This past week was the biggest week in medical education, which culminates in the Residency Match. It also marked the swsx festival in Austin, featuring the best of technology and entertainment. So this post is dedicated to commemorating these two seemingly unrelated yet simultaneous events. The generation that matched are the doctors of the future who are extreme technophiles and not afraid to use it in medicine. They may even make their career decisions based on them. On the interview trail, they will often ask whether the program has an electronic health record. So, as senior students embark into their residency, it seems only fitting to explore how technology is changing medical education. Since there is a lot to say, I’ll write a follow up on how it is affecting preclinical education but the focus is on the match and residency training here.
Technology and the Match During the 2011 residency match, social media was in full force, and the internet was atweeting as medical students, schools, and educators were espousing the #MatchDay and #MatchDay2011 hashtags. Several medical schools actually embraced social media to actively announce where their students were going via Twitter, dedicated blogs, or Flickr (yes Eastern Virgina students wear costumes!). As students celebrated by announcing where they were going, faculty (including myself) could welcome them into their own program. Current interns could rejoice that they were that much closer to the end of their grueling internship, except that they were still going to be on call overnight, while the newly matched have restricted duty hours.
Students often wonder about the size and capability of the mega-computer that runs the algorithm that produces the matches. Unfortunately, this year’s match was marred by a serious computer crash during the precious hours of the Scramble highlighting the worst case scenarios when we depend on technology. The computer crash also does not bode well for the implementation of next year’s Managed Scramble which will increase the numbers of aspiring residents who will use the Electronic Residency Application Service to apply to programs in the post-Match mayhem that is the Scramble. In addition, the current debate over the “All -in” plan will require heavier technological capability as international medical graduates will be required to enter the Match (unlike US Seniors, they can accept positions outside of the Match).
Technology and Residency Training Technology certainly increases our capability in monitoring resident duty hours and collect evalutions through Learning Management Systems like New Innovations or e-Value. However, the implementation of electronic health records actually increases time to do work in many cases, which may make it harder to comply with duty hours. Although decision support can improve quality of care, others worry that overreliance on decision support may result in physicians who subscribe to cookbook medicine and worse, can’t operate without technology. For example, one program director stated that she was going to resort to a ‘blue book’ exam for residents to demonstrate how to do admission orders using the classic mneumonic ADC VAN DISMAL.
More interestingly, just like email and internet has made it possible to conduct business 24/7, the remote access of electronic health records makes it possible to work from home, after you leave the hospital. This may come in the form of ‘epicstalking’ as our attendings and residents refer to it – the process of ‘following a patient’ by looking at the labs and studies through virtually logging in to the hospital’s electronic health record “Epic” from home, long after departing the hospital. Attendings can use epicstalking to ensure that the hospitalized patients are receiving the therapies that are indicated and that the residents are presenting all the information (in essence a form of supervision). However, residents often epicstalk to try to check to see what is going on with the patient they have handed off and gone home, a time when they should be resting. With shorter hours, will more work be transferred home? It is possible, and how this time will be counted in residency duty hours is still anyone’s guess.
In the meantime, maybe a consult to the supersmart Watson can help us tackle these problems?
Also, stay tuned for part 2 which will look at technology and medical student education.
–Vineet Arora, MD
While Valentine’s Day is coming soon, a different sort of ‘love letter’ may be sent or received by senior medical students. As recruitment season draws to a close, residency programs and applicants may be busy exchanging notes of interest, affectionately dubbed “love letters” by scores of medical students and on 
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