I'll just leave this here....

[SLUser11]

http://www.ncbi.nlm.nih.gov/pubmed/26836220

http://www.nejm.org/doi/full/10.1056/NEJMoa1515724?query=featured_home

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[thedrjojo]

I literally posted this simultaneously...

Asc is all a buzz about this

 

[doc05]

the fact is that the requirements for the "flexible" duty hours group wasn't all that flexible. no big surprise that there was no difference.

 

[Hangry]

I thought John birkmeyers response was a bigger mic drop

Do you agree with him? Based on past threads I always thought you were a fan of the more flexible schedules.

 

[SLUser11]

Residency could/should be much more education focused rather than service focused.

Agree 100%, but I fear that the pendulum has swung too far toward the education side. If there's no service component, there are many non-technical skills that will be lost. When the service component is lost, the autonomy/patient ownership/ability to triage/professionalism/maturity can be negatively affected.

Also, if it is 100% education without service, the residents should probably be paying tuition rather than getting paid....I know this is an unpopular thing to say, but it's probably true.

 

[Hangry]

I agree that there has to be some aspect of both.

But there have been a number of studies showing the amount of time residents spend on various tasks. The two that stand out to me are one presented at APDS last week showing that residents spend less than 10% of their total work hours actually operating, and the study from internal med showing the amount of time spent in direct patient contact (can't remember the number, but absurdly low).

I think the balance is still tipped far on the service side at most residencies.

A talk I heard presented recently quoted that an IM intern spends on average 7 minutes face to face with each of their patients in a 24 hour period, while spending 40% of their time working on the EMR. Don't recall where that data came from, but the speaker was legit.

 

[dienekes88]

I agree that there has to be some aspect of both.

But there have been a number of studies showing the amount of time residents spend on various tasks. The two that stand out to me are one presented at APDS last week showing that residents spend less than 10% of their total work hours actually operating, and the study from internal med showing the amount of time spent in direct patient contact (can't remember the number, but absurdly low).

I think the balance is still tipped far on the service side at most residencies.

A lot of challenges to altering the education/service balance.

For one, the residency size may be loosely optimized to the number of cases available. If you increase the number of residents, then it is at the cost of case volume per resident.

The other option would then be to hire APPs, and that is very expensive. Additionally, residency is the primary time to figure out all the non-operative as well as the operative aspects of care, and if floor issues are being farmed out to APPs while ICU care is being farmed out to ICU APPs, then how will anyone be able to develop all the experience that requires hands-on patient care to take responsibility as the attending physician? Having said that, there are tasks that aren't even patient care related but rather systems-related, but systematically extracting these would be... daunting.

I don't have the right answer, but part of it is has to be cultural and beyond medicine or surgery. It's about how we select medical students; how we train the students; and how we treat each other in training. It's about the culture of "work/life balance" that has been created: balance is a luxury... and primarily of the affluent. It's hard to develop those incredible relationships with patients that make the sacrifice worth it when you're watching the clock. We can't go back to the way things were, and we definitely can't adhere to the mentality "I did it this way, so it's the only way to do it." However, there's something to be said for making sure that surgery is arduous.

 

[dpmd]

However, there's something to be said for making sure that surgery is arduous.

Considering i just spent 48hrs on call (due to someone else needing to trade their call) during which i only got a total of 8 hrs sleep during that time due to emergency cases along with the usual appy/chole/sbo consults i would agree with this statement.

Edit: the 48hrs doesn't include the 8hrs i spent after my call ended finishing up cases, consults, and rounds.