Blog | Thursday, October 17, 2013

How regulations are hampering resident learning


Over the years, we have had regulation after regulation imposed on the patient note. We have had the addition of computer systems that work well for billing, but not as well for patient care. We have work hour requirements that lead to more handoffs, and now we demand that residents spend significant time preparing and delivering handoffs.

And the result – Work Habits of the 21st-Century Intern

The distressing paucity of time that interns spend with their patients is not a new phenomenon: Back in 1989—before both work hour limitations and computers—a similar study showed that interns spent about 20% of their time with patients and about 40% in documentation (NEJM JW Gen Med Jun 30 1989). However, things clearly are moving in the wrong direction. These fascinating data ring completely true and should give program directors impetus to reevaluate critically the present routines of clinical training.

Osler taught us that we need to observe and communicate with patients at the bedside to really learn medicine. During training we need to spend sufficient time with our patients to understand disease and the progression of disease. When we sacrifice time with patients for charting, then we sacrifice our residents’ growth.

We see American Board of Internal Medicine pass rates decreasing.

Perhaps there is a link.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.