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Reflections |

A Program Director's Lament

Bradley W. Kesser, MD
Arch Otolaryngol Head Neck Surg. 2011;137(10):982. doi:10.1001/archoto.2011.140.
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I stand here today to tell you the way
We teach the young women and men,
‘bout removing the parotid without disturbing the carotid
‘Cause it's not like it was way back when.
With the faculty distinguished, all cigarettes extinguished
They commanded tremendous respect
Stood proud and tall never shirking from call,
And knew every otolaryngological aspect.
Those were the days, they seem like a haze
With white coats all pressed,
Residents did well not to speak up or tell
If they were feeling a little bit stressed.
So that was then and this is now,
I tell you my dear alums,
Cause you won't even believe, least of all conceive,
That the faculty are more like their mums.
We send them on retreats with plenty to eat
To teach the 6 core proficiencies
Competencies they're called; and it's just not my fault
We must document every deficiency.
You see them all here, they're a pain in the rear
Can you really teach professionalism?
No matter how many times Dr Cantrell answers the chimes
We ask, “Is it this resident's mannerism?”
These are some ways we teach them these days
With conferences, simulation, and drilling.
Has anything changed or is it all just arranged
To maximize collections and billing?
Skills labs are key, drilling a bone to a T,
And case numbers are ever so critical
Are they memorizing facts and just going through acts
Or are they truly becoming analytical?
And the assessments—oh yes—what a great big huge mess
I try to keep them all straight.
Who's evaluating whom—I’m running out of room—
In my office when I stay up so late.
Clearly you see that 360 degrees
Is the way that we get them all done
It's paper and paper and paper and paper
I can't possibly track every one.
This is our eval for competencies six, 24 questions thrown into the mix
Another set of questions addresses their skill
Tying knots and avoiding clots,
Doing surgery, without prescribing a pill.
Respect for tissue and time and motion, the 2s will close and the 3s will open
Careful instrument handling and flow of the operation
Detailed knowledge of the case—please pick up the pace!
Ensures things go well to gain admiration.
Watching a resident evolve with the faculty involved
Is truly a rewarding sight
Reporter to interpreter to manager then educator
It's incredible watching them take flight.
So I beg your permission, your free will and volition
To discuss a few rules we obey
PGY-1s are required after they're hired
To do these rotations some way.
I know they are hated, duty hours are mandated
So residents get lots of rest
They take call at home and answer pages by phone
But come in if they know what is best!
80 hours a week is the max we can keep
A resident under our thumb
A day off in seven, oh my, this is heaven
And no more than 30 (hours) for one single run.
The hours are changing and so more arranging
Will have to be shortly enforced
16 hours is the max for the first year hacks
With napping strongly coerced.
We have done quite a bit to comply with this. . . . stuff
And now we're in full compliance.
Residents now tell if they're not feeling well
And go home on their own self-reliance.
So teaching residents you see is not as easy as can be
It's filled with difficult tasks
But it's rewarding and fun and here proficiently done
Especially if the RRC asks!
So I can't help but brag and wave our UV-A flag
After making everything perfectly clear
‘Cause it's the people you know that make it all go
For the Department we all hold so dear!


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