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How I Learn or Don't in Radiology


Have pragmatic needs become the primary driver between wanting to learn and needing to learn new skills and technologies in radiology?

It started simply enough. One of the light fixtures in my backyard suffered fatal injury and wasn’t to be salvaged. The thing was over a decade old. Even if I could somehow find the exact same model for replacement, its nearby mates were very weathered, and a shiny new one would look weird next to them. Time to replace them all!

One of the most dangerous phrases when fixing/improving one’s digs is “While we’re at it …” but the thought occurred to me that we do more than a little entertaining out there so why should we install another bunch of boring white lights? I had heard of multicolored units, even things that could be programmed to actively change (red and green at Christmas for instance). Why not do that?

I knew I was embarking on a learning curve. I had no idea how prolonged or steep it would be. The first step was discovering that the actual bulbs, not the lighting fixtures, were the things I should be focused on changing. Then, realizing I had heard of “smart bulbs” before, I set about giving myself an education on them and that process is nowhere near finished.

At some point, it felt like I had learned enough to plunk down coin and buy the needed number of smart bulbs along with a “hub” to instruct and coordinate them. The gear arrived a few days ago, and I earmarked part of the weekend to do the hands-on part of my learning. I am hoping that one of the things I don’t learn was that I have made an expensive mistake.

At the risk of foreshadowing the remainder of my blog, until I made the purchase, I wanted to learn the intricacies of smart bulbs and their networks. Once the vendor had my money and I had the product, I pretty much needed to learn, lest the whole exercise turn out to be a waste.

Like any other highly educated and trained folks, radiologists do an awful lot of learning just to have a chance of entering the field ... and more to remain viable once practicing. Some things come more easily than others and that also goes for how well we remember them.

For instance, I found that my brain just doesn’t want to absorb or retain a lot of MSK stuff. Remembering how thick tendons should be, how many MR slices a meniscus should get through to be considered normal, etc., just wasn’t happening for me. I am sure plenty of readers — especially those who do MSK — experienced no such issues and are wondering how on Earth it could be a problem for anyone else.

Personal talents and preferences play into it. Complexity of the stuff to be learned is undeniably a factor as well. However, something else is in the mix, and I think it’s often taken for granted or otherwise overlooked: motivation.

Taking my not quite mental block with MSK as an example, I wasn’t ever very motivated to become adept at it. When I was in training, there was no shortage of other stuff to cram into my noodle, and the little matter of working numerous hours while trying to maintain something of a healthy life outside of the hospital. Something had to give, and if I was going to be mediocre at something, routine MSK stuff seemed less consequential than, say, body or neuro cases coming through the ER at 2 a.m.

To put it another way, if you had asked me whether I wanted to be good at MSK, of course, I would say yes. However, I knew, at some level, that I didn’t need to be. A couple of successful decades later, all of my other skills have been more than sufficient to fill my workdays. When you know (or think) that you don’t need to learn something, you’re less likely to decide to learn it. As I have mentioned in this blog before, there is a vast chasm between wanting to do something and deciding to do it.

That constantly plays into radiology work and not just clinically. We rads vastly differ in our self-appraised capability to learn computer-related stuff. Some seem wizard-like to others in terms of their ability to get the most out of their PACS, RIS, and voice rec. I daresay most, if not all of us, could learn such savvy if we had proper motivation.

As it happens, though, most of us just settle on what we need to get our work done. If I consider myself likely to use hotkey commands #1 through 7 and voice commands A through G, I learn those. The software might have ten times as many helpful tools, but I know they are irrelevant to me (or I have wrongly decided they are), and thus I don’t learn them.

This isn’t all a matter of laziness or stubbornness. Much is reasonable and pragmatic. For instance, I could commit the Fleischner Society and Lung-RADS guidelines to memory, but I have no real need to waste mental bandwidth on all of that, especially when they are subject to change. It’s easy enough to summon their web pages whenever needed (or to have a dictation template that includes the details). There is virtually no downside to my using those workarounds.

When the Internet was a little less robust, I accomplished the same by papering part of my office wall with a few routinely consulted references: charts for normal organ size at various pediatric ages, NASCET criteria for stenosis via Doppler, and others I have now forgotten (I forgive myself on account of that being nearly 20 years ago). Turning my head to look at those was a lot less invested time/effort for me than it would have been to memorize all of those details.

Compare that against getting up and walking over to a bookshelf (or going to another room) to page through textbooks, and the balance would shift. Committing the stuff to memory would then be the lesser hassle, and I would be more motivated to do it.

I think most rads, once settled into our careers, find optimized points of comfort between learning versus not learning. Unless circumstances around us change — for instance, shifting caseloads or workplace logistics — there aren’t many things that move these subjective needles.

If, however, a point comes where one finds oneself thinking, “You know, this constantly looking up item X is getting annoying,” or “I could use a hotkey or voice command to make my workstation do Y,” it’s a fine time to reflect on the differences between wanting to learn and deciding to do it.

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