Surgical Residency: Quick Fixes

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Surgical Residency Quick Fixes

• Thomas V. Whalen, MD, MMM
• UMDNJ - Robert Wood Johnson Medical School

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(No Transcript)
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The future aint what it used to be.
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It was hard to have a conversation with anyone.
There were too many people talking.
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CIR Testifying to OSHA

• The culture of medical education celebrates such
  acts of self-destruction by calling them
  self-discipline and self-reliance. Medical
  educators who defend the current system believe
  that the more you work the more you learn. This
  culture is epitomized by the more than
  half-serious joke, "The problem with working
  every other night is that you miss half the good
  cases." Any reasonable human being can see that
  the problem with working every other night is
  that you miss half the rest of your life, and
  endanger your patients' lives in the process. But
  the medical establishment has demonstrated over
  many years that it simply isn't capable of
  thinking reasonably on this score. That is why
  strong government action in response to this
  petition is so important. The fact is that
  medicine requires an ongoing devotion to
  learning, not a commitment to working the kinds
  of hours most physicians will never encounter
  after residency.

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Were lost, but were making good time.
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Youve got to be careful if you dont know where
youre going cause you might not get there.
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You cant think and hit at the same time.

• Busy Faculty
• Decreased Teaching Time
• Decreasing Tolerance and Patience
• Decreased Role Modeling
• Decreased faculty Job Satisfaction

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You can observe a lot by watching.
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Scrutinize Rotation Call Schedules

• Priorities of education over service
• While not totally ignoring service
• Realign surgical teams
• Cross coverage at night

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Protected Conference Time

• Promulgate no-beeper time policies
• Acquaint attendings with these times
• Monitor and discuss with offenders
• Set an example first and foremost

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From Medstudents.Net

• Often used and abused in residency. Some
  attendings are jerks.

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Treatment of residents

• Zero tolerance of abuse
• Insure that residents treat each other and
  students with respect
• Be an example your self

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Program Atmosphere

• Set a work environment that will attract and
  retain individuals
• Work on faculty attitudes
• At a minimum, apportion students to the better
  role models more often
• Demonstrate that there is a distinct future to
  the field of general surgery
• Examine your program's treatment of female
  students, residents, and staff

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Lobby Hospitals to Provide Support

• Eliminate non-educational busywork
• Investigate DME and IME for your own hospital(s)
• Set services that will have reduced or no coverage

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Work Hours

• This is virtually out of our hands
• So if not on track get ready
• In house versus phone call
• Strict 24 hour limits

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Surgical Night Float

• Has been tried
• Being done in NYC
• Network collaborate

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Won't quality of care suffer if physicians keep
'handing-off' patients to other doctors?

• A hand-off must be made at some point in time no
  doctor can stay with a patient forever. No study
  has shown that quality of care suffers as a
  result of the regulations put in place in New
  York State, while an ample body of literature
  exists that demonstrates the hazards of overtired
  physicians. (AMSA Web Site)

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Continuity of care

• By year level
• Set expectations
• Should we model resident continuity on group
  practice?

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If you ask me a question I dont know, Im not
going to answer.