SCOTTSDALE, Ariz.—The educational environment is changing, “perhaps more drastically than ever before,” and the otolaryngology community may not be doing enough to face these changing times, said Jesus Medina, MD, FACS, in his presidential address to the Triological Society here on Jan. 24 as part of the organization’s Combined Sections Meeting. Click here to listent to the entire Presidential Address.
Restrictions on training hours and a changing culture with more emphasis on personal time and increased family responsibilities has put a strain on the education of residents, a strain that calls for taking immediate steps to improve how residents are trained, said Dr. Medina, professor of otorhinolaryngology at the University of Oklahoma Health Sciences Center in Oklahoma City. “Resident work hour regulations were long overdue, they’re here to stay and they’re likely to be reduced further in the future,” he added.
Unfortunately, the pinch on training hours has come as the amount of material to be learned has increased, and more demands on educators has had an impact on how residents are taught, he said.
“It is undeniable that the motivation and enthusiasm to teach have been diminished by the pressure of faculty time that results from a heavy burden on patient care, by the increasing need to rely on clinical productivity to ensure an adequate income and by the fact that it is becoming increasingly more difficult to teach surgical skills by practicing on patients,” he said.
Solutions
In the face of these changes, Dr. Medina offered the following recommendations:
Change the training schema in otolaryngology. He proposed that the fourth year of medical school could be used toward the first postgraduate year. This would give the student a jumpstart on obtaining the knowledge and skills needed for residency. Some of the rotations of the first residency year, such as emergency medicine, could easily be covered in the fourth year of medical school, he added. While this would take time to implement, it would be a worthwhile endeavor, he said, adding that this would provide a better transition into residency and increase the time available for training.
Guide residents so that they can maximize the efficiency of their learning. Research has shown that almost half of otolaryngology residents exhibit a “convergent learning style,” meaning that they learn best by doing tasks with help from a supervisor when needed, he said. “For these individuals, didactic lectures and brainstorming sessions are not useful. Intuitively, then, helping each resident identify how he or she learns best would be useful,” he said. “We need to stop forcing everyone to attend our lectures…. That 45 percent of residents with a convergent learning style cannot afford to daydream through lectures and then have to find another time that they can learn their own best way.”