Here are several things to consider about learning radiology in addition to my articles on Approaching the R1 Year, How to be a First Year Radiology Resident, and Radiology Call Tips.
Develop Robust Search Patterns
Real search patterns are not just the order in which you analyze a fresh scan, they are a series of if-then statements:
If I see this finding, then I will look carefully at this other structure for an associated abnormality.
For example, if I see a lobar hemorrhage, I will look extra carefully at the dural venous sinuses and regional cortical veins on this non-contrast CT to ensure there is no hyperdensity to suggest thrombosis. If I see a spine fracture, I will look extra carefully at the soft tissues to ensure no obvious epidural hemorrhage or interspinous widening to suggest and ligamentous injury. If I see scalp swelling, I will look at the immediate underlying bone and underlying & countercoup intracranial contents to ensure no subtle fracture or hemorrhage escaped my notice on the first pass.
Interrogate Your Knowledge & Test Yourself
In today’s educational environment, asking pointed questions–especially those designed to stretch and assess your knowledge (pimping)–has fallen out a favor. This may be a combination of generational changes as well as the desire to create a safe space for learning, but regardless it is not as common as it used to be.
That being said, it is important for you to interrogate and assess your knowledge. This includes testing in the form of multiple choice questions and spaced repetition flashcards and things of that nature, but should also include self-pimping: you need to learn the skill of asking yourself the same questions that a harsh attending would ask of you.
As a deliberate learning exercise, ask yourself what it would take for your differential considerations to be plausible. Sure, this low-ish density collection is probably a chronic subdural hematoma or hygroma. But what would it take for you to consider a subdural empyema? Did you look at the mastoid air cells and paranasal sinuses?
Be Proactive
Don’t wait until somebody tells you to read about something to learn something, you already probably know the things that would’ve helped because you know the things that would’ve meant a better performance today: which pathological terms you didn’t understand, which body parts you had no clue about, which differentials were totally beyond your fund of knowledge.
Yes, it’s good to get through some kind of comprehensive entry-level text on your first rotation and to do whatever else people ask you to do, but it’s also worth learning about the things that are relevant to you now before you make the same mistake twice. Every diagnostic consideration raises its own series of differentials and potential complications.
Acknowledge the gaps and work to fill them every day. Adding the fruits of that labor to an Anki deck is probably an easy right move. Doing it continuously will remove a lot of the friction and build-up that makes us otherwise never quite get around to it.
Excuses Are Generally a Waste of Time
There’s a blurry line between explaining yourself to improve your approach and making excuses for your unavoidable lack of experience or inevitable mistakes.
Unless you want to explain your reasoning in order to have somebody correct your faulty reasoning, it usually doesn’t matter why you’re wrong. Not seeing things is just part of the learning process. Making the finding but reaching the wrong conclusion is often a teachable moment, but many mistakes are just a matter of reps. We all know that satisfaction of search and anchoring are big biases, so your attending doesn’t need you to explain why you didn’t notice something. The miss speaks for itself.
If you want to know why you’re wrong, then keep talking. Otherwise, let’s move on.
Reasonable Thoughts
Common sense and Bayesian updating are perhaps the most critical skills for medical critical thinking.
Base rates matter. They matter so much.
Common things are common. Weird presentations of common things are usually still more common than rare things. And rare things often only become reasonably plausible when their pretest ability becomes higher in context.
For example, intramedullary lymphoma is quite rare. But it would make more sense as a consideration for spinal cord pathology in a patient with new weakness if the patient has a known widespread lymphoma than if they just, say, had a flu shot.
Common sense and context awareness would prevent many diagnostic blunders.
Separate Content from Source
You can learn from every attending, even the bad ones.
Avoid their mistakes.
Finally, It’s OK That It’s Hard.
Difficulty and challenge aren’t bad, they are a critical part of human flourishing.
If you’ll excuse the crotchety-old-man moment, I think many of us have gotten into a mindset where we feel that the things people ask of us are an impediment to us living our best life, that hard work is intrinsically unfair, that anything even the slightest bit tedious is scut.
Not only is all this wrong–and trust me it’s not just because I’m getting older–but it’s also unhelpful.
There are certain parts of the world that we can change and certain parts that we can’t. The reality is that even the best careers have boring, tedious, and even unfair parts. We can’t have the good parts of a meaningful career if we are too quick to reject every part that doesn’t spark joy.