This article is adapted from a post in Dr Koshy Jacob's "Building Revise Radiology in Public" series on LinkedIn.

Ask a radiologist who trained a couple of decades ago how they learned emergency radiology, and you'll hear a version of the same story: being woken in the middle of the night, driving into the hospital, and reporting an urgent CT brain with no home reporting station, no remote access, and no teleradiology service quietly absorbing the overnight work.

It was exhausting. But it taught something that's harder to come by now, and if you're a trainee today, that gap is worth thinking about honestly.

What on-call used to teach

The value wasn't only in the reporting. It was in everything around it. You learned to make decisions under pressure. You learned that your report mattered. You learned that behind every scan was a patient, a clinician waiting for an answer, and sometimes a life-threatening situation unfolding in real time.

That combination, real stakes plus real time pressure plus no one to defer to, built a kind of judgement that's difficult to teach in a lecture. You didn't just recognise the finding. You decided what to do about it, now.

Why today's training is different

Modern training is different, and in many ways better. But trainees may not always get the same volume or intensity of independent decision-making. The overnight reps that forged that judgement are, for good reasons, less frequent.

Here's the reassuring part: nobody needs to be woken at unreasonable hours to learn emergency radiology. The pressure can be simulated. The thinking can be trained. The decision-making can be practised.

What it requires is motivation, because no one is forcing you into that scenario anymore. You have to create it. You have to imagine the patient deteriorating, the clinician waiting, the clock ticking, and ask yourself the only question that matters in that moment: what would I do now?

How to build the judgement deliberately

The skill you're building is not just recognising findings. It's making quick, safe decisions when it matters. Those are different abilities, and the second one needs its own practice.

A few principles help:

• Treat each case as a decision, not just a diagnosis. Don't stop at "what is it." Push to "what do I do, who do I call, how urgently."

• Simulate the pressure. Put a clock on it. Force yourself to commit to a management step rather than hedging.

• Mine your real work. Every on-call case, every discrepancy, every missed diagnosis, every "I should have seen that" moment can become training, if you approach it that way.

• Reframe the exam. Exams can feel like they get in the way of becoming a good radiologist. They don't have to. Approached properly, every case becomes part of both your exam preparation and your clinical development at once.

This is exactly the area we want to develop further at Revise Radiology. We already have a strong bank of emergency radiology material across 2A and 2B, and we're building it into something even more practical, focused, and decision-based, so that practising under simulated pressure becomes something you can do deliberately rather than only learn by being woken at 3am.

Building this properly, at scale

That academy-style approach, where real cases and simulated pressure become structured training, is something we're expanding. We're signing a memorandum of understanding with CMET, the education division of UCSI Hospital in Malaysia, with the plan to start an international radiology training programme.

We're genuinely excited about it, and there's more to come.

For now, the takeaway for any trainee is simple. The intense, decision-forcing on-call of the past taught judgement almost by accident. You can build the same judgement on purpose, and doing so will serve you in the exam and long after it.

Explore our emergency radiology material across FRCR 2A and 2B, built around making safe decisions under pressure, not just spotting findings.

Want to see how the case-based teaching works first? Take a look at our courses.

Originally shared by Dr Koshy Jacob on LinkedIn. Follow the series there