Thursday, August 30, 2007

Hoops Versus Learning: Why Does No One Want to Go to Morning Report?

This is really just a rant. I'm annoyed this week.

Perhaps it's just some sort of personality flaw, but I've generally never been very good at jumping through hoops. I mean, I always did the bear minimum to get through any hurdle that I couldn't find a way to walk around, but I always grumbled and rarely did it with a smile. On the other hand, I've always been very good at doing what needed to be done. Like many people, I'm also very dedicated to things that I find interested and/or valuable.

I was a sub-par student at a sub-par high school. I learned nothing, and the thing was one giant hurdle. Did I graduate? Yes. I sure grumbled though, and my grades were a reflection of my commitment. When I got to college, everything changed. I studied things that I liked. I made very good grades (as all of us in medical school did), I published some abstracts, I was disciplined and motivated. As I worked myself through college, my weeks were generally of the 80 hour variety, but I never burned out. As time has gone along in medical school, I notice some of my high school habits coming back. I try to duck out of classes, I grumble a lot, I try to avoid responsibility.

I've put a lot of thought into it, and I realize that it's because I'm jumping through hoops. I will not pretend like some that I'm not learning anything. I'm learning a lot. I'm just learning it in a ridiculously inefficient way. I'm not afraid of hard work. I usually embrace it, but not when it's pointless. Is there some practical value to learning how to do a pap smear even though I find it personally revolting (you know you do too)? Yes, so I did it. Is there any value to anyone rounding four times on the same patient? No. It is highly inefficient, and I twiddle my thumbs most of the time. This is what qualifies as a hoop.

I think different people have different levels of hoop tolerance. As I said, mine is low. The problem is, that post-hoop threshold, your desire to engage in the rest of the activity is significantly impaired. Thus, if I'm on a rotation, and I feel like half of my time is wasted, It hurts the learning value of the rest of the time. I become disillusioned with the whole thing.

This brings me to morning report. On a certain rotation, morning report was a 15 minute to 1 hour get together with the entire department each and every morning. The value of this particular activity was highly variable. Sometimes an interesting patient would be presented, and there would be a lot to think about. Sometimes people would ramble for an hour. The problem was, I was spending about 80 hours a week at the hospital. MANY of these hours were spent sitting around waiting for admissions while on "call." This was a complete waste of time. By the second week, I was simply sick of sitting around the hospital, because half of the time I was there was useless in terms of educational value. I would have been happy to perform tasks with educational significance during this time, but it was not to be. Thus, when morning report came, I was sick of it. I wanted nothing to do with it. I though to myself, "I could have slept an extra hour without this," or, "I haven't seen my kid in two day because of this." The hoops overtook the value. I probably learned less that way.

The funny thing, is that the residents didn't usually look too pleased either. The post call residents had a longing in their eyes that screamed, "shut up and let me finish my floor work so that I can go to bed." They learned nothing. For them, it was a hoop. The attendings didn't get paid to be there. I couldn't figure it out.

Morning report isn't like some of the other hoops with obvious beneficiaries. It's obvious that certain interests are vested in maintaining training monopolies, long resident work hours, and a myriad of other hoops you have to jump through (ERAS *cough* *cough*). There is no such obvious interest for morning report. It's nothing but a culture of hoops and useless hurdles that keeps them going. Honestly, I hope I make it through medical school with enough interest intact to actually enjoy being useful as a physician. The hoops will remain, but I should atleast get paid for dealing with them. Money motivates me to jump. One can only hope.


Blogger golum said...

I used to hate most morning reports too.
we get thrust with so much crap, that the stuff we like( seeing patients, diagnosing stuff, reading specific illness and trying to discuss therapy) is buried under.
morning reports, noon conferences can be a drag unless the chief residents or program directors make a real effort to make it time and effort worth

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