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Monday, July 23, 2007

Still more on house staff duty restrictions-faculty angst

I have written before about the changes in house staff medial education in the post duty hour restrictions era and evoked some critical comments by house officers. Also, more recently I commented on articles in the Annals of Internal Medicine which seemed to provide some reassurance that at least there had been no negative effects on patient safety with the restrictions (some had feared that increased hand offs might lead to fumbles and more patient risk).

Well, the wheel is still in spin and now we have a different slant on the issue, one that is less reassuring in regard to the effects on resident education and medical school faculty job satisfaction which could affect faculty retention particularly in the already waning area of general internal medicine.

The July 23, 2007 issue of the Archives of Internal Medicine has a very interesting and I believe important article discussing the views of a number of medical school faculty members who have a list of what they believe to be significant negative aspects of the new resident educational landscape in internal medicine. Th WSJ medical blog covers this article here.
(Effect of Residency Duty-Hour Limits, Reed DA et al. Arch Int Med/Vol167 (no 14),p 1487)

140 key clinical faculty at 39 internal medicine residency programs were surveyed and 111 replied. The article give the results of that survey.

While no evidence of patient safety problems were presented the faculty reported worsening communication with patients and diminution in overall quality of care ( I am not sure how quality was defined). While there was said to be lower levels of resident fatigue and improved personal-professional life balance the faculty believed generally that resident education suffered as did the accountability of the residents to their patients along with decrease in the resident-patient relationship and according to some faculty there was worsening professionalism among the residents. As faculty did more work while house staff did less work, faculty satisfaction decreased. There seemed to be less time for teaching and learning.

This is not a hard data article but a presentation of the impressions of IM resident training program teachers most of whom trained in a era that was very different. One difference is that many faculty likely grew up medically with their limbic cortices branded with the concept that as a professional obligation they should place the needs of the patient above their needs and the primacy of that directive seems no longer to hold the same exhaled position in the medical ethical scheme.

The authors say this:

...with the increasing focus on safety and the advent of duty hour restrictions, our understanding of professionalism may be evolving to include greater valuation of personal needs.

I am still trying to figure out what that means but I do not think the major driver in the sea changes that have taken place in the medical education of residents is concern about work-life balance on the residents. As to what is, I hope to say more later.

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