< Back to front page Text size – +
Posted by Ishani Ganguli October 4, 2013 05:45 PM
Lately, I've spent a lot of time walking briskly around the hospital, two to three pagers clipped to my sagging scrub pants and a Code Blue checklist tucked into my back pocket for easy reference. I'm working as "Senior On" - one of the more defining roles of the senior medical resident at Mass General. During each two week block, six of us take turns responding to and leading the management of cardiac arrests and other medical emergencies throughout the hospital.
I encountered the role during my first overnight call as a fourth year medical student, when the 80-something-year-old man with widespread lung cancer I'd met minutes before became unresponsive and triggered a call for the rapid response team. I watched with relief as the Senior On resident strode in, flanked by a pharmacist and nursing supervisor. As I breathlessly reported my patient's rapid decline and the resident calmly took charge, I wondered how I'd ever have the knowledge and confidence to fill her Dansko clogs. It has since become a matter of habit.
There is something comforting about the linearity of medical training, the notion that if you hold on through each phase, you'll come out the other end a fully-formed doctor. The progression is deliberate and plain to see: During the first year of our medicine residency, we learn how to take care of patients as the primary responders and are intimately involved in every detail of their care. In the second year, we bear the added responsibility of supervising those interns and leading teams. This year, we extend our reach to the role of medical ambassador: We work as consultants to other doctors (most often psychiatrists and surgeons), advising on complex medical problems and assessing patients' medical risk prior to surgery. We triage patients from the Emergency Department or from other parts of Mass General to medical units and decide whether we'll accept patients for transfer from other hospitals.
Though the steady march of time has served medical training for decades, the changing health care landscape and the restrictions imposed by duty hours have fragmented the time we spend caring for and learning from patients, leading medical educators to wonder if this approach now misses the mark. What has emerged is so-called competency-based education. It is the one of the suggestions offered by the Carnegie Foundation, the group charged with rethinking medical school 100 years after Abraham Flexner first imagined it in its modern, largely unchanged, state. The debate was re-invigorated by a recent series in the New England Journal of Medicine examining the merits and flaws of shortening medical school to three years.
For residency training, the Accreditation Council for Graduate Medical Education (ACGME) now requires that we fulfill core competencies in categories such as medical knowledge and practice-based learning. At a more granular level, and because every trainee's exposure to patients and medical problems is inevitably unique, this needs to translate into a checklist of sorts for our residency training experience. In our program, we've started to log procedures like spinal taps and intravenous line placements - both to document and encourage more experience doing these procedures and to track our outcomes. Some of my co-residents are introducing "learning road maps" on key topics in internal medicine that we can use to identify and fill in personal gaps over our three years. The hope is that we truly and systematically earn the status conveyed by the title of senior resident and emerge better doctors for it.
The author is solely responsible for the content.