Louisville Medicine Volume 64 Issue 1, | Page 31

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 (continued on page 31) JUNE 2016 29