nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Wednesday, July 28, 2010

Surgery Residents: More Rested But Less Experienced

And the controversy over training hours for doctors goes on and on...

A study in the Archives of Surgery (June 2010), makes the case that limiting surgical residents to 50 hour work weeks has had a negative effect on training and quality of care in Sweden.

This is just the latest in a back and forth battle about how many hours residents who are in specialty training should work every week.

Although I went through training when there were no limitations on hours, and I often worked over 100 hours a week, I harbor no misgivings about that being necessary for effective training.  No macho "it makes you tough" assertions, or "If I did it, they should" nonsense. 

Yes, I was tired and had no personal life.  But in one year of general surgery training I did twice as many operations (under direct supervision) than I would have otherwise.  My training program was extreme, but I remember hearing that surgical residents who worked at the Mayo Clinic rarely were able to do any cases of their own in their first year of training, while I had done at least two hundred.

There's an argument to be made for having residents rested when they work.

There's also an argument that the more patients with different problems you see, the better doctor you are.  And unless you want to double the years it takes to specialize in general surgery from 5 to 10 years (any sub-specialization would be on top of that), to gain the exposure, then more time spent taking care of patients--in the time available--increases expertise.

A corollary to the "longer hours are better" argument is that frequently passing off your patients to other doctors, as occurs with limited hours, introduces error also.

For Onion Peelers,
Residents and consultants indicated a negative effect of the 50-hour workweek limitation on surgical training (62.8% and 77.2%, respectively) and on quality of patient care (43.0% and 70.1%, respectively) (P < .001 for both). Most residents and consultants reported that operative time (76.9% and 73.4%, respectively) and overall operating room experience (73.8% and 84.8%, respectively) were negatively affected by the work hour limitation. Only 8.1% of residents and 4.9% of consultants perceived the work hour limitation as beneficial to surgical training. Conversely, 58.4% of residents and 81.5% of consultants considered that residents' quality of life had improved (P < .001).

So what's the optimum?   I'm not sure.  I'm hard-pressed to say it's really just an issue for surgical training.  The more patients you see in any specialty, the better you get.  Is 60 hours enough?  80?  Or go back to the open-ended scheme that was traditional from early in the 20th century through my training era?

Recall that Dr. Kildare (1930's) LIVED in the hospital.

Doc D

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