Residents: The Perils and Promise of Educating Young Doctors

With great clarity and authority, David Ewing Duncan dissects the complicated process by which America's doctors are trained - a process little known by those outside of medicine, and often misunderstood even by physicians who have been through it. Here is a sympathetic yet provocative examination of this most critical phase of training; years that profoundly shape young physicians and directly impact how our healers will treat us, especially as managed care propels us into a new era of health care.
Residents draws on four years of intensive study, hundreds of interviews, and thousands of hours spent following and living among residents, medical educators, and patients. In their voices, oftentimes strained and wearied by long, grueling weeks in the wards and O.R.s, we feel the repercussions of a needlessly rigorous and, Duncan contends, outmoded system.
Residents also proposes a blueprint to expand on reforms already under way in some of the nation's great academic medical centers. Amid all the abstractions and technicalities batted about by policy makers and pundits, Residents offers real insight into the root cause of our nation's health care predicament and how we might begin to fix it.

Duncan spent four years observing, and sometimes living among, residents in more than a dozen U.S. hospitals. He saw dosages mixed up, drugs given that shouldn't have been, procedures put off for days because a resident forgot or was too busy, and horrific, life-endangering incidents that might never have occurred with proper supervision. He met overworked, pushed-to-the-edge residents everywhere, many suffering severe sleep deprivation, overwhelmed by a system that uses errors as a training tool and purposely places young physicians with minimal training in complex, intense situations. All those he interviewed spent at least 20% of their time-and often 70%-at such basic tasks as finding clean sheets and starting intravenous drips without backup support. Suicides and suicide attempts were shockingly frequent among residents. Duncan (Hernando de Soto) has written a chilling expose that should be read at all hospitals and medical schools. His proposed reforms, including protected sleep time, hands-on teaching, tighter supervision and caps on the number of hospital admissions, seem eminently sensible.
Copyright 1996 Reed Business Information, Inc.

No-punches-pulled scrutiny of the flawed system that produces our nation's doctors. As the husband of an overstressed, overworked, and overtired resident in pediatrics, Duncan (Hernando de Sota, 1995, etc.) saw firsthand the impact our present residency system had on one doctor. Here he looks at the bigger picture: how it affects not just doctors but patients and society in general. For four years he followed hospital residents on call, keeping records of their actions, attitudes, hours, supervision, and patient outcomes; he also interviewed dozens of doctors, medical educators, patients, and nurses. The result is an anecdote-filled account of what's wrong with the system and how it came to be the way it is. Where statistics are available, he cites them, but one of the flaws of the present system is its failure to collect hard data on its own level of safety or effectiveness. Where reforms have been made-- as in New York State, where the famous Libby Zion case led to legislation restricting the number of hours residents can work-- he describes them, but these are few and far between. Duncan is persuasive in his argument that a system that once worked fairly well when medical knowledge was limited now drops inexperienced and minimally supervised young physicians into complex, difficult situations, that it overworks and underpays them, and that it too often fails to protect patients from the hazards of treatment by sleep-deprived and undersupervised residents. Concluding with a warning that the very survival of our nation's teaching hospitals is being threatened as managed care reshapes the medical marketplace, Duncan offers no solutions to that problem but has some practical suggestions for revamping residency programs. An up-close and sobering picture of medical education's imperfections. (Author tour) -- Copyright ©1996, Kirkus Associates, LP. All rights reserved.

Being a physician is a privilege, but how that privilege is earned is an issue for educational theory and practice that is now being bitterly contested. Nowhere is this more evident than in the training of interns and residents. From William Osler and Abraham Flexner to recent events such as the Libby Zion case (see Natalie Robins's The Girl Who Died Twice, LJ 8/95) and the New York State Bell Commission, reformers have confronted traditionalists in an idealistic struggle. Duncan, a journalist and author married to a pediatrician, has gathered a riveting collection of facts and stories and fairly presented all sides of this vital and complex issue. Advocates of a "total immersion" residency program that they claim has produced the best doctors in the world are challenged by those who are convinced that residency programs are unduly harsh and leave new doctors scarred and burnt out at the beginning of their careers. Of fundamental concern is the question of how severely rigorous and demanding residency programs put patient care at risk by allowing inexperienced residents to learn the art of medicine on real people. Duncan's presentation of the powerful tension in medicine between differing pedagogic ideals is highly recommended for medical school libraries and other medical collections.?James Swanton, Harlem Hosp. Lib., New York
Copyright 1996 Reed Business Information, Inc.