"Is an error-free residency what we really want?"

retired doc on the effects of limiting residents’ work hours:

Do we not learn in part by making errors in an environment where we are buffered and protected by our mentors and more senior colleagues? How will this cohort of residents fare when they are truly out on their own and there will be no team to hand off to when they have been up most of the night taking care of patients and fielding phone calls? Will they call their office and tell them they won’t be in until noon because they need their protected ten hours post call?

Comments

J
Are you freaking kidding me? Tell the patient that your over-tired resident made a mistake because he or she was trying to, “learn better”. Jeeez.
Of course you should try to maximize your education. But not at the possible expense of a patients well-being.
grey,md
j: we need to cut retired doc and his generation some slack; perhaps, when he did his residency there were only less than 50 medications to go around with, some form of x-ray to image with, and the blood tests were not panels yet; yes, they did great physical examination that they saw the manifestations of more advanced disease, unlike nowadays when you could get sued for failure to diagnose a malady in its very early stages; to the older generation that sold-out the present, all the developments in medicine and the younger generation’s “failure” to utilize such correctly, as in digesting the tons of information, are signs of lack of ability, that could possibly be overcome by getting residents exhausted and learning fatigued if you hammer it harder, somehow you can nail it in…
Anonymous
Tell the patient that your over-tired resident made a mistake because he or she was trying to, “learn better”. Jeeez.

For that matter, try to explain the reasons to the relatives of someone killed in a car accident caused by a resident driving home after he hand’t slept for a while. Is retired doctor going to take responsibility for that?
DocJohn
There is plenty of research that shows people do not learn best by putting them under intense pressure and keeping them up working for 16 or 24 hours at a time. Those kind of working conditions sound more like a third-world sweat shop than a way to learn modern medicine in the world’s most technologically advanced society.
Panda Bear
Oh her Christ’s sake. I am so sick of the mentality that we have to be chattel slaves to a hospital that uses us as low-payed labor to keep the meat moving in an out of their patient mills.
Blah blah blah. If you can’t train somebody for a job, any job, in eighty hours a week for three to six years then something is wrong with how you conduct training.
Sleep is pretty important too. Why should any person be deprived of it during the many years of medical training? The hospital doesn’t give a rat’s ass about residents and work them 24 hours a day, seven days a week if it could to extract as much profitable work out them as possible for taco jockey wages.
The fact is that I want to sleep seven hours every day and that I have some family and social responsibilities outside the salt mine. Screw the old school doctors lamenting the fact that we are no longer the scut-whores over whom they used to have absolute authority. Times have changed. Back in the sixties when those little punks were residents hospitals moved a lot slower, there was less to know, and you could go into private practice after completing a single intern year.
Big friggin’ deal. They may have been in house but, and many of my older attendings who are not such punks, confirmed this they slept a lot more than we do on call because the interventions were fewer, the hospital stays were much longer, and their census usually consisted of stable, long-term boarders. Today the modern hospital is a factory and we work harder on call than we do during the day.
Anonymous
Agreed. To enhance efficiency doctors need to be trained to be experts in providing high volume care at reasonable fees to enhance value. That means that primary care will be high volume screening and management of uncomplicated medical conditions. All physicians need to become more focused, not on trying to learn to be a jack of all trades or trying to be the hero with disease management that is not the everyday occurrence.
Anonymous
honestly, we all know its about cheap labor.
24 hours seems fair. 18 seems better.
when i was a med student. we had a CAP on admissions. how many admissions do you have to do in a nighttime to get some “experience”. id say that after 3 you forget the details. Its no pleasure to write up many admissions in one night. certainly it would be ok to HEAR about the interesting admission, but filling out an H/P and doing a H/P on EVERY TEACHING PATIENT IS OVER KILL (of course the attending wants it done). PERSONALLY, ID THINK A BETTER IDEA WOULD BE TO EXTEND THE NUMBER OF YEARS IN RESIDENCY. instead of working long shifts.. do a 4 year internal medicine residency or 3 1/2 years instead of 3. do family medicine in 4. do surgery in 6. do obgyn in 5-6. why do we have to speed the residents thru their rotations. give them time to READ and COMPREHEND THE information they are RESPONSIBLE FOR. make a 30 day rotation 45 days. it sure would be nice to learn more about the specialty fields without being sent to another rotation where you spend 10 days learning the service and then never see the content of the previous rotation for 3 more years or more.
Personally , I see no problem with a 4 year internal medicine residency. make the hours better. give them time to digest more. let them have a CAP on admissions. and maybe have more residents around to do the work. we wont see a shortage of doctors.
Mike
Are you kidding? Extend IM residency? Isnt three years enough?That last year is often ajoke anyway. Make it two years I say.
Anonymous
is 2 years really enough time to learn Rheumatology, all the pulmonology drugs, the details of cardiology enough to practice effectively, and on and on. ? how many months of endocrine do you do? enough to check a TSH every few weeks? or enough to really have a grasp on the practice? make it 4 years. we will have safer doctors. you can afford one less year of practice. 2 years of int med goes very fast. you certainly arent ready for practice. the only reason you think the 3rd year is a joke is because you dont have as much tedious chart work to do. but do you really know enough internal medicine?

"Is an error-free residency what we really want?"

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