BOSTON, MA – A controversial new policy at a premier surgical training program is turning heads.
Last year, General Surgery Residency Program Director Dr. Philip McCocktosen was faced with a dilemma of increasing efficiency among the programs trainees. “It was a real problem. With the crackdown on actually following the 80-hour work week, we needed to squeeze more hours of work… I mean education into the day.”
The solution was obvious. While surgery interns are incredibly hard working, they are human beings, prone to fatigue, hunger, and thirst.
“That really is the problem, the human aspect of it,” Dr. McCocktosen stated.
“Fatigue is hard to fix. But hunger and thirst are actually pretty easy to remedy, if you are willing to think outside the box.” Dr. McCocktosen’s solution was to place a feeding tube in all the interns at the start of the year.
“This really kills two birds with one stone,” he explained. “First, it makes feeding easy, and can be done throughout the day without taking breaks. But it also means an extra case for one of our senior residents. If they do a percutaneous endoscopic gastrostomy, then they get an upper endoscopy out of it, and we are short on those.”
All five of the new categorical interns and the four preliminary interns volunteered to have the tubes placed.
Dr. John Swanow, one of the critical care attendings, raved about the new policy.
“It really is great. It cuts down on the need for breaks. I can start rounds at 7:00 am and round straight through to dinner time. When the intern starts looking a little famished, I just grab some Pivot and give them a bolus. Sometimes I flush a little coffee in there if they seem too tired.”
Dr. Amy Lase, a pancreatic and hepatobiliary surgeon, was similarly impressed.
“Yesterday I had a twelve-hour Whipple. I had to leave twice to eat, once for lunch and again for dinner while our fellow was redo-ing the pancreatic anastomosis for the second time. Thankfully, the feeding tube meant that the interns could stick around and retract. I just had our circulator reach under their gown and give them some sterile water and some Jevity every few hours. With some healthy shot.”
“You know, we really should place foley catheters in them as well,” Dr. Lase stated, as a wry smile came across her lips. “Bathroom breaks are the next layer in efficiency.”
While critics have decried the policy, Dr. McCocktosen is firm in his belief that it increases productivity.
“We have measured an 18% increase in intern productivity, based upon our benchmarks. This really gets us back to where we need to be. Back in the days of 120-hour work weeks, at least 10-20 hours of that was spent eating or sleeping. This at least takes care of the eating part.”
The surgical trainees had mixed feelings, however.
“Overall I like it, as it is a time saver,” stated Dr. Sam Leake, a categorical intern. “When I need to get here at 5:00 am to pre-round, I no longer need to eat breakfast in the car. I can just grab some feeds and flush them in my tube and run.” He paused. “On the other hand, I do miss eating actual food. That was nice.”
