New M.D.

Key Goal: Well-Rounded Residents

By Lauren Eckstein, M.D.

A pervasive disconnect exists today between what is taught in residency — and possibly also fellowship — and what lessons are valued by physicians in training.

For instance, in the interest of advancing academic medicine and encouraging critical thinking, scientific research is frequently an integral component of resident education. Indeed, for some, conducting original research is necessary to satisfy the requirements of graduation. Of course, such pursuits are worthy of residents' time and attention. They help to teach the scientific method to young practitioners, and their elevation to a position of importance within the training program helps to underscore the merit of these endeavors.

Expanding the limits of medicine is a noble pursuit. Moreover, it engenders a sense of commitment to the broad community that makes up one's field of practice. One is not simply an isolated practitioner but rather a partner in a diverse and expansive community. Indeed, as an investigator, one is a contributing member of the field, borrowing heavily from the lessons of the past, but also helping to advance the state of the art.

Optimally, ideas should flow freely among physicians and information should be disseminated widely and rapidly. Learning to participate in the scientific process engenders these collaborative attitudes, empowers the individual and develops the skills necessary to participate in this dynamic environment. Simply put, original scientific research is the cornerstone of modern academic medicine and the quintessence of the physician scientist. It is the foundation of all diagnostic and therapeutic modalities upon which we rely, and contributing to this process should be the ideal to which we aspire.

Accordingly, we should provide extensive opportunity for physicians in training to pursue original research. Indeed, we should encourage and support in any way necessary this critically important activity. The nascent scientist should be equipped with the didactic knowledge, the practical wisdom and the financial means to be successful in this endeavor.

Research Is Not for Everybody

However, we must also recognize that for many, scientific research is not their calling. On the contrary, physicians are attracted to the field of medicine for diverse, often very personal reasons.

Although committed practitioners, scientific research may not align with these motivations and may not be compatible with their individual career goals.

Therefore, it is incumbent upon us as educators (as well as upon governing bodies such as the Accreditation Council for Graduate Medical Education) to recognize and accommodate these divergent interests. Indeed, by consuming a significant quantity of non-clinical time, a dogmatic commitment (or worse, a strict requirement) to purse scientific exploration during residency not only may limit the opportunity available to investigate other meaningful aspects of medicine but also may inhibit the instruction of other essential components of medical practice.

To be a competitive clinician following the completion of residency, it is essential that a few critical requirements be fulfilled during the training period. To begin, it is necessary that one is exposed to countless, diverse patients. One must see the full spectrum of disease presentation to be able to recognize its many forms in future.

In addition, one must receive instruction in the latest surgical interventions and become proficient in modern techniques and cutting-edge technologies to provide the care that patients deserve. Finally, one must develop the independence and confidence to decisively and effectively apply these teachings.

No doubt these objectives are embodied in all training programs. But to be successful one must also be familiar with practice management, contract negotiation, billing, coding and other critical skills that are frequently overlooked during training. It is not that these lessons should replace clinical instruction or scientific inquiry, but rather that they deserve equal attention. A successful practitioner must also be a successful businessperson, and a successful residency must recognize and service this duality. OM