I went and read some of the original source stuff on this and may I say I have never seen anything so deserving of...
I went and read some of the original source stuff on this and may I say I have never seen anything so deserving of the hashtag #backpfeifengesicht .
First of all, any number of programs constantly flirt with or straight up violate the rules anyway. I can't deal with refuting the original thing, but let's just play with the quotes in the link.
Item 1:
"... the longer work hours ... would also improve medical training by giving young doctors more realistic experience."
Of what? Extremely few practicing physicians work in an environment where they'd have to provide patient care for 16 hours straight, nevermind 24 or 28. What are they planning to do? Send us all into combat zones? I call excrement.
You want realistic experience? Have them try to negotiate with an insurance company. Have them try to see 80 patients in one day while staying on schedule and not making any of them wait. Ok, that's for pros. How about 60? 50? FYI, 50 patients between 8am-5pm with no breaks is about 10 minutes per patient. Exceptional healthcare happening here.
Item 2:
"Just as drivers learn to drive under supervision in real life on the road, residents must prepare in real patient-care settings for the situations they will encounter after graduation,"
Ok, wow. Item 2a, false analogy -
Presumably he means truck drivers, because just any old driver analogy is complete nonsense. In which case, the one to one ratio of a Master Driver to a Noob is completely unrelated to the Intern or Resident who is effectively on their own and has a back up of a series of more experienced but equally fatigued Residents until you get to the Chief Resident(s). Sometimes there are Fellows; there are NO Attendings in many situations. Of course, if you are bringing in the Chief or an Attending, something had better be in serious need of their personal attention or you are in deep compost.
You are very rarely trained one on one by an attending so that's complete hooey, anyway. Sometimes by a fellow, but you are almost always working in teams or on your own. Believe me, second year and senior residents get right stroppy if a first year/intern bothers them much.
Item 2b, the "real" world -
If you are going into a hospital based setting, residency is directly applicable to most of what you will do after graduation. Say, Emergency Medicine, or many surgical specialties. However, you will generally not encounter most of what you have to deal with in residency in your day to day practice in an exceptionally large percentage of post graduate practice. I'll be generous and give this half credit.
Caveat: real world you may take 2 weeks on-call from home as an Intensive Care specialist, but then you have months of a regular old work schedule. That is VERY different from working six days a week, including at least 2 days (so 24+ hours) where you are on-call in house. P.S. That one day off is almost never a full 24 hours. Also, this is averaged over 4 weeks, so you can really get a messed up schedule going.
2b subset - "real patient-care settings"
Residencies happen in hospitals and clinics and outpatient centers of various sorts. If they aren't, why did you accredit them? What do you think they do? Hang out in Starbucks in case someone burns themselves on an extra-hot, no foam latte? And what does this have to do with how many hours you work?
Item 3:
"Training to become a practicing physician can be compared to training for a marathon," Nasca says. "You must learn how to pace yourself, take care of yourself and recognize your limits."
How do I tell somebody to stuff their sports analogies in a polite and professional manner? See, competitive athletes, even amateur ones, get to figure out what works for them and train on their schedule in the way that works best for them. Plus, they get to decide if they want to train for time, or distance, or whatever performance gauge they are most interested in. Oh, and they have control over their training environment, nutrition, and coaching or other input. Oh, and they get to set their pace! Interns and Residents have control over none of this.
You may or may not get to eat, you may or may not have enough brain power left to both study and figure out how to shop for and cook healthy food for yourself. You can choose to get an extra two hours of sleep or go to the gym, work out for an hour, shower, and then get some sleep. Just as a few examples.
A very personal example is the bit where people died in my residency because they tried to drive home post-call. Well, gee, why didn't they pace themselves, take care of themselves, and recognize their limits? I mean, they wanted to go home and sleep. Why would they do that?
Another personal example is the time when I was post call in medical school and knew I was too tired to drive anywhere and asked to be excused from rounds, which were being held at a different hospital an hour's drive away. And was told no, I had to be there or I'd be in trouble.
Good news, rumble strips and very little traffic on the highway. Bad news, falling asleep on an elevated highway while driving. The rumble strips woke me up and I crawl-drove to the nearest exit, got off, found a parking lot and slept in my car.
When I woke up and was awake enough, I finished driving and went to the end of rounds. Where the Senior Resident second only to the Chief wanted to know why I hadn't been there the whole time and was all ready to tell me what a horrible human being I was and how much trouble I was in. P.S. He's the guy who said I couldn't be excused from rounds.
I'm pretty sure I managed to politely inform him that I had only by sheer luck not died and he could file as negative a review as he'd like of my dead body because I was pretty sure at that point it would not impact my overall grade. To his credit he shut up and backed off.
Meanwhile, I had clearly learned how to pace myself, take care of myself, and recognize my limits, and when I appropriately went to the appropriate person was basically told I was a bad medical student and had better abrogate all of that and do what I was told.
Oh, and my understanding of any form of competitive athletic training is that you do not do the same thing, repeatedly, every day without a break. Guess what you do in medical training. Rinse, lather, repeat.
Awesome analogy, Dr. Backpfeifengesicht.
http://www.npr.org/sections/health-shots/2016/11/04/500554058/medical-interns-could-work-longer-without-a-break-under-new-rule
http://www.npr.org/sections/health-shots/2016/11/04/500554058/medical-interns-could-work-longer-without-a-break-under-new-rule
First of all, any number of programs constantly flirt with or straight up violate the rules anyway. I can't deal with refuting the original thing, but let's just play with the quotes in the link.
Item 1:
"... the longer work hours ... would also improve medical training by giving young doctors more realistic experience."
Of what? Extremely few practicing physicians work in an environment where they'd have to provide patient care for 16 hours straight, nevermind 24 or 28. What are they planning to do? Send us all into combat zones? I call excrement.
You want realistic experience? Have them try to negotiate with an insurance company. Have them try to see 80 patients in one day while staying on schedule and not making any of them wait. Ok, that's for pros. How about 60? 50? FYI, 50 patients between 8am-5pm with no breaks is about 10 minutes per patient. Exceptional healthcare happening here.
Item 2:
"Just as drivers learn to drive under supervision in real life on the road, residents must prepare in real patient-care settings for the situations they will encounter after graduation,"
Ok, wow. Item 2a, false analogy -
Presumably he means truck drivers, because just any old driver analogy is complete nonsense. In which case, the one to one ratio of a Master Driver to a Noob is completely unrelated to the Intern or Resident who is effectively on their own and has a back up of a series of more experienced but equally fatigued Residents until you get to the Chief Resident(s). Sometimes there are Fellows; there are NO Attendings in many situations. Of course, if you are bringing in the Chief or an Attending, something had better be in serious need of their personal attention or you are in deep compost.
You are very rarely trained one on one by an attending so that's complete hooey, anyway. Sometimes by a fellow, but you are almost always working in teams or on your own. Believe me, second year and senior residents get right stroppy if a first year/intern bothers them much.
Item 2b, the "real" world -
If you are going into a hospital based setting, residency is directly applicable to most of what you will do after graduation. Say, Emergency Medicine, or many surgical specialties. However, you will generally not encounter most of what you have to deal with in residency in your day to day practice in an exceptionally large percentage of post graduate practice. I'll be generous and give this half credit.
Caveat: real world you may take 2 weeks on-call from home as an Intensive Care specialist, but then you have months of a regular old work schedule. That is VERY different from working six days a week, including at least 2 days (so 24+ hours) where you are on-call in house. P.S. That one day off is almost never a full 24 hours. Also, this is averaged over 4 weeks, so you can really get a messed up schedule going.
2b subset - "real patient-care settings"
Residencies happen in hospitals and clinics and outpatient centers of various sorts. If they aren't, why did you accredit them? What do you think they do? Hang out in Starbucks in case someone burns themselves on an extra-hot, no foam latte? And what does this have to do with how many hours you work?
Item 3:
"Training to become a practicing physician can be compared to training for a marathon," Nasca says. "You must learn how to pace yourself, take care of yourself and recognize your limits."
How do I tell somebody to stuff their sports analogies in a polite and professional manner? See, competitive athletes, even amateur ones, get to figure out what works for them and train on their schedule in the way that works best for them. Plus, they get to decide if they want to train for time, or distance, or whatever performance gauge they are most interested in. Oh, and they have control over their training environment, nutrition, and coaching or other input. Oh, and they get to set their pace! Interns and Residents have control over none of this.
You may or may not get to eat, you may or may not have enough brain power left to both study and figure out how to shop for and cook healthy food for yourself. You can choose to get an extra two hours of sleep or go to the gym, work out for an hour, shower, and then get some sleep. Just as a few examples.
A very personal example is the bit where people died in my residency because they tried to drive home post-call. Well, gee, why didn't they pace themselves, take care of themselves, and recognize their limits? I mean, they wanted to go home and sleep. Why would they do that?
Another personal example is the time when I was post call in medical school and knew I was too tired to drive anywhere and asked to be excused from rounds, which were being held at a different hospital an hour's drive away. And was told no, I had to be there or I'd be in trouble.
Good news, rumble strips and very little traffic on the highway. Bad news, falling asleep on an elevated highway while driving. The rumble strips woke me up and I crawl-drove to the nearest exit, got off, found a parking lot and slept in my car.
When I woke up and was awake enough, I finished driving and went to the end of rounds. Where the Senior Resident second only to the Chief wanted to know why I hadn't been there the whole time and was all ready to tell me what a horrible human being I was and how much trouble I was in. P.S. He's the guy who said I couldn't be excused from rounds.
I'm pretty sure I managed to politely inform him that I had only by sheer luck not died and he could file as negative a review as he'd like of my dead body because I was pretty sure at that point it would not impact my overall grade. To his credit he shut up and backed off.
Meanwhile, I had clearly learned how to pace myself, take care of myself, and recognize my limits, and when I appropriately went to the appropriate person was basically told I was a bad medical student and had better abrogate all of that and do what I was told.
Oh, and my understanding of any form of competitive athletic training is that you do not do the same thing, repeatedly, every day without a break. Guess what you do in medical training. Rinse, lather, repeat.
Awesome analogy, Dr. Backpfeifengesicht.
http://www.npr.org/sections/health-shots/2016/11/04/500554058/medical-interns-could-work-longer-without-a-break-under-new-rule
http://www.npr.org/sections/health-shots/2016/11/04/500554058/medical-interns-could-work-longer-without-a-break-under-new-rule
İ need to be able to give this one plus per sentence, minimum, and G+ isn't letting me.
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