(SOUNDBITE OF MUSIC)
ANNOUNCER:
This is Residents in a Room, an official podcast of the American Society of
Anesthesiologists, where we go behind the scenes to explore the world from the point of
view of anesthesiology residents.
DR. JESSICA IBANEZ, HOST:
Hi everybody and welcome to Residents in a Room. I'm today's host, Dr. Jessica
Ibanez, one of the chief residents here at Johns Hopkins. Today, rather than
interviewing other residents, we’re actually going to turn the tables and interview veteran
podcaster, Dr. Jed Wolpaw. Dr. Wolpaw is an Assistant Professor of Anesthesiology
and Critical Care Medicine at the Johns Hopkins University School of Medicine, and the
host of the popular podcast ACCRAC. Thank you for joining us today, Dr. Wolpaw.
DR. WOLPAW:
My pleasure. It’s a pleasure to be here.
DR. IBANEZ:
Let’s start with the world as it is today. We're recording in April 2020, so COVID is
rapidly evolving, changing our routines and how we care for patients. It's fair to say that
we're learning a lot, and learning it quickly. Can you talk about what you've learned,
maybe share with the audience some of the things you think are most important to
understand in this moment?
DR. WOLPAW:
Sure. Thanks Jess. This is an unusual time, maybe even an unprecedented time, and I
think it is really bringing out, not only a lot of important lessons, but a lot of really
impressive uh, signs and uh, demonstrations of how we can step up. We as people in >
general, we as healthcare providers, um, and so I’ll talk about a little of that.
One of my favorite lessons, I always try to keep in mind that I speak about it from time to
time, is that we have to always be a little skeptical of what we think we know. The
human brain really likes to have things figured out, and to just be able to say, all right, I
know this, I have the answer, this is knowledge, I can now move on to other things. We
do that in medicine a lot and one of the talks I give sometimes it's thinking about how we >
need to question the things that we think we know. There are countless examples
throughout medical history of times where we were sure of something and it turned out
to be completely wrong. And one of the things I think we seen in this rapidly evolving
pandemic, is that there is that temptation again to think we have figured it out. You hear
on the news and even around the hospital all the time people saying, oh, we know this.
These patients need this. For example, at the beginning when we first started seeing
these patients here, we thought they really benefited from high levels of PEEP. We
thought that once they got on the ventilator, we put them on high levels of PEEP, not
even just the standard ARDS PEEP, but high, the high levels, the kind of high PEEP
table and that they would benefit from that. Now, why did we think that? Because the
first few COVID-ventilated patients that we saw at, at Johns Hopkins did benefit from
high PEEP, and so we figured, okay, this must apply to the disease as a whole. As it
turns out, that was not correct. Those were unusual patients for a variety of reasons and
it turns out that a lot of these patients actually have high compliance and they don’t heal
and in fact non only do they not need high PEEP, but they may actually be harmed by it.
And so we’ve had to re-examine what we thought we knew, and question it. I think that's
something that we really need to keep in mind, that as desperate as we may be, that to
be able to grasp at a new therapy or you know, someone says this drug may work or we
think this might be the cause of hypoxemia, and there’s all kinds of theories out there.
The real answer is we don't know and in fact the, um, some of the current guidelines,
there was a, a kind of meta-analysis that came out recently that, that said look, for all
these therapies, all we know is don't use them unless it's part of a clinical trial because >
we just don't have evidence for it. And even though it's tempting to kind of grasp at
straws, you want to be careful. You don't know if you may actually end up hurting
patients, and without good evidence you want to be very cautious. So I think one of the
things were seeing in much more rapid fashion than we normally see things in medicine
is, we think we know something it turns out not to be right.
And so we want to be very careful and remember that there's a lot we don't know, and
that's okay. It's okay not to know and uh, we have to be okay with that. So that's one of
the lessons I think we see a lot. Another is, really what we're capable of and what I
mean is the incredible way in which, not just healthcare providers, but of course, Jess,
you and I are in the midst and surrounded by healthcare providers and are healthcare
providers ourselves. And so what we see, day in and day out, are our providers really
stepping up. And, the, the example, I would give of course, cuz I'm most intimately
involved with, is our Residency Program. And our residents have had their schedules
completely upended. They've been pulled off of electives, they've been told they,
sometimes the night before, that actually they're going to be deployed instead of to the
operating room to a, a new ICU, maybe an ICU they've never been in cuz it's usually run
by medicine. Or maybe an ICU that didn't exist two days ago because we just stood it
up as a new ICU to take care of the influx of COVID-19 patients.
And almost without exception, people have stepped up in ways that I really think is,
would have been hard to understand without seeing it. And that is just selflessly,
bravely, without question, saying I will do what is needed. I will take care of these
patients. I will work with whoever you need me to work with because this is my calling.
This is my, my job. Now, we want to be very careful that we don't, uh, spread the idea
that people should be doing this unsafely. We do want all of our healthcare providers,
our residents and everybody to be protected to the best extent that we know is safe. So >
we have been lucky here that we've had adequate levels of personal protective
equipment for the disease, and we make sure that they have that before they go into
work with these patients, but given that they are able to be safe, people have really
stepped up and, and not complained about the changing of schedules and, and the, you
know, random weekend shift they didn't think they were going to have to work, but that
they they now work.
So it's been inspiring to see this and then the final thing that I've been really touched by,
is the response of the community. I think that you see such gratitude towards healthcare
providers that really we don't normally think of, or see. Of course a patient who comes in
and who gets treated and does well, will be grateful to their clinicians, but on the part of
the broader community, this realization that healthcare providers are really on the front
lines and are doing this work and putting themselves uh, at risk and, and to see, for
example, the 7 p.m. cheer that happens in New York City every day, uh, for healthcare
providers. I think that was initially started in, in Europe and Italy, I think, and, and now
has spread, at least a New York, and maybe other cities, I think is really is really, um is
really touching. And I think we have to realize of course that, that one of the things I
hope comes from this is that there are a lot of essential workers in our communities. It's
not just healthcare providers. I mean think about the grocery store clerks. If they weren't
working, grocery stores had to close, right? We'd all be in trouble. How about the people
who are collecting the garbage? If they weren't working, we would be having some
major issues with what we would do with our trash. So there's a lot of people who
maybe we don't normally think of as essential to keeping society running, but who
absolutely are. And then that's true inside the hospital as well. Of course, it's absolutely
not just physicians and nurses who are the essential workers, right? I mean one of the
things we've seen really clearly is, for example, respiratory therapists. When you’ve got
a disease that's landing a lot of people on ventilators in a way that they were not before,
in numbers that hospitals haven't seen before, you have to have respiratory therapists
who are experts at setting up these ventilators, adjusting the modes, uh, and are very
much in those rooms putting themselves at risk. It is essential that we have them, and to
the point where, and, and I know I should have mentioned, another way our residents
have stepped up, is actually being trained to work as respiratory therapists. Because if
we don't have enough respiratory therapists, we need people who are already familiar
with ventilators, which our residents are, who can play those roles. And so some of the
inner play, some of the flexibility we’ve seen from, from everybody, is really quite
inspiring. So while it's terrible, this, this time is terrible, because people are getting sick
and dying there are some real glimmers of, uh, hope and of inspiration that have come
from what people are able and willing to do, um, that I think really, really show the good,
wonderful side of humanity.
DR. IBANEZ:
Yeah. Two of the things that you just mentioned, flexibility and the challenge of being
okay with not knowing, um really resonate with me and I think from a resident
perspective, certainly, this is not how I expected the end of my residency. But if I had to
pick a silver lining, I do think that I'm going to be a better clinician and a better leader
moving forward. You know, as you mentioned, stepping up, helping in ICUs as a chief
resident working with staffing models and trying to meet the demands of the hospital,
protecting our own residents and being mindful that they are getting some wellness and
some time off. So if I had to say that, you know from this whole epidemic, we will have
some benefits, I think it's that these physicians training during these times are going to
be that much better.
DR. WOLPAW:
I couldn't agree more. I think that your generation, the generation who are residents
during this time, are going to know what it is to have run a, an ultra-marathon. And for
the rest of your career, I think you will, and your colleagues will, have a perspective that
very few others will, because you will have made it through this. And just as, you know if
you run 26 miles and then someone says, you know, oh do you want to go for a 5 mile
run? That's 5 mile run feels like a breeze, because you now know what it feels like to
run 26 and I think similarly, you know, this will put in perspective the challenges you will
face and, and especially for folks like you Jess, who are Chief Residents who are
intimately involved with making these schedules and arranging these policies, it will be a
lesson that will inform your ability to lead um, from, from here on out and I think it again,
yet another positive that will come from this.
DR. IBANEZ:
Thank you for those insights. I think everybody was really waiting to hear what your
thoughts were in terms of what the climate we’re living in now with COVID. But let’s turn
to the podcast and kind of go back to the beginning. What made you even want to start
a podcast? And specifically, why did you want to do a podcast, instead of a blog, or a
YouTube channel?
DR. WOLPAW:
So I think to understand this you have to realize that I am not technologically savvy at
all. So, you know, I, I laugh when you give me these other options because, um, I
wouldn't have the first clue how to start a YouTube channel. So that makes that one
easy. I am not even sure I knew at the time I started the podcast that there were
YouTube channels. So, um where this came from is when I, uh, and, and you may know
I initially match into emergency medicine. I thought that's what I was going to do, and I
started as an intern and in fact, prior to matching, when I knew I was going into
emergency medicine, I started listening to a podcast, that everyone recommended. It
was called EM-RAP. EMRAP stands, I believe for Emergency Medicine Reviews and
Perectives. And it was a great show. It was released uh, once a month with kind of a
bulk of about, you know, about 10-ish hours of, uh, content. It was some reviews of
articles, some interviews with experts, some discussion of topics and it was, as far as I
could tell, listened to by every emergency medicine residents in the country. It was
talked about at conferences. You would, as a resident, talk about it with your attending,
bring something up, oh I heard this on EMRAP, such and such, what do you think about
this? It was part of the conversation and it was a great way to study. You know, I, I, run
a lot, so I'd be out running in the mornings before a shift and I'd listen to a chunk of
EMRAP and then I'd come to work and I could ,you know, think about how that would
apply to my patients.
So it was a really, really wonderful thing and when I decided to switch into
anesthesiology, I was excited to start listening to the anesthesia version of EMRAP, but
it didn't exist, and I was really taken aback. In fact, it's for a while, I thought I just wasn't
finding it, but it turned out that it didn’t exist, there was nothing like it in anesthesiology.
And I remember as a res, an anesthesia resident, thinking, wow, this would be so great
to have. You know, I wonder if I could do something like this and just have, had no idea
how one would even record, uh, this kind of content, get it out, in, onto the web or
anything in place as a resident. I had very little time. Not only was I a resident, but also
had, uh, my wife and I had our first two kids while I was a resident, so, it was a busy
time, and, and those ideas never went anywhere. So then I came and did my fellowship
at Johns Hopkins and when I finished fellowship and started on faculty, the then
Program Director, my predecessor, as Program Director, asked me, I guess thinking I
was a young faculty member with teaching experience, and might know about tech stuff,
said to me, oh, you know, Jed, do you know about any audio resources for our
residents? They’re always asking me for audio resources, and I don't know the answer.
And I kind of laughed, and I said, you know, I've been thinking about this now for years,
um, and, and I, I'm going to try I'm going to try to make, to make something for that.
So, I didn't know what I was doing, but I figured okay, you know, there's this thing called
Garageband on my computer. I looked up some videos on how to use Garageband and
I just took a lecture that I routinely would give to the residents in person and I just
recorded it. Didn't know what I was doing, I pushed record in Garageband, I didn’t have
a microphone, I just talked into my laptop, the audio quality was terrible, this is
ACCRAC, episode 1. Uh, I believe it's on gas laws and I, uh, just talked. And, uh, then I
figured out how to make that become an MP3 and I emailed it out to the residents at the
time and I said, you know if anybody's interested here, here's an MP3. And almost
immediately, I started to get feedback from residents saying this is great. Can you do
more? And, uh, one very tech-savvy resident said, look, you know, you need to you
need to put this online and I said sure, but I have no idea how to do that and he helped
me create a website and, and learn how to post these things online and put them on
YouTube and that was how it started and, uh, that was more than three years ago. And
now we got, uh, now 170 episodes and more than 50,000 listeners every month, so, you
know, it’s, never imagined that it would become what it has become. I, I thought when I
started, that, that I would just email these out to some of our residents, and maybe if
they friends in other programs, they could forward these emails along, but never
imagined it becoming what it has, but I'm glad because I think it's, it's been helpful for
folks and it's been a lot of fun for me to do.
DR. IBANEZ:
When you first started, was there a specific group of people that you were targeting for
example, residents, attendings, medical students?
DR. WOLPAW:
Yeah, absolutely residents. So, I was at the time, starting to get involved with our
residency program. I think right when I started it, I wasn't yet officially involved in any
kind of role, but I was doing a lot of teaching of residents and knew I wanted to be
involved in resident education. And again that impetus of the, my predecessor, as
Program Director saying, you know, that the residents were interested in this, and um,
and so that’s what I did. I, as I said, I took the, I took a lecture that I had given to
residents anyway, and just recorded it. So I was very much thinking that the primary
audience would be, would be residents.
DR. IBANEZ:
Were there specific knowledge gaps starting off that you wanted to address, or did you
think that this was just going to be educational in terms of, uh, clinical content, and when
did the wellness, um, kind of podcast start?
DR. WOLPAW:
So I thought initially that we would kind of go through the list. Not necessarily every
single detail but use the ABA, American Board of Anesthesiology, keyword list as a
guide and just try to cover all those topics. Uh, in recent months, uh, Gillian Isaac, one
of my Associate Program Directors and I have actually started doing that. We've picked
a couple of key words and gone through them. Um, so that was the initial plan, and
there are a variety of prior episodes that kind of did that, but it evolved over time, partly
because, I think, as the listenership grew I got a lot of requests from people. And then
the listenership became much more diverse. So rather than just residents, while there
are a lot of residents who listen, there’e also a lot of medical students, attendings, both
in the community and at, at academic centers, fellows in critical care, some of them are
medicine trained, CRNAs and students CRNAs.
So, it's really a wide audience with a lot of diverse interests. And so I've tried to be
responsive to audience requests and also cover lots of different things. So we still do
some very much, kind of, resident board prep stuff. But we also, I've also interviewed
the lead authors of a variety of critical care articles. So it really spans the gamut, and,
and even though have gone outside a little bit to do some things that aren't related to
clinical care at all. So, for example, I did book review of a, just a fascinating book on
intermittent fasting that I read and really was very taken by, which by the way is the
most listened to episode of all time because it appeals to the lay public. Right? So it’s
not limited to this audience of healthcare providers. And so have done some of that, and
then have talked some about what we'll call kind of well-being topics as you say. And
well-being and specifically not limited to, but very much focused on trainee well being, is
a, is a real focus of mine, it's something that I'm very interested in, both as a Program
Director and a physician. And so I've started to do some of the episodes that are
focused on that, to really try to reach out to folks and, and help. And also to give ideas
to other programs and to institutions about, uh, ways they can start to think about this
very important topic.
DR. IBANEZ:
Obviously, continuing education is very important to you and you’ve spoken how
important it is to treat residents as adult learners. Can you talk a little bit about the kinds
of education administered and the learning achieved in these different phases? For
example, medical school vs. residency, post residency, what that is now, and what you
think, how that would look like in the future.
DR. WOLPAW:
So I think a lot of education, certainly medical school education and residency
education, has been very focused on more traditional forms of learning. Now, medical
schools have done a good job of doing, and it varies from school to school, but whereas
10, 20 years ago, medical school for the first two years was all lecture. You sat in
lectures and that was it. And you took tests and that was your education until third year,
when you went into clerkships. Medical schools, as I said, have done a lot to really try to
do more small group learning and more, um, experiential-based learning, and I think,
have, have done a good job with that.
Residency, is, is a different animal altogether. And it's because there is a fundamental
difference between residency and medical school in that residency has this conflict built
into it, where the residents are both still learners, but they are also employees. And the
entire system of medicine is based on, and relies on, their labor. And so unlike medical
students who nobody relies on medical student labor, we can't function, our hospitals
are built to function with resident labor. And without that resident labor, we would not be
able to function. And what that means is that there's a conflict between the education
that residents want, and need, and deserve, and the labor that hospitals need. And
those two are not always misaligned, in other words, working in a hospital does provide
very important experiential education, but it's not, it cannot be limited to that.
So there needs to be additional education that happens that should be learner-centered
and that is difficult because you have to pull residents away from the patient care that
they're providing in order to give them didactic education, small group education,
simulation education. And so there in lies the conflict, and then the other piece of this
conflict is that when the system of residency education, or residency in our country
started, there were very few residents. They were all men, they lived in the hospital and
they, for, for a while, they actually weren't allowed to marry or have families and so they
worked all the time, but that's all they had to do. That's very different than our system
now, where we have both men and women, with, some already with children some have
children while they're training as my wife and I did, who are, have a lot of responsibilities
outside the hospital.
And we've added a lot of non-clinical requirements, right? The ACGME requires a
scholarly project, they require a quality improvement project, they require a lot of testing.
So there's in-training exams that are weighted pretty heavily when it comes to fellowship
applications, which is a problem, but, but it is what it is. There is the basic exam in
anesthesia. There's advanced exam in anesthesia. And so you have all of this studying,
project work, all of these things that residents have to do that, that have to happen
separately from their time giving patient care and they have lives that cannot be just
stopped during the period of their training. And yet we still have a system designed as if
none of that existed. And so that's the inherent conflict and that's where I think we really
need to be willing and able and creative about how we think about changing the
structure of our residency training so that it fits with that, with those other obligations so
that we can have residents who are well-trained, can take good care of patients, but
also are well themselves and also can accomplish all those other things that they're
required to accomplish, all without burning out over the course of their training.
DR. IBANEZ:
So it seems like you, you mentioned that sometimes the needs of the residents and the >
residency programs are misaligned, at times. There has been some evolution, um,
through time, but if you had to, for example, think of the best way that learning
methodologies and teaching would be for residents now, what would your picture of that
be?
DR. WOLPAW:
So, I would just say, Jess, that I think it's not wrong to say that the priorities and needs
of the residency program and the residents are sometimes misaligned, but I think more
accurate might be that the needs and priorities of residents and the needs and priorities
the hospital are, are often misaligned, because it's the hospital that relies on the labor of
the residents. Residency programs have to be responsive to what the hospital needs
and wants, of course, uh, because residency Program Directors answer to their
department chairs, who answer to the hospital. So it all filters down, but I don't think
you'd find many Program Directors who wouldn't love to give their residents more
flexibility, time off, ability to handle these other things if they could, if they were allowed
to by their department and their, and the hospital. And so I think it really filters down
from the top. And if you think, if you check out a couple of pieces that we published, so
there's an article in Academic Medicine that really examines the history of relying on
resident labor and how, uh, and I kind of been there, write and kind of challenge both
the ACGME and, and hospitals and programs to really think about how can we change
the priorities and the incentives and then kind of a follow-up piece, uh, that I did with a
Carrie Adair at the Duke Patient Safety Center. It was published recently in the Journal
of Patient Safety, where we really called on the Joint Commission and CMS to say look,
you know, you're going in and citing hospitals for things like not having enough boot
covers in the operating rooms. Fine. If we think that that may affect patient safety,
though there's no data to suggest that it does, but there's so much data to suggest that
burnout hurts patients. We know that burned-out providers make more medical errors.
There's just no doubt about it.
So why isn't the Joint Commission sighting hospitals who don't improve their levels of
burnout in employees, including trainees? That would change the incentives. That would
mean that hospitals now are incentivized, just as they, I mean hospitals buy boot
covers. Why? Not because they necessarily believe that boot covers are so important,
but because if they don't they'll get cited. And so if they knew that if they didn't have
comprehensive programs in place to improve the well-being of their employees, they
would get cited, then they would do it. But the incentive isn't there and so they don’t.
And so this really has to come from, it has to be institutional change. And that's what we
really need, I think, to look for.
So, that, I believe your question was around, you know, what can we do? What changes
do we need to see? I think we need to see those kind of changes. On a, on an
individual kind of programmatic level, there’s only so much that an individual residency
program can do because, of course, the program has to answer to the department, has
the hospital as we said. Now I do think that we can push, and one of those talks I give
regularly all over the country, is about how we can, within the boundaries of the system
that we have, we can start changing things to make it better. And I think we've done a
lot of this here in our program, where, within the boundaries of what is allowed, we have
really tried to make residency more doable for our residents to help people still be able
to live balanced lives while working. It's not perfect. I would do it differently if I could.
For example, one of the things I think we really need to think about as uh, in medicine in
general as an institution across the country not just anesthesia, but every specialty, is to
think about changing the structure of the work that residents do. In other words, the idea
that we, kind of, you know, are limited to 80 hours, so therefore we should be, everyone
should be working, you know, 79 hours a week because that’s what’s allowed, doesn't
make any sense. We need to think creatively. Should we, for example be having a limit
to a four-day work week, where residents works four days every week? They get their
weekend off and they get one weekday that’s protected. Not that day that's guaranteed,
you know, that we have a day for example, every two weeks that’s protected for
education. You still want that, but I mean, a day off. A day with no work responsibilities,
a day when residents could spend time with their family, could go to the doctor, go to
the dentist, pick up groceries, whatever it is that, that they need to do to be healthy
members of the community and well members of their own family. Could we imagine
that?
Or what about splitting residency? This has been experimented with, where instead of
one person working 80 hours a week, two people would kind of be buddied up and
would each work 40 hours a week. So, you know, there are, these, these things are
done. In fact, that, part-time residency is being done in the United Kingdom in a couple
of specialties, so, there’s, this has been written about in emergency medicine, and, uh, I
don't remember the other, but one other specialty. They are experimenting with this.
They are allowing people to do for example of 50% time residency. Now obviously, you
have to think this through. So if we did that, if we said all right, you're only going to work
40 hours a week. Do we then have to extend the training? Well, how would we know
that? This then leads us to, uh figuring out, can we do competency-based advancement
instead of just saying, well every single resident in anesthesia needs an intern year and
three years of anesthesia training, some might, some might need more, some might
need less.
So if they're working fewer hours a week, some people probably would need an extra
year or two. Some might not because they're going to pick up the skills they need but
we need to figure out how to know if they picked up those skills, and if they're ready to
practice independently, not just time-based but competency-based. So we would need
to figure that out. And then for those people who would need to do more years, what
about the enormous amount of debt that they carry, right? That's a huge sacrifice to say
you need to spend another couple years making a much, much smaller salary than you
will eventually make, when you have this debt burden and so we need to think about
debt forgiveness. We need to think about reducing the amount of debt that our trainees
have uh, across-the-board.
And of course, this is isn’t an issue in the United Kingdom because, because college
and medical school don’t cost anything, anything near what they cost here and so debt
is not a problem. So it’s these things we have to be, to be thinking about, not on an
individual program level, but on a society-wide level.
DR. IBANEZ:
This is some great advice and I've seen some of this on our own program. How do you
think this applies to what's happening now with residents dealing with COVID, and what
are your suggestions for them?
DR. WOLPAW:
You know, that’s a great connection to make, Jess, and I think about this a lot because
what we have right now, at our center, and I'm sure, at medical centers across the
country, everybody’s stepping up. But, I do think that a, a large portion of the additional
work, stress, exposure is happening with residents, because again, its residents are our
main labor force and so we have, for a, certainly it's somewhat dependent on the
specialty. So surgery, medicine and anesthesia residents are, I think, really at the front.
Now, we've had incredibly inspiring volunteers from other specialties, dermatology,
neurology, plastic surgery, residents who aren’t, are kind of not doing much right now
because we stopped all elective procedures, stepping forward and saying, look, tell me
where you want me. I will help.
But that aside, all residents are working, are under a huge amount of stress, are
deployed to the ICUs. We've opened up many new ICUs for COVID patients, and, and
we’re staffing them primarily with residents. And so, I think, what I hope is, that
individual medical centers and society as a whole will say, wow residents really stepped
up. They didn't get paid any more for doing the work that they did, for putting
themselves at risk, and yet they did. They worked harder than ever. They worked all this
time in these high-risk units, and we as society, owe them a debt of gratitude. They save
lives, countless lives, and I hope that opens up conversations that haven't been fully >
open before. Conversations around more aggressive debt forgiveness for resident
physicians, conversations around reduction in medical school tuition so that they don't
have that debt in the first place, conversations around more benefits for residents
around child care, and, uh, hazard pay, and pay for additional time. Conversations
around some of the stuff that I mentioned before, time off during the week. This idea
that 80 hours a week is a reasonable amount of, of work is ludicrous. It may be better
than 120, but it doesn't mean that 80 is, is good. And we had recently this whole debate
in medicine, of course, around whether you know within that 80 hour work week, is it
better to do 28 hour calls and then have a post-call day, or is it better to just do, you
know, 16 hours straight as a maximum and so that we basically went to add a dayfloat/
night-float system, and get away with these long 24 to 28 hour calls?
And there was some difference here and there, but really not a lot of difference. And I wasn't surprised in the least that there wasn't a huge amount of difference because it's still too much. The, the study I wanna see is 40 hours a week, compared to 80 hours a week. Would that reduce burn out? Would the people working 40 hours a week be more well? And how different would their competency be? We don't know. We don't know. Everyone thinks that if we reduced time to 40 hours a week, we would have to double the length of training. I don't know. Maybe it would just mean that we’d have to be more efficient about the training that we do. Maybe we have to really just focus on the most high-yield learning and experiential, uh, training.
So there's a lot that we can think about and I hope that after this kind of sacrifice that the residents are, are making right now across the country, it opens up those conversations much like when during World War II the GI bill that was passed, guaranteeing when these soldiers came home, they would get a subsidized college education, changed the face of the middle class in this country. It changed the way people were able to access education. So this was a, a feeling in society that these men and women, mostly men I think at the time, were fighting and dying for their country. When they come back we owe them a debt of gratitude. It's not that different, what residents are doing across the country right now. We as I said, are very lucky that we have appropriate personal protective equipment, but there are hospitals that do not, and where residents are putting themselves at very high risk frequently because they don't have appropriate equipment. And yet they're still putting their lives at risk to care for these patients who need them, and society needs to open up their eyes and say this was a huge risk, a huge sacrifice, and we need to address some of the issues that these residents are struggling with.
DR. IBANEZ:
Thank you so much for talking with us today, Dr. Wolpaw. Your continued advocacy for residents is admirational and much appreciated. This is Dr. Jessica Ibanez, and that's another episode of Residents in a Room, the podcast for residents by residents. Join us again soon.
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