Veterinary Radiology

Last week, Ryan Schultz, Winnie Lo and Randi Drees wrote about how they approached studying for the board exam. This week, in part II of the interview, they talk about their favorite resources, and top tips for preparing for the exam. Although these articles are about the ACVR exam, the ECVDI exam is very similar in content and format. There should be plenty of helpful advice that’s applicable to everyone!

AZ:What were some of your favorite resources (books, websites, etc)?

Ryan:

By far the best were real good cases with a known follow-up and then going over other differentials for what it could have been.

Randi:

I really like my paper summary collection, that is a great resource.

Winnie:

I found that “The Handbook of Small Animal Radiological Differential Diagnosis” by Dennis et al to be a useful summary of differentials.  Thrall was also a useful overview.

AZ:What are your top 3 tips for studying for the oral exam?

Ryan:

Practice making oral reports on real cases with known diagnoses.

Practice the structure of your report: Findings (+ summary of the pertinent ones if there are a lot), Radiographic diagnosis, Differential Diagnoses, Plan

Stay broad in your differential diagnoses (i.e. neoplasia or infectious and then narrow it down rather than say adenocarcinoma or abscess), learn the differentials you may not have seen in your residency and have memorized lists of differential diagnoses ready to spit out whenever you see something common (lung pattern).

Randi:

Make a clear list of differentials in your head to fall back on for all the sections. I liked to have that written, that I would have to have something to flip through between the sessions.

Make a clear system for yourself on how you are going to read the films and stick to it.

Practice oral exam sessions (mock boards).

Winnie:

See lots of cases on clinics.

Have a set of differential diagnoses for certain radiographic findings

Remember to correlate findings to history/presenting complaint.

AZ:What was the difference between studying for writtens and orals?

Ryan:

The good news is that it took A LOT less time to study for orals and there is much less memorization! Just PRACTICE and go over a lot of cases.

Randi:

Well, the list to study is not as well defined for the orals as for the written. And it is much more fun to study for the orals.

Winnie:

More reviewing cases rather than sit-down studying.

AZ: Do you have any other advice for next year’s residents?

Ryan:

Just read cases in the boards as you see them. A lot of cases were a lot easier than I was expecting. So don’t overread them.

Randi:

Find yourself something to do to clear your head inbetween the exam sessions. I had up to 5-6hrs between sessions and you can’t really study in that time. I flipped through my differential lists, went running for 2hrs, something like that.

Try to be relaxed and READ THE FILMS, READ THE FILMS, and dont forget to READ THE FILMS in the sessions. The problem is that you won’t get any feedback during all the days of the exam, as you may be used to on the clinic floor or from mock boards. So just believe you are right (you may have to be a bit sarcastic about this now and then and don’t worry about your screw-ups, that keeps the spirits up over the 3 days. These days are exhausting enough, so you don’t need to worry on top of things about the mistakes that you for sure will make, or not if you are truly brilliant.

After the written exam is done, the radiology residents start preparing for the oral (certifying) exam. This is a long exam, broken into several parts over two or three days. It’s quite different from the detail oriented written exam, and focused on putting all of that information together for interpreting imaging cases. I asked Ryan Schultz and Winnie Lo from UC Davis, and Randi Drees from the University of Wisconsin, Madison, to give us their perspective on how to prepare for this portion of the exam.

AZ:How many months ahead of the exam did you start preparing?

Ryan:

I guess I started preparing with KCCs the first year of the residency, but specifically I started studying for the oral boards about July (2 months before).  I needed time to recover from the writtens first.

Randi:

2 months minus 2 weeks for ECVDI meeting travel = 1.5 months study time.

Winnie:

I started earnestly preparing about 2 months before the oral exam.

AZ:What did you start with and how much time did you study per week?

Ryan:

I started by having faculty members present about 2 cases once a week and really trying to improve my report style by making it more concise.  I was used to spending a lot of time on findings and then thinking over all the differential diagnoses in KCC. When preparing before the orals I would be very thorough on the findings (so as not to miss subtle lesions at the edge of the film) but would make a timely list of 1-3 differential diagnoses in the order I thought was my likely.  I did this for about a month before boards while also skimming over books on differential diagnoses and contrast studies which I hadn’t seen much of (just looking at images and reading the descriptions).  The month before the boards I would practice making oral reports on a couple cases at a time at least 2-3 times per week with other residents or faculty.  I also practiced making oral reports and talking to myself the remainder of the weekdays (go somewhere where no one else will hear you – but it really helps, otherwise when I’d read the answers on cases I would believe I would have said some stuff that I may not have).  The week just before boards I practiced making oral reports on cases in front of people everyday for maybe an hour.

Randi:

I started with a “quick” re-read of Thrall that took a little longer than anticipated, and typing up a list of differential diagnosis from that per chapter. I was full time on clinics between the written and orals, hence study time was not much more than 1 hr during the weekdays and maybe total of 8hrs on the weekends.

Winnie:

Preparing for orals was very different than for writtens.  I didn’t really have any sit down sessions to study.  I did spend about 2-3 hours going over old cases in our archives.  Mostly it was being on clinics and seeing cases.

AZ:What was your approach to studying? (journals, cases, mock orals, any software, etc)

Ryan:

I mostly went over a lot of cases; digital, hard copy and on the ACVR website.  I also looked at a lot of images in a book or two on contrast studies.

Randi:

I had read the pertinent veterinary radiology books at one point in my residency, however as my memory sometimes tricks me in deleting important details I did a quick review. As stated above I started with Thrall, making myself a “rescue” list of differentials in case of getting lost. For Large Animals I used Butler as baseline knowledge, for US Nyland / Matoon (both of which I had summarized at some earlier point) & Penninck / d’Anjou. Reading titles & looking at pretty pictures and figure legends is great as a refresher. I topped that up with flipping through other radiology books that were available in our department library.

I had previously summarized and copied title / abstract / pretty pictures the papers of the recent years to a single page per article and went through those on the weekend before the exam. That was my baseline especially for CT / MRI, as this is still marginally covered in books at this point. For NucMed I used the handbook and my paper summaries.

For artifacts I went down the lists on the objectives and wrote a brief statement for each for appearance, cause, remedy. I tried to memorize those, my brain was a little resistant to studying & memorizing after the writtens, however I still could remember some of it during the exam.

The most important thing however were the mock board sessions generously given by my faculty and fellow residents. I had about 8 weeks of Mon-Fri 8-9am mock boards with 4-5 cases per session. It is pretty hard on the self esteem, but really worth it as it gets you in the swing of talking / thinking through consecutive cases in an organized fashion even if you have no idea what you are dealing with. And that is going to happen on the exam in one or the other way and that way I didnt get too thrown off by that then.

Additionally it is a very valuable and condensed one on one learning experience. I feel I have almost learned more in this short period than before in the residency, or lets say got more fine tuning on my skills. So if you dont have that in place, I would strongly reccomend to ask your faculty or fellow residents to do something similar for you.

Winnie:

I thought being on clinics was the best preparation.  Mock orals were also extremely helpful.  They helped me organize my thoughts and to practice my delivery in a concise and direct manner (getting in the groove, so to speak).  I also did review recent journal articles to refresh some topics in my mind.

Last week we started with some tips on preparing for the written board exam by Matt Cannon, Sophie Dennison and Randi Drees. The article covered the timeline for starting to prepare and dividing your time, as well as reviewing the literature. This week they cover their favorite study resources and the top three tips for studying for the written exam.

If you have tips for next year’s residents, please add them to the comments section! Everyone is welcome to contribute. As you can see from last year’s and this year’s interviews, each resident has a unique approach that worked for them. The more advice we can gather, the greater chance we’ll have of finding good advice to suit any study style.

AZ:What subject took the most time?

Matt:

Probably Alternate Imaging, just due to the sheer volume of information. The material is familiar because most of it is what we do on a daily basis, but there is a lot of associated literature and physics. I ended up making a decision early on that I would not get bogged down in the fine details of things like MR physics and instead be sure that I had a basic knowledge and understanding of the material to fall back on. I think this helped me avoid spending too much time on details that would probably never show up on the test anyways. For me, the easiest sections to study were Radiation Biology (there is only so much material to read on this subject) and Anatomy (again, it’s knowledge that we use daily).

Sophie:

Pathophys without a doubt.

Randi:

Reading the papers, including Phyisology & Pathophysiology. Physics went only fast bc I went though it in depth before.

AZ:What was the hardest subject to study?

Matt:

Pathophysiology, hands down. Studying for this section is like looking into a black hole. The objectives are nebulous and open-ended and the source material is varied and overwhelming. If you don’t set boundaries you could spend an infinite amount of time on each objective. Even after studying this section extensively, I still felt like 99% of the material I studied was not asked, and I’m still not sure where some of the questions came from. I wish I had better advice to give on how to prepare for this section, but if I had to do it over again I’m not sure what I could have done differently.

Sophie:

Pathophys – the objectives don’t really advise what level of learning is needed ie. organ level, cellular level, receptor level. So it becomes a little bit of guesswork and gambling.

Randi:

Pathophysiology, because it is very hard to determine where to set the limit, how in depth one may be asked.

AZ:What were some of your favorite resources (books, websites, etc)?

Matt:

Standard books I read included the NM handbook, Nyland/Mattoon, Thrall, Christensen’s Physics, Bushberg for CT/MR/Digital radiography, Kremkau for US, Hall for Rad Bio, Wallack for contrast agents, and Ettinger for pathophysiology. Other resources I found helpful were Slatter and Bojrab for surgical/bone stuff and pathophysiology, Radiographics review articles for MR/CT physics and artifacts, Dr. Kittleson’s cardio website via UC Davis (www.vmth.ucdavis.edu/Cardio/cases), Dr. Buchanan’s cardiac embryology website via UPenn, an MRI physics website at www.e-mri.org, and various review articles in Vet Clinics of North America and Clinical Techniques in Veterinary Practice. The online resident notes were really hit-or-miss. Sometimes they were great, but other times they were too detailed or not detailed enough.

Sophie:

Ettinger on line, I also went through Guyton before I started Ettinger back at the start of my second year, but not convinced that was really necessary although the background was good. Raphex physics exam and Huda for physics practice. WIKIPEDIA  - its amazing what shows up on there…but only trust the referenced stuff.

Randi:

Guyton for physiology. Zagzebski for US. Bushberg for general physics and radbio. Nuclear medicine Handbook. And my paper collection. Wikipedia. Google.

AZ:What are your top 3 tips for studying for the written exam?

Matt:

Plan ahead – I felt that having at least a loose study timeline was very helpful in keeping me organized and not freaking out, even if I didn’t always adhere precisely to the timeline. Starting a year ahead of time should be more than sufficient, even if you just plan to read a few hours each week. I actually made a 5 week timeline before the exam detailing how I would spend each week, and I think it prevented me from losing it.

Use the people around you - Before you start, ask older residents or faculty members what books/articles/resources they would recommend reading and what resources probably aren’t necessary to read. There is a lot of material out there and you can’t read it all, so having a game plan as far as what you are going to study is key.

Relax – It’s a cliché but you must do it. All the time you are really stressed out is wasted time. Everybody kept telling me that I would pass but I didn’t believe them and got stressed out and you probably will not believe them either. But the fact is that most residents pass the exam, although you will not feel that way when you finish. There are at least several sections that you probably could pass without even studying so that should make you feel better as well (although I don’t recommend trying this).

Sophie:

Start early – its easier to get in the habit of an hour or two a night and then step up from there rather than freaking out at the last minute and trying to get brain to engage.

Use other notes eg. the 2005 answers as a skeleton but make sure YOU can answer all of the objectives questions. Making a summarized version of your notes is a great way of giving yourself a ‘quick reference’ guide for the last couple of weeks before the exam.

Remember you are training to be a radiologist not an internist and gauge study to that.  I tried to study to the level I felt I needed to know on the clinic floor to answer most questions.

Randi:

Read as much as you can during your residency along the objectives. Read as many papers as you can during your residency, I found it easier to read by organ system than by year. Understand the physics at least halfway before you really start studying right before the exam.

Compile some kind of short form of the objectives for yourself to review. It is too overwhelming otherwise.

Sleep enough. Do lots of sports.