Radiologists spend much of their day talking to other doctors, and selection panels test that directly. The scenarios are about saying no to a referrer without damaging the relationship, phoning a critical finding so that it is acted on, and talking to a patient who is frightened of radiation or surprised by an incidental finding. This guide covers each and the structure that scores.
The referrer who wants a scan you would not do
A referrer is pushing for an urgent CT you believe is not indicated. How do you handle the conversation?
The panel is scoring three things: whether you understand the clinical question before you decline, whether you can decline politely and with reasons, and whether you offer a way forward.
Start by asking what the clinical question is. Many disputed requests resolve when the referrer explains what they are worried about and you can suggest the right test. Then explain your reasoning in terms of the patient: the radiation, the contrast, the low yield, the better alternative. Offer the alternative: a different modality, a delayed scan with a review, a discussion with the consultant. If the referrer insists and you still believe it is wrong, escalate to the radiology consultant rather than either refusing outright or giving in. Document the discussion.
Say how you would keep the relationship: the referrer is a colleague you will speak to every week, and a reputation for being obstructive hurts patients as much as a reputation for rubber stamping. The answer that fails is the one that either refuses without listening or agrees to avoid conflict.
The critical finding
Tell us about a time you communicated a critical or unexpected finding to a clinician.
The structure the panel wants: the finding recognised as critical, a direct phone call to the treating clinician rather than a report left to be read, the finding stated plainly, the clinician's name and the time documented, a read back to confirm understanding, and an escalation if the clinician cannot be reached. Give a real example with the outcome. If you have none, describe the process and say that you know the hospital's critical results policy.
The anxious patient
A patient is anxious about radiation from a scan. Acknowledge the worry, explain the dose in terms they can grasp (comparisons to background radiation are the usual approach), explain why the scan is needed and what would be lost without it, and say what is done to keep the dose low. Offer the alternative if there is one. Check they feel able to proceed. The panel is scoring plain language and respect.
The incidental finding
How would you explain an incidental finding to a patient who was not expecting it? Usually the treating clinician explains it, and the panel wants to hear that you know that, that the finding is communicated to them clearly with a recommendation, and that if you are asked to speak to the patient you would do so honestly, with the uncertainty acknowledged and the next step clear.
The referrer who wants a report changed
A clinician asks you to change a report because they disagree with it. Discuss it: look at the images together, hear their reasoning, and if you were wrong, add an addendum and say so. If you were not, explain why the report stands. The report is your professional opinion and it is not altered to suit a referrer, but a conversation about it is always appropriate. Involve the consultant if the disagreement matters to the patient's care.
The multidisciplinary meeting
Some panels ask how you would contribute to a cancer or trauma multidisciplinary meeting. Preparation of the cases, clear presentation of the imaging, a view on the question being asked, and openness to the clinicians' context. Say what you have seen done well.
What the panels score
Understanding the clinical question, declining with reasons and alternatives, direct and documented communication of critical findings, plain language with patients, professional independence over reports, and the relationship kept throughout. Radiology panels have a low tolerance for arrogance and a low tolerance for weakness, and the scenarios find both.
Preparing
Practise the referrer conversation with someone who pushes hard and refuses to listen, because that is the condition on the day. Know your hospital's critical results policy. Prepare a real example of a critical finding call. Then practise the patient conversations in plain words, timed to two minutes.