does it matter what residency you go to
Do Prestigious Residencies Mean Meliorate Doctors?
Styles of practicing medicine vary from hospital to hospital, and they get transmitted to immature residents through a "hidden curriculum."
Styles of practicing medicine vary from hospital to hospital, and they are transmitted to young residents through a "hidden curriculum."
Johns Hopkins Hospital [AlaskaLoneWolf/Flickr]
Each fall, medical students in their 4th and concluding year select a medical specialty and apply to residency programs. Residency, which lasts anywhere from 3 to eight years, is run by teaching hospitals. It'southward when newly minted MDs learn the hands-on, applied skills of doctoring -- how to brand diagnoses, perform surgeries, club and interpret tests, etc. They besides learn how to deal with patients and families, and work with other caregivers.
Just like colleges and medical schools, residency programs vary in terms of reputation -- which naturally affects the number and quotient of the medical students who apply to get in. But does preparation at a prestigious hospital mean residents will become good doctors? Peradventure not.
A written report from the Dartmouth Institute for Health Policy and Clinical Practice offers medical students a glimpse of the kind of doctors they're likely to become, depending where they exercise their residency. It compares 23 of the country's "acme" teaching hospitals on various aspects of patient intendance: How they treat patients in their terminal few months of life, how many surgical procedures they perform, and what the patient experience is similar. As the report notes, "understanding variations in the way care is delivered by these institutions is important because it affects residency training and, thus, the way residents in a given program will practice every bit physicians."
For example, the most prestigious hospitals are non necessarily the ones teaching the most empathetic or even the safest intendance. Looking at how patients are treated in the last six months of life might seem like an odd way to compare hospitals, much less residency programs, simply its actually a skillful measure of the kind of doctors residents volition learn to be, and it speaks to broader aspects of the training program. Looking at these patterns of care can help medical students find the all-time residency programs for them -- even if they're non necessarily the "best" programs.
Whether they are on the path to becoming pediatricians or pediatric encephalon surgeons, residents absorb the habits and assumptions of the senior doctors effectually them. Those habits include things like whether or not to admit patients with chest pain to the hospital, how oftentimes to recommend elective surgeries similar knee joint replacements, and what kind of treatment to recommend to patients reaching the finish of life.
Practice style varies from hospital to hospital, and gets transmitted to young residents through what'southward oft called the "hidden curriculum." It'due south 1 of the well-nigh important differences between residency programs. As the Dartmouth report makes clear, there is huge variation in the intensity and complexity of intendance delivered to very sick patients, even among hospitals considered the all-time in the land.
The list includes places like Cedars-Sinai Medical Center in LA, where dying patients average twice as many days in the hospital and inpatient doctor visits as the national boilerplate -- and they undergo more invasive tests and more fourth dimension in the ICU on top of that. On the flip side, there's the Academy of Utah Hospital in Common salt Lake City and Scott and White Memorial Hospital in Temple, Texas, where patients have 38% fewer medico visits and infirmary days than the national boilerplate.
Even more surprising, patient safety likewise varies widely across hospitals. Stanford and NYU Medical Center take around 20% fewer central line infections than the boilerplate infirmary; Mass General, on the other hand; has nearly iv times as many. At many of the hospitals listed, uncontrolled diabetes is virtually unheard-of, merely at Brigham & Women's Hospital, another famous hospital in Boston, and at UCLA Medical Center, patients have uncontrolled diabetes at iv times the national average rate. And for some reason, Johns Hopkins -- supposedly a national leader in medicine, and a dream destination for thousands of med students each yr -- doesn't report prophylactic information at all.
The report as well provides crucial context near what intensity of care means for patients: contrary to what most people (and even many med students) may believe, more intense care doesn't necessarily assist patients live longer. Studies by researchers at Dartmouth and elsewhere have not shown that more intense cease-of-life intendance clearly improves or extends patients' lives. Nor are patients and their families more satisfied when they get more than hospitalizations, treatments and tests. In fact, the contrary is true: patients at college-intensity hospitals are much less satisfied than patients given gentler intendance.
Rankings of this sort have very real consequences. U.Due south. News & Earth Report's "All-time Colleges," probably the best-known ranking of undergraduate institutions, tin change the puddle of applicants a school gets and the number of applicants who choose to enroll -- and ultimately the quality of an entering class and the amount of financial assistance the college will offering them.
While this report includes only 23 of the nation's most renowned medical centers, data on over 200 hospitals and how they fare in these arenas is publicly available at the Dartmouth Atlas of Health Care.
We hope that this ranking from Dartmouth will be read by medical students across the country, and that they volition begin choosing residency programs that teach a safer, gentler course of medicine -- the kind of intendance patient satisfaction data suggests patients really want. The title of the Dartmouth study poses the crucial question for med students and young docs: "What kind of doc will you be?" The balance of us, all of whom volition one mean solar day be patients, should be asking a similar question: What kind of doctors do we desire?
Source: https://www.theatlantic.com/health/archive/2012/11/do-prestigious-residencies-mean-better-doctors/265038/
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