Applying to Radiology

Radiology is a very exciting and innovative field of medicine. Radiologists have such an important role in the investigation of a patient’s condition and the field is becoming increasingly popular. In this article, we discuss what is great about radiology, how you can apply and how to put in a competitive application.

Why Radiology?

Now more than ever, patients almost always undergo some sort of imaging investigation, and this imaging is integral to shaping the decisions that clinicians make around diagnosis and management. Therefore, the importance of Radiology as a specialty cannot be underestimated. When undertaking a Radiology placement as a final year medical student, I was fascinated by the work carried out by the consultants. Their level of knowledge and understanding of anatomy, physiology and pathology was so detailed, and they had to apply this knowledge to help answer important clinical questions.

Radiologists don’t just look for pathology – they have to work out the clinical significance of the finding and relay that to the clinician in a way that allows them to understand what next steps they need to take. If you want to have that kind of role in shaping patient care, then Radiology is for you.

As simple as it sounds, another reason I like Radiology is because it is just so cool. Many a patient has expressed how interesting it is to be able to see “inside” a person, and I can’t help but agree. In real-time, I can look at someone’s aorta, or watch them swallow contrast and see it go through the oesophagus into the stomach. You learn about the physics of medical imaging which can be very tough but also very interesting (I now actually understand the difference between T1 and T2-weighted MRI imaging – that was a tough physics lesson!) I am constantly being pulled away by colleagues to look at an interesting finding CT or MRI, and no two days in work are ever the same. 

This is a specialty in which doctors have a notoriously good work-life balance, although this is beginning to change for consultants dealing with an ever-increasing workload. Every consultant and trainee I met on my taster week told me how happy they were and how they would highly recommend Radiology, and nationally it is one of the highest-ranking specialties for clinician satisfaction. 

What is the training programme like?

Radiology is understandably competitive to get into. Trainees undergo a five-year run through programme and will often start with no nights or on-call shifts, and will always be heavily supervised, allowing plenty of time to focus on learning.

Training Pathway

Clinical Radiology has a 5-year run-through training programme (ST1-5), however, you may choose to specialise in interventional radiology in which case there is an ST6 year. There is no application process for ST3 post as this is a run-through programme. You can find out more about the training pathway for clinical radiology here.

Clinical Radiology pathway

Image from here

Life as a Radiologist

Most patients will make contact with the radiology department when seeking help for a health issue, so contrary to popular opinion, Radiology trainees end up with quite a lot of patient contact. I currently have two ultrasound clinics, one breast clinic and one fluoroscopy list per week. This means I have contact with patients every day, and instead of standing behind a consultant writing notes, running off to write discharge summaries or sending off referrals, I get to spend one-on-one time with patients. I really love being in the breast unit because I get to be part of a fantastic team who are not just performing important investigations, but also supporting patients as they go through a daunting and emotional process. It also means I get to be involved with a variety of image reporting, ultrasound and biopsy. 

The application process

To help build your portfolio you should understand the application process for Clinical Radiology. Look at the RCR’s website for more information: 

November - Applications open on Oriel (the same website you'll have used for F1/F2)
This part of the application is simple. You must ensure that you meet the Person Specification which includes:
– Medical degree
– GMC license to practice
– Completed (or due to complete) Foundation Training within 3.5 years of the start date
– Eligible to work in the UK
– 18 months or less experience in Radiology by the time of the interview date
December - Bookings for the Multi-Specialty Recruitment Assessment (MSRA) open
If you meet the eligibility criteria (see above), you will be asked to book an MSRA slot. This is an online exam that taken in a Pearson Vue Computer Testing Centres which are dotted around the UK. The booking process is first come first served so book quickly! There is a minimum cut-off score that you must meet to be invited to interview. The MSRA score also contributes to a third of your final application score, so you must do as well as you can in this exam.

The MSRA test is split into 2 sections:

Section 1: Professional Dilemmas (Situational Judgement Test)

Time: 110 mins
What it covers:
1) Professional integrity
2) Coping with pressure
3) Empathy and sensitivity

Question Types:
1) 29 Ranking Questions: Rank all responses in order of appropriateness, as discrete actions
2) 29 Multiple Choice Questions (MCQs): Choose the 3 best responses out of 8. Taken together, the 3 responses should fully resolve the situation.

Section 2: Clinical Problem Solving
Time: 75 mins

What it covers:
1) Cardiology
2) Dermatology/ENT/Ophthalmology
3) Endocrinology/Metabolic
4) Gastroenterology/Nutrition
5) Infectious disease/Haematology/Immunology/Allergies/Genetics
6) Musculoskeletal
7) Paediatrics
8) Pharmacology & Therapeutics
9) Psychiatry/Neurology
10) Renal/Urology
11) Reproductive
12) Respiratory

Question Types:
1) 43 Extended Matching Questions (EMQs)
Presented with 7-10 response options, followed by multiple questions linked to this response set. Select the 1 most appropriate response for each question. Each response can be selected once, more than once or not at all.
2) 43 Single Best Answer Questions (SBAs)
Given a scenario: Select the single most likely answer/diagnosis out of 5-8 response options
3) A few Multiple Best Answer Questions (MBAs)
Given a scenario: Select the 2 or 3 most likely answers out of 6-8 response options

Early January – Sit the MSRA

How to prepare for the MSRA
I advise you start revising 2 months before the exam date. Use at least one or two online question banks (e.g. Passmedicine, MCQ Bank, etc.) The old Oxford Handbook practice SJT questions are useful also for revision. Complete the MSRA sample questions which are available on the GP recruitment website and take the Pearson VUE generic tutorial to familiarise yourself with the controls and screen layouts (you will receive an email about this prior to the exam). 

Early February – Invitation to interview

Your portfolio should be ready at this point and you should have ideally already started preparing for the interview. Once you receive your invitation it is time to ramp up the interview prep. 

Early February – Interview

Your interview will be in Stuart house, not in the RCR building (people make this mistake every year!) 

You will have three stations at the interview: 

1) Portfolio Self-Assessment Station
This is where you score your own portfolio out of 10. You will move to another station later where interviewers will question you on why you have scored your portfolio a certain way. You should be honest but also be savvy about this: if you think there is a chance you can get a point for something then put a point down. You will have to justify this in the interview room later, so be prepared. I got points where I didn’t think I would, so read the assessment criteria thoroughly!
2) Interview station - Contributes to one third of your overall score
Practice, practice practice. There are loads of useful resources to prepare for interview but the most important thing to do is ask Radiology trainees what questions they got and learn from this. Be as honest and relaxed as you can. You will only get 3 or 4 questions so learn to answer questions in a way that drops in all of your qualities and achievements. The Society of Radiologists in Training has a fantastic example of this (see resources below). Be prepared for a range of questions and not just the usual “Why Radiology”.
3) Portfolio Scoring Station - Contributes to one third of your overall score
This is where you have to justify the points you’ve given yourself, so again you should be honest but also don’t be afraid to go for points if you think there’s a chance you’ll get them!
How to use the Portfolio Scoring Station to your advantage!
Radiology is different to other specialties because in this station you will be the one guiding the interviewers through your portfolio. You should prepare for this in several ways:

Have a beautifully laid out portfolio: You should be able to find everything they ask you to show easily. You should not have to look hard for anything. Highlight and colour code things so that the interviewers see your point-scoring evidence quickly and clearly. You should look at CST and Radiology trainee portfolios for inspiration.

Preparation: When the interviewers say “show me why you scored yourself two points for teaching”, you should be able to flick to the correct section with the portfolio facing the interviewers, not you. You should not be turning the portfolio to face you or trying to desperately flick through to find the page you want. I recommend practising this when you prepare for the interview. Have friends ask you to “show me…” and try to find the page smoothly as possible. Following the previous tip will help you with this.

Impress the interviewers: They’ve asked you to show your evidence of taster week. Don’t just show them the certificate, show them the reflection you did after (this should be on the next page). If you’re asking about your teaching experience, justify your points by showing them an analysis of the teaching feedback you received, the reflection you wrote about your teaching after, and how this shaped future teaching sessions.

A few days post-interview – Submission of job preferences

Early March – Offers!

How to build your portfolio

Building a Radiology portfolio is not too challenging but it is worth bearing in mind there are a few things that you will only score on if you have completed them within a year before your interview (normally held in February). It is really important to speak to ST1s because the criteria can change every year and so they will be able to give you the most recent advice on what you need for your portfolio. You should also read the RCR’s website for information on what they are looking for as the point scoring system is based on this (see below).

You will likely need to show evidence of:

  • Research into a career in Imaging through a taster week (minimum)
  • Undergraduate and postgraduate degrees and qualifications
  • Clinical Governance, audit and quality improvement
    • This is important. For full marks, you must have presented two quality improvement or closed-loop audits at national conferences for two points within the last year.  
  • Teaching and training experience 
    • For top marks, you either should have a Pgcert, attended a course such as Teach the Teacher, or be involved in a national teaching programme such as ATSP
  • Research activity and Publications 
    • First-author publication in a peer-reviewed journal will get you two points for this.
  • Evidence of discretionary effort/ achievement 
    • This is about achievements outside medicine. Do you play an instrument? Sports? Have you won a competition? Been involved in a big charity project? Put it in your portfolio. 

When I applied there were no points for leadership roles or prizes, however, I put these in my portfolio and showed them off at the interview. Be aware that the assessment can change yearly, so while I don’t think you should overfill your portfolio, I do believe it is important to prepare to show off important achievements don’t expect to come up. 

Useful Resources

By Dr Lara Jehanli BMBS, The SRT Secretary

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