Residency Training Overkill

[Emapp20177]

Sounds like a great description of primary care medicine.

Except the answer isn't "send the patient to the ED."

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[littlejuan]

Don’t get me wrong I still very much respect US EM physicians.

However after working in both countries I personally don’t believe that our EM training is the best in the world.

I see the same level of acuity at my residency (minus frequent bites from poisonous things and likely less trauma), just not 24 hour shifts. What type of supervision do the residents get (or whatever the equivalent to US residents)? I personally think that what separates good training from bad training is not just the acuity level of the patients, but great guidance, or else you won't be learning good medicine/good EM medicine.

 

[Venko]

Folks, i know it hurts to hear someone say they have less respect for US EM docs than SA docs...

Yet, if you are doing the best at your role and for your future career / patients...then who really cares what the online anonymous poster says in broad sweeping statements?

They couldn't work in my shop any easier than I could work in South Africa. I'm confident that I am more well versed on my patient population, my system of care, and my legal and documentation. Requirements.

Both groups can: Intubate, do lines, pressors and vents. They are certainly better st cracking chests than me, but I'm certainly better at managing complex cancer and post op patients.

It's two different worlds with great dedicated practitioners in both of them.

You be you. Work hard, learn what you need for your patients, and ride off into the sunset.


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[BoardingDoc]

Folks, i know it hurts to hear someone say they have less respect for US EM docs than SA docs...

Yet, if you are doing the best at your role and for your future career / patients...then who really cares what the online anonymous poster says in broad sweeping statements?

They couldn't work in my shop any easier than I could work in South Africa. I'm confident that I am more well versed on my patient population, my system of care, and my legal and documentation. Requirements.

Both groups can: Intubate, do lines, pressors and vents. They are certainly better st cracking chests than me, but I'm certainly better at managing complex cancer and post op patients.

It's two different worlds with great dedicated practitioners in both of them.

You be you. Work hard, learn what you need for your patients, and ride off into the sunset.


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Did anyone seem offended? The two scenarios are so grossly disparate that comparing one to the other is pointless. I think pretty much everyone here realizes that.

 

[Venko]

Did anyone seem offended? The two scenarios are so grossly disparate that comparing one to the other is pointless. I think pretty much everyone here realizes that.

Apollyon is usually a good voice of the people in my experience.

...

But to say you "lost respect" sounds either misguided or just insulting.

...

Also, I believe the other poster in fact did compare the two...before "losing respect"


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[BoardingDoc]

Apollyon is usually a good voice of the people in my experience.

Fair enough, I think I must have missed that response.

Also, I believe the other poster in fact did compare the two...before "losing respect"

I know. However, alpinism appears to be the only one trying to make a 1:1 comparison, which as I've stated, is pointless.

 

[alpinism]

I see the same level of acuity at my residency (minus frequent bites from poisonous things and likely less trauma), just not 24 hour shifts. What type of supervision do the residents get (or whatever the equivalent to US residents)? I personally think that what separates good training from bad training is not just the acuity level of the patients, but great guidance, or else you won't be learning good medicine/good EM medicine.

So on a typical night shift you're doing upwards of 30 resuscitations?

That's a normal night shift at many of the EDs over there.

The point I'm trying to make is that they see far more sick patients and as a result they get far more experience taking care of sick patients. Now honestly this shouldn't be very surprising to anyone since SA has a huge problem with poverty and violence and also has some of the highest rates of HIV and TB in the world. Not only that but their hospitals are severely underfunded and understaffed and as a result there is often only one 24/7 ED available for every million people. With regards to supervision it varies based on the hospital but generally speaking there is always a consultant either in the department or available on call. That being said medical training in SA is different than in the US and over there emergency residents have to complete 2 years of internship before even starting residency. As a result PGY6 senior residents are more than capable of working without close supervision.

 

[alpinism]

To get this thread back on topic.

No I don't think that our residency training is overkill and instead would argue that most residents don't see enough sick patients.

 

[littlejuan]

So on a typical night shift you're doing upwards of 30 resuscitations?

That's a normal night shift at many of the EDs over there.

I am confused, you said that its not uncommon to have 10+ intubations, chest tubes, and central lines in a single 24 hour shift. If just on overnight you are doing 30+ resuscitations shouldn't those numbers be way higher?

F*ck it, cutting all this out. Seriously though locations with high acuity, sick patients with all kinds of diseases and little to no access to care exists in the US.

You also have to realize that certain standards like, documentation, metrics, contacting private physicians, setting up clinic appointments, etc are way different in the US than in SA. The care and environments are just different, not sure how you lose respect for US EM physicians because of that. Seems strange.

 

[alpinism]

I am confused, you said that its not uncommon to have 10+ intubations, chest tubes, and central lines in a single 24 hour shift. If just on overnight you are doing 30+ resuscitations shouldn't those numbers be way higher?

Anyway, typically on an 8 hour shift where I am at I get roughly 4-8 resuscitations (but I am not the only resident on either, there are more than just 2 docs on for 24 hours), lots of sick patients with untreated HIV, COPD, ESRD, CHF, etc. Tons of sick patients not going to resuscitation as well. My main site at my residency is a county hospital with tons of codes and patients with out of control medical problems. We also work at a hospital with a crazy high admission rate. Obviously, the numbers are not to the level of SA, but the acuity is pretty damn high where I am at. You also have to realize that certain standards like, documentation, metrics, contacting private physicians, setting up clinic appointments, etc are way different in the US than in SA. The care and environments are just different, not sure how you lose respect for US EM physicians because of that. Seems strange.

Haha dude they don't do an intubation, chest tube, and central line for every resuscitiation.

Besides after a few months they've done so many procedures they're happy to let the med students do a few under close supervision.

 

[alpinism]

I am confused, you said that its not uncommon to have 10+ intubations, chest tubes, and central lines in a single 24 hour shift. If just on overnight you are doing 30+ resuscitations shouldn't those numbers be way higher?

Anyway, typically on an 8 hour shift where I am at I get roughly 4-8 resuscitations (but I am not the only resident on either, there are more than just 2 docs on for 24 hours), lots of sick patients with untreated HIV, COPD, ESRD, CHF, etc. Tons of sick patients not going to resuscitation as well. My main site at my residency is a county hospital with tons of codes and patients with out of control medical problems. We also work at a hospital with a crazy high admission rate. Obviously, the numbers are not to the level of SA, but the acuity is pretty damn high where I am at. You also have to realize that certain standards like, documentation, metrics, contacting private physicians, setting up clinic appointments, etc are way different in the US than in SA. The care and environments are just different, not sure how you lose respect for US EM physicians because of that. Seems strange.

And yes the situations are very different in both countries.

Obviously we have to deal with way more paperwork and regualtions that take away from patient care.

 

[littlejuan]

Haha dude they don't do an intubation, chest tube, and central line for every resuscitiation.

Besides after a few months they've done so many procedures they're happy to let the med students do a few under close supervision.

I know, but with that many just overnight you would think that throughout the day there would be even more thus amassing way more procedures. Anyway, I was talking about acuity level of patients, not volume. I still think that only two residents (or equivalent) doing 24 hours shifts with that many patients means that a whole lot goes unsupervised and thus the learning of good medicine may fall by the way-side

 

[namethatsmell]

When is the part where we whip our ****s out and start measuring?

Oh, wait...


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[littlejuan]

When is the part where we whip our ****s out and start measuring?

Oh, wait...


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It's not about dick measuring but the guy was acting like there was no high acuity in the US, like there aren't places here that are basically 3rd world countries with poor access to care and patients who let their disease processes go way out of control

 

[namethatsmell]

It's not about dick measuring but the guy was acting like there was no high acuity in the US, like there aren't places here that are basically 3rd world countries with poor access to care and patients who let their disease processes go way out of control

Yeah my comment was primarily directed at him/her.

He was basically saying his Rex Kwan Do is superior to our style of fighting. And there's only one way to respond to that...

 

[turkeyjerky]

Folks, i know it hurts to hear someone say they have less respect for US EM docs than SA docs...

Yet, if you are doing the best at your role and for your future career / patients...then who really cares what the online anonymous poster says in broad sweeping statements?

They couldn't work in my shop any easier than I could work in South Africa. I'm confident that I am more well versed on my patient population, my system of care, and my legal and documentation. Requirements.

Both groups can: Intubate, do lines, pressors and vents. They are certainly better st cracking chests than me, but I'm certainly better at managing complex cancer and post op patients.


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Really? I don't think I'm very good at all at handling post op or cancer patients.

 

[Venko]

Really? I don't think I'm very good at all at handling post op or cancer patients.

Sometimes sarcasm doesn't come through very well via web posts, so forgive me if I didn't catch your intent. Regardless, I'm speaking about my ability to handle post op and cancer patients. Yours will be unique to your environment.

Sincerely,
Venk


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