Postgraduate Medical Education

For many years the postgraduate training interlude was looked upon as an initiation rite into the exclusive world of medical practice. Stress and a heavy workload have long been accepted as part of this process. Recently, a growing number of educators, as well as many trainees, have emphasized the negative aspects of this process.

A key problem is that most physicians, including young attendings, consider the troubling environment of postgraduate training a “rite of passage,” and they forget some of the most traumatic interactions of their careers. It is important not to block out one's memories of the stress and trauma of the apprenticeship years in order to avoid repeating inflicting the injustices on others further down in the hierarchy. Unfortunately, it appears that the abuse phenomenon may still be perpetuated nationwide in the most rigid training programs.

Already, competition, rather than team effort, may be fostered in medical school. The emphasis is strong on the science of medicine, with the human aspects of medical care often being neglected. In the residency, the heavy workload and its associated responsibilities overshadow educational goals. A further impact of these conditions is the tendency toward physician desensitivation, but reforms over the past few years have improved both the education and training systems. Nevertheless, unhealthy demands are still being placed upon prospective practitioners. It took a fatal error in judgment by a sleep-starved resident to bring about the 80-hour work week for New York State residents, which has also been adopted in other areas. Those outside the system are still astounded by such conditions, while some within the system regret that changes have been made.

The dehumanization effect may be initiated in medical school when patients are presented merely as abstract cases. Standardization of patients to 150-pound white male stereotypes makes it harder to think in terms of patient differences.

The negative impact of stress and long work hours was ignored for a long time. When its effects in human terms became evident, such as substance abuse or increased divorce rate, more attention was given to the problem. A number of approaches have been developed to cope with this problem, including formation of support groups. The consensus is that, while progress has been made, it will take time to alter long-entrenched attitudes.