“There is nothing wrong with change, if it is in the right direction.”
~Winston Churchill

Every morning I wake up and I have the same routine. Alarm rings at 430 am, I put on my running shoes; I make my cereal and cup of coffee; I check my email; and then I set off for another run. This is what I do. I am in training. I don't think I am ever not training for something. Every morning I wake up, I wonder why I am doing it. I have nothing to prove. But, something drives me to be better, to run faster.

I find that endurance training is very much like residency training. There is a lot of time placed into doing tasks that seem not to matter. Long shifts and busy work seem to be without use. How will this train you to be a better surgeon? Discharging patients and giving excuses for work and school, these are social work tasks, I am a surgeon, this is below me.

Each week, I have a set mileage goal. It is on my schedule. Short (4-5 mile) runs for speed; medium runs (7-10 mile) at tempo pace; and the long runs (14-22 mile) for endurance. All of these runs serve a purpose in completing the ultimate goal of finishing a race and/or improving on a previous time. There are many different ways of preparing yourself for an endurance race, such as a marathon. There are many books to read and philosophies to follow. There are also different goals that people have. Many years ago, people trained intensely, many running over 100 miles a week. Over time, the training elite have realized that that is not necessarily important and alternate training schedules have come out. Rest and diet have become a key component of optimal training for the endurance athlete. Mileage goals and speed of training has changed; cross training implemented. Most people now believe that depending on you goals, high mileage (total weekly) breaks you down more than builds you up.

Residency is endurance training and the 80 hour work week a philosophy change. The training elites, the attending staff, will have to adjust to the changes in philosophy. There will of course be many who will resist. Of course for many years, high hours where seen as a rite of passage, a test of you character, and necessity for your growth as a surgeon. The truth is that it is probably not necessary for overall growth of a surgeon. The system does need to become more efficient and more streamline. Change is painful.

Many of the old guard in medicine are asking, "who moved my cheese?" Many are like Hem, they do not want to change; and others are like Haw, somewhat resistant to change, but once they can see that change is needed. People like Haw realize that the change is better and that with the change there is growth.

So will the change be a success? I think it will. I think hospitals will become more streamline and efficient. More support staff will be present to assist in some of the busy work. This takes time. It is a large systemic change. Like increasing a patients potassium, we can't just push the medication. It has to be dripped in slowly so that the body can adjust. As the system adjusts, so must the training physician. Like the marathoner, although you don't have to do 100 mile weeks, you still must put in the miles, otherwise you will not complete the race. Consistency is one of the keys to successful training. So every morning, like it or not, the alarm rings; I put on my running shoes; I make my cereal and cup of coffee; I check my email; and then I set off for another run.

“What you leave behind is not what is engraved in stone monuments, but what is woven into the lives of others.”



ORTHOPAEDIC RESIDENCY: The attending perspective.  A blog specifically for medical students interested in orthopaedics and orthopaedic residents. It is orthopaedic residency from the attending's perspective.

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