PHILADELPHIA-- Abusive physical demands on surgical residents have not significantly lessened in the 25 years since the problem was highlighted in a pioneering book.

Trainees in surgical residencies today have more work to do in less time and are taxed with sicker patients who have shorter lengths of stays than was the case 25 years ago, according to Charles Bosk, a University of Pennsylvania sociologist.

In the preface to the second edition of "Forgive and Remember: Managing Medical Failure," his book about errors in the practice of surgery, Bosk, a professor of sociology and medical ethics at Penn, writes that abusive physical demands are still common in surgical residencies.  

Bosk examines how the stress of the workplace contributes to medical error, which the Institute of Medicine of the National Academy of Sciences identifies as the eighth leading cause of death in the United States.

"Surgical residency has grown more stressful at the same time that the faculty claim that training programs have been scourged of past abusive practices," Bosk said.

"There is still the same time-pressured ordeal of learning by doing and the same personal vulnerability that comes from a seemingly never-ending series of competency tests," he said.

Bosk began conducting research for his book in 1979, spending 18 months with the surgical service of a major teaching hospital, living and working with interns, residents and attending surgeons and studying the ways in which surgeons recognized and managed medical mistakes.

His book has been comprehensively updated and expanded to reflect changes in medical practice and management since it was first published.