Today’s residents have more to read but less time to learn

As everyone knows, residents are now restricted to working 80 hours per week. One of the lesser known side effects of this work hours limitation is the drastic loss of educational conference time.

Since at least one third of the residents must now go home after morning rounds, afternoon conferences are no longer possible. Most residency programs now devote part of at least one morning per week to dedicated educational time.

JAMA Surgery recently described how one program chose to comply with the mandate to teach some of the more fuzzy resident core competencies. Their weekly didactic schedule of one hour of grand rounds and one hour of small group learning now includes 10 hours per year (representing 10% of the 100 hours allotted to formal teaching) on practice-based learning and improvement, interpersonal and communication skills, systems-based practice, and professionalism.

The specific topics are structure and policy of U.S. health care, advocacy, medical economics and finance, history and consequences of major legislation, innovation in health care, health information technology, comparative effectiveness, health care disparities, basic management principles, quality, performance improvement, patient safety, coding and billing compliance, legal issues, litigation, risk management, clinical practice models, contracts, relative value units (RVUs), personal leadership styles, power and influence: organization psychology, negotiation and conflict resolution, communication, ethics, and last but certainly not least, one of my favorites – Six Sigma.

I don’t mean to disparage the authors of this paper. They’re only trying to follow the rules. I’m just glad I’m no longer a residency program director having to commit 10% of my program’s precious educational time to things like organization psychology, history and consequences of major legislation, and Six freakin’ Sigma.

But I guess it could be worse. At this year’s meeting of the Association of Program Directors in Internal Medicine, the following slide suggesting books that should be read by every chief resident was shown.

Todays residents have more to read but less time to learn

I would love to meet the chief resident who had not only the time, but also the inclination to read all 17 of these books.

“Skeptical Scalpel” is a surgeon blogs at his self-titled site, Skeptical Scalpel.

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  • T H

    If they only have to be in the hospital 80 hours, that should leave PLENTY of time to read about their patients in (Harrison’s/Sabiston’s/William’s/ etc – pick the specialty, insert major text here). Or on their tablet/phone/etc.

    Or podcasts to and from work while driving.

    • Skeptical Scalpel

      It’s also possible to read while in the hospital. Then maybe one could read a few of those books on the list.

      • T H

        “Sleeping on call? That wastes the time to learn.”
        – one of the attendings during my ICU rotation.

        • Skeptical Scalpel

          Yes, and we used to say we hated working every other night because we missed half the cases.

          • T H

            We were fibbers.

  • Dr. Drake Ramoray

    Now I understand why all the new residents are all gung ho ACO/PCMH after training. Also explains at least half the posts on this site by medical students and residents. I weep for my profession.

    • Skeptical Scalpel

      I forgot to account for the time residents might spend blogging. Thanks for reminding me.

  • http://www.thepatientdoc.com The Patient Doc

    My husband is a gen surg resident, starting vascular fellowship in July. I agree he doesn’t have as much time to learn, but I feel like it’s more due to doing logs and other paperwork all the time. He gets his reading in by listening to audiobooks during his one hour commute back home. Also I feel during training, we were used to do other people’s task such as ekgs, blood draws, placing IVs, and my favorite- transport.

    • Skeptical Scalpel

      Interesting. How can this be? I thought that when hours limits for residents were established, scut work was supposed to be done by someone else.

      • http://www.thepatientdoc.com The Patient Doc

        Not in understaffed NYC hospitals. I’d get pulled off rounds with my attendings, or noon conference to do scut work all the time during intern year. I do believe the scuttling decreases as you move up in rank, but the bottom line is sometimes if you want something done you gotta do it yourself- like push patient down to CT. And I have to ask, who is really monitoring work hours? I know some of our Ortho res who were working close to 100 hrs a week, no one’s gonna speak up. But I do think things have gotten better. The hospital my husband is at now has a residents union, so they keep an eye on things. I guess it really just depends on the hospital.

        • Skeptical Scalpel

          Thanks for the candid response. I’ve worked in NYC myself. I believe you.

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