Is the Future of Residency Training Like Avatar?

During one of the keynote addresses at this past weekend’s ACGME meeting, Dr. Carolyn Clancy, head of the Agency of Healthcare Research and Quality, highlighted the definite need for enhanced patient safety and training on healthcare IT for residents who will be the practicing docs of the future. At the very end, she compared the future of residency training to Avatar – an epic battle followed by enlightenment. Because I am a huge science fiction fan and working in graduate medical education, I was especially struck by that comment. So, I continued to think about this analogy during the meeting –and even after I came home and saw the Oscars and saw James Cameron’s science fiction 3D-blockbuster lose to ex-wife Kathryn Bigelow’s critically acclaimed war movie, The Hurt Locker (interesting article on why it lost here).

So does the Avatar analogy work? Well, in Avatar, you have some militant members of a species (humans) trying to preserve and protect their world. On the other side, you have a new and evolved species who value working in teams and have a symbiotic relationship with their environment. Interestingly, you also have a doctor and a paralyzed soldier who go undercover to initially understand the species and then they both end up becoming one of them in the process, with one of them ultimately leading the new species to victory. I must say that the Avatar analogy is especially interesting in light of the MOST talked about session at the meeting —the implications for residency training from the different generations currently in the medical workplace (note: not the same ppt or speaker but helpful). At one end, you have Baby Boomers who are leading residency education and often long for the ‘way it used to be’. Contrast that to millenials (current interns and students) who are more used working in teams, value balance in their lives, and also have a symbiotic relationship with technology (namely their smartphone). Of course, there are also Gen Xers (this would be me) in the middle who may be trying to understand the millenials…So, are there a few Gen Xers who will literally fall in love with the idea of being a millennial and help them get their way? It’s starting to look possible…

What is the epic battle? Not a surprise here – the epic battle is on – and its about resident duty hours – how long should residents work? That battle was highlighted at the meeting…There is a lot of public pressure being exerted on the ACGME to adopt the IOM recommendations. But there are also a lot of program directors who voiced concerns about what will happen to resident education and where the resources will come from to ensure patients are cared for. Everyone was also trying to figure out if 16 hour limits would be put into place or not… The only thing that anyone could say with certainty is that new proposed standards would be released this Spring (as early as April) with a public commentary period followed by approval in September and full implementation expected by July 2011.

What will the enlightenment be? One possibility is better supervision – or an environment in which it is not about total hours but its about enhanced learning and patient safety through better supervision. In the words of Dr. Bertrand Bell who chaired the Bell Commission in the wake of Libby Zion’s death that ultimately heralded the NY State duty hour restrictions for residents, “Supervision, Not Regulation of Hours, Is the Key to Improving the Quality of Patient Care.” This has led some to suggest that supervision got lost somewhere along the way and the focus has really moved to hours. The tide appears to be turning since even the IOM report includes the title “supervision” and actually goes so far to recommend that there is 24/7 on site supervision by a qualified supervisor (meaning faculty). Will this happen? Well, it already does in some specialties – OB/Gyne and Emergency Medicine to be specific. Will this happen in across the board? I don’t know for sure, but I do know that we could be doing better to train faculty to provide better supervision at night especially. This is one reason we have been working to develop videos and teaching tools to highlight barriers to supervision and how to better address these barriers (See our Supervision: First Day on the Wards film that we debuted at the ACGME this year- note we won’t be winning any Oscars!).

So, does the future of residency training look like Avatar??? Well, it’s certainly better than resembling the critically acclaimed and Oscar winner ‘The Hurt Locker’. Plus, it would be much better funded!



  1. Seems to me that the future is still Up in the Air, that what we really need is An Education. Though Dr. Bell is no doubt a Serious Man, without more data on this we’re really stuck in The Blind Side. The residents I’m working with now (like all residents) tell me that more sleep is Precious.

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