Editor's Note: Many thanks to our colleague and member who share his experience & insight about radiology application and recruitment. This is article is an opinion piece to encourage, empower and guide members considering a career in radiology. Further information about radiology recruitment should be sought through the appropriate channels for radiology recruitment and training. 
In June last year, I took a second look at Radiology. It had always been one of the specialities that resonated with me in medical school, however, my initial research into the UK version years ago made me rethink.
Thankfully there was a Radiology Conference hosted by the Society of Radiologists in Training (SRT) was held that month. Attending this event exposed me to different sub-specialities and sparked my interest some more. It helped to see a Nigerian Professor who qualified as a consultant here as one of the speakers (representation matters!). I also went through the poster presentations and saw a Nigerian trainee as one of the presenters. I then searched on NDUK and was added to a group for Nigerian Radiology Trainees/Consultants in the UK. Fortunately, the Nigerian trainee who presented at the conference was also in the group and was happy to be contacted privately. He kindly organized a webinar (for myself and some other colleagues) and clarified the process of applying to radiology. I'm hoping to do the same with my experience; so here is a ‘brief’ summary of the process.
Application to ST1 radiology usually holds only once a year due to the posts being completely filled during the first round. There are different aspects to the application I would attempt to address each after the other; Portfolio (30%), MSRA (40%), and Interview (30%)
BUILDING MY PORTFOLIO
HEE England (Now NHS England) publishes the specifications and self-assessment criteria when registration for MSRA opens in November i.e. 1 month before the deadline. That is quite a short time to build a portfolio but the practice is to work with the guide for the previous year and try to score as highly as possible, hoping they don’t change too much in the next one.
For example, it would be a good strategy to go through the 2023 Specifications, grade yourself and make a decision on the points you can realistically reach before November if you are interested in the next application cycle. While I must say that the contents could change year to year, I (personally) do not expect too much change in the near future with the massive overhaul they did this year.
My experience:
The UK Radiology Speciality Training group (UKRST) Facebook group was a very informative resource for this (along with their Whatsapp group for prospective applicants). I spent a weekend reading through all of the application stories on their Facebook page. This was helpful because it showed how different things worked for different people and gave me a range of options to explore in building a competitive portfolio in the different domain sections. As a doctor in the UK not employed by the NHS, this was important as those who are already working in the NHS might have access to a portfolio, audit departments, resources, and educational supervisors. My general approach with my portfolio was to attempt different things within reason and see what worked.
Taster Weeks: The hospital I worked in had a radiology department but there were no consultants I could shadow. The dept manager kindly connected me to a tertiary centre where I got one booked and suited to my rota. I enjoyed my taster days but one piece of advice I got early on was to interact with the early-year trainees as much as I could and get their advice for application as they would most likely have fresh memories of the process. This proved to be really helpful in my efforts to build my portfolio and prepare for the interview. For my second taster week, a friend working in the NHS had a chat with a consultant in the radiology department of the hospital she worked in, and the consultant kindly obliged me. I had to sign some forms and send my certificates as part of the safeguarding/patient data protection check.
Conferences: I attended about 2 reasonably priced conferences. This was helpful in terms of knowledge about the specialty or things to talk about in the interview but did not contribute directly to the portfolio points.
Audit: Due to a lack of access to a formal audit department, I had some difficulty in completing radiology audits so I did two cycles of a non-radiology audit in the ward I worked on, thankfully supported by one of the GPs I worked with. I tried to collaborate with a colleague in the NHS to do a radiology audit but was not the first author/lead so it was graded the same as my non-radiology audit (didn’t end up submitting it). I presented both audits at national (online) conferences.
Presentations/Publication: The Nigerian Radiology trainee (from the SRT conference) suggested a topic I could present at a conference and after some initial research, I came up with an abstract and submitted it to two conferences that were still accepting presentation applications. It got accepted at a National Interventional Radiology (IR) Conference. Another trainee I connected with during my taster week helped did some final reviews of my poster presentation providing me with some very valuable feedback. In addition, if you have a radiology audit you are the first author/co-author for, this is a roundabout method. You could just present your audit as a poster at national/international conferences. You secure points under two domains with one audit.
Teacher training and Teaching Experience: Since I did not have access to students/Foundation Years/other Junior Doctors, I explored different training avenues which included trying to organize a teaching session for some nurses. This was unfortunately unsuccessful. I ended up taking a Teach the Teacher training (counts for points) and also had the added advantage of being able to participate in organizing a national program. Cost about 400 GBP but I got the full score for this domain, so all in all I think it was worth it.
2. MSRA
This is the single most important part of your application because it is the criteria for qualifying for the interview, and effectively reduces the competition ratio from 10:1 to 2:1 if you meet the cut-off (539 this year). It also had the highest percentage of the final score (40%).
I took the September MSRA (as practice because it does not count for Radiology). My thinking was that it will get me familiarized with the exam but looking back, based on exam content, I don't think it was so helpful. It did however help me to get the process part of it sorted out (signing the CREST form on time and sorting out the minor unexpected issues that came up with it, exam rules and settings) such that those things were not an issue when the main application round came around. It might have been more helpful if I had time to read for it but I was doing portfolio runs.
I chose to use PassMedicine and MCQ Bank because they kept coming up in my exam research. The advice I got from trainees and from online resources was to target a prep time of about 3-4 months before the exam. I wasn't able to keep to this strictly because of the little time I had to pull my portfolio together but passive preparation started in October and became more intense in November. I requested one week's leave in addition to a week off I had so I could focus on the final preparations before my exam.
People recommend going through the question banks completely twice. I was able to go through them once and go through most of the corrections again. I recommend you do at least both but you can add a third question bank if you have the time/resources. I would add that it would be beneficial to understand your baseline knowledge(e.g a mock test) and then plan your preparation from there.
After the MSRA exam:
I took a break, lol! Exam results took about 4 weeks after the last date in January before release and then we had to wait for the interview invites. The invites came via email and were sent two weeks before the actual interview. In my opinion, two weeks would be inadequate to prepare for a highly competitive interview, so to be well prepared you might need to prepare well ahead by faith.
3. INTERVIEW
I did an interview course for the interview section. They gave model answers to some of the common interview questions and this gave me an idea of what to read. The UKRST Whatsapp group also held a mock interview session for those invited for interviews. You are interviewed by two different panels(of trainees) with feedback given. I was very unprepared for the initial interviews but it helped me realize I needed way more practice and areas of improvement. I also had practice sessions with about 3 trainees I met during my taster weeks…they gave a lot of actionable feedback. My mirror was also helpful in my practice..lol.
Guidance on the areas of focus was released some days prior to the interview. It was held online on MS teams and was conducted by two consultants with a non-clinical observer; The cut-off when scores were published was around 36/60.
CHOICE OF PROGRAM
There were webinars held by IR Juniors and the British Institute of Radiology that gave some insight into different areas and programs, so please look out for them. The GMC training survey and Radiology Cafe were also helpful in this regard too. Ultimately where you go for training is a personal choice for you, as factors like affordability, diversity, family, opportunities and the quality of the programs themselves would come to play. I was fortunate to get my first choice and grateful to God for His help through the process.
CONCLUSION
This is about 6-7 months of slow days packed into one post. I have tried to be as detailed as possible but a good perspective would be to understand one is mainly working on one thing at a time - apart from the time when you would be building your Portfolio and preparing for the MSRA. You just need to focus on the next step ahead.
Try to optimize your portfolio as much as possible because the competition no dey play... but be aware that if you have a very high MSRA score and pass the interview well, there’s a reasonable chance you get a training slot with an average portfolio.
I hope this post sheds some light on the process for those interested in applying for this specialty. I am hopeful for the journey ahead, Trusting that the God that started it, will complete it.
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