Originally published in MedPage Todayby Emily P. Walker, MedPage Today Washington CorrespondentMore that a year after the Institute of Medicine (IOM) issued a report calling for mandatory naps for medical residents, the organization responsible for implementing -- or rejecting -- the IOM's controversial recommendation has yet to make a decision.
The Accreditation Council for Graduate Medical Education (ACGME), which has ...
Posts tagged Residency
ACP: Resident work hours – Managing a precarious balance
The following is part of a series of original guest columns by the American College of Physicians. by Steven Weinberger, MD, FACP
In December 2008 the Institute of Medicine (IOM) released its report entitled “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety,” in which it proposed a number of changes to the current regulations developed and enforced by the ...
How to make your medical grand rounds thrive
Early last year, my boss Talmadge King and I were at an ABIM meeting (we’re both on the board), and the group was debating a controversial topic. Another participant at the meeting, like Talmadge the chair of a prominent department of medicine, said, “We polled 250 people at our grand rounds last week, and they said ‘X’.” The audience gasped – ‘X’ was a completely unexpected ...
The balancing act between science and art is what makes medicine so challenging
Medicine is at risk from a technology takeover.Consider hospital rounds, for instance. Records are electronic, and doctors have to sort through data from an increasing number of diagnostic tests, like laboratory values and imaging results. Even before stepping into a patient's room.Stanford's Abraham Verghese continually reminds doctors about what's most important: the patient before us. In fact, his essay published a few years back in the New ...
ACP: 10 major challenges that confront medical education over the next decade
The following is part of a series of original guest columns by the American College of Physicians. by Steven Weinberger, MD, FACPAt times of calendar transitions, e.g., at the onset of a new year or a new decade, the popular press often takes a broad view in looking retrospectively at the outstanding or defining events and people of the past ...
Learn how to conduct a family meeting by using a structured approach
On my last day of ward attending, I handed out an EKG that resembled the Dow Jones industrial average over the last 10 years (not pictured). The normal pattern of an EKG was completely disrupted: ST segments were markedly elevated, P waves were hidden, and beats were grouped in odd patterns. My medical team laughed and shook their heads.I asked why.A brave intern responded that he was completely at a ...
Surgeons don’t receive enough training when resident work-hours are capped
by Crystal Phend, MedPage Today Senior Staff WriterLimiting surgical residents' work hours has compromised both surgical education and patient safety, according to an analysis concluding that an 80-hour work week isn't enough. The maximum 80-work week imposed in the U.S. for residents is too little to provide mastery in surgery, Gretchen Purcell Jackson, MD, PhD, and John L. Tarpley, MD, ...
Is the hospital July phenomenon a myth?
"Don't go to the hospital in July."That's the prevailing public perception, since that's when new resident-physicians begin their hospital training. And indeed, there have been studies from Australia and England showing a higher rate of death and adverse events during this time.But what about in the United States?Recent data isn't so conclusive. A piece from American Medical News points to a recent study from the Journal of the ...
How emotional stress affects physician training
Much has been made of fatigue increasing the number of medical errors doctors make.But what about other factors, like emotional stress?That's a little-reported issue that Pauline Chen addresses in her recent New York Times column. In residency, some doctors-in-training have to care for small children, among other life issues. As Dr. Chen notes, "whenever one of us experienced additional stress apart from our work, the house of ...
How to reduce the risk of medical errors from patient hand-offs
One of the consequences of capping resident work-hours is increasing the frequency of patient hand-offs.In a recent column in The New York Times, surgeon Pauline Chen cites a somewhat frightening statistic that during a course of a typical 5-day hospitalization, patients "are passed between doctors an average of 15 times."And residents sign over patients several hundred times during the first few weeks of training.One interesting solution would be to ...
Do resident work-hour restrictions increase surgical complications?
by Chris Emery, Contributing Writer, MedPage TodayReductions in resident physician work-hours at teaching hospitals in 2003 were associated with an increase in complications related to surgery to repair hip fractures, a new study found. The rates of pneumonia, hematoma, renal complications, and blood transfusions associated with hip surgery rose disproportionally at teaching hospitals compared to other hospitals after resident ...
How to make industry influence transparent in continuing medical education
by Larry Husten, Ph.D.A recent hearing of the Senate Aging Committee on continuing medical education (CME) should scare anyone who might need to see a doctor in the next few years. But you don't need to be a Washington policy wonk to discover that there's a huge problem with CME.Just walk into the lobby of any major downtown hotel when a large medical conference is in town and you will ...
Should patients care how many times a doctor has performed chorionic villus sampling?
When it comes to procedures, experience counts.In a recent op-ed in the WSJ, maternal-fetal medicine fellow Adam Wolfberg talks about the potential complications of chorionic villus sampling (CVS) (via Suture for a Living). Used to assess the risk of Down Syndrome in the fetus, it involves inserting a 3 1/2 inch needle into the mother's uterus to obtain cells from the placenta. The rate of miscarriage is ...
Do doctors set themselves up for physician burnout?
It's no surprise that doctors are prone to burnout, especially during residency training.But, according to a study cited by Pauline Chen in a recent New York Times column, it's part of the doctor-in-training culture. In fact, residents "from seven different specialties and found that they set themselves up for burnout by accepting, even embracing, what they believed would be a temporary imbalance between the personal and professional aspects ...
Why would a doctor stop seeing patients?
It's no secret that training a doctor takes a tremendous amount of time and money, both from the physician and the government, who subsidizes a substantial amount of the cost of training.So, in the midst of a physician shortage, internist Toni Brayer wonders about doctors who simply decide to stop seeing patients.After talking to a young physician who made such a decision, and instead, is starting a a pharmaceutical ...
ACP: Embracing a culture of cost-effective health care
The following is part of a series of original guest columns by the American College of Physicians.by Steven Weinberger, MD, FACPIn his column in the June 1 issue of The New Yorker, Dr. Atul Gawande used the example of McAllen, Texas, to illustrate the widely disparate spending on health care around the country. This oft cited article captured the attention of President Obama, who reportedly has made it required ...
10 President Obama posts you may have missed
With entries dating back to 2004, here are 10 classic blog posts on President Obama:1. How the primary care doctor shortage threatens Obama’s health reform plan2. The Obama health care summit, and did the President offer any clues to the upcoming health reform effort?3. Is Physicians for a National Health Program the biggest threat to Obama’s health reform plan?4. Did Obama provide any health care clues ...
5 top medical comments, June 14th 2009
Here are some of the more interesting comments readers have left recently.1. Carla Kakutani on how Massachusetts' health reform won't relieve ER overcrowding: Insurance does not equal access (although it’s better than nothing). Nothing changes until every stakeholder recognizes they have to control costs and allow a rebuilding of primary care in the US. That includes doctors and patients, along with everybody’s favorite villians, the insurance companies and big pharma. ...
Poll: Is further reducing resident work hours worth the cost?
The Institute of Medicine is recommending "rapid implementation" of its proposed plan to further restrict medical residents' work hours. The plan includes a 5-hour nap during extended shifts, a strict 16-hour cap on shifts without naps, reduced workload, and more days off.But at what price?It seems like common sense that better rested doctors make fewer errors and contribute to better patient care, but data from several large-scale studies does not ...
How to get doctors to embrace health care reform
Doctors still wield tremendous influence in the health care debate, since they still have the confidence of most patients.If Congress and the Obama administration can convince doctors to support health care reform, it can be, as the ACP's Bob Doherty notes, "decisive in determining if the public will be behind the effort, because voters are much less likely to support health care reform if told that it will result ...
