My rant on GME exposed some raw nerves. As sometimes happens, the commenters extrapolate what they think I said, rather than what I said.
My concern is meaningful volume of patients. The second year medical student thinks you can learn about long tail patients from books. Any physician will tell you that knowledge does not equal wisdom. Books cannot teach you to take a proper history. You have to learn through taking many histories. Books cannot teach you to respect the Columbo moments – those moments when you know that something is bothering you.
Osler once said, “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” You must read, but you really need bedside experience.
My point (and I will try to make it more clearly) is that training must provide enough patient volume to allow physicians to become excellent. I did not propose longer hours. I would have more time devoted to patient care.
The second year student has bought into the team building concept. While that is important, ultimately the physician has the responsibility. If our physicians have insufficient clinical experience, then not team building will help the patient.
I believe that I continue to improve as a physician because I see, teach about and discuss many patients each month. Each patient adds to more experience and wisdom data bank.
Many residents take learning medicine very seriously. Most residents endorse rigorous yet humane training. I worry about the loose of rigor in training.
We should decrease scut work – and many training programs have done this. I support the 80 hour rule, but do not want residents to necessarily miss noon conferences because of the arbitrary 24+6 rule.
This issue is complex and nuanced. I called for careful thinking about the downstream impacts of any rules passed to protect residents. We need to protect them, but will also must protect the patients for whom they will care.
