Blog | Monday, October 15, 2018

Show respect for how hard your interns and residents work


As we age, we look back and convince ourselves that we were better and worked harder than the current generation. Dr. Gurpreet Dhaliwal addressed this issue beautifully in an essay – The Great Generation

Today's trainees are every bit as professional, motivated to learn, and devoted to their patients as previous generations. Students and residents follow duty hours but then log on from home to monitor their patients, write orders, and stay in touch with their on-call colleagues.7 They come to the hospital on their mandated days off for family meetings. They connect with their patients despite unprecedented paperwork, computer work, and throughput. And yes, they are on their smartphones constantly—reading about medicine, texting colleagues to coordinate care, and talking with patients' families.

While I agreed strongly to this essay, many remained skeptical. One of recent chief medical residents just published a study that confirms the above thoughts. Trends in Inpatient Admission Comorbidity and Electronic Health Data: Implications for Resident Workload Intensity

In the era of duty hour regulations, there is increasing concern regarding resident workload compression. We conducted a retrospective, observational assessment of all internal medicine resident admissions to a Veterans Affairs hospital over a 15-year period to evaluate several admission components that impact resident workload and workload intensity, including electronic health record (EHR) data burden and patient comorbidity. A total of 67,346 admissions were included in the analysis. Mean patient comorbidity, as measured by the Charlson Comorbidity Index, increased throughout the study period. EHR data burden, measured by numbers of notes, medications, and discharge summaries available per patient at the time of admission, also increased over the study period. These findings suggest that EHR data burden and comorbidity have increased over time, which impacts resident workload in the era of duty hour restrictions.

We worked hard back in the 70s. Residents work hard now. The work is different. We thought drawing blood and starting IVs defined scut work. We did not have to use EHRs, write notes to satisfy billing requirements, or have as many diagnostic tests and medications to use.

As an older attending, I explain that our training was different, neither better nor worse. I believe this attitude is one that all attending physicians should adopt.

db is the nickname for Robert M. Centor, MD, MACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and the former Regional Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds regularly at the Birmingham VA and Huntsville Hospital. His current titles are Professor-Emeritus and Chair-Emeritus of the ACP Board of Regents. This post originally appeared at his blog, db's Medical Rants.