[Alvin]

Just wondering what a typical day to day routine of a 1st year reg is like?

I think the experience would vary not just site-to-site but also what type of shift you’re rostered on for the day. But generally the day starts like this…

1. Get coffee ????
2. If on diagnostics, check in with the boss you’re reporting to for that session
3. Protocol studies – this means going through all referrals and specifying the type of imaging technique required to answer the given clinical question. This can be a bit of a steep learning curve at first, but you’ll soon come to appreciate that the majority of referrals follow simple rules on how to protocol. Some sites have SRMO’s who may handle the bulk of this.
4. When with a consultant, a decent amount of time is spent getting feedback on cases you report, which is where you learn a variety of things. Broadly speaking; how to approach reporting that particular study, image interpretation, pitfalls, pathology etc.
5. Reviewing studies with radiographers – primarily to determine whether further imaging (beyond the protocol you specified) is required. Sometimes the radiographers are alerting you to a significant finding they have identified with the patient on table, which may necessitate escalating to the relevant team (eg. discussing with ED or NSx an intracranial bleed) or discussing with your consultant.
6. If on interventional, read up on all the cases for that day. Pre-procedural checks. Review prior imaging. Discuss with boss. Coordinate with nurses and radiographers. Talk to teams. Review patients post-op. Honestly, for a first-year, it’s mostly about getting everything organised and checked so the day runs smoothly and efficiently – rather than learning the procedure. Again, some sites have SRMO’s who assist greatly with this.

There’s often tutorials throughout the day or during lunch. They can be didactic or case-based. There’s also MDT’s, which usually consultants or more senior reg’s run.

Do you have to run every report by a consultant?

At my site, every reg report in-hours gets verified by a boss before being published. After hours, reg reports get published as preliminary (meaning it is publically viewable). The next morning (ideally), a boss will amend or verify those reports.

How much interventional work is done in 1st year? TIA

Depends again on site. Some sites don’t have much interventional work. Some sites have separate interventional departments. The complexity of IR caseload also varies. I would say, overall, don’t expect to do a lot. At my site, the main priority of first year is to pass exams and to get ready to report after hours.

Hope that helps ????

[Alvin]

Yes I believe Westmead has been reaccredited for training

[Alvin]

Hey @wilsontao

These are some good questions – understanding the system is important to preparation 🙂

Here are my thoughts…

1. Do you know how many positions LAN 1 and 2 usually offer historically?

Each home hospital within a LAN has a fixed number of trainee positions accredited by RANZCR, e.g. RPA has 18, Westmead has 15. The yearly intake for new trainees for that home hospital each year depends on the number of registrars moving on. For example, if 4 final year registrars pass their exams and move on to consultancy, then 4 positions will open for 1st year trainees for that same home hospital.

However, sometimes regs may need extra time to pass their exams, so a position would only open up once they pass – which could be mid-year for example.

Now to answer your question, I’m slowly putting together historical data on the Insights page (click here). It’s worth checking every once in a while as I slowly update the data from across the LANs. I also encourage other trainees to help provide input so we can paint a complete picture of radiology training across Australia.

2. When they say 50 positions for LAN 3, is that the intake across all 5 years as opposed to first year in take? Eg. there might be 20 positions to share between years 1/2 and 30 to share between 3/4/5 etc? So in reality there might only be like 10 positions for year 1?

Yes – 50 positions within LAN 3 includes all current trainees from all home hospitals. In NSW at least, there’s no set allocation for how many 1st, 2nd, 3rd yr trainees (I think the same would apply for other states/territories). This all depends on the movement of the registrars towards the end of the training. It may also be possible that no 1st year trainees are recruited for a home hospital if no registrars move on that particular year.

3. What is the difference between SRMO and Unaccredited Trainee? I assume being an unaccredited trainne would give you a higher chance compared to SRMO to get you onto a trainee position the following year? So strategically the best way to preference would be Trainee -> Unaccredited -> SRMO?

I assume you’re referring to SRMO and unaccredited trainee positions in radiology specifically.

On paper, an unaccredited trainee/registrar bears more responsibility than a SRMO. But… in practice, I imagine the job itself is much the same. i.e. I don’t know of sites where there is both an SRMO and an unaccredited trainee, where the latter assume more senior responsibilities. Thus I would think panels would view the two positions similarly. It’s probably different for other specialities like surgery and critical care where there is more of a distinction.

I think at the end of the day, if you were unsuccessful in getting a trainee position, I would probably choose the job that best suited my personal circumstances (distance, hours etc), personal interests or matched a training site that I would one day like to work in.

I’m going to slowly gather job data on these ‘stepping stone’ jobs (like SRMO/unaccredited roles) offered in the main recruitment and post it up in the insights page. Stay tuned 🙂

[Alvin]

Hey @wilsontao welcome 🙂

You’re right about there being few radiology research opportunities and even fewer academic radiologists.

Having spoken to some Directors of Training and a few registrars on the program, having “some research” in radiology is what they’re looking for, i.e. I don’t think having a PhD or Masters by research is necessary.

As a medical student, you could start by doing some case studies or pictorial reviews. This could be done anywhere as radiologists often keep a record of noteworthy cases but don’t always have the time to publish them. I would suggest approaching the DoT to express your interest, even if it means they direct you to someone else.

Alternatively, if there is a research component embedded in your degree, you could explore doing a larger project with the department when the time comes (some uni’s don’t like their students starting their research projects early, let alone starting higher research degrees)

[Alvin]

Depends on how you define an error. At face value, it implies for every case there is only 1 correct diagnosis (which the radiologist did not provide). But of course, there are many situations where there is legitimate potential for differences in interpretation. Many disease processes manifest radiologically with non-specific or common features. So often it’s a matter of giving an opinion, which is influenced by individual factors like subconscious biases etc – rather than a definitive diagnosis. To move closer to the ‘truth’, aside from obtaining more clinical/lab evidence, clinicians can also gather more opinions by discussing the case at an MDT, usually with a subspecialty consultant.

Then you have other errors, like missed findings. Where the diagnosis is evident in retrospect, sometimes subtly… sometimes obviously. It happens. In this case, the original report author should be first approached to allow them to review the case and make an addendum as they see fit. Side note: all addendums should be notified to the referrer and communication of such should be documented on the report (definitely something worth mentioning in the interview especially because so many court cases arise due to failure of communication)

The interview scenario can get tricky, for example, the original report author is away and non-contactable. What do you do? It’s a case-by-case assessment. The original report author should still have the right to addendum their report first, so the referrers might need to wait for this with the caveat being that this doesn’t immediately impact patient care. In real life, this is usually the case. It is not common practice for consultants to give 2nd opinions on reports they didn’t report themselves (in an unofficial, undocumented manner, outside of an MDT) as it can add confusion and possibly even further discrepancy. Think about the legal ramifications too.

If the scenario is such that it is a clinically urgent circumstance such as a sudden change in the patient condition, well the patient should probably be re-imaged, rather than have an old scan with a potential error re-looked at. Things could’ve changed over the interval. The original report author should still be notified.

How does the registrar get caught in the middle of this? Fair question. I guess they’re usually the most accessible staff member in the department and so, therefore, the first point of call.