Reviewing the Stages of 'Psychoradiological' Development

Taking it as a given that I was going to med school to become a psychiatrist, I made psychology my major in undergrad. One of my favorite classes was on “personality theory,” which delved into various approaches: psychoanalytic, behavioral, humanistic, etc. Each examined the process through which a human grows and develops from infancy to however old the individual makes it.

It can get a little repetitive to keep going over the same stages of life, even with the differing lenses of competing theories. Several took a staged approach, divvying up an individual’s life in terms of what he or she is likely to be capable of and dealing with at this age or that. I found myself wondering whether, years hence in med school, they would be telling us to embrace this theory, disregard that one, or proclaim the whole lot of it to be pseudoscientific hogwash.

Some of it did seem to just be assigning terminology to things that anybody might have come up with contemplatively sitting in an armchair. A lot of these psych theories didn’t just seem applicable to a person’s actual life, or formative years within. You could use them to, say, dissect one’s lifespan as a student, from pre-K through grad school. Today’s blog is the result of a recent realization that a radiology career is just as apt fodder.

For a case in point: consider my sort-of namesake Erik Erikson (you might be amazed how much writing’s out there about spelling our names with K versus C). His theory contained eight stages, each based on a dichotomy with which an individual in the stage contends. The first stage, for instance, is in infancy: “Trust versus mistrust.” If successful, the child learns that he or she can trust parents (or others) to provide care and support, laying the foundation for good relationships later and even a sense of identity. Failure results in fear and a perception that the world is unpredictable, even scary.

I mentioned that you could adapt any timeframe in one’s life to this theory, so I could make that first stage apply to the “infancy” of one’s medical career as a first-year student, but I am applying the first stage to the beginning of radiology residency training. Instead of a baby learning whether or not to trust his or her caregivers, the fledgling rad figures out whether his or her senior residents, fellows, and attendings are trustworthy.

You probably remember going through this. You could count on some of your superiors to teach you wisdom or procedures, but not so much for others. In my residency, for instance, we knew some attendings commonly offered “black pearls” of “not wisdom” that we would best not commit to memory.

One learns who can be counted on to arrive and read out the overnight cases on time versus keeping the post-call resident waiting an extra hour or two. In times of crisis — when one needs help with a tricky scan or has a power struggle with a demanding referrer — one also comes to understand which attendings will have one’s back, and which ones are more likely to abandon or even backstab.

The second stage, “autonomy versus shame/doubt,” focuses on early childhood, when a properly developing kid learns to do things for him- or herself, such as toilet training. Good parenting includes encouragement of success as well as avoiding undue punishment for failures and enabling the young one to explore interests.

I apply this to the latter portion of residency and fellowship when the trainee should be reading cases and doing procedures more independently. Attendings are still around for consultation and backup, but one doesn’t want new rads to emerge into the field without feeling like they can handle things on their own. Per the name of the stage, trainees either develop autonomy, or doubts themselves and/or feels shame at their sense of inability.

Third is “initiative versus guilt,” around ages 3 to 5. It introduces peer interactions, some in the absence of adults/superiors. One gains a bit of independence, making some of one’s own decisions. Otherwise, the theory goes that “guilt” results from being a dependent burden on others. The kid also asks a lot of questions in order to understand this big world with which he or she is coming to grips. Good, informative responses reward his or her initiative. Guilt can result from “you should know this already dummy” kinds of retort.

I map this to rads in their first job after training. It’s rare that one can hit the ground running. The “real world” is almost never a precise match to the academic environment in which one has just spent the last half-decade or so. Sometimes I wonder whether this stage might be a little delayed for rads who continue on in academics. On the flipside, someone who goes out and moonlights during fellowship probably gets a head start.

Regardless, the newly minted attending is technically ready to practice rads unassisted, but may need to lean on more seasoned teammates, who will be supportive in a good first job. Not all work environments are suitable for that and, unfortunately, sometimes the only way to find that out is by blundering through the situation firsthand.

You can look up the remaining stages (“industry vs. inferiority,” “identity vs. role confusion,” etc.), but I have hopefully conveyed the idea. A life in radiology, or any other full-length career, is a microcosm (maybe micro- isn’t the right prefix since it can last for multiple decades) of life as a whole. One moves from learning how to stand on one’s own feet to figuring out one’s abilities, strengths/weaknesses, and subsequent overall approach to things.

At some point, the focus turns outward. I have squared myself away. Now what will I do for the world (or rad group, even radiology field as a whole) around me? What kind of connections will I make? Am I creating a legacy of which I can be proud? When all is said and done, will I be able to look back on my path and be satisfied with it?