Residency is training, not just staffing
These are not mutually exclusive. When daily duty, on-call shifts, red tape and understaffing consume the schedule, supervised training can become dependent on informal practices rather than a verifiable framework.
In short: A resident can work hard and still be under-trained. Training must be measured separately from the operational work that keeps the department afloat.
Principle: residency is a program of progressive training, not a mechanism by which deficit, disorganization, or uneven involvement of other roles is covered by resident availability.
The Romanian rules talk about the curriculum, work scale, notebook, monitoring logbook, coordinator, tutor, module evaluations and training centers. The question is not whether there are rules, but whether they actually protect the resident's time and progress.
The resident can become a flexible workforce: responsible enough to fill gaps, but insufficiently protected as a trainee. That produces responsibility without authority, work without feedback, and fatigue without measurement.
The resident does not clearly know who is supervising him in each rotation or how quickly he can get help when the case exceeds his level.
Procedures and skills may be formally documented, but without direct observation, formative feedback, gradual progress, and verification of actual independence.
Lectures, presentations, medical literature clubs, simulator or case discussions disappear when the ward needs someone to cover the daily flow.
There is not enough transparency about the quality of the centers: available cases, trainers, feedback from residents, missed rotations and remediation.
When the evaluator also controls the career, the resident can avoid reporting lack of training, abuse, or unsafe delegation.
It is not the clinical work that is the problem. The problem is repetitive work that does not bring supervision, competence, progressive autonomy or protection.
In a large hospital, the resident should not be the mechanism by which the ward compensates for the unequal distribution of clinical and administrative responsibilities. These situations must be discussed institutionally, without hunting people: who works, who trains, who is responsible and who actually covers the activity?
If residency is consumed by clinical volume, documentation, and staff shortage compensation, the system gains cases in the short term and loses physicians in the long term: specialists who are less trained, tired, capped, or out of the country.
Medicine requires exposure, practice, and responsibility, but it does not require permanent hospital attendance as proof of loyalty. A resident needs patients, procedures, supervision, formative feedback, reading, sleep, and adequate recovery time to become a good resident.
Training does not have to be an informal process based on individual overload tolerance. It must be an intentional process: clear goals, appropriate cases, progressive accountability, study time, and honest evaluation.
The resident must bring energy, learning, continuity and additional capacity. But the core activity of the hospital must be ensured by incumbents and stable teams. When a ward depends on residents for normal functioning, the residency becomes a gap-filling mechanism, not a training program.
Residents should not be portrayed as incapable or frail. Residency involves hard work, responsibility and clinical exposure. The problem arises when the system normalizes unlimited availability, work without read time, on-call shifts without recovery, and training left to chance.
If the real schedule means on-call shifts, sheets, phones, patients to follow, paperwork to redo, and informal attendance over the schedule, personal time and learning time disappear. Without time to read, discuss cases, and receive formative feedback, residency turns from training to operational survival.
Who verifies, independent of the local hierarchy, that each resident receives cases, procedures, feedback, supervision, and educational time commensurate with the year of training?
Training depends on the actual capacity of the centers, of measured time and of safety to report deficiencies.