The right amount of working hours for professional development

[Techmonkey]

---

Members don't see this ad.

Just a question out to the residents. Do you feel that you would be better off in terms of professional development if you were working less hours and had more time to receive teaching or to publish? While I appreciate that you need to get a certain amount of procedures under your belt to achieve necessary competence I also think that there is a degree of diminishing marginal returns with regards to repeated procedures.

So while I probably wouldn't get enough practical experience working 20 hours a week, wouldn't working 120 hours a week taking bloods, filling forms and cannulating patients be overkill? Personally I would rather spend my time on publishing, preparing for exams or receiving teaching instead of taking bloods for the 10,001th time since that's less about developing one's skills/knowledge than it is about meeting patient demand.

So ideally how much work would you like to do?

 

[BKN]

Just a question out to the residents. Do you feel that you would be better off in terms of professional development if you were working less hours and had more time to receive teaching or to publish? While I appreciate that you need to get a certain amount of procedures under your belt to achieve necessary competence I also think that there is a degree of diminishing marginal returns with regards to repeated procedures.

So while I probably wouldn't get enough practical experience working 20 hours a week, wouldn't working 120 hours a week taking bloods, filling forms and cannulating patients be overkill? Personally I would rather spend my time on publishing, preparing for exams or receiving teaching instead of taking bloods for the 10,001th time since that's less about developing one's skills/knowledge than it is about meeting patient demand.

So ideally how much work would you like to do?

If you are routinely drawing bloods and starting IVs as a resident, you're in the wrong place. You shold be managing and evaluating patients, operating if you're a surgeon, going to conferences, rounds and studying some (but you learn by doing medicine not reading about it.)

How many hours? If you want to be minimally competent by the end of residency it should be near the limits (80 hrs per week, no more than 24 hours in a row receiving patients, etc, etc).

 

[lowbudget]

I think if you'd rather spend your time publishing, prepping for exams, and listening to lectures, you're probably more PhD oriented than you think. Medicine's more than just doing procedures. Any technician can do procedures. And any protocol can crank out a diagnosis or treatment plan. In residency, ideally, you're learning and perfecting your history, your physical exam, your differential diagnosis, your work up, your management and counseling skills. I've come to learn that it's harder than you may think because nothing is clear cut. Someone's gotta take all the chaos and make order out of it.

Residency is about making judgements in the face of gray areas. It's about building clinical intuition despite your obvious inexperience, understanding nuances. And, for those who are entering the work force for the first time, it's about learning how to get things done and make things happen. I don't know how many hours or how many patients it would take to get you there... but many attendings, good ones at least, who have been doing medicine for years will tell you how humbling taking care of patients can be. The moment you think you know everything is the moment when something goes real wrong.

 

[McDoctor]

Residency is about making judgements in the face of gray areas. It's about building clinical intuition despite your obvious inexperience, understanding nuances. And, for those who are entering the work force for the first time, it's about learning how to get things done and make things happen. I don't know how many hours or how many patients it would take to get you there... but many attendings, good ones at least, who have been doing medicine for years will tell you how humbling taking care of patients can be. The moment you think you know everything is the moment when something goes real wrong.

I agree.

However, I do think that residency training in primary care medicine can be more refined to facilitate the development of clinical skills. For instance, although the varied rotations done month to month in an FP residency (such as surgical rotations) certainly offer the chance to broaden scope of knowledge, there remains limited utility to spending a large portion of the day scrubbed in on surgical procedures that will never be performed by a general practitioner in his career.
General surgery rotations are just one example of a rotation during residency that encompasses a good chunk of time that clearly could be better spent elsewhere.

 

[Techmonkey]

I agree.

However, I do think that residency training in primary care medicine can be more refined to facilitate the development of clinical skills. For instance, although the varied rotations done month to month in an FP residency (such as surgical rotations) certainly offer the chance to broaden scope of knowledge, there remains limited utility to spending a large portion of the day scrubbed in on surgical procedures that will never be performed by a general practitioner in his career.
General surgery rotations are just one example of a rotation during residency that encompasses a good chunk of time that clearly could be better spent elsewhere.

I'm actually in the UK. After graduation we undergo housemanship (soon to be called the foundation programme). Time is spent largely taking histories, patient exams, taking bloods/cannulating and filling forms. From what I've seen of surgical firms only the consultants seem to be operating with the others assisting. Is it different in the US?

Personally I'm leaning towards one of the lifestyle specialties so I'll have more time to broaden my interests. Are there any that tie-in well with pharma/biotech so that one can get exposure to the other side of healthcare?

 

[tigershark]

I think if you'd rather spend your time publishing, prepping for exams, and listening to lectures, you're probably more PhD oriented than you think. Medicine's more than just doing procedures. Any technician can do procedures. And any protocol can crank out a diagnosis or treatment plan. In residency, ideally, you're learning and perfecting your history, your physical exam, your differential diagnosis, your work up, your management and counseling skills. I've come to learn that it's harder than you may think because nothing is clear cut. Someone's gotta take all the chaos and make order out of it.

This is the attitude that is destroying medicine, the attitude that publishing, research, academics, etc. are just for PhD's. It's those things that make medicine a profession and not just a job. The more we move towards a check-in-check-out-just-doing-my-job attitude the more power we lose and the more we become expendable. It's what makes PA's and NP's and all the other mid-level providers think they can do everything we do. And if you take the academics and innovation out of the equation, they are right.

Residency is the ideal time to foster an academic/professional mentality and is sorely overlooked in most residencies. The OP is on the right track. Residency should be about building the consumate professional, not just extracting the maximum hours of labor weekly.

On the interview trail the residencies who were commited to training a "complete physician" clearly stood out from the rest. The program
I ranked first provided protected lecture and research time, paid trips to conferences, public speaking training, leadership training, business/legal education, and teaching opportunities at the associated med school. The residencies who appeared to be nothing more than sweatshops went to the bottom of the list.