tag:blogger.com,1999:blog-4968787219619380438.post6036007772186289425..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: Medical Education Is Changing in a Bad Way and It Will Affect You!Skeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-4968787219619380438.post-14249649365091669982013-08-23T07:47:21.487-04:002013-08-23T07:47:21.487-04:00Teresa, thanks for the interesting and thoughtful ...Teresa, thanks for the interesting and thoughtful comments. We already know from at least 3 different papers that ward residents spend about 12% of their time taking care of patients. It would be interesting to see what that % is for ED residents.<br /><br />In June, I heard Richard Reznick of Kingston, Ontario speak. He is revamping medical education in Canada. They will be going to competence-based training in a few years. I blogged about that concept back in June (http://bit.ly/18OzmjF). It will be interesting to see if it works.<br />Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-63663642702284896372013-08-22T23:41:19.652-04:002013-08-22T23:41:19.652-04:00Are all hours in a 16 hour day actually learning h...Are all hours in a 16 hour day actually learning hours? How much of it is useless clerical work? How much of it is pure clinical decision making? I think there are ways we can short cut learning and be more efficient with the process?<br /><br />That said, I work in Emergency Medicine where our learners have always worked less that the staff physicians (on average), and they are an added bonus rather than mandatory-help. My ED does not stand still without a learner (I see roughly the same number of pts with or without learners, I've kept my own metrics). And I am not dependent on my learners to run the department. This is in contrast, of course, to many in patient services where the resident to staff ratio is not 1:2 or 1:3. One of my friends asked rhetorical question one time: If you need 6 residents for your team, and can't handle the volume if they're away at academic day, are you really able to handle that volume??<br /><br />All in all, I still think, though, that often ward medicine and in-patient medicine is highly inefficient for learning. And a LOT of the time spent in the previous 16 hour days was unnecesary and unhelpful for learning. Yes, occasionally, there would be a great case that MIGHT happen... But I have learned during my EM training that you can't 'will' great cases to happen! You certainly can't sleep in the ED waiting for a great case either. (I would have lived for 4 straight years in the ED before another thoracotomy... Luckily, I happened to be working the day we did a double-one).<br /><br />So I would posit that if time was the ONLY metric for learning, then yes, you might be right regarding work hours and their impact on surgical learners. <br /><br />Deliberate practice theory suggests that you can get better by practicing... deliberately! And if we can find the right technologies or spheres where your learners can 'practice' (whether that be simulation lab or serious games, etc..), maybe there is a light at the end of the tunnel.<br /><br />You will note that North of the Border, a hard number did not wind up in our national consensus statement (http://www.residentdutyhours.ca/). Even our provincial housestaff organization in Ontario (PARO) has taken the stance against sleep deprivation, but has acknowledge the tension between quality learning and work hours. <br /><br />That said, as educators we need to rise to the occasion. A recent TED talk highlighted the importance of scarcity in spurring creativity. <br /><br />Yes, they were talking about scarcity of money... but ANY resource can be scarce. And in medicine, for better or for worse... Time is going to be the resource that is scarce. <br /><br />We need to find our creativity and think about how we flourish under the conditions. Most MDs are survivors and fighters, and I think that we will find our creative selves to overcome the perceived obstacles. I feel we have to believe we can innovate before we actually can get out there!!<br /><br />We have to be more efficient about the time spent learning and working... And as educators we need to actually be thoughtful and mindful of all the competing interests that residents may have at work (in the OR, on the wards, in the ED, prepping for exams, doing research).<br /><br />Can we rise to the occasion? It seems like such a tall order, I fear too many people are giving up before they even try!<br /><br />@TChanMDTeresa Chanhttp://tchanmd.blogspot.canoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-76239425108609536622013-06-24T17:25:48.664-04:002013-06-24T17:25:48.664-04:00Thanks for commenting. I'm not sure what you m...Thanks for commenting. I'm not sure what you mean by "Things have changed since the old days, when staff guys listened to histories mostly for billable procedures, but not much."<br /><br />I'd say there's a big difference between a combat soldier who does nothing but what he is told and a surgeon.<br /><br />Perhaps some could learn general surgery in 4 years, but if you look at some of my recent posts on this, you will note that many can't do it in 5. And this is the era of the 16-hour day.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-82725978418435022062013-06-24T17:19:46.690-04:002013-06-24T17:19:46.690-04:00Yep, you guys in Med So-Called Education always si...Yep, you guys in Med So-Called Education always singin the same ol tune...<br /><br />Face it: Residency, especially in your discipline surgery, is indentured servitude. Things have changed since the old days, when staff guys listened to histories mostly for billable procedures, but not much. <br /><br />If you can train an average person to be a combat soldier in 18mos, the brightest should be able to learn General Surgery in 4 years...but it never was about education, it was about service and staff guys billings. <br /><br />I like your blog but you are wrong on this. Anonymousnoreply@blogger.com