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.
Back in the 1990’s, my husband and I spent a year working at one of the largest hospitals in West Virginia. The patients were the nicest people in the world, and the hospital staff was terrific—kind, generous, and hard working. Some of the surgeons were excellent, but others definitely were not. My husband (a cardiac anesthesiologist) and I had to cope with surgical complications the likes of which we had …
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When is it better for doctors to make mistakes?
Like many of my colleagues, I teach and supervise students, residents, nurses, and respiratory therapists. I’m also the medical director of a PICU. Overall, I’ve been teaching and doing administration for over 30 years. And, like most of my colleagues, I never received any formal instruction at all in how to do these things. To some extent I got help from my own mentors, primarily by watching what they did, …
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Reward or punishment in medical training
I don’t like selecting colleagues through the Match. The process was established to allow students to get the best opportunity available and I feel that our program (and our patients who rely on our trainees to provide care) is in jeopardy every year. It always turns out better than I anticipate, so I shouldn’t complain. However, we have to interview 60 prospective residents to fill our six slots so …
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Advice to prospective family medicine residents
As an MD, nutritious and healthy cooking and eating are very important to me.
We as physicians do not receive adequate training in nutrition, healthy lifestyle choices, and disease prevention in general while in medical school or in residency. On top of that, we work long and difficult hours, often overnight shifts during which we consume processed, fatty foods, void of any nutritious value and we find ourselves suddenly with an …
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Physicians do not receive adequate training in nutrition
Every medical student is a bit apprehensive when he/she knows they will be assigned a new resident. The same questions always come up. Will the resident be nice? Will they understand my busy schedule? Will they make me do a ton of scutwork? Will they make me write all of his/her progress notes? And maybe most importantly, will they let me leave early to study for boards or enjoy the …
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The 3 types of residents that medical students will encounter
I got home recently after a 14 hour day in the operating room with (predictably) a pair of really tired feet, which lead me to think about shoes, foot rubs, and the fact that no one ever talked to me about this in my training.
What kind of shoes should you wear in the hospital?
There’s a lot of walking in the hospital, but there’s even more standing. Running shoes don’t provide …
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What kind of shoes should you wear in the hospital?
The resident’s training can be compared to the one received by Navy Seals or U.S. Marines in many ways. Physical endurance, psychological warfare towards the trainee, long service hours and quick life or death decisions are all aspects of both types of preparation. In most cases, this turns out to be a great burden on the resident’s life, especially on the interns, whose lives have dramatically changed from one day …
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Happy residents do much more for their patients
I sit here today, in this small, windowless call room with its low twin bed that is covered in untouched hospital blankets and sheets. Tonight is one of my last nights on a 30-hour call shift in the medical intensive care unit. Yet another mile-marker on this long journey of residency. My day began at the break of dawn, when I and another resident passed each other in the parking …
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Reduce sedation in critically ill patients
The recently instituted 30-hour-shift work restrictions placed on medical residents have created a need for “dayfloat” services to safeguard potentially unsafe handoffs in patient care and help residents adhere to duty hour limits. The past two weeks I’ve been the dayfloat resident for the cardiology inpatient service. My job is to round with the post-call team, help them get out of the hospital on time, and then take care of their …
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Making tailored health education standard of care
I am a third world doctor.
My patients have first world expectations.
Somewhere in the middle, I end up working too hard and then going home feeling cheated. For I too have expectations. I am in a tension between the reality and my aspirations.
In Jamaica, health care is free. Day after day, and night after night its freeness is confirmed, tested. But the system is inanimate. It doesn’t feel its own failure, …
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First world healthcare expectations in a third world country
I recently admitted a patient with a pulmonary embolism. Before heparin drip was started, my attending ordered a hoard of eccentric, non-indicated hypercoagulable workup in the hope of avoiding the effect of heparin on these test results, including phosphatidylserine antibody and methylenetetrahydrofolate reductase DNA. I watched in horror as the nurse drew out approximately 13 tubes of blood, since each test needs its own tube.
On rounds, the attending of course …
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Useless thought experiments during medical school and residency
The wards had an odd sanguine feeling that day. The large glass pane doors were streaming a glow from the summer outside, and all was right because I had actually managed to have a lunch break. The High Care Ward is where the most intense monitoring is done so that we doctors can observe suffering in slow motion. I can’t remember what brought me there but in the first bed …
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I wish House, MD was here
Dear future practicing physician,
Choose primary care. I know all around you there are pressures to choose to become a specialist. I remember those pressures well. In medical school, one of my favorite mentors was predicting that after I got a taste of primary care, I would “come crawling back” to him. I still chuckle about that conversation to this day. In residency, I remember several seminars for us built …
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Dear future practicing physician, choose primary care
“How are residents supposed to prepare for real life as a surgeon if they can’t even work twenty-four hours straight now?”
I hear this complaint about once a month from a someone trained in the Golden Age of hazing. Outside of anecdote, we’ll never know if surgeons are better trained now or twenty years ago, or fifty. But it’s too painful to imagine every-other-night-call wasn’t of critical importance.
Residency resembles the …
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Can I do residency again in a better rested environment?
Congratulations! You are an amazing group of young men and women. In college, medical school and residency your dedication and discipline, but most of all your idealism helped you to persevere and conquer some difficult challenges. In college, your friends studying philosophy and literature and history wondered how you had the endurance to study biochemistry and organic chemistry and calculus. Not to mention the Krebs Citric Acid Cycle.
You studied hard …
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Inspiration for new primary care doctors
The average week for a medical resident training in Mexico can easily exceed 90 work hours. Mexico is a country that takes pride in offering full health coverage for 100 million citizens. This is a new policy and free public medical care is being pushed to the limit. The situation is simple, the work load in outpatient clinics, operating rooms, the wards and emergency rooms across the country is …
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The life of a medical resident in Mexico
I grew up playing a variety of different organized sports. Looking back now, I notice that no matter what the sport my best performances were always on teams which were led by inspiring coaches. The same could be said about my education, with teachers replacing the coaches. Whether I knew it at the time or not, throughout my life I have had a number of mentors who have brought the …
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The value of a mentor during medical training
Residency is hard. The hours are long, the work is grueling, and, simply put, hospital food is not good. Many days, we, as residents, walk the wards in a lifeless haze – coasting on the wings of our white coats, our fuel tanks pointing way past empty.
During these times, we find ourselves sitting in wheelchairs that are stored in dark remote corners, questioning whether or not all of this is worth it. For years, …
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A reminder of why doctors do what they do
When I completed my overnight shift and left the medical ICU the morning of July 1, I raised my arms victoriously. I uttered, “Finally, internship is done!” I may have been one of the last to speak such words.
As of July 1, 2011, intern year forever changed. In the world of medicine the first year of residency, or intern year, is when doctors earn their stripes. Traditionally it is …
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Work hour restrictions seem painful now, but are a gift
Here’s the scenario. It’s Friday evening. You’ll be back at work on Sunday. You’re sleep deprived because you are a resident. You haven’t spent any quality time with your significant other, friends or family because you haven’t had any real time off. Next week has plenty of call and it would really help if you planned out good food for the week and cooked something. And, by the way, …
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How medical residents should spend their time off
