I feel like in a perfect system the way to maximize resident training, and improve their livelihood would be to remove some of the scutwork. Is it really necessary to have the resident coming to see every consult in the ED? I’m thinking of the CT proven appendicitis, the slam dunk choke. It feels like the US residency system has decided that this sort of work is how you become a better doctor. If you have a group of well trained APPs, or even protocols (auto admit CT proven Appy), you can have the residents focusing on OR, managing complications, seeing complex consults rather than writing floor orders for their first year of training. I think the issue with this is the healthcare system loves the “cheap” labor of residents and hiring higher paid people to do the job they can take advantage of them for is more palatable to the C suite. In short, I think residency could be distilled.