Medical Education—service vs. education

Teaching new doctors is an interesting process. Much has been done over the last ten years to improve the way we teach new doctors. Medical residents still work very hard, but there are strict rules on work hours and other “service” duties that can interfere with education and safety.

One of the issues that often comes up in running a residency program is the problem of “service” vs. “education”. Per the accrediting body that does these things:

The learning objectives of the program must not be compromised by excessive reliance on residents to fulfill service obligations.

Along with details such as work hours limitations, this is one of the more important guiding principles for residencies. This can be a real problem on certain very busy medical services, such as an intensive care unit.

Residency is work; there is no getting around that. But in exchange for this work, residents expect to receive teaching, feedback, and respect. There are operational measures of these parameters used in evaluating residency programs.

When residents aren’t treated with respect, aren’t given proper feedback, and aren’t taught, it frankly pisses me off. These young doctors are counting on us to mitigate their fears and build their confidence. They are counting on us to impart the practical knowledge that they will use to save lives. There is very little justification for using a resident as your personal scut-monkey, and even less for yelling, degrading, or otherwise humiliating them. That’s not how you make good doctors.


  1. On the one hand, there’s a certain “misery loves company” component that makes me glad that basic research with our post-docs aren’t the only one with a rather perculiar (and potentially highly exploitable) trainee period.

    On the other hand, it makes me just as pissed off that intelligent, educated people in any career path aren’t treated with respect and trained properly (via feedback and teaching).
    Plus, since I’m guessing I will probably be a patient in the care of a resident at some point or another, I get to be worried that putting them in a poor state of mind may negatively impact my health. Great.

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