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> to boast about it What the actual fuck? Why would anyone who loves their wife or husband choose to enter such a program? (Best-case scenario: a few years o

> to boast about it What the actual fuck? Why would anyone who loves their wife or husband choose to enter such a program? (Best-case scenario: a few years of data produced this anomalous result, someone noticed it and decided to draw attention to it, and it has since scared away all married students, so that there will never be any future data points to contradict it.) Still, from what I know about medical school and residency in general, any place that periodically assigns 24-hour work shifts just because is ... perverse. Edit: Ok, it's not 100% "just because"; there are some rationalizations. https://www.ama-assn.org/residents-students/residency/3-tips-new-med-school-grads-facing-old-24-hour-shift https://www.ama-assn.org/residents-students/residency/3-tips...

jseliger 6y ago
Still, from what I know about medical school and residency in general, any place that periodically assigns 24-hour work shifts just because is ... perverse. It's worse than you think: https://jakeseliger.com/2012/10/20/why-you-should-become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-school https://jakeseliger.com/2012/10/20/why-you-should-become-a-n... Once a person has taken on the debt from med school, it's extremely difficult not to continue. Residency programs know this.
MereInterest 6y ago
That was more or less my reaction as well. I could understand there being a few years of anomalous data as a result of small sample size, but to then boast of it rather than taking it as a sign of very serious issues doubles down on a bad sign. I agree that the 24-hour shifts are ridiculous. I could see some potential benefit for reducing the number of shift handoffs (e.g. 12-hour shifts expose patients to 2 shift changes per day, but 8-hour shifts expose patients to 3 shift changes per day), since shift handoffs have been shown to be the source of miscommunications. However, as your link points out, there is no decrease in standard of care resulting from removing 24-hour shifts, so that is not a reason to keep 24-hour shifts. Also, thank you for the link on it, though the tone of that article was definitely odd. It took the lack of effect of shift duration on patient care as a reason to extend shifts back up to 24 hours, rather than concluding that there is no reason to keep shifts at 24 hours. Similarly, it takes as a given that after a 16-hour shift, you only get 8 hours off, rather than treating that as another sign of poor shift scheduling. (From the article, “When you’re on a 16-hour shift that ends Monday at 11 p.m., you still have to come back to the hospital on Tuesday at 7 a.m.,” she noted. “When you’re on a 24-hour shift, you leave on Tuesday at 7 a.m., and you don’t have to report back for duty until Wednesday. That is a better arrangement. You have the rest of the day to do things.”)
- waterhouse 6y ago
  > the tone of that article was definitely odd Yeah, I interpret it as self-serving propaganda and mendacity. I will assume the worst at every turn—for example, that the supportive quotes are cherry-picked; that they insert pictures of smiling doctors to try to make people think those opinions are normal; that they made certain that the dissenting doctor's opinion was described as "a minority opinion", and was immediately followed with "Dr. Mathis did acknowledge, however, that the ACGME change in requirements was here to stay"; that the "members of the AMA’s Resident and Fellow Section" they apparently polled were cherry-picked; that they asked several poll questions and chose to report the one with the most favorable result (and that "Do you think it's a good idea?" scored worse than "Do you think it's better than 16-hour shifts?"); that they reported it as "a majority" because it sounds higher than "52%"; et cetera. This is unfair, but I expect it's the best starting point for understanding. > Similarly, it takes as a given that after a 16-hour shift, you only get 8 hours off Yeah, it appears to be easier to work for an additional 8 hours and get the whole next day off, than to persuade those who choose the shifts to let you come in a couple of hours later on the day following a 16-hour shift.
dreamcompiler 6y ago
I don't think I'd want to drive across a bridge if one of the main criteria for career success for a civil engineer was "ability to pull all-nighters 3 times a week for many months." And yet when we go to the hospital that's exactly who is treating us.
- waterhouse 6y ago
  To be fair, I think it's more like a 24-hour shift every several weeks, not multiple times a week. And I don't think residents get weeded out if, say, they make errors during 24-hour shifts at >2x the rate of other doctors; I'd guess that, if any weeding occurs, it would be based on the "overall error rate" instead. I do have opinions about how to select doctors. For example, surgeons in particular should be selected a lot more for manual dexterity, and less for ability to memorize facts that appear on the MCAT.

jseliger 6y ago

Still, from what I know about medical school and residency in general, any place that periodically assigns 24-hour work shifts just because is ... perverse. It's worse than you think: https://jakeseliger.com/2012/10/20/why-you-should-become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-school https://jakeseliger.com/2012/10/20/why-you-should-become-a-n... Once a person has taken on the debt from med school, it's extremely difficult not to continue. Residency programs know this.

MereInterest 6y ago

That was more or less my reaction as well. I could understand there being a few years of anomalous data as a result of small sample size, but to then boast of it rather than taking it as a sign of very serious issues doubles down on a bad sign. I agree that the 24-hour shifts are ridiculous. I could see some potential benefit for reducing the number of shift handoffs (e.g. 12-hour shifts expose patients to 2 shift changes per day, but 8-hour shifts expose patients to 3 shift changes per day), since shift handoffs have been shown to be the source of miscommunications. However, as your link points out, there is no decrease in standard of care resulting from removing 24-hour shifts, so that is not a reason to keep 24-hour shifts. Also, thank you for the link on it, though the tone of that article was definitely odd. It took the lack of effect of shift duration on patient care as a reason to extend shifts back up to 24 hours, rather than concluding that there is no reason to keep shifts at 24 hours. Similarly, it takes as a given that after a 16-hour shift, you only get 8 hours off, rather than treating that as another sign of poor shift scheduling. (From the article, “When you’re on a 16-hour shift that ends Monday at 11 p.m., you still have to come back to the hospital on Tuesday at 7 a.m.,” she noted. “When you’re on a 24-hour shift, you leave on Tuesday at 7 a.m., and you don’t have to report back for duty until Wednesday. That is a better arrangement. You have the rest of the day to do things.”)

waterhouse 6y ago
> the tone of that article was definitely odd Yeah, I interpret it as self-serving propaganda and mendacity. I will assume the worst at every turn—for example, that the supportive quotes are cherry-picked; that they insert pictures of smiling doctors to try to make people think those opinions are normal; that they made certain that the dissenting doctor's opinion was described as "a minority opinion", and was immediately followed with "Dr. Mathis did acknowledge, however, that the ACGME change in requirements was here to stay"; that the "members of the AMA’s Resident and Fellow Section" they apparently polled were cherry-picked; that they asked several poll questions and chose to report the one with the most favorable result (and that "Do you think it's a good idea?" scored worse than "Do you think it's better than 16-hour shifts?"); that they reported it as "a majority" because it sounds higher than "52%"; et cetera. This is unfair, but I expect it's the best starting point for understanding. > Similarly, it takes as a given that after a 16-hour shift, you only get 8 hours off Yeah, it appears to be easier to work for an additional 8 hours and get the whole next day off, than to persuade those who choose the shifts to let you come in a couple of hours later on the day following a 16-hour shift.

dreamcompiler 6y ago

I don't think I'd want to drive across a bridge if one of the main criteria for career success for a civil engineer was "ability to pull all-nighters 3 times a week for many months." And yet when we go to the hospital that's exactly who is treating us.

waterhouse 6y ago
To be fair, I think it's more like a 24-hour shift every several weeks, not multiple times a week. And I don't think residents get weeded out if, say, they make errors during 24-hour shifts at >2x the rate of other doctors; I'd guess that, if any weeding occurs, it would be based on the "overall error rate" instead. I do have opinions about how to select doctors. For example, surgeons in particular should be selected a lot more for manual dexterity, and less for ability to memorize facts that appear on the MCAT.