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Dissipating the Foggy Myth of the Black Cloud

Niel F. Miele, MD
Arch Pediatr Adolesc Med. 1994;148(3):333. doi:10.1001/archpedi.1994.02170030103031.
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Tanz and Charrow1 should be commended for their attempt to dissipate the stratospheric (or perhaps cumulus) legend of the so-called black cloud. Their evidence appears to show that actual work experiences during the internship year do not differ greatly between residents. Differences in perceived workload, however, were attributed in part to differences in work styles, and not to actual workload.

In my experience, many residents who have acquired the reputation of a black or white cloud have had this title bestowed on them while working in the emergency department (ED). A somewhat related reputation of "sieve" or "wall" may also be accorded a resident working in the ED, depending on the number of admissions for which he or she is responsible. I suspect that the overall workload between residents in the ED is also similar and am curious if Tanz and Charrow have any information regarding the interns' ED

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