Perhaps physician José Carlos Ferreira Pires (1854-1912) was incredulous when he learned that, nowadays, a chest X-ray takes just a few minutes. When he brought the first x-ray machine to Brazil, in 1897, patients spent half an hour on their feet. Imagine, then, showing him an ultra-modern image of the skull, in color and very detailed – how to interpret it? What if a 21st century doctor told him that a machine, equipped with artificial intelligence, could help in this exam interpretation process?
It is impossible to imagine such a scene without considering the immense temporal and technological distance that separates the former and current figures of radiology. In just over a century of existence, imaging tests have taken a giant leap – from analog to digital. Today, thousands of images are generated in a single chest radiology exam, for example. And only the knowledge and updating of these professionals guarantee an accurate diagnosis.
If the 21st century leaves behind those who do not keep up to date, among professionals in the medical field, this race for knowledge is even more important. This is certainly the case in Radiology. In the intense discussion about the future of careers, there is only one way out: to study and understand the complementary role of emerging and exponential technologies such as artificial intelligence. In about 10 or 15 years, a good radiologist will no longer be that doctor with a “good eye”, who catches all the details of an exam and arrives at the diagnosis. But the one who understands about language processing, data analysis, and machine learning systems and, above all, understands human relations and successful patient experience.
An outdated radiologist, in this short period of little more than a decade, will take the same fright as Dr. Pires, in case you landed here in a time machine. The changes will be sudden. Algorithms are already being used to analyze images and reach a verdict on the patient – and they will do it faster and more efficiently than any doctor, with a much more complete collection of data. Radiologists will be responsible for supervising the diagnoses identified by these machines, checking the images and results – hence the importance of mastering these new technologies – and other tasks, such as evaluating the previous medical history and the results of physical examinations. The value of the radiologist will be in their ability to synthesize a multitude of medical knowledge, images and clinical data, and articulate precisely what they imply.
For this, the search for updating needs to be constant and throughout life. But this does not need to be taken as a burden, it is an inherent human quest.
The pandemic – not to leave the medical field – has made evident this renewed interest in learning by humanity. According to Google, searches for online courses grew 130% in the first days of April 2020, when social isolation still started here. In universities, digital students have also increased: the demand for virtual courses increased by 400% at Fundação Getúlio Vargas in that period, compared to the months of January and February 2020.
It is as if people had finally realized the opportunities outside traditional education centers, specialization courses or postgraduate courses – a vision that also needs to reach radiologists. Considering quick or open courses as learning still sounds like a hobby – or like an irrelevant point in the curriculum. As if it were not a real way of acquiring knowledge. That's because many people still see education from the old industrial perspective: teacher teaches, students learn, in a methodology that intends to reach everyone uniformly, with no chance for the development of differentiated talents, within conventional teaching spaces. But the truth is that we spend little time on the gym benches: according to Conrado Schlochauer, a specialist in learning, we only spend 3% of life within formal education.
The long road of learning also happens in the remaining 97% of our history. And technology favors this eternal learning process. This is what we intend to talk about below: the protagonism of each one as a creator of knowledge. Based on a relatively recent concept within education, the lifewide learning – which will certainly help train the best radiologists of the future. Here, every source of learning counts.
Lifelong Learning and Lifewide Learning
For many centuries, more precisely since the 1500s, theorists have discussed the need to maintain learning throughout life. Jan Amos Moenius, pedagogue, scientist, writer and educator, talked about eight schools – from before birth to the “school of dying”. Much later, in 1833, the German educator Alexander Kapp, created a new term: andragogy. It was nothing more than adult-oriented learning strategies. Like his predecessor, he reinforced the need to maintain education throughout life.
This discussion remained strong throughout the 20th century, when technological changes were more and more frequent, the universalization of formal education began to become a reality, but with inequalities still remaining, as well as the new qualification needs of the workforce. In 1997, UNESCO promoted a education meeting and popularized the term “lifelong learning”. There is no mystery in the concept. The idea is that we continue to be constantly updated; that learning is maintained at every stage of life.
That year, however, Unesco would place an even broader aspect on the concept of learning in adult life. “The whole set of ongoing learning processes, formal or otherwise, through which adults develop their capabilities, enrich their knowledge and improve their technical or professional qualifications or direct them towards a new direction to meet their own needs or society”, the document said.
It was a new stage. Until then, only conventional teaching was considered, within institutions as tangible forms of learning. Not that older experts haven't questioned this structure. In 1926, Eduard Lindeman, author of the book “The meaning of adult education” (The meaning of adult education, in free translation) suggested forms of education not linked to classrooms and formal curricula. For basic reasons. If we are such learning machines, how can we consider only the knowledge acquired with the help of specialists, within classrooms? What about all the experiences and situations we go through throughout life? Doesn't count as learning?
count. And hence the concept of Lifewide Learning, something like broad life learning, or that encompasses all aspects of life. Thus, universities, to name a formal space, extrapolate the limits of classrooms. The living spaces, cafeterias, sports and leisure provide knowledge, with the constant exchange of experiences and ideas. Extracurricular classes or volunteer programs as well. In this concept, everything is learning, even if the main objective is simply entertainment, like going to the museum or reading a book. This idea does not only serve highly qualified professionals, such as radiologists, who want to keep up to date. Lifewide Learning, precisely because it is not restricted to technical-applied knowledge, needs to be universal and inclusive.
According to Ronald Barnett, in an article published in the book “Learning for a Complex World: A Lifewide Concept of Learning, Education and Personal Development”, the difference between Lifelong and Lifewide Learning is simple. “Lifelong is learning over time, and ideally, as the term suggests, it lasts a lifetime. (…) We see college education as one step in this series of stages of the journey. In essence, lifelong learning it is a series of learning experiences in successive time zones of a lifetime,” writes Barnett. “Lifewide learning, in contrast, is learning in different spaces simultaneously. It is literally lifelong learning for an individual at any given time.”
It is important to consider other aspects of life as sources of knowledge, beyond the walls of formal education. Because, according to LIFE survey (Learning in Informal and Formal Environments), an American research foundation specializing in learning, the time spent in formal institutions after entering the professional market is minimal. During the high school phase, we spend 18.5% of the day at school; then, during the passage through graduate school, this time drops to 5%; and it only diminishes over time, when work and family dominate our lives.
How can radiologists learn from lifewide learning?
The first advantage is clear: with the fast pace of technology, anyone who wants to continue in radiology will need – and a lot – to keep up with its advances. But there are other benefits. This autonomous search for knowledge, characteristic of the lifewide learning, generates motivation, stimulates creativity and confidence. In research carried out by the University of Surrey, in Guilford (England) quoted by Barnett, students who sought extracurricular experiences – as varied as possible, such as volunteering at Unicef or joining a sports team – repeatedly cited words such as “enthusiasm”, “confidence” and phrases such as “I learned to deal with pressure”. .
Easy to understand the reasons. Imagine the pressure, internal and external, on a radiologist who, in 10 years, has no idea how intelligent robots work. You can imagine dozens of balloons of doubts popping up in their heads: “Am I going to lose my job?”, “Is this diagnosis indicated by the machine really right?” On the other hand, an up-to-date professional will feel much more confident and excited about the complementary use of new technologies. You will know how to take advantage of this new reality to improve your own quality of life and even your productivity.
Therefore, these experiences, as well as voluntary participation in free courses, become so important. They help in the construction of what UNESCO classifies as the future of education: the transformation of the “integral being”, which unites emotional intelligence with the mastery of professional techniques.
One of the ideas of lifewide learning it is precisely to show people this capacity for self-learning, to transform themselves into such an “integral being”. “By helping them become more aware of their presence in the world, we have the potential to see them gain deeper understandings about how the parts of their lives connect and how this acquired development from different experiences is integrated to make them able to become who they want to be,” write Colin Beardand and Norman Jackson.
And here come the secrets to develop – or improve – the ability to learn autonomously. The first is to get involved with subjects that really interest you. A more idealistic radiologist may feel much more comfortable getting involved with social projects, such as the Doctor Without Borders – and meet the challenge of making remote diagnostics in patients from developing countries with serious military conflicts. Others may prefer to focus on interventional radiology. The ideal is to find your ideal. In general, no one uses the word “enthusiasm” when doing tasks that are disconnected from their values, without a personal interest in the subject, as the Surrey students said. Only then are you able to awaken the feeling of belonging, and really be present. “The learner must be actively present and aware of his interactions with the material and social environment”, explains Knud Illeris. One of the fundamental needs today is to learn to be an apprentice.
Another secret comes from real-time engagement with unexpected issues. It's part of the learning curve: you have to learn to put your knowledge (all of it, including interpersonal relationship skills) into new contexts. Whether in an emergency situation in front of a patient, or in the face of an intriguing and unknown exam. The new way of learning is to take stock of the result of these actions – the enthusiasm, the resolution – and assess whether they worked well or not. Self-analysis is also part of self-taught learning process.
a true apprentice lifewide captures messages in all environments and moments. Present, he realizes where he went wrong or right, or simply what learning came from that experience – whether watching a movie or performing a teleradiology on a patient in the interior of the Amazon.
challenges and trends
In this new reality, the main economic trends are technological development, structural economic change and, consequently, a greater demand for competence and lifelong learning. It is no longer possible to learn at once what is necessary to carry out a job.
“Knowledge and competence become a 'perishable' good. Partly as a result of technological development, the organization of workplaces is also changing. Hierarchical models are dismantled to make room for flatter organizations in which individual demands for competence increase. The knowledge society is no longer a dream, but a current reality”, write researchers from the Swedish National Education Agency in the book “Lifelong Learning and Lifewide Learning”.
Technology itself offers opportunities for lifelong learning for all. But it also poses a challenge to education: how to streamline and expand traditional learning environments? How to involve these personal experiences in teaching circles, in favor of lifewide learning? How to transform a course into something similar to the exchange of ideas that takes place in hospital cafeterias and corridors? It is necessary to take what happens in those other 97% of our lives to a learning environment, but without the weight of traditional teaching methods – from top to bottom, with curricula predetermined by specialists. Sharing experiences also generates knowledge. Traditional views of learning still need to be changed. No more radiologists need to fly thousands of miles to take a class with the top names in the field – they're just a screen away. Virtual teaching is already a trend. More than that: an opportunity to expand access to knowledge.
Not by chance, the CBR20 – 49th edition of the Brazilian Congress of Radiology and Diagnostic Imaging, which takes place from the 4th to the 11th of October, created two arenas. In one, residents can put their knowledge to the test with quizzes and tests. In another arena, senior doctors face each other and confront their learnings.
The CBR20 took seriously the importance of combining the sharing of individual learning – that thing of taking the cafeteria talk to the courses – with the studied knowledge and know-how. The Congress promotes a mix between the traditional and the new. There's room for traditional-style lectures and hands-on courses with image viewers and challenging cases. There is still the Point and Counterpoint Arena, where two experts with opposing views discuss procedures and controversial topics, and Rádio Expandida, open to the wider public. In all these virtual 100% environments, the public can participate with comments and questions. This is how we invite all congress participants to make the most of CBR20. It is a broad starting point for learning throughout and in all facets of life.
Your participation in the Congress depends on the search driven by knowledge. And it also pervades the experiences lived and apprehended in events full of other radiologists, in different situations – whether traditional or more modern. Participate!