"Homework" in Residency?

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Alienman52

Alienman52

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Hi all,

Quick question:
Other than call, is a typical resident done for the day upon leaving the hospital? I know for medical students/pre meds the day only really starts when classes end. Do residents essentially get some type of, "homework," after their shifts, or are they free to do as they please until their next shift??


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I read through some of the residency review threads and some programs had mandatory quizzes and didactic portions during the day.
 
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popopopop said:
I read through some of the residency review threads and some programs had mandatory quizzes and didactic portions during the day.
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Gotcha. Just curious to know what I'll be doing when I'm not in the hospital during residency years.


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Alienman52 said:
Gotcha. Just curious to know what I'll be doing when I'm not in the hospital during residency years.


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Click to expand...
You can't diagnose something you've never heard of. You can't work up something you don't know exists. Reading to expand your knowledge and prepare for weekly/daily didactic sessions is essential for developing a competent knowledge base for your future practice. The time for reading is at home, as you don't have the time to read enough in the hospital.
 
SouthernSurgeon said:
"Homework" as in formally assigned? No.

Although I have heard of some programs that do formally assign reading.

However, you do take home a crap load of work. Unfinished notes, presentations that need to be made for teaching conferences, etc.

Plus we all make an effort at least to read since we are all still learning. For surgery in particular reading and watching videos is needed to help prepare for upcoming OR cases.
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This. Becoming a physician means you're committing to becoming a life-long learner. You may not have formal assignments or use textbooks anymore, but you should always be reading up on recent research, looking at new treatment modalities and preventative measures, and refreshing yourself on things you haven't seen in a while or zebras you see but aren't familiar with. It's part of why continuing education hours are required for every field in every state until you decide to retire from medicine or die.
 
I could be mistaken but I believe Derm residency has a major component that is learned through readings outside of clinic. Even though the hospital hours may be fewer than many other programs, a significant chunk of time is usually spent learning even once you "leave work"

I'm sure the Derm people can correct me if I'm wrong
 
PGY-1 Psychiatry resident at a busy program so on service total hours is ~60-80/week including day work and call. You can get through the a few of the big text books in a year reading about 30-60 mis/day. We have weekly 4hr didactics that rarely have associated reading.

I still use the approach I used in med school, namely reading the digital textbook, highlighting as needed and making Anki cards. I use it for remembering psychopharm concepts, drug names and receptors, dosing ranges, basic results of key studies, random facts, etc. We take the Psychiatry Residency In Training Exam (PRITE) every year which most programs including other specialties do something similar. They help prepare for specialty boards, and for better or worse look like Step/Shelf tests.

Big picture though, most residency "learning" is piecemeal, non-formalized, and done in settings that aren't conducive to actually remembering things. I know a lot of residents, for whatever reason (and especially in busy specialties) just don't have time to do reading outside of work and think you can just learn on the job. Especially in psychiatry where you can get away with poor diagnosing/prescribing and therapeutic approaches that are basically just you giving your opinion, without hurting the patient in the here and now. Worse, if you aren't doing outside reading or appraisal/application of what evidence does exist, you end up just miming what your attendings do without learning the underlying reasons. Winging it like that wouldn't work in surgery.
 
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Hah, you're even going to have homework as an attending. It's called CME and maintaining Board certification ever 6-10 years.
 
Dermpire said:
I could be mistaken but I believe Derm residency has a major component that is learned through readings outside of clinic. Even though the hospital hours may be fewer than many other programs, a significant chunk of time is usually spent learning even once you "leave work"

I'm sure the Derm people can correct me if I'm wrong
Click to expand...
I've heard this too, from a derm resident I believe
 
There's plenty of things you'll need to do outside of work in every specialty: paper readings for journal club/ebm, presentations to your program, random modules for your program/hospital/GME department... Plus readings in your main specialty both for your own day to day patient care as well as exposure to things you don't see commonly but will see on the boards.

Overall, it is less homework than m3 year for sure... But it's certainly more than zero.
 
Not an intern yet, but as far as can tell it feels a lot less like work to learn about your chosen field than it did learning for ms 1,2,3.
 
Reading up on new journal articles should be stuff we should be doing day 1 in medial school, and yet we have this archaic backward system that depends on treating outdated books as gospel.
 
sholamd said:
Maybe I shouldn't admit this, but I study hours every night (as a Derm PGY-2). I'm studying only slightly less than I did as a med student. I like to believe I'm doing it for my future patients...
Click to expand...


Of course you can admit it. Derm residency is kinda like starting M1 over again. You are not wrong in saying that most people find the reading/work load similar to the preclinical years. People whine about how derm residents have shorter days (and I admit, this was great to have), but the sheer volume of knowledge in dermatology requires amounts of reading that just don't occur in most other specialties.
 
IslandStyle808 said:
Reading up on new journal articles should be stuff we should be doing day 1 in medial school, and yet we have this archaic backward system that depends on treating outdated books as gospel.
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Med school does need to start with books and not articles. You need a source that puts all the information together in the beginning, and an article that does that is a textbook.
 
hamstergang said:
Med school does need to start with books and not articles. You need a source that puts all the information together in the beginning, and an article that does that is a textbook.
Click to expand...

Correct but they're not teaching you how to evaluate that information, this is something that needs to be emphasized more. Even in masters and Ph.D. programs, they have classes where you are actually evaluating articles which is lacking in medical school.
 
IslandStyle808 said:
Correct but they're not teaching you how to evaluate that information, this is something that needs to be emphasized more. Even in masters and Ph.D. programs, they have classes where you are actually evaluating articles which is lacking in medical school.
Click to expand...

I don't know about your school, but how to evaluate scholarly articles is definitely something we covered in mine.
 
xffan624 said:
I don't know about your school, but how to evaluate scholarly articles is definitely something we covered in mine.
Click to expand...

There are definitely schools where they are doing an excellent job in teaching this skill, I wish it were more uniform across medical schools.
 
IslandStyle808 said:
Reading up on new journal articles should be stuff we should be doing day 1 in medial school, and yet we have this archaic backward system that depends on treating outdated books as gospel.
Click to expand...
Buddy, you gotta walk before you can run. You need to know the base materials before they can be updated. I mean, m1/m2 sometimes have way too much detail on the very basics, but knowing your pathophysiology is what separates you from the NP.

username456789 said:
Of course you can admit it. Derm residency is kinda like starting M1 over again. You are not wrong in saying that most people find the reading/work load similar to the preclinical years. People whine about how derm residents have shorter days (and I admit, this was great to have), but the sheer volume of knowledge in dermatology requires amounts of reading that just don't occur in most other specialties.
Click to expand...

:eyebrow: Because no other specialty requires a breadth of knowledge.

Or maybe they just about all do.

I feel far worse for the general surgery resident that has to learn the pathophysiology and treatment of surgical diseases of most of the body, while working 80 hr weeks, than the derm resident working to memorize an atlas on top of his 30 hour weeks.
 
Raryn said:
Buddy, you gotta walk before you can run. You need to know the base materials before they can be updated. I mean, m1/m2 sometimes have way too much detail on the very basics, but knowing your pathophysiology is what separates you from the NP.
Click to expand...

Yet masters students and doctoral students start evaluating articles along with book studies from the beginning.

I'm not saying you don't need book knowledge or a base. However, to trust that book knowledge too much and not realize its changing is bad. Physicians have wrote books on this topic. I'm stating that evaluation of journal article at an early stage can help some one transition into clinical years and even residency far better. You have professors who will help you in learning to understanding what is the important aspects in reading these article. You can't understand the difference in importance of a randomize clinical control study from a prospective cohort with just a physiology text book. You need to practice this skill by looking at many journal articles, its not something you acquire simply with a text books alone (you need both).
 
Raryn said:
:eyebrow: Because no other specialty requires a breadth of knowledge.

Or maybe they just about all do.

I feel far worse for the general surgery resident that has to learn the pathophysiology and treatment of surgical diseases of most of the body, while working 80 hr weeks, than the derm resident working to memorize an atlas on top of his 30 hour weeks.
Click to expand...


I think you must be replying to the wrong person. The things you're insinuating or pretending I was suggesting were nowhere within my post. Perhaps you clicked on the wrong thread?
 
username456789 said:
I think you must be replying to the wrong person. The things you're insinuating or pretending I was suggesting were nowhere within my post. Perhaps you clicked on the wrong thread?
Click to expand...
You explicitly said " the sheer volume of knowledge in dermatology requires amounts of reading that just don't occur in most other specialties."

My response is that every specialty has a breadth of knowledge, from family medicine to internal medicine to dermatology to ortho. Not sure how it isn't clear.
 
Raryn said:
You explicitly said " the sheer volume of knowledge in dermatology requires amounts of reading that just don't occur in most other specialties."

My response is that every specialty has a breadth of knowledge, from family medicine to internal medicine to dermatology to ortho. Not sure how it isn't clear.
Click to expand...

Again, you're not addressing my point.

Yes, each specialty has a breadth of knowledge.

As is evident by the consults I used to get, dermatology is essentially non-existent in medical education unless you're in dermatology. You pretty much start from scratch in residency, which is absolutely not the case for most specialties.

What I was pointing out is that the amount of outside reading required for dermatology does indeed dwarf most mainline specialties. Similar things could be said with regards to, say, pathology and radiology.

I never suggested we had it harder or that I would have preferred to toil away in the OR for 80 hours a week. Just stating that the amount of time spent reading is in excess of what most other people have to do. Nothing I said in my original post was incorrect, but it seems like your feelings got hurt or something.

Clear for you now?
 
username456789 said:
Again, you're not addressing my point.

Yes, each specialty has a breadth of knowledge.

As is evident by the consults I used to get, dermatology is essentially non-existent in medical education unless you're in dermatology. You pretty much start from scratch in residency, which is absolutely not the case for most specialties.

What I was pointing out is that the amount of outside reading required for dermatology does indeed dwarf most mainline specialties. Similar things could be said with regards to, say, pathology and radiology.

I never suggested we had it harder or that I would have preferred to toil away in the OR for 80 hours a week. Just stating that the amount of time spent reading is in excess of what most other people have to do. Nothing I said in my original post was incorrect, but it seems like your feelings got hurt or something.

Clear for you now?
Click to expand...

I'm picking up what you're putting down. There's a few other specialties that are similar, in fact. I don't think the breadth of derm's knowledge base is appreciated as much as it should be.

OP -
Intern year, for anyone, is about survival initially. A lot of the reading you do at first is on-the-job just so you can get enough of a handle to put in an order that needs to get in. Then it's reading survival guides, or shoreing up the most obvious holes in your knowledge first. Most programs will have noon conference or journal clubs to push you out to where you ultimately want to be, on the forefront surfing the wave of the ever moving tide that is medicine.

Besides reading on the job to survive, I would write down things through the day I wanted to read about later to know more. I'm a very piecemeal type learner though. I would even read on my phone on the John, because, there's never enough hours in the day and no shortage of opportunities to look stupid.

I would read just enough to try to get my job done and get out without violating work hours, and get sleep. Focus on efficiency. The more efficient you are, the more well rested you are, the better able you will be to do all the other things you need to do, and to learn. Then you will be better able to spend the recommended 30-60 min a day of reading to get really good.

I would sign my last order so I wasn't violating hours, but I was the person that frequently sat at a hospital computer as long as I could stand it, because I would do better work there, once I'm home I can't even be ****ed to do emails. That's when I would do emails, read stuff, work on presentations, etc etc. You need to be careful if you do this that you are not signing anything in the EHR beyond your work hours, and you don't want people to see you doing this if they are going to think it's a work hours violation. If you can take your work home with you, more power to you. There's no shortage of it.

Anyone that thinks a resident is going to be reading 2 hours a day AFTER work in an average 60-80 work week is just plain crazy.

OP- I see that you are an accepted student. Hopefully they will pair you up with a primary care preceptor. Just looking at an average doc's desk is enough to give you a clue to the "homework" a doctor has when they aren't actually seeing patients.

Residencies do specific things that are like homework, the "official" side of homework is probably the least you will ever have in your academic career, while the "unofficial" side will be the most.
 
Off the top of my head - some have tests (a lot of them surprise test) , mandatory research, writing academic material (for the attending) , CME and preparing for various exams. These vary by specialty and program.
 
Crayola227 said:
I'm picking up what you're putting down. There's a few other specialties that are similar, in fact. I don't think the breadth of derm's knowledge base is appreciated as much as it should be.

OP -
Intern year, for anyone, is about survival initially. A lot of the reading you do at first is on-the-job just so you can get enough of a handle to put in an order that needs to get in. Then it's reading survival guides, or shoreing up the most obvious holes in your knowledge first. Most programs will have noon conference or journal clubs to push you out to where you ultimately want to be, on the forefront surfing the wave of the ever moving tide that is medicine.

Besides reading on the job to survive, I would write down things through the day I wanted to read about later to know more. I'm a very piecemeal type learner though. I would even read on my phone on the John, because, there's never enough hours in the day and no shortage of opportunities to look stupid.

I would read just enough to try to get my job done and get out without violating work hours, and get sleep. Focus on efficiency. The more efficient you are, the more well rested you are, the better able you will be to do all the other things you need to do, and to learn. Then you will be better able to spend the recommended 30-60 min a day of reading to get really good.

I would sign my last order so I wasn't violating hours, but I was the person that frequently sat at a hospital computer as long as I could stand it, because I would do better work there, once I'm home I can't even be ****ed to do emails. That's when I would do emails, read stuff, work on presentations, etc etc. You need to be careful if you do this that you are not signing anything in the EHR beyond your work hours, and you don't want people to see you doing this if they are going to think it's a work hours violation. If you can take your work home with you, more power to you. There's no shortage of it.

Anyone that thinks a resident is going to be reading 2 hours a day AFTER work in an average 60-80 work week is just plain crazy.

OP- I see that you are an accepted student. Hopefully they will pair you up with a primary care preceptor. Just looking at an average doc's desk is enough to give you a clue to the "homework" a doctor has when they aren't actually seeing patients.

Residencies do specific things that are like homework, the "official" side of homework is probably the least you will ever have in your academic career, while the "unofficial" side will be the most.
Click to expand...

Hey where is a good place to find various intern survival guides
 
Lame. Can we at least talk about how you have some sort of a life in residency (after intern year).
 
IslandStyle808 said:
Correct but they're not teaching you how to evaluate that information, this is something that needs to be emphasized more. Even in masters and Ph.D. programs, they have classes where you are actually evaluating articles which is lacking in medical school.
Click to expand...

We definitely got a 1.5 month long crash course in how to design, interpret, and evaluate studies. I think
 
IslandStyle808 said:
Correct but they're not teaching you how to evaluate that information, this is something that needs to be emphasized more. Even in masters and Ph.D. programs, they have classes where you are actually evaluating articles which is lacking in medical school.
Click to expand...

Imo, this is something all students should be proficient in before getting to medical school. It's not that hard to learn how to evaluate the merit of an article, anyone planning on going to med school should be able to accomplish that during their 4 years of undergrad. There's already so much material to learn in med school, critical thinking shouldn't be something that people already have, not something they're trying to pick up while trying to memorize all the minutiae on the boards.
 
WedgeDawg said:
We definitely got a 1.5 month long crash course in how to design, interpret, and evaluate studies. I think
Click to expand...

Feels too short for me. Should be at least 5-6 months bare minimum, but around 1 hour per week.
 
Stagg737 said:
Imo, this is something all students should be proficient in before getting to medical school. It's not that hard to learn how to evaluate the merit of an article, anyone planning on going to med school should be able to accomplish that during their 4 years of undergrad. There's already so much material to learn in med school, critical thinking shouldn't be something that people already have, not something they're trying to pick up while trying to memorize all the minutiae on the boards.
Click to expand...

I agree it should be a 1 semester requirement for all schools. However, the problem is that you wouldn't know how to integrate the design knowledge with medical knowledge if done separately. I analyzed medical articles in the past (more epidemiological articles) for my stats/epi courses, but I lacked the medical knowledge to make sure I truly understood whether they were good procedures or treatments. For example, a drug that causes an increase in blood pressure as a side effect should not alarm you as much as some one getting a heart attack. Having that understanding of "clinical end points" (points of death and disability) and knowing how to use them in the evaluation of studies is extremely important. Having this all integrated into formal teaching sessions will help students a long way in being self sufficient in analyzing articles.
 
sliceofbread136 said:
Hey where is a good place to find various intern survival guides
Click to expand...

I wrote one, if you SDN search function my name and "intern megapost"

otherwise, I would SDN function the concept

when I started, I was on ICU. So I googled "ICU Survival Guide" until I found one that seemed to address what I needed help with.
Same with wards, ED, etc you get the picture.
 
sliceofbread136 said:
Not an intern yet, but as far as can tell it feels a lot less like work to learn about your chosen field than it did learning for ms 1,2,3.
Click to expand...
The difference is that as an MS 1,2,3 your main goal is to learn the general knowledge needed to be proficient in each field and/or pass Step and shelf exams. Residency requires becoming an expert in your chosen specialty. There is much more reading and studying involved in this than I thought as a med student. Seemingly meaningless information becomes very important as there is no longer some other person to defer knowledge to. What once seemed like minutiae is now information you will be expected to know, because no other specialty may know it, and other attendings in other specialties will now come to you with questions asking for recommendations. Having a basic understanding of something adequate to answer a multiple choice question is far different from knowing something well enough that you are confident in prescribing a new medication, performing an invasive procedure, or giving another physician recommendations on how to manage a patient. While the scope of knowledge needed may be smaller, the depth of knowledge is so much more
 
Alienman52 said:
Hi all,

Quick question:
Other than call, is a typical resident done for the day upon leaving the hospital? I know for medical students/pre meds the day only really starts when classes end. Do residents essentially get some type of, "homework," after their shifts, or are they free to do as they please until their next shift??


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Click to expand...

No, the typical resident is not "done for the day" upon leaving the hospital. Exams are much less frequent than in med school, but they still exist--and doing poorly on them can result in major repercussions. Most residency programs have in-service training exams (ITEs), which are sometimes held once or twice the first year and then yearly thereafter. These are to make sure residents are adequately studying and preparing for board exams. Boards are written and sometimes oral exams that are held during or shortly after the last year of residency. These frequently test a lot of material that you won't simply learn "on the job"--the oddball stuff that can kill patients and you need to know about, but which you might not see a whole lot in real life. You will also be expected to put together presentations for your class, rounds, M&M conferences, etc. And you will likely have to do some research and/or quality improvement projects. The ACGME (the body that regulates residencies) is really big on that stuff as of late. Finally, you will be tasked with the time-consuming job of deciding if you want to do fellowship or go straight into the workforce after residency, and then applying for said fellowships or jobs.

Expect to spend between 5-10 hours per week at home on these outside-the-hospital tasks during residency. Sometimes more and sometimes less depending on if an ITE or board exam is coming up.

Good luck!
 
Last edited:
Dermpire said:
I could be mistaken but I believe Derm residency has a major component that is learned through readings outside of clinic. Even though the hospital hours may be fewer than many other programs, a significant chunk of time is usually spent learning even once you "leave work"

I'm sure the Derm people can correct me if I'm wrong
Click to expand...

This is true of every specialty--even "hands on" fields like surgery, emergency medicine, anesthesiology, etc.

One thing that differentiates physicians from other providers is studying and knowing well the countless "zebras" that you will possibly never see in your career but you need to know about. Those things are frequently learned mostly by reading about them.
 
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