Radiology residency might seem to be strictly a matter of science and technology. We might think that as long as trainees assimilate the required knowledge and develop the requisite skills, they will be prepared to practice radiology independently. In fact, however, radiology residency encompasses not only science and technology, but also a cultural dimension. Culture involves something deeper than knowledge and skill, which reaches down more deeply into our basic assumptions about the way things work. Though many of us rarely talk about this cultural dimension of our professional lives, it profoundly shapes the way we think and act. By enhancing our understanding of the cultural aspects of radiology education, we can perform more effectively as educators and help our trainees better prepare for careers as radiologists.
Culture in medicine
Human biology is relatively constant across different times and places, but practices around health, disease, and healing often vary widely. For example, phlebotomy was a mainstay of medical treatment in George Washington’s day, and Washington himself underwent repeated bleedings during the last hours of his life. Today, by contrast, we would regard such uses of phlebotomy as barbaric. Many cultural elements are situated in binary contrasts. Take the idea of the edible and the inedible or the raw and the cooked. In our culture, no one would think of eating a cat, whereas doing so is common practice in some Asian societies. Conversely, many Americans routinely eat beef, whereas Hindu societies treat cows as sacred. Such binary contrasts are unconscious, but when they are taken as a whole, they help to define what it means to belong to a particular culture and to distinguish one culture from another.
The profession of medicine has a culture, and each medical discipline, including radiology, exhibits its own subculture. It consists of elements that may seem meaningless in isolation from one another, but combine to form a coherent overall system. Residents begin participating in this culture of radiology from their first day of training. Rapid advances in science and technology make radiology one of medicine’s most dynamic fields. To take full advantage of such innovations and incorporate them effectively into our education programs, we need to understand the underlying culture that shapes the way we perceive and use them. Among the most important binary contrasts in radiology’s culture are those between information and knowledge, teacher and student, interpretive and noninterpretive skills, formal teaching and experiential learning, and right and wrong answers.
Information and knowledge
Information and knowledge may seem similar, but they differ in crucial respects. Information is what we can read or hear and later recall, whereas knowledge we can not only recall but actually put into practice in creative problem solving. A competitive educational environment can prove detrimental to the sharing of knowledge. From the beginning of training, medical students and residents feel pressure to memorize as much information as possible, and to demonstrate it on examinations. This may breed a culture of knowledge hoarding, in which we suppose that the only way we can excel is to prove that we know more than others. In fact, such an approach to knowledge can prove highly injurious. The best interests of patients, medical science, and the profession of medicine all depend on knowledge sharing. What we know attains its greatest value not when we clutch it tightly to our chests, but when we share it with others.
Although knowledge sharing is crucial, merely disseminating more information is not necessarily beneficial. It is unlikely to enhance understanding and may merely contribute to the problem of information overload or information pollution. After the number of daily emails in our inboxes exceeds a certain threshold or their relevance falls below a certain level, they do little more than make it increasingly difficult to attend to the messages that really matter. The same could be said about the articles in professional journals, the scientific and educational sessions at professional meetings, and the questions we pose on standardized examinations. As medical science and clinical medicine continue to expand, it becomes increasingly important that we help learners focus their attention on the most relevant and useful material.
Teacher and student
It would seem that the underlying goal of radiology residency is simple: provide trainees with the requisite information, knowledge, and skills so they can one day practice independently and perhaps even serve as teachers of others. The distinction between teacher and student appears clearest in medical school, when the gap in knowledge between student and teacher is the greatest. By the later years of residency training, this gap has narrowed considerably. Yet there never comes a point in a radiologist’s career at which it is safe to stop learning.
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Interpretive and noninterpretive skills
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Formal teaching and experiential learning
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Right and wrong answers
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