Radiology ST1 Applications 2021/2022

 

 

On this page we give an overview of Clinical radiology training and the application process. We delivered a workshop on how to get into radiology at the SRT 2022 conference with the help of IR Juniors, Please see on our YouTube channel (Session 1: application overview, Portfolio and MSRA, Session 2: Training structure and Interviews).

Radiology Training and Curriculum

 

Clinical Radiology Training is a 5-year run-through programme (ST1- 5) with an additional year for training in interventional radiology if that is your chosen career. ST1-3 consists of ‘Core training’, where trainees are expected to develop general radiology skills enabling them to deliver general acute and emergency services. ST4-5 are subspecialty training years for developing more advanced skills whilst maintaining general radiological skills. The Clinical Radiology training curriculum was updated in August 2020, increasing the flexibility of training and emphasising the importance of maintaining general radiological skills including basic image guided practical procedures.

https://www.rcr.ac.uk/clinical-radiology/specialty-training/radiology-curricula

Types of training: Academies vs. traditional schemes

There are now 2 styles of training – academy and hospital-based training. Traditionally, the hospital-based style of training has been used. Trainees are expected to be within the workplace, reporting studies and performing interventions under supervision in an apprenticeship style of training. Academy training is off-site learning using a vast archive of radiological images to learn from. Time is still scheduled to be spent in the clinical environment in nearby hospitals regularly and increases as trainees become more senior.

Peninsula radiology academy has a purpose built building for teaching clinical radiology trainees. They usually have a yearly open day where you can learn more about what it is like to train at an academy. More information can also be found on their website (https://www.penra.org.uk/open-day/).

Post CCT fellowships

Learning does not stop once you have completed your consultant training. While not compulsory many people opt to undertake a fellowship year or two prior to starting a consultant post. This gives the opportunity to learn an additional subspecialty in greater depth or to learn to report a particular imaging investigation or perform a procedure that is only done in a small number of hospitals. These are often advertised by the hosting institutions individually.

Academic clinical radiology training

The official academic training route in radiology involves applying to an NIHR funded scheme which in ST1 is the Academic clinical fellowship (ACF). This typically runs from ST1-ST3 and usually 25% of your time is funded to be protected for research. This may take the form of one day a week of undertaking research or separate dedicated research blocks of a few months each year/during training. Your research progress is usually reviewed at ARCP and it will often give you time to find a project and apply for funding for a PhD, MD or fellowship to undertake between core training and subspecialty training.

It is important however, you are clinically competent as you need to still complete what is expected of a clinical trainee in less time. You still need to apply for clinical training alongside the ACF application and be deemed to a standard to be offered a clinical post as you will also be undertaking clinical radiology training alongside the academic training. After ACF if you want to continue along the academic route you will need to complete a PhD or MD between core and higher training to be eligible for a clinical lectureship, which would mean you can continue research alongside ST1-ST5/6 subspecialty training.

ACF posts vary in type and region every year and are advertised on oriel annually prior to the clinical application deadline and the potential projects advertised. It is often best to contact the organiser given in the advert to ensure the project is one you would enjoy before applying. See the NIHR website for more info and to see the desired criteria for applicants. (https://www.nihr.ac.uk/explore-nihr/academy-programmes/integrated-academic-training.htm)

There are often very few ACF and clinical lecturer posts and they are usually competitive. If you can not get a post or feel it is not right for you but are still interested in research then there are other options to pursue this as part of your career. Often it is still possible to undertake research alongside training out of interest, in recognition of this the RCR have developed a research curriculum you can follow in your own time to receive a ‘RCR research certificate’ to acknowledge the gained experience. (https://www.rcr.ac.uk/clinical-radiology/academic-radiology-and-research/research-certificate)

 

 

RADIANT UK is a collaborative research network affiliated with the RCR that provides trainees with opportunities to get involved in high-quality multi-centre research projects (www.radiantuk.com)

FRCR Examinations

First FRCR:

Towards the end of ST1, around March on anatomy and physics.

Please see the RCR website for more details (https://www.rcr.ac.uk/clinical-radiology/exams/frcr-part-1-radiology-cr1). 

First FRCR – Anatomy:

Consists of 100 free text questions where you are asked to identify the normal anatomy on a single picture of any imaging type (Plain film, CT, MRI, US, fluoroscopy).

The best way to learn anatomy is to look up anatomy in an atlas or online while reporting. A useful book atlas is Weir & Abrahams’ Imaging Atlas of Human Anatomy. There are some good online anatomy atlases such as eAnatomy (https://www.imaios.com/en/e-Anatomy). There are also online question banks where you can test yourself such as the free radiology cafe anatomy mock papers (https://www.radiologycafe.com/exams/mock-anatomy-exams/).

First FRCR – Physics:

Consists of 200 true or false questions on medical physics.

This is often reported to be one of the most challenging exams as it is very different from what most people have previously learnt. The best way to learn medical physics is by reading up on it in Farr’s Physics for Medical Imaging. Radiology cafe additionally has great up to date physics notes free online, and is also available as a text book (https://www.radiologycafe.com/frcr-physics-notes/). Another great resource is the Radiology-Integrated Training Initiative (R-ITI), an e-learning resource created by the RCR which covers the topic in great detail on an interactive platform (https://www.e-lfh.org.uk/programmes/radiology/). There are additionally a number of practice question books and online question banks.

2A Final FRCR exams 

Usually done early ST3 Consists of two 3 hour single best answer papers sat on the same day or week. This can be on any part of radiology to assess clinical radiology knowledge, for example, pathology and imaging techniques. A great resource is the Radiology-Integrated Training Initiative (R-ITI), which covers all of the RCR clinical radiology curriculum (https://www.e-lfh.org.uk/programmes/radiology/).

2B Final FRCR exams 

Usually done early ST4. The final exam during training, and has 3 components:

  • Rapid reporting of plain films
  • Long cases
  • Viva; oral discussion of cases

This is often the exam that trainines report being most similar to their day to day job and therefore one of the best ways to prepare is to report lots of scans and to practice presenting cases to consultants. Often 2B style teaching (presenting cases) will start from ST1.

Oriel application process

Applications are accepted through Oriel. Important dates for the 2021 applicants are shown in Table 1. The timeline is similar each year (https://www.oriel.nhs.uk/Web).

Applications Open for Academic Clinical Fellowships 1st October 2021
Applications Open for ST1 10am 4th November 2021
Applications Close 4pm 1st December 2021
Evidence verification upload dates for the portfolio assessment 17th December 2021 – 7th January 2022
Multi-Specialty Recruitment Assessment (MSRA) window 6th January – 15th January 2022
Multi-Specialty Recruitment Assessment (MSRA) results published by 4th February 2022
Invitations to Interview 7th February 2022
Interviews 21st February – 24th February 2022
Initial Offers 14th March 2022

 

MSRA

The Multi Specialty Recruitment Assessment (MRSA) is a benchmarking test used to help select candidates for an interview. The MSRA was originally used for GP recruitment however now forms an important part of the Clinical radiology ST1 selection as it is important to have a broad and general base of medical knowledge prior to starting training. The exam is marked using a normal distribution and a cut off score has been used to select who will be invited to interviews in recent years (and mark used as ⅓ of overall ranking after interview). The Exam is a single exam lasting just under 3 hours consisting of two sections:

  • Professional Dilemmas: About difficult situations that may arise in the workplace and how you would handle them. It requires ranking the best response to a situation out of multiple options. This is similar to the ‘Situational Judgment Test’ (SJT) that UK final year medical students sit.
  • Clinical Problem Solving: Typically consists of Single best answer style questions on any area of medicine typically in the setting of a GP clinic patient or ward setting.

 

For full details about the exam see this year’s applicant guide (https://gprecruitment.hee.nhs.uk/recruitment/applicant-guidance/msra).

The most important thing to know for the Professional Dilemmas section is the GMC Good Medical Practice (GMP) guidelines (https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice) – make sure to read them. Resources for the UK situational judgment test (SJT) can be useful, as the exam also tests knowledge of the GMP guidelines. These resources include practice papers (https://foundationprogramme.nhs.uk/situational-judgement-test-sjt/practice-sjt-papers/) and the book ‘Situational Judgement Test (Oxford Assess and Progress)’, although the exam format/style is not exactly the same

The best resource for the Clinical Problem Solving section is online past papers such as passmed (https://passmedicine.com/gpst/index.php), which also contains professional dilemmas questions. There are also some preparation courses, but make sure to look into them and make sure you think it may help before spending your money if they are not free.

Portfolio

The portfolio scoring criteria in recent years has been released on Oriel with applicants required to self-score and then upload evidence onto another website at a later date. The portfolio typically consists of 5 sections with 0, 1 or 2 points for each section (Max of 10 points). What is expected changes most years so try to do more than you think is required for each section if you can to ensure no surprises. Don’t get too stressed if you are not getting points for all sections, very few people get the full 10 points! Just make a list of what you need to do and work on your weak areas. 

The most important part of your portfolio is your radiology taster experience, as this when you see and decide if the career is actually for you. During your taster you can also enquire about starting an audit or other projects. It can help to write down your experience each day of your taster and reflect on it. Make sure to get a letter from a consultant saying how much taster time you had and what you did during that time.

 

For radiology audit ideas have a look at the RCR audit templates https://www.rcr.ac.uk/clinical-radiology/audit-and-qi/auditlive/search-radiology-audit-templates. There are lots of opportunities to present at conferences, such as our annual conference and the BIR and RCR annual conferences. Keep an eye out for the abstract calls/deadlines as they are usually far in advance of the meetings. The presentation does not have to be an audit or research, and could be an interesting case or teaching on a subject e.g. teaching poster on ultrasound scoring of thyroid nodules.

Interviews

In 2021 the interviews were moved online due to the pandemic and the style of the interview also changed significantly. The two types of interviews are discussed below. It is difficult to predict how the interviews will change in the future, but if they do move to be back in person it is likely they will keep many elements of the new/ online style of interview. 

 

Old style/ in person interviews

When interview were possible in person the interviews typically consisted of 3 stations each 10 minutes:

  • #1: Self marking Portfolio

Mark portfolio based on given scoring (done online last year).

  • #2: Commitment to radiology

10 minute discussion where you are asked questions on how much you know about the specialty and what makes you a good candidate. They may have asked questions on how much you know about the role of a radiologist or your thoughts about issues facing the specialty.

  • #3: Portfolio review and scoring

You would typically show your evidence from your portfolio to a panel as to why you gave yourself that number of points in each section, and they would ask you some additional interview questions.

 

New style/ online interviews

The new style of interview when moved online was changed so that the self marking and portfolio assessment was done online prior to the interview. The interview in the previous two years consisted of a 15 minute panel interview on teams, using the structure below.

General tips

  • Prepare answers for as many potential questions as possible so you are not surprised.
  • Some variation of the ‘why do you want to do radiology’ question will almost always come up. Therefore this answer should be perfected and important to make a good first impression.
  • Make sure to SELL yourself and mention your achievements when relevant to an answer (e.g. mention a prize you won or if you presented an audit nationally).
  • Try to relate answers back to something you have done/seen that is relevant to radiology (e.g. whilst on my taster week in radiology, I saw…).
  • Don’t be afraid to pause before answering and plan what you are going to say!! This is much better than getting confused and stopping mid sentence or giving a poor answer.
  • If it feels like interviewers are being harsh don’t take it personally! They are interviewing lots of people and may not be aware they are coming across this way, or may just be their interviewing technique for everyone.

 

Online/ teams specific tips

  • Test internet connection and location before (in exactly the same place!!)
  • Test lighting at the same time of day – avoid glare/sun in your face
  • Look at the camera, NOT at the interviewer’s eyes 
  • Laptop or computer height – don’t show the interviewer up your nose! 
  • Have a back up plan if wifi/computer/teams/anything fails

Resources and how to prepare

  • The book ‘Medical Interviews (3rd Edition): A comprehensive guide to CT, ST & Registrar Interview Skills’ has useful advice for generic interview skills and for the ‘what you would do in this scenario?’ questions.
  • There are interview courses or talks which may be helpful such as the one held at our 2022 conference.

Training schemes and Job rankings

After the interview you will need to decide on job rankings. This will be released on Oriel with each region and number of jobs. It is important to look into what the training scheme will be like before ranking as you will likely be spending 5 years there. The best way to get an idea about the scheme is by speaking to registrars in the region. There is also typically information available on the deanery website. 

In the 2021/22 application round there were a small number of ST1 interventional radiology jobs that could be ranked. These mean you could get additional IR training from ST1, but would still be able to change to diagnostic radiology prior to ST4 or switch into IR if not on an IR route from ST1.

SRT applications Video Talks

Please see the How to get into radiology session held at the SRT 2022 conference delivered with the help of IR Juniors. There are first session is an overview of the application, portfolio marking and MSRA. The second session is on the clinical radiology structure and interviews.

 

And finally good luck!

We wish you all the best of luck with your application and hope this overview has been helpful!

Jordan Colman (Radiology ST1 Surrey, KSS) and Emma Watura (In-coming Radiology ST1, Sussex, KSS).

 

*Disclaimer: This is only a general guide based on the authors individual experiences and so may not be 100% accurate, and is also likely to change year on year.