From RCB - My hands-off teaching style was learned at Baylor and at Waco and in rural practice. It is the style that I think that we must have if we are to train "hands-on" so that students and residents can make decisions and learn to care for patients. I tended to let residents make decisions and run the show. Many of our attendings run things like they were the actual care givers. Perhaps changes in the last 3 years have necessitated this style as we are much busier and patients are here for a very short time.
The trend you describe appears to be more prevalent around the country in med school and residency. Are we "dumbing down" medical education because of productive, billing, documentation, and legal concerns? Med students that I'm interviewing are doing less now than when I was student. Residents are doing less procedures than when I was a resident. Is that good for medical training?
Just completed a legislative study here in Virginia re: obstetrics. Deliveries are going down for med students, ob residents and FP residents in many parts of our state. Folks are graduating with less experience. Makes you wonder how they will do in the postgraduate setting at least
early on.
Roger Hofford, M.D.
It may be the rose-colored glasses on my almost-40-year-old eyes, but I seem
to recall doing more procedures in residency than our residents currently
do. Some possible reasons I have thought about include all the ones you
mention, plus:
1. availability of consultants generates their increased use. Some programs are in areas where there are more consultants
2. fewer procedures are needed these days because of continuing evolution of diagnostic and therapeutic technology. Transvaginal ultrasound has replaced culdocentesis when the concern is ectopic pregancy. CT often replaces peritoneal lavage in trauma. More MRIs, fewer adult LPs. More HIB vaccines, fewer infant septic work-ups and therefore fewer suprapubic taps and infant LPs.
#2, especially, is not all bad. But along with you I wonder about the skills of future generations of physicians. Yet outside the small circle of those involved directly in medical education, the general public has little understanding of the process by which physicians are "produced" (how I hate that word). Everyone wants a good doctor, and most people are comfortable that theirs is pretty good, or at least not dangerous. But nobody understands that their good doctor was once an incompetent first-day first-year medical student, and that many resources (teachers, patients,
money, buildings, time, etc) were needed to produce the transformation.
--Chris Ryan