Residents, attendings, and the physicians who remember training writing on KevinMD about residency: intern year, duty hours, supervision and autonomy, pay and unions, having a family during training, mistreatment, the Match for international medical graduates, and what physicians say should change about how residents are trained. Many contributors write anonymously, and many write while still in training. For a maintained record of what residents and attendings have said about residency itself on KevinMD since 2004, from intern year through the end of training, attributed by author and date and organized by question, see Residency: what residents and attendings say, in their own words. For what international medical graduates have said about the Match, visas, and being foreign in American medicine, see Immigration and medicine: what physicians say about immigrant doctors and immigrant patients, in their own words. Medical school itself is a separate record.
Scientist J. Robert Oppenheimer once said, “There are children playing in the streets who could solve some of my top problems in physics, because they have modes of sensory perception that I lost long ago.”
Like physics, medicine has its share of problems, namely cost control.
Like children, we must open our perception to the problem of cost control to consider other possibilities that better account for the issue than the theories …
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Get rid of the trolls in medicine
There is much talk about cynicism in medicine, and I remember being confronted by it almost from the beginning. In fact, I still remember how shocked I was the first time I heard a provider describe a patient in a disparaging matter.
We were responding to a 911 call regarding a woman in her 30s who was feeling short of breath. I remember being worried; she seemed too young to be …
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The value of continuity clinics cannot be understated
There were many things I pictured myself doing as I endured four years of medical school: building relationships with my patients and their families, performing complicated procedures, sleeping with my shoes on so I could jump up at any moment when I was on call. One thing I didn’t imagine was that I would be learning about and becoming a part of the labor movement.
My experience at UCSF Benioff Children’s …
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From the bedside to the bargaining table
As I begin another year teaching EKGs to our new residents, I find I am increasingly asking myself, “Where to teach?”
I do not mean to imply a geographic sense to the word “where” (although this is difficult, too, as residents move from hospital to hospital in large health care systems like ours as they change rotations), but rather as more of a “level.” What level do I teach our residents …
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The desire to spoon-feed medical residents today
In case you haven’t noticed, a hot new topic in education is “grit.” In order to reduce the long-standing 20% attrition rate of surgical residents, some say we should select applicants who have more grit or conscientiousness.
A recent paper in Surgery reported residents who dropped out of programs had decreased levels of grit as measured by a short-form survey. But due to unexpectedly low attrition rates in the surgical programs …
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Selecting grittier surgeons is harder than you think
While demographic data may suggest otherwise, I still consider myself a minority, albeit a less common one. I am a young woman in medicine, and I am a natural blonde.
I barely qualify for a prescription for eyeglasses, but I have found they give credence to my words and patients seem to take me more seriously. Perhaps three years of residency training …
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The blonde minority: Sexism is alive in medicine
As a fourth-year medical student, it was fairly easy to maintain a healthy lifestyle. When you have much leisure time and are relatively stress free, you can eat healthy, stay physically active and maintain quality mental health. However, as I begin the journey called residency, it is clear that the task of maintaining my own health will be much more difficult.
But the importance of this task should not be overlooked. …
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The unhealthy behaviors of physicians
Two years ago, I received my first employment contract. Not long after Match Day, I did what 115,000 physicians in training did that year and will do again this year: I signed the contract promptly and returned it. I tried to read the contract carefully, but it didn’t really matter. Unless you no longer want to be a physician, there is no other choice but to sign.
Today, as president …
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Medical resident pay needs serious reform
I performed my first paracentesis in November of my intern year. It was 3 a.m., and I was on overnight call in a packed ICU. The patient, a 45-year-old male with hepatic encephalopathy, was hardly alert enough to remember my name. He didn’t know I was an intern. He didn’t know I’d never even attempted a paracentesis before.
After I finished, I added the patient’s name to my procedure card. I hurried to get an ABG …
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The ethics of trainee-patient encounters: Are we practicing on the poor?
July as a newly minted intern: It was the best of times, it was the worst of times.
The only analogy I can make is you feel like a middle school kid sitting in a PhD course, desperately trying to back-learn everything in a language of acronym alphabet soup you’ve never heard before.
If medical school is drinking from a fire hose, this is trying to sip from Niagara Falls. You have …
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Reflecting on the first month as a new physician
You’ve changed.
No longer do we see you sluggishly walking en route to work every morning with refillable coffee thermos in one hand, robotically scanning some kind of social media feed with the other.
We are concerned that the regular and cyclic day time group texts received from you are now occurring at odd hours of the night. Your persistence to move …
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Working the night shift as a resident physician
This time of year I get a lot of questions from fourth-year medical students about applying to residency. So, here’s my answer to the question, “What should I look for in a good family medicine (FM) residency program?”
It’s FM, so everyone (for the most part) is going to be nice, friendly, and welcoming when you go to visit. They will show you a curriculum that’s in line with the Accreditation …
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3 questions to ask prospective family medicine residencies
I recently read some statistics that shocked me, but not really. In the U.S., 60% of medical students come from families with incomes in the top 20% of the nation. Meanwhile, only 3% come from families with incomes in the lowest 20%. Not much socioeconomic diversity in the house of medicine.
Now, I realized early on that I didn’t have a lot of company in this respect, but I didn’t think …
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The lack of socioeconomic diversity in medicine
My father who was a junior doctor in Britain’s National Health Service (NHS) in the seventies would have been grateful for the match scheme, an algorithm that places medical students in residency programs in the U.S. The training in the NHS was unstructured. Physicians carved their own training by joining a patchwork of hospital positions in disparate places.
Over a few years we lived in Yorkshire, East Anglia, Wales, East London …
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The Match: A testament to the genius of central planning
A PubMed query of the phrase “social media” yields 8,747 unique peer-reviewed articles. When the search is refined to “social media medical education” there are 578 articles. When “professionalism” is also added to the search string, there are only 31 article results. This suggests that very few authors are writing about the topic: Approximately 0.4% of the available peer-reviewed literature about social media pertains to how we doctors should use and …
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More medical academic literature is needed on social media
I argue with my father a lot. He works as an intensivist at a community hospital in Indianapolis while I am about to graduate from a highly academic internal medicine program in Chicago. Needless to say, we have very different perspectives.
He sometimes expresses views similar to those written in an article, “When I Was a Resident: How Duty Hour Rules Are Creating a Lost Generation of Physicians.” I started residency the …
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Duty-hour regulations do not define me as a doctor
When I graduated from my residency, far from my current professional home, I wanted to write a book called How Not to Get Yelled At in the Operating Room. Or How to Clear the Fear from Your OR.
I had these titles in mind because I struggled so much during my intern year. It was a tough year, full of intense patient care and sleep deprivation, but the challenge that I most wanted help …
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Reducing the stress of teaching surgical residents
Change causes distress for most people. In medicine we have a hierarchy that disdains most change. Medical students, residents, attending physicians all seemingly reject change. Practicing physicians dislike change. Yet change occurs and is necessary. I learned a great deal about change from my mother. This anecdote may help put change into perspective.
Many years ago, we lived in a 3 bedroom house. In the evening we all sat in the …
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Physicians must be part of the change process
KevinMD.com recently published the article “It’s time to make the Match disappear” written by medical student Amy Ho. I firmly agree with her that the current match system is wildly inefficient and needs fixing. However, she is throwing the baby out with the bath water in abandoning the algorithm which yields an extremely effective system.
Firstly, when one examines her data, which in itself is correct, one also …
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Defending the residency Match and its algorithm
