Are the doctors of tomorrow going to sink or swim?

We finally broke down and bought floaties. The kids played for a few days in the shallows, but since neither of them are yet proficient swimmers, they dared not wander into deeper waters. Each day they watched as younger kids scooted around the pool wearing wing like contraptions colored with cartoon characters.

I never liked the idea of floaties. Much better, I thought, to let them struggle and build on the lessons from last summer. But as the days went on, we realized that they would have more fun with a little independence.

The kids were overjoyed when we fit the balloon like apparatus over their arms. They were released from their own physical restraints.

All impetus to grow and learn was gone.

***

The oversized spinal needle gleemed as I held it up before attaching the 50cc syringe. I had worked my way through the pulseless electrical activity algorithm and finally came to pericardial tamponade.

The hustle and bustle of the VA was oddly quiet at midnight. A little over a year ago I was a medical student, now I was the most senior physician in house. I was about to plunge a large needle below the xiphoid process and angle up toward the heart. Then I would pull back and advance slowly.

The blood squirted into the syringe like an avalanche of red water. I looked up at the monitor and noticed that the rhythm converted to sinus. Moments later, I palpated a pulse when groping for the carotid artery.

My patient would code a few more times that night before eventually succumbing. Each time, the interns and I would race to the bedside and commence resuscitative efforts. There were no attendings, no seniors residents, and no floaties.

***

A decade later, medical training has changed. The transition from learner to decision maker is more gradual. By the third year of training, many residents have never run a code by themselves.

The problem with flotation devices is that they allow you to survive when you are a weak swimmer. They do not help you develop the skills you will need to keep your head above water. They are a crutch. Life saving in the beginning, deadly in the long run.

We need to clarify this duality in medical education. Careful oversight has to be balanced with incremental decision making and independence.

At some point or another, the floaties have to come off.

Are the doctors of tomorrow going to know how to swim?

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion.

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