Letters to the Editor
We appreciate Sinha and colleagues’ thoughtful reply to our article. Clearly both in European and U.S. medical schools, the ongoing duty hours debate is affecting not just postgraduate education but also medical student education—an unintended consequence of these changes to be sure, but one with the potential to significantly impact all future doctors. The authors’ point about having logbooks and dedicated observation for procedural skills is well taken and supported by data in our study. We found that medical students reported the highest level of confidence in suturing. During our students’ surgical clerkship, dedicated time both for practice and formal testing of this skill is likely responsible for that finding, as we incorporate a formative OSCE into their experience.
One challenge for other procedural skills, at least at our institution and at many others in the United States, is that the patient’s primary physician no longer performs many of these tasks. For example, other physicians (neurology/neurosurgery for lumbar puncture, anesthesia for intubation) and ancillary staff (respiratory therapists for arterial puncture, phlebotomy for venipuncture, and designated RN teams for placement of IVs) have largely replaced interns as the team members responsible for these aspects of patient care. As such, Sinha and colleagues’ suggestion that medical students gain increased procedural experience through more dedicated time with interns or newly qualified doctors may not be valid in our system.
The larger question remaining is whether or not broad procedural competence should be a reasonable expectation of all graduating medical students. We continue to believe, as Sinha and colleagues and the respondents to our survey do, that at least for a core set of procedures, this should be a goal. The devil, of course, is in the details of how to accomplish that, and while suggestions like the one from Sinha and colleagues are welcome, the answer unfortunately remains elusive.
Jeffrey J. Dehmer, MD
Fellow, Pediatric Surgery, Children’s Mercy, Kansas
Michael O. Meyers, MD
Associate professor and program director, General
Surgery Residency, Department of Surgery, University
of North Carolina, Chapel Hill, North Carolina;