I believe in the power of education. I'm sure we all do, or we wouldn't be doing what we do for a living, whether it is practicing medicine as established IRs, working to gain a foothold in the field, or studying at the nascent phase of our career when the learning curve is the steepest. Everyone learns at a different pace and with a different style. In fact, I would posit that those differences are what make teaching both so formidable and so fun. Trying to get the lessons through to everybody in the room is challenging but at the end so very fulfilling; it is truly what makes being an educator so appealing. And at that end of the day, it isn't simply those in academic settings who teach; every practicing clinician reading this editorial teaches on a daily basis, whether it is formal or informal.

Most of the learning of our craft comes from those who have learned it before us. Whether we are talking about those who directly taught us at the bedside or PACS-side, or those who taught those who taught us, we undoubtedly learn the most from one another. However—what if that isn't sufficient? How do we best round ourselves as practitioners of medicine rather than as “proceduralists,” “angiographers,” or “catheter-jockeys” (seriously—is there a more ridiculous and distasteful term?). We can learn some of that from our direct IR teachers, but they might not have the knowledge base to teach those particular skill sets themselves. If we box ourselves in by only teaching one another, we then run the risk of what we have in the past blamed others for doing, such as 15 years ago with IR condemning vascular surgeons teaching their trainees how to do endovascular interventions or 25 years ago with diagnostic radiologists chastising obstetricians in teaching ultrasound. We would do well to remember that many of those things that we consider core IR procedures are (trying to think of a better word than “stole,” but kind of coming up empty here) from other specialties. Central venous access? IVC filters? Balloon angioplasty (no, it wasn't Dotter)? Even some of the things we as a field did invent were simply less invasive ways to do things that replaced something that was already established, such as TIPS and surgical portosystemic shunts. So my question is this—should we be relegating ourselves to only learn from one another, or should we be willing to learn from those outside of IR who can teach us either something new entirely, or at the very least teach us to think of something with which we are already familiar in a different way? I think most of us would advocate learning all we can to better serve our patients: that seems like a no brainer. Keep that thought.

When I think of my own teachers, and those from whom I've learned the most, the vast majority are of course other IRs. I have been incredibly fortunate to learn from many of the greats, including those from the generation before mine as well as contemporaries. I had the privilege of training under three of the best (Waltman, Mueller, and Kaufman—first names unnecessary), but have also worked with others over the years (Kumpe, Durham) who framed my understanding of IR as I was developing my own practice and skill set. I am of the age now that I am learning as much about the practice of IR from those a few years behind (Gaba, Bui, Lewandowski, Funaki, Arslan—and the list grows) as from my contemporaries. I am, and we are, all privileged to have those tight IR connections on which we so heavily lean. But, to my point above, we are missing a tremendous opportunity if we limit ourselves to learning our craft solely from those like us.

I received a lesson in extending myself outside the world of IR in my second job, which was at Denver Health. Denver Health is the main safety net hospital in Denver, and a level 1 trauma center. The chief of surgery there is a world-renowned trauma surgeon by the name of Gene Moore. Gene is the most well-published author whom I know personally, and has edited the bible of trauma care (now in its ninth edition). He is also a translational researcher par excellence, and I understand he is a magician in the operating room. He became more than a work colleague and mentor, also becoming a good friend. However, before I even knew his name or who he was, on one of my first days on the job I was invited to join the trauma team rounds in the surgical intensive care unit (SICU) at DG. I was, in effect, considered part of the team from the day I walked in as a pretty darn young IR who hadn't proven his way yet. And I was welcomed to the team as someone who brought something unique to the trauma enterprise. It wasn't just me, but everyone who brought something to the team was welcomed, including therapists of all sorts and charge nurses. The only caveat was that if you had something to offer, you'd better bring it forward—to not do so was a violation of your duty. Gene and the other trauma surgeons (most notably Walt Biffl) all preached the same mantra—if you have something to add to patient care, bring it on. Without a doubt I learned more about trauma care that I taught, and I particularly learned what I could add to the care of those patients. But it went even two steps further. First, I learned what gaps were necessary to fill, and how IR might help fill those needs. And second, I learned to be part of a multidisciplinary team long before the idea came into vogue.

Like my experience at Denver Health, I don't think any of us hesitate to welcome the opportunity to learn from those outside of our field, particularly when it comes to optimizing the care of our patients. I see that kind of collaboration even now in our training program. Our residents now go to the SICU (as all IR residents around the country do), but they also rotate on vascular surgery and hepatology to round out their own education. These are things our IR section simply couldn't teach them in our environment. I am grateful to those attendings on other services for teaching our residents—it isn't mandated or handed down from above. In a truly collaborative and altruistic fashion, they do it because it is the right thing to do.

This brings me to the final point. I'm bringing this up at the end because if I brought it up at the beginning you would likely have stopped reading and found something more enjoyable (Laundry? Dishes? Anything but this?) to do with your time. The point is if we find it necessary to get education from others, and others are willing to educate us, should we not have some obligation to do the same? I have heard innumerable IRs chastised for sleeping with the enemy, for training others to “do our job.” How can we justify that stance if we want teaching from others? I'm not suggesting that we train ourselves so we are out of jobs, but are we dedicated to advancing patient care or to advancing ourselves?

As I said earlier, I think most of us would advocate learning all we can to better serve our patients. Do we not also have a moral obligation to teach all we can for the same reason?

Article published online:
04 May 2023

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