[lenticular]

Residents don't sleep much, so this doesn't surprise me at all.

Related, the residency process needs to be massively reformed. The flimsy justification for making people responsible for human lives work 80 hours a week is usually that the long hours help them learn faster. But that's really BS. The brain has an incredibly hard time forming new memories when sleep deprived.

I know a couple of nurses who often talk about how spaced-out residents are at night. They'll page them to consult on something, usually waking them up. The residents will usually just blearily agree with whatever the nurse was planning on doing, so they aren't getting in meaningful physician supervision.

[synaesthesisx]

The pioneers of the modern residency system were fueled by copious amounts of cocaine & other stimulants. Perhaps we need to reevaluate the requirements & expectations we place on medical residents today. It's essentially a form of professional hazing, and I personally know many surgical residents that are literally operating on people today while absurdly sleep deprived (by no fault of their own, just the insane hours of their program).

That said, if whoever's operating on me is running on 3 hours of sleep I'd rather they be hopped up on stimulants than not...

https://en.wikipedia.org/wiki/William_Stewart_Halsted

[sarcasmOrTears]

One time I met with the head of an union and he told me many tough jobs (mining mainly) were perfomed while on drugs, which aren't available anymore causing all kinds of issues for the workers. I wonder if there was truth in that statement and maybe some formal research on this.

[killjoywashere]

As I recall, the CIA did do a fair amount of this research on this, up to and including implanted cortical stimulators, which created some serious backlash.

Getting prescribed "on/off" switches in pill form is a well-known thing in the military. You just can't do combat air patrol over remote areas of Asia without some uppers. This quickly went from the pilots (mid-grade officers) and other fight crew, to being adopted by folks who have to go halfway around the world routinely (flag officers).

It's an active topic of conversation, some do, some don't. As a military physician who was a line officer and has been through 5 years of graduate medical education (internship + residency), and now occasionally has to do those round-the-world trips, it's not clear to me that there's an obvious right answer in policy or per-person. We (leaders and followers alike) expect leaders to function at the outer limits of human capacity, and have for a long time. I can tell you this: it doesn't get easier with age: a fairly common definition of success as a leader is proving your ability to take on more responsibility, so the more you do, the harder it gets. So avoid starting early.

[audiblebleeding]

As a former surgical resident, can reluctantly confirm. I've had many conversations half-asleep where I've afterwards been slightly uncertain of whether I just had a conversation with someone or was dreaming.

That said though, those situations generally concern relatively safe decisions, like minor pain killer dosage adjustments. If what the nurse calls about is sufficiently serious, adrenaline kicks in - and that thing can get you going really fast.

Actually, I wouldn't be surprised if some of the most expensive (in telomeric sense) part of residency is exactly that; the situations of mobilization from near-zombie sleep state to hypervigilance within seconds.

Naturally residency can and should be organized better than it is, but there are reasons why things are fundamentally organized the way they are as well. From a resident's perspective, on-call time primarily buys you time for elective surgeries - where the real learning happens.

[nopinsight]

What are some good reasons that things are organized this way?

I’ve heard that long shifts help with continuity as fewer doctors need to pass information about the same patient thus reducing communications overhead a bit. Anything else?

If only that, it seems the drawbacks in terms of risks to care quality as well as to the resident’s learning & long-term health may be greater than the benefits.

[audiblebleeding]

I think 'needlesurgeon's answer otherplace in this thread answers this well. Especially in adressing the point that it is in a way essentially a numbers game; It takes a certain patient population size to provide sufficient volume and diversity of cases per year to educate a certain number of surgeons over a certain span of years. You could make on-call easier by thinning this out over more surgeons-in-training, but then it would take almost twice as long for them to get the same experience. The problem with this is that the duration of a normal career isn't really that long compared to the time it takes to master a surgical field. If you work really hard and have great progression, you may be able to be top notch in your field for maybe 5 years before your skills start to decline. Also, those surgeons who are on top of their fields are incredibly important for the field as a whole, as it is they who inform all other surgeons through a kind of cascade of consultations.

The thing with continuity is right. Hand-overs always means some degree of information loss, especially for non-verbal information. One of the most imporant clues indicating need for surgery can be the character of stomach pains upon manual examination for example. If the same surgeon does the examination with some hours intervals, he or she may be able to detect subtle signs of deterioration which a new surgeon would not.

> resident’s [...] long-term health

Oh. Well. Haha. When an anesthesiologist colleague of mine commited suicide at one point the only thing we were told at the morning briefing was that the planned surgeries of the day would regrettably not be initiated exactly on time.

[watwut]

The learning curve argument boils down to "yes actually long term sleep deprived surgeons learn faster then rested ones unlike the rest of population".

[sagarm]

It's well known that mortality rates spike when new residents enter hospitals: https://www.nber.org/digest/sep05/w11182.html

[village-idiot]

Patient deaths rise during residency programs, meaning that we’re not only burning out the residents but we’re also killing random civilians for the sake of the residency program.

[egocodedinsol]

> They'll page them to consult on something, usually waking them up.

IME they're usually not asleep.