2) at least for surgery residency, don’t accredit institutions to accept residents unless they have the ancillary staff available to run a hospital. too many hospitals with residents are underfunded and literally depend on residents doing hours of scut work that contribute nothing to their education. as i said in my previous post, many surgery residents do not meaningfully participate in surgery until their 3rd year of residency because they are camped out in the MICU and surgical floors for over 80hrs a week. this means 40% of their residency has evaporated by the time they get to really learn to operate. even if they don’t get to operate until 2nd or 3rd year, if they weren’t working >80hrs per week they might have a chance to actually read a textbook to learn some things about surgery. my surgery colleagues were always so exhausted and stressed they rarely had the energy to spend time reading. in other residencies it is common for residents to read 3hrs assigned reading per night after work with lectures the next day on the material. some institutions spread residents so thin, the scut work done by the residnets becomes critical to the functioning of the hospital at the expense of their education.

Either stop calling it medicine and rename it doctoring (which occurs with regulated hours) or accept that people sometimes get sick at incovient times, and that tired docs will do the best they can. I’m really glad that the (superb) docs who treated my family members had done enough procedures while they were exhausted that they could do the techinically demanding work (making it look effortless).

I didn’t much enjoy my MICU rotations as a resident with the 24 hour call but I did learn how to stablize someone quickly in the middle of the night. It is not responsible to graduate residents in any field who have not mastered the basic skills of their field.

Even pathologists take call!

At least half of the work, particularly at the junior level, can and should be done by ancillary staff. Unfortunately, residents are looked at as a cheap source of 24 hour labor by addendings and hospital adminstrators who perversely label slavery as education.

Frank

“More than a third of surgical residents think that regulations designed to limit their work schedules to a maximum of 80 hours per week represent a “significant barrier” to their training.”

That’s true. Equally true is that two-thirds don’t. A more appropriate headline would be:

“Majority of surgical residents favor work hour restrictions”

What an interesting way to present statistics – highlighting the minority view and making it sound like the majority.

Also, several of my colleagues that did surgery hardly scrubbed in to any cases until their second year of residency. They were doing over 80hrs per week of scut work in the ICU and surgical floor and never made it into the OR. Many of them didn’t meaningfully participate in the operations until their THIRD year of residency.

The probelm is not that 9 years is not long enough time for training. I think a lot of the problem is wasting a lot of the 9 years on activities that provide limited benefit.