By Sefira Bell-Masterson, Dr. Lakshman Swamy and Dr. Christopher Worsham
A few things in medical education have changed in the past 100 years.
A century ago, for instance, resident physicians-in-training literally lived on hospital premises.
They received room and board but no other compensation. They routinely performed any task related to patient care, ranging from transporting patients to the operating room to performing their surgeries.
Clearly, things have changed. But what hasn’t changed is how medical residents are used for any task that needs to be done during a patient’s hospital stay.
Today, residents are expected to learn medicine, care for patients, and improve our health care system — often in addition to teaching and research. All this needs to be done within a limited number of nationally regulated duty hours, now the subject of an ongoing and increasingly controversial conversation in the medical community since restrictions were put in place in 2003 and 2011.
Over the past decade, there has been much debate about the benefits and drawbacks of duty hour restrictions, yet prior research into this topic has shown mixed results. Earlier this month, however, researchers published results of a first-of-its-kind randomized trial (the FIRST Trial) of 117 surgical residency programs across the country. The study’s authors concluded that there was no difference for patients or their doctors’ satisfaction whether residents worked under current duty hour restrictions or under more flexible rules. Results of a similar trial performed on medical residents (the iCOMPARETrial) are expected later this year.
As residents ourselves, we believe the duty hours conversation has missed a major point: Though our hours are being limited, what we actually do during these hours is not.
There has been a great focus on the number of hours worked, but silence about the actual work done.
Erica, a resident in obstetrics and gynecology in Delaware, routinely runs her own lab tests in the office. Karl, a pediatrics resident in New York, often spends valuable time in the room with a child and her parents laboriously copying information from her medical record to fill out school forms.
Adil Yunis, an internal medicine resident in Boston, will spend 30 minutes on the phone trying to get a cardiology appointment for his patient who just had a heart attack.
These tasks (all real, but with two last names withheld ) are examples of what many residents call “scut.” Continue reading