Two Physicians Assert Importance of Patient Service During Residency

Drs. Kesselheim and Cassel recently published their perspective about the important role of patient service in medical education (“Service: An Essential Component of Graduate Medical Education.” New England Journal of Medicine, 2013;368:500-501). The authors observe that the role of “…service is being harmfully undermined within the medical profession and within graduate medical education (GME) in particular.” They cited an ACGME resident annual survey from 2007-2008 that identified “…excessive service obligations” as the most frequent indicator of program noncompliance. “Scut work” (transporting patient, phlebotomy, telephone delays while scheduling diagnostic tests) is distinguished from educational service functions that permit residents to employ their professional knowledge to clinical patient care and its documentation. They suggest that the later types of service to patients should be considered for inclusion in the ongoing ACGME “Milestone Project”, a new educational tool to assess resident progression through residency with the final goal of professional autonomy.