I don’t think I was ever more uncertain about my chosen field than in the first couple of months of my R1 year. Coming off my intern year, I had gained in skill and responsibility, and I wouldn’t have been unhappy taking on a role as an internist during my PGY2 year.
I didn’t read all that much radiology material during my intern year and had no radiology electives because there was no radiology residency where I did my transitional year (an ACGME requirement). So when I began radiology at a new institution—with new people and a new hospital—it was a complete reset.
The first lecture I attended as a radiology resident was GU #3, the third part in a series on genitourinary imaging, covering topics like intravenous pyelograms. I had absolutely no idea what was going on. That feeling—of being completely lost—defined much of my early experience in radiology. I lacked the foundation to get anything meaningful out of the lectures.
In the reading room, I spent a lot of time transcribing and editing reports—often repeating words I didn’t understand about anatomy I barely knew. We had a weekly first-year radiology resident interactive conference (a 2-hour pimp-session) based on chapters from Brant and Helms, but this meant I had to do additional reading on my own time, which didn’t always align with what I needed to learn for my rotation. The questions were always challenging and got harder until you failed. There was no escape.
Of course, in the end, it all worked out. At the time, I benefited from some slower rotations at the VA, which gave me some extra time to shore up my reading. And I kept plugging away, day after day, on service, doing my best to understand what I was looking at and awkwardly dictate that into comprehensible English (hopefully quietly enough that no one could hear me).
It’s not weird to find radiology disorienting when you first start—it should be expected. The medical school process trains you for clinical medicine. Especially between third year, fourth year, and the intern year, you develop along a continuum that doesn’t naturally lead toward a career in diagnostic radiology.
Becoming a radiology resident is a step backward in personal efficacy. For someone who has done well in school, met expectations across multiple clerkships, and excelled on tests, it’s frustrating to suddenly feel useless.
Some people struggle with feeling like they’re not a “real doctor” in radiology because they are removed from direct clinical care for a large portion of their time. But that sense of detachment is even more profound when you can’t even do your job yet. You can only watch an attending highlight your entire report, delete it en bloc, and start from scratch so many times before your ego takes a hit.
Some attendings even dictate reports to you word for word as though you’re very slow, inaccurate, fleshy dictation software, and then judge your performance by how well you parrot everything back. This process can feel infantilizing.
But, as I’ve previously discussed in the craftsmanship mentality of residency training, I believe we can find satisfaction in our work by taking pride in doing it well.
Reading books is important. Doing practice cases and questions is important. Watching videos can be helpful. You absolutely must do the extra work to become proficient in radiology. You can’t just rely on the list gods to expose you to the full spectrum of pathology needed to adequately learn radiology and provide high-quality diagnostic care.
When everything feels overwhelming—the sheer volume of material, the anatomical complexity, the endless variations in pathology—the answer is to take it one scan at a time.
From the titular reference of Ann Lamott’s beloved Bird by Bird: Some Instructions on Writing and Life:
Thirty years ago my older brother, who was ten years old at the time, was trying to get a report on birds written that he’d had three months to write, which was due the next day. We were out at our family cabin in Bolinas, and he was at the kitchen table, close to tears, surrounded by binder paper and pencils and unopened books on birds, immobilized by the hugeness of the task ahead. Then my father sat down beside him, put his arm around my brother’s shoulder, and said, ‘Bird by bird, buddy. Just take it bird by bird.’”
You learn by doing. Every day is a learning experience. Every scan is a chance to learn a new anatomical structure or detail. Every pathology is an opportunity to expand your internal library of normal versus abnormal. Every case is a lesson—not just in recognizing the pathology present but also in differentiating it from other possible diagnoses. Yes, the work has to get done, but it can’t just be about getting through the work.
The key to being good at radiology—beyond hard work, attention to detail, and sustained focus—is realizing that taking it scan by scan isn’t just a temporary survival strategy for residency:
It’s the way we learn—when we’re right, actively reinforcing our knowledge, and when we’re wrong, absorbing the painful but essential lessons that only come from making mistakes over and over and over again.