What does it take to make a medical expert? Practice, practice, practice. And, unfortunately, some error along the way.
Patients instinctively know this, which explains the near universal preference for a seasoned doctor over a freshly minted one. I have yet to hear a patient clamor to be treated by a young resident.
Medical educators are keenly aware of it, too, and of a conflict at the heart of medical training: what may be best for making a skilled, independent-thinking doctor may not always be best for patient comfort or safety.
How, for example, can an inexperienced psychiatry resident learn how to do empathetic but rigorous interviewing to assess patients' risk of harming themselves or others, without leaving some patients feeling misunderstood or badly treated? How can a doctor become expert at using psychotropic drugs or doing psychotherapy without making mistakes along the way?
Just as we want psychiatrists in training to become confident and knowledgeable, we also have to protect patients from the errors that result from their inexperience.
But one day, our residents will leave the protective cocoon of training and go out on their own. Have we struck the right balance among education and training and patient safety to produce psychiatrists who can function independently? I'm not sure we have.
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