What residents are not learning: observations in an NICU

In light of the November 1999 report of the Institute of Medicine on medical errors as a leading cause of death and injury, and the July 2000 report of the Accreditation Council for Graduate Medical Education citing violations of work-hour standards for residents and interns, there is a clear need for substantial changes in residency training. The author, a clinical bioethicist, uses his extended observations at a neonatal intensive care unit (NICU) of a major U.S. teaching hospital to outline specific concerns about residents' and interns' training, medical and otherwise, that create unnecessary hazards and other difficulties in the medical care of children. These concerns-which arise from constructive criticisms he makes of specific NICU procedures, methods, approaches, and policies-apply directly to training residents in several areas of medicine and more generally to all residents' training, and echo many of the issues stated in the reports mentioned above. The author maintains that a well-rounded medical education, fostering not only clinical skills but others (e.g., skills in teaching; in communication; in collaborating with nurses, social workers, and others; in working with families; in showing compassion; in dealing with confidentiality issues; in using common sense; in being the patient's advocate), is crucial for producing well-rounded physicians. He emphasizes that in order for such a well-rounded education to occur, the residency program-which in many cases means the attending physicians-must teach and model these varied skills and attitudes to their trainees.