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

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, 2022). 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 lot. I'm a Fellow of the Royal Australian and New Zealand College of Radiologists. I'm a Fellow of the Royal College of Radiologists in the UK. After that, I came to the UK in 2007.

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

I love 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 actually honourably given the FRCR. 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 there is a problem with the FRCR examination and, for that matter, with any examination or interview. You have a set amount of time in which you have to let the other person know whether you're knowledgeable or not.

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 doing it for a very long time. I took radiology a long time back 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, with management.

I think there is no other specialty that has that unique advantage where you tend to see patients in clinic. I run my own clinics, I do their imaging and then I perform the intervention and then I follow them up in clinics later, so complete holistic care is provided.

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 some courses in Bangalore. And what led me to do those courses was talking to previous examiners of the college.

What the examiners told me was that people from your part of the woods, they know radiology, but they don't know how to communicate it. I told them, okay, I'll take you to my part of the woods, you tell them how to communicate it. So, we started the courses.

They've been exceedingly successful because what happens is when you come from India, for example, you have certain ways of communication, you have certain mannerisms in an examination and those are not things that are easily understood by examiners across in the UK. So, what these courses do is bridge that gap.

I always believe that people taking their exam, 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 across? And that is where these courses help.

CMC is very dear to me. CMC is the place where I learned 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 core training years, the three years. So people will have to prepare for it on multiple levels.

One is, 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 specialty is called clinical radiology and not just radiology. It's not just imaging. One of the key things our trainees do is prepare by going 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.