New Horizons in Management series
Edited by Janice Langan-Fox and Cary Cooper
Chapter 6: Intern Coping, Stress and Patient-Adverse Events: The Human, Hospital and System ‘Cost’ of Developing Medical Expertise
Janice Langan-Fox and Vedran Vranic THE COST OF DEVELOPING MEDICAL EXPERTISE Physicians are repeatedly exposed to patient suffering and death, which can be overwhelming. Their job is extremely difficult, and is probably even more difficult during the period of ‘in-house training’ that immediately follows the completion of medical school. Various terms exist internationally for such post-medical school training and include medical ‘residents’ (e.g. the USA), ‘interns’ (e.g. Australia) and ‘house officers’ (e.g. the UK). This particular period of medical training seems to impose two pressures on such trainees: pressure to succeed (Feudtner et al., 1994) and fear of error, and/or reprisal (Caldicott & Faber-Langendoen, 2005). Medical residents are at the bottom of the medical hierarchy and depend in many ways on the indirect and sometimes subtle messages of their senior supervisors about how to behave and perform in the job (Inui, 2003). Such staff have been trained in an era in which showing emotions was perceived as ‘weak’ – an ethos that has been perpetuated from one generation to the next (West et al., 2006). Implicitly, residents come to understand that they should be able to tolerate stress, and that they should not need to show their emotions (Angoff, 2001; Paice et al., 2002; Siegel, 1994). These norms are conveyed through the hidden curriculum of daily interactions by which residents learn how to become effective physicians (Hafferty & Franks, 1994; Hundert et al., 1996). If this current system works, however, then one may question why the availability and support from senior doctors and...
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