Physician Training Stress and Accelerated Cellular Aging • Hacker News Board

Re: Physician Training Stress and Accelerated Cellular Aging

#11

Post by synaesthesisx » Sat, May 18, 2019, 7:44 PM UTC

lenticular wrote: post #5

Residents don't sleep much, so this doesn't surprise me at all. Related, the residency process needs to be massively reformed. The flimsy justification for making people responsible for human lives work 80 hours a week is usually that the long hours help them learn faster. But that's really BS. The brain has an incredibly hard time forming new memories when sleep deprived. I know a couple of nurses who often talk abo…

The pioneers of the modern residency system were fueled by copious amounts of cocaine & other stimulants. Perhaps we need to reevaluate the requirements & expectations we place on medical residents today. It's essentially a form of professional hazing, and I personally know many surgical residents that are literally operating on people today while absurdly sleep deprived (by no fault of their own, just the insane hours of their program).

That said, if whoever's operating on me is running on 3 hours of sleep I'd rather they be hopped up on stimulants than not...

https://en.wikipedia.org/wiki/William_Stewart_Halsted

Re: Physician Training Stress and Accelerated Cellular Aging

#12

Post by hinkley » Sat, May 18, 2019, 7:58 PM UTC

Do intense residencies make better doctors or is this one of those self destructive cost saving measures?

Sort of reminds me of the concussion situation in football. Some coaches, I believe especially college level, are looking at subbing in other training methods to reduce on field practice time and thus chance for injury. Maybe walking the hospital floor 12 hours a day isn’t the best training.

Re: Physician Training Stress and Accelerated Cellular Aging

#13

Post by cycrutchfield » Sat, May 18, 2019, 8:01 PM UTC

hinkley wrote: post #12

Do intense residencies make better doctors or is this one of those self destructive cost saving measures? Sort of reminds me of the concussion situation in football. Some coaches, I believe especially college level, are looking at subbing in other training methods to reduce on field practice time and thus chance for injury. Maybe walking the hospital floor 12 hours a day isn’t the best training.

I think a lot of it is just hazing. Attendings probably feel like just because they were given a hard time during residency they need to do the same to the newcomers.

Re: Physician Training Stress and Accelerated Cellular Aging

#14

Post by i_am_proteus » Sat, May 18, 2019, 8:03 PM UTC

davemp wrote: post #6

nradov wrote: post #3

Earlier quoted context omitted.

Are submarines more stressful than surface ships? I was never in the Navy but I've heard surface warfare officers complain that they were constantly sleep deprived. Between standing watches, training, maintenance, and managing subordinates they barely got a few hours of poor quality sleep per day.

Subs keep their air at significantly lower oxygen concentrations for fire safety reasons which may contribute to the stress. I had a teacher tell stories about sailors putting bags over whatever emitted the oxygen and then breathing it directly.

This is not strictly true. Shipyard maintenance periods are one of the most stressful times, and the boat is openly ventilated.

What's important for fire safety is not letting oxygen get above normal atmospheric concentrations.

Re: Physician Training Stress and Accelerated Cellular Aging

#15

Post by nradov » Sat, May 18, 2019, 8:06 PM UTC

davemp wrote: post #6

nradov wrote: post #3

Earlier quoted context omitted.

Are submarines more stressful than surface ships? I was never in the Navy but I've heard surface warfare officers complain that they were constantly sleep deprived. Between standing watches, training, maintenance, and managing subordinates they barely got a few hours of poor quality sleep per day.

Subs keep their air at significantly lower oxygen concentrations for fire safety reasons which may contribute to the stress. I had a teacher tell stories about sailors putting bags over whatever emitted the oxygen and then breathing it directly.

The average PPO₂ on submarines appears to be no lower than the air in Aspen CO. People living in Aspen don't age faster than normal. Since higher oxygen levels cause oxidative stress in the body it's even possible that lower oxygen might protect against some aging symptoms.

Re: Physician Training Stress and Accelerated Cellular Aging

#16

Post by [deleted] » Sat, May 18, 2019, 8:23 PM UTC

nradov wrote: post #15

davemp wrote: post #6

Earlier quoted context omitted.

Subs keep their air at significantly lower oxygen concentrations for fire safety reasons which may contribute to the stress. I had a teacher tell stories about sailors putting bags over whatever emitted the oxygen and then breathing it directly.

The average PPO₂ on submarines appears to be no lower than the air in Aspen CO. People living in Aspen don't age faster than normal. Since higher oxygen levels cause oxidative stress in the body it's even possible that lower oxygen might protect against some aging symptoms.

[deleted]

Re: Physician Training Stress and Accelerated Cellular Aging

#17

Post by assblaster » Sat, May 18, 2019, 8:41 PM UTC

yingw787 wrote: post #4

Not surprised at all. I have friends still in med school. Apparently there’s an exam called the Step 1 where you can only take it once, and if you pass but don’t do well enough then you get shipped to somewhere not great to do your residency. I thought the hardest part was the MCAT but I was totally wrong :(

Step 1 can be retaken, along with all the other exams of the USMLE.

Re: Physician Training Stress and Accelerated Cellular Aging

#18

Post by assblaster » Sat, May 18, 2019, 8:47 PM UTC

Procedural specialities will always need an extreme amount of hours spent honing their skills. Considering that your experience is the basis for a good outcome for your future patients when you are solely responsible, you know that the more you work the better off you'll be.

The procedural specialities operate on a hierarchy that emphasizes underlings doing most of the grunt work while senior residents can be all day in the operating room. There's likely a better way to do it, but this is how it has been done for decades and just won't change.

Re: Physician Training Stress and Accelerated Cellular Aging

#19

Post by yingw787 » Sat, May 18, 2019, 8:59 PM UTC

assblaster wrote: post #17

yingw787 wrote: post #4

Not surprised at all. I have friends still in med school. Apparently there’s an exam called the Step 1 where you can only take it once, and if you pass but don’t do well enough then you get shipped to somewhere not great to do your residency. I thought the hardest part was the MCAT but I was totally wrong :(

Step 1 can be retaken, along with all the other exams of the USMLE.

You’re right; you can retake the Step 1 up to six times. However, you can retake it if you fail, you can’t retake if you pass. AFAIR that’s what my friends were worried about; you can retake if you fail but if you were planning on failing why retake it. It’s the pass with a low score that sends you to a bad place.

Re: Physician Training Stress and Accelerated Cellular Aging

#20

Post by chriselles » Sat, May 18, 2019, 9:14 PM UTC

I’ve worked on a human performance assessment program for nearly 10 years.

We induce stressors cross the spectrum to better inoculate volunteer candidates from stress and enhance their resiliency.

They are often suffering from sleep deprivation/deficit.

We have very robust safety procedures in place.

After observing hundreds of volunteer candidates in depth over nearly a decade, I would say that sleep deprivation/deficit is an exceptionally and deceptively dangerous problem.

Akin to carbon monoxide poisoning in a way.

Members of the military and first responders may need to operate for extended periods with little to no sleep/rest. And that includes physicians in training for things like mass casualty scenarios.

So it IS worthwhile to possess “reference points” of personal adversity to manage decision making while stressed.

But to LIVE a sleep deprived life of a physician resident is nothing short of madness and a recipe for failure.

I’ve been under Assessment. And it certainly feels like it ages you prematurely. And anecdotally, it appears to do so to many of our candidates. Temporarily.

I’ve had my telomeres measured a few times.

Fortunately, active effort to target 7+ hours of daily consistent sleep, fitness, nutrition, and other choices seem to play a factor in outlier telomere length.

Or I’m just lucky.

Just because we have always done it this way with residents, doesn’t mean we should.