By the time I started my residency training in 2004, the ACGME regulations that limit residency training to 80 hours/week were in place. I had finished medical school and a rotating internship in the Philippines and so was not a stranger to taking call every other day or every 3 days. Being on call, taking care of one admission after another, can be mind numbing. Compared to the grueling experience of the system in the Philippines, it was refreshing to be on call only once every 4 nights. I thought I would use the free time to read up on things that I encountered.
By Dr. Karmela K. Chan
But even for the most well-intentioned resident such as me, that was not the case. Like other residents, I ended up using the extra hours for non-medical pursuits. Residents are frequently so exhausted from all the in-hospital work that by the time the day ends the last thing they want to do is study some more. Realistically, the most learning that I got from residency did not happen on my off days, it happened in all those hours that I spent in the hospital – from both patient care work and educational activities.
I contend that despite the standardization of medical education and training, what each doctor knows is quite distinct. Medical school teaches us the science; training teaches us the art. We are each a product of a unique permutation of experiences – cases we saw, mistakes we made, pearls we gleaned from our mentors.
People who advocate for fewer resident work hours cite studies that show that better-rested house officers make fewer mistakes, or that performance on standardized exams is no different for residents with different work hours. But the art of medicine is so much more than avoiding mistakes or performing well on standardized exams.
I learned the basics of rheumatology from my fellowship, seeing patients 12 hours a week, and spending the rest of the time on didactic work. But in my first 2 years of practice of seeing patients 5 full days a week, my skill as a rheumatologist has improved exponentially.
I understand the importance of ensuring patient and house staff safety. But this is a multifactorial problem and I wonder if we are barking up the wrong tree here, and compromising physician quality as a result.
Dr. Chan is a rheumatologist in private practice in Pawtucket, R.I.