Which field has such a limited body of knowledge that without reading you can gain everything with on the job learning especially in the new work hour construct?
I'm curious
Ask Raryn, not me. He's the guy who says that on some of his residency rotations five minutes and he's good... (And then gets defensive when I suggest other fields consistently need a lot more in every rotation month).
I said on average I'd bet many residents (particularly in the more competitive aka consult specialties) read something close to 10 hours a week outside of work (on top if whatever didactics and uptodate reading they do while at work) and probably kick themselves that it wasn't 20.
Again, if you are in a field where the value you add is a little knowledge and a lot of manpower and hands on skill, perhaps there's a distinction from the fields where 90% of what you really bring to the table is just the specialized knowledge base. That's what i was inelegantly using the phrase "competitive" as a proxy for-- The non-generalist consult you call when you need help managing a complex patient. If you could manage him with your few minutes on uptodate, there wouldn't ever be need for that expertise. And you don't really just need another body at the table. In fact you need someone who brings MORE to the table than the guy who graduated with you in med school and now also just reads at least five minutes a day plus attends his didactics. He's not going to bring more to the analysis if his view of medical practice is that he hangs up his coat at the end of the business day and doesn't ever crack a book, or if he just reads a few monthly journal articles, or a couple of blurbs on uptodate.
And again I'm not saying any specialty should be doing less -- Raryn did. I'm suggesting even the generalist should be doing a ton of reading outside of work, because there's a ton to know. I'm just conceding that maybe Raryn knows what residents are actually doing in whatever field he's in, which frankly doesn't sound like enough, and is way way off for many other specialties. It would be a boon to medicine if residents in every specialty logged significant hours outside of work honing their craft. I hope and suspect many do much more than the "at least five minutes" threshold. Saying many specialties do more than he's describing isn't really a suggestion that other specialties can get away with less, or that he's doing enough.
And yes, in case you didn't guess I'm somewhat playing devils advocate here in jumping all over Raryn's post (I don't really mean to single him out but he sort of fed an easy lay-up here) and trying to use it to ignite this interesting discussion -- the topic of resident reading outside of work is interesting to me, hopefully a few others, and probably pertinent to readers of SDN. Too many people seem to feel like they are done learning after med school and can pick up enough during the work day. That's probably not the case in any specialty regardless of what people are getting away with, and certainly not good for patient care. In some fields the converse notion is regularly and repeatedly beaten into you, read, read, read, but apparently not all. And certainly there's an ideal and a reality out there, and as suggested in this thread quite a few outliers. Certainly worth some discussion.
But anyway in stating that "at least five minutes" outside of work is really not enough in any specialty, and that the lower threshold of what's enough perhaps depends on your role in patient care (generalist vs consult) I'll draw the first blood here. Are there really fields where you don't gave to read as much? Perhaps, but if you are taking that position you really can't get defensive when other specialties consider themselves more learned. Can you really look up what you need on uptodate and get by on whatever you glean in day to day practice? Doubtful, and the notion of consult services is established based on t he need for specialized knowledge above and beyond what your intern can dig up in a few minutes on uptodate.
