Bringing about the end of resident abuse

Residency Program Insider, December 29, 2017

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When a person hears the word "abuse" the graduate medical education system isn't usually the first thing that comes to mind. Because the duration of residency is self-limited in its nature, there is less incentive to instigate grassroots changes. The expectation is that physicians in training will bear the brunt of the abuse during their residency since they can look forward to eventually being able to inflict similar pain on trainees as they rise through the ranks. Many residents, however, are beginning to think that the grin-and-bear-it method is no longer enough. According to anonymous physician submissions, here are a few common-sense changes that could improve the residency experience for all. One recommended solution is to cut back on residency duty hours. The research has echoed public preference for years now. Sleep deprived trainees serving as primary caregivers are dangerous and potentially unreliable. Of course, certain more intensive training programs--such as those for neurosurgeons--can call for physicians to work on cases that exceed 16 hours. In this case, exceptions should be made accordingly. The lifestyle implications of such fields should be made clear from the get-go, so that residents aware of their limits can self-select early in the residency process. There is the argument that should residency hour cutbacks be implemented; newly graduated residents might not be as competent as their predecessors who put in more hours during training. There is a degree of validity to this argument, however there is also an easy solution. Residencies can be switched to a more competency-based education system. Under such a system, those who have mastered the required skills become eligible for graduation and those who need more practice time would continue as residents. This would encourage the training standards to become more universal and might serve to alleviate impending physician shortage. By increasing the number of residents available at a given time, duty hours can be limited, and the competency-based system can be implemented without major adverse effects on quality of training or patient care. Source: Kevin MD

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