Look at the ACR learning files and try and see if you can study with one or more of your fellow residents to make studying more interesting for you. Like someone said above, look at as many cases as possible. Don’t give up until you know you have given it everything you’ve got. Everyone has hit rough spots and feels stupid sometimes, even though they won’t admit it.
-
A lot of people on these boards are reluctant to tell people to do something outside of radiology because they personally would hate doing anything else. There’s no big deal changing residencies, it’s just a couple years of your life where you wandered off into the wrong path of radiology which is much better than staying on the wrong path for a long time. Radiology is not for everyone.
-
Radiology is pattern recognition. And the learning curve is so different for everyone. Trust us, you will “get it” one day.
May I ask if you are in a small community program? I’ve seen both sides (small community clear the list speed! no education versus top-tier ivy focus on education, excellent didactics, well-rounded)
-
-
-
-
-
-
-
-
-
