[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".