I’m Out of Training. Now What?

The transition from training to practice comes quickly.

Out of TrainingFour years of medical school, one year of internship, four years of residency, and two years of fellowship later, I am finally done with my training! Now what?

There was no time to prepare for the change. On June 30, I put in a full day of work as a fellow, then on July 1, I began my first full day of work as an attending. The workstation had the same exact PACS and dictation software as the prior day, and yet it felt so different.

While as a trainee I provided preliminary reads overnight, providing final reads as an attending is a whole new experience. Although I spent six years training for exactly this, nothing truly prepares you for signing off on cases for which you are the final word. While final reads can be nerve-wracking, the people around me were very helpful. Once I got over my hesitation to ask for help when needed, these became learning experiences that allowed me to draw on the skills of a host of experienced radiologists. If I was advising a young resident today, I would tell you to get involved in as many cases as possible to best prepare for the future.

Don’t get me wrong, final reads come with a full set of advantages, one of which is that you no longer have to wonder which attending will be on the next day to call the lungs normal versus CHF. After spending years emulating others’ phrasing, some of which I agreed with and some of which I disagreed with, it was freeing and fun to word things as I wanted. Of course, a week in, you realize you are mimicking many others’ words and have yet to find your own voice. The semantics that I disagreed with as a resident turned out to actually be helpful in some circumstances. I would suggest trainees take note of the different ways things are stated and file them away for future reference.

The oddest part of finishing training was going from a resident that referring clinicians would pass over when looking for opinions, to being the expert on emergent cases. Confidence comes with time, but also with practice. Preparing for and being involved with interdisciplinary conferences during residency helped this transition.

The transition from trainee to attending is real. But like the thousands of radiologists before me, it came and went. What made the experience especially smooth were the residents and the staff. From showing me where the bathroom was and how to contact the ER, to explaining which list to read, the people around me helped transition me into the program. The residents and staff are the troops on the ground, what makes the hospital run. Further, the skills I have picked up through my involvement with the ACR RFS and by going to the annual ACR meetings have been invaluable. Now I am lucky to work in an institution focused on patient care, and having an understanding of value-based imaging has helped me quickly become a contributing team member.

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