An Interview with Dr Ram Vaidhyanath

This article is taken from a transcript of an interview with Dr Ram Vaidhyanath, a consultant radiologist at the University Hospital of Leicester, UK. Dr Vaidhyanath is the vice president and president-elect of the British Society of Head and Neck Imaging. He received the award ‘PK Ganguly Visiting Professorship’ by the RCR. The Anatomy4FRCR is Dr Vaidhyanath's brainchild.

Q. Could you tell us a little bit about yourself?

I started medicine back in the late 70s, but then wanted to become a neurologist and I did medicine. I did my membership, and then I realised that radiology was the way forward. That's when I moved into radiology in the late 80s. It was the beginning of the 90s when Head & Neck was an upcoming subspecialty. I got very interested and moved sideways from Neuroradiology. That's when I was appointed as a consultant in Leicester, as one of the first Head & Neck radiology consultants in the late 90s.

At the back of it was always my passion and interest to teach along with my other passion for anatomy. So the combination of the 2 led me to imbibe technology as we go by and to develop many courses. These courses are very prominent today in the radiology trainees' calendar.

Q. What made you love anatomy?

I had some very great anatomy teachers. We used to do hardcore dissections and for them to look at Cunningham's manual of anatomy, look at your Grey's anatomy and learn that gross anatomy. It was such a huge thing and given my kind of family background, I was more tuned towards neuroradiology or neuroanatomy. My father unfortunately lost his battle to Parkinson's. He was diagnosed a bit late, but I realised there was so much more to neuroanatomy.

I looked at the other side of it from a patient perspective. The way we look at medicine is we look at it like a vocation, which is good, that's what it is. But its different when you're looking at it from a patient side. Especially since it was my father, that brought a different dimension into the whole thing.

Q. What would you say about trainees these days in terms of their focus and their knowledge of anatomy?

A large bit of the traditional old-school teaching is lost today for various reasons. Rotational things, you're there for a very short time. COVID changed the whole thing for us, which is where I'll come back to why we started Anatomy4FRCR. It is that we have lost that traditional way. You and I used to sit in hot seat and were under pressure in front of your peer group, asking difficult questions. There were days we didn't know the answer, but it made you tough and it made you go back. As much as I am for the virtual world that we are living in, replicating that kind of a situation is not going to be the same.

Q. Tell me a little bit about the Anatomy4FRCR course then that you set up. When did you set it up? Why did you do it? And you've answered a little bit about the why, but what's different about it?

If we think back to our anatomy exam when we did our FRCR. We had this film viewing session. So we were led into a room with 30 lightboxes, with each one having a film on it. And there was a question that was pasted at the bottom of that lightbox. You had to move from one station to another and answer those questions in 30 minutes. In 2009/2010 the college moved into an electronic platform. In 2010, we got the idea that we could run a course like this, very similar to what the college did when we were doing the exams. We were very lucky to have about 16 Macs at that time and the platform they were using was Mac. And so it was a no-brainer to get that started. We ran the first Leicester anatomy course in January 2010 for the March exams.

If you look at the exam itself, when you look at the actual RCR website, the description of the anatomy exam says that most of the questions are easy. But if you put yourself in a trainee position, you start your radiology training in the UK in August/September. That way you should be prepared to do the exams in March, six months down the line. It is a very short time for anybody to grasp that kind of breadth of knowledge. That's where we said these are the key areas that the examiners are going to ask you. We were guessing what the examiners were going to come up with. And this is where the discussion session comes in. It helps you figure out how you could actually get to that answer. You look at structures around it, because there's not one structure in that particular slide. You also show them in different orthogonal planes, and different modalities. So it becomes a very useful tool, especially if you've got six months to prepare.

Q. How would you say people should prepare? How would you learn radiological anatomy now as a new student? 

The way the college set out, the first FRCR was the most difficult exam. You had four attempts to pass it, and if you didn't pass in those four attempts, you could not continue your radiology training.

Professor Cher, from Leicester, questioned why we were putting the obstacle right at the beginning of somebody's career. And that's when the change occurred, they brought the anatomy exams back.

I look back at the way we learned anatomy. You referred to a textbook. Weir and Abraham were like the Bible. And if you could figure out the 40 little arrows that were there in that one image, your eyesight was very good. But we've got so many resources today, lots more opportunities to look at these things. So where we are helping is trying to focus all that knowledge into getting into that exam mode and getting the exams out.

Radiology and anatomy knowledge is for life. You're still learning every day. You need to be up to date with your anatomy knowledge. So your anatomy knowledge does not end with the six months and the first FRCR exams. It stays with you for as long as you're a radiologist.

Q. If I was a candidate and I wanted some preparation strategies for the exam, what would you say?

So the basic thing would be to understand what the exam is all about. The RCR website is pretty good, especially the updated one. They've got the test platform as well. And they have the lightbulbs course and they have already gotten a test to use the practical platform on which the exam runs. Then you're already tuned to it, isn't it? The second thing would be to look at each of the modalities. You're comfortable with some of them, and not so comfortable with some of the others.

So concentrate on things you're not comfortable with. I find that for many of the trainees, Head & Neck, Cardio Vascular, that side of things is where there are more questions these days. Those are things that you want to focus on. There is a wide range of free material available. Quiz yourself and your colleagues. Have a broad range of stuff that you need to know for the exams and then break it into modalities. Studying together is very important. You sit with your peer group and look at these things you get collective knowledge. It's human nature to be competitive, to think, how is it that X knew the answer that I didn't know about? And that is healthy.

Q. What is your view of people using resources like Anatomy4FRCR and Revise Radiology and simulating the exam experience? Do you think people can manage without it?

Exams are the necessary devils in our careers. We need to get moving. You can't be stuck in Year 1 or 2 and say I'm not progressing because I've not got the exams. So there is that kind of motive. Yes, it's not that I'm going to learn all my anatomy in six months or the two days of anatomy for a first-year webinar. The idea is that you want to get through that phase of exams and get to a stage when you say they're all done. We want to get through the exams for a good reason. We want career progression. We want to move on to becoming a consultant.

Most questions are straightforward and it's just that kind of 20-25% that you need to focus on. We show a whole range of normal anatomical variance. Again, that's a big part of the exams because variance could mimic pathology.

Q. Do you have any encouragement for people who would be considering a career in radiology?

I was very lucky to be the radiology lead for the Leicester Medical School for five years. Today I see at least a dozen of my medical school cohorts as radiology trainees or consultants. And that translates into saying, that radiology is the future. Your surgeon colleagues, your medical colleagues, everybody wants to do radiology. You need that much input into radiology. Where you differ from these clinicians is having good knowledge of radiological anatomy. The kind of techniques that you can use to answer the clinical question that is being asked. These days we are harnessing the power of very powerful imaging tools. We’ve changed ourselves to doing CTs and MRIs, instead of the traditional angiograms.

Q. What are your interests, Dr Vaidhyanath? What are your hobbies apart from being a consultant radiologist, teaching and travelling around the world?

I'm a small man in that respect. Travelling is a huge part. We have been very fortunate to travel to many parts of the world. My other big interest is taking teaching to areas that don't have access.

So I've been making regular trips to India, to teach radiology residents there. At the moment we are looking at working with radiology groups in Africa. I believe this is a huge area which needs our support today. I've been very fortunate to work with some wonderful colleagues across the world.

And you've probably heard of the Cortex Club which is a free club that we started by Mohit Agarwal. We're trying to build a link with Neuroradiologists in Ethiopia at the moment and there's a lot of interest.

What we are doing in terms of this virtual teaching helps there. You can't go there physically ever so often, especially considering what happened with COVID. You can still do a lot of teaching in a virtual setting, and then go there when you can and teach them in person. The interest that is there, the hunger for knowledge that is there is huge.

Q. Is there anything else you'd like to tell our audience?

I’d like to reinforce what you said earlier. It's the combination of the two platforms, Anatomy4FRCR and Revise Radiology, that is fantastic. And I believe it'll all go very well for radiology trainees, not just in the UK, but across the world.

Click here to read about our Anatomy4FRCR Course