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.
An excerpt from Top 5 Questions to Ask Your Doctor
by Sagar Nigwekar, MD and James Sutton, RPA-C
Tips for Talking to Your Doctor
Entering a doctor’s office can be like entering a different world. There are often “rules” and “protocols” that the doctor, nurses, and staff follow that you may not be familiar with. This book offers some very helpful questions for you to have an intelligent conversation with …
I received a wonderful inquisitive e-mail from a 1st year medical student. He aspires to an academic internal medicine career and, as a non-traditional student with an MPH, has realistic goals. He asks:
What scares me is the prospect of going into a relatively low-paying specialty in such a non-lucrative practice environment with such massive educational debt. Are there any other challenges to going into internal medicine that are unique to …
People like us, who believe in physics, know that the distinction between past, present, and future is only a stubbornly persistent illusion.
– Albert Einstein
The surgical case is delayed for ten minutes and I am getting restless. I anticipate a very difficult dissection. The cancer has returned after extensive prior treatment with surgery, chemotherapy and radiation. I have enlisted additional help to make certain that everything goes as smoothly as possible. …
I’ve just finished a month “on-service” as a teaching attending for a general medicine team here at GlassHospital. This means I served as the physician of record for every patient admitted to the team.
You might find it interesting to know that patients admitted to the hospital’s general medicine service get assigned to their teams by random assortment. Since there are five teams, one team takes call every fifth day. …
An audiobook except from Intern: A Doctor’s Initiation, now available for download on iTunes.
Intern: A Doctor’s Initiation — Click to play audioclip
by Sandeep Jauhar, MD
Chapter one
I had been an intern less than an hour, and already I was running late. The sloping footpath leading up to the hospital was paved with gray cobblestones. My feet ached as my oversize leather …
My husband and I recently traveled to Wuhan Medical School in the Hubei Province in central China.
Our medical school has partnered with Wuhan to help inform their curricular reform efforts. We spent 4 days touring the hospitals and teaching facilities, meeting students and faculty, going on rounds, and giving talks. Although the language barrier was challenging, we had incredible translators who worked to translate every slide we spoke …
I have met several women who have completed residency and maybe even practiced beyond that, but decide to quit and stay at home with kids. I wonder – why would a woman who has gone through all of that training just quit? It would seem like the hard part is behind them and I am perplexed by their decision but, of course, I …
In the early 90s, I had the privilege of directing UCSF’s exceptional internal medicine residency program. It was a time of transition. A decade earlier, residency accreditation requirements (dictated by the Accreditation Council for Graduate Medical Education, ACGME) were fairly benign and largely ignored – marquee programs like ours were generally given carte blanche to organize our residents’ experience as we saw fit.
Since the Accreditation Council for Graduate Medical Education (ACGME) instituted its Outcome Project approximately 10 years ago, residency training programs have progressively focused on how well their residents have acquired knowledge, skills and attitudes in six broad domains. These “general competencies” include medical knowledge, patient …
Q. I just found out last week that I’ll be a new mom in November, making me an official mother in medicine! I’ve been reading the blog for a while, because I love hearing what all of you have to say about your lives. Here’s my question: What tips would you give for surviving residency while pregnant, especially 30-hour calls (without caffeine)?
Dr. Carolyn Clancy, head of the Agency of Healthcare Research and Quality, recently highlighted the definite need for enhanced patient safety and training on healthcare IT for residents who will be the practicing docs of the future.
At the very end, she compared the future of residency training to James Cameron’s Avatar – an epic battle followed by enlightenment.
Because I am a huge science fiction fan and working in graduate medical …
When I make rounds with my students and interns, I always try to sneak in a poem at the end. I think poetry is important because it helps convey the parts of the medical experience that don’t make it into textbooks. It’s important because it teaches creative thinking—something of immense value to doctors.
It’s important because interpreting metaphors is a critical clinical skill in diagnosis; patients’ symptoms often present in metaphorical …
Anyone affiliated with a teaching hospital knows that the controversy regarding resident work hours is heating up again. It’s been over 5 years since the ACGME limited resident hours to 80 hours per week with a maximum of 30 consecutive hours. While this may not sound like ‘reform’, as someone who trained prior to these rules, it is definitely a change.
More recently, the Institute of Medicine issued a …
From time to time, I hear a “mature” person lament the sad state of affairs of the “next generation.” Sometimes I wonder whether the same concern should apply to the next generation of doctors.
I was at a cardiology meeting, and my schedule included a breakfast program. As I headed toward the meeting, I …
by Emily P. Walker, MedPage Today Washington Correspondent
More that a year after the Institute of Medicine (IOM) issued a report calling for mandatory naps for medical residents, the organization responsible for implementing — or rejecting — the IOM’s controversial recommendation has yet to make a decision.
The Accreditation Council for Graduate Medical Education (ACGME), which has …
In December 2008 the Institute of Medicine (IOM) released its report entitled “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety,” in which it proposed a number of changes to the current regulations developed and enforced by the …
Early last year, my boss Talmadge King and I were at an ABIM meeting (we’re both on the board), and the group was debating a controversial topic. Another participant at the meeting, like Talmadge the chair of a prominent department of medicine, said, “We polled 250 people at our grand rounds last week, and they said ‘X’.” The audience gasped – ‘X’ was a completely unexpected …
At times of calendar transitions, e.g., at the onset of a new year or a new decade, the popular press often takes a broad view in looking retrospectively at the outstanding or defining events and people of the past …
On my last day of ward attending, I handed out an EKG that resembled the Dow Jones industrial average over the last 10 years (not pictured). The normal pattern of an EKG was completely disrupted: ST segments were markedly elevated, P waves were hidden, and beats were grouped in odd patterns. My medical team laughed and shook their heads.
I asked why.
A brave intern responded that he was completely at a …
by Crystal Phend, MedPage Today Senior Staff Writer
Limiting surgical residents’ work hours has compromised both surgical education and patient safety, according to an analysis concluding that an 80-hour work week isn’t enough.
The maximum 80-work week imposed in the U.S. for residents is too little to provide mastery in surgery, Gretchen Purcell Jackson, MD, PhD, and John L. Tarpley, MD, …
I had been an intern less than an hour, and already I was running late. The sloping footpath leading up to the hospital was paved with gray cobblestones. My feet ached as my oversize leather …
