Behnam Vahdati Nia - OMSI Co-president of Rad Club Touro University – California Spring 2011 Radiology: An Overview A medical specialty in which a variety of radiologic methodologies are used to diagnose and treat diseases Been around for over 100 years Great technological advancements in the last 30 years Diagnostic Radiology uses diagnostic and image guided therapeutic techniques in: Nuclear radiology Diagnostic ultrasound (US) Magnetic resonance (MR) Computed tomography (CT) Interventional procedures Use of other forms of radiant energy Over 80% of Radiologists sub-specialize in: Abdominal Radiology Endovascular Surgical Neuroradiology Neuroradiology Pediatric Radiology Nuclear Radiology Vascular and Interventional Radiology Cardiothoracic Radiology Musculoskeletal Radiology http://www.radiologyinfo.org/en/careers/index.cfm?pg =diagcareer Patient Details Most patients are ambulatory and then inpatient ~50% adults and ~40% 65+ ~50% acute, ~30% chronic, the rest check-ups/terminally ill Five Most Frequently Encountered Illnesses/Conditions: 1. Trauma 2. Cancer/malignancy 3. Central nervous system disease 4. Respiratory diseases 5. Breast disease/mammography Work-force (2010) Total # 26.5K = 8.48 per 100,000 An increase from 7.70 in 1996 Only 30% female Work-place: Office Based Patient Care <70% Hospital: ○ 4,654 residents (<18%) , CA ~13% total ○ <12% physicians Other (~5%) ○ ○ ○ ○ ○ Administration Medical Teaching Research Locum Tenens (subs) Other Compensation Academic Medicine: ~$300K-400K Clinical Practice: ~$300K-650K Resident: ~$49K Personal Characteristics Interest Specialty Average Score Complex Problems 4.5 Comprehensive Care 4.0 Diagnostic Precision 5.3 Emergency-Critical Care 4.0 History Taking 2.8 Home Health Care 2.3 Immediate Results 5.5 Knowledge of Anatomical Structures 5.0 Knowledge of Organ Systems 4.4 Laboratory Results 4.6 Palliative Care 2.9 Patient Counseling 2.3 Prevention and Education 3.4 Procedural Care 4.8 Psychological Care 2.3 Reproductive Care 2.6 Social Context 2.6 Technology in Medicine 5.1 CiM Residency: An Overview Generally 5 years, including a PGY-1 year First year in a preliminary medicine, transitional program, or preliminary surgery program PGY-1 year must consist of training in internal medicine, pediatrics, surgery or surgical specialties, obstetrics and gynecology, neurology, family practice, emergency medicine, or any combination of these Four years in radiology at the same or different institution Categorical programs: less common - PGY 1-5 ○ PGY 1 intern year and the radiology residency are combined , and applied to together Advanced programs: most common - PGY 2-5 Most programs participate in the Electronic Residency Application Service AND the National Resident Matching Program. What’s residency like? For PGY1 Average hours on duty per week 51.4 Average maximum consecutive hours on duty 18.1 Average days off duty per week 1.7 Average percent of training in hospital outpatient clinics 33.2% Average percent of training in non-hospital ambulatory care community settings 5.8% Average resident/fellow compensation $48,806 Average number weeks of vacation 3.5 Residency Spots 25 AOA spots at 14 sites (7 at Michigan) 141 ACGME PGY-1 spots at 34 sites 8 filled by DOs 949 ACGME PGY-2 spots at 163 sites All DOs In The NRMP 2045 applied, 1444 matched = 70.6% DOs active in ACGME DR residencies 2009: 178 = 4% total What do Program Directors look For when… Selecting for interviews (From NRMP 2010) Factors Percent of Programs • • • • Class ranking/quartile Personal Statement USMLE/COMLEX Step 1 score Grades in required clerkships 71% 71% 69% 67% • Medical Student Performance Evaluation (MSPE/Dean's Letter) 67% • Letters of recommendation in the specialty 65% • • • • Honors in clinical clerkships Grades in clerkship in desired specialty Gaps in medical education Consistency of grades 62% 59% 59% 59% What do Program Directors look For when… Ranking applicants in the Match (From NRMP 2010) Factors Percent of Programs • • • • Interactions with faculty during interview and visit Applicant was flagged with Match violation by the NRMP Interactions with housestaff during interview and visit Interpersonal skills 4.8 4.8 4.7 4.6 • Feedback from current resident 4.6 • Evidence of professionalism and ethics 4.4 • • • • Class ranking/quartile USMLE/COMLEX Step 1 score Grades in required clerkship Honors in clinical clerkship 4.3 4.3 4.2 4.2 Some tips from our matches… Radiology, its a tough field to get into, as is all the R.O.A.D residencies, and even worse, it seems that most good residencies are getting even harder to get into “You won't be disappointed in radiology. No matter what anyone says, we are the happiest bunch of people in the hospital - we enjoy our jobs more, we have less stress, we fill out less paperwork, we make more money, and we take more vacation. It's a pretty winning deal. Plus we are constantly evolving, we are completely evidence based, and we will always be needed.” You can't compete without boards You must take and do well on USMLE: 235+ on both steps (average for matched). Use First Aid by adding notes. Do well on first two years class ranking Get good letters. Consider doing a rads research rotation and getting a small paper done and your mentor should write you a strong letter. Also, you need a good letter from one primary care and one surgical doc. Get application done early and submit it day one. Apply broadly (20-30 on average to get 10-15 interviews) Do away rotation at places you are interested in and make a good impression. If you have a connection to a place let them know about it Clinical grades are more important. Didactic grades don't matter much Do research and get published USMLE questions required understanding concepts, where COMLEX was more basic recall. There are a few good DO programs out there, but they are small, and often not in the best locations Newly matched example application: Good grades (very good in the actual science classes, not so much in OD, OMM) Mostly studied on his own with review books (versus lecture/powerpoints) Used First aid, BRS Pathology, BRS Physiology, Microcards Practice questions were extremely useful USMLE World > Kaplan Q bank COMLEX: ~620 USMLE 1:~250 USMLE 2, COMLEX 2: not taken at time of application Strong letters, one particularly strong one from the chief of abdominal imaging 6 weeks research rotation and 1 case report written with said chief Volunteering: nothing Withdrew from AOA match, Matched ACGME on his 6th (and last) ranking Note: He did not take Step 2s at time of applying and wished he had. Taking the step 2 and doing well on it will further support your application. I also recommend doing some volunteer work? Resources: Radiology Dr. Pera Advising US machines late May? Dr. Hisley Research OsiriX (Mac OS) BB site / elective? RSNA (Radiological Society of North America) http://www.rsna.org/medstudents.cfm Cases, training, DDx, journals, etc… StatDx https://my.statdx.com/ Cases with precise diagnostic info and images + anatomy + more Residents/radiologist use it (on call too) One login at a time Learning Radiology http://www.learningradiology.com Others… http://www.radrounds.com/ Connections Cases Others… http://www.auntminnie.com/ Forum for anything regarding radiology/residency News Cases Career CME Resources: Residency Careers in Medicine (CiM) https://www.aamc.org/students/medstudents/cim/ Identify career goals Explore specialty and practice options Choose a specialty ○ Questionnaires characteristic to specialty match Select and apply to residency programs ○ Application timeline Make good career decisions ○ Four-Step Career-Planning Process Residency Programs FREIDA http://www.ama-assn.org/ama/pub/education- careers/graduate-medical-education/freida-online.page Information + Statistics AOA List http://www.opportunities.osteopathic.org/ ACGME List http://www.acgme.org/adspublic/ Applications & Match ERAS (Electronic Residency Application Service) https://www.aamc.org/students/medstudents/eras/ transmits applications, letters of recommendation (LoRs), Medical Student Performance Evaluations (MSPEs), medical school transcripts, USMLE transcripts, COMLEX transcripts, and other supporting credentials from applicants and their designated dean's office to program directors. NRMP http://www.nrmp.org/ For matching applicants' preferences for residency positions with program directors' preferences for applicants (both MD/DO) AOA Intern/Resident Registration Program http://www.natmatch.com/aoairp/index.htm Some Points About AOA & NRMP Matches Match to AOA Residency, NRMP is OVER Do Not Match AOA, ALIVE in the NRMP No Match with AOA or NRMP, Free Agent Match with AOA Internship, ALIVE for PGY- 2 Residency in the NRMP Critical to Understand the Distinction Between PGY-1 and PGY-2 Matches in the NRMP Any attempt for an applicant or program to supply specific rank order info. prior to the match is a violation of the match Thank you!