How to Approach and Plan for Higher Education in Radiology?

We started the section ‘Beyond the shores’ focusing on pursuing higher education abroad on the blog over a year and a half ago. Since then, we have covered various options on studying abroad, including the US, UK, Singapore, Canada, and Australia. Besides, we also covered how to prepare for various exams like FRCR and EDiR.

The plethora of choices available to the average radiology trainee in India is now phenomenal, but also quite confusing. I see an increasing trend of going abroad for fellowships/observerships, and also of giving various foreign exams. This blog is my perspective and advice on how to approach these choices and their pros and cons. I have personally spent three years in clinical fellowships in the US before coming back (so there is some bias), but have by now also interacted with numerous colleagues who have gone through different countries and systems so as to try and give a (hopefully) balanced view.

How to select the right Fellowship program for you

Know what you eventually want: In order to select the right fellowship for you, you need to first decide whether your plan is to get board certified and settle down abroad, or get subspecialty trained and return back to India. It is fine to keep both options open, but it certainly would be easier to choose the right program for you if you are clear on this upfront.

Which is the best place to learn?: First things first. While Indian training programs (especially some of the subspecialty training fellowships) are good, the fellowship training you get abroad is way better than the one you would receive in India (due to a variety of reasons we won’t go into in this blog). Overall, the clinical fellowship program from any decently good institute in the US (and perhaps Canada) is unmatchable. This is not just my opinion, but also what I have gathered from European-trained radiologists who have been my friends and co-fellows in the US. Of course European or Singapore fellowships, especially the good ones, are also excellent; you will learn a whole lot of radiology wherever you go. But essentially if you want to train in the best possible way, I would suggest aiming for a North American fellowship. (Know that Canada doesn’t need MLE scores, so it is easier to apply to but more difficult to secure compared to an American fellowship).

Where is it easier to settle down: On the other hand, settling down (at least right now in the post Brexit era) is much easier in the UK; so you could aim for that if that’s what you wish to achieve. Even Australia is opening its doors right now, and is another good option. ABR (American Board of Radiology) certification needs you to work for four consecutive years in the same institute, which is getting less predictable to secure than it used to be (but still reasonably possible). Note that these trends keep varying, so you need to know what is the scene when you are applying. Having said all this, also know that as far as salaries go, North American salaries are much more than their counterparts elsewhere.

How long a fellowship? In my humble opinion, a one-year fellowship is perfect. The European 3-month fellowships are a good option, but 3 months is not enough for an average trainee to master a subject. So if you are aiming for the 3 month fellowship, ensure that you spend at least 6 months prior to the fellowship working in a good institute in India and focusing dedicatedly in that subspecialty. For example, if you are going for a 3-month MSK fellowship, work in an MSK predominant workspace in India to prepare. Remember, all fellowships abroad are golden opportunities to learn, but they are not meant for someone to brush up on basic anatomy and common pathologies alone. The stronger your base, the faster you will impress them and the more you will learn along the fellowship. I would advise even those selected for a US fellowship to train dedicatedly on the same subspecialty in India in the time you get before the fellowship begins.

Do I really need to go abroad If I wish to settle in India? Yes and no. There are many excellent institutes in India where you can learn to become a fantastic radiologist. Having said that, the education in India is very self-driven; you will have to be more of an Eklavya learning from what you see, unlike the fellowships abroad where you will be mentored and taught by experts during the fellowship like Arjun was. So if you are an average or just above average radiologist, training abroad will be the best way forward. If you are exceptionally smart and hard working, have an aptitude for self-learning, are pro-active in attitude, and are not afraid of asking questions to the senior faculty and referring physicians to clarify doubts, then perhaps you could learn and become almost as good by simply being in a good Indian institute/ center. A smaller brownie point is the tag of a foreign-trained radiologist, particularly if you wish to settle in a metro and work in a prestigious hospital or center. The tag always helps in your application.

However, one of the biggest advantages of studying abroad is just the experience you get beyond image interpretation when you train and stay abroad. You will find it easier to create and follow SOPs, break hierarchies, confidently discuss scans with physicians, and become an overall more well-rounded radiologist and person once you are back in India.

How to plan on a successful Fellowship application

Just like Rome was not built in a day, a successful fellowship application is not something which can happen overnight; you need to plan ahead for this.

How important is having publications?: A good CV (essentially one with a few publications) is most crucial in getting the best possible institute. Know that only accepted publications can be included in the CV. Most publications unfortunately have a timeline of at least a year or so from the day you decide to write them up (even if it is a case report), so try to have a few under your belt during your residency if you wish to go abroad. Luckily, the CV can be more inclusive and includes elements beyond publications. A blog you have written, having had a departmental responsibility like say creating the resident rotation schedule, having basic proficiency in the local European language, or even working in an NGO in a medical or radiology role could help as well! Read more on how to write a good CV in our previous blog.

Are letters of recommendation helpful?: A good reference can be very helpful. So if you are planning to apply abroad, try to connect with radiologists in India who have personally worked abroad or who have good contacts abroad, share your plans, and ask for their advice. Try to work with them/in their institute if you can, as a good LOR is not going to come easy. There is no qualm in this modus operandi; you will usually get the LOR only if you earn it. A standard LOR is not a game-changer; everyone gets that. It’s the personal message or email recommending you which does the trick.

Is an observership needed?: Some trainees go abroad for observerships hoping that they can apply subsequently in the same institute. Most would club this with an exam (say STEP 2CS) or a conference (say RSNA/ECR), as you can kill two birds with one stone. This may be helpful (especially if you do not have a strong CV), and worth a shot if you have the time and money for it (I personally was able to secure a fellowship without doing an observership). I would suggest being practical in selecting your institute of observership. Try securing an observership which does not charge you any money, and try securing it in a city where you have a free place to stay. Importantly, the success of an observership is not just in impressing the faculty in that institute with insightful questions and great diagnoses; it is also in successfully writing a paper. So if you do secure an observership, email and tell them much before joining that you would want to publish something while you are there. Give them a few areas of interest if you have any, so that they can connect you to the right person to mentor you on this.

These are a few of my tips on how to create a strong fellowship application, maximizing your chances of securing your dream fellowship. Do feel free to add your views and experiences in the comments section, so that everyone can gain from them.

MD, DNB, DM, FRCR, EDiR et al; do you really need so many degrees?

During my MD residency, many of my colleagues also gave the DNB exams after clearing their MD. I didn’t, because I was very clear on one thing; it is going to take time and effort to clear the DNB exam without any potential benefit for me in the future. I can now safely say that I made the right choice. So let’s talk about when (and when not) to give various additional examinations.

Plan to go abroad for further training/ for settling down?: This is a no brainer. You of course have to give the concerned exam if you wish to go abroad. So you must give USMLE for going to the US or FRCR for going to UK (the latter helps even for other countries like Dubai or Singapore). You can probably secure the 3-month ESOR (European School of Radiology) fellowship even without giving EDiR, but now many trainees are giving it ‘just to increase their chances that extra bit’; so I suppose this will become a common trend up in a few years from now. You can read more on EDiR, FRCR and USMLE on these aspects in our dedicated blogs on these exams.

Want to keep the option open?: If you are giving FRCR or USMLE just to keep the option open in the future without any definite plans of going, its probably not worth the time, effort, and money (it costs at least 4-5 lakhs and a year or two to give the exams). You can instead just wait and give it later, if you do end up deciding to go abroad. It might delay your plans a little bit, but it’s safer than spending all that time and money without anything coming out of it in the end.

Broadly, I have seen more than 70% of my colleagues or residents who have given these exams without a definite plan to apply abroad not doing anything useful with the degree subsequently; and that’s quite a big figure! So my advice would be to instead try and decide fast on whether you wish to go abroad or not.

Clearing the exams might help in securing an observership?: I am not very certain on this one. You could literally go for a paid 1-month or longer observership and a vacation in the same amount that you are spending for the FRCR or USMLE or EDiR; besides if you spend that much time in publishing a few articles, you could boost your observership chances even higher probably.

Clearing the exams might improve job prospects in India?: This is one thing you must research in the region where you plan to work. If clearing FRCR improves your job prospects or salary, then it might be worthwhile giving it. However, whether this really does happen is questionable in many parts of the country, so ask people who know about this (I am not one of them) rather than taking this at face value.

What about DNB after MD? My take on this remains unchanged from my residency days. DNB is just another written paper followed by bruising practicals, and is equivalent to an MD degree. There is no reason to spend time preparing for another exam when you could instead be spending that time learning more clinically-oriented practical radiology in a good institute/center.

The sum of it regarding exams: My personal opinion is that many trainees are nowadays giving expensive and time-consuming foreign exams like FRCR and EDiR without any definite plan to make use of the degree in the future. They give it because they are free during the bond year, because the pay scales have improved and they have earned enough to pay for the exam, because there is a secondary incentive of getting to travel abroad, or because they see others giving it and feel some sort of peer pressure. Please think this decision out long and hard before taking the plunge, because it does involve a lot of time and expenditure. I would suggest to also consider utilizing this time and money instead on learning practical radiology in a good institute in India along with some research, and then perhaps going for a paid or free observership abroad in a good institute, along with a vacation. Don’t chase degrees, chase your dream.

Look forward to hearing everyone’s views on this!

– Akshay Baheti, Tata Memorial Hospital

30 thoughts on “How to Approach and Plan for Higher Education in Radiology?

  1. Aditi

    Dear Dr
    Thank you for a great write up
    I have some queries

    1. I understand some fellowships like musculoskeletal radiology in usa takes only american radiology graduates.
    I was wondering which fellowships are easier for international medical graduates.

    2. Is score really important for applying to usa and canadian fellowships or an average score is still fine?

    Thanks

    Like

    1. 1. MSK, breast and intervention would be more difficult to secure. Abdomen, chest, cancer, emergency, pediatric are amongst the easier ones to secure.
      2. Score is important, but not as much as your CV, which is by far the most important thing.

      Like

  2. Vikram MUNGAMURU

    “education in India is very self-driven; you will have to be more of an Eklavya learning from what you see, unlike the fellowships abroad where you will be mentored and taught by experts the fellowship like Arjun was”

    Liked by 1 person

  3. This is a fantastic article Dr. Baheti. Thank you for openings eyes of young and enthusiastic radiologists who want to apply for fellowships in abroad. I want to request you to fill in some details regarding those having DMRD. Are DMRDs allowed to do fellowship in USA/Canada/UK after clearing USMLE/PLAB? What is the status of ARDMS (USA) and DDU (Australia) certifications for a radiologist interested in developing career in ultrasonography?
    Thank you.

    Like

    1. Thanks a lot Shubham. DMRD alone is a bit difficult to secure a fellowship in the US and Canada as most institutes wont accept the application; I do not know the status with UK. Doing a secondary DNB would be advisable. Afraid I am not very sure about ARDMS either as I have not heard of it before, but in the US, sonography is performed by ultrasound techs and not radiologists (who only interpret the images). So you will have to check whether the degree is for radiologists or for technicians. You will have to find out about it and DDU with other sources. A blog on Australia should be coming up soon; keep a lookout for it.

      Like

  4. Dr Nazia Tahir

    A very good effort indeed..Though you have mentioned in quite detail, but if you find sometime and elaborate separately about securing fellowship abroad esp UK/Canada/Australia with FCPS degree

    Like

  5. Pingback: The Tata Memorial Hospital Cancer Imaging Fellowship – Cafe Roentgen

  6. Shabana

    Thank you for clarifying many doubts sir. But during post graduation i didnt do any publication sir. I want to pursue in foreign universities sir. Can i make it Without publication???

    Like

    1. There is no yes or no answer Shabana. You still can get it. UK for example currently needs more doctors! However, the chances of securing one in a better institute will always be higher if you can publish something now. It is never too late to start!

      Like

      1. Good question. You will have to into the fellowships we have covered in our blogs and see if CPS candidates are allowed to apply ; most require only MD / DNB radiologists. I think your best bet would be to directly approach pvt fellowships and ask them whether they would be willing to take you; fellowships with entrance exams which have eligibility criteria will become out of bounds. You might have to work there as an SR to demonstrate your ability snd convince them as well. Also definitely try the ultrasound fellowships ; we have listed them on our blog as well and will cover them soon. Last option is to think about giving dnb entrance. Others with experience do feel free to opine here.

        Like

  7. Dr yashasvi

    Highly informative article.. Kudos to your effort doctor. I’d request you to come on articles like how to secure good jobs in gulf. Few first person experiences will be very helpful.
    Thanks

    Like

  8. Anonymous

    Thanks, Dr. Baheti for an informative article!

    But still, it is unclear to me that What is the correct pathway for a post MD candidate to apply for a fellowship in UK without FRCR/ EiDR/ USMLE?? Please guide….

    Like

    1. I am not the best person to answer this as I haven’t worked in the UK, but from what I understand you need to either complete FRCR or PLAB to do clinical work in the UK. Would appreciate if someone else who has the experience can comment as well! Akshay

      Like

      1. Anonymous

        Thank you for the enlightening article. I however want to know what exactly constitutes a good CV before considering applying for fellowships in US, as USMLE is a tough exam to crack, especially post MD Radiology. And what year of MD Radiology is preferably good to start preparing for fellowship opportunities in the US? Especially if I have done my post graduation from an average institute limited in its academic training? If US is too tough, I would prefer focussing on the FRCR exam, which is more approachable than the USMLE exam… Could you offer me any advice on this?

        Like

        1. This is my personal take. US has the best training there is to get, and decent chances of being able to settle there (but work is busier as well). UK is less of training and more of being able settle down into a cushy job quickly (as of now – situation may change 3 years later). But then the pay in US is inordinately more than in UK; you wont be able to fly your family business class if in the UK. If you wish to apply to the US, you would either need a few publications, or go there as a research fellow first for this purpose; getting lucky without publications is an exception and not the rule. So overall US is tougher but more lucrative.
          I would suggest deciding on what lifestyle you wish for eventually; dont decide based on ‘toughness’. Spend a month talking to people and listening to their experiences (even UK involves a lot of paperwork and patience) and figuring out yourself and deciding, and then create a plan for the next 3 years on the roadmap to succeed.
          Akshay

          Liked by 1 person

        2. Nirmita

          Thank you for your advice. If I may, I want to know what it is like to give the USMLE steps after PG in Radiology. The very fact of preparing for subjects like pharmacology and microbiology is giving me jitters. And that is just step 1! One of the strongest reasons I chose radiology was so that I could distance myself from those subjects…
          Can you also please elaborate on the USMLE steps as well? As the exam pattern is one I find complex.
          Also, please advice me as to when I can start preparing for the USMLE exams if I do decide upon US fellowships, and the scores that I should be targetting.
          Please forgive me if I seem very under-informed…

          Like

        3. I gave my steps during my bond year. They are not very difficult. Took 2 hours a day for 6 months or so to finish the steps 1 and 2. Its easily doable. For the exam pattern etc, you will have to speak to people who have given it (generally MBBS students) and understand. The key is to first decide whether you wish to go to the US or not. Once you decide, assume it will take a year or so to give everything and get ECFMG certified. – Akshay

          Liked by 1 person

  9. A best blog written and important guidance given by Dr. Akshay Baheti, Consultant Radiologist at Tata Memorial Hospital-Mumbai. He is trained from United States and obtained 3 yrs Fellowship in Radiology-Subspeciality.

    Please follow his advice and walk on his “Ekalavya training (Self Driven)” Highway before taking turn on higher education in Diagnostic & Clinical Radiology Career. .

    Like

  10. Namra Gohil

    Hello Sir. The article is wonderful. Can you please tell more about how to secure the 4 year long fellowships in the us. And are we paid during the fellowship? How long will it take to get certified and become a consultant radiologist in the usa?

    Like

    1. Thanks Namra. We have a blog on applying to the USA. Please read it. You are paid well for the fellowship; the main issue is securing the 4 year pathway. Once you complete it, you become eligible to give the boards and get certified.

      Like

  11. In my opinion, To get any type of Paid/Non-Paid 1-4 yrs Post MD/DNB Fellowship in United States, you must pass/Clear USMLE-4 steps entrance exam and obtain ECFMG Registration.

    If you complete fellowship and do not have American Board Certified Qualifications and Active Medical License to practice in any states of US & Canada;you will not get job and forced you to return India.

    Better to pass USMLE and complete 4-6 yrs Residency curriculum in Diagnostic Radiology (DR) then you can settle in USA & obtain Citizenship also.

    Like

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