During the throes of his Osler internal medicine internship, Rich Ambinder recalls falling asleep while listening to a patient’s heart. It was 2 a.m. He had been on the wards for roughly 26 hours. “I heard her say, ‘Doctor, doctor, are you awake?’”
It was hardly a proud moment, but an instructive one.
The 62-year-old Johns Hopkins Hospital oncologist tends to mention this anecdote whenever he and his son Alex, a third-year Osler resident, discuss their medical training experiences. As the new crop of residents begins on July 1, the Ambinders are among a number of parent/child Osler trainees who can shed light on the challenges—and learning opportunities—that have accompanied their respective residencies.
“I think anyone from a generation earlier thinks there were some valuable things about continuity, seeing patients overnight and very sick patients evolve over a period of time,” says Rich. “But I have no doubt that the system I grew up in had many problems.”
As examples, he cites frequent 30-hour shifts, limited supervision (“No simulation lab; it was more see one, do one, teach one.”) and paper records (“It could take days before the medical records office could locate a patient’s history.”). Rich also recalls the small number of women in the program 35 years ago.
Since 2003, the Accreditation Council for Graduate Medical Education (ACGME) has imposed duty hour restrictions on medical residents for patient safety reasons. Now residents can work no more than 80 hours per week, and shifts cannot exceed 16 hours.
Alex, who completes his residency this month, says he’s found the fatigue of residency manageable. “I was actually hypomanic at first—it was so exhilarating,” he says. However, he struggles with the forced handoffs. In the new landscape, “I’ve had people kicking me out the door when there’s a discussion about a patient that I’d like to be a part of,” he says. “Yet there’s something good about having boundaries.”
Some positive things about the program haven’t changed, agree father and son: the camaraderie and high-caliber teaching. Unlike the competitive environment in college and medical school, says Rich, “people in the Osler residency make you feel like you’re part of a team.”
Like his father, Alex will specialize in hematology/oncology. He begins his fellowship in July at Johns Hopkins, where Rich also trained. After completing his first year, Alex will serve as an Osler assistant chief of service. “I hope to foster the same kind of environment that made my residency more enjoyable,” he says, “thanks to people who were excited about medicine and respectful of my own sort of learning but pushed me to do better.”
Helen Selonick Prevas, who completed her Johns Hopkins internal medicine residency in 2012, cut her teeth on Osler folklore. Both of her parents are alums: Martha Selonick, Osler 1979, and Stuart Selonick, Osler 1978. They are currently in private practice. Martha is a cardiologist; Stuart, an oncologist. He has also been teaching outpatient medicine to Osler residents for the past 30 years.
As a youngster, Helen often “hung out” on the wards with her parents. She knew from an early age that she wanted to be a doctor. Now she’s about to complete her first year of a fellowship in critical care at the University of Maryland Medical Center.
But between her second and third year, following the birth of her daughter, sleep deprivation hit hard. Even with babysitting support, she says, maintaining a balance was tough. She was on call every fifth night. Thankfully, she says, Osler colleagues were kind about reworking schedules. “We’re used to swapping call,” she says.
In the 1970s, during her mother’s every-other-night-call era, very few female trainees—if any—had children. And, because of the small percentage of women residents back then, Martha Selonick was often presumed to be a nurse. “That still happens,” the cardiologist says, noting that her field attracts more men, “but not nearly as much.”
The program’s latest parent child-duo is Paul Scheel Jr. (Osler 1990), director of the Division of Nephrology, and Paul Scheel III, a recent graduate of Washington University School of Medicine. After looking at multiple residency programs, the junior Scheel says he liked Johns Hopkins most because of its structure and “dedication to excellent teaching”—and because of family, of course.
Chances are he and his father will overlap on cases, as has occurred with the Ambinders. “It’s a lot of pressure to live up to my dad’s name,” says the younger Scheel, “but it’s not any more pressure than I already put on myself.”