The "resident's dilemma"? Values and strategies of medical residents for education interactions: a cellular automata simulation.
OBJECTIVE
Medical residents engage in formal and informal education interactions with fellow residents during the working day, and can choose whether to spend time and effort on such interactions. Time and effort spent on such interactions can bring learning and personal satisfaction to residents, but may also delay completion of clinical work.


METHODS
Using hypothetical cases, we assessed the values and strategies of internal medicine residents at one hospital for both cooperative and non-cooperative education interactions with fellow residents. We then used these data and cellular automata models of two-person games to simulate repeated interactions between residents, and to determine which strategies resulted in greatest accrued value. We conducted sensitivity analyses on several model parameters, to test the robustness of dominant strategies to model assumptions.


RESULTS
Twenty-nine of the 57 residents (50.9%) valued cooperation more than non-cooperation no matter what the other resident did during the current interaction. Similarly, thirty-six residents (63.2%) endorsed an unconditional always-cooperate strategy no matter what the other resident had done during their previous interaction. In simulations, an always-cooperate strategy accrued more value (776.42 value units) than an aggregate of strategies containing non-cooperation components (675.0 value units, p = 0.052). Only when the probability of strategy errors reached 50%, or when values were re-ordered to match those of a Prisoner's Dilemma, did non-cooperation-based strategies accrue the most value.


CONCLUSIONS
Cooperation-based values and strategies were most frequent among our residents, and dominated in simulations of repeated education interactions between them.
Heckerling
P S
PS
Department of Medicine, University of Illinois, Chicago, IL 60612, USA. pshecker@uic.edu
Gerber
B S
BS
Weiner
S J
SJ
D000533:Altruism; D001291:Attitude of Health Personnel; D002641:Chicago; D003198:Computer Simulation; D003299:Cooperative Behavior; D003657:Decision Making / Q000941:ethics; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D005716:Game Theory; D006785:Hospitals, University; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007400:Interprofessional Relations / Q000941:ethics*; D008297:Male; D010820:Physicians / Q000941:ethics / Q000523:psychology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014584:User-Computer Interface; D016526:Workload / Q000523:psychology