Editorial, Editor's Forum

Letter from the Editor

I had no intention of watching the entire first season of Fuller House in one day. Instead, I had a mile-long to-do list that should have been completed before my next shift: a presentation to prepare, an article to write, a topic to review. Yet one episode begat another, and several hours later I was still watching DJ and Stephanie Tanner solve family crises, engage in awkward group hugs, and recite cheesy catch phrases. Pretty soon my planned “productive day off” turned into a nostalgic lazy day with the cultural icons of my childhood, and I was torn between feeling refreshed and incredibly guilt-ridden.

When I allowed myself to look beyond the imperfect acting, there was something rejuvenating about the predictable happy endings and the strong family values, both of which are too often lacking within the walls of our emergency departments. My decision to forgo my to-do list was therefore in the name of emotional well-being. Yes, that was it. But why did I feel the need for rationalization? Perhaps it was because of an inherent personality flaw, or perhaps it stemmed from a much broader sense of duty — to my future patients and to the specialty.

There is a sentiment among some resident educators and practicing attending physicians that current residents may be less competent and less invested in patient care than they have been in the past. These opinions have emerged from the controversial duty hour regulations put forth by the Accreditation Council for Graduate Medical Education (ACGME) in 2003 and again in 2011, which were largely born out of concern that resident fatigue had become a major patient safety issue. Since the new duty hours have been in effect, however, there has been greater concern that the increased number of medical handoffs has simultaneously increased the risk of medical errors and worsened an important aspect of resident education: continuity of care. To make matters worse, the current duty hour requirements have paradoxically failed to reduce resident fatigue and burnout despite the “extra” time to sleep, or in my case, watch a resurrected 1990s sitcom.

Has the current emphasis on duty hours really bred a “clock-punching” mentality meanwhile eroding our sense of service and professional citizenship? Or, does the fact that we have also been unsuccessful in reducing resident burnout highlight a much more complicated issue at hand? How are we to maximize our goals of patient safety, education, and resident wellness when the healthcare system within which we work often feels more like an overcrowded conveyor belt stacked with incredibly complicated patients who we must manage perfectly within a very limited amount of time?

In our featured article this issue, Dr. Alison Smith elegantly reviews the history of the ACGME’s accreditation requirements for resident duty hours, the controversial FIRST trial published in February of this year, and the most recent highlights from the ACGME Congress in March. Most importantly, Dr. Smith emphasizes an opportunity for resident input after the ACGME releases a draft of their recommendations this spring. It will be a critical time for emergency medicine physicians to make specific recommendations to the ACGME based on our specialty’s unique practices and needs.

As EMRA members, we must keep in mind that one of our organization’s most important priorities is to advocate for emergency medicine physicians in training (see Dr. Dhaliwal’s President’s Message for a more detailed description of EMRA’s strategic plan). I encourage you to empower yourselves to play an active role in the decisions that will affect resident education for years to come. Within the convoluted and rapidly changing health care arena in which we practice, have we figured out the best way to truly care for patients, optimize resident educational opportunities, and find time for personal growth and development? Or do we still have a long way to go? (Cue sentimental music, living room couch, and group hug here): Decide for yourself and make your voice heard.