I think it all depends on the person. People like Shannon like to challenge themselves to recreate real life objects using their graphics programs. Others have done great stuff by scanning things (someone did some neat metal charms once) and cleaning up the image digitally.
If you look at my gallery I made some bookplates.
BOOK PLATES
I did these in Photoshop. I drew a rectange and some circles. I erased the center of the rectangle, made some holes in the circles and started to layer on filters and styles to get a metal look.
I say play around with anything at your disposal. You could make some great charms by taking clip art and adding filters. Or try out freehanding some things. You'll be surprised how quickly you get to know your program and how much easier it gets as you go along.