COMMENTARY

What Would You Change About Residency?

Alexa M. Mieses, MD, MPH

Disclosures

June 20, 2019

Change 2: More Specifically Prepare Residents for Day-to-Day Practice

Specialty training widely varies in terms of how well each program prepares you for day-to-day life after residency. Although clinical medicine is important, knowing how our healthcare system functions and how individual clinicians can and will function within this system is equally as important. We must also learn how our patients will interact with the healthcare system. Everything from healthcare payment models to how to bill for all the services a physician provides should be a routine part of medical education.

Preparation for life after residency shouldn't stop there. We should embrace our patient's experiences and learn how to best advocate for them within our chosen field. Medical trainees should receive instruction on issues related to financial literacy and running a business because both are essential. We should be challenged to be creative and flexible outside of the examination or operating room in order to be more effective in an ever-changing healthcare landscape.

Change 3: Establish an Emphasis on Trainee Wellness

I've said it before and I'll say it again: Residency training needs to emphasize wellness. Only in medicine is it acceptable—and even seen as a badge of honor—to work 80 hours or more per week. Residents need time to be human beings away from the hospital. Medical and dental appointments, doing the laundry, grocery shopping, and many other basic needs are put on hold while residents serve as a huge human resource for the hospital in which they train.

Furthermore, residents not only need sufficient time away from the hospital but must establish a good balance between learning and service. Medical trainees are often in a "gray zone" between learner and independent clinician. It is this muddied role that serves as a barrier to changes in training.

Finally, the environment needs to be one that is safe for learning and mental well-being. Sufficient oversight must be put in place without punishment from the hierarchy of medicine. For example, time in the operating room is often taken away and used as a punishment if a surgical trainee is subpar or does not adhere to the norms of the program. More generally, residents are afraid to disclose or report medical errors for fear of retaliation. Some residents complain of too little or too much oversight, which either induces fear about providing medical care or makes us feel as though all autonomy is stripped away. Separate but related is the fact that mental health is ironically still stigmatized in medical training. Although the climate is changing in these areas, we need to do better—and fast.

Depression is more common among residents and medical students compared with the general population. One doctor commits suicide every day in the United States, which is the highest suicide rate of any profession. Although suicide is a complication of depression and often made worse by substance use, burnout is often the cause among medical trainees. Let's take better care of those who care for others.

Hopefully, these philosophic approaches will be at the forefront of the work the American Medical Association grant recipients will be doing and at the center of all changes to residency that will come.

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