Radiopaedia Blog

The Royal Melbourne Hospital Neuroradiology and Neuropathology Departments will be publishing the cases presented at our monthly multidisciplinary meetings online as Radiopaedia Playlists, so that everyone can benefit from these cases. These will be uploaded approximately monthly, and will contain a selection of unusual cases or particularly nice examples of more common pathology. In almost all instances each case will have both imaging and histology. 

Click here to view current cases (Feb 2014)

Past meetings:

 

How do examiners, or for that matter your referrers or colleagues, form an opinion of your competence? This may seem like a glib question, but stop and consider.

An examiners duty, at a fundamental level, is to decide if you know enough about everything relevant to the practice of radiology to be unleashed on an unsuspecting and largely trusting public. How do they try and accomplish this daunting task? Well, they show you a handful of cases. Statistically this is not a very sound method, after all, even if you consider knowledge in a very superficial way, there are thousands upon thousands of individual facts, and during an exam only a tiny fraction of this knowledge can be directly examined.

So what do they do? They judge you based on a few answers and extrapolate from there to the totality of your possible knowledge. If that worries you, it should, but only if your technique is lousy.

A candidate with good technique will convince the examiner that each correct answer represents merely an example of a vast amount of untested knowledge, whereas each incorrect answer is an unfortunate fluke,  just happening to land in a tiny puddle of ignorance.

Poor technique, on the other hand, will convince the examiner of the opposite. Each correct answer represents a chanced up inconsequential island of knowledge stranded in a vast ocean of ignorance. Each incorrect answer on the other hand, merely confirms how little that candidate knows.

 

Thus, with exactly the same mix of correct and incorrect answers, your technique can give very different impressions, and in many cases be the difference between passing and failing.

So where does that leave you? Time to pack it in and go home and cuddle up to a large tumbler of single malt on the couch while watching The Wire for the third time (this is a fairly good plan at the best of times; The Wire is after all the best TV ever made)? Well, perhaps, but not because of the unfairness of exams. There is a relatively simple solution; stop studying and start thinking and practicing. It is my day to day experience that trainees have absorbed great quantities of factual knowledge but have not taken the time to tie all of it together, and that as a result in an exam setting, or when speaking to clinicians, they come across far more ignorant than they actually are. Now you need to take the time to work out how all these facts and disparate conditions fit together in the context of cases, and be able to articulate this quickly and clearly in an oral setting.

I have already covered some aspects of how to effectively practice without wasting time and how to practice your oral technique in the shower in previous posts, and in future posts I hope to also go into how to use cases as the starting point for study, the secret art of relevant negatives and why you should never surprise your examiner, but for now if you are in sight of your exams, let me leave you with this advice: you are better off practicing cases until you are limited by your knowledge and not your technique. Then and only then, hit the books again. 

 

Next: The secret art of relevant negatives

 

Dr Frank Gaillard is a neuroradiologist at the Royal Melbourne Hospital, Melbourne, Australia, and is the Founder and Editor of Radiopaedia.org.

NB: Opinions expressed are those of the author alone, and are not those of his employer, or of Radiopaedia.org

 

Every month or two we will collate some of the feedback we get from our users and post it on this blog. It is always rewarding to hear that what we are building is important and appreciated. If you have feedback or a story of how Radiopaedia.org helps you, please send it to [email protected]

 

"Great job by Radiopaedia. I keep courses in Echography and Conventional Radiology in African developing Countries and I take advantages of your work." Anonymous

 

"May I show my deep appreciation for your invaluable work,and the ultimate use you offer for us radiologists and other physicians." Dr H.E. 

 

"Dear Radiopaedia, I can't overstate how much you are important and useful for the advancement of Radiology. I want to say thank you. I'm a resident doctor in Radiology in a Nigerian hospital." Dr AS

 

Ok so this is nowhere near as lurid (or entertaining) as it sounds. One of the cornerstones to developing a successful oral technique for radiology exams is practice. The majority of this practice, as I discussed in the previous post on how to effectively practice for oral radiology exams, and not waste time should be on your own where you have the opportunity to work on each film, breaking down an oral exam into individual types of films. You can however take a step even further back by practicing the phrasing and choosing the words you want to use without the distraction of an actual film.

This might sound silly, but the last thing you want to be struggling over is how to phrase your discussion on the day of your exam. During your viva your mouth should be on autopilot, freeing your mind (what's left of it) to think about the case. To get to this point you must have developed a consistent presentation style. This acts as scaffolding upon which you hang stock phrases. The best way to do this (although this is not very time effective) is just to report thousands and thousands of films in your day to day work; this is of course something you should all be doing. Unfortunately exam cases are a different subset of real life cases. 

One way to create a polished style is to visualize a case and start talking, paying attention to the words and not the particulars of the case. A great place to do this is the shower, but of course you can do this anywhere else you are alone with some time to kill, and free from too many distractions.

No known copyright restrictions: http://flic.kr/p/6t3jGe

The sort of questions you should ask yourself during this exercise are:

  • does what I am saying make sense?

  • am I implying something I do not wish to imply? (e.g. if you use the term “cystic” when describing a necrotic glioma, the examiner may well wonder if you are thinking about low grade tumor, and later wonder if you understand what the word “cyst” means)

  • is my terminology precise? (e.g. one of my pet hates is the use of the word "density" rather than "intensity" when describing the appearance on MRI)

  • are my descriptions clear and concise? (e.g. when describing a mass, logically work your way through its macroscopic appearance, imaging features, relations to surrounding structures etc… 

  • am I clearly separating my description from discussion? Nothing creates the sense of confusion than jumping between findings and interpretation. 

  • am I including relevant negatives but not too many irrelevant ones? Think ahead of the differential you are going to entertain and make sure you touch upon the features of each. 

By practicing in this way, in or out of the shower, you should find that your presentation will be more polished and as a result you will be able to articulate the knowledge you have better.

Remember... (this is important, so pay attention): spending a few hours improving your technique will improve every single case you every get shown in your exam. Spending the same amount of time reading about a specific topic will probably result in no improvement, as you are unlikely to be asked about that particular condition. So unless you technique is awesome and much better than your knowledge, you should be spending more time in the shower. 

 

Next: Islands of knowledge or puddles of ignorance

 

Dr Frank Gaillard is a neuroradiologist at the Royal Melbourne Hospital, Melbourne, Australia, and is the Founder and Editor of Radiopaedia.org.

NB: Opinions expressed are those of the author alone, and are not those of his employer, or of Radiopaedia.org

 

 

The Royal Melbourne Hospital Neuroradiology and Neuropathology Departments will be publishing the cases presented at our monthly multidisciplinary meetings online as Radiopaedia Playlists, so that everyone can benefit from these cases. These will be uploaded approximately monthly, and will contain a selection of unusual cases or particularly nice examples of more common pathology. In almost all instances each case will have both imaging and histology. 

Click here to view current cases (March 2014)

Past meetings:

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