Internship and residency have been portrayed in novels and movies and on television for many decades, in terms that range from the heroic and melodramatic to the downright comic. The reasons for the appeal of the residents' stories are fairly obvious. Generally young and handsome or beautiful people, society's best and brightest, brimming with book knowledge, then set at the bottom of the clinical hierarchy as indentured servants and expected to cure and care for patients whose own life and death stories would make decent drama in itself. A dead-on formula for success.
Many of these fictionalized accounts have sensationalized the residents' private lives—what they get into when they're not on the job. What hasn't been recognized and examined until recently—until residents began talking about going on strike to gain more reasonable working conditions—is the fact that residents are filling 4 different and demanding roles while they are on the job: student, teacher of other students, clinician, and employee. This month's Virtual Mentor focuses on these 4 aspects of the resident's worklife and the conflicts inherent in endeavoring to function competently in all roles at once.
The potential conflicts are realized in one of this month's clinical cases (Performing Procedures on the Newly Deceased) and in the PowerPoint® presentation (Balancing Patient Care and Student Education). This issue's health law case points out that, in the eyes of the law, a resident may be liable for negligence or malpractice if he is acting in one role (clinician) but not if he is acting in another (student). Two essays in the Policy Forum section look at the National Residency Matching Program and changes proposed to the matching system by the NRMP itself and by an external critic of the system. In the Medical Humanities section, resident Joe Bovi, MD reflects on the (not uncommon yet) always unique experience of a patient's death. And, in a column for Medicine and Society, Virtual Mentor's editor, Audiey Kao, MD, PhD, suggests an alternative to the moonlighting activities that residents pursue for additional income and experience.
The learning objectives for the March issue are simply stated, but not so easy to master.
- Identify the chief responsibilities of each role the resident is expected to fulfill.
- Understand how the role responsibilities can come into conflict.
- Learn to analyze conflicts between role responsibilities.
- Identify resources that can help resolve conflicts between role expectations.
There's always much more to say on any topic than a journal can expect to cover in one issue, so let us hear from you about the stress and challenges (or the victories and rewards) of internship and residency.