Appreciated Unhappy Resident,

I left the Wednesday residency retreat with many unsaid thoughts. I’ve been involved in medical education for almost 15 years. I’ve been a residency program director, associate program director, section chief, mentor and resident probation officer. Through the years I’ve worked with numerous medical students, residents, fellows, faculty, administrators, deans, chairs and vice chairs. I’ve also been part of multiple educational task forces, committees, emergency meetings, Pow Wows and retreats. I’ve worked with tired and disillusioned residents before and this retreat felt like a big Déjà vu. I wish you would listen and trust what I have to say, but you probably won’t. Regardless, this is a letter for you.

I was a radiology resident 20 years ago and medical education was very different. I know you’ve heard this before – the good old days. But was it better? Or worse? Did we work more? Or less? The honest answer is that nobody knows. If you ask me, some things were better, and some others were not. Everything changes. There is nothing more constant than change itself. Medicine and radiology have changed immensely in the past decade. To put in perspective, when I was a resident there were no PACS or EMR – we had to spend time organizing films in the negatoscope and handwriting our dictations. Teleradiology and voice recognition were science fiction. Radiologists got paid more for cases, but the volumes were much lower. It was certainly simpler, but less efficient. Today we have more volume and higher technological efficiency, which invariably translates to more work in less time. It’s easy to understand why you feel that medical education may be taking the back seat in our residency program. But that’s not the truth. Let me explain.

There is no doubt that the clinical demands (time) of all physicians have multiplied in the last two decades. More information, patients, regulations, better treatments and lower reimbursements are just a few of the culprits. It almost feels like a race; everyday running as fast as possible to finish all our clinical responsibilities so we can go home at a decent time. No wonder there seems to be little time left for education and research! The bad news is that one to one teaching in every single clinical encounter is mostly dead, a thing of the past. The very good news is that information technology has made the passing of knowledge much more efficient. There is an abundance of information at our fingertips; from peer reviewed journals to books to up-to-date virtual conferences. 15 years ago, residents arrived at call with a carry-on suitcase full of books because there was no google (Not to count the many books in the mini ER reading room library). The only way to get tested on medical knowledge was thorough one to one teaching or formal tests. Today we have online quizzes and tests prepared by the same Societies that are tasked to maintain knowledge adequacy. I feel like the faculty is here to teach experiences acquired through the years and to reinforce your knowledge. Traditional teaching is still important, but it has evolved in medicine and it will keep evolving in the years to come. In fact, many younger students prefer to watch recorded classes in double speed from the comfort of their home or coffee shop, than to sit for hours in a classroom. Please understand that today more than ever, you own the responsibility of acquiring factual knowledge. The faculty is responsible to teach you how to best apply that knowledge, based on their experience.

Now let’s talk about the ACGME. All the opinions expressed here are my own and do not represent in any way the opinions of the Program Director (Dr. Kist), the Chair (Dr. Otto), the Vice Chair of education (Dr. Restrepo), the GME office or UT Health SA. Furthermore, I hold no administrative position in our Department or Medical School related to medical education. With that said, the ACGME is a necessary “evil”. There has to be an all-powerful institution that sets rules/laws that ensure quality and safe medical education for both trainees and patients. Without the ACGME, medical education would be extremely variable between institutions and quite frankly dangerous in some places. But please know that the ACGME will never do anything for you as an individual resident. The ACGME doesn’t help any institution besides setting rules and providing information/education about them. That brings me to the ACGME annual survey. To this day I don’t really understand why most residents and faculty don’t understand the purpose of this survey. This is not the tool to express temper tantrums or to “punish” your residency program for recent negative events. In the past 15 years I’ve been part of three surveys “trashed” by the residents and in three different institutions. In all three cases, the bad “score” was related to transitory resident discontentment. Usually a consequence of recent change in management, the resignation of an unhappy key faculty, the transfer of residents or even the change in information technology. The three instances resulted in emergency meetings, retreats, pow wows and promises. Some positive things were achieved, but many more hurt feelings were left behind. What I don’t recall for sure is the ACGME sending money to the institution or fixing the residents perceived problems. A bad survey would just raise a flag. A flag that can result in probation or loss of accreditation. In that event, everybody will lose, but YOU the resident would lose the most. Be honest in the ACGME survey, but don’t use it as a tool to “punish”. The ACGME has been around for a long time and is no dummy. Like a colleague told me many years ago: “It takes very disillusioned and angry residents to continuously “trash” the ACGME survey, knowing they’re shooting themselves in the foot. And the ACGME knows that, which I believe is the purpose of the survey, like an interview – to weed out the extremes”.

I hold great memories of my days as a faculty and program director at The University of Puerto Rico. The residency program had little resources when compared to the large programs in the continental US. At that time, we were at least 10 years behind in technology. Also, most of the faculty were part time given the low salaries. But we had something much more precious – pride and passion. The residents were proud to be part of the training program and they wore their lab coats with the radiology department insignia with pride. We felt the sky was the limit and those residents accomplished monumental success. Five years of extensive research production, 100% first take board passing rate and a collective 95 percentile on the in service! There is no doubt in my mind that those residents were very smart, but what set them apart was their passion and love for the training program. They fed each other with enthusiasm and positivism, and it made them industrious. You can do the same in our residency program. Our residency program has all the tools you need to be successful; you just need to add passion and enthusiasm. Be positive, be proud of where you are and of what you’re becoming. Inevitable obstacles are always better conquered with the right attitude. We are UT Health San Antonio, and we are awesome!

A single resident has little power in a big institution like ours. Or at least that’s probably the way you feel. But a group of united residents has more power than a Chair. I say this with all honesty. Our medical center would not exist if it wasn’t for patient care and education – not one or the other, but both. As a group, you have more power than what you would ever believe. But you have to do it in a cohesive and responsible way. Our training program is not perfect and there is always room for improvement. You can bring about numerous positive changes if you stick together and organize. Bring your well-intentioned complains, they are important to us. But bring them the right way, and the first step is to unite.

We all tend to think that the grass is always greener on the other side of the fence. Because of things we hear/read or friends we have on the other side. But the problems I described above affect every single medical center in the US. I was recently talking to a faculty at UPenn about the changes in medical education and the increase demands on faculty. The problems she described to me were extremely similar to the problems I experience in our institution. Furthermore, I’ve worked at two other educational institutions (UAB and UPR) and can honestly say that they too face constant problems and challenges. Nobody is immune to hard times. Focusing on the problems in front of you is much more productive than concentrating on the perceived strengths of some other place.

Let’s work together and let’s move forward. Your education is our priority. I sometimes wish you were a fly in the wall during our faculty and administrative meetings. Yes, we complain when the residents arrive late and show little evidence of study. But much more than that, we fight for you and for your educational experience. We are all proud of our residency program and want nothing more than to see you all succeed and become the best radiologists in the nation. In all honesty, that’s our commitment.

Lastly, I want to offer you a piece of advice about work ethics and hard work. Medical education is hard. There is no sugar coating here. But medicine is and will always be in my opinion the most sacred profession. The sacrosanct moment when another human being completely opens up to you in hopes of a cure or relief. To alleviate human suffering is the greatest gift we can give or receive in this life. For that reason and as a faculty, I will allow you to participate and learn from the patient I’m caring for only if you are willing to assume this sacred responsibility. There are no excuses and there is no half commitment. If you’re truly invested in your education, if you work hard and if you’re kind, you’ll leave this place with all the tools you need to be successful. Of that, I’m 100% certain.