FREAK-est Links

  1. First-year medical residents made more mistakes when they were required to work fewer hours.
  2. Automated education: EdX offers classes online, marks essays and tests.
  3. Telemedicine has doctors in Texas treating patients in Antarctica.
  4. The history of capitalism is all the rage in history departments.
  5. More Nutella thieving: this time it’s not Columbia University students.

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  1. JDitt says:

    I think it is misleading to say that residents that were required to work fewer hours made more mistakes.

    First, the number of hours they worked decreased by only 3 per week. Second, the study did not measure the number of medical errors that an intern made. It asked residents whether they “were concerned about making a serious medical error”–the number of residents that said yes increased from 19% to 23%–not a big difference.

    I wouldn’t be surprised if the reason they more frequently reported that they were concerned about making a serious mistake after the duty hour restrictions was due to attending physicians always commenting on how this system is flawed.

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    • Seminymous Coward says:

      Wow, that is one misleading study summary for the resident hours. There were so many problems with the design that JDitt’s list only covers some. The residents were given the same workload as before. Shockingly, this didn’t result in any more sleep. Also, the study compares groups of residents from different years. It’s almost like it was designed to show that overworking residents is a great idea…

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    • Pshrnk says:

      A better rested resident is also probably more likely to recognize when they have erred. The headlines for this study are damaging propaganda. Residents working longer hours may be making more mistakes and simply not be recognizing them….so they would be learning less. The interpreters of this study should get TP from Amazon, because it is crap! I prefer a doctor who is aware of her errors.

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      • Ariffic says:

        Needs further study! On the one hand, one makes fewer mistakes when well-rested, but on the other hand shorter shifts mean more handoffs, and every handoff is an opportunity for one resident to give incomplete information about patients to the next one.

        I don’t think we know for sure whether we need shorter or longer hours given this tradeoff.

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  2. Andrew B says:

    Funny how when “science” does not agree with people’s preconceived perceptions they tend to disagree with it. I am one of those docs who worked longer hours as a resident than my son does now as a resident. Handoffs are a major factor in errors, and the new paradigm causes more handoffs. On the other hand I am glad my son has it a little easier.

    Similarly today an article came out from a UCSD study that Bloomberg’s idea of limiting large sodas causes a probable increase in soda obtained, and is worse for the environment. Wonder how he and his followers will handle that (I would tend to favor his idea more if he also banned high calorie Starbucks’ drinks but that would hurt his more upper class constituency.)

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    • Pshrnk says:

      Are you for or against hospitalists?

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    • Enter your name... says:

      Two questions:

      (1) Do you know anything about the situation in the UK, where interns and residents are limited to about two-thirds the number of hours that the US ones are? (It’s about 50 hours a week AND the rest of the staffing is adjusted to accommodate this.) If the UK is getting good results from residents who are working a sustainable load, then why should the US “need” to work a time and a half as many hours per week?

      (2) Have you talked to your son about how the residents cheat the limits? For example, ask him where in the hospital the residents hide when they’re supposed to be off the clock, but still have work to do that can’t be done elsewhere. Ask him if he’s ever heard of someone telling a supervisor, “I haven’t finished my work, but I’m legally not permitted to keep working any longer.” Ask him if anyone in the IT department ever audits the number of hours they spend logged in to the hospital computer systems, and compares that to the legal limits. (Answer: No. No hospital can afford to have hard data that proves they’re setting the workload too high.) Ask him whether getting 40 phone calls a night from the department is “reasonable” under the graduates’ guidelines for on-call work, or if it basically means that you worked another eight or ten hours off the clock and are showing up to work again, having previously worked 24 hours in the hospital, just finished ten sleepless hours at home on the phone, and are now scheduled for another 18 hours of hospital work.

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    • Philo Pharynx says:

      I agree that handoffs are a source of errors. One solution to that is work longer hours and introduce fatigue-based errors to the mix. The other idea is to study how handoffs are made and develop procedures to reduce errors in the handoffs.

      The second will cause a ripple effect, as residents aren’t the only one doing handoffs. It’s something you’ll see in every hospital, teaching or not. Improvements to this procedure will reduce errors across the board.

      Handoffs do occur with longer shifts as well. Less often, but I suspect that the handoff procedure at the end of a longer shift is more error prone because 1) fatigue and 2) you practice the procedure less.

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    • Seminymous Coward says:

      I, for one, would just as happily attack the design of a study that came up with a conclusion I liked. I want my decisions to be based in evidence, which I sincerely hope is a sentiment you share if you practice medicine. A badly-run study is bad evidence, regardless of where it points.

      It’s a lackadaisical attitude to design of experiments that results in 9 doctors running one survey-based study so poorly but still getting it published in JAMA Internal Medicine.

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      • JDitt says:

        I agree with your second point–I can’t believe there were so many physicians from well known institutions who were on this paper.

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  3. Chris Cornette says:

    In reference to your next podcast and what the Pope is saying read this: http://www.vatican.va/holy_father/leo_xiii/encyclicals/documents/hf_l-xiii_enc_15051891_rerum-novarum_en.html
    Remember the Marxist/communist societies are godless and take a look at how God is being taken out government institutions in our own country of late.

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  4. Chris Cornette says:

    In reference to your next podcast and what the Pope is saying read this: http://www.vatican.va/holy_father/leo_xiii/encyclicals/documents/hf_l-xiii_enc_15051891_rerum-novarum_en.html
    Remember the Marxist/communist societies are godless and take a look at how God is being taken out government institutions in our own country of late. I think you will enjoy.

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