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Fri May 8 02:14:26 BST 2009

Hmmmmm.  Seems to me that you did a really nice job of restating my posts, Mike.  Thanks.  Only, I never said I was right - I just said we need to figure out who IS, and how we can build a better mouse trap, 'cause the one we have at the moment isn't working.

Take care,
Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Sise, Mike MD
Sent: Thursday, May 07, 2009 8:32 PM
To: trauma-list at trauma.org
Subject: A dose of reality in residency training

Time for a reality check:

1.      "Old school" every other night on call was horrible and ruined many marriages and careers - errors were common and frequent. During that time in my life, my wife's favorite saying was that the world's biggest lie is that it will be better next year.
2.      It takes a very large amount of clinical experience to become a surgeon - a critical mass of sick patients, operative experience, mentored leadership time, and senior decision making responsibility
3.      Five years of 80 hours or less per week, truncated by mandatory time away, lack of longitudinal responsibility may not be long enough to accomplish the independent status required of graduates in the US system
4.      The European and Great Britain model of extended training after residency is probably out of the question in the US where medical school is not free and most interns already have $200,000 or more debt and don't get paid well as residents. Who will ask our new young surgeons to live with their debt another 2 to 4 years, maybe longer?
5.      Further work restrictions will demand of us a complete redesign of training programs and the expectations of graduate surgeons. Will we have a "1st Officer" status like the airlines where our young surgeons don't have primary operative responsibility for a set number of years and operative volume after residency? Work force shortages make that seem unlikely and yet young surgeons may be forced to do something like that on their own out of sheer necessity.
6.      Time to stop fighting over who's right and who's wrong over this issue. The old days are gone for good and any of us who trained that way and complain about the new graduates are not making it any more likely that we will find an effective new way to train the next generation of surgeons. They are just as dedicated and committed as we were and they deserve our unqualified support. They need us to help them learn what we did - how to be there for our patients in hours of desperate need when there is much at stake and decisive action is required.

Mike Sise, San Diego

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A dose of reality in residency training