We thank Miele for his thoughtful comments and agree that the reputations of sieve and wall are analogous to black cloud and white cloud. However, because first-year residents in our program do not take overnight call in the ED, we did not collect any data from them during their outpatient rotations and have no way of evaluating the contribution of their ED experiences to their reputations. Nonetheless, we suspect that the ED experience did not have a major effect on residents' reputations since reputation was so highly correlated with sleep and our residents leave the ED at 11 PM.
We agree that it would be interesting to have a measure of resident efficiency to compare with reputation, but we did not collect any data that address this. We continue to think that resident work style and efficiency are very important in resident education and hope that more attention