"Strategic napping" for medical and surgical residents?

How would you feel if your surgeon had just waken up from a "strategic nap" before operating on your brain? Here's a snippet from a recent New England Journal of Medicine commentary titled, "The ACGME’s Final Duty-Hour Standards — Special PGY-1 Limits and Strategic Napping." You'll see that I've highlighted the section on strategic napping:

On September 28, the Accreditation Council for Graduate Medical Education (ACGME) released new standards to which residency programs must adhere or risk losing their accreditation. Recognizing societal demands for improved patient safety, the task force that developed the standards has embraced stricter duty-hour limits and greater supervision for trainees in the first postgraduate year (PGY-1). The new standards reflect many of the recommendations made by the Institute of Medicine (IOM) in a 2008 report1 but differ from them on one critical issue — how graduate medical education (GME) programs can best prevent harmful medical errors committed by sleep-deprived residents. The IOM recommended that resident shifts longer than 16 hours include an uninterrupted 5-hour sleep period. The ACGME task force concluded that such a long sleep period was unworkable, instead recommending “strategic napping” during long shifts.

Are we kidding here?  Do we really think that we're going to reduce medical errors by ensuring that our medical and surgical residents are taking "strategic naps?"

Welcome to all the new interns and residents

Today is July 1 and it's the official "start date" for interns and residents. Many interns started in June to go through orientation, but July 1 will probably always be considered the ceremonial start date for internship and residency.

Given that all university and teaching hospitals are now full of interns who graduated from medical school a few months ago, this is a time when you may want to avoid the hospital. After all, these new doctors are still trying to get accustomed to writing orders and signing "MD" or "DO" after their names. Meanwhile, those who just finished up their internships are now responsible for supervising teams of interns and medical students. Are they ready for the challenge?

Now that the interns are officially "doctors," most of them are wearing long white coats instead of the short white coats that most medical students have to wear (there are a few exceptions: some institutions make their interns and residents wear short white coats).

Here's my tip for all the new interns and residents out there: Don't be afraid to ask for help when you think you need it. 

Good luck to all the new interns and residents! 

101.5 Degrees: The 2009 MGH Surgery Intern Music Video

These people are talented! How do surgical interns find so much free time? Watch this classic video:

The 2009 MGH Surgery Change Show Intern Music Video that rocked a nation. Shot live on the helipad, in the ether dome, in the burn unit, and in the real-life operating rooms of Massachusetts General Hospital.

Good luck to all the new interns!

Traditionally, internship/residency starts on July 1. However, there are some programs that start 1 week before July 1. Call it "orientation." Some programs give interns a one week break between the completion of internship and the start of residency. Sounds nice, doesn't it? Would you rather start one week early to get that one week break? Good luck to all the new interns!

Using the iPhone or iPod Touch in Healthcare

The Apple iPhone and iPod Touch are versatile devices that can be used in the healthcare setting. Can you think of more than 15 ways they can be used? If you're a medical student or a resident, maybe you can empty your white coat and replace some of your tools with this single device. Here's my list of 15 ways:

1. Epocrates (drug reference)
2. Web browsing (research)
3. Record patient data
4. 2-way communication with others (get rid of those pagers!)
5. Neuro/rehab tests and exercises (use the built-in accelerometer and improve your gait)
6. Visual acuity tests and exercises
7. Vibratory stimulation test (no need for that bulky tuning fork)
8. Auditory test (can you hear that high-pitched sound?)
9. Reflex hammer? Maybe, if you're really talented.
10. Take a photo of that rash or wound (great for surgery and dermatology)
11. Flash cards
12. Anatomy reference (try ADAM)
13. As a phone to answer your pages (if you still carry a pager)
14. As a flashlight in your call room
15. To watch Scrubs, ER, or other educational medical TV shows.
16. Medical podcasts, earn CME/CE credits.

I could go on and on, but I was thinking about these things as I played around with my iPod. Can you add to this list?