Life is arduous, difficult, a perpetual struggle. It calls for gigantic courage and strength. More than anything, perhaps, creatures of illusion as we are, it calls for confidence in oneself. Without self-confidence we are as babes in the cradle. Virginia Woolf, A Room of One’s Own Your wisdom is consumed in confidence. Do not go forth today. William Shakespeare, Julius Caesar
Confidence is a mixed blessing. In some cases, we are perfectly capable of doing something, and all we need to undertake it is a bit of confidence. A familiar example would be medical students performing their first blood draw or starting an intravenous line. The biggest hurdle is often simply working up the courage to make the attempt. But confidence can also be a liability. In some cases, we physicians do not recognize our own cognitive or technical limitations and end up saying something or attempting something for which we are not adequately prepared. Recognizing the difference between justified and unjustified confidence is an important trait of a good physician.
A similar principle applies to learning radiology as a medical student. Most students initially approach radiographs and other imaging studies with considerable trepidation. Prior to medical school, many have never encountered such images firsthand, and even the ones who have done so often received no formal instruction on how to interpret them. At our institution, formal radiology instruction is provided primarily in the second and fourth years—the former in the context of a multidisciplinary introduction to medicine course and the latter through a required fourth-year radiology clerkship. Students also receive some radiology instruction in their introduction to anatomy course in the first year.
Yet we have observed that self-reported student confidence in interpreting radiology examinations increases in the third year, when students are rotating through their clinical clerkships. These include the standard clinical disciplines of medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry, and so on. During this year, radiology is not a formal part of the medical school curriculum, and students receive no formal radiology instruction. The increase in their confidence is perplexing, and it suggests that either radiology learning is taking place in informal settings or students are developing confidence in radiology through their study of other disciplines.
It is quite possible that students learn some radiology “on the fly,” while helping to care for their patients on other services. For example, a student on an internal medicine rotation might order a chest radiograph to evaluate for pneumonia, then actually review the image with a radiologist and thereby learn something about chest radiology. Likewise, a student on surgery who orders an abdomen/pelvis computed tomography to assess for suspected small bowel obstruction might glean insights into image interpretation in this context. Radiology is an important part of clinical medicine, and it is reasonable to suppose that clinical work exposes students to radiologists and on a fairly frequent basis.
It is also quite possible that a good bit of this radiology education is taking place without the direct participation of radiologists. For example, internists, surgeons, pediatricians, and others—but not radiologists—may be doing a substantial proportion of the teaching. It is also possible that students are picking up many lessons more or less on their own, simply by comparing images and reports or reading up on their cases in resources that include radiologic images. Everyone who has ever studied medicine knows that a substantial amount of medicine is self-taught. If students learned only what was presented in formal lectures, their education would be insufficient.
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