It’s definitely possible and I’d be surprised if a resident suicide didn’t engender a period of self reflection in the program. Not that I know you, but from your posts it seems like you’ve had to take an unflinching look into yourself and adjust some of the internal machinery. Not everyone can be honest with themselves, and among those that are relatively few are going to be in a position to make changes that matter.
We typically hold leaders responsible for the systems they head, but most academic department heads are going to be firmly in what would be considered in the corporate world as middle management. They have input but are limited in terms of selecting their employees are, they’re at the mercy of the hospital in terms of nursing and ancillary staff support, and they may have limited power to directly address bad behavior by their attending colleagues. None of this excuses the system when it fails, but it makes it understandable that most people are going to take a look at the effort to change the system vs the effort to change the individual and come down on the side of modifying the individual.
I completely agree with this. I'd like to think that I have, with reflection and engagement on SDN, grown in my views about training, so thank you for that.
I've come to realize that the issue of resident training failure is multifactorial and that the adversarial view is not helpful. In another thread we discuss psychopathic PDs. I don't think that's common, nonetheless I'm inclined to believe that dysfunctional leadership for whatever the cause, is one real issue among many. Regardless of what the issue is or how common, I'm inclined to believe a few things:
There are bad apples. There are problems that aren't a result of "bad guys," as well. Speaking out about abuses, while understandably trying to avoid retaliation, whether from individuals or systems, is what we all owe one another in the profession to address these issues.
Residency training failures, in the absence of serious professional or character issues (I am quoting more than one PD here), are multifactorial. There are likely interventions at the medical school and program level that might improve outcomes. I believe most medical school graduates, lacking issues not felt to be "non-remediatable", can be remediated into practicing clinicians of one sort or another, and many are not. Note, I am not speaking of jerks who get let go. I cannot say what proportion of residents let go "deserve" to have their clinical career ended vs those who could be "saved." But the goal should always be to get those who can get there safely, to get there. I believe that is what programs want. We lack the tools right now to salvage all the ones I think could be salvaged, and that is not the fault of most programs, actually. Which to my mind makes it more tragic, and more difficult to address.
However, I don't think we'll get anywhere until we address how the practice of medicine is funded, because I agree that is what ties the hands of most schools regarding the quality of physician-student educational interactions, and programs in remediating their residents or those residents being able to move on to another field.
I believe major change will be top down if at all. OTOH, it is up to us grunts on the ground to try to change the culture by speaking out, and doing our best to go above and beyond supporting the education and well-being of our students and fellow physician in any way we can.