opinion : lowered residency work hours makes better physicians

A recent discussion with an attending highlighted an important generational gap in academic medicine, one that has become much more pronounced with the changing resident work hour requirements. The issue is that older doctors feel that the end-all of learning as a student and a resident is achieved by maximizing the hours spent in the supervised clinical setting (“on call”). Most younger doctors tend to avoid these on-call hours, which the older attendings often believe is because of laziness or lack of dedication to medicine. This is a misconception that needs to be corrected however. Young doctors do not like structured clinical on-call hours because we recognize that they are sub optimal for learning.

The first reason that traditional on-call hours are sub optimal for learning has to do with what is expected of doctors during those hours. Most of the work done during these hours is “scut” work, both patient and institutional paperwork that had nothing to education. The second and more important reason however is that people in my generation who have grown up with computers and online resources have come to realize that self-directed, active learning is by far the most effective means to learn the vast quantity of data required to be a competent physician.” Back in the day”, the only way to get information from a good medical lecture was to sit physically in the room and listen to that person talk(some hospitals had physical tape recordings?). Today almost all lectures from any medical school are available to be instantly streamed on the Internet. Throughout medical school, most students have learned to maximize their study time by using their personal preferred online resources. While current residents often spend 100 hours per week learning medicine just as their predecessors did, we understand that is much more effective to have less time with direct patient care and more time in front of our computers studying in the areas that we are weakest on. While this does not necessarily apply to procedure oriented specialties such as surgery, information oriented specialties such as medicine and radiology clearly benefit from residents having extra time when they're not on duty to study as they see fit. In this light, it is easy to see that a resident who spends 80 hours on call and 20 hours studying on their own time is going to be a more knowledgeable resident and one who spends 100 hours on call faxing pharmacy requests and rewriting safety checks. There was a time when the only way to see rare cases was to be on call when these cases came to the hospital, but instant access to electronic resources has made this an issue of the past, especially in radiology.

The idea that you can be a better resident in less time is hard to understand to someone who grew up in an era where commitment and quality were measured by number of cases seen and amount of time put in. It is difficult for many old-timers understand that you can be a better doctor by putting in less time as long as that extra time is used correctly. Young doctors can in fact be better trained in fewer hours.

For the record: 2011 goals

Well, I have abandoned this blog for almost 2 years, but i still have opinions so i might as well go back to sharing them.

2010 was a good year for me. my long term goals are mostly on hold as I complete medical school clinical rotations and my life is consumed with academics. I have done well in all my classes so far and did well on Step 1 boards so academics are going well.

Financially I made less money but also spent a lot less money. I have not been able to do much work but my free food and housing easily makes up for that. I had no losses in the stock market this year and my modest investments grew at a rate that outpaced the interest on my student loans so my paying forward strategy is working well.

on the social front, my mother seems to be happily remarried and i have made efforts to improve my relationship with my sister. I have been visiting friends from high school and college to stay in touch despite my busy schedule. I also reached out to other relatives and visited my grandparents in florida.

as for life goals, I delivered a baby (6 in fact), scrubbed into surgery and

without further rambling, here are my 2011 goals:

-choose a specialty and apply for residency

-take the Step 2 boards and score as high as I did on Step 1

-honor at least half of my clinical rotations

-return to tutoring

-loose the 15lbs I gained in 2010

-travel to a foreign country

- watch at least 25 movies, read at least 5 books (not tb's), go to at least 5 concerts.

- at least 50 blog posts

well that was not very ambitious but it will keep me very, very busy

For the record: 2008 goals

That's part of my annual looking back and setting goals, I must say that 2007 was truly a banner year. I look at all the different areas of my life and I seem to have improved all of them, and a half to predict that many of them will probably go downhill in 2008. Briefly a list of achievements in 2007:

• Entered into a significant long-term relationship with a woman I love.

• Almost 30% yield on investments

• got two new great jobs (admissions counselor and tutoring)

• nearly doubled my income

• got a sweet new single apartment in a beautiful residential neighborhood

• acquired almost an entire set of furniture

• significantly upgraded many of my things (new TV, camera, MP3 player etc)

• achieved a 4.0 GPA

• went many new places, and tried several new things.

As far as my goals that I did not achieve from the last year they include:

• Publishing and other scientific article (this should occur in early spring)

• building my running to at least 5 miles (this is one area where I completely failed)

• doing 200 hours of community service (probably not even one... )

• traveling outside of North America

All that said, here are my goals for 2008:

• Get into an allopathic medical school

• at least he 25% increase in income

• match 30% return on investments I achieved last year

• use the money to continue to upgrade material possessions

• read the least 12 books with at least five on topics other than medicine

• return to working out at least four times a week

• move into an even better apartment

• spend less money on non-durable goods

• do some community service and try to get involved with a least one local organization.

• Travel outside of North America (at least get a passport)

• continue to achieve at least a 3.5 and get my MS degree

Last year wasn't pretty amazing year. I will be hard-pressed to make as much money as I did last year and it's hard to top finding the woman of your dreams or this particular apartment that I'm in. I do anticipate getting into medical school however, which will set me back in the short term but will clearly move my life ahead to achieving my long-term goals. It is quite possible that I will make no money and do almost nothing outside of school for the next four years but I'm having the time of my life now and over the next six months in order to make up for the fact that my life may fall into a holding pattern so that I can become a doctor.

For the record : 2007 Goals

I set several goals last year and am happy to say that I accomplished most of them. Last year was an amazing year: I graduated from college, got my first apt, and proffesional job, entered grad school, and did more concerts, traveling, and dating and made more money than in any previous year. 2006 will be a tough act to follow, but I believe in continous improvement so here, in no particular order, are my goals for 2007:

first of all, goals that I had last year that were not achieved:

- pay off at least 10% of my student loans (not likely)

- travel outside of North America

- enter into a serious relationship (sustaining is really the goal here)

and new goals for 2007:

- make at least a 10% return on investments

- get a 3.5 or better GPA

- do at least 200 hrs of community service

- earn more income than I earned last year

- build up my running to at least 5 miles at a time and 20 miles a week

- publish another scientific article

- move to the suburbs

- learn how to cook pastry

- reduce clutter

sex, money, and grades, that's what it is all about...