Excellent Article on Match History and Potential Problems
Just as Match Week is about to kick off, here’s an awesome article that talks a little about the history of the match and discusses the match algorithm, an NRMP lawsuit, and implications that the match contributes to poor resident working conditions. It’s a somewhat long read, but definitely worth it.
Every March, hundreds of graduating medical students put themselves at the mercy of a mathematical algorithm that pairs them with the teaching hospital they’ll go to for their residency training.
Participating students and hospitals submit rank-ordered lists of their preferences; on Match Day, a computer comes up with a matching of students to programs that all participants must accept.
The system is based on an elegant mathematical theory dating from the 1960s, yet medical students, unversed in game theory, have trouble believing that it’s fair.
It’s not surprising, then, that three disgruntled physicians, fed up with the low wages and long hours that characterize medical residencies, are blaming the algorithm for their woes.
Are Medical Students Meeting Their (Best Possible) Match? [PDF]
Grey’s Anatomy: They Really Do Work Long Hours
Most of you probably watch some medical drama shows on TV. First there was ER, and now it seems that every other show on television has something to do with medicine. Right now, the three biggest shows are probably Grey’s Anatomy, ER, and House, M.D.
I really like Grey’s Anatomy. I never got into ER or House too much, but I’ve seen each of them on more than one occasion. I don’t care for the more comedic shows like ‘Scrubs’ at all.
In my opinion, Grey’s Anatomy is the most ‘releastic’ of all medical shows on T.V. House is too far-fetched with bizarre and rather rare diagnoses. E.R. is not representative of my brief experiences in the emergency department during my student rotations.
Hours Watch Is A Must See
I know I’ve got a link to Hours Watch over to the right, but I thought I’d post this here so you’ll have a better chance at getting over there.
From their About page:
“Hours Watch is dedicated to ending excessive work hours for medical residents, and finding solutions that enhance patient care and residency education. Hours watch is jointly sponsored by the Committee of Interns and Residents, and the American Medical Student Association, organizations that have led the fight to reduce unsafe and unhealthy overwork of medical trainees.”
I really like what they’re doing and I 100% support the cause.
Decreasing Work Hours versus Patient Care
While probably not going to change anything, a recent study published in the Journal of Surgical Research has shown that decreasing work hours alone does little to perceived patient care.
Note the keyword above – perceived.
The study was conducted among 156 surgical residents and had an excellent 94.5% response rate and consisted of surgical residents already regulated by work-hour restriction (maximum 80-hour work week) and residents who had not previously been regulated by work-hour restrictions.
The problem is not in the decreased work hours. Anybody with any common sense is going to realize that you are more efficient and more on top of your game if you’re well-rested. Just look at pilots in the commercial airline industry – they don’t let those guys work insane hours.
The flaws in patient care were found to be primarily in communication among residents. More precisely, we’re talking about cross-coverage and shit like that. In other words, whenever a resident passes on his census to a covering resident, that communication needs some improvement.
What’s interesting about this study is that it looked at decreased work hours versus patient care. The study found no improvement in patient care with decreased work hours. Now, many will look at this and say “so decreasing work hours doesn’t work.”
Not true. Decreasing work hours is a reasonable method to ensure that residents provide better care to patients. The residents are better rested, have more of a life, and everybody wins.
Another study needs to be done that looks at improving communication among cross-covering teams. That’s the real problem. Sure, it took this study to begin pointing that out, but let’s not give decreasing work hours a bad rap for failure to provide patient care improvements.
Interns Working More? Yep.
Medical News Today is reporting that medical interns often work longer hours than mandated according to two studies in the September 2006 issue of JAMA. I knew this all along, but the studies and news are interesting nontheless. According to MNT:
“The study included Web-based surveys of self-reported percutaneous exposures from 2,737 of the estimated 18,447 interns in U.S. postgraduate residency programs from 2002 to 2003. Each month, comprehensive Web-based surveys asked about work schedules and the occurrence of PIs in the previous month.
From a total of 17,003 monthly surveys, 498 PIs were reported. Of these, 294 were due to lacerations from a sharp instrument (such as a scalpel), and 204 were due to a needlestick. Rates of injuries varied significantly, depending on type of residency. Interns in surgery and obstetrics/gynecology residency programs had the greatest risk, presumably because they perform more invasive procedures than other specialties.
More than 80 percent of medical interns surveyed in 2003-2004 indicated they were working hours in excess of what is currently mandated, according to a study in the September issue of JAMA.”
It really is time to start cracking down on these programs. Head on over to HoursWatch and report anonymously.