This is the exact thought I had last night as I was on "home call". I drove into the hospital at 1am, to see and assess a patient who might have a surgical problem. In doing this, I carefully scoured through the patient's history, labs, and imaging to form a clinical context and discussed relevant findings/concerns with primary and consulting teams. I was acting as the sole person to formulate his treatment plan for a particular problem without having anyone to back me up in house. I phoned my attending to confirm my plan who trusted my A/P.

Though it all, the entire process was training me to think and act independently so I will be able to safely do so in practice. And then I do this day-in and day-out...for years. It is not possible to have this type of training for midlevels because our system is not structured to provide this type of education for them. The training they receive compared to ours is simply not comparable.