How regulations are hampering resident learning

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Category : Medical Rants

Over the years, we have had regulation after regulation imposed on the patient note.  We have had the addition of computer systems that work well for billing, but not as well for patient care.  We have work hour requirements that lead to more handoffs, and now we demand that residents spend significant time preparing and delivering handoffs.

And the result – Work Habits of the 21st-Century Intern

The distressing paucity of time that interns spend with their patients is not a new phenomenon: Back in 1989 — before both work hour limitations and computers — a similar study showed that interns spent about 20% of their time with patients and about 40% in documentation (NEJM JW Gen Med Jun 30 1989). However, things clearly are moving in the wrong direction. These fascinating data ring completely true and should give program directors impetus to reevaluate critically the present routines of clinical training.

Osler taught us that we need to observe and communicate with patients at the bedside to really learn medicine. During training we need to spend sufficient time with our patients to understand disease and the progression of disease. When we sacrifice time with patients for charting, then we sacrifice our residents’ growth.

We see ABIM pass rates decreasing.

Perhaps there is a link.

Comments (2)

Rules are what people use when logic fails. Students and staff are being over worked by unscrupulous organizations, so a rule is put in place that stops the practice only to prevent those same people from participating in a learning experience.

How often is HIPAA used in some manner to prevent the meaningful exchange of information in favor of commercial gain or useful discussion?

In an ever increasing passive/aggressive society where every advantage is being sought by those who have been charged to act in a manner that places others needs above their own we now find “rules” designed to place the decision making process with a third party.

Logic is sacrificed in favor of uniformity and an easy rule. The price of those rules are bore by those who could most benefit by flexibility and common sense.

Steve Lucas

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