In Let Me Heal, prize-winning author Kenneth M.Ludmerer provides the first-ever account of the residency system for training doctors in the United States and, by tracing its evolution, explores how the residency system is of fundamental importance to the health of the nation. In the making of a doctor, the residency system represents the dominant formative influence. It is during the three to nine years spent in residency that doctors come of professional age, acquiring the knowledge and skills of their specialty or subspecialty, forming a professional identify, and developing habitts, behaviors, attitudes, and values that last a professional lifetime. Let Me Heal examines all dimensions of the residency system: historical evolution, educational principles, moral underpinnings, financing and administration, and cultural components. It focuses on the experience of being a resident, on how that experience has changed over time, and on how well the residency system is fulfilling its obligation to produce outstanding doctors. Most importantly, it analyzes the mutual relationship beetween residency education and patient care in America.
The book shows that the quality of residency training ultimately depends on the quality of patient care that residents observe, but that there is much that residency training can do to produce doctors who practice in a better, more affordable fashion.
Kenneth M. Ludmerer is Professor of Medicine, Professor of History, and the Mabel Dorn Reeder Distinguished Professor of the History of Medicine, Washington University, St. Louis, Missouri.
1. ANTECEDENTS ; The Search for Clinical Experience ; The Quest for Specialty Training ; The Passion for Discovery and the Birth of Clinical Science ; 2. JOHNS HOPKINS AND THE CREATION OF THE RESIDENCY ; Graduate Medical Education Enters the University ; The Scientific Practitioner and the Promise for the Nation ; Work as Play ; Diaspora ; 3. THE GROWTH OF GRADUATE MEDICAL EDUCATION ; Completing the Infrastructure ; The Maturation of the Internship ; The Spread of the Residency ; In Search of a System ; 4. THE AMERICAN RESIDENCY ; Educational Principles ; The Moral Dimension of Graduate Medical Education ; The Learning Environment ; Cultural Influences ; 5. THE LIFE OF A PRE-WORLD WAR II HOUSE OFFICER ; Obtaining a Residency ; Experiencing the Residency ; Education and Service ; 6. CONSOLIDATING THE SYSTEM ; The Second Reform of Medical Education ; The Rise of the Specialty Boards and the Triumph of Residency ; Graduate Medical Education and the Public Good ; 7. THE EXPANSION OF THE RESIDENCY IN AN ERA OF ABUNDANCE ; From Privilege to Right ; The Maturation of Clinical Science and the Creation of Subspecialty Fellowships ; The Ascendance of Specialty Practice ; The Propagation of Wastefulness ; 8. THE EVOLVING LEARNING ENVIRONMENT ; The Decline of the Ward Service ; The Preservation of Educational Quality ; Maintaining the Moral Mission ; 9. THE LIFE OF A POST-WORLD WAR II HOUSE OFFICER ; Changes and Continuities ; Quality, Safety, and Supervision ; Education and Service, Again ; 10. THE WEAKENING OF THE EDUCATIONAL COMMUNITY ; The Marginalization of House Officers ; House Staff Activism ; The Discovery of Burnout ; 11. THE ERA OF HIGH THROUGHPUT ; The New Learning Environment ; The Subversion of the Moral Mission ; Changing Attitudes toward Work and Life ; 12. THE ERA OF ACCOUNTABILITY, PATIENT SAFETY, AND WORK-HOURS REGULATION ; Work Hours Restriction ; Perpetual Dilemmas ; 13. PRESERVING EXCELLENCE IN RESIDENCY TRAINING AND MEDICAL CARE ; Challenges, New and Old ; Aligning Education and Patient Care