How to succeed in the specialist trainee year 1 clinical radiology applicationBMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i1673 (Published 03 May 2016) Cite this as: BMJ 2016;353:i1673
Clinical radiology is an increasingly popular specialty. Roma Patel explains how to get through the selection process
Clinical radiology is an increasingly competitive specialty that has seen a rise in the number of trainee applications in recent years. Its appeal is diverse, and it attracts a range of applicants from foundation trainees to senior specialist registrars. With radiology consultant posts currently on the national shortage list, the Royal College of Radiologists has increased the number of training places. With an almost guaranteed consultant job on completion of training, clinical radiology is one of the most attractive specialties available.
This is reflected in its competition ratios. In 2015 there were 917 applications for 244 places with a 100% fill rate.1 The radiology application process has always relied on its interview stage to distinguish among candidates and this will be this article’s focus.
The Royal College of Radiologists uses a national recruitment system—Oriel—and all applications are accessed and processed through this. From 2016 the process will use the timeline below:
Applications open: November-December
Specialty recruitment assessments: early January
Interviews: end of February
Offers released: March
Candidates need to familiarise themselves with these dates to avoid missing any deadlines.
The interview consists of three stations, each lasting around eight minutes. The aim is to find out if the candidate meets the criteria listed in the 2016 clinical radiology person specification,2 so it is important to get to know this document. In the past, stations have focused on five keys areas:
1. Medical portfolio
The portfolio is a reflection of an applicant’s achievements. Candidates should not let the portfolio sit on the table unopened: they need to use it to demonstrate their achievements in relation to the person specification.
The portfolio should include evidence of a taster week in radiology. It would also be beneficial, but not essential, to undertake and include the results of any postgraduate examinations. Publications are also valuable. It is recommended to have experience of audit or teaching, or to have completed a course in radiology.
2. Career in radiology
Here candidates need to demonstrate their insights into what a radiological career involves. Use taster weeks and speak to local radiology departments for further exposure. Useful areas to consider studying are the Fellowship of the Royal College of Radiologists exam structure, radiology training schemes, technological advances, and the opportunities and challenges of a career in radiology. Most importantly, candidates need to think about why they want to do radiology and what makes them suited to it.
This involves report critiquing, image interpretation and/or prioritisation of scan requests.
For report critiquing, establish whether the radiological report provided answers the clinical questions asked. Evaluate its structure and ascertain whether it highlights positive findings and important negatives in a clinically significant manner.
For image interpretation, candidates should use a systematic approach with appropriate terminology, depending on the imaging modality shown.
- Describe the type of image
- Describe the pathology and associated features
- Provide a differential diagnosis
- Give the next step in management
For prioritisation of scans, applicants should establish whether the requested imaging modality is appropriate for the patient. They also need to assess the impact on patient management and the availability of resources (if an out-of-hours request). The applicant must explain their rationale for each answer.
This area aims to assess how candidates deal with work based ethical scenarios and involves a discussion with the interview panel. For example, how would you deal with an intoxicated senior colleague at work? What would you do if a patient who has been irradiated later informs you she is pregnant?
Firstly, identify the main issues relating to the scenario. Useful areas to consider are radiation protection, consent, professional behaviour, and the four ethical principles (autonomy, beneficence, non-maleficence, and justice).
Secondly, explain why these areas need to be addressed and what concerns they relate to, such as patient safety.
Thirdly, candidates need to explain how they would resolve the issue, while making sure they gather appropriate information, act within the realms of patient safety, involve their seniors, and act responsibly in accordance with General Medical Council guidelines.3
This is generic to most subspecialty interviews. A project will be presented for the candidate to systematically critique. Candidates are usually given eight minutes to prepare. Read through the project and go through the different stages of the audit/research cycle where applicable, and assess whether the presented project conforms to it. When presenting, identify the strengths and weaknesses of each cycle and recommend improvements.
Top trainee tips
Attend a course that focuses on the interview stage
Practise presenting images out loud. Learn common pathologies that a foundation doctor would be expected to identify. Get to know the appearance of different modalities such as computed tomography, magnetic resonance imaging, and positron emission tomography-computed tomography
Have an approach/structure for each question/station. Highlight achievements/qualities
Above all, speak confidently and show genuine enthusiasm and interest
I have read and understood BMJ policy on declaration of interests and declare that there are no competing interests