Editorial: When I was a resident, things were really tough...and other impaired memories

By Stuart E. Mirvis, MD, FACR
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Dr. Mirvis is the Editor-in-Chief of this journal and a Professor of Radiology, Diagnostic Imaging Department, University of Maryland Medical Center, Baltimore, MD.

Sometimes, in the evenings, I like to share stories about my residency days with our current on-call radiology residents. I do this both for entertainment purposes (mine and theirs) and to convey some sense of how "good" the residents have it today. You see, most of us seasoned radiologists, I believe, recall their residency training as being more difficult, demanding, and challenging, etc. than today's training programs. This presumption is a source of pride, a badge of honor in having successfully "run the gauntlet."

When I tell my stories of 25 years ago, I always mention the limited space, outmoded equipment, lost films, tyrannical and often bizarre-acting faculty, 36-hour shifts, and combative teaching conferences, among many other complaints about my training. Some of my stories really get the residents' eyes wide and mouths agape. Some stories they just can't believe. I feel like I should beat my chest after recounting the worst of it.

Actually, upon further reflection, though, I believe I had it much easier than the residents of today. I walked into the Chairman's office in 1980 with barely an appointment. Since I had 2 eyes, could hold a mostly sane conversation, and graduated from a medical school he had heard of, I was accepted into the program on the spot. Today, every candidate for residency is in the top of their class, charming, refined (well, not all), and usually has an Olympic medal or papal recommendation. The competition is fierce at the outset.

While I worked 36-hour shifts, typically 4 to 5 of those hours were spent sleeping. Our residents now work on a "night-float" schedule but don't sleep, at least not intentionally. While on-call, I was able to run off for an hour and play Star Trek online (yes, there was a limited online capacity even then) without difficulty or complaint. Today, with so much of medical care centered on diagnostic imaging, the telephone rings and pages in the Emergency Room are constant. I was responsible for covering 1 hospital on-call; our residents now cover 4. Most of the imaging studies requested during my residency had some rational indication; in today's litigious environment, a valid indication is a more welcome event. I could actually say "no" to a requested study or "it will be done tomorrow" and have it stick. Today, only the bravest residents even attempt that. Usually, my faculty backed me up in my on-call decisions. Today, the faculty usually leans toward giving in to our "customers" without argument.

The current department has ample space, top-of-the-line equipment, large reading rooms "of the future," a resident lounge, a highly regarded (only slightly peculiar) faculty, and much more. On the other side, today's residents have whole new technologies to quickly learn (MR, PET, MDCT, SPECT, Doppler and Power sonography, etc.). The knowledge base required for radiology has grown extremely rapidly and continues at that pace today. Much of this new information is not basic science detail but is required for daily clinical practice. Finally, I believe, at baseline there is an expectation of routinely excellent performance, leaving little room for rough spots during residency training.

I have a lot of respect for our residents and those I typically encounter as a visitor to other departments. I think they function at a considerably higher level than I needed to when I was a resident and constantly meet enormous intellectual and emotional demands. So if you think radiology residency training was really tough in the old days, I believe it is a lot tougher now. Perhaps, it's a sentiment to keep it in mind the next time one of your residents lets you down a bit.

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Editorial: When I was a resident, things were really tough...and other impaired memories.  Appl Radiol. 

April 09, 2007

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