A minimalist reading regimen in residency

[deuist]

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I've noticed that EM which I traditionally didn't see as an overly academic field (as pre-med/M1) seems to be slowly becoming academic driven, i.e. like internal medicine docs. "You must read this 2200 page textbook", "I read every journal article published in my field" etc.

That might be because you are at a medical school. For some community docs, if it wasn't for mandatory CME, they would never learn anything new after residency.

 

[deleted109597]

Nobody gives a $%# about being the best EM doctor they can be, at least in terms of knowledge base. It's hard to think of another specialty in medicine that actively punishes you for having above normal competence. Knowing exactly how things should be done just makes dealing with the actual state of things that much more painful. So we learn where we can take shortcuts and what we can safely forget and rationalize that we can alway Google it until we forget enough about the subject to not even consider looking it up.

Yes. But many also become "mini-experts" in some random field or other. Otherwise we wouldn't have so many fellowships.

I wish being more than just "adequate" wasn't something bad. Similar to what Weingart says about people who do resuscitation well, only to have their colleagues tell them that they shouldn't because it encourages the ICU to expect that in the future. I try not to go out of my way to belittle people (usually), but I have no problem if someone appears to be unintelligent because I'm better able to perform my duties than they were.

The intellectually honest would prefer to stay on top of their game instead of just maintaining homeostasis.

 

[Cerberus]

Nobody gives a $%# about being the best EM doctor they can be, at least in terms of knowledge base. It's hard to think of another specialty in medicine that actively punishes you for having above normal competence. Knowing exactly how things should be done just makes dealing with the actual state of things that much more painful. So we learn where we can take shortcuts and what we can safely forget and rationalize that we can alway Google it until we forget enough about the subject to not even consider looking it up.

I think we're punished for not being experts as well. If you only have a weak understanding of a subject and talk to a consultant about it, your deficit becomes obvious and they will use this against you (especially if you are at an academic center and dealing with a consultant who has no incentive to admit/consult on your patient). I remember talking to a consultant as an intern and getting bullied because I didn't know as much as they did. I hated getting beaten up on consults so I learned the medicine and read more and more to try to master the material. I find my job is infinitely easier now because when a consultant tries to give me **** about a consult, I know exactly what to say to get them to back down and do their job.

 

[Tiger26]

I think we're punished for not being experts as well. If you only have a weak understanding of a subject and talk to a consultant about it, your deficit becomes obvious and they will use this against you (especially if you are at an academic center and dealing with a consultant who has no incentive to admit/consult on your patient). I remember talking to a consultant as an intern and getting bullied because I didn't know as much as they did. I hated getting beaten up on consults so I learned the medicine and read more and more to try to master the material. I find my job is infinitely easier now because when a consultant tries to give me **** about a consult, I know exactly what to say to get them to back down and do their job.

Well said--feel the same way

 

[Arcan57]

I think we're punished for not being experts as well. If you only have a weak understanding of a subject and talk to a consultant about it, your deficit becomes obvious and they will use this against you (especially if you are at an academic center and dealing with a consultant who has no incentive to admit/consult on your patient). I remember talking to a consultant as an intern and getting bullied because I didn't know as much as they did. I hated getting beaten up on consults so I learned the medicine and read more and more to try to master the material. I find my job is infinitely easier now because when a consultant tries to give me **** about a consult, I know exactly what to say to get them to back down and do their job.

We're definitely punished for being sub-par. However the part that makes your job easier is not being extraordinarily competent in the consultant's field but knowing how to deal with the consultant as a person and what their preferences are. You need a certain level of competence to talk to consultants, but above that most consultants are neither interested in nor effected by your input. They have their own schedules and expect you to keep the patient stable until they can get around to seeing them. In the academic setting this is somewhat less apparent because of house staff (especially fellows that can do procedures) but often the lower levels of house staff are just buying time until the attending can staff the case.

 

[Arcan57]

Yes. But many also become "mini-experts" in some random field or other. Otherwise we wouldn't have so many fellowships.

I wish being more than just "adequate" wasn't something bad. Similar to what Weingart says about people who do resuscitation well, only to have their colleagues tell them that they shouldn't because it encourages the ICU to expect that in the future. I try not to go out of my way to belittle people (usually), but I have no problem if someone appears to be unintelligent because I'm better able to perform my duties than they were.

The intellectually honest would prefer to stay on top of their game instead of just maintaining homeostasis.

I wish it wasn't bad either. I'm driven by internal factors to maintain and expand my knowledge base but there's no significant reward for doing so. Given the nature of our specialty, the chances of having read up on a rare disease prior to seeing it and that knowledge being useful in saving the patient's life is very low. So there's not a big positive feedback loop from that standpoint. In terms of making your shifts easier, you'd probably be better off using the time spent studying to hang out with your consultants/eat in the staff lounge when not on shift. If you're aggressively learning and growing as an attending it's because you've made an active decision that the knowledge is important to you for its own sake.

This is why I cringe when I hear med students trying to find the "easiest" residency. If you don't get your house in order before becoming an attending, there's nothing that going to incentivize you to do it afterwards.

 

[deleted109597]

Eh