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Work-hour guidelines, pregnancy during residency, acquired immunodeficiency syndrome, due process, stress, support... the ponderings of a residency program director. I have been involved in residency education in one way or another for 20 years now, during which time there have been many changes. For fun, I made my list of changes affecting residencies from 1969 to 1989. Following are some of the items.
Training includes more: more behavior, more child development, more continuity practice, more adolescent medicine, more intensive care (neonatal and pediatric), and more subspecialty experience. (From where did the time come? Of what is there less?)
The "real world" intrudes on residency more now. The buffer period provided by the draft is gone, financial indebtedness is greater, and there is no on-campus resident housing community. I share with others the impression that spouses generally are less tolerant of the demands of residency now.
There is less opportunity to experience what is satisfying about "being the doctor." The pace of residency was never leisurely, but the turnover of patients was less rapid; length of stay has been compressed almost beyond our ability to establish rapport, let alone trust or respect. Those children and families who do stay in the hospital tend to become savvy veterans of the system.
Roberts KB. THOUGHTS ON RESIDENCY EDUCATION, 1969-1989. Am J Dis Child. 1989;143(3):294. doi:10.1001/archpedi.1989.02150150048016
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