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

We have decided that Revise Radiology will not exhibit at any conference or event that is not specifically focused on radiology trainees. I want to explain that properly, because the reasoning took me longer to arrive at than it should have, and because I am criticising something I have willingly participated in and enjoyed.

First, what conferences are good for

I should say clearly that this is not a complaint about conferences, and certainly not about any particular one. The meetings I have attended have been worth attending. The academic programmes are often excellent, the sessions built by people doing years of unpaid, persistent work are frequently the best thing in the building, and the conversations in corridors and over dinner have been the most useful part of every trip I have made.

This is about one specific activity within all that, and about who ultimately pays for it.

Who is actually in the room

Here is the observation that eventually changed my mind, and it is structural rather than financial.

Our candidates are trainees, and a great many of them are in India, Pakistan, Nigeria, Egypt, Malaysia and elsewhere. Trainees do attend international congresses, and many make considerable sacrifices in order to be there. But the obstacles are real and they compound. Registration is usually discounted for trainees, which genuinely helps, though it remains a significant sum on a trainee's salary. Flights and accommodation in an expensive host city may or may not be funded by a department, and often are not. A visa may be required, with the cost and the uncertainty that carries. Study leave has to be granted by a department that is short-staffed. Any one of those is surmountable. Together they mean the proportion of trainees in the room is a good deal smaller than the proportion of trainees in the profession, and delegate lists skew towards consultants for reasons that have little to do with who would like to be there.

Which means that when we take a stand at a major congress in order to reach FRCR candidates, we are paying premium rates to reach a room in which our own audience is thinly represented, and thinnest of all among the candidates our preferential pricing and our scholarships exist to help. I have written recently about the documented gap in examination outcomes between UK and international candidates, and about how much of it reflects accumulated disadvantage rather than ability. It would be a strange kind of incoherence to write that and then concentrate our spending on the one venue where the same financial pressures shape who is able to be present.

Who the customer is

The second thing is about incentives rather than motives, and I want to be careful about the distinction, because I do not think conference organisers are cynical people.

Exhibition and sponsorship income substantially funds the academic programme at most major meetings. That is not a scandal; it is how the economics work, and without it registration fees would be considerably higher. But it does have a consequence that is worth naming plainly. In that model the exhibitor is the paying customer and the delegate is, in commercial terms, what the customer is paying for access to. Everyone involved may have entirely good intentions and the structure will still point that way.

What that meant in practice for us, at more than one event now, was that our conversations with organisers were overwhelmingly about what we would pay and where we would stand, and almost never about what we were trying to achieve or whether the event could help us achieve it. I do not think anyone was behaving badly. The model simply does not have a slot for that question.

What a stand actually costs

I am not going to publish our figures, but I will describe the trade honestly, because the pounds are less illuminating than the alternative use.

The money for an exhibition stand at a major congress comes out of the same budget that funds our scholarships and our preferential pricing. It is not a separate marketing pot that appears from nowhere. Every stand is a specific number of candidates who could have had a scholarship, or a specific reduction in price across a cohort, that did not happen. When I looked at it in those units rather than in pounds, the decision became difficult to argue against, and it stayed difficult however much I wanted the stand.

Because I did want the stand. I should be honest about that too. There is real pride in seeing your organisation's name on a board alongside companies many times your size, and I felt it. That pride is a poor reason to spend money that belongs, in every sense that matters to me, to the candidates.

What we are giving up

This decision has costs and I would rather set them out than pretend it is all upside.

We will be less visible. Competitors will have a presence at meetings where we do not, and some radiologists will form an impression of the market in rooms where we are absent. There will be candidates who would have found us at a stand and now never hear of us at all, and I am not comfortable about that, because those are real people whose preparation we might have improved.

We think the trade is right anyway. Reaching a smaller number of people while charging all of them less seems to us a better outcome than reaching more people by making the courses more expensive. But it is a trade, not a costless act of principle, and anyone can reasonably think we have called it wrong.

What we will still do

We are not withdrawing from the profession's gatherings, and I want to be clear about that, because there is a version of this decision that would be simply antisocial.

We will attend conferences. We will speak wherever we are invited and have something useful to say. We will meet candidates, faculty and colleagues in the corridors, at dinners and in the bar, which is where the genuinely valuable conversations happen at every meeting I have ever attended. If you are at an event and you want to talk about your preparation, or your career, or something we are getting wrong, find us and we will make time. None of that requires a stand.

We will exhibit at events that are genuinely built around trainees, because that is where our people actually are. And we intend to run considerably more face-to-face teaching ourselves, which puts our money directly into a room full of candidates rather than into a floor plan.

Most of all, we are committed to bringing our prices down. That is the whole point of this. We were not built to maximise returns, we give a substantial share of what we make away, and money not spent on presence is money available to make the courses reach further.

One point of disclosure

I want to be accurate here rather than claim a virtue I have only recently acquired. Revise Radiology has paid for my conference travel in the past. For my most recent trip I paid my own way, because by then I had begun thinking about all of this properly and did not want a candidate's fee going towards my flights while I was at an event partly representing us.

I mention it for one reason only. The cost of exhibiting does not work that way. It cannot be quietly absorbed by an individual, it comes from the organisation, and the organisation's money is candidates' money. That is the entire argument, and once I had seen it clearly I could not unsee it.

A closing thought for the sector

I suspect a good many organisations in radiology education are spending money on presence that they would rather spend on the people they exist to serve, and are doing it because everybody else does and because absence looks like decline. If that describes you, this is me going first.

The trainee who struggles to fund the flight to the congress is usually the same trainee who struggles to fund the course. We should probably stop concentrating our marketing on the room they are least likely to be in.

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