[skybrian]

It sounds like the strategy is put in a lot of hours doing routine cases (where little learning happens) in order to experience the rare cases. This seems inefficient? Couldn't residents be called in to look at the rare cases?

I guess they would need to be close by when it happens, but that doesn't seem to justify sleep deprivation?

Or maybe there are other ways to increase the odds of seeing a rare case?

[riahi]

This is the difference between coding the solution to a tough technical problem yourself versus watching someone else code it.

There can only be so many assistants.

[needlesurgeon]

I'm told by my anesthesia friends that it take about 6 weeks to train someone to be technically proficient at putting someone to sleep and waking them back up again.

The five years of training are needed to understand why you're doing it, and to see enough disasters to know how to get yourself out of the disaster situations.

While I don't fly planes, I would imagine flying a plane would be similar.

I also drive a car. While I was technically proficient while I got my license, it took years to get to the point of predicting the behavior of other drivers on the road, and to not panic when unexpected events happened (hydroplaning, odd pedestrian behavior, etc.).

[riahi]

It's a similar telescoping training problem in Radiology. We can train someone to have basic proficiency in interpreting a specific imaging examination in a relatively short period of time, but building the knowledge base, following up ambiguous diagnoses with pathology correlation, and seeing sufficient volume requires 5 years after internship. This doesn't even include all the knowledge we have to know for image acquisition, artifacts, and protocol design/QA. After all, you don't see what you don't know.

Yes you can look at case books and question banks and sample teaching cases, but until you are dictating the case primarily and have to decide whether to call a diagnosis which will have profound downstream treatment implications, it's a very different experience. While most specialists are comfortable with their area of imaging, I'm talking Radiologists remote reading cases for a rural location, where their report will determine if the patient is transferred and to where, with significant costs to the system and the patient if they are wrong.

I'm not sure how to "fix" it other than adopt a variant of the "commonwealth" competency-based system in Australia, where residencies have "usual" terms but if someone is competent and willing to sit the board certification exam early, they can try.