3 ms·

> You don't let the junior engineer wild in production. You place guardrails around them until they learn and prove themselves as capable. The exact same thing

> You don't let the junior engineer wild in production. You place guardrails around them until they learn and prove themselves as capable. The exact same thing can be done in medicine. You mean like a residency?

alephnerd 3y ago
A residency is direct care of a patient. MDs already have internships and shadowing during their degree.
- haldujai 3y ago
  Residents provide direct care under supervision and have many guardrails, as the comment I was replying to stated. Clinical clerkship is not an internship, interns are first year residents. Shadowing does not teach you medicine.
SkyPuncher 3y ago
Residency is one form of that. A form with extreme labor restrictions and no ability to move jobs.
- haldujai 3y ago
  Yes, the system as designed by a cocaine addict[1] is broken. Residency is still necessary in principle. In a specialty program one only starts to become competent in PGY4. It's a difficult problem to fix, I finished my residency training in Canada where we don't have ACGME protections in place and while it was far more abusive than US programs (where I currently work) it certainly made us very competent at the end, better than I am seeing in the average US trainee I supervise. I'm not sure what the solution is to be honest. Competency is almost entirely driven by clinical volumes and exposure, you don't train to handle the 90% of normal cases but the 9% that are challenging and the 1% that's incredibly complex. If you're not working long hours (or spending many more years in training) chances are you won't get that exposure. With that said one could argue with the current expectation that everyone does 1-2 fellowships we're already training longer. [1]https://en.wikipedia.org/wiki/William_Stewart_Halsted https://en.wikipedia.org/wiki/William_Stewart_Halsted

3 ms·

> You don't let the junior engineer wild in production. You place guardrails around them until they learn and prove themselves as capable. The exact same thing

by haldujai 3y ago

alephnerd 3y ago
A residency is direct care of a patient. MDs already have internships and shadowing during their degree.
- haldujai 3y ago
  Residents provide direct care under supervision and have many guardrails, as the comment I was replying to stated. Clinical clerkship is not an internship, interns are first year residents. Shadowing does not teach you medicine.
SkyPuncher 3y ago
Residency is one form of that. A form with extreme labor restrictions and no ability to move jobs.
- haldujai 3y ago
  Yes, the system as designed by a cocaine addict[1] is broken. Residency is still necessary in principle. In a specialty program one only starts to become competent in PGY4. It's a difficult problem to fix, I finished my residency training in Canada where we don't have ACGME protections in place and while it was far more abusive than US programs (where I currently work) it certainly made us very competent at the end, better than I am seeing in the average US trainee I supervise. I'm not sure what the solution is to be honest. Competency is almost entirely driven by clinical volumes and exposure, you don't train to handle the 90% of normal cases but the 9% that are challenging and the 1% that's incredibly complex. If you're not working long hours (or spending many more years in training) chances are you won't get that exposure. With that said one could argue with the current expectation that everyone does 1-2 fellowships we're already training longer. [1]https://en.wikipedia.org/wiki/William_Stewart_Halsted https://en.wikipedia.org/wiki/William_Stewart_Halsted