Changes are coming in residency training

The CMA posted this morning that residency expectations will be changed by 2017. It will be competency based  rather than time and exam based. In theory, this is already going on. You need to be recommended to sit your licensing exam by your program. If your program sees you as a resident at risk, they should not recommend you. From what I understand, this rarely happens, what Dr. Jason Frank in the article calls "failure to fail". Medicine in general has a tendency to pass students who should be re-mediated, or, kicked out. People are shocked that my school kicked 3 people out of our program, despite being a pass/fail school. So, sub-par residents can make it through to their exams missing essential skills.

My clerkship program was quite focused on our actions - for example, we all needed to deliver one baby vaginally, place 5 peripheral IVs, etc. etc. Students were not always able to complete the activities though because their residents scooped them all, their consultants didn't have time, or there just weren't enough patients. Fake signatures abounded, our teachers were willing to sign off when we were able to describe what we would do if given the opportunity. My exam in IM was meant to be hands on, but ended up being a  seated conversation between me and my preceptor.

In my experience, preceptors who are not in academic centers are not great teachers and can be even worse at giving feedback. Many I've met choose to stay away from academic centers to keep away from the extra workload of teaching and research. For residency programs to have such a strong focus on competency and the improvement of those competencies, there needs to be a significant improvement in the training of preceptors, especially those who are based in the community and in rural settings. 4 years is an optimistic turn over time. Many of the docs I've worked with this year are holding me to the same standards they were held to 15 years ago in their training in a specialty other than family medicine. Getting those docs into this decade, into my specialty, will take some effort. It will take much more to get them in line with an entirely new way of completing residency.

If however, this is based on objective observations by a small number of mentors/preceptors who can watch the resident progress from tadpole to frog, it will be a step in the right direction. These observers will need to have their own mentors to help them differentiate where a new resident should be versus a senior. The proposed evaluation program assumes that those evaluating residents will be able to make these distinctions. Unless you have experience with many residents at various levels, knowing how a resident is performing can be tricky.

Most concerning to me though, is the dependency of this type evaluation on numbers of patients. I've been worrying about this since I noticed the rising number of learners coming behind me while we are rushing patients out of hospitals. Despite taking on extra call shifts, totally ignoring PAIRO's rules about hours working, and leaving my cell number for all attendings to call me with juicy cases, at the end of my residency I have spaces in my skills log that are empty, experiences my residents told me I would get after clerkship. If I was graduating from residency in 2020 with the bad luck that I've had for catching cases that are on the relegated list of "must do's", it would take me extra time to finish. Which is fine. But it also means that I'd be taking those vaginal deliveries from junior residents and clerks, because shit does flow downhill.

In an ideal world, this is a great proposition. I try to be optimistic but  my experience with community docs having something extra to do makes it hard. I expect the community and rural programs to lose preceptors when their responsibilities change.

Why cats are not doctors

Good to know.



But somewhat patient centred right?




This is unfortunately not species specific.

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What Med School is Like

It seems like whenever I get overwhelmed with what is happening at school, someone asks me how school is going. They mean well. I love that they care, I really do, but I have no way of explaining how I'm feeling without sounding like I'm whining.

The blogger "The Rumours were True" compared med school to eating 5 pancakes every day. He has something there, and it's definitely worth a read.

The idea was made into a short film.

Why do we put ourselves through it?

Dr. Unnecessarily Angry Surgeon comes to in to teach at least once a month

I've been able to get to know the entire class. Really. I know everyone's name and at least 2 bits of interesting information about them. Even the ones who never come to class.


OK, too many videos on one page, I'll start actually writing now.

I love school, it's a great experience. What gets to be stressful though is how absolutely impossible it is to do everything I want to. My undergrad style of note keeping went out the window within a few weeks of starting class - there just isn't time and it just keeps coming. There are "interest group" lectures about absolutely everything. It's a great way to learn what I want to do when I'm done school and I want to hit every one, again, can't.

There are a million committees and community interaction groups, councils and academic events that I want to take part in but again, just no time.

Not to mention the weekly (at least) party.

I'm constantly feeling guilty that I'm not getting to everything and doing as much as I possibly can. It's a bizarre thing. I'm getting used to the fact that I can't do everything but I don't like it. You know I'm pouting.

An American Swimmer Inspires Me

Have you been paying attention to this woman? Holy Moley! Dara Torres is an American swimmer (why I hadn't noticed her before this morning). She's the oldest woman competing in the Olympics. What an inspiration, especially considering how young this field is.


There isn't an age limit on any of the changes we want to make in our lives. Don't say you would do something if you only x years younger. I call your B.S. and tell you to just do it!


I was actually in tears this morning while I was watching the news reports posted above. I was so scared when I first hit my med school class last year, afraid of what they would think of me as so much older than them. Listening to what Phelps said about Torres (mom) made me think that he was being a bit immature. It's so much easier to slough off comments made about Dara than they are about me. What a great lesson. Someone in the class called me Mom once this year b/c I was giving him a hard time when he came to my house (pardon me if I want my kitchen left in one piece). I snapped. I too would prefer to be thought of as an older sister - it makes sense to me since my little brothers are the same age as the class. Either way, I hope I can remember how proud I feel right now of going into med school at my age.

In an unrelated topic, profs/administration/tutors need to back off students. Either they're creeping our Facebook, or complaining that we don't get to class often enough, or bitching about our work ethic. It makes me absolutely crazy. I spent a significant amount of time and energy this week trying to calm down the teachers in the course I'm helping develop - it's ridiculous.