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. Perhaps this is one early indicator that something is amiss. The final outcome of current changes in residency training will not arrive soon. It will be heralded by neither a new, sweeping legislative bill nor another corporate initiative to trim spending on health care services. The final analysis will be made in another time, when today's medical trainees take the helm and exercise the knowledge, skills, and virtues that they are learning now.