The challenge of being an ST1 Radiologist
Within the first month of being an ST1 Radiologist, I realised immediately that it is going to be very challenging in comparison to being an ST1 in Emergency Medicine (EM).
When I started working in A&E as an ST1 (2012), the majority of the cases were relatively straightforward since medical school and the 2 years of foundation training had prepared me well. The bread and butter of A&E included chest pains, minor illnesses, MSK injuries, neurological deficits etc, all of which had one would have most certainly come across prior to EM training. After completing 2 years of ACCS training (ICU, EM, Acute Med), I was fairly confident with almost all acute conditions and was able to manage them appropriately with minimal senior input. I was also able to independently insert central/art lines, chest drains etc.
However, during the first month of being an ST1 Radiologist, I quickly understood how little anatomy I had remembered from medical school and my poor knowledge of pathologies reflected in radiological imaging. I felt completely inadequate and out of my depth in this new specialty. Frequently, when being tested on anatomy in an ad-hoc fashion by consultants, I had to get used to phrases like "I don't know". This provided me with motivation to learn more anatomy.
Within weeks to months of learning anatomy, I slowly gained an appreciation for the relationship between normal and abnormal structures. This gradually allowed me to spot pathologies during reporting sessions. My first cross-sectional reporting was on a CT-Abdo/Pelvis of an 18 year old, male with a right iliac fossa pain. Within minutes, I was able to spot a focal area of abnormality in the right iliac fossa. With a few more minutes, I realised that there was an appendicolith, thickening of the appendix, small amount of surrounding free fluid and thickening of the right lateral anterior renal fascia. My final diagnosis of an acute appendicitis was later approved by the supervising consultant. Despite making such an easy diagnosis, that was truly an incredibly satisfying moment but also helped me recognise that I have a long journey of learning ahead before gaining the same feeling of appropriate level of confidence I once had in A&E.