Dr Sally Ayesa
A conversation about education
I am in a privileged position. This is partly because I have one foot in training and the other foot post fellowship, able to have frank and honest conversations with both trainees and radiologists about some big topics including radiology education and how we teach.
In 2018 I found out I had won the HR Sear Medal for my exam performance. Initially, I dealt with some ramped up imposter syndrome (if you are interested read more about this here) but then this started to change. Colleagues were starting conversations with me about how I got to this point - what I did, how I did it, how I coped. They were genuinely interested in my journey, because trainees all around the country were walking the same path. Not only that, but a significant proportion were stumbling and falling.
Please don't for a second think that I am not humbled by this. Do I believe that there was a healthy dose of luck in getting me to this point? Absolutely. But there had to be more to it. Fluking all ten components seems a little unlikely.
So I started having conversations; online and in person, at work and in my personal time, with colleagues, friends and family members - inside and outside of radiology. Rather than answers, what I have been left with is a list of questions which we should be asking ourselves, our teachers and mentors, our managers and our community. These are some of the big questions I am asking myself today.
The first question - is there a problem?
Possibly this is an over simplification. Perhaps a better question is - what can we improved? This could be balanced and explored by also identifying what we as a community do well.
I have always been a firm believer in identifying problem areas and promoting improvement, so in this vein I believe that there are certainly areas to improve. Crystallising a gut feeling into a group of achievable goals is, however, easier said than done.
For example, we could make broad sweeping statements that radiology exams need an overhaul, but these mean nothing unless we understand the goal of the exam itself. Is the goal to test a specific skill set? Is it to model real world problems and test how a senior trainee navigates their practice? Is it to provide a learning framework to consolidate learning and maintain a set standard of practice? Is it all of these things?
A controversial question - is training fit for purpose?
Last week I was lucky enough to sit down with a visiting professor and take an hour of her time for a project I am developing. Dr Clare Morris has spent her career researching medical education, working with all disciplines of healthcare to help us improve the way we teach and learn. A key question she asked me, quite early in our discussion, was whether I thought that the assessment structures in medical imaging education were 'fit for purpose' - that is does our assessment structure align with the goals of the training program? Are we measuring our registrars on their ability to pass exams or on their aptitude as safe community radiologists?
Alarmingly, she followed it up with another question that I didn't have a good answer for - what is the goal of the radiology training program? Reflecting, I guess that the simple answer is to produce a safe and knowledgeable radiologist who is comfortable working in a general medical imaging department.
But does this over simplify our profession? Should the long answer weave in development of clinical problem solving, team work, continuing education and subspecialty interests? And how do we apply a bench mark to these ideals?
The big question - how can we do things better?
In my opinion, we should be asking this question constantly. When doing small tasks, completing large projects, or working within a nation-wide community. The moment we stop looking to improve and grow is when we stagnate, and things fall apart.
Medical imaging as a specialty has experienced exponential growth over the last few decades, especially when you consider the progressive introduction and availability of new technologies, pharmaceuticals and standards of practice. The environment is changing (rapidly so), but have our methods of teaching and expectations placed on our trainees grown to match? Are we applying antiquated models of education to a system which has long since outstripped it? If this is the case, simply asking 'can we do better' becomes one of the biggest questions and potential cans of worms to open.
I like to ask questions. I usually don't have answers (or even know if an answer exists), however, it invites others into a conversation with you. It invites shared ideas, collaboration, shared experiences and challenged ideals. It invites growth and change. Together.
"The most dangerous phrase in the language is "we've always done it this way"
Admiral Grace Hopper