Tuesday, June 14, 2011

Tradeoff between quality of care and readiness to practice?

The following CNN Health report includes a CNN Radio report regarding new regulations limiting the lengths of shifts worked by medical interns and residents.


The essential point is that while long shifts have been shown to contribute to medical errors that "shorter" shifts (say 16 hours at a time) will undermine the quality of the educational preparation of medical interns and residents. In a comment to the report "ramparts1815" stated that recent graduates know less and can do less than graduates five years ago. He or she adds, "And the public should realize that really good doctors and surgeons peak at 5-10 years after training."

As a university teacher I think a lot about the level of preparedness of new graduates. Something seems to be happening that is affecting the nature of the cognitive skills of emerging young professionals. Perhaps it is the cognitive overload of trying to digest so many streams of incoming information at a time. Even watching CNN television now involves continually receiving two or three news reports at the same time. Nicholas Carr suggests as much in his book, The Shallows: What the Internet is Doing to our Brains. It has been suggested that increasing rates of autism may be of environmental/chemical origin. If true, might the same chemicals be affecting the cognitive capacities/processes of all of us? Are we each losing individual cognitive capacity while our networked collective capacities are increasing?

To me, the bottom line is that if it takes increasingly long to educate physicians and surgeons and if their abilities peak and then tend to decline only five to ten years after graduation, we have problem. All things considered, if I have to be rushed into a hospital for some medical emergency I hope to be seen by people who are not so tired they cannot at that moment provide their wakeful attention. Nor do I expect when I go to a physician that others have perhaps endured medical errors in the past so as to somehow contribute to the quality of his or her education. I don't claim to have the answers here, but I wonder if there is something incorrect in the reported concern that when someone in training goes home for rest after a 16 hour shift that they do not adequately appreciate their needs to learn.

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