Residency pre-Fellowship is Different (A Rant)

You know I work an average of 70 hours per week, and you can guess that making time to study is hard. You might not know how much there is to study. And did you also know that I'm expected to go to one conference per year and publish 1.5 peer-reviewed publications per year?

Let's start with the stuff that ACOG puts out. There are 79 Practice Bulletins and 236 Committee Opinions. Those are usually three- to fifteen-page documents, including references and tables. That sounds almost manageable, but then the Guidelines for Women's Health Care is 907 pages long and the Guidelines for Perinatal Care is 599 pages long. There are also seven Task Force documents, only one of which I've even opened (the Hypertension in Pregnancy report, which is a hundred pages long). Te Linde's is 1300 pages, Gabbe's is 1200, as is Creasy's. And then there are landmark papers that we are supposed to know.

Our program recently started giving us "homework" because our CREOG scores went down. I do not think this is the right answer for me. The answer is no more wasted lecture time, let me privately study and read. Don't give me extra materials, let me work through what I'm responsible for first.

And I'm also supposed to study obstetrics and gynecology while researching and furthering the field. This seems stupid in several ways, and I suppose the old way of doing it was that attendings did research and used medical students and residents as peons so that they could learn how to do it. I can't memorize study designs and statistical tests while also trying to memorize pelvic anatomy! In fellowship you have to do your own statistics and are usually responsible for higher-level study types (e.g. randomized controlled trials, bench science, etc), but you get a year without clinical responsibilities to do it. This week I clocked 70 hours and I presented a poster and submitted a manuscript.

Time spent researching is time not spent studying. Time spent reading a practice bulletin is time not spent reading a textbook (viewed by my program as better). Time spent reading a textbook is time not spent praying. This truth goes on and on for cleaning the house, sleeping, cooking, exercising, and recreating.

Recently I had a mentor meeting and we talked about the juggling act. "Residency is a different animal for you, compared to your peers who don't want to do fellowship," she said. "It's a fundamentally different thing." In my opinion it's fundamentally crazy. </rant>

Cholera isn't the Plague

There is a scene in the Italian movie about St. Guiseppe Moscati that gives a good image for the Catholic bioethicist.

We know that St. Guiseppe had a role in addressing the 1911 cholera epidemic in Naples. His research prompted him to make public health recommendations to prevent its spread. In the movie, this is summarized dramatically in one scene. The saint finds city officials burning the furniture and belongings of cholera victims in order to stop the spread of disease.

St. Guiseppe commands that they stop, insisting that cholera isn't the same as the plague. (Cholera is spread by fecal-oral transmission, and is therefore much less contagious than diseases droplet or airborne vectors.) The solution to the cholera epidemic was hygiene and effective plumbing, not quarantine and destruction.

I think of this scene when I am considering bioethical issues. Many theology teachers cautioned me never to think about practical ethics in terms of what I could get away with. Others reminded me not to conclude that we should stay far away from anything possibly problematic. The first approach is irresponsible; the second, Pharisaical.

I try to take St. Giuseppe's approach. His research into the true nature of things permitted him to see what he and others ought to do. That way, he could place legitimate restrictions on people while also freeing them from unnecessary burdens.