Dictation is such a powerful skill.
I strongly believe that writing is an incredibly valuable skill, and in many ways, I feel that writing is how you really learn how you think. But speaking out loud has its own benefits—for figuring out what you want to say and practicing the skill of taking nebulous ideas and turning them into crisp prose.
With experience, it’s also simply faster than typing with your hands and more accurate with spelling than your clumsy fingers.
The Value of Verbalizing in Radiology
The return of the radiology oral boards is, I think, largely a reflection and acknowledgment of the reality that taking cases is a valuable skill—not just because of the performance art component or the ability to assess critical thinking, but because the ability to verbalize and think out loud is an inherently valuable skill, even if it’s hard to quantify.
The more you say things, the clearer you can become in how you express yourself. It’s also no secret that we create mental shortcuts and cognitive macros in our ability to rapidly describe things, just like riding a bicycle. If you hear an older attending free-dictate every single word of the report like a well-paid auctioneer like we’re still living in the 1990s, you would see how powerful that automaticity can be.
I don’t know if it’s the same basal ganglia circuitry, but it’s also undeniably something that you can see every first-year resident develop a library of as they practice. Dictating reports is part of the learning process, even if it doesn’t feel like learning specifically.
The more you verbalize complex cases, the more you reduce the cognitive load of those interpretations. I think the ability for people to gain speed and confidence in reading cases is not just a matter of how many cases you’ve looked at, but likely also a reflection of how many cases you’ve dictated.
Dictation as a Personal Superpower
I also think—taking a step back from radiology—that dictation is a super valuable skill. I’d always been drawn to the idea of dictating but wasn’t really able to put enough reps in to become comfortable with it until I became a radiology resident. I even bought a copy of Dragon back in high school after NY Times columnist David Pogue started dictating all of his columns, but had terrible results at the time. This was a symptom of my desire to be a writer but inability to put in the actual work to be less terrible at writing, and the incorrect belief (that I still fall prey to) that if I had just the right tool, I would magically get things done.
Even outside of accuracy problems with earlier software (especially my admittedly not very clear speech), the fact was that I had the same writer’s block with a blank page whether I was trying to type or to speak.
But since starting residency and thanks to the built-in voice transcription of modern cell phones, I’ve been able to capture ideas that would have been lost in the ether or only partially captured through written shorthand (less well-formed and often unintelligible to my future self).
As I’ve written before, I even dictated the majority of the first draft of my book about student loans while walking on a bridge between the reading room and our noon conference.
Dictating while walking is an especially incredible gift, because the act of pacing around is distracting enough to help you silence your internal editor and allow the free flow of ideas without being demanding enough that the actual thinking itself is impaired.
While the dictation is never the final draft, it provides incredible, unfiltered raw material for revision. Editing and expansion are where, for me, the real craft of writing takes place, but there’s so much less friction when you’ve built some momentum through dictation.
If you think you might want to start writing but can’t seem to build the habit, try speaking first.