Life after Match Day: An Interview with Pejman Ghanouni, MD, PhD, First-Year Stanford Radiology Resident

Dr. Ghanouni was accepted into the Radiology Residency Program at Stanford. He was particularly excited about the opportunity to apply his graduate research skills earned studying adrenergic receptors to molecular imaging. While earning his PhD in molecular and cellular physiology, Dr. Ghanouni studied how adrenergic receptors respond to hormone binding. To investigate how a hormone causes a biophysical change and what that conformational change means for protein activity, Dr. Ghanouni fluorescently labeled purified receptors, using similar approaches to molecular imaging methodologies. He hopes to apply what he has learned to this field.

Why did you choose radiology?
"I stumbled upon radiology. As a medical student, I took an introductory radiology course taught by several of the faculty here, including Dr. Mindelzun, and I really enjoyed it. Through a rotation with Dr. Mindelzun that followed the class, I saw that as a radiologist, one has to know something about everything. Actually, a lot about everything. For each disease, a radiologist has to blend knowledge of clinical symptoms, pathology, treatment, prognosis, and, of course, what the disease looks like using various imaging modalities, all to arrive at a reasonable list of possible diagnoses."

"The breadth of the field appealed to me. Another thing I liked about radiology was that it's a field that tends both to reinvent and to expand itself. Some procedures originally done by radiologists are now performed by other specialists. Our field has moved on to invent new things, whether evolutionary new algorithms for imaging, or, as in molecular imaging, potentially revolutionary new technologies and applications. I found those possibilities appealing as well. Even during the course of my training, the field will develop new imaging approaches. I'm fortunate to be at one of the places where those technologies are being developed and tested."

"I saw how fundamental radiology is to clinical decision making. Now as a resident, I enjoy my involvement in evaluating a patient, merging what we provide by looking at images of a patient's pathology with the clinical information that physicians provide. We're a service to the rest of the hospital. I appreciate that aspect of it. I like interacting with my colleagues. I've been here long enough to I recognize a lot of faces when they come and talk to us about whatever is going on with their patient, and I enjoy working with them to figure out what might be wrong."

"The last thing that was missing for me was that, as a PhD, I wanted to pursue academic research. I wasn't sure how, with my molecular biology and biochemistry background, I would be able to pursue research and radiology. The people I knew who have done research in radiology have had a physics or engineering background. They performed fundamental research on engineering, computer science, and algorithm development. It wasn't until Dr. Gambhir came that I saw an opportunity to apply my own background to research in the molecular imaging program here. I think that opportunity clinched my decision to pursue a career in radiology."

What was the residency interview process like?
"Interviewing is tiring. You have to travel, and deal with jet lag, and hotels, and driving directions, make a showing at the pre-interview dinner, try to answer the interviewers' questions intelligently, and then do it all again the next day or week."

"By the time an applicant gains an interview, everyone's academic record is similar. At that point, it has more to do with how you present yourself personally. How do you communicate? Are you easy to get along with? Are the interviewers, your future colleagues, likely to want to spend the next four years in a dark room with you?"

"Usually, there are five half-hour interviews. As an applicant, I was trying to get a sense of the personality of the various programs. And of course, the interviewers were trying to get a sense of me. Later, the interviewers get together and discuss their impressions of the applicants. It's not scientific, but it seems to work. Each program tries to attract people with particular personalities, reflecting the personalities of the people who are already there."

Where did you do your internship?
"I did a transitional internship at Santa Clara Valley Medical Center, which is the local county hospital. As a transitional intern, I rotated through the specialties--surgery, obstetrics/gynecology, pediatrics, medicine, emergency medicine--for one or a few months each, as opposed to spending a full year as a surgery or medicine intern. Through this type of internship, I was re-exposed to the various fields of medicine, but now as an intern, I had more responsibility in managing my patients. I loved it. The Valley is a fun place. Like most county hospitals I've heard of, the interns play a very hands-on role in managing the patients. Plus, the pathology that we saw there was amazing. All too frequently, our patients presented late in the course of a disease, and we would see and learn to manage the consequences of that."

"During some of my internal medicine months, I also rotated through Stanford. Since I'd been here as a student, I was generally familiar with the organization here. Stanford tends to be much more specialized, with fellows in every subspecialty helping to manage the patients. On the other hand, there are complex patients that I helped care for here that aren't going to be seen at most hospitals."

What has your first year as a resident been like?
"In a word, humbling. After all of these years of study, I almost feel that all I learned was the equivalent of the alphabet, and now I actually have to learn to read and write. It can be a frustrating transition; as an intern, I could do a good job taking care of very sick people. Now as a first-year radiology resident, I don't know enough to do more than listen and read. Basically, I've spent the year trying to build a foundation of knowledge, in preparation for taking call. We are eased into call, with lots of supervision by more senior residents, fellows, and attendings. On the other hand, by the time you are a third-year radiology resident, you are ready to manage most situations yourself. So when somebody comes to the Emergency Department (ED) and you're looking at their films, trying to figure out what's wrong with them--a surgeon may walk in to talk about another patient, a pediatrician may walk in, an internist, all trying to figure out what's wrong with their patients--you have to know the pathology for all of those patients. It's exciting that I'll be able to do that soon, but it's daunting because I have a lot to learn before then. Our class is about to start call, and while there is an element of anxiety, from what everyone tells me, you tend to learn a lot on call, in part because of the level of responsibility. I'm looking forward to it."