Cost-Effective Equality & Residency

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The reason certain residencies have a robust global health or research program and others have mediocre ones is not that the opportunities don’t exist — it’s the degree to which you have to fight the system for them.

All residencies are not created equal. Each hour you spend working as a resident has different value per program. Think of it as the cost effectiveness of a program. This metric refers to the amount of education and the other benefits of the program you may get per hour of work you do in residency. This metric is individual-specific. You may value location versus your salary, or opportunities to travel versus opportunities for advancement in a subspecialty. If you’re someone who is praying to just get into, or happy just to be in, a residency, then you might not find this article useful. But most medical students and residents are high-achieving leaders who were, or are, doing any number of creative activities outside of medicine.

You have options as you go through your interviews, and each program should be weighed individually as the cost of choosing the wrong one could be significant. You need to ensure your program is a program with high cost effectiveness for you. This may mean a program where residents can seamlessly take advantage of opportunities in research, leadership, community service, or anything that piques your interest. The limiting factor is not always availability of opportunities, it’s actually usually infrastructure.

Once you’ve chosen a program that has the right availability of opportunities to match your interests, you may be surprised to find that the accessibility to those opportunities is not what you thought. In any other industry, minor inefficiencies in the system may go unnoticed or worked around without any significant distress. Unfortunately, due to residents’ time constraints and responsibilities, just the slightest hitch in the system — say, someone not replying to an e-mail — can mean the failure of access to the opportunity. Thus, abounding opportunities is likely not enough; accessibility to opportunities needs to be accounted for. What are programs doing to facilitate opportunities? What are some levels of infrastructure they have set up? You should ask both questions to residents and residency leadership.

There’s always the other side of the coin — the devil’s advocate, so to speak. Being a top-notch EM physician is a priority to every resident and thus the driving mission of every residency. Residents must abide by a certain set of requirements to complete their training and each program has their own spin on the curriculum. Many programs like to take pride in their creative ways to implement it. This can be very exciting, but it can also be restrictive.

Though there is a set curriculum, residencies are still far from standardized. For example, there is no set number of hours that each EM resident is expected to have worked clinically during residency. While a focus on this aspect of residency is definitely very appreciated, providing a robust curriculum is not enough anymore — just like getting good grades is not enough to get into medical school. Current residents have been bred to want more. The system has selected for them to be higher achievers than ever before. The balance between work, extracurriculars, and life is not new to residents, but the over-representation of work in that equation might be. Programs should feel the charge to step up to the expectations of each resident’s needs. Many programs are doing this well; others may want to be able to accommodate, but don’t know how.

There are many ways that programs have thought of to ensure accessibility to their available opportunities. The suggestions below are from residencies around the country who are finding ways to include residents in extracurricular EM activities.

  • Involve a resident in every publication.
  • Use a scheduling system for accommodating requests seamlessly.
  • Ensure strong knowledge and relationships with an associate teaching institution.
  • Provide information, access, and support for opportunities in advocacy.
  • Enable access to funding for national and regional conference attendance.
  • Set up infrastructure for IRBs and statistical help for research.
  • Facilitate resident involvement in hospital-wide committees.
  • Ensure ease of access to global health funding options.
  • Actively update websites.
  • Use social media for communication.

Many programs do many of these things. Many programs think they’re doing these things, but fall short. The reason certain residencies have a robust global health or research program and others have mediocre ones is not that the opportunities don’t exist — it’s the degree to which you have to fight the system for them. This holds true for nearly all specialty interests in residency. The struggle varies enormously and really makes the difference.

So how can you know what programs are doing? You can check their websites, join their social media outlets, and ask around. Ask program directors what infrastructure there is and ask current residents how that has been working out. If you’re in a program already, ask for advice. Know that you are in training and you will be, or are, working very hard. Make sure that you are maximizing the cost effectiveness of your hours worked by being aware of the infrastructure needed for you to accomplish your desired interests during residency.

What is your program doing to integrate residents and create a time cost-effective experience? Tweet @emresidents and show some residency pride! You can also comment here.

Most medical students and residents are high-achieving leaders who were, or are, doing any number of creative activities outside of medicine.

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