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Physician Training Stress and Accelerated Cellular Aging

biologicalpsychiatryjournal.com

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Re: Physician Training Stress and Accelerated Cellular Aging

#31

Post by nopinsight »

audiblebleeding wrote: post #29
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…

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 th…

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.

Re: Physician Training Stress and Accelerated Cellular Aging

#32

Post by [deleted] »

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…

[deleted]

Re: Physician Training Stress and Accelerated Cellular Aging

#33

Post by chriselles »

Havoc wrote: post #24
chriselles wrote: post #20

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/def…

>We induce stressors cross the spectrum to better inoculate volunteer candidates from stress and enhance their resiliency. Oh god. That gives me flashbacks to university. They gave us this super messed up exam schedule - writing majority of waking hours & not knowing what class/course/topic you're walking into. Asked the profs WTF is up with the cruel exam plan and that was that exact answer: The professional exam (c…

Wow!

That sounds fascinating.

I’ve never heard of such an example of specifically induced stress in academia.

The concept sounds intriguing, but I wonder if the inducement of stress in a testing environment as an add-on/addendum after would be of value. Effectively two tests, one with and one without induced stress. Experimental/control groups.

Re: Physician Training Stress and Accelerated Cellular Aging

#34

Post by Havoc »

saulrh wrote: post #30
Havoc wrote: post #24

Earlier quoted context omitted.

>We induce stressors cross the spectrum to better inoculate volunteer candidates from stress and enhance their resiliency. Oh god. That gives me flashbacks to university. They gave us this super messed up exam schedule - writing majority of waking hours & not knowing what class/course/topic you're walking into. Asked the profs WTF is up with the cruel exam plan and that was that exact answer: The professional exam (c…

> The professional exam (country's CPA equivalent) is structured like this so yeah we structured your exams to intentionally & artificially create stress. Even on second and third thought this seems insane. I can understand doing it on something that turns out to be relatively inconsequential as a learning experience, but doing it for people's PEs and final exams? That sounds like a great way to overwhelm every possi…

>this seems insane

A little bit. Big part of the issue was that the professional exam results were published by originating university.

So there was this really perverse incentive for universities to send only the most battle hardened candidates into the process to kept the very public stats on the uni's performance on these independent professional exams high.

And if you think that's wild - it gets better. This being HN: Some enterprising genius looked at this entire process and decided he's going to set up a recruitment company that does nothing other than exporting survivors of above process. Literally park them anywhere globally - nothing really matters & nobody cares where cause clearly these guys can cope and collecting a juicy placement fee is easy money. One of the best/safest business models I've ever seen - leverages a beautifully subtle anomaly in the global labour market that isn't immediately obvious to outsiders.

>Being able to handle acute stress is not that useful for a civil engineer or similar.

Alas in my particular world (Accounting/auditing) it is. 3 months of soul crushing stress and rest of year is more relaxed. Rinse & repeat.

>Teaching people to handle chronic stress?

That's one saving grace I guess. I find that 3 months of intense stress is bearable. Or rather it's about the limit of my endurance.

Certainly not healthy - talking about this purely practically.

Re: Physician Training Stress and Accelerated Cellular Aging

#35

Post by audiblebleeding »

nopinsight wrote: post #31
audiblebleeding wrote: post #29

Earlier quoted context omitted.

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 th…

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.

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.

Re: Physician Training Stress and Accelerated Cellular Aging

#36

Post by saulrh »

Havoc wrote: post #34
saulrh wrote: post #30

Earlier quoted context omitted.

> The professional exam (country's CPA equivalent) is structured like this so yeah we structured your exams to intentionally & artificially create stress. Even on second and third thought this seems insane. I can understand doing it on something that turns out to be relatively inconsequential as a learning experience, but doing it for people's PEs and final exams? That sounds like a great way to overwhelm every possi…

>this seems insane A little bit. Big part of the issue was that the professional exam results were published by originating university. So there was this really perverse incentive for universities to send only the most battle hardened candidates into the process to kept the very public stats on the uni's performance on these independent professional exams high. And if you think that's wild - it gets better. This bein…

> Alas in my particular world (Accounting/auditing) it is. 3 months of soul crushing stress and rest of year is more relaxed. Rinse & repeat.

Cripes.

And I bet that the soul-crushing stress even after you've gotten the license is probably because you don't have enough people licensed to do the work, which in turn is because the universities try to keep their stats high which artificially restricts the supply. And there's probably a feedback loop going on where the industry considers the stress "normal" and adds it to the PE because "that's how the industry is and you need to be able to handle it", normalizing the deviance and inducing evaporative cooling [1].

No offense, and thank you for being able to handle your job because auditing is one of those things that's certainly necessary for the smooth functioning of civilization and it really sounds to me like the supply of that capability is dangerously restricted, but... yet again I am thankful that my interests guided me to a career in software engineering.

1. https://www.lesswrong.com/posts/ZQG9cwKbct2LtmL3p/evaporativ...

Re: Physician Training Stress and Accelerated Cellular Aging

#37

Post by arebours »

needlesurgeon wrote: post #21

North American Neurosurgeon here. My opinions are based on my personal experience and my understanding of the literature. I am not an expert in residency well-being or work-hour restrictions. First: the literature is unequivocal about the effects of chronic sleep deprivation. This cellular aging article fits within what is known already. Sleep deprived humans are dumber, more stressed, and now age faster that non-sle…

First of all thanks for this comment. That's a lot of interesting input.

To be honest I don't really see any reason to treat doctors differently than other professionals. There are plenty of difficult jobs that people's lives depend upon but I've yet to see a career path forcing trainees or juniors to go through such hard conditions for several years for pennies.

> Further work hour restrictions could turn the 15-year training process into a 16 or 17 year process. Fair enough, this could solve the problem. But really? From a purely economic perspective, this is silly.

From a purely economic perspective everyone works too little for too much. Why don't we start to treat residents like human beings, cut the long hours and pay them decently. Where do we find the money? Maybe in regular doctors' sacks - the difference in pay before and after residency is crazy. In 2017 residents went on a country-wide strike over working conditions in my country (https://www.bbc.com/news/world-europe-41777785) and it's said they'll go on another one this year.

As a side note I think a lot of issues in health service is a lack of proper management. Every time I'm in a hospital I can't help to notice hiring someone like an office manager, who's only job is to smooth communication between workers and patients and workers themselves would be huge.

Re: Physician Training Stress and Accelerated Cellular Aging

#38

Post by chriselles »

saulrh wrote: post #30
Havoc wrote: post #24

Earlier quoted context omitted.

>We induce stressors cross the spectrum to better inoculate volunteer candidates from stress and enhance their resiliency. Oh god. That gives me flashbacks to university. They gave us this super messed up exam schedule - writing majority of waking hours & not knowing what class/course/topic you're walking into. Asked the profs WTF is up with the cruel exam plan and that was that exact answer: The professional exam (c…

> The professional exam (country's CPA equivalent) is structured like this so yeah we structured your exams to intentionally & artificially create stress. Even on second and third thought this seems insane. I can understand doing it on something that turns out to be relatively inconsequential as a learning experience, but doing it for people's PEs and final exams? That sounds like a great way to overwhelm every possi…

I definitely agree with teaching all folks to both mitigate for physical/mental/emotional/social stressors as well as for making effective decisions while experiencing stress.

Chronic stress is an interesting choice of words.

I believe far more people than we realise experience chronic stress, some of which can be mitigated effectively, and some not.

I don’t think it’s worth training people to mitigate for extreme stress unless their profession compels/requires it.

Risk of permanent damage is real.

Re: Physician Training Stress and Accelerated Cellular Aging

#39

Post by shrimp_emoji »

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.

Isn't the new meta that aging isn't due to oxidization but to an impairment to the body's anti-oxidization mechanism due to under-oxidization? Because, if that's the case, more oxygen would slow your aging by putting your anti-oxidization system to work.

None of this is oversimplified and stupid.

Re: Physician Training Stress and Accelerated Cellular Aging

#40

Post by riahi »

skybrian wrote: post #27
needlesurgeon wrote: post #21

North American Neurosurgeon here. My opinions are based on my personal experience and my understanding of the literature. I am not an expert in residency well-being or work-hour restrictions. First: the literature is unequivocal about the effects of chronic sleep deprivation. This cellular aging article fits within what is known already. Sleep deprived humans are dumber, more stressed, and now age faster that non-sle…

It sounds like the strategy is put in a lot of hours doing routine cases (where little learning happens) in order to experience the rare cases. This seems inefficient? Couldn't residents be called in to look at the rare cases? I guess they would need to be close by when it happens, but that doesn't seem to justify sleep deprivation? Or maybe there are other ways to increase the odds of seeing a rare case?

This is the difference between coding the solution to a tough technical problem yourself versus watching someone else code it.

There can only be so many assistants.

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