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.
Giving and receiving feedback is really hard. When I left training and joined the faculty at a major medical school last year I found many things about my new position daunting. Fitting into a well established practice; learning a new system; being a teacher; juggling different services and roles; billing appropriately; and last but not least, giving feedback.
Psychological and logistical hurdles make it challenging to deliver feedback. Constructively criticizing the …
“That makes no sense!” a friend recently blurted out to me after I finished helping her understand how the vast majority of internal medicine residents are trained in this country. Her incredulousness was less about the “how,” and more about the “where.”
No doubt. When you consider that the overwhelming majority of practitioners will ultimately be practicing almost exclusively in the outpatient environment, and that cost-conscious healthcare reform efforts are specifically …
As the sun rises in hospitals across the nation, medical interns start their age old ritual of rounding and examining patients. While the old guard may feel that paper and pens are being replaced by impersonal interactions of mouse clicks and scrolling through the electronic medical records; the essence of the intern experience remains the same.
It is a year filled with a roller coaster of highs and lows which adds …
When I was growing up in the 1960s, at the height of the Cold War, there was always some smart aleck boy on the playground who had “facts” to share about the Soviets. His recitation was meant to emphasize how weird, how different, how other our arch enemies were. “They make you wear all brown and gray there.” “They eat only boiled cabbage and potatoes.” “They tell you what to …
I’ve been a family medicine residency faculty member for nearly 5 years, and I’ve come to observe the yearly cycle of a residency over that time. Reminding myself of that cycle helps me weather and celebrate the peculiarities of each time of year.
July-September: Adjustment
Every resident’s role changes on July 1. For the first-years, it’s their first day of being called “doctor.” Second- and third-year …
Recently, I was having a discussion with a colleague about being a doctor. She confided in me that if someone asked her about becoming a doctor, she would tell him or her to become a nurse practitioner. After reading the emotional open letter to our policymakers in Washington DC, it may sound like a reasonable suggestion. After all, why go into this much debt and spend …
The practice of medicine is based on a solid fund of knowledge and a physician’s ability to quickly assimilate and organize information during a patient encounter. However, the process of making a diagnosis and formulating a treatment plan is not always straightforward. Often, what separates the truly exceptional physicians from the rest is the ability to attack problems from alternative angles–more simply put, creativity.
Traditionally, medical education is centered around science. …
I don’t know about you, but this article made me feel more than ever that in order to choose the right specialty, you have to predict the future of the field. Don’t choose a field that’s going to be heavily affected …
It’s that time of year when third year medical students are grappling with anxiety as they prepare their residency applications. Those uncertain feelings of ambivalence can only be assuaged by a successful “match.” Critical to recruitment committees, but often overlooked by students, are the influential personal statements.
Everybody coming out of medical school has a long list of accomplishments and abilities. The competition is steep. A powerful narrative has the potential to …
I can remember making rounds with a seasoned surgical attending in medical school. In typical fashion, surgical rounds were a lot like the military. The “General” (attending physician) at the front, always commanding respect (and often fear) followed by the chief resident, junior residents, interns and finally medical students. Cases were presented, statuses were updated and plans were formulated. Then came the barrage of medical fact questions–mostly directed at the …
Columbus gets the credit, but in 240 BC, Eratosthenes of Cyrene discovered that the earth was round. In 1990, the Hubbell telescope proved that the universe is expanding. In the 21st century we know that the world is round but with the Internet and smart phones, it feels small and flat. With ease of travel and technology, all aspects of modern life have changed, including medical science, practice, and education.
At a time when one in three Americans report difficulty paying medical bills, up to $750 billion is being spent on care that does not help patients become healthier. Although physicians are routinely required to manage expensive resources, traditional medical training offers few opportunities to learn how to deliver the highest quality care at the lowest possible cost. While the gap is glaring the problem is not new.
Once again, medical schools continue their annual fraudulent and misleading statistics in regards to primary care workforce production. The Dean’s Lie is back and rampant across the country. It only seems to get worse.
Al Franken, the humorist-turned-senator, once published a book that was titled “Oh, the Things I Know!” Indeed, by the time we reach parenthood, it is truly amazing what we keep up there in that attic of a brain.
Here is a brief selection of things about the practice of medicine that I have had to discover for myself or never quite figured out, including clinical pearls, aphorisms, dictums, platitudes, mysteries and …
The problem of medical resident work-hours has vexed medical educators for decades. The traditional model of sleep-deprived residents led to highly publicized medical mistakes, most famously the Libby Zion case in 1984.
Nobody wants tired doctors caring for them.
In response, various restrictions have been placed on how many hours medical residents are allowed to work. Since 2011, for instance, medical residents were …
I just took step three of the national board exams – the final in a series that all U.S. physicians must pass to practice medicine unsupervised. The two day exam, composed of multiple choice questions and simulated patient cases requiring free-text answers, brought up subjects that we haven’t thought about since medical school (Sick children? Terrifying.) The test also shed some light into how doctors think under pressure and why reigning …
A resident is a person who has an MD, meaning they have completed 4 years of school, but they are not yet qualified to actually do anything. An MD is just a piece of paper saying you did your time in the lecture hall/lab. Residency is where you learn how to be a doctor. The term “resident” originates from the old days in which newly-minted doctors were actually living at …
I’m told every doctor has their list of unsolved patient mysteries. Those patients where something terribly awful or something miraculous happens for which you lay awake at night trying to understand. The nature of doctors is to want solve problems and figure out medical mysteries in sleuth-like Sherlock Holmes fashion. It’s these unsolved mysteries that you remember as they perplex you for days, weeks, possibly years after.
Since the days of Sir William Osler, medical education has been done in much the same way by everyone everywhere. Doctors and academics slave away for hours and hours preparing lectures for students and trainees, all the while being locked away in their own isolated little silos. An anthropologist from Mars (to borrow an image from Temple Grandin made famous by Oliver Sacks) would find this remarkable. Could it really …
Being a single mother in medical school and residency isn’t a piece of cake. But, being a single parent in this world isn’t a piece of cake, either, and being a medical student and / or resident isn’t a piece of cake. Foregoing medical school isn’t necessarily the answer to any of that.
Here is some general advice I will share with parents, single or otherwise, who are facing decisions about …
