In response to critics lodging complaints about the cost of higher education, Robert Hutchins, president of the University of Chicago from 1929 to 1945, once wrote, “If you think education is expensive, try ignorance!”
In our own day, education remains under threat. Teaching, and especially teaching well, takes not only money, but also time and effort. Attention radiologists devote to medical students, residents, fellows, and other learners is drawn away from other activities, such as interpreting studies and performing procedures. Such clinical work generates additional revenue, while education generally does not. In some quarters, enthusiasm for the educational mission has waned.
Colleagues and leaders in some departments may not share an innate enthusiasm for education. Asked to describe their own professional mission and expertise, many will not mention education first, and some may not mention education at all. Many are so focused on clinical or fiscal challenges and opportunities that they have little or no time left to think about educational matters. For these reasons, it is vital that radiologists with strong commitments to education serve as effective advocates for the educational mission. Someone needs to stand up for education and provide articulate and persuasive arguments on its behalf.
To do this, educators need to reflect on some very fundamental questions, among the most basic we can pose about our discipline. The first is the most basic of all: why are we here? If our purpose is strictly to apply what we know to patient care and generate clinical revenue, then education plays no role. Yet if we do nothing more, the field will eventually cease to exist. To fail to teach radiology to medical students and residents would be to consign it to the dustbin of history and to guarantee that our own children and grandchildren would never be able to follow in our footsteps. The only way to perpetuate a discipline beyond the current generation is to teach it to the next one.
A critic of education might agree but nonetheless choose not to invest in it. To say that the long-term survival of the field requires education does not imply that any particular radiologist or group needs to be doing it. That one group chooses to devote little effort and few resources to educating the next generation of physicians and radiologists does not require that others follow the same course. So long as other programs take the educational mission seriously, noncontributors can enjoy the benefits of well-educated radiologists in the future without investing in it themselves. Economists call this the “free-rider problem.”
How should we respond to a department that chooses to function as a free rider, reaping the benefits of others’ educational investments while making no such investment itself? There are two important responses. First, there is something inherently unfair about expecting others to pull your weight, such as opting out of an immunization program because the numbers of those who do get immunized produce sufficient herd immunity. Second, there is the possibility that education is a worthwhile and choice-worthy activity in itself. If excelling in education provides important intrinsic benefits, then those who opt out are shorting themselves.
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