Residents were trained to recognize and treat improbable and rare diseases. Today, the medical case that does not fit a neat algorithm quickly comes to the attention of a small battalion of case managers. It is not unheard of for discharge planning to begin even before the patient enters the hospital. Perhaps more than anything, the hurried pace of health care delivery has changed the resident's appreciation of the course of illness. An increasing proportion of resident training now takes place in the outpatient setting.
Diagnosis is quicker, and more time is spent with healthier patients.
While these changes are not without benefit to patients, for medical trainees educational opportunities are lost by not being able to follow a particular illness until it is resolved. Today's decisions are made farther from the bedside and according to algorithms established by statisticians. While this reduces idiosyncrasies in treatment, it also tends to shortcut the process of thinking through complex problems and all their alternative solutions. Subtle effects lie hidden and sometimes unfold in further doubts. In this issue, Ivan Oransky discusses concerns over the number of residents leaving medicine.