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Survival bias and abandonment of inherited thinking in residence

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A challenge: choose a time during residency training when the burden of patient care and education merged with scarce family time or social life, and the need to quit smoking remained on the back of the tongue . Think of someone you contacted, be it a co-resident, an assistant, a mentor, and think about their response. What is positive? Or it was something like, “You’re lucky, I didn’t have anyone to call.” “ACGME is getting soft.” “Residents have it easy now.” “I slept in the hospital for weeks.” “I did; you can too.” “Shut up and keep your head down.”

In the era of rebuilding a new normal in light of the COVID-19 pandemic, health and wellness have come to the fore for ACGME and residency programs across the county. However, a toxic and negative way of thinking persists in the background, carried on between the old man’s club and the handshakes behind closed doors perpetuating defensive medicine. To train new practitioners in what it means to be holistic and to practice holistically, the teachings themselves must adapt and evolve and eliminate the toxic mindset of negative idioms rather than teaching.

It is a problem within all residency programs. It is easily perpetuated as it takes the place of time, effort, and interest to stop, listen, and help. Attendees must learn to recognize teaching opportunities from experience, rather than relying solely on the hierarchy in which you teach and supervise those below you. Learning arises from assisting as a person, as a physician, from his wisdom and years as a practicing physician. The art of medicine cannot be navigated solely from the UpToDate or Harrison pages. With assistants, residents, and interns in them, residency programs must break the cycle of exploiting idioms as excuses to teach. This cycle produces doctors where burnout is greatest, mental health problems are on the rise, and patient care suffers.

Journalist and author David McRaney looks at an interesting way to frame this problem. Discuss survival bias, which is the tendency to focus on survivors rather than what you would call a non-survivor in the situation. It states, “not only does it not recognize that what is missing may have important information, but it also does not recognize that some information is missing.” Survival bias in residency is looking up to older people and doing what they did, listening to the advice they were given, and following in their footsteps. Residency is then simplified and down to whatever the person did before you. The opportunity for growth, inquiry, enthusiasm, and autonomous learning outside of pertinent matters is lost and thrown away, as neglected as “just do it.”

I am not innocent in offering “just hang your head and get over it” as words of comfort when listening to a fellow practitioner seeking guidance. It takes time to pause and work with the individual to troubleshoot their technique, recognize patterns of behavior, and find points of ineffectiveness. Staying compliant with current forms of teaching shapes inherited thinking and hampers the evolution of residency programs. By identifying these problem areas, you mold yourself to a better doctor and become more assertive and confident in your abilities.

The solution to this problem is easier said than done. It begins with redefining the standards for residency programs, how progress is measured, and how we teach. Implementing a program that encourages equality over equity is key. Equity treats all students equally, but fairness recognizes their different needs and gifts. Residency standards can continue to rise and remain high; However, the path to get there can be individualized.

My goal is not to reinvent the wheel. However, there is an unspoken and unwritten rule that you must suffer to grow. I am opposed to that. As an intern immersed in hospital medicine amid the COVID-19 pandemic, “suffering” is not what I want to see in my residence. Having finished my internship year and beginning my second year, I have grown in a way that I cannot even describe. Most importantly, I have identified how I can continue to evolve and how programs can evolve as well. I want to be pushed, challenged, and taught of the wisdom of those above me, not just thrown into the fire and asked why I got burned as I claw out, melted to the bone. Let’s transition from a primitive wagon wheel to an all-season all-terrain tire and continue to evolve residency programs accordingly.

Elena Keith He is a family doctor.

Image Credit: Shutterstock.com


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