In recent years, medical and surgical resident have been working fewer hours per week, in contrast to the 80+ hour-workweeks that were common in the past. Fortunately, we have options available to deal with the problem of the reduced workweek. In sum, we must enhance those hours our residents do spend on the job.
First, we must recognize that though all doctors have received training, not all have the same levels of cognition and psychomotor skills, and so we must tailor their training accordingly. Secondly, we can improve our ability to give feedback to the interns and residents under our supervision and provide honest, constructive critiques to help them learn. A key weapon in our training arsenal is the simulator. As medicine has become more sophisticated, so has our ability to train through simulations. While it is true that our simulators are not as sophisticated as flight simulators, for instance, certain skills can be acquired through repeated training in simulated surgeries.
Next, we can develop a system of meaningful rewards to motivate interns and residents to work harder during their reduced workweeks. Research has shown that people will work harder if they believe that their efforts will lead to rewards. Most residents are motivated, but they may become discouraged in the face of the constraints placed upon them by the hospital work environment and the relative loss of autonomy they experience as trainees. We must encourage residents to work around these obstacles.
Finally, we must never forget the circumstances that brought us to this point and strive to make the best use of whatever hours are available to us. Since we typically measure experience in terms of time, if we must reduce the time available to gain experience, we must make that time more meaningful.
This article is a brief synopsis of points raised by Dr. Gustavo Stringel
in his President’s Address to the Society of Laparoendoscopic Surgeons, which was published in the Society’s Journal in 2010. Dr. Stringel currently holds the posts of Surgeon in Chief and Director of Pediatric Surgery and Minimally Invasive Surgery at the Westchester Medical Center’s Maria Fareri Children’s Hospital