How does a radiology trainee decide on their subspecialty?

1. NPDr Nassim Parvizi, Chair of the BIR Young Professionals and Trainee (YPAT) Special Interest Group (SIG), explores what factors influence radiology trainees to take their subspecialty path.

After listening to her local colleagues and peers from the YPAT group, Nassim conducted a national survey to find out more. Here she reflects on some personal stories and explores what might help trainees to make the right decision.

“My subspecialty interest is interventional oncology and this stems from an interest in oncological diagnostic imaging and intervention, alongside opportunities for research. I find the technical aspect challenging and stimulating. Both palliative and disease-modifying procedures such as ablation require careful planning and meticulous technique to ensure adequate destruction of the tumour and preservation of surrounding organs and tissue.”

Dr Jim Zhong, ST12 JZ

“My subspecialty choice is chest and cardiac. My reasons for choosing it were a mixture of the quality of training in the subspecialty within my deanery and the variety of work I can expect to do in that subspecialty when I’m a consultant. Work–life balance was also a consideration. I think that this subspecialty carries quite a high workload compared with other subspecialties but I do find it more interesting and I think that is more important in the long term.”

Dr Louise Wing, ST4

“My subspecialty choice is musculoskeletal radiology. I have chosen this because of the broad spectrum of diagnostic challenges it offers including sarcoma, bone infection, rheumatology and sports injury imaging. MSK radiology also provides a wide variety of established and evolving interventional procedural work.”

Dr Joseph Papanikitas, ST5

“My subspecialty interest is neuroradiology with head and neck imaging. I have always had an interest in neuro, head and neck pathology, with a background in ENT surgery prior to radiology training.

General radiology training was fantastic in exposing me to other areas, however, I always felt most enthusiastic when discussing head and neck or neuro cases! I chose a fellowship which combined both elements and this made me 100% confident I had pursued the right career choice.”

Dr Reena Dwivedi, Consultant

3.rdI decided to pursue radiology as I find diagnosing disease the most interesting and intellectually challenging aspect of clinical medicine. I also enjoy doing procedures. Now, over half-way through my specialty training as an ST3, I need to choose my subspecialty so that I tailor the rest of my training appropriately. Through reflecting on some personal and work-related factors, a mix of different modalities, intellectual challenges and geographic considerations are aspects that I prioritise.

My training has taught me that life as a future consultant will entail balancing clinical work with other responsibilities such as management and teaching albeit clouded by the uncertainty of what the future holds for our NHS. As a trainee, not only do I strive to strengthen my clinical skills, but also want to develop other skills such as leadership and management. Being part of the BIR YPAT SIG, I get to exercise such skills as part of a multidisciplinary team alongside excellent BIR colleagues discussing topical issues, doing projects, organising events and developing educational resources. This is very enjoyable and rewarding.

4. all

These are just a few examples from my peers and colleagues in the YPAT group. But I was curious to find out more about the criteria trainees use to make their decision. Together with my clinical supervisor I conducted a national survey to better understand the future aspirations of fellow radiology registrars in the UK to aid workforce planning (Royal College of Radiologists 2014 workforce report) and identify modifiable factors that may help address the areas likely to meet staffing shortfalls. We designed an online questionnaire and distributed it to all radiology trainees in the UK by social media, through the BIR and RCR junior doctor’s forum between December 2015 and January 2016.

What does everyone else think?

Most of the 232 respondents entered radiology after foundation training and were in their first few years of training. The survey responses demonstrated the most popular subspecialties are musculoskeletal radiology, abdominal imaging and neuroradiology, which combine different imaging modalities and provide intellectual challenges. The least popular subspecialties are gynaecological and oncological imaging, which may not be included as specific rotations during training to make one aware to consider them as a subspecialty. There were variations in the first choice subspecialties based on year and region of training. Factors that influenced subspecialty choices were a strong personal interest, a mix of imaging modalities and a successful rotation during training.

What can we do to make it better?

From our survey we found that, unsurprisingly, trainees’ experiences during various subspecialty rotations and positive role models can influence their perceptions and affect their future choices. Furthermore, an awareness of job prospects plays an important part. It is vital that areas with unmet need provide better engagement and training to appeal to trainees. Unfortunately, it is often in such subspecialties that staff are over-stretched, have to work long hours, and have little time to engage with and educate trainees. The BIR benefits from a mix of members from across different regions and subspecialties, which can act as a great resource to gain an insight into life outside of one’s training scheme and learn about different career pathways as well as job prospects.

At the BIR we would like to help you make your decision the right one for you. Let us know how you would like us to provide the information you need (webinar, practical role playing, in-person training?) Please let us know how we can help fill your knowledge gap.

Email sigs@bir.org.uk

About Dr Nassim Parvizi

Nassim Parvizi started her clinical training as an academic foundation trainee in the North West Thames Foundation School where she had an interest in quality improvement and patient safety. She undertook a secondment as part of the NHS Medical Director’s Clinical Fellow Scheme at the Medicines and Healthcare Products Regulatory Agency during 2012. Nassim is currently an ST3 and Academic Clinical Fellow Clinical Radiology on the Oxford Scheme. Nassim is also a member of the BIR MRI and Clinical Intelligence and Informatics Special Interest Groups.

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