To become a fully privileged physician after medical school, one must undergo the vigorous on-the-job medical training known as residency. There is much to know about how residency works in general. It involves duties to perform and requirements to meet.
Terminology
Historically, an internship referred to the first year of clinical training while a residency referred to a separate subsequent training program. Currently, new doctors simply apply for one residency program. While the term "internship" is somewhat obsolete, it may still be used for those who have trained for one year and then switched to a different residency program.
In addition, the word "intern" may still refer to a first-year physician in training and "resident" may refer to a physician in the second year of training or beyond. Otherwise, a resident is the general term for a physician in residency, regardless of training level. Trainees in fellowships, which are programs beyond residency, are called fellows. Fully trained physicians who teach are called attending physicians, or "attendings."
Program Structure
Residency programs are at least three years long and vary according to the specialty. Training in internal medicine, for example, takes three years while training in surgery takes five years. Some residencies, like radiology and opthalmology, require one year in internal medicine or another field as a preliminary prerequisite before starting. Many programs do accommodate these one-year preliminary interns alongside those staying for the entire program.
Residencies are divided into rotations exploring the different parts of a field, such as a month of neonatal ICU in a pediatrics residency. In hospital rotations, the treatment teams usually consist of an intern, a resident, and an attending. Depending on the facility, medical students can also be part of the team.
More specialized fields have their own training programs called fellowships. They are just like residency programs in terms of how they function, except that they require completion of certain residencies before starting. For example, a vascular surgery fellowship requires completion of a general surgery residency.
Clinical Duties
On hospital rotations with direct patient care, the typical day starts with pre-rounding, the process in which interns check on all assigned patients and develop a treatment plan for each. The resident discusses each plan with the intern and also handles major patient issues if the intern needs assistance. Afterwards, the attending arrives and the team starts rounding. This process involves the intern presenting the latest developments and proposed treatment plan for each patient. The attending proceeds to teach the intern and resident about the best course of action, often in a way that makes them actively think rather than passively learn. After rounds, the team completes patient care tasks for the day, including but not limited to waiting for results of additional tests, performing hands-on procedures on patients, and talking to patients' families.
Of course, variations of this do exist. For example, a surgery residency also includes operating room duties and the obstetrics portion of an obstetrics/gynecology residency involves delivering women in labor. The actual duties of a residency program are ultimately determined by the specialty involved.
The expected hours and days for work depend on the specialty and the rotation. Call duty is characteristic of most residencies, requiring residents to work later than usual, sometimes overnight, every couple of nights so that they can have new patients to care for and perform other necessary duties. Weekend duty is also required in many cases. Long work hours in residency programs have always been an issue. New regulations by the Accreditation Council for Graduate Medical Education (ACGME), effective July 1, 2003, limit resident work hours to a maximum of 80 hours per week on the average with shifts no longer than 24 hours straight and one day off for every seven days.
Educational Duties
Because residency is an educational process, various lectures are scheduled for residents to attend in between patient care duties, provided that there are no major issues with the patients. They include morning report for patient case discussions, noon conference for lectures by attendings, and journal club for journal article discussions. Also, a team attending may ask his or her residents to look up a medical topic to discuss, which encourages them to be independent learners.
Licensing and Board Certification
Assuming the physician is trained in the United States, there are two credentials to earn after the medical degree. A state medical license allows one to provide unsupervised patient care and requires successful completion of both Step 3 of the United States Medical Licensing Examination (USMLE) and a minimum number of years in clinical training. Board certification is the recognition of full competency in a specialty, achieved after residency by passing a test administered by a specialty medical board, like the American Board of Radiology.
Final Words
The preceding is meant to be an overview of what to expect in residency, whether as an aspiring physician or as a layperson curious about the process. It is important to know that this is a very intense process requiring new doctors to work harder than most people, all to provide the best possible medical care.
References
- American Medical Association (AMA) - How Do You Become a Physician?
- University of Chicago Internal Medicine Residency Program - A Typical Day in the Residency Program
- American Medical Association (AMA) - Fellowship and Residency Electronic Interactive Database (FREIDA) List of Specialties and Subspecialties
- American Board of Medical Specialties (ABMS) - What Board Certification Means
