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Comment & Response
October 28, 2013

The “New Normal”—Reply

Author Affiliations
  • 1Department of Medicine, Johns Hopkins University, Baltimore, Maryland
JAMA Intern Med. 2013;173(19):1845-1846. doi:10.1001/jamainternmed.2013.9712

In Reply We thank Drs Farnan and Arora for their thoughtful letter. The responses residency programs have had to current duty hour limitations and the consequent work compression have far-reaching effects on the trainee and patient experience, including education and transitions of care. Our study only measured a few of the important short-term outcomes of the 2011 duty hour restrictions. We agree that the “new normal” will require “novel ideas and approaches” and believe we must demand scholarly evaluation of all important changes, using meaningful outcomes, to ensure that any interventions will allow us to produce competent internists and provide excellent and safe health care delivery. Curricular innovation should maximize spontaneous and structured patient-centered learning. For example, senior trainees and faculty should have coaching to develop teaching skills for the 1- to 3-minute lesson. In addition, substantial and effective use of modular, trainee-directed learning must be developed. Many programs have started using online and mobile technologies; however, increasingly robust platforms will likely be needed. We further believe that the science of transitions of care will need to inform this ubiquitous process. The amount of data available for each patient can be easily overwhelming. There is a need to understand how to present and communicate effectively amidst that volume of information. Centers focused on patient safety are using human factors experts to examine the effective transfer of information. The results of this and other work can hopefully begin to establish best practices for handoffs and transitions of care. Ultimately, research in all these areas will inform an evidence-based approach to build the “new normal” for training the next generation of physicians.

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