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.
“Are you more or less cynical than when you started residency?”
This was the question my program director asked our senior internal medicine residents at a recent dinner with Dr. Bob Wachter. If you aren’t familiar with Dr. Wachter, he is widely acclaimed as the “father of hospital medicine” and a renowned champion of patient safety and quality. His blog, Wachter’s World, is chock full of insightful commentary on the American health …
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Residents need to feel empowered by their hospitals
A newly minted physician, one who has just graduated from medical school, is not yet ready (or licensed) to practice medicine. The next phase in medical training is called residency, a 3 to 5 year span of time during which the new doctor is given teaching, supervision, and increasingly allowed to function independently in his or her chosen specialty.
Since 2003 residents have been limited to working 80 hours per week, averaged over …
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Are today’s newly graduated residents ready to practice medicine?
Congratulations, student doctor, you studied hard and scored well on your exams — not only on your MCAT but in your organic chemistry classes as well. You mastered anatomy as well as pharmacology, neurology and more “ologies” than you care to remember. Now it is time to get hands-on learning experience, without being able to hide in the library while preparing for your clerkship shelf exams or showcasing your talents …
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It’s time to reverse the standardized patient experience
Becoming a doctor takes time, but those outside of medicine do not always realize how convoluted the process can be. Central to the perversion is the National Resident Matching Program (or “the Match”).
After college and the two years of classroom-based training in medical school, students are ushered into clinical training through third year core rotations in predetermined specialties. In the spring of their third year, students must decide on their …
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It’s time to make the Match disappear
A year ago in a post about law school applications decreasing, I speculated about whether a similar phenomenon would occur with medical schools.
In that post, I commented on the impending problem of too many medical school graduates and not enough residency training positions. I cited an article that appeared in the New England Journal of Medicine in 2011 in which the CEO of the Accreditation Council for Graduate Medical Education …
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The residency chances of offshore medical school graduates
One of my biggest pet peeves is taking over the care of a floor full of complicated patients without any explanation of their current conditions or plan of care from the physician who most recently treated them. Absent or inadequate verbal and written “handoffs” of patient care are alarmingly common in my experience. I work primarily as a locum tenens physician, traveling across the country to “cover” for my peers on vacation …
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How to fix the problem of patient handoffs
In my transition from pure learner (i.e., the med student role) to teacher-learner (i.e., the attending), I’ve actually found myself focusing more on the learner than the teacher part of my dual existence. Strong learning seems to be requisite to strong teaching, and I am realizing that succeeding on the next level requires some extra meta-cognition, that is, learning to learn in new ways.
Learning to unlearn
In med school, learners amass an …
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Teaching doctors: Learning to learn in new ways
Over the years I have strived to develop my bedside manner. On rounds many learners comment on this aspect of my doctoring, and these comments have led to much self reflection. This commentary may convince some readers that I have the answers, but I do not. Sometimes I do very well, but sometimes my skills fall short. I do try to connect with patients and families, and give them confidence, …
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Developing bedside manner comes from understanding who the patient is
Picture this.
You walk into your doctor’s office for an urgent visit for new distressing symptoms. He (or she) takes your blood pressure, temperature, heart rate. All within normal limits. He asks you several questions pertaining to your symptoms, does a thorough exam and perhaps orders a quick in-office lab or two. You ask him what he thinks is going on.
The quandary
If it’s a slam dunk diagnosis, the branch point in …
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Do patients have a right to know their doctor’s uncertainty?
What do you do when your ideal residency program does not exist? This is a truth that all perspective applicants must come to terms with, but I was still hoping that I would be the exception. I had created my list of everything my top family medicine program must have, including strong research mentorship, dedicated faculty, and a welcoming resident environment, and I had an idea going into the interview season what …
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Choosing a perfect residency: What goes into a rank list
Match Day: It’s among the most memorable moments of medical school, a time when students, friends, family and faculty gather to open those coveted white envelopes. It’s the symbolic first step out of medical school and into residency, and a tradition that is beloved by many. Yet the matching process is viewed by those outside of the medical profession (and to some within it) as a very odd way to …
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Is Match Day outdated?
More than a century of American medical history was turned on its ear recently by the announcement that the groups that accredit medical residencies will unify their standards. Don’t be too hard on yourself if you failed to understand the significance (or notice at all). But this should be viewed as good news across the land. As someone who trains doctors from both traditions, I certainly welcome a more level playing field.
First, …
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The merging of MDs and DOs: A unification of training standards
On Twitter a while ago, a medical student asked me how surgical program directors select new residents. Then a discussion arose among some academic surgeons on the same topic. Someone suggested that medical school grades were the best way to tell whether an applicant would be a successful resident.
The fact is that we aren’t really sure what the best way to choose residents is.
First, here’s what we really do.
A 2011 Read more…
What is the best way to choose residents?
The past few months I have joined thousands of individuals hoping to match into a residency program in 2014. I have had interviews all over the country and spent way too much time living out of a suitcase.
For many students, residency interview season is exciting. For others, it’s stressful and exhausting. But for me, more than anything else, the interview trail was inspiring.
I am currently applying to internal medicine-primary care …
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The bottleneck in ensuring sufficient primary care physicians
“A new roadmap for improving residents’ professional skills was released Tuesday by the Accreditation Council for Graduate Medical Education (ACGME)” begins the press release.
As I dove into this announcement a bit further, I discovered the origins of this initiative outlined in this executive summary published by the ACGME on the “CLER Program:”
The Accreditation Council for Graduate Medical Education (ACGME) recognizes the public’s need for a physician workforce capable of meeting the challenges of …
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Does the ACGME serve the needs of tomorrow’s physicians?
Here’s a question I’m almost afraid to ask: when you go to a doctor (not one you see all the time), does the doctor usually introduce himself (or herself) and explain what they are there to do?
And, do they sit down?
I really hope that you are answering yes … but I know that the answer is often no.
In a study recently published in the Journal of Hospital Medicine, researchers observed 29 …
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What to do if your doctor isn’t polite
Recently, our residency program had the excellent fortune of hosting Dr. Bob Wachter as a visiting speaker. Dr. Wachter is considered a pioneer in the hospitalist movement and has built his career around inpatient quality and safety. During lunch with Dr. Wachter, some of our residents, and hospitalist faculty, we discussed the topic of resident autonomy in the hospital.
In the glory days of residency, I imagine that house officers experienced …
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Will resident autonomy disappear completely in the future?
In the past 84 days, I have traveled to eleven different cities, been left stranded in two unfamiliar airports by cancelled flights, met approximately 124 new people and briefly recited the more interesting parts of my life story far too many times to count — all for the purpose of matching to a residency program in March. Exhausting doesn’t come close to summing it up.
And yet, this process has also …
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Why I am grateful for Match Day
Recently, I had the fortune of hearing the tale of Bob and his bum knee.
It all started when Bob picked me up at the end of a busy clinic day in his neon orange Subaru. Given that this particular shared car service promotes friendly conversation, Bob started up the gab by asking me what position I held in the medical center. After describing my work as a …
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Declining care from physicians in training
During my year as a chief resident, I have the privilege to attend on the general medicine service for 8 weeks. I recently completed 4 weeks and, as expected, found myself in an entirely new realm of patient care and accountability. I would be remiss without recalling a few of the pivotal lessons and poignant moments that stand out.
Transitioning from resident to attending inevitably results in greater scrutiny. Despite my best …
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The transition from chief resident to attending
