Prevention of Impairment Among Residents in Training

The rigors of residency training and the rites of passage endured between graduation and practice have been cataloged over the years in a variety of biographical and anecdotal formats, including books that range from scholarly surveys¹ to best-selling novels.² Norman Cousins'³ earlier editorial on this topic identified internship as "the weakest link in the entire chain of physician training" and provoked a lively debate in the correspondence columns of The Journal regarding the degree to which the experience provided legitimate preparation for practice or was a hazardous form of hazing.

The national survey by Smith and co-workers4 published in this issue of The Journal provides a much needed source of information with which to temper the debate. Their major finding is that 0.9% of internal medicine residents take a leave of absence because of emotional impairment during their training, declining from a peak of 1.4% during internship to