Recent research has shown that trainees in both in the United States and the United Kingdom do not feel confident in their abilities to operate or care for critically ill patients. I have commented on this (here and here) but haven’t discussed the possible causes.
Of course, we surgeons have been complaining about the work hours limitations for years, feeling that the education of residents will suffer. There may be some validity to this as expressed in the article about graduates of medical training in the UK, where the work hour limit is now at 48 hours per week.
Regarding surgical training, more than 25% of recent residents are worried that they will not be able to operate by themselves when they begin practice.
Numbers collected by the American Board of Surgery and the Residency Review Committee for Surgery and published in Annals of Surgery show that for many operations the operative experience of residents is ominously low. For example of the 121 types of cases considered by program directors to be absolutely essential, the mode (most common number) reported by graduating residents for 63 of those case types was none.
This may not strictly be due to work hours limitations. There are conflicting studies on the impact of those restrictions on case volumes.
Resident insecurity is related to a number of factors. To me, the most important of these is that residents almost never operate independently in the 21st century. There is much more supervision than there was in the past. This may be because of increased regulatory scrutiny, medicolegal considerations and patient demand.
For those who like the pilot/surgeon analogy [I don’t but use it when it supports my biases], would you like to fly with a pilot who had never soloed before? Better for a young surgeon to solo during residency when help is readily available than when she is in practice, don’t you think?