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.
One of my Physician’s Weekly posts last month was on the subject of surgeons possibly losing proficiency for doing open cases because of the ever-increasing popularity of laparoscopic and other minimally invasive techniques resulting in declining numbers of open operations for residents during their training.
Although some suggested that knowing how to do open cases would be unnecessary in the future, to me that is wishful thinking.
Another commenter said, “We are …
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The problem of fellows in surgical training
Months before my life was upended, a doctor friend tried to explain my forthcoming role in terms I’d understand. “Imagine being on call 24 hours a day, seven days a week,” he said. “You’re in charge of a single patient, but she is needy as hell.”
Medical training prepared me for motherhood in some ways (the assortment of facts blurrily retained from my pediatrics rotation in medical school; the skill, or delusion, …
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Reflections of a new mother in medicine
The dream was that reason, in the form of the arts and sciences, would liberate humanity from scarcity and the caprices of nature, ignorance and superstition, tyranny, and not least of all, the diseases of the body and the spirit.
-Paul Starr, The Social Transformation of American Medicine
In a local bookshop just outside of Boston, a small group made their way to their cherished celebrity bookclub. Tucked away on a foldable chair …
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Putting the humanities back into medicine
Just about thirteen percent of the 100,000 plus resident physicians in the United States are union members — and many more would choose to join if it weren’t for the fierce pressure exerted by some teaching hospitals, chairs and program directors. Although it is illegal to threaten resident physicians with retaliation for expressing their desire to form a union, the law is difficult to enforce. Ought medical educators examine …
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Patients lose when resident physicians are afraid to unionize
When I was an acting medicine intern in Manhattan’s Bellevue Hospital at the turn of the century, all employees who provided the hospital’s “ancillary services” went home between the hours of 5pm and 8am. It was the job of the on-call interns to fill in. If a patient needed a stat blood draw or IV line replacement in the middle of the night, his nurse paged the intern to do it. If …
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How scut work has changed for today’s generation of doctors
When a doctor finishes medical school, he or she then faces what is truly the most difficult part of their journey into becoming a physician: graduate medical education. The goal of internship, residency, and fellowship training programs — what is collectively called graduate medical education, or GME — is to take newly minted doctors, just out of medical school, and turn them into competent physicians, able to practice in their specialty independently. And …
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Why graduate medical education is failing
“What is the one best test?”
A test-taker’s frustration boils over as they read this prompt and think, “in real life we would do all of the above.” And for the most part, they are correct. In the United States, medical trainees are taught for exam purposes to answer the one best test for diagnosis or the one best procedure for management.
However, in practice the same trainees watch our role-models take …
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Medical trainees have access to far too many resources
Let’s talk for a moment about medical education. I went to a work-related party recently and rode in the elevator with a dear friend who is my contemporary, and a more senior and highly regarded faculty member known for her work in medical education. Both were afraid for the future of medical education in different ways.
My contemporary was concerned that the emphasis on the use of advanced technologies like ultrasound …
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Teach caring people how to be caring doctors
Despite recent buzz about shifting resident education to community health centers, hospital based education is here to stay. The model of education, though outmoded, is simple. Get residents exposed to as much disease as possible, in the shortest amount of time. The future of American health care is not in acute management of tertiary care; but in integrated, team-based care. To get there involves focusing not only on educational content, …
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Is deep learning in medical education possible?
Imagine you, like most traditional medical students, went to college for four years to earn an undergraduate degree. Like many, you might also have obtained a graduate degree or worked for a period of time. You then spend time and money fulfilling extracurricular activities, taking the Medical College Admission Test (MCAT), applying to schools and traveling for interviews. If you are part of the lucky minority — roughly 40 percent …
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It’s a fearful time for medical students
This past spring, I went to Dar es Salaam, Tanzania to do an internal medicine elective at Muhimbili University of Health and Allied Sciences. I rotated through two sub-divisions of internal medicine while I was there: infectious disease and cardiology.
The medicine
When I initially stepped onto the infectious disease ward, I saw the janitors mopping the cement floors with soap and water. The ward was crowded and the patients lying on …
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Medicine is a universal language
Recently, I attended the annual AAMC meeting where the question, “What will medical education look like in 2033?” was asked in a session called “Lightyears Beyond Flexner.”
After this thought-provoking session, I too pondered academic medicine’s fate. I would like to share my reflections in this forum.
Without question, technology stood out as a major theme in this conference. And for good reason: clearly it is already permeating every corner of our …
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How technology will revolutionize medical training
As I look back all those years ago to when I chose medicine as a career, I suspect that my motives were similar to most people who enter this wonderful profession. I wanted to become a doctor because I had a genuine and sincere desire to help people. I also liked the idea of a busy and energetic job, one where I was comfortably as far away as possible from …
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The human side of medicine that no computer can ever touch
In my 3 years of residency, the nearly universal resident response to outpatient continuity clinic was a disturbing, guttural groan. I recognize that many aspects of primary care drag down even the most enduring physicians. But I have also found primary care — particularly with a panel of high-risk and complex patients — to be a welcome challenge. I recently spoke with one of my institution’s main advocates for academic primary …
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Primary care suffers from guideline overload
Since the beginning of it all, since that exact moment where I shot up from my friend’s dorm room cot with a revelation to pursue my ancestral calling in medicine, I have been continually questioned by family and friends on exactly where I sit in the totem pole of physicianhood. And I get it. With terms like sub-intern, intern, senior resident and attending, it must be confusing …
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What does it mean to be a medical intern?
I had always thought I could never be a great doctor because I felt too emotionally bound to my patients. It was impossible for me to hold back tears when feeling that gut wrenching empathy for families mourning the passing of their loved ones. Because it always seemed as if I were the only resident moved by these scenes, I reasoned that this was an unprofessional impulse that prevented me …
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Bringing emotions back into medicine
As a resident, probably the most common piece of feedback one receives is, “Read more and expand your clinical knowledge base.” This critique is a standard and generic piece of feedback to encourage the younger generation to never quit in the endless pursuit of knowledge. As our erudite attendings know, medical knowledge always evolves and often reverses course. Thus, the trainee is reminded to establish the habit of keeping up …
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What’s the best way to keep up with medical literature?
Earlier this year, we launched the Teaching Value and Choosing Wisely Competition in conjunction with Costs of Care and the ABIM Foundation. Why a competition? Not surprisingly, traditional “literature review” yielded little by way of promising strategies for educators who wished to learn how to teach about value.
However, we had all learned of isolated stories of success, occasionally through attending professional meetings, sometimes via networking with colleagues, or more …
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Finding the most promising innovations to teach value
