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Residency is a stage of postgraduate medical training certification in a primary care or referral specialty. It is filled by a resident physician who has received a medical degree (M.D. or D.O.) and is composed almost entirely of the care of hospitalized or clinic patients, mostly with direct supervision by more senior physicians. A residency may follow the internship year or include the internship year as the first year of residency. The residency can also be followed by a fellowship, during which the physician is trained in a sub-specialty. Image File history File links Gnome-globe. ... Medical education is education related to the practice of being a medical practitioner, either the initial training to become a doctor or further training thereafter. ... The Medicinæ Doctor or Doctor of Medicine (M.D. or D.M.) is a doctorate level degree held by medical doctors. ... The Medicinæ Doctor or Doctor of Medicine (M.D. or D.M.) is a doctorate level degree held by medical doctors. ... Osteopathy is the body of medicine that originally used strictly manipulative techniques for correcting somatic abnormalities thought to cause disease and inhibit recovery. ... For the record label, see Hospital Records. ... A medical intern, in the context of medical education in the United States, is a historical term for a physician in training who has completed medical school, passed step two of the USMLE or COMLEX-USA, and is undergoing his or her first year of post-graduate training (PGY1). ... A fellowship is the period of medical training that a physician may undertake after completing a residency. ...

Whereas medical school gives doctors a broad range of medical knowledge, basic clinical skills, and limited experience practicing medicine, medical residency gives in-depth training within a specific branch of medicine. A doctor may choose a residency in anesthesiology, dermatology, emergency medicine, family medicine, internal medicine, neurology, obstetrics and gynecology, pathology, pediatric medicine, psychiatry, physical medicine and rehabilitation, radiology, radiation oncology, general surgery, or other specialties. The field of surgery has several specialties such as neurosurgery, orthopaedics, otolaryngology, ophthalmology, and urology. Texas Tech University Health Sciences Center in Lubbock, Texas, USA. A medical school or faculty of medicine is a tertiary educational institution or part of such an institution that teaches medicine. ... Anesthesia (AE), also anaesthesia (BE), is the process of blocking the perception of pain and other sensations. ... Dermatology (from Greek δερμα, skin) is a branch of medicine dealing with the skin and its appendages (hair, ass, sweat glands etc). ... This article or section does not adequately cite its references or sources. ... A general practitioner (GP) or family physician (FP) is a physician who provides primary care. ... Doctors of internal medicine (internists) are medical specialists who focus on adult medicine and have had special study and training focusing on the prevention and treatment of adult diseases. ... Neurology is a branch of medicine dealing with disorders of the nervous system. ... Obstetrics and gynaecology (often abbreviated Ob-Gyn in the US and O&G elsewhere) form a single medical specialty and have a combined postgraduate training program. ... A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... This article is about the branch of medicine. ... Psychiatry is a branch of medicine dealing with the prevention, assessment, diagnosis, treatment, and rehabilitation of the mind and mental illness. ... Physical medicine and rehabilitation (PM&R) or physiatry is a branch of medicine dealing with functional restoration of a person affected by physical disability. ... Image A: A normal chest X-ray. ... Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ... A surgeon operating General surgery, despite its name, is a surgical specialty that focuses on surgical treatment of abdominal organs, e. ... “Surgeon” redirects here. ... Insertion of an electrode during neurosurgery for Parkinsons disease. ... Orthopedic surgery or orthopedics (BE: orthopaedics) is the branch of surgery concerned with acute, chronic, traumatic and recurrent injuries and other disorders of the locomotor system, its musclular and bone parts. ... Otolaryngology is the branch of medicine that specializes in the diagnosis and treatment of ear, nose, throat, and head & neck disorders. ... This article is about the branch of medicine. ... This article or section is in need of attention from an expert on the subject. ...

In North America it leads to eligibility for board certification. North America North America is a continent[1] in the Earths northern hemisphere and (chiefly) western hemisphere. ... Please wikify (format) this article as suggested in the Guide to layout and the Manual of Style. ...

Terminology

A resident physician is more commonly referred to as a resident, or alternatively as a house officer. Residents have graduated from an accredited medical school and hold either an M.D. or D.O. The residents collectively are the house staff of a hospital. This term comes from the fact that resident physicians traditionally lived the majority of their lives "in house," i.e. the hospital. Duration of most residencies can range from three years [mostly for primary care residencies] to more than seven years for a specialized field such as neurosurgery. A year in residency begins on July 1 and ends on June 30 the following calendar year. A first-year resident is often termed an intern. Depending on the number of years a specialty requires, the term junior resident refers to residents that have not completed half their residency. Senior residents are residents in their final year of residency. Some residency programs refer to residents in their final year as chief residents (often in surgical fields). Alternatively, a chief resident may describe a resident who has been selected to extend his or her residency by one year and supervise the activities and training of the other residents (typically in internal medicine). Post-residency physicians are referred to as attending physicians or attendings. A medical intern, in the context of medical education in the United States, is a historical term for a physician in training who has completed medical school, passed step two of the USMLE or COMLEX-USA, and is undergoing his or her first year of post-graduate training (PGY1). ... An attending physician has completed residency and practises medicine in a hospital, often focusing on the speciality learned during residency. ...

History

Residencies as an opportunity for advanced training in a medical or surgical specialty evolved in the late 19th century from brief and less formal programs for extra training in a special area of interest. They became formalized and institutionalized for the principal specialties in the early 20th century, but even in mid-century, residency was not seen as necessary for general practice and only a minority of primary care physicians participated. By the end of the 20th century in North America, very few new doctors go directly from medical school into independent, unsupervised medical practice, and more state and provincial governments are requiring one or more years of postgraduate training for medical licensure. Alternative meaning: Nineteenth Century (periodical) (18th century — 19th century — 20th century — more centuries) As a means of recording the passage of time, the 19th century was that century which lasted from 1801-1900 in the sense of the Gregorian calendar. ... (19th century - 20th century - 21st century - more centuries) Decades: 1900s 1910s 1920s 1930s 1940s 1950s 1960s 1970s 1980s 1990s As a means of recording the passage of time, the 20th century was that century which lasted from 1901–2000 in the sense of the Gregorian calendar (1900–1999... In most countries, only persons licensed by specified government-approved professional associations are allowed to practice medicine. ...

Residencies are traditionally hospital-based and in the middle of the twentieth century, residents would often live in hospital-supplied housing. "Call" (night duty in the hospital) was sometimes as frequent as every second or third night for up to three years. Pay was minimal beyond room, board, and laundry services. It was assumed that most young men and women training as physicians had few obligations outside of medical training at that stage of their careers.

The first year of practical patient-care-oriented training after medical school has long been termed internship. Even as late as the middle of the twentieth century, most physicians went into primary care practice after a year of internship. Residencies were separate from internship, often served at different hospitals, and only a minority of physicians served them.

Europe

United States

In some of the United States, doctors can obtain a general medical license after completing one year of internship. Many residents have medical licenses and do legally practice medicine without supervision ("moonlight") in settings such as urgent care centers and rural hospitals. However, in all residency-related medical settings, residents are supervised by attending physicians who must approve their decision-making.

Matching

Access to graduate medical training programs such as residencies is a competitive process known as "the Match." Senior medical students usually begin the application process at the beginning of their (usually) fourth and final year in medical school. After they apply to programs, programs review applications and invite selected candidates for interviews held between October and February. After the interview period is over, students submit a "rank-order list" to a centralized matching service (currently the National Residency Matching Program, abbreviated NRMP) by February. Similarly, residency programs submit a list of their preferred applicants in rank order to this same service. The process is blinded, so neither applicant nor program will see each other's list. This article or section does not adequately cite its references or sources. ...

The two parties' lists are combined by an NRMP computer, which (theoretically) creates optimal matches of residents to programs using an algorithm. On the third Thursday of March each year ("Match Day") these results are announced in Match Day ceremonies at the nation's 125 U.S. medical schools. By entering the Match system, applicants are contractually obligated to go to the residency program at the institution to which they were matched. In mathematics, the stable marriage problem (SMP) is as follows: Given n men and n women, where each person has ranked all members of the opposite sex with a unique number between 1 and n in order of preference, marry the men and women off such that there are no...

On the Monday prior to Match Day, candidates find out from the NRMP if (not where) they matched. If they have matched, they must wait until the Match Day (Thursday) to find out where. If they have not secured a position through the Match, the locations of remaining unfilled residency positions are released to unmatched applicants the following day. These applicants are given the opportunity to contact the programs about the open positions. This is what is known as "The scramble." This frantic, loosely structured system forces soon-to-be medical school graduates to choose programs not on their original Match list. Occasionally and unfortunately, this sometimes requires students to choose entirely new specialties. The scramble is widely considered to be an unfavorable and highly stressful way of obtaining a residency position.

Inevitably, there will be discrepancies between the preferences of the student and programs. Students may be matched to programs very low on their rank list, especially in the competitive specialties like dermatology, ophthalmology, orthopedics, radiology, and radiation oncology. Dermatology (from Greek δερμα, skin) is a branch of medicine dealing with the skin and its appendages (hair, ass, sweat glands etc). ... This article is about the branch of medicine. ... Orthopedic surgery or orthopedics (BE: orthopaedics) is the branch of surgery concerned with acute, chronic, traumatic and recurrent injuries and other disorders of the locomotor system, its musclular and bone parts. ... Image A: A normal chest X-ray. ... Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ...

A similar but separate osteopathic match exists which announces its results in February, before the NRMP. Osteopathic physicians (D.O.s) may participate in either match, filling either traditionally allopathic (M.D.) positions accredited by the Accreditation Council for Graduate Medical Education (A.C.G.M.E.), or osteopathic positions accredited by the American Osteopathic Association (A.O.A.). The word physician should not be confused with physicist, which means a scientist in the area of physics. ... Osteopathy is the body of medicine that originally used strictly manipulative techniques for correcting somatic abnormalities thought to cause disease and inhibit recovery. ... Allopathic medicine is the name given by Samuel Hahnemann, the founder of homeopathy, to the methods of his medical foes. ... The Medicinæ Doctor or Doctor of Medicine (M.D. or D.M.) is a doctorate level degree held by medical doctors. ... The ACGME or Accreditation Council for Graduate Medical Education is the body responsible for the accreditation for postgraduate medical training programs (i. ... American Osteopathic Association Founded in 1898 in Kirksville, MO, the American Osteopathic Association (AOA) is the representative organization for osteopathic physicians in the United States. ...

Further information: Comparison of allopathic and osteopathic residency training

In 2000-2004 the matching process was attacked as anti-competitive by class-action lawyers. See, e.g., Jung v. Association of American Medical Colleges et al., 300 F.Supp.2d 119 (D.D.C. 2004). Congress reacted by requiring that antitrust cases cannot make this argument. See Pension Funding Equity Act of 2004 § 207, Pub. L. No. 108-218, 118 Stat. 596 (2004) (codified at 15 U.S.C. § 37b). Osteopathic medicine Doctor of Osteopathic Medicine (D.O.) A.T. Still, M.D. (founder) Schools · Physicians Medicine · US Medical education Osteopathic Manipulative Medicine AOA · Licensure · AACOM Allopathic & Osteopathic Medicine § Comparison § History Index · Wiki Project This box:      This article discusses similarities and differences between allopathic and osteopathic medicine. ... Anti-competitive practices are business or government practices that prevent and/or reduce competition in a market. ... This article or section does not adequately cite its references or sources. ... // The United States Reports, the official reporter of the Supreme Court of the United States Case citation is the system used in common law countries such as the United States, England and Wales, Ireland, Canada, New Zealand, Hong Kong, Australia and India to uniquely identify the location of past court... The United States District Court for the District of Columbia is the United States District Court that hears cases originating in the District of Columbia under Federal law. ... This article is about anti-competitive business behavior. ... Title 15 of the United States Code outlines the role of the commerce and trade in the United States Code. ...

The USMLE score is just one of many factors considered by residency programs in selecting applicants. The median USMLE Step 1 scores for graduates of U.S. Medical Schools for various residencies are charted in Figure 4 on page 11 of "Charting Outcomes in the Match" available at http://www.nrmp.org/matchoutcomes.pdf

History of long hours

Medical residencies traditionally require lengthy hours of their trainees. Early residents literally resided at the hospitals, often working in unpaid positions during their education. During this time, a resident might always be "on call" or share that duty with just one other doctor. More recently, 36-hour shifts were separated by 12 hours of rest, during 100+ hour weeks. The American public, and the medical education establishment, recognized that such long hours were counter-productive, since sleep deprivation increases rates of medical errors. This was noted in a landmark study on the effects of sleep deprivation and error rate in an intensive care unit.^[1] The Accreditation Council for Graduate Medical Education (ACGME) has limited the number of work-hours to 80 hours weekly, overnight call frequency to no more than one overnight every third day, 30 hour maximum straight shift, and 10 hours off between shifts. While these limits are voluntary, adherence has been mandated for the purposes of accreditation. Sleep deprivation is a general lack of the necessary amount of sleep. ... See also preventable medical errors In the United States medical error is estimated to result in 44,000 to 98,000 unnecessary deaths and 1,000,000 excess injuries each year. ... The ACGME or Accreditation Council for Graduate Medical Education is the body responsible for the accreditation for postgraduate medical training programs (i. ...

Critics of long residency hours trace the problem to the fact that resident physicians have no alternatives to positions that are offered, meaning residents must accept all conditions of employment, including very long work hours, and that they must also, in many cases, contend with poor supervision.[2] This process, they contend, reduces the competitive pressures on hospitals, resulting in low salaries and long, unsafe work hours.

Graduates of the old system (100+ hour work-weeks) postulate that shorter work hours may lead to residents gaining less clinical experience. Whether this will be reflected in numbers of procedures performed, patients seen, competitiveness in job placement and/or other tangible outcomes measures is yet to be seen.

Some of the clinical work traditionally performed by residents has been shifted to non-physician personnel. This may include some of the non-patient care facets of medicine typically referred to as "scut work."

Adoption of an 80 hour work week

Regulatory and legislative attempts at limiting medical resident work hours have been proposed, but have yet to attain passage. Class action litigation on behalf of the 200,000 medical residents in the US has been another route taken to resolve the matter.

Dr. Richard Corlin, president of the American Medical Association, has called for re-evaluation of the training process, declaring "We need to take a look again at the issue of why the resident is there."[3] The American Medical Association (AMA) is the largest association of medical doctors in the United States. ...

The U.S. Occupational Safety and Health Administration (OSHA) rejected a petition seeking to restrict medical resident work hours, opting to rely on standards adopted by ACGME, a private trade association that represents and accredits residency programs.[4] On July 1, 2003, the ACGME instituted standards for all accredited residency programs, limiting the work week to 80 hours/wk averaged over a period of four weeks. These standards have been voluntarily adopted by residency programs. OSHA logo The United States Occupational Safety and Health Administration (OSHA) is an agency of the United States Department of Labor. ... Year 2003 (MMIII) was a common year starting on Wednesday of the Gregorian calendar. ...

On November 1, 2002, the 80-hour work limit went into effect in residencies accredited by the American Osteopathic Association (AOA). The decision also mandates that interns and residents in AOA-approved programs may not work in excess of 24 consecutive hours exclusive of morning and noon educational programs. It does allow up to six hours for inpatient and outpatient continuity and transfer of care. However, interns and residents may not assume responsibility for a new patient after 24 hours.

Though re-accreditation may be negatively impacted and accreditation suspended or withdrawn for program non-compliance, the amount of hours worked by residents still varies widely between specialties and individual programs. Some programs have no self-policing mechanisms in place to prevent 100+ hour work-weeks while others require residents to self-report hours.

Criticisms of limiting the work week include disruptions in continuity of care and limiting training gained through involvement in patient care.^[5]

Changes in postgraduate medical training

Many changes have occurred in postgraduate medical training in the last fifty years:

1. Nearly all doctors now serve a residency after graduation from medical school. In many states, full licensure for unrestricted practice is not available until graduation from a residency program. Residency is now considered desirable preparation for primary care (what used to be called "general practice").
2. While physicians who graduate from osteopathic medical schools complete a one-year rotating clinical internship prior to applying for residency, the internship has been subsumed into residency for allopathic physicians. It is now uncommon for an allopathic physician to take a year of internship before entering a residency, and the first year of residency training is now considered equivalent to an internship for most legal purposes. Certain specialties, such as ophthalmology, radiology, anesthesiology, and dermatology, still require prospective residents to complete a separate internship year, prior to starting their residency program training.
3. The number of separate residencies has proliferated and there are now dozens. For many years the principal traditional residencies included internal medicine, gynecology, pediatrics, general surgery, ophthalmology, orthopaedics, neurosurgery, otolaryngology, urology, physical medicine and rehabilitation, and psychiatry.
4. Pay has increased, but residency compensation continues to be considered an educational stipend and is not sufficient as a "living wage". Additionally, few residents live in hospital-supplied housing anymore, but unlike most attending physicians (that is, those who are not residents), they do not take call from home; they are usually expected to remain in the hospital for the entire shift.
5. Call hours have been greatly restricted. In July of 2003, strict rules went into effect for all residency programs in the US, known to residents as the "work hours rules". Among other things, these rules limited a resident to no more than 80 hours of work in a week, no more than 30 hours at a stretch (with no new patients in the last six), and call no more often than every third night. In-house call for most residents these days is typically one night in four; surgery and obstetrics residents are more likely to have one in three call. A few decades ago, in-house call every third night or every other night was the standard.
6. For many specialties an increasing proportion of the training time is spent in outpatient clinics rather than on inpatient care. Since in-house call is usually greatly reduced or absent on these outpatient rotations, this also contributes to the overall decrease in the total number of on-call hours.

References

1. ^ Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT, Lilly CM, Stone PH, Lockley SW, Bates DW, Czeisler CA (2004). "Effect of reducing interns' work hours on serious medical errors in intensive care units". N Engl J Med 351 (18): 1838-48. PMID 15509817. 
2. ^ Drazen JM (2004). "Awake and informed". N Engl J Med 351 (18): 1884. PMID 15509822. 

See also

• Foreign medical graduate
• Physician training
• Post graduate year annotation (PGY)
• Postdoctoral researcher
• Validation of foreign studies and degrees

A “foreign medical graduate” or FMG is defined as “an individual whom has graduated from a medical school, not within the United States, and whom has qualified to practice medicine in a foreign state. ... For other uses, see Doctor. ... PGY, short for post-graduate year, is a numerical scheme denoting the duration of residency of medical residents and house officers in North America. ... A postdoctoral appointment (colloquially, a post-doc) is a temporary research position held by a person who has completed his or her doctoral studies. ... Validation can be total or partial validation of foreign university and non-university studies and degrees. ...

External links and sources

• Match anti-trust suit dismissal
• The Accreditation Council for Graduate Medical Education in the United States
• The American Osteopathic Association Accreditation for osteopathic residency
• FindArticles.com - 'Medical education's dirtiest secret - use of medical residents', Humanist, M.H. Klaiman (November-December, 2003)