This week is the annual fellowship match, where internal medicine residents across the country learn where they’re going to do their oncology, cardiology, gastroenterology, or any other subspecialty training.
I've been involved in this process 30 years ago and as recently as 2 years ago and the only time I was certain about a candidate's ability to be a great doctor/cardiologist was if I had spent time with them on hospital rounds or in the outpatient clinic.
And the emphasis on evidence of interest in research and an academic career forces those who are great clinicians to waste time generating scientific noise.
As you state "Residents aren’t conducting randomized controlled trials. Often, they’re churning out the same low-quality observational research that poisons the literature and confuses patients."
Great post. Fitting mention of Goodhart’s law which seems very fitting here.
I got my cardio spot outside match, years ago. My first choice program called, and said spot is yours if you accept it right now. Easiest choice ever. But it certainly undermined the intent and spirit of match.
I don’t know what the solution is, other than completely agreeing with you that “resident research” 99.9% of the time is a total waste of time for everyone involved, including the resident.
The match itself is a reasonable if we didn’t try to game it as you said. The whole research in residency thing is now out of control!
And finally, when I was in the fellowship committee almost every candidate had great scores etc and we ended up choosing who was felt to be a good fit with our current fellows and who they liked - Often not the best candidate if you were looking at performance or potential
Excellent points and I agree I'm not sure on how exactly to make the system better.
I think you hit on the real crux of the problem though, which needs to be really studied and dissected. How do we identify those students and residents that will make the best doctors? That also probably needs to be broken down into who will make the best surgeon, radiologist, cardiologist, PCP, etc.?
The crazy thing is the system as it stands (i.e. med school, residency, fellowship) generally works, meaning we train, mostly, good physicians. It's just mind blowing that we have no idea how we actually do that.
Brilliant observations!
I've been involved in this process 30 years ago and as recently as 2 years ago and the only time I was certain about a candidate's ability to be a great doctor/cardiologist was if I had spent time with them on hospital rounds or in the outpatient clinic.
And the emphasis on evidence of interest in research and an academic career forces those who are great clinicians to waste time generating scientific noise.
As you state "Residents aren’t conducting randomized controlled trials. Often, they’re churning out the same low-quality observational research that poisons the literature and confuses patients."
Great post. Fitting mention of Goodhart’s law which seems very fitting here.
I got my cardio spot outside match, years ago. My first choice program called, and said spot is yours if you accept it right now. Easiest choice ever. But it certainly undermined the intent and spirit of match.
I don’t know what the solution is, other than completely agreeing with you that “resident research” 99.9% of the time is a total waste of time for everyone involved, including the resident.
The match itself is a reasonable if we didn’t try to game it as you said. The whole research in residency thing is now out of control!
And finally, when I was in the fellowship committee almost every candidate had great scores etc and we ended up choosing who was felt to be a good fit with our current fellows and who they liked - Often not the best candidate if you were looking at performance or potential
Excellent points and I agree I'm not sure on how exactly to make the system better.
I think you hit on the real crux of the problem though, which needs to be really studied and dissected. How do we identify those students and residents that will make the best doctors? That also probably needs to be broken down into who will make the best surgeon, radiologist, cardiologist, PCP, etc.?
The crazy thing is the system as it stands (i.e. med school, residency, fellowship) generally works, meaning we train, mostly, good physicians. It's just mind blowing that we have no idea how we actually do that.
Terrific post. The analogies to quality metrics are spot on.
Et tu Practice Standards? Those were always my “go to” when I worked. I’d be interested in reading your thoughts about the process.