[hga]

It is sub-optimal (to the extent that people die) to train doctors how to make decisions when they're tired by forcing a bunch of doctors to be tired most of the time.

It'll happen sooner or later, if not done during residency. But residencies have the advantage of a degree of supervision, and in a location where ... I hate to call it a support system, but, still, the people working with them know they're residents and expect them to green et. al.

The alternative is this happening when they're "on their own", even if part of a multi-doctor practice, clinic, ER or whatever. After residency they will statistically be making decisions when they're tired or otherwise not at their best. Didn't sleep well the night before, got woken up because one of their patients is in a crisis and their input is needed (although I gather that's less common nowadays), and there are the unexpected emergencies when their skills are needed without prior warning.

My take on the current system, butressed by all the doctors I've talked to about this, is that it's "optimal" when you consider all the factors. Just focusing on the residency period is insufficient to make a judgement.

[Perdition]

But is there any actual evidence that the long shifts in residency actually improves future performance under those conditions?

It seems to me that it is mostly based on tradition and gut feeling.

Most of the issues with non-resident doctors working when tired could be fixed by increasing the number of doctors and physicians assistants. Of course physicians organizations fight against that as it would lead to lowering their income.

[hga]

None of the examples I gave would be helped with increasing the number of doctors etc., except some emergency situations (in others, a finite number of doctors will be able to show up). As well as snowwrestler's point that the number of handoffs must be minimized, must be traded off with how long each doctor works.

I don't an practical means to obtain "actual evidence", it would require incredibly intrusive tracking of the careers of a bunch of doctors, and deciding the why of adverse outcomes is frequently going to be subjective.

I.e. was it the doctor or the patient? Which patients were more likely to have a bad outcome because of genetics or past history? The subject of "compliance" is sobering, sure you can prescribe a wonder drug, but you can't make the patient take it (aside from some TB regimens where compliance in taking a nasty multi-drug cocktail for 18 month or thereabouts is enforced).