Resident Lounge Becoming a Physician

Competency-based medical education holds the promise of producing a bettertrained workforce — and for many physicians, this training could be accomplished within a shorter time frame.

With trainees increasingly exposed to a culture that values efficiency, clinical protocols, and specialized expertise over scientific debate and critical thinking, new programs are creating linkages between unexplained patient presentations and scientific inquiry.

As an intern, you arrive at the hospital before dawn, speed-walk to sign-out, plan a route to see your patients before morning report — less than 10 minutes each to see how they’re feeling, examine them, check in with the nurse. Which are the moments that will matter?

There is sexism in medicine, but there may also be a more insidious obstacle. I’ve been haunted at every step of my career by the fear that I am a fraud. And not only do we women tend to perseverate over our inadequacies, we also often denigrate our strengths.

When we become obsessed with finding the right answer, at the risk of oversimplifying the richly iterative andevolutionary nature of clinical reasoning, the result is the very antithesis of humanistic, individualized patient-centered care.

One of the oddest aspects of concluding residency is the obligatory termination of all our patient relationships. The separation process highlights the value of the fundamentals of old-fashioned patient–doctor relationships. How can we make it smoother for everyone?

Through irrelevant, friendly comments or questions, physicians can establish key connections with patients. Such small talk conveys physicians' recognition of patients' individuality and their own shared experiences, observance of details, and openness to conversation.

A medical student working in a homeless shelter for mentally ill men finds himself thinking of William, a shelter resident, as one of his patients. But that's the last thing William wants to be, and the current health care system seems a long way from meeting his needs.

Dr. Michael Kahn started giving lessons to third-year medical students on working with “difficult” patients. Kahn writes that the exercises can demonstrate the immediate payoff of knowing even a little bit about a patient's life.

Paternalism in discussing resuscitation status has given way to an approach in which patients may be asked to choose from a bewildering array of medical options, but physicians-in-training are rarely taught how to lead such conversations confidently and effectively.

The details of residents' participation in surgery are often not disclosed to patients — an omission that sometimes necessitates overt deception. What if we openly discussed resident participation with patients instead of hiding our need to train future surgeons?

Caught in the transition from intern-as-workhorse to a system in which senior residents must take up the slack from interns with more restrictive duty hours, a resident asks, “Will we continue to put patients first if we don't learn the hard way to put ourselves last?”

In medical school, students are taught to follow a script: “What brought you to the hospital today?” In this essay, Benjamin Brody, a medical student, discusses the challenge of the conversations that happen after histories are taken, when the patients' ...

The level of supervision of residents is increasing, with an attendant perceived loss of autonomy in decision making. However, as with duty-hour restrictions, there is no evidence regarding the effects of increased supervision on educational value or future quality of care.

Standardized patients prepare like actors learning a role, but they are also educators, and no one else in medical school is positioned to give students a patient's-eye view of the doctor–patient relationship.

Since social problems affect health and treatment effectiveness, considering them in assessments and treatment plans should improve outcomes, reduce costs, and improve patient satisfaction. How should clinicians learn to explore and address social determinants of health?

In the wake of the death of Freddie Gray and the protests over unjust treatment of black Americans, the internal medicine residency program at Johns Hopkins launched a curriculum aiming to provide tools for improving population health and reducing health disparities.

Why isn't the fourth year of medical school being used to meet the needs and desires of medical students, residents, and residency programs? The problem, in part, is the overly burdensome process of preparing for and applying to residency programs.

Critics argue, essentially, that there is no ethical way to study residents' duty-hour rules in a randomized fashion. But in assuming that untested practice is safe, we have compromised trainees' freedom to judge for themselves when their patients need them.

When a patient at a U.S. teaching hospital says she wants no trainees involved in her care, do we tell her to go elsewhere? Transfer her to the nonteaching service? Or somehow convince her that she will receive better care on the teaching service?

Should a patient be permitted to refuse potentially lifesaving care? As a psychiatry resident, Dr. Benjamin Brody is routinely asked to make decisions about whether a patient's judgment is impaired.

Dr. Lisa Rosenbaum writes that there is little room for diagnostic uncertainty in the hospital systems where physicians train. But diagnosis for the sake of diagnosis can be an ill in its own right.

Dr. Viviany Taqueti describes the case of a 29-year-old heroin addict with chronic aortic insufficiency who presented to the emergency department with acute onset of fever, chills, anorexia, and malaise. The patient seemed indifferent to the medical team'...

Nostalgic for the bad old days of her own training, a physician wonders how, lacking the satisfactions and pleasures of taking responsibility for patients during absurdly long shifts, today’s trainees will learn key lessons about what it means to be a doctor.

In the practice of medicine, the person you are is as important as what you know. Medicine is intensely intellectual, but it is also an endeavor of your heart. As you learn about disease and diagnosis and treatment, you are learning about illness, the patient, and yourself.