DOCTORS’ LOUNGE
requires many years of commitment and
intensive experience. Neurosurgical learning episodes — from initial contact with the
patients, through their evaluation, surgical
treatment and immediate postoperative
care — encompass many hours. To obtain
the greatest educational value from these
learning episodes, and to offer the safest
care for neurosurgical patients, a resident
must be present throughout this sequence
of events. When these episodes cross the
shift boundaries set up by work hour restrictions, as is often the case, our residents
are forced to decide between doing what is
best for their patients and their education
or following the rules that tell them that
because their shift is over, they must punch
the clock. We need to take our residents off
the horns of this dilemma.”
At the Work Hours Congress, representatives of every Specialty College or Academy presented position papers that outlined
their experience in training their residents
since the 2003 and the 2011 standards were
enforced. In particular, they offered solutions that would ensure that flexible work
schedules - suited to each specialty by its
particular demands – would meet both the
rest and the educational requirements for
young doctors. Blanket restrictions that
apply equally to the Chief Resident in Cardiovascular Surgery and the PGY-2 in Internal Medicine make absolutely no sense.
One rises in the medical ranks on merit,
based on hard-won skills and knowledge.
The most senior residents have to assume
the responsibilities of the fully-fledged independent doctors of the world. They have
to prove they can shoulder the burden of
deciding, perform the right operation at
the right time, master the million details
of patient care, recognize the complication,
and teach the junior staff. Some days, you
must work nonstop for hours on end to
do all these things right. As is stands, we
are producing surgical graduates who are
not independently qualified to do multiple
standard operations, because they have been
forced to go home. If we make the work
restrictions specific to each specialty, and
reduce unnecessary limits for senior residents, we could finally again teach doctors
what they need to know.
In a nutshell, the purpose of graduate
medical education is just that: preparing the
trainee to become independently competent and confident in assessing, diagnosing
and caring for the patient. You can’t do that
on bankers’ hours, or even dermatologists’
hours.
Dr. Barry practices Internal Medicine with
Norton Community Medical Associates-Barret. She is a clinical associate professor at the
University of Louisville School of Medicine,
Department of Medicine.
FROM THE BLOGOSPHERE
GO AHEAD, LOOK IN ON
THEM, DON’T BE AFRAID
“G
Bert Guinn, MBA, CAE
o ahead! Look in on them.
We do it all day. Don’t be
afraid,” said the officer who
led us through the main artery of the Louisville Metro Department of Corrections.
Dozens of us career-minded professionals
ambled along feeling totally awkward about
whether or not we should gaze into these
tiny jail cells and make eye contact with the
inmates. The individual chambers barely
had enough space for a sleeping pad right
next to an exposed toilet. I wondered if it
was even possible to do push-ups in the
available space. Should we wave? Should
we say, “Hello?” Should we walk briskly
stealing quick glances or rather meander
along taking our time as if viewing the caged
inhabitants of a people zoo?
We tried some of those options. None felt
anywhere close to being appropriate. It was
somber, sobering, and quite frankly a very
sad ordeal. Most of us had some tears over
seeing so many lost souls who had not only
lost their freedom, but had been stripped
of multiple layers of dignity.
Yet, despite the gloom, I think this was
my most preferred Leadership Louisville
day. Perhaps it’s because as a group, it felt
like we finally felt enough ease to address
some large and serious elephants in the
room: chiefly, the fact that our Louisville
jail is disproportionately occupied by African-Americans, over double the percentage
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JUNE 2016
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