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.
Earlier this year, the physicians at my academic family medicine practice met with two senior officials from our parent health care organization to be oriented to its new initiatives and projects. Their presentation documented the organization’s ongoing investments of many millions of dollars into renovating subspecialty care suites and purchasing new radiology equipment that was likely to be highly profitable, but provide dubious benefits to patients.
Two of my colleagues asked …
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We are spending billions to train the wrong kind of doctors
It is unfortunate, but now medicine is on the clock. We now must not only battle disease, but we must also battle time. Physicians are asked to do more in less time. Innovations such as EMR (which in theory are supposed to increase efficiency) sometimes actually slow clinical practice to a halt.
Additionally, ongoing debate exists as to how best train medical residents and prepare them for the practice of medicine. …
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Medicine is on the clock: An unfortunate reality
Nearly twelve years ago, Major League Baseball’s Cleveland Indians were losing to the Seattle Mariners 14-2 in the 6th inning. Cleveland, who were fighting off the resurgent Minnesota Twins and the pesky Chicago White Sox in a tight division race, were playing against a Mariners team that would finish the season tied for the most wins ever in a single season. Despite the seemingly insurmountable lead, Cleveland came back to win …
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As residency begins, always remember there is hope in medicine
An interesting conversation recently took place among residency program directors in my field of internal medicine.
At issue was the declining pass rate of first-time test takers of the ABIM Certification Exam.
It’s a mouthful to say, but the ABIM exam is the ultimate accolade for internists. One is only eligible to take the exam after having successfully completed a three-year residency training period (the part that includes “internship,” right after medical …
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Declining board exam pass rates: Blame millennial doctors?
While everyone has heard the old adage about not getting sick in July because of new interns, the truth is that new interns nationwide have started already. Yet, you don’t hear much about the “late June effect?”
So is the July effect overblown or true? Well, there have been many studies – so many so there was a recent systematic review co-authored by one of my own co-interns a long time ago. …
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The July effect: Welcome to the summer of supervision
On July 1st, four years ago, I walked through Massachusetts General and Brigham and Women’s Hospitals with an odd mixture of fear, relief, and excitement. Now, as I leave the hospital after my last shift of emergency medicine residency training, I am filled with a similar hodgepodge of emotions and reflections.
1. “You were terrified of being a doctor!” I mentioned this article to the attending who oversaw my first shift as …
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Reflections after 4 years of emergency medicine training
I have been spending time at an academic medical center lately and I’m noticing some obvious flaws in our method of shaping the doctors of the future.
When I went to medical school I was trained by physicians who were eminent in their areas of specialty and also did some research. They taught in classrooms and as attending physicians when we were working on the wards as doctors in training. I …
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How should we be training the next generation of doctors?
I overheard nurses praising the pilot of a new technology with the promise of improving communication, safety, and saving on healthcare spending. The innovation: two-way texting. That’s one of the many indicators that hospitals are stuck the technological stone age.
Imagine how many eyes light up when you offer providers fewer logins, autopopulating forms, and uncluttered menus. There’s an assumption that technology, in the context of healthcare, has to be bad …
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Why EMR companies don’t care about usability
Do you report it to your supervisors? Go to the police? Go to a rape crisis center? Or would you try to carry on the next day because you are the only one who has certain duties that need to be done? Or do you keep quiet because you are afraid of the negative publicity and treatment that might befall you, your department, and your medical center?
This is not an …
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Imagine being raped by your senior resident: What would you do?
At a recent faculty meeting, we learned that the first year residents in anesthesia will now have to take and pass a written exam at the end of their first year. They will have a certain number of tries and if a resident can’t pass it by the third try they’re either out of the program or held back in some way.
Now, it used to be when I was a baby …
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No anesthesia resident left behind
Let’s get one thing clear from the start: I love nurses. My grandmother was a nurse’s aide. My aunt is a nurse. My mother is a nurse. Nurses have been by my side for the most frightening and important experiences in my life (in the hospital and out). However, I’m not a nurse. I’m a doctor. And when someone calls me …
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Thanks for the compliment, but I’m not a nurse
During my ambulatory care rotation, I got the opportunity to tag along with my attending on a house call to a geriatric couple. The husband, “Joe,” had recently been in the hospital for severe respiratory illness. His wife, “Sally,” had recently fallen and broken her hip and was recovering from a hip replacement.
While my attending checked on Sally, he advised me to talk to Joe. We chatted a while about …
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Why medical residents should do house calls
When I was a fourth-year medical student in 2002, I signed up for an intense sub-internship rotation in family medicine. My goals for this rotation were two-fold: first, I wanted to make sure that I was ready for intern year and, second, I needed a good letter of recommendation to match into a good family medicine residency program.
On this rotation, I was essentially treated like the other interns. I had …
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Limiting resident work hours: Patients remain our utmost priority
Jennifer was one of my first patients as a new doctor, and she came to see me about an unintended pregnancy. A single mom to a rambunctious 5-year-old girl, Jennifer was struggling economically and battling depression. We talked about the options available to her: continuing the pregnancy and preparing to parent another child, offering the baby for adoption or having an abortion. She chose to continue with the pregnancy, and …
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Family medicine residents need to learn reproductive healthcare
One Saturday morning at the Salt Lake City Veterans Affairs Medical Center, I got out of a call room bed and realized I had done it. The year everyone dreads, the year everyone says, “you just need to get through” was finally over. I had completed my write-ups on all the patients I admitted overnight. My emergency room consultation requests had been seen. I checked my pager for missed pages: …
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One morning I woke up and I wasn’t an intern anymore
If you’ve read my reviews of the new medical TV show Monday Mornings, you’ll know I’ve been critical of many things about it. I was particularly disappointed with the way the show handled one of its central themes: the morbidity and mortality (M&M) conference.
I thought it might be useful to tell you how most real M&M conferences are run. M&M conferences generally take place at hospitals with residency training …
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What really happens in a morbidity and mortality conference
The fight for equality for lesbian, gay, bisexual, and transgender citizens has been a long and storied one. We have fought for rights related to family, marriage, anti-discrimination and service to our country. We have reveled in the freedom to be openly ourselves in public and have cheered as the fight for equality became a priority not only for ourselves but also for our straight allies. As Rhode Island recently …
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LGBT health care equality: Be your patient’s advocate
