Being a physician is a privilege, but how that privilege is earned is an issue for educational theory and practice that is now being bitterly contested. Nowhere is this more evident than in the training of interns and residents. From William Osler and Abraham Flexner to recent events such as the Libby Zion case (see Natalie Robins's The Girl Who Died Twice, LJ 8/95) and the New York State Bell Commission, reformers have confronted traditionalists in an idealistic struggle. Duncan, a journalist and author married to a pediatrician, has gathered a riveting collection of facts and stories and fairly presented all sides of this vital and complex issue. Advocates of a "total immersion" residency program that they claim has produced the best doctors in the world are challenged by those who are convinced that residency programs are unduly harsh and leave new doctors scarred and burnt out at the beginning of their careers. Of fundamental concern is the question of how severely rigorous and demanding residency programs put patient care at risk by allowing inexperienced residents to learn the art of medicine on real people. Duncan's presentation of the powerful tension in medicine between differing pedagogic ideals is highly recommended for medical school libraries and other medical collections.-James Swanton, Harlem Hosp. Lib., New York
No-punches-pulled scrutiny of the flawed system that produces our nation's doctors.
As the husband of an overstressed, overworked, and overtired resident in pediatrics, Duncan (Hernando de Sota, 1995, etc.) saw firsthand the impact our present residency system had on one doctor. Here he looks at the bigger picture: how it affects not just doctors but patients and society in general. For four years he followed hospital residents on call, keeping records of their actions, attitudes, hours, supervision, and patient outcomes; he also interviewed dozens of doctors, medical educators, patients, and nurses. The result is an anecdote-filled account of what's wrong with the system and how it came to be the way it is. Where statistics are available, he cites them, but one of the flaws of the present system is its failure to collect hard data on its own level of safety or effectiveness. Where reforms have been madeas in New York State, where the famous Libby Zion case led to legislation restricting the number of hours residents can workhe describes them, but these are few and far between. Duncan is persuasive in his argument that a system that once worked fairly well when medical knowledge was limited now drops inexperienced and minimally supervised young physicians into complex, difficult situations, that it overworks and underpays them, and that it too often fails to protect patients from the hazards of treatment by sleep-deprived and undersupervised residents. Concluding with a warning that the very survival of our nation's teaching hospitals is being threatened as managed care reshapes the medical marketplace, Duncan offers no solutions to that problem but has some practical suggestions for revamping residency programs.
An up-close and sobering picture of medical education's imperfections.