Bursaries awarded in 2016
Final year medical student, Hull York Medical School
I was privileged enough to receive a travel bursary to help towards my medical elective. Here is a quick run through of what I managed to pack into six weeks!
My medical elective was completed in the ‘Jewel of the Mediterranean;’ Malta. I was placed in Mater Dei, the main hospital in the country, providing care for everyone on the islands of Malta, Gozo and Comino. I did a six week elective and made the most of my time there. Choosing Malta was an easy decision as it has a health care system very similar to the one in the UK; namely being free to access and with a Primary and Secondary care system. I wanted to further my knowledge of radiology and decided it was vital to go somewhere with similar technologies to the UK, so that I could gain transferable skills to use back at home. Malta has a huge amount of history and culture; something else that appealed to me as I have always had an interest in history, and I thought I could combine several of my passions. I wanted to be able to say that I had truly explored whichever country I had visited whilst on my elective as it is such a great opportunity to live as a local for six weeks, and with Malta being so small I certainly managed this!
I found the first day very daunting, mainly due to the language barrier. I was aware that English is the official second language after Maltese, and was told that a vast majority of the island speaks English, but in reality, whilst they are all fluent, most of the time they communicate in Maltese. This was quickly resolved, and I got to know the team well. Soon I was being invited to observe and get involved with numerous procedures/imaging techniques. The department was large, so there were always procedures going on, and everyone was willing to teach. I spent time with many consultants and registrars which gave me the opportunity to see many imaging modalities. This included time spent in Interventional radiology; where I saw many angioplasties, a cerebral angiogram which revealed a stenosis in the sigmoid sinus, performed in the brand new angiography suite which opened while I was there!
I watched many paediatric ultrasounds, where I saw a Wilm’s tumour, another post nephrectomy and also many screening scans for developmental dysplasia of the hip (DDH). I discussed the possibility of scanning every child for DDH and not just for those at high risk. This is something that other European countries are currently doing, and something currently up for debate in Malta.
In particular, I found the time spent with the Musculoskeletal radiologist extremely useful, as seeing so many ultrasounds being performed reinforced my knowledge of anatomy, and helped me appreciate what is ‘normal’ and thus to recognise when there is pathology present. I managed to follow some patients from their initial ultrasound scan, through to their fluoroscopy guided steroid injections, right to their arthrograms, allowing me to see how different pathologies are seen with different modalities. I saw lots of breast MRI’s and ultrasounds being performed and reported, including some fine needle aspirations and biopsies, which also allowed me to improve my technique of breast examination, as I could examine the lesion, and then seconds later actually see what I had felt; giving me a much better understanding of what a fibroadenoma feels like as opposed to a probable malignancy for instance. I learnt some simple things like how to determine on scan whether there is fatty infiltration in the liver, which is something I appreciated, as due to the nature of our MBBS course we do not get to spend much time observing scanning or reporting. I was even allowed to do some supervised scanning, which was really beneficial, as it gave me a better appreciation of the technique. This is something I had been unable to do in the UK. Another great experience was being allowed to insert a drain for malignant ascites; a great experience after watching so many of them being inserted over the previous six weeks.
I spent the majority of my time with a hepatobiliary radiologist, as he gave me the most time and taught me so much. He introduced me to procedures such as microwave tumour ablation, and ellastography, just to name two. I was exposed to so many modalities and procedures, and genuinely feel like I have learnt much more about the specialty I want to pursue in the future and feel more motivated than ever; as radiology is something we only get limited exposure to in our normal medical curriculum.
On the whole, I undertook an observational role; however I made a point of asking the clinical indications for a scan, or looking up any findings or abnormalities I had not been exposed to or witnessed before. Most things I learned about the practicalities of scanning such as how to actually use the ultrasound machine and the physics behind the process will probably not be useful until I start my postgraduate training, but it is always good to appreciate. I feel that I have gained a vast amount of knowledge from my elective, including my favourite fun fact; it is very common on Malta’s smaller sister island of Gozo to have familial splenomegaly! I scanned someone from Gozo and found a spleen of 18cm, and naturally was shocked! Only to be told that it is a common occurrence!
I found speaking to other radiology trainees useful as it made me realise what is important for me to do in order to improve my chances of being accepted onto the training programme in a few years’ time. Being around so many scans and people reporting also gave me more experience in plain films, ultrasounds and CT’s which will be extremely useful as a medical student and junior doctor on the wards. I loved reporting, as it gave me the opportunity to test what knowledge I had obtained over the six weeks and put it into practice. I can honestly say that my knowledge of the specialty has improved immensely, and more importantly for me, it has confirmed that this is the career path that I want to follow, and made me motivated to do so.
Overall, I thoroughly enjoyed my elective. As well as being in a great department who were very supportive, I took full advantage of my weekends in Malta and discovered several lovely places and made many memories that will last a lifetime. Due to so many students of different nationalities coming to Malta for their elective, I met great people from all over the world, such as Australia, Vietnam, Spain, Italy, New Zeeland and of course Malta, giving me the opportunity to talk about what medicine is like all over the world and discuss both the advantages and disadvantages. I consider myself privileged to have been awarded a bursary by the Royal College of Radiologists to help with the costs of my travel, and appreciate the help so much! It allowed me to make even more of my elective, and learn lots about both radiology as a specialty and the Maltese culture! What’s more, to top off an amazing experience, I was proposed to by my now Fiancé, truly making Malta the best experience I could ever have wished for.
Year 4 medical student, University of Newcastle Medical School
For my elective, I travelled to Thailand and spent four weeks at a big university hospital in the middle of Bangkok called King Chulalongkorn Memorial Hospital. I spent my time in the bustling radiology department, attached to the neuroradiology sub-team. The aim of my elective was to not only to improve my skills at spotting pathology on films, but also to explore radiology as a possible future career.
There were film reviews every morning, where the registrars presented particularly challenging or interesting cases. The consultants would then work through the case, quizzing and teaching. I saw a huge amount of rare (and sometimes bizarre!) pathology, and getting teaching from leading consultants in the field was a brilliant experience. I was always so impressed with their ability to look at subtle differences in the scan in front of them and confidently make a diagnosis, which would make a big difference to the patients up on the wards.
I spent time in the afternoons on the hospital radiology system looking at emergent scans. I made myself work through the scan before looking at the provisional reports - which were fortunately in English! Over the four weeks I (slowly!) started to spot more and more abnormalities myself which was a brilliant feeling. Every week there were MDT meetings to attend, chaired and lead by the radiology consultants. My favourite was the paediatric neuroradiology MDT. As a tertiary center, any interesting or rare cases were seen by the department, meaning the MDTs were full of lots of unusual pathologies that I had never seen outside of textbooks before. It was lovely to see each doctor presenting a case at the MDT begin by thanking the radiology team for their input with each case, something I hadn’t seen so far at MDTs in the UK! There was always a lot going on in the department, such as afternoon journal clubs. Everyone in the team, including the most respected consultants in their fields, were keen to stay on top of advances in radiology to provide the most up-to-date care to the patients passing through the department.
For any undergraduates considering organising their elective, I can thoroughly recommend spending time in a radiology department. It is a valuable opportunity to see what the specialty is really like, and I certainly left wanting to see more. You also get to work with some of the most knowledgeable doctors in the hospital and see a huge variety of medical and surgical cases. I’d like the thank the Royal College of Radiologists for their very generous support which made my elective possible!
Year 4 medical student, University of Birmingham Medical School
My five-week long summer elective experience took place at Birmingham Heartlands Hospital. I had three main objectives I was aiming to fulfil by the end of my placement. Firstly, to improve upon my depth and breadth of knowledge of radiological principles and practice. Secondly, to understand the operation of a radiology department at a large district general hospital in terms of integration within it and working with other parts of the hospital. Finally, I wanted to be able to make an informed choice as to whether radiology is a suitable potential career for me. Through a range of activities at the hospital, I was quite comfortably able to meet all of these aims.
My time was split evenly between diagnostic and interventional radiology. During a typical week I spent two days in interventional theatres and observing other image-guided procedures. I spent a further two days in diagnostic radiology where I sat in on reporting sessions and received teaching. On the fifth day I was able to direct my own learning – for example observing subspecialist procedures or radiological procedures outside of the radiology department (e.g. in cardiology). In my own time I also read around the procedures, imaging, and pathologies that I had seen.
To experience diagnostic radiology, I spent time with various consultants and registrars and became familiar with the radiological interpretation of all areas of the body in different modalities including plain films, ultrasound, fluoroscopy, CT, MRI, and nuclear imaging. I am now able to better interpret findings on these tests and understand their significance in disease processes. I also learnt the mechanisms and limitations of each modality and how this information could be used to utilise them suitably to diagnose and manage disease.
During my time in interventional radiology I saw a wide variety of both vascular and non-vascular fluoroscopic procedures. The vascular procedures I observed were varied and involved many different vessels of the body. They included many types of angioplasties, arterial and venous stent insertions, and arterial embolisations. Non-vascular procedures I saw were equally diverse and ranged from nephrostomies to vertebroplasties to hepatobiliary procedures such as TACE and PTC. As well as fluoroscopic procedures I also became familiar with a wide variety of imaged-guided procedures (both CT and USS). These included line insertions, tissue biopsies, drains, and more specialized procedures such as radiofrequency ablation. Through my observation and reading around all of these procedures I became familiar with the wide variety of techniques and equipment used in these procedures in different circumstances and appreciated their role within the overall management of pathologies.
During these experiences I also developed an understanding of the roles of different members of the radiology department. For instance, I learnt about the crucial role of radiographers, theatre nurses, and HCAs in carrying out interventional procedures. I was also taught by various members of the team. For instance, after spending time with radiographers I learnt how studies of various modalities were taken and assessed for quality. This was important for me as it demystified the inner workings of the radiology department and I now appreciate the variety and depth of activity taking place.
I also witnessed the role of the radiology department as a whole within the hospital. I was able to see many interactions between the radiology department and other hospital departments. For example, I learnt how requests can be best made of the radiology department – be it by providing an accurate clinical history for imaging or by requesting the right investigation in the first place. On a wider scale I also sat in on various MDT meetings where I saw the role of radiologists in decision-making processes by explaining and justifying their interpretation of complex findings to a range of healthcare professionals. I have learnt how each side can best interact with the other, and this will be useful to me at all stages of my future career.
I explored the overlap in roles between radiology and other specialties by spending time outside of the department. For example, I observed stress echocardiography and coronary angiography, endoscopic procedures, and vascular surgery which are all procedures that overlap with the work of the radiology department. I was thus able to appreciate the breadth of knowledge required as a radiologist and the ramifications of this overlap in the future practice of radiologists.
One of the most useful outcomes of this placement for me is that I can now make an informed decision as to whether a career in radiology is suitable for me. I developed an understanding of the process of training and the nature of the work in the specialty – seeing both it’s advantages and disadvantages. During my time, I saw that radiology is a demanding and difficult career choice. It is a competitive field that requires a great deal of knowledge, intelligence, and perseverance to excel in. Despite this, I am very attracted to it for a variety of reasons. E.g. radiologists are highly skilled and valued members of the hospital who are in a prime position to facilitate patient care, although this is not always appreciated by others. I was also intrigued by the wide variety of work available and subsequent scope for subspecialisation which I think I would allow me to find my niche.
Consequently, I am seriously considering radiology as a potential career. I intend to work towards becoming an excellent radiologist over the next few years. To do this, I will first aim to become a great doctor in general as radiology heavily involves clinical reasoning, problem-solving, knowledge of anatomy and physiology, and – contrary to popular belief – patient contact. I will also aim to develop skills that are specific to radiology – for example spending time interpreting films or trying to carry out as many ultrasound-guided procedures as possible. I have also identified my own deficiencies – for example anatomical knowledge – which I hope to address in the future.
Ultimately, my elective experience was invaluable in developing me both personally and professionally and I have gained all I had aimed for and more. I believe I can build on this experience and use it in the future to become successful in any career pathway. I would recommend an elective in radiology to any student interested as it is a unique opportunity given the limited exposure to the specialty in medical schools in the UK. I would finally like to show my gratitude toward the RCR for the extraordinary support provided – including the RCR elective bursary – and encourage other students to endeavour to make use of this provision.
Year 4 medical student, University of Birmingham Medical School
In May 2016, I undertook a 4-week elective in Bach Mai Hospital, Hanoi, Vietnam. During this period, I had the opportunity to spend time in the Radiology department, therefore fulfilling my aim of experiencing Radiology in a developing country. Bach Mai Hospital is an urban District General Hospital and currently one of the largest hospitals in Vietnam, having around 1400 beds.
My timetable involved watching patients undergoing x-ray, ultrasound, MRI and CT scans, as well as sitting in on the reporting of these scans. I also attended department meetings in the mornings in which case discussions took place. In the final week I delivered a presentation at a department meeting about medical education in the UK. I was taught to recognise pathology that is much rarer in the UK, such as advanced tuberculosis on radiographs.
I was able to draw many interesting comparisons between Radiology in Vietnam and the UK. For me, the most notable finding was the hours that the trainee radiologists worked in Vietnam; 7 days per week every week, with only 3 weeks’ holiday per year. Despite this, doctors remained in high spirits, dedicated to providing an effective service for their patients. The training for Radiology in Vietnam is also different to that in the UK; medical students are taught Radiology as part of their curriculum to a greater degree than in the UK. I feel that medical students in the UK should have more Radiology in the curriculum as well as much earlier exposure. There are only 12 medical schools in the entirety of Vietnam. After completing 6 years of medical school, doctors become a ‘resident doctor’ for 3 years, where they are immediately undertaking the role of ‘junior radiologist’, rather than the foundation years required of doctors in the UK. This may explain why there is the need for a greater degree of Radiology training at medical school as they are immediately required to undertake the role of ‘Radiologist’. Following the 3 years as a resident doctor, they then become the equivalent of a consultant radiologist. Unlike the UK, there was a lack of sub-specialisation within Radiology; the only subspecialty was interventional neuroradiology.
The Radiology department had 8 CT scanners, 8 MRI scanners, several ultrasound and x-ray machines, and interventional Radiology. Like the UK, they had also made use of the PACS system which was introduced 5 years ago. However, the hospital took over 1000 radiographs per day which meant that their version of the PACS system was not large enough to accommodate them. Therefore, radiographs were still reported on a lightbox. Unfortunately, this resulted in a huge amount of paperwork which was expensive for the hospital.
The indications for scans differed from the UK in some instances, such as every post-operative patient had a chest radiograph every day for 4 days after their operation due to the high risk of pneumonia. Furthermore, every patient with lung cancer had an MRI head due to lung cancer patients commonly presenting late and therefore suffering with coexisting brain metastases. Interestingly, requests for scans were not accompanied by a brief patient history, as they are in the UK. This made it difficult for radiographers to know which part of the anatomy to focus on and the sequence to adopt during the scan. It also made it more difficult for radiologists to write the most useful report for the requesting clinician because they didn’t have a specific question to answer.
It was fascinating to see the speed of patient turnover, especially through x-ray and ultrasound; full abdominal x-rays were completed within a few minutes and radiographs were interpreted in seconds. I was told that this was as a result of a high demand from patients, who travelled up to 500km, to receive the services of the main city hospitals as opposed to the less trusted services of the province hospitals. Additionally, many patients requested scans as a ‘general check-up’ despite a lack of any symptoms. Unlike in the UK, patients requested scans instead of the doctor, so long as they could pay for them. This meant that the majority of scans were actually reported as normal. On talking to the radiologists, I realised that this posed the most significant challenge for them, as the result of such a high turn-over rate was that doctors were rushed and diagnoses were inevitably missed.
I want to thank RCR for helping to fund my elective. I have found this elective inspiring as I have experienced the exciting field of Radiology in a completely different environment to the UK. I believe that witnessing the many positive aspects in the Radiology department in the Bach Mai Hospital has broadened my outlook, as well as increased my interest in pursuing a future career in Radiology and the opportunities that it provides.
Bursaries awarded in 2015
Final year medical student, University of Leicester Medical School
For my elective, I arranged a 6-week radiology placement at University Hospitals Leicester NHS Trust. The elective program was designed so that I got the chance to spend 2 weeks in each of the 3 Leicester hospitals. The aim of the elective was to get an introduction to the speciality of Radiology. I wanted to be able to rule in or rule out radiology as a career option at the end of 6 weeks.
In my first two weeks at the Glenfield Hospital, I got to see musculoskeletal radiology. I observed ultrasound guided arthrograms of the hip, knee and wrists. I observed MRIs being carried out and then sat in to report the images. I learnt to recognise the differences between T1, T2 and fat suppressed images. I was able to appreciate normal anatomy and pathological changes in these images. There was the chance to see thoracic radiology as well. I practised interpreting plain chest radiographs, which is an important skill for a junior doctor. I also discussed CT thorax, cardiac CTs and CT angiograms with the consultants I was with where I saw pathologies such as collapse, consolidation, tumours, pneumothorax, PE, coronary artery disease etc. Watching how myocardial perfusion imaging is done and then looking at the images later on was also very interesting.
A common misconception about radiology is that you have to sit in a dark room all day looking at a screen. Although, reporting scans is a big part of the job, there is scope for patient contact when performing procedures such as barium studies, ultrasound or CT guided biopsies. I could see that patient skills are equally important when consenting for these procedures and explaining it to the patients. Communication skills are also important as the radiologists form a key cog in MDT meetings and in general inpatient management. I attended the lung cancer MDT and saw how crucial imaging is in the management of our patients.
During my 2 weeks at Leicester General Hospital, the focus shifted more towards the abdomen. I got familiar with abdominal ultrasounds including those in acutely unwell renal transplant patients. I saw pathologies such as tumours, inflammatory bowel disease, diverticulitis, appendicitis etc. I got further experience of nuclear imaging when I sat in to report V/Q scans, bone scans and indium WBC scans. I got some “hands-on” experience when I was able to assist in inserting and changing nephrostomy tubes and chest drains. I also spent an afternoon observing ERCPs where I saw some straightforward gall stone extractions, but also one that got complicated due to a device failure. The basket that was being used to extract the stones had got stuck and would not come out. With the patient getting restless and retching with a tube down their throat, the radiologist had to be resourceful and lead the situation. He had to ensure the patient received enough pain relief and sedation to tolerate the procedures, try to extract the faulty device from the patient's bile duct using all his knowledge and tools available. In the end, using some improvisation and the help of experienced nurses, the situation was resolved.
At the Leicester Royal Infirmary, I spent time with the paediatric radiologists. I saw barium studies in children, ultrasound head in premature children for germinal matrix haemorrhage and how MRIs are conducted differently in this patient group. Another huge part of my learning in the LRI was in the A and E reporting room. Here, I got the chance to experience neuroradiology. I saw pathologies like extradural and subdural haematomas, subarachnoid haemorrhage, cerebral infarcts, haemorrhagic stroke, MS, tumours etc. I also observed vascular interventional radiology where I saw angioplasties and therapeutic embolisations being carried out.
By the end of my elective, I had experienced a variety of radiological investigations and got a good feel of what the speciality is all about. I was also able to appreciate how important the speciality is, but also realised the limitations of imaging. As medical students, it is easy to think of CTs and MRIs as a gold standard investigations that hold all the answers. However, this is not usually the case. Differential diagnoses are always made on history and examination. Radiology will only help when a specific question is asked of it to rule in or rule out a diagnosis or plan management. Additionally, speaking to the trainees and consultants gave me a good idea about the training pathway and what would be expected of me. I was offered to take part in an audit project during the next few weeks, which I would quite happily be involved in. I am glad that I did this elective because now I have identified a speciality that I really enjoy and it has helped me make an important decision regarding my future career.
Year 2 medical student, University of Cambridge Medical School
For my elective, I travelled to Wellington Hospital in New Zealand for a 7 week placement with the radiology department. Radiology has always interested me and I was keen to improve at plain film and CT interpretation before my foundation years as I believe these will be important skills to take to the job.
During my time in the department, I spent my mornings with the registrars and my afternoons doing data collection for the audit. The mornings were valuable because I was lucky enough to receive one-on-one teaching from whichever registrar I was shadowing. In New Zealand, they are very used to having students and are encouraged to see teaching as a part of the job so they didn’t mind taking me under their wing. This made it a very enjoyable experience and I learnt a lot especially through having my anatomy knowledge thoroughly tested! I really liked this attitude to teaching and hope to emulate this in my future practice. I spent most of my time on plain films and CT, since I think these will be more useful to me in the short term, but I was also able to spend time on MRI, ultrasound, and fluoroscopy and watching interventional radiological procedures.
In the afternoons, I carried out data collection for the audit set up for me by my supervisor, Dr Arun George. We are looking at whether interventional radiology, such as taking biopsies, impacts upon a patient’s survival when a new mass is found in a patient with a previous history of cancer. We hope to look at the results from both a palliative care and radiological perspective in order to come up with conclusions and guidance for further research and future practice. I had just finished data collection when I left and so we were not able to spend much time looking at the results but our preliminary observations suggest that there was a positive correlation between a new mass having malignant histology in a patient with a previous history of cancer, perhaps suggesting that they may not need the procedure to determine this in the future. Once we have the information on 6 month mortality, we are hoping to begin writing the paper in the near future.
Overall, I really enjoyed my elective in Wellington Hospital and loved my department. Everyone was very friendly and welcoming and I learnt so much during my time there. It was a brilliant introduction to radiology as a career and I would like to thank the RCR for their bursary to help make it possible.
Year 4 medical student, University of Sheffield Medical School
I undertook my elective placement in the Department of Radiology at the University of Tokyo Hospital, Japan. My supervisor had developed a computer-assisted detection tool for automatically detecting lesions on various scanning modalities and I spent my elective carrying out a research project to evaluate the performance of this tool in detecting cerebral aneurysms on CT angiography.
My role was to first identify and create 3D models of the aneurysms in a cohort of patients who had undergone CT angiography. My ability to understand CTAs grew rapidly and soon I was able to readily identify the aneurysms, as well as other variants of the cerebral vascular anatomy. Following this, with my supervisor’s guidance, I was able to feed the information into the computer-assisted detection tool and generate results.
I found the research experience to be extremely valuable and would recommend undertaking a research project during the elective period. Opportunities to develop research skills are hard to find within the medical curriculum and often it can be difficult to commit the time required to do research on top of clinical placements. The elective period therefore provides the perfect time to do this.
In addition to the research project, I was able to attend clinical meetings and an international radiology conference. These were enjoyable and also gave me the opportunity to travel outside of Tokyo.
I very much enjoyed my elective period and felt that I gained excellent experiences from it. I am very grateful to the Royal College of Radiologists for their generous support, from which I was able to fund this elective opportunity.