Saturday, August 23, 2003

This from the August 2003 Contemporary Surgery (PDF). An editorial from the head of surgical oncology at M.D. Anderson commenting on the impact of the 80 hour limit at his institution. He recounts a phone call with the director of a residency program "which we have had a training relationship for more than 30 years" could no longer rotate residents through.
The 80-hour workweek was the culprit, I was informed. It was forcing a global manpower realignment. Residents were being pulled off a nationally recognized burns rotation at another medical school in the area. Also residents would no longer be able to rotate through a busy, hands-on endoscopy service. Likewise, the total number of residents assigned to one of the best trauma rotations in the country...would be cut signifigantly. All of these alterations were necessitated by the nearly 35% functional decrease in available coverage hours that the 80 hour workweek mandate was creating. (emphasis mine)
In order to sit for the boards the graduating resident must have performed certain numbers and types of procedures. Many of them are performed on "specialty" rotations, such as the ones described above. Because those rotations are being taken away, operative experience will suffer. (See my earlier posts on the matter). Many smaller and not-so-small programs (Mayo and Cleveland Clinic send their residents off for their trauma rotations, I think) send residents out for more core-related rotations that, if eliminated, will have a greater impact on their education. Hiring more residents is not an option because the 5-year spots that are out there aren't being filled as it is. I think that in the next few years there is going to be a dilution of caseload to the point that residencies will last at least six (clinical) years.
Dr. Pollock goes on to praise the intangible benefits of the pre-80 hour era:
I'm not an expert enough to know about the numbers,(statistics used to back up the 80 hour limit) but I do know what cannot be enumerated: the lessons learned late at night or early in the morning, whether working alone or on a team, after having already "been there" for more than the legislated 24 hours. The sense of pride and accomplishment, of being able to surmount the obstacles. These are perhaps the most valuable "take homes" I learned back in that pre-80-hour-week residency milieu.
If hospitals would not use their residents as cheap replacements for phlebotomists, transport aides, or nurses the time spent in the middle of the night would be educational and useful. Most of the bad outcomes I recall from training were not so much from residents being too tired to think, but from them being too lazy to get out of bed. Read the whole thing, and as always I welcome your comments.
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