The
Relative Cost of Being a Resident
Having just returned from Kilimanjaro Christian Medical
College (KCMC) in Tanzania, Africa, I read with interest
the Jill E. Beland, M.D., (October 2003) account of
the trials of being an American anesthesiology resident.
Her article reminded me of the two anesthesiology residents
I had the pleasure to work with at KCMC. They don’t
have resident or fellowship salary issues because they
don’t receive a salary during training. They have
to seek out funding to pay for their postgraduate education.
Once they complete their training, they can look forward
to a yearly income of about $2,000. There are no fellowships
available so this is not a major career issue. The stress
of having to balance studying and family, when you get
home from the hospital, is not a big problem because
the one with a family is living in a dormitory six hours
by bus away from his pregnant wife and 2-year-old daughter.
There is no stress about deciding what books to invest
in because there is no bookstore selling anesthesiology
books. They can relax about all the hassle of dealing
with invasive monitoring and PACU patient management
because there are no facilities for invasive monitoring
and there is no PACU. They just have to try to find
a functioning ECG monitor, a blood pressure cuff that
fits and the one functional oximeter in the department
for their patient.
Interpreting lab results is not problematic because
they often are not available. Due to staff shortages,
they often get additional learning opportunities by
working after being “on call.” They also
get the experience of delivering anesthesia care to
a population with a high prevalence of HIV.
Perhaps when Dr. Beland finishes her training and accepts
her first six-figure yearly salary, she might enjoy
participating in the ASA Overseas Training Program and
commiserating with the anesthesiology residents she
meets there about “the cost of being a resident.”
Wendy J. Watson, M.D.
Brookfield, Wisconsin
Statistics Reveal That Statistical
Analysis Is Flawed
Several articles in the November
2003 ASA NEWSLETTER (“Performance and
Outcomes Measurement”)
appear to contain the same assumption that the accumulation
of ever-increasing amounts of data in a relational
database will permit the discovery of new knowledge
and relationships among the data. Unfortunately this
may not be true.
Since we can perform an arbitrarily large number of
queries on any given database, the reliability (“P-value”)
of the conclusions should be adjusted to reflect the
number of past, present and future conclusions. As
we increase the number of comparisons (hypothetical
relationships within the data), the likelihood that
any individual relationship is only due to chance
increases. One method to compensate for this is to
decrease the threshold P-value. For example if we
make five comparisons, we should consider using P<0.01
(0.05/5). This is a special case of the Bonferroni
inequality.1 If we do not do this, our
“new knowledge” may be entirely factitious.
This problem was illustrated by an article in the
Wall Street Journal several years ago on large
customer databases developed by grocery corporations
for marketing. After the expenditure of millions of
dollars, one of these companies was able to “discover”
that customers who bought diapers were likely to buy
baby food but not much else.
Another difficulty with large relational databases
is the need to classify data. Waste of data is inherent
in any classification system that does not store all
the original data. A photograph compressed into a
JPEG file contains much of, but not all, the original
data and can never be re-expanded into a perfect copy
of the original.
Large databases may be useful for suggesting what
to investigate with future randomized, controlled
trials but do not deliver any “scientific proof”
by themselves.
Peter H. Norman, M.D.
M. Denise Daley, M.D.
Houston, Texas
References:
1. Glantz SA. Primer of Biostatistics. 4th
ed. New York, NY: McGraw-Hill; 1997:90.d
Thanks to Mark J. Lema, M.D.,
Ph.D.
Dr. Lema, I am not at all certain how the members of
our ASA can thank you for your editorial wisdom and
sense of humor. You have guided the NEWSLETTER
with unusual insight and, when needed, tough, but appropriate,
commentary. The “Aphorisms” have been especially
welcome!
Many of us are sorry that you are retiring from your
post as Editor, but understand that there is more to
life than the Editorship of the NEWSLETTER.
Thanks for all the efforts for the benefit of the anesthesia
community!
Steven R. Young, M.D.
Indianapolis, Indiana
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