Resident Training and RRSs

Abstract

An increased focus on patient safety on the part of regulatory and accreditation agencies has led to a host of reforms aimed at improving patient welfare. Rapid response systems (RRSs) have emerged at the same time as resident work hour restrictions have come into effect, public awareness of medical error has increased, and new models of residency program accreditation have been instituted.1,2 While well-intentioned, these reforms and improvements in healthcare have not emerged as a coherent and user-friendly package. For example, concerns over medication error have led to directives for computer entry of drug orders, but this is not always compatible with a desire to maximize time at the bedside in the face of work-hour limitations. Likewise, the implementation of protocols and pathways that have provided higher quality of care may pose a threat to the concept of applying and individualizing basic and clinical science at the bedside. And while resident work-hour restrictions have been promulgated as a measure to improve patient safety, compliance with these new rules requires even greater reliance on patient handoffs – a class of events believed to be associated with risks of their own.3,4 While numerous other challenges abound for those involved in resident education, the question to be dealt with here is whether the implementation of medical emergency teams or rapid response systems – a classically patient-centered intervention – interferes with medical education, or whether there are ways in which medical education can be enhanced through the existence and operation of a medical emergency team.