Medical Training Reform Notes

Introduction

  • Scenario: Exhausted pilot and copilot, highlighting the dangers of overworked professionals.
  • Regulations exist for many professions to prevent overwork, but not consistently in medicine.
  • Scenario: An exhausted resident doctor in an emergency room making critical decisions.
  • It is legal and accepted for resident doctors to work 24-hour shifts and 80-hour weeks in many academic hospitals.
  • Jake Goodman's background:
    • Wanted to be a doctor since age five.
    • 22 years of schooling, three degrees (two from the University of Georgia).
    • Loves being a doctor but not the medical training.
    • Witnesses enthusiastic future doctors being broken down physically, mentally, and emotionally.

Medical Training

  • Frequent social media posts about resident doctors' suicides due to overwork and a culture of silence.
  • Medical training ironically creates more mental health sufferers than healers.
  • Potential for change: Revamping the medical education system to improve resident doctor well-being and patient care.
  • Jake Goodman's qualifications:
    • Launched Destination Med School on 01/26/2020 to document his journey and highlight problems in medical training.
    • Grew a community of over 2,000,000 followers with videos viewed over half a billion times.
    • Shared his personal experience with depression during training.
  • Three major problems in medical training:
    • Resident doctors are overworked, leading to medical errors and suboptimal patient care.
    • Medical training is a hierarchy that perpetuates mistreatment, emotional abuse, and fear of retaliation.
    • Trainees are afraid to seek help for their mental health, causing more untreated mental illness.
  • Problem 1: Insufficient sleep and recovery.
    • Rooted in Doctor William Stuart Halstead's program at Johns Hopkins University in 1897.
    • Resident doctors lived in the hospital and worked 24/7.

Resident Work Hours

  • Doctor Halstead's cocaine addiction fueled his ability to work long shifts, but his teachings spread.
  • Libby Zion Law: Implemented work hour restrictions after the death of Libby Zion due to a medical error by an overworked resident.
  • Current status quo: 80-hour work week, with shifts up to 28 hours.
  • Sleep deprivation effects:
    • Physiological impairment similar to alcohol intoxication.
    • Being awake for 24 hours straight is equivalent to having a blood alcohol content of 0.1 (above the legal limit to drive).
    • Decreased concentration, problem-solving ability, and memory recall.
    • Leads to more medical errors.
  • Medical errors are a leading cause of death, with up to 250,000 deaths per year in the US.
  • Twenty-four hour shifts are a recipe for disaster.
  • Problem 2: Hierarchy and culture of mistreatment.
    • Medical training hierarchy: Attending physician, fellow, chief resident, senior resident, junior resident, intern, medical student.
    • Team culture starts from the top (attending physicians).
    • Attendings may have endured years of overwork, mistreatment, and emotional abuse.
    • The abused can become the abusers.
    • Many attending physicians treat colleagues with respect, grace, and dignity regardless of training level.
    • Pressure and little margin for error in medical training.

Medical School Lecture

  • Negative evaluation can feel like career is over.
  • Example: Medical student harassed by a surgeon but afraid to report him due to his position and influence on her recommendation letter.
  • Problem 3: Fear of seeking help for mental health.
    • Med students and residents witness severe trauma without formal training on how to grieve.
    • Higher rates of mental illness compared to the general population.
    • Study in the Journal of the American Medical Association: One in four med students and residents experience depression annually.
    • One in nine trainees experience suicide ideation.
    • Only 16% of trainees with depression seek help.
    • Barrier: Fear of being unable to receive a medical license in states requiring disclosure of mental health treatment.
    • Doctors may have to report if they sought treatment for ADHD or depression after a loss.
    • Fear of jeopardizing their medical license leads to suffering in silence.
    • State medical boards claim the question protects the public.

Conclusion

  • Medical school and training have become an occupational hazard.
  • Training that sends one in four into clinical depression is unethical and unsafe.
  • Solutions:
    • National level: Increase the number of resident doctor positions.
    • The US is projected to be short 124,000 physicians by 2/1934.
    • Improve access to mental health services without fear of repercussions.
    • Doctor Lorna Breen Health Care Provider Protection Act: Legislation to protect the mental health of medical professionals, named after an emergency medicine physician who died by suicide due to fear of losing her medical license after seeking mental health treatment.
    • Local level: Resident doctors are unionizing to fight for safer working conditions and humane medical education (no hazing, harassment, or fear of retaliation).
    • Individual level: Future doctors should take notes on good and bad examples of mentors.
    • Create the learning environment they wish they had.
    • Acknowledge and thank resident doctors for their sacrifices.
  • Together, we can change medical training and create a brighter future for students, doctors, and patients.