{"id":3077,"date":"2020-11-24T14:03:12","date_gmt":"2020-11-24T19:03:12","guid":{"rendered":"https:\/\/blogs.nejm.org\/general-medicine\/?p=3077"},"modified":"2020-11-24T14:03:12","modified_gmt":"2020-11-24T19:03:12","slug":"they-dont-make-em-like-they-used-to","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2020\/11\/they-dont-make-em-like-they-used-to\/","title":{"rendered":"“They Don\u2019t Make ‘Em Like They Used To”"},"content":{"rendered":"
\"Dr.<\/a>

Dr. Sant is a General Surgery Chief Resident at NYU Langone Health, Bellevue Hospital, and Manhattan VA in New York, NY.<\/p><\/div>\n

\u201cWhen I was your age, I walked to school uphill both ways, barefoot in the snow!\u201d<\/strong><\/h4>\n

One of my favorite anecdotes from my attendings is about the cardiothoracic ICU experience in the \u201980s and \u201990s. Reportedly, each resident would arrive on day 1 of the rotation and would remain in the ICU for 30 straight days, being let out for an hour on Sundays \u2014 if there was time. I’ve heard it corroborated by so many people, I’m beginning to think that it might actually be true!<\/p>\n

While this training model might have had benefits, re: continuity of care, immersive learning, and opportunities for autonomy, it is obviously unreasonable. In recent years, duty-hour regulations have been implemented to protect residents and patients. In 1989, New York state adopted the Bell Commission\u2019s duty-hour restrictions, including the 80-hour work week. In 2003, the ACGME adopted these restrictions across residencies and specialties throughout the U.S.<\/p>\n

Today’s training model is kinder. Not surprisingly then, older generations seem to think subsequent generations have lost a certain toughness and ability to handle stress, leading to an overall cultural decline. Interestingly, attendings have rarely been the ones to make me feel lesser for not being forged in the same crucible. Instead, I’ve noticed (and probably contributed to) these expectations of greater toughness and less entitlement from senior residents, and this cascades on down to the interns and medical students.<\/p>\n

Fear can hinder learning opportunities<\/strong><\/h4>\n

I remember my chiefs and senior residents from my intern year. I was simultaneously in awe of them and terrified of disappointing them. While they sometimes were tough on us, they, in turn, would talk about how much harder their chiefs had been on them! They would laugh among themselves: \u201cCan you imagine if we had asked our chiefs that? Can you imagine if we had presented a consult to our chiefs that way?\u201d<\/p>\n

I have learned a tremendous amount from my seniors, and I am grateful for their mentorship. I wonder, though, if I might have learned a lot more with a relationship based less on fear. In the OR recently, I instructed my junior resident, \u201cWe’ll place the purse-string sutures, then move on to the Stamms.\u201d \u201cCould we quickly just go over Stamms again?\u201d she replied.\u00a0 I would never have dared to ask my chiefs such a question! (\u201cThey’ll think I don’t know… what if they make me feel dumb… they won’t let me place the stitches.\u201d) But I really wish I\u00a0 could have felt uninhibited enough to ask for clarity on a technique! I could have learned so much more. I didn\u2019t think less of the questioner, our attending didn\u2019t seem to mind either, and we ended up sharing a great learning opportunity.<\/p>\n

\"tired<\/a>Culture shift<\/strong><\/h4>\n

Ever since my own intern year, I have seen residents collectively judge each new class of interns.\u00a0 \u201cThey don’t have the same feeling of responsibility that we did.\u201d \u201cThey\u2019re part of the shiftwork generation.\u201d \u201cThey complain too much.\u201d \u201cThey ask questions without even trying to figure it out themselves.\u201d<\/p>\n

My peers and I seem no different than our predecessors in how we view each incoming class.\u00a0 However, I believe we are more understanding of the growing emphasis on work-life balance. This is reflected in how the program\u2019s priorities have changed: We now try to get residents into the OR as much as possible, starting intern year, and there is more focus on wellness and learning. These changes are decidedly positive \u2014 we try to get residents home on time whenever possible, we don\u2019t make them sit around idly waiting for their chiefs until 9 pm every day, and we want them to be happier, be more rested, and have more opportunities to learn and operate.<\/p>\n

Solution: Clear expectations and greater empathy<\/strong><\/h4>\n

As part of this culture shift, residents have a more collegial working relationship: What used to be implied in relationships based on fear is now communicated explicitly in more humane terms: \u201cYou should go home on time, but I expect you to complete these tasks and update me before you leave\u201d or \u201cI want you to assess any issues and propose an action plan before you escalate it to me.\u201d\u00a0 Setting clear expectations can take time and might seem harsh, but helps eliminate any misconceptions held by the newer residents.\u00a0 This is invaluable for both resident and patient.<\/p>\n

Recently, I talked with one of my attendings about this issue and asked him how he remained patient with all of us residents.\u00a0 He replied, \u201cI worked very hard as an intern, but when I reflect honestly, I know I wasn\u2019t the best intern at all times! I missed out on many major life events of my family and friends. These realizations have made me more understanding of today\u2019s residents.\u201d Such candid self-reflection, humility, and empathy go a long way in helping bridge the gap between instructor and student.<\/p>\n

A few months ago, a junior resident called me during the night to clarify something. Such a call would have had one of my former chiefs spluttering, \u201cWhy didn\u2019t you call the pharmacist and ask her to help you?\u201d I calmly addressed his questions and hung up. As I was drifting back to sleep, pondering why the resident felt he ought to call me about this issue, I had a brief flash of clarity, \u201cI’m glad he felt comfortable asking me!\u201d<\/p>\n

\"NEJM<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

\u201cWhen I was your age, I walked to school uphill both ways, barefoot in the snow!\u201d One of my favorite anecdotes from my attendings is about the cardiothoracic ICU experience in the \u201980s and \u201990s. Reportedly, each resident would arrive on day 1 of the rotation and would remain in the ICU for 30 straight […]<\/p>\n","protected":false},"author":1305,"featured_media":3080,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[17,1661,19,1660,37,69,1659],"class_list":["post-3077","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-about-residency","tag-chief-resident","tag-clear-expectations","tag-communication","tag-empathy","tag-resident-experience","tag-teaching","tag-training-culture"],"yoast_head":"\n"They Don\u2019t Make 'Em Like They Used To" - Insights on Residency Training<\/title>\n<meta name=\"description\" content=\"Dr. Sant discusses the shift in the way that residents interact with each other and with their attendings .\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2020\/11\/they-dont-make-em-like-they-used-to\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\""They Don\u2019t Make 'Em Like They Used To"\" \/>\n<meta property=\"og:description\" content=\"Dr. Sant discusses the shift in the way that residents interact with each other and with their attendings .\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2020\/11\/they-dont-make-em-like-they-used-to\/\" \/>\n<meta property=\"og:site_name\" content=\"Insights on Residency Training\" \/>\n<meta property=\"article:published_time\" content=\"2020-11-24T19:03:12+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2020\/11\/worried-nurse.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"580\" \/>\n\t<meta property=\"og:image:height\" content=\"387\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Vivek Sant, MD\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Vivek Sant, MD\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2020\/11\/they-dont-make-em-like-they-used-to\/\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2020\/11\/they-dont-make-em-like-they-used-to\/\",\"name\":\"\\\"They Don\u2019t Make 'Em Like They Used To\\\" - Insights on Residency Training\",\"isPartOf\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\"},\"datePublished\":\"2020-11-24T19:03:12+00:00\",\"dateModified\":\"2020-11-24T19:03:12+00:00\",\"author\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/8f8952abc8435c26c55463d54d32bd3c\"},\"description\":\"Dr. Sant discusses the shift in the way that residents interact with each other and with their attendings .\",\"breadcrumb\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2020\/11\/they-dont-make-em-like-they-used-to\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2020\/11\/they-dont-make-em-like-they-used-to\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2020\/11\/they-dont-make-em-like-they-used-to\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/blogs.nejm.org\/general-medicine\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"“They Don\u2019t Make ‘Em Like They Used To”\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/\",\"name\":\"Insights on Residency Training\",\"description\":\"Observation of residents across diverse medical specialties\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/blogs.nejm.org\/general-medicine\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/8f8952abc8435c26c55463d54d32bd3c\",\"name\":\"Vivek Sant, MD\",\"description\":\"Vivek is completing his chief residency in General Surgery at New York University. 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