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We listened intently while our attending radiologists delivered that famous mantra to us first-year diagnostic radiology residents.
Each of us had already had four years of medical school under our belts; my classmates and I were finally medical doctors—MDs—and now we were embarking upon the next five-year-long journey to becoming full-fledged, board-certified diagnostic radiologists.
Having matched in our chosen subspecialty, we now faced new horizons of challenging academic and clinical training. It was an exciting and thrilling time, and we rushed to each new task with alacrity.
Indeed, we were baby radiologists: first, we would learn to crawl, then we would learn to walk; and then, finally, we would learn to run. Only after studying countless radiology texts and enduring many sleepless call nights at the hospital would we complete the race that ultimately, back then, would end with successfully completing the written and oral radiology board examinations in Louisville, Ky.
Soaking up as many facts about as many specialties as we could, my classmates and I were eager young sponges. Digesting vast amounts of information on a daily and nightly basis, we strived to become the ultimate peer physician consultants, the “Doctor’s Doctor;” the oracles of knowledge; the sages of modern medicine.
Indeed, our future oral board examiners would demand that we memorize whole phonebooks of information—virtually every medical fact pertaining to every medical and surgical specialty and subspecialty. Learning the diseases and diagnoses of every patient with each different type of ailment was critical.
Along the way, we residents participated in “Noon Conference.” Noon Conference was where our attendings grilled us daily on anything and everything to do with radiology: pathology, physics, medicine, surgery—you name it, we had to know it. Noon conference case sessions, in particular, served as mock oral board examinations. In reality, they looked—and felt—more like interrogations.
They took place in a dank, shadowy room with a single, lonely chair situated in front of a lighted viewbox. As the rest of the class stood by like helpless witnesses, that day’s victim would be called to THE CHAIR and grilled mercilessly:
“What do you see on the mammogram, Dr. Conway? What makes you think that the calcification is nothing to worry about? Are you CERTAIN it’s a benign fibroadenoma?”
“What about those bowel changes on the next film, Dr. Conway? Do they represent Crohn’s disease or ulcerative colitis?
Sometimes our instructors would provide us with lunch, but most of us—our stomachs churning with anxiety—could tolerate little food. One colleague confided that she could handle just a few small grapefruit wedges, which she would quietly nibble at the back of the room. She lost considerable weight as a consequence.
As much as we disliked these taxing sessions, deep down we knew they were essential for our growth and necessary for preparing us for the Diagnostic Radiology Oral Board Examination.
This ultimate and legendary radiological inquisition was held for many years at the Executive West Hotel in Louisville. I still recall how the senior residents used to return from the Executive West, gather us junior residents together, and tell tales like the great whalers of yore pulling up a stool and sharing stories of the sea.
Our eyes were big as saucers as we absorbed their stories and advice. They described the hotel: Outdated orange shag carpet. Olive bedspreads. Darkened rooms set up with lighted viewboxes. They told us about the “Chime Lady,” who pinged notes on her xylophone as she floated like a ghost through the dim, drafty hallways outside the exam rooms. Each chime signaled when time was up; each resident then moved to the chair and viewbox in the next room, where another examiner waited to pepper him or her with one tough query after another on the next film and topic.
We laughed as the upperclassmen shared their stories, but deep down, we felt a mix of fear and delight as we anticipated our own turn at the Ultimate Inquisition.
Finally, after five years of Noon Conferences, it was our turn to make the pilgrimage to Louisville. We traveled directly from the airport to the Executive West.
There, on the evening before the oral boards, I ordered my last supper: A plain turkey sandwich on white bread, accompanied by chips and a pickle spear. Piles of my most treasured radiology books were gathered around me, with bookmarks strategically placed on critical pages. They had been my loyal companions for many years. I took one final look at my notes and the highlighted pages of my most trusted tomes. I anticipated the many questions I would be asked by the attendings the next day.
I reviewed the many mnemonics teeming in the recesses of my brain; the facts, statistics, and images tucked away in my memory banks. But the last thing I remember thinking before falling asleep that night was “CCCR.” It was advice that had been passed down from senior residents who had completed the Oral Boards; they told us simply to be “Cool, Confident, Competent and Relaxed.”
I awoke the next morning ready to go. This was my day. It was do-or-die time; there was zero room for error. My examiners wore poker-faced expressions, not a smile or frown to be found among them. For what felt like forever, I read one film after another, each one more challenging than the previous. I had never seen so many spines, brains, abdomens, chests, or extremities. Arteries and veins seemed to tangle in front of me, as each one beckoned to be identified; each malady begged to be diagnosed.
Grueling as it was—and it definitely was—my Oral Board exam was not unlike all those Noon Conferences my classmates and I had endured the past five years. I was grateful that we had had those daily sessions; our mentors had been superb teachers, and they had prepared us well.
When the exams were finished, we congratulated one another and breathed a collective sigh of relief, having completed the most difficult specialty board exam in the world. We were board-certified diagnostic radiologists at last; the trip was complete. We now felt bulletproof.
As our van drove off to the airport, I looked bleary-eyed through the rear window and watched the Executive West Hotel disappear into the distance. Now, I thought, all of us traveling in this vehicle would leverage our knowledge and skills to a greater cause—we would help each patient to both survive and thrive.
These thoughts were uplifting, and they buoyed my spirits as we arrived at the departure gate to return home. Although weary from the examination, I was quietly joyful.
This radiology journey truly had been worthwhile, and I knew it would remain so for many years to come.
Conway S.  Journey to Louisville: A Memoir.  Appl Radiol.  2017;46(11):30-31.
By Sarah Conway, MD| November 13, 2017
Sarah Conway, MD is a board-certified diagnostic radiologist and President of Delphi Radiology Associates, a Health Solutions Consulting firm specializing in healthcare quality, safety, and cost management.