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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

#51

Post by thedoctor79 »

needlesurgeon wrote: post #45
outlace wrote: post #42

Earlier quoted context omitted.

Do you think hyper-specializing might be a solution? Right now I see many physicians end up only working within a narrow sub field of the field they trained in. For example, a neurologist goes through 4 years of general neurology training and then ends up only working in an epilepsy clinic and after a few years probably forgot how to manage myasthenia gravis. Or a neurosurgeon that ends up only doing spine cases. Wou…

Hyper-specialization has been an approach taken by the medical establishment. For instance, within the last decade, the "vascular surgery" specialty opened up as a specialty straight out of medical school. Vascular surgery procedures used to be a subset of procedures largely (but not exclusively) performed by general surgeons (neurosurgeons still routinely do carotid endarterectomy procedures, for example). There are…

I'm not a professional so what I'm saying could be stupid, but I don't see why anti-coagulant medication has to act globally in the organism for something that is a localized issue. I realize the circulatory system is not segmented, however couldn't there be something to be done with the time of action of the anti-coagulant? From my vague recollection, clot formation has something to do with turbulent flow post-valve as well, so improvements might be made in this area as well... try getting a fluid dynamics expert in the team that designs the valves, and I'm not joking. FWIW.

Re: Physician Training Stress and Accelerated Cellular Aging

#52

Post by heterochromatin »

kensai wrote: post #50
needlesurgeon wrote: post #45

Earlier quoted context omitted.

Hyper-specialization has been an approach taken by the medical establishment. For instance, within the last decade, the "vascular surgery" specialty opened up as a specialty straight out of medical school. Vascular surgery procedures used to be a subset of procedures largely (but not exclusively) performed by general surgeons (neurosurgeons still routinely do carotid endarterectomy procedures, for example). There are…

For the cSDH conundrum and similar tough calls, it is indeed complicated, that's why one needs to stick to guidelines or expert opinion. If there are no clear instructions, then the attending's way is the highway. Or your gut feeling. The most important thing in this case is to document your decision and notify patient and relatives. (resident neurologist here) :)

Hyper specialized internal med sub-subspecialist here.

I unequivocally agree with GP poster about the value of generalists. The systematic devaluation of internal medicine physicians (by this I mean not ABIM subspecialty boarded) is a tragedy.

Re: Physician Training Stress and Accelerated Cellular Aging

#53

Post by heterochromatin »

assblaster wrote: post #18

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…

Do not make the mistake of undervaluing experience gained from an unbelievable number of hours in cognitive specialties as well.

Re: Physician Training Stress and Accelerated Cellular Aging

#54

Post by village-idiot »

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…

Patient deaths rise during residency programs, meaning that we’re not only burning out the residents but we’re also killing random civilians for the sake of the residency program.

Re: Physician Training Stress and Accelerated Cellular Aging

#55

Post by mncharity »

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…

I wonder how changing technology might change system design tradeoffs and opportunities?

Better VR/AR, and event capture with lots of cameras, will blur the current gulf between "I saw it done" and "I saw a recording".

Medical simulation is improving and increasing. And some changes in medicine make it easier to simulate (arthroscopic, robotic). Changing optimal training mix.

Simulation big picture and long term... how will pilot training change, when even basic flight sim games are fully immersive environments with hands-on haptic controls? So how might medical training change, if a kid's "Operation" game includes AI patient interviews, playmate and automated-character resource management, and perhaps off-the-shelf haptics comparable to current med school sims?

Improving general education. This is more a social/political/systems change, but tech may help catalyze it. Let's see... a first-tier genetics course instructor says what they most wish their incoming students had learned, but haven't, from earlier undergraduate and pre-college bio courses, was simply a firm grasp of central dogma. Something that with good tooling, can be made accessible in early primary school. And I've talked with first-tier med students, who had no idea how big cells are, beyond "really really small". How might medical training change, if the education of its incoming students was failing less badly?

Apropos competency-based training, I years ago saw a proposal, I presume unimplemented, for a large-scale reentrant medical-training curriculum for India. Without having to start from scratch, an EMT could become a nurse, a nurse could train as a GP MD, an optometrist could level up to a non-surgical ophthalmologist, and so on. If our ability to do assessment improves, both simulation and non, then at least where there is a medical training shortage, perhaps there might be alternatives to quality control of training and practice being founded on institutional training-process controls.

Re: Physician Training Stress and Accelerated Cellular Aging

#56

Post by riahi »

needlesurgeon wrote: post #46
riahi wrote: post #40

Earlier quoted context omitted.

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.

I'm told by my anesthesia friends that it take about 6 weeks to train someone to be technically proficient at putting someone to sleep and waking them back up again. The five years of training are needed to understand why you're doing it, and to see enough disasters to know how to get yourself out of the disaster situations. While I don't fly planes, I would imagine flying a plane would be similar. I also drive a car…

It's a similar telescoping training problem in Radiology. We can train someone to have basic proficiency in interpreting a specific imaging examination in a relatively short period of time, but building the knowledge base, following up ambiguous diagnoses with pathology correlation, and seeing sufficient volume requires 5 years after internship. This doesn't even include all the knowledge we have to know for image acquisition, artifacts, and protocol design/QA. After all, you don't see what you don't know.

Yes you can look at case books and question banks and sample teaching cases, but until you are dictating the case primarily and have to decide whether to call a diagnosis which will have profound downstream treatment implications, it's a very different experience. While most specialists are comfortable with their area of imaging, I'm talking Radiologists remote reading cases for a rural location, where their report will determine if the patient is transferred and to where, with significant costs to the system and the patient if they are wrong.

I'm not sure how to "fix" it other than adopt a variant of the "commonwealth" competency-based system in Australia, where residencies have "usual" terms but if someone is competent and willing to sit the board certification exam early, they can try.

Re: Physician Training Stress and Accelerated Cellular Aging

#57

Post by needlesurgeon »

mncharity wrote: post #55
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…

I wonder how changing technology might change system design tradeoffs and opportunities? Better VR/AR, and event capture with lots of cameras, will blur the current gulf between "I saw it done" and "I saw a recording". Medical simulation is improving and increasing. And some changes in medicine make it easier to simulate (arthroscopic, robotic). Changing optimal training mix. Simulation big picture and long term... h…

Simulators are effective only as their verisimilitude. Certain neurosurgical procedures are well-reproduced using simulators (most notably the insertion of external ventricular drains[0] for hydrocephalus). Surgical simulation have also shown to be be effective in systems where the principle goal is to get the trainee used to getting visual and limited tactile feedback in specific settings, such as laparoscopic procedures. One thing that has been extensively explored is providing trainees biofeedback about their roughness of manipulating tissues. This in itself is useful; but, to use a musical metaphor, it's more like practicing scales than practicing a performance.

It turns out that recreating tissue in a VR environment that looks and feels like real tissue is a really hard problem. This is a growing industry, and I have no doubt that developers / biophysicists / clinicians will continue to produce more and more realistic systems. Frankly, we're just not there yet. Right now, there is no substitute for the real thing.

Put another way: imagine using a flight simulator where one couldn't reproduce the physics of a real plane. This would be somewhat useful, but have limited transference to actually flying a real plane.

[0] https://www.ncbi.nlm.nih.gov/pubmed/26115472

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