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Bucking the national averages and setting a new standard, students from The University of North Texas Health Science Center at Fort Worth’s Texas College of Osteopathic Medicine’s Class of 2025 applying for radiology residencies went a perfect 10-for-10, besting the nationwide average of 81% of all applicants and only 67% of DO applicants successfully matching into radiology. There are many reasons for the across-the-board success in this highly competitive field, but the seed for this type of outcome was planted by Dr. Spencer Smith, a diagnostic radiologist and adjunct assistant professor in TCOM’s Department of Medical Education and Health Systems Sciences.

For the past seven years, he has taught the advanced and longitudinal radiology elective courses offered to TCOM students in a practical, but also engaging, manner.

The highly unusual elective didactic radiology rotation is unique in the country for the breadth and depth of radiology that is covered in a course for medical students. Students study around 240 PowerPoint slides a day before the class to get familiar with the materials. The class meets from 8 a.m. to 1 p.m. every weekday, going over the slides that are embedded with images of just about anything you could imagine, from the normal to the paranormal and even out of this world. Which is done on purpose.

“TCOM students are just learning machines,” Smith said. “They know a lot of medicine by their third and fourth years, so they have the scaffolding built up already, but they have had little exposure the imaging aspect of medicine. I break things up in my class, with 20 minutes of silliness scattered throughout the day to stretch another 90 minutes of good work from them.”

During these intense classes covering the labyrinth of slides the students have studied, he likes to slip in something unusual and sometimes not believable.

Or is it?

This sequence of slides is one example of his hijinks. To set the students up, he first shows them a genuine postoperative CT scan of a patient with a large surgical opening between the nasal cavity and a maxillary sinus. His next slide shows sinus radiographs purported to be of a different patient who underwent the same procedure but who awoke one morning to the new sensation of something moving in his left cheek.

The faint shadow of a grasshopper is just barely visible over the left maxillary sinus on the X-rays. Some students can make it out, but others don’t appreciate it until he brings up a green rectangle to outline the area of interest, along with a photo of a grasshopper.

“A grasshopper must have crawled up through the patient’s nose, through the surgical defect, and into the sinus while the man was sleeping the night before!” he exclaims, as the credulous students nod in amazement.

But the grasshopper shadow is photoshopped – there is no grasshopper – and they have fallen for his ruse. He calls out with glee, “I gotcha!”

“Such foolishness just takes about 60 seconds of class time, and I believe that inserting a few playful things like this in our classroom sessions keeps students on their toes and keeps the ultra-long 5-hour sessions from becoming too boring,” Smith said.

All jokes aside, what Smith is doing is giving TCOM students an advantage long before match day. His class is designed not only to teach students far more radiology than they could learn elsewhere, but to give them extensive practice taking unknown imaging cases and presenting them using the vernacular of radiology as if they were already in a residency.

“I was pleasantly surprised to see that TCOM Class of 2025 students went a perfect 10-for-10,” Smith said. “TCOM has had above-average radiology match results for several years, placing 84% of applicants into residencies since 2017, but successfully matching all applicants was unprecedented.”

“This was the first time that 80% of our applicants, instead of just 10 or 20%, were able to take one of my electives during their third year instead of their fourth year, thereby arming most of them with sophisticated imaging skills prior to their fourth year away radiology audition rotations for the first time. I suspect that extra impressive showings on these auditions made residency programs more likely to rank our students in the match.”

Katie Costello, who matched at The Ohio State University Wexner Medical Center in Diagnostic Radiology this year, saw the impact of the class on her performance during her away audition rotations in radiology.

“He really models it after a radiology residency,” Costello said. “I was on rotation with Dr. Ikponmwosa Iyamu-Osagiede at Medical City Fort Worth and I looked at chest x-rays and had some of the basics down. After taking Dr. Smith’s class, he mentioned how much of a difference he noticed in how I was able to interpret studies. I felt more confident in what I was looking at and using the language to describe what we are seeing by making us talk and see what we are doing in class, which makes it much more comfortable.”

Costello was already interested in radiology; her father, Dr. Richard Costello, is a 2000 TCOM graduate and a radiologist himself. However, the class isn’t just for those interested in pursuing a radiology residency.

“Dr. Smith does a great job in class and makes it relevant for everyone,” Costello said. “Those who are going into emergency medicine will see this, and so many other fields as well. If you are a rural physician, you will absolutely read a radiology report and that’s why the course was so great for people to take, because it does apply to everything.”

TCOM students themselves have been laying the groundwork for this type of success for years as well. The Radiology Club has become the most active imaging club in the state. The Texas Radiological Society began holding a medical student symposium during its annual meeting in 2023. Although there are 16 medical schools in Texas, for each of the three symposia since inception, fully half of the students in attendance have been from TCOM, and our students have also helped plan the symposia and moderate panel discussions for the past two years.

Smith is very proud that so many of our students were willing to leave home at 4:30 a.m. to attend the Saturday morning symposium held in Austin last February. Smith suspects that this extra effort has been noticed by residency program directors and rewarded.

“One example is UT-HSC in San Antonio,” Smith said. “Its faculty and residents help put on the TRS medical student symposia each year. The program has 10 diagnostic radiology residency positions each year, and it probably received close to 1,000 applications for the 2025 match. “It is remarkable that four of our students matched there. I am so proud of them.”

Despite being retired himself from active practice in the field, the passion from Dr. Smith about his profession is palpable.

“I’m just the kind of guy who has been a gunner but can’t gun anymore,” Smith said. “I had a feeling that if I wanted to do this, I wanted to go flat out and make this a top-notch teaching program where we can do something unique that you couldn’t pay other people enough to do. I never try and sell the students on radiology. They can tell that I really love it, and I’m passionate about it, but everyone has to find the right field for their personality. I’m just glad I’ve been able to help polish their skills along the way.”

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