171 Ashley Ave.
Charleston, SC 29425
843-792-1414
800-424-MUSC
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July 2006
Letter From Our Chair
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L. Lyndon Key, MD
Professor and Chairman
Department of Pediatrics |
Dear faculty, Children's Hospital staff and other friends,
Residency training has always concentrated on turning out residents who are competent in carrying out patient care; however, it is becoming clear that physicians need to learn other skills to apply their knowledge and experience.
Up until the present, we have assumed that by the end of 33 months of exhaustive--if not exhausting--training, we would have taught not only the knowledge, but also the values necessary for practicing medicine. However, with new residency duty hours reducing the training period by 30 to 50 percent, it is no longer clear whether residents will receive adequate training in three years.
It's likely that additional competencies will help ensure residents can make up for the lost time by working on their own knowledge acquisition. For instance, they must learn how to continue learning.
Certainly, for most, the traditional three-year period will be enough for them to function in fellowships or in private practice.
Yet most educators fear that this is not the case. In recent years, board scores have decreased, as have in-training exam scores.
Older practitioners report that new pediatricians require two to three years in practice before they feel competent enough to handle the challenges of a practice on their own. Data suggests that, prior to the residency duty hour changes, these new practitioners needed just one to two years.
What can be done?
After listening to experts at five different meetings over the last year, I am convinced these problems are universal.
I believe there are solutions. While neither I, nor anyone else, is sure that the "competency-based" approach to learning will solve the problem, I am sure that it will help us focus on the right issues.
For those of you who do not know what the COMPETENCIES are, I will provide the following list (for more, visit www.acgme.org/outcome/comp/compFull.asp.)
First, there is PROFESSIONALISM. The basis of this competency is to be respectful to patients and co-workers through compassion and integrity.
Professionalism means having a COMMITMENT TO EXCELLENCE. A few years ago, I lived in downtown Charleston next to a couple of pediatricians nearing the end of their careers. Every night, as I looked out of my study window, I would see this husband and wife team reading journals and discussing issues. Such dedication is born, not only out of a desire to do a good job, but also out of love and respect for our patients.
Thus, I expect every resident to do "homework." I expect every resident to take advantage of every conference and learning experience. We have a great faculty who will mentor each resident at the bedside and guide her decisions. Take advantage! Not only by caring for patients, but by "being there" for learning.
If nothing else, the idea of competency emphasizes the importance of learning. However, as is oft said, "Book-learning is not enough." Thus, it is important to develop the ability to look at what you and your colleagues are doing and to improve patient care.
This may be through PRACTICE-BASED LEARNING, which is tied closely to our course in evidence-based medicine. This program is offered to residents as a luxury. During a resident's three years, the faculty (which will include third-year residents) will help her to build a repertoire of methodology that will allow her to be a lifelong learner.
The program is being offered as a valuable educational experience, free of charge. Similar programs would cost $10,000 to $20,000/person to duplicate in private practice.
A new term and approach has now surfaced on the horizon, SYSTEM-BASED LEARNING. This teaches us to look at healthcare from the standpoint of all the different services and institutions that are involved in delivering treatment, rehabilitative and preventive services.
This discipline is designed not to assess the best way of doing something, but to allow learners to understand the ways in which funding decisions, income expectations, and patient health are related.
Preventive strategies are going to be very important as the number of elderly citizens increases and the cost of new technology continues to rise, perhaps providing unaffordable cures.
The traditional competencies of MEDICAL KNOWLEDGE and PATIENT CARE are no longer enough. INTERPERSONAL SKILLS AND COMMUNICATION SKILLS are becoming a lost art, as we depend more on the evidence and the technology than the synthesis that can be approached only by good, old-fashioned medical decision-making and bedside manner.
The time to learn all of these skills is brief, yet residents must achieve competency in each area. They will likely make it out in three years, but only if they attend to the business of learning. They will have to decide what they need most, but their abilities will ultimately be judged by their faculty, their fates decided by the certification of their readiness to practice pediatrics by their Chair.
Think of it this way: You would want a doctor for your child to be, at a minimum, competent in all these areas of expertise.
Yet to go beyond competency and become truly outstanding requires that the whole is more than the component parts.
I look forward to taking this journey with our students and residents. It starts now. Take advantage of the opportunities.
Sincerely,
L. Lyndon Key, MD
Chair, Department of Pediatrics
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