In a nutshell, the diagram above explains your ‘choices’ in the 3rd year of medical school.
This morning, I finished my 4-week Radiology rotation by sitting for my shelf exam. So far, this has been my fifth rotation of the year – I’ve now finished Ob/Gyn, Pediatrics, Psych, Family Med, and Radiology. Next week, I start Neurology. It’s likely that I’ll start on their stroke service for a couple of weeks. From there, I’m not really sure how it works. I may sound in doubt because, as is the nature of my life, I’ve learned to never trust my schedule until it’s printed out on orientation day. After all, 3rd year medical students don’t actually make their schedules, the strings of fate or somewhat pulled from the background. You have some general say in how the game will precede, would you like to fight Hard Man first or Gemini Man? Either way, the end game is completion of a linear experience, we all know there’s going to be that final boss battle (STEP 2).
Radiology was a very fun rotation, for a variety of reasons. I’ll be upfront, a lot of the enjoyable parts of the rotation was the lifestyle. They not only allowed time to be prepared, but they also directly encouraged making time for your personal life. We had time to be human.
Radiology, though fundamental, is most often an optional elective in medical school. Most medical students do not end up taking Radiology. At our program, we had to choose between Radiology, Emergency Medicine (EM), or research. This isn’t to imply that students who took EM didn’t want to benefit from Radiology, because part of the function of 3rd year is to try rotations before we apply during early 4th year, there just wasn’t time for some with definite plans of EM. I’ve never really given EM much thought, I’ll try it during my 4th year as an elective. And, I didn’t have any research projects on the back burner that would justify a research block. To be honest, I’ve been waiting for this rotation since Ob/Gyn.
You see, 3rd year, it’s arguable if your decision of “order” helps all that much. If you have Psychiatry first, well you’ll soon learn there’s a lot of medicine involved. Should you have Family Medicine first, then you’d wish you’d had Ob/Gyn, Pediatrics, Psychiatry, or Medicine beforehand. Either way, you pick up tools, you learn new things on rotations and use them in the others.
The first time I had to attempt reading an radiology image was on my first rotation, Ob/Gyn. It was a pelvic ultrasound, and even though I knew the pelvic anatomy down cold, to be honest I had no idea what I was looking at on the screen. It took a lot of practice, mostly via pattern recognition to lock-in the images up with concepts. The first time I was truly responsible for knowing an X-ray was on my Pediatrics rotation. There was a 2-week old neonate on our service, he was there for a fever and trouble breathing. As per protocol, reflecting current evidence and practice, the baby head a lumbar tap, labs, X-ray, the works. At some point, we narrowed it down to pneumonia involving the right lower lobe – that’s what I knew after calling the radiologist, and asking for a quick lesson in their interpretation. The mother stayed with her child day and night, the father would practically range from being at work to living at the hospital with his wife. Interestingly, the father was an attending at a prestigious hospital in New England. The mother of the patient wanted to have our team meet, when the husband was around, to explain our progress and plan. At our meeting with the family, I had to explain the X-ray to a doctor who most likely has been practicing longer than I’ve thought about medical school. I explained, he nodded a lot, and at the end everyone seemed relieved because we had a diagnosis. This is when I first though, “Radiology is kind of cool.”
Thus, for the last 4 weeks, I’ve been invested in all things radiology. We covered modalities to obtain images and impressions about the body and disease: X-ray, CT, MRI, nuclear scans, and ultrasound. We were allowed to go into any department we liked, such as Interventional Radiology, Mammography, and brain imaging rooms. We were even encouraged to eat, i.e. taste barium and gastrograffin (the former tolerable, the latter utterly disgusting). There were a couple of presentations, and we had to hold noon conference for the residents and attendings, for one day. Overall, it was a great experience.
My day started rather late, i.e. waking up at 7:15 AM for a 8:30 AM lecture. We usually would get out at 9:30 AM, then we had time to complete some mandatory accomplishments and assignments. We were required to go to three noon conferences a week, and two take one call evening. Our afternoon featured a second hour lecture, then we were free to do whatever we wanted with our time. Occasionally, I’d go back to a room to practice reading more scans with radiologists, other times I’d complete some of my treasure hunt of assignments, at other times (most of the time) I’d go home to study and relax. Patient interaction was very limited, typically only during procedures, or when someone looks lost in the hallways. Radiologist schedules are loaded to be efficient, a radiology interpretation can have a large impact on patient care and decisions. Thus, bottle necks of reads are to be avoided. So, the day and our schedules were just built efficiently. It requires a lot of background knowledge to read an image, that is something this rotation has taught me, after hanging out with radiologist for a month it’s obvious they spend a lot of their “free time” reading to become better radiologist.
Now, the best result of this rotation is that I can actually see stuff. I’m ready to use my newly received eyes for patient care.