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Faculty Focus with Dr Raghuram Lakshminarayan: It’s not just picking up findings on imaging, but how you...

Revise Radiology

Revise Radiology

November 9th, 2022

This is a transcript of an interview with Dr Raghuram Lakshminarayan which has been edited for clarity. Dr Lakshminarayan is an examiner on the CMC Vellore FRCR 2B Course (9-10 January, 2023). In this interview, he discusses the FRCR 2B Exam, and his advice for candidates who are sitting the Exam soon.

Q. Could you introduce yourself and your connection to CMC Vellore?

I'm ever grateful to CMC Vellore because that's where I learned my tricks of the trade, as it were, with radiology. After that I traveled quite a bit. I'm a Fellow of the Royal Australian and New Zealand College of Radiologists, and a Fellow of the Royal College of Radiologists in the UK. I relocated to the UK in 2007.

I have been the Training Programme Director (TPD) for East Yorkshire, sending trainees through radiology training and examinations. Now I am the DTPD for Yorkshire for Interventional Radiology. I'm also the secretary of the British Society of Interventional Radiologists. So, I've always been involved with training.

I am passionate about training. I think training is probably the only way we can get our future embedded firmly in medicine in whatever specialty it is.

Q. How long ago did you sit the FRCR? What was your preparation like?

I was awarded the FRCR honorarily. So, the way I would look at that question is slightly different. I think I would look at the huge number of trainees that I have supported in Yorkshire who were trying to go through the FRCR examination.

Most trainees, be it overseas or in the UK, are extremely talented. They work extremely hard. But the challenge with the FRCR examination and, for that matter, with any examination or interview is that in a set amount of time in which you have, the examiners need to be made aware of your knowledge of radiology.

A gap appears because most people have the knowledge but they're not able to put that across to the examiners and allow the examiners to make that decision.

That's where I think the courses that we are running, like in CMC Vellore and other places, will come into play to try and help trainees through the system.

Q. What are your specialisations and interests and what led you to choose them?

My specialisation is interventional radiology.

I've been practising it for a very long time. I specialised in radiology because I used to consider it something like photographing the interiors of the human body. And imaging was a key factor then. But when you join medicine, you still want to be in contact with patients.

I quickly realized that interventional radiology gave me an opportunity to combine imaging with patient care and management.

I think there is no other speciality that has such a unique advantage where you tend to see patients in the clinic, perform their imaging tests and then the intervention to treat, followed by seeing them back in clinics later. So, a complete holistic care is provided by a single individual.

Q. What was the idea behind the CMC Vellore course?

I have done many FRCR courses in India before. In fact, we started in 2015 and we used to run courses in Bangalore. What led me to do those courses was talking to previous examiners of the college, who reiterated that the candidates from India knew radiology. But they lack the ability to communicate it. I decided to take this as a challenge and we had previous examiners who came to India to help teach radiology, especially around presentations and examinations. So, we started the courses.

They've been exceedingly successful as candidates from India have certain mannerisms which are not things that are easily understood by examiners across in the UK. So, these courses bridge that gap.

I have always believed that people taking their exams, especially from India, are spending a lot of money and putting in a lot of effort. But there is one part of the jigsaw puzzle missing. How is it that you actually deliver this information? And that is where these courses help.

CMC is very dear to me. CMC is the place where I learnt my radiology. CMC is a great institution. It's been there for over 100 years. I would say it's a temple of knowledge. And I am grateful. It's a privilege for me to travel back from the UK, or at least be there virtually in order to support a course that's run out of CMC Vellore.

If you want me to encapsulate CMC in one word, that word would be quality. Anything that CMC does has a certain level of quality. I'm sure you'll enjoy the course.

Q. What advice would you have for trainees sitting the 2B exam now?

The 2B exam in the UK is not an exit exam. It is an exam that happens after somebody has undertaken the three core training years.

It's not just picking up findings on imaging but it also reflects how you understand it, how you interpret it, how you communicate it and how you suggest that certain next steps are taken, be it further imaging, be it further tests, or be it further kinds of management.

That's why the speciality is called clinical radiology and not just radiology. It's not just imaging. One of the key things our trainees do is prepare by presenting and spending more time with consultants in each area. The exam covers multiple areas and you start realizing that you may have some deficiencies. For example, you may be lacking in pediatric radiology, then what you do is you go and spend time with a pediatric radiologist, you do sessions with that person and you go for courses and you go for viva practice. That's how you become holistic when it comes to taking the examination itself.