The Learning Cliff

I've heard the beginning of residency called a steep learning curve. I am finding that it feels, at times, more like a learning cliff. You slam yourself against it repeatedly and attempt to find some handholds on your way up, while girding yourself for some inevitable slides back down.

I can only hope that it is not a Sisyphean adventure. I am told that it is not. It is, of course, partly just the usual "learning the ropes" that comes with a new job. On top of that it is confronting the vast bounds of ignorance that you previously knew you suffered from, but successfully were able to ignore. On top of THAT it is navigating the social dynamics intrinsic to any tightly knit group of coworkers who have to learn to work together for 80 hours a week (plus all that time hitting the books trying to make sense of what just happened).


I did manage to have an interesting conversation with an attending about just that latter topic, the 80 hour work week. Of course there are still those who decry its limitations, and I would say that I used to be one of them. However now that I am confronting the realities of both that work week and trying to raise a 3 month old, I much better understand the reasons for the changes. It is simply impossible to lead a balanced life in the modern age, take care of all the other aspects of life, and work much greater than 80 hours a week unless you are the sort (and more power to this sort) that doesn't need to sleep very much at night. For those who have married their job, instead of other people, perhaps more can be asked. But for those of us with families, it would be too much. I think it would impart a kind of spiritual sickness on the experience of residency for those like myself that would be devastating for the profession as a whole.

There is a fantastic piece in the New York Review of Books that describes some of the changes that led to the modern residency. To be sure, these comments apply as much to internal medicine as to my own discipline, pathology. The academic hospital environment has been compromised by the economic requirements of what is, fundamentally, a large corporation. It should be required reading for anyone entering residency (really, anyone entering medical school).

That said, I am still somewhat of an advocate for Malcom Gladwell's 10,000 hours to becoming an expert mantra. 160 hours down, 9,840 to go.