Thought you all might enjoy hearing this story <a href="http://www.npr.org/ramfiles/atc/20020521.atc.15.ram" target="_blank">NPR Story on Yale Gen Surg Residency</a> Requires Real Player
A very interesting audio, thanks for sharing. Friends at MCP-Hahnemann tell me they have recently done away with overnight call altogether. It seems we are witnessing a domino affect here. This bodes well for resident training. Lets hope some of these dominos tip before we are done training
A pretty superficial & uninformative report to me. There was no context of the specific points Yale was penalized for (which apparently go WAY beyond just work hours)nor any background on what training is elsewhere in the country & the world.
It wasnt that specific, but I think the implications are large. That being larger audience exposure and a strong message to other programs that whatever their faults are they need to correct them because now residents will be heard by others who will take them seriously. I dont think that this will hurt Yale in matching in the future...it will have a "famous" effect for a couple years.
This was overall very general... As to the solutions, hiring more nurses,PA,etc... why not more residents??? And 80 hours is normal? For who? A bit vague, as to senior residents only being in the hospital 3/4 days and not being able to manage 350 cases yearly... or not being exposed to that many thus limiting their training. Were these committee suggested solutions or did Yale decide on their own to this method of correcting the problems? And will the accredication committee accept these solutions? IMHO, Yale should create more resident openings at all levels and stop using bandage approach to the program's difficulties. I wish them luck, but I think spending 1mil and not addressing the specific concerns is a mistake.
In theory, the PA's & NP's will do the work which is necessary to run the hospital but not educationally valuable -- i.e. scut. This reduces resident workload, preserves resident caseload and does not have the federal funding & marketplace implications of hiring more residents.
The reason this piece was not specific enough for some peoples' tastes is because it was intended for the general public, not medical professionals. It was interesting to hear this kind of story on a nationally syndicated radio program, because it is a good indication that changes are occuring in medical training programs. It is good for the public to know what medical training is really like, and that the kind of hours residents work are attrocious. As a soon-to-be resident, I feel that the public is one of our strongest allies in our struggle to be treated like people with lives outside of medicine. The general surgery program at my medical school already employs some PAs to take care of the "scut". Their work consists of doing pre-op physicals, taking care of discharge planning, signing medication refills etc. It is nice for the residents, and it actually really helps the medical students as well, because much of this is scut that we would be helping out with as well. However, it is still not enough. The residents still work well over 100 hours a week.
</font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Klebsiella: <strong>A very interesting audio, thanks for sharing. Friends at MCP-Hahnemann tell me they have recently done away with overnight call altogether. </strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">How is this possible? Are they using a night float system?
DuneHog--Thanks for the interesting post! I find it funny when people from other professions talk with doctors about work hours. I personally run into this all the time, when I explain to non-medical friends that surgery programs are trying to reduce their hours to 80/week. They usually laugh and think I'm joking! The NPR announcer was trying to question the appropriateness of 80 hour work weeks, but the doctor from Yale corrected him, saying "less than 100 hours is reasonable" On another note, I think the ACGME's suspension of Yale's accredidation has finally gotten the attention of surgery programs across the country. I heard a rumor from a resident at my program (not Yale) that call schedules will be significantly reduced for interns next year! <img border="0" alt="[Clappy]" title="" src="graemlins/clappy.gif" />
Ironically, by and large it's not surgery residents that are leading the charge for strict limits on work hours. In a # of different forums and platforms, surgery resident representatives to resident organizations have argued against an arbitrary limit on hours involved in patient care. The move towards moving some of the administrative work to allied health professionals is a nice idea, but honestly that kind of work does not take up a signifigant part of my time. After listening to the NPR report, I'm still confused about how hiring a few nurses will signifigantly affect things. More likely changes in some rotations will have to made to make services smaller (& perhaps even have some attendings patients not even have resident coverage) as well as declining to take the historically high level of trauma/indigent care at some teaching hospitals
Re: surgeons and residencies-- Please read Bland KI, Isaacs G. Contemporary trends in student selection of medical specialties: the potential impact on general surgery. Arch Surg 2002(Mar);137:259-267. Cheers -a.
