Tragedy of the Commons

A common theme of the first day of the Telluride Summer Camp was the tension between autonomy and supervision during resident education. It seems reasonable to assume that any patient or family member would prefer maximal supervision of residents at all times, likely including the presence of an attending physician. Resident education, however, requires periods of independent practice, and in particular, requires periods in which a resident’s thoughts and skills are stressed. This tension represents a tragedy of the commons. Each individual actor rationally prefers maximum involvement from the most experienced physicians, but if all actors behave this way, the resource shared by all society (education of future physicians) suffers. Tragedies of the commons improve when interested parties are granted ownership rights. In this case, both patients and residents have obligations: for patients, to allow for involvement of trainees in their care and to understand the progressive responsibility that residents can handle; for residents, to recognize situations in which they require help and to feel that asking for assistance is not a sign of weakness.