Stupid Questions Thread

[Messerschmitts]

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I thought I'd start a thread for people with "stupid" questions that they're a bit embarassed to ask because they feel it shows their profound ignorance about the medical field/application process, etc. However, we're all busy people, and I think it's inevitable that there'll be some gap in your knowledge/understanding of things, just by accident.

I'll start with my own stupid question: What's the deal with interns and residents? I thought after graduating from medical school, you go into a residency programme and become a resident. However, I've recently discovered there's something called an intern, which is below a resident. From what I've pieced together from TV medical dramas, the pecking order seems to be:
Dept. chief (?)> Attending physician > resident > intern > med students doing clerkships

What's the deal with this? Also, what's the difference between a regular, practising physician and an "attending"? Is an attending just a doctor who teaches in a teaching hospital?

Stupid Question #2: What do surgeons do when they need to use the bathroom? Do they have to "scrub out", go to the bathroom, then decontaminate and come back in? Or is there some "other" solution?

 

[ND2005]

I'll start with my own stupid question: What's the deal with interns and residents? I thought after graduating from medical school, you go into a residency programme and become a resident. However, I've recently discovered there's something called an intern, which is below a resident. From what I've pieced together from TV medical dramas, the pecking order seems to be:
Dept. chief (?)> Attending physician > resident > intern > med students doing clerkships

What's the deal with this? Also, what's the difference between a regular, practising physician and an "attending"? Is an attending just a doctor who teaches in a teaching hospital?

Stupid Question #2: What do surgeons do when they need to use the bathroom? Do they have to "scrub out", go to the bathroom, then decontaminate and come back in? Or is there some "other" solution?

#1: Depending on the program, some residencies require you to do a 1 year internship before starting the actual residency (eg doing a 1 year general surgery internship before starting an ortho residency)

#2: Well...urine is sterile...

 

[Messerschmitts]

#1: Depending on the program, some residencies require you to do a 1 year internship before starting the actual residency (eg doing a 1 year general surgery internship before starting an ortho residency)

Actually that's what I thought, but that would mean those people on Grey's Anatomy, for example, should be done with their internship by next season, assuming the show intends to maintain some semblance of accuracy?

Btw, we're both accepted at UCinn, cool!

 

[ND2005]

Actually that's what I thought, but that would mean those people on Grey's Anatomy, for example, should be done with their internship by next season, assuming the show intends to maintain some semblance of accuracy?

Btw, we're both accepted at UCinn, cool!

I was kind of wondering that with Grey's as I wrote. They should actually be done with their internships by now, I would think (we're in season 2).

Scrubs took care of that problem by having the interns do their internships at the same hospital as their residencies.

 

[gdbaby]

Oooo! I've got one:

1. What are electives all about in medical school? I thought you went to classes for two years, then you did clerkships for two years. Where do these electives fit in?

BTW: I didn't get into Cinncinati (didn't apply either) but I still think you're cool.

 

[drmota]

what if the hokie pokie IS what its all about?
-mota

 

[Rafa]

1. I've got one. What are the lengths of terms in med school? Is it the same as undergrad (September-December, January-May), or are students expected to stay throughout the summer/etc?

2. One more. What's the most stressful part of the first year of med school?

 

[Messerschmitts]

Scrubs took care of that problem by having the interns do their internships at the same hospital as their residencies.

Emergency medicine requires an internship before the residency programme? That's news to me!

BTW: I didn't get into Cinncinati (didn't apply either) but I still think you're cool.

Ha ha, what're you talking about, gdbaby? You got into UI Carver, way cool! Well, with the exception that they don't let you apply for in-state tuition after the first year. But other than that, very cool indeed. I interviewed at Carver and got put into the final pool decisions. 🙁

As for electives, I'm not sure, but I think certain schools (like UCSD) has blocks of time where you don't have any classes and can be used for free study, research, or taking one of the elective classes like "medical Spanish" or "medical Mandarin".

Later when you're doing your clerkships, most med schools have it so that in the fourth year you've got like a month or two of unscheduled time. The required core clerkships only take up about ~1.5 years, not the full 2 years of your third and fourth year. This is for you to travel around the country interviewing for residencies, but also I think a lot of schools require you to pick a few "optional" clerkships to do during the unscheduled time. I don't know about other schools, but I know at UCinn for example, Emergency Medicine is an elective. It's not part of the core clerkships, and you can skip it if you choose some other clerkship for your electives. I'm definitely doing the EM elective though, since that's one of my main interests. Things like Anesthesiology and Neuro-whatever are usually electives at most schools. Things like IM, Peds, and OB/GYN are generally part of the required core clerkships.

If I'm off my rocker, someone correct me!

 

[gdbaby]

Hope to see you all at Carver. We'll rock the MERF down!

Okay, question #2: So, I am interested in geriatrics. Sometimes that is under IM, sometimes FM. When do you do geriatrics? Is that in a fellowship? In my residency, do I just refuse to treat people until they show me an AARP card?

 

[pseudoknot]

Emergency medicine requires an internship before the residency programme? That's news to me!

There are three types of EM residencies:
1-4 (four years, all integrated in the same program: no separate internship)
1-3 (three years, as above)
2-4 (four years total, but this time only three EM years with a separate intern year required)

By far the most common is the 1-3 model. Some of the oldest and best known EM programs are 1-4 though (Denver, Highland).

As for electives, I'm not sure,

Most med schools don't have electives in the preclinical years, or in the third year (when the core clerkships are done, generally medicine, surgery, pediatrics, OB/GYN, psych, and I'm sure I'm forgetting something). The fourth year is mostly or all elective at almost all schools. Sometimes there will be specific requirements or selectives (frequently a sub-internship). There is also typically a lot (2+ months) of vacation time available in fourth year. You can also schedule rotations at other hospitals as electives.

 

[JimmyG]

Hope to see you all at Carver. We'll rock the MERF down!

Okay, question #2: So, I am interested in geriatrics. Sometimes that is under IM, sometimes FM. When do you do geriatrics? Is that in a fellowship? In my residency, do I just refuse to treat people until they show me an AARP card?

When I have told people that I want to be a geriatrician, they all give me a blank stare 😱 with that look in their eyes like, you serious? So it's nice that I'm not the only one wanting to go into geriatrics..

What I have learned is that you can go into EITHER IM or FM and then, yes, do a fellowship in geriatric medicine. But, don't quote me on that....

Or you could just refuse to treat people who DON'T have Medicare. (That's a change ) Then they don't have to try to find that card...

 

[diosa428]

I think that an "intern" is generally a first year resident. Most specialties don't require an actual intern year (ie - general medicine), but the first years still may be called interns (ie - "Intern Blues" is about first year pediatric residents).

Most schools offer electives in the fourth year, some offer elective time in the third year. They are useful for the following reasons:
1. You can rotate through anything you want (for example, if you're interested in something you did not rotate through during your third year).
2. Most schools will let you do "away" rotations at other schools - if you're interested in a particular place for residency, you can rotate there as a sort of "audition".
3. Most schools will let you do international electives during this time.
4. Some schools will also let you do research as an elective.

 

[gdbaby]

When I have told people that I want to be a geriatrician, they all give me a blank stare 😱 with that look in their eyes like, you serious? So it's nice that I'm not the only one wanting to go into geriatrics..

What I have learned is that you can go into EITHER IM or FM and then, yes, do a fellowship in geriatric medicine. But, don't quote me on that....

Or you could just refuse to treat people who DON'T have Medicare. (That's a change ) Then they don't have to try to find that card...

HA! Good to meet another future geriatrician. When I was at Creighton and told my student interviewer that I wanted to go into geriatrics, he smiled and said he recently read a journal study that stated Geriatric Internal medicine physicians had the highest career satisfaction across the specialties.

Thanks for the info about when I finally get to get my hands on some old people. Ewwww, that didn't sound good.

 

[JimmyG]

HA! Good to meet another future geriatrician. When I was at Creighton and told my student interviewer that I wanted to go into geriatrics, he smiled and said he recently read a journal study that stated Geriatric Internal medicine physicians had the highest career satisfaction across the specialties.
Thanks for the info about when I finally get to get my hands on some old people. Ewwww, that didn't sound good.

That is very interesting...and great to know!

 

[ND2005]

Emergency medicine requires an internship before the residency programme? That's news to me!

For the record, the characters on Scrubs aren't in emergency medicine.

JD and Eliot are internalists, working in the ICU. They are now attendings.

Turk is general surgery. He's in the last year of his residency.

 

[gdbaby]

That is very interesting...and great to know!

Last comment hijacking the thread. Here is a link to the article. The web format sucks and the American Geriatrics Society may have a better version.

http://archinte.ama-assn.org/cgi/content/full/162/14/1577

 

[Law2Doc]

I think that an "intern" is generally a first year resident. Most specialties don't require an actual intern year (ie - general medicine), but the first years still may be called interns (ie - "Intern Blues" is about first year pediatric residents).

"Intern" is largely historical. At one time not too long ago, all med school graduates did a year of internship in general medicine before specializing. So everyone's first year of residency was called the internship year. After that year, you would start your residency in your actual specialty. These days, in most fields, you basically start your residency from day one (as seen on Grey's Anatomy), although I think for some (IM, etc.) you end up doing exactly what you would have as an intern.

 

[Messerschmitts]

So is Grey's Anatomy just being stupid in depicting the gang as still being "interns" for 2 years now?

 

[Law2Doc]

So is Grey's Anatomy just being stupid in depicting the gang as still being "interns" for 2 years now?

I don't really watch the show. Did they bring in a new batch of residents below them? If not, there are bigger problems with the hierarchy than the mere titles.

 

[Zoom-Zoom]

"Intern" is largely historical. At one time not too long ago, all med school graduates did a year of internship in general medicine before specializing. So everyone's first year of residency was called the internship year. After that year, you would start your residency in your actual specialty. These days, in most fields, you basically start your residency from day one (as seen on Grey's Anatomy), although I think for some (IM, etc.) you end up doing exactly what you would have as an intern.

While we are on this topic, what the heck is a "preliminary" year?

 

[snobored18]

On the intern, resident, fellow theme...transition years...do these folks have to go through the match again after the transition year or do they already have a residency...I've never understood this and been way to lazy to look it up myself, but it would be interesting to hear since it would be a good way to look at match lists.

 

[diosa428]

On the intern, resident, fellow theme...transition years...do these folks have to go through the match again after the transition year or do they already have a residency...I've never understood this and been way to lazy to look it up myself, but it would be interesting to hear since it would be a good way to look at match lists.

If you're going into a specialty that requires a prelim year, you apply for both the prelim year and the subsequent residency at the same time. However, my guess is that some people may only match into a prelim program (or end up scrambling and getting one). I don't really know what happens to them.

 

[snobored18]

If you're going into a specialty that requires a prelim year, you apply for both the prelim year and the subsequent residency at the same time. However, my guess is that some people may only match into a prelim program (or end up scrambling and getting one). I don't really know what happens to them.

yeah these are the folks im interested in because you will often see someone who has a prelim year at X hospital and then continues to Y college of medicine for Z specialty...but those folks who have only transitions what happens to them is a mystery to me...and all I know is I want to go to a school that this doesn't happen to many people (preferably no one)...I mean I suppose it could just be someone who refuses to give up on that super competive specialty but it could also be someone that no residency director would take...it will be interesting to hear the answer

 

[snobored18]

Note to self SDN hates the mac...stupid double post

 

[happydays]

Pardon my ignorance, but here goes:

Q: Do some med students do a fellowship instead of a residency? How does someone know if they want to do a residency or a fellowship? What is a fellowship? Are you on the same order as a resident, and how long is it? How many fellowships do people do?

Q: Does a resident have to take certifying exams? If so, how often are we going to need to take these tests and when do we take them (after or during residency)?

Q: Are you paid the same as an intern, resident, and fellow?

 

[SuzieQ3417]

Pardon my ignorance, but here goes:

Q: Do some med students do a fellowship instead of a residency? How does someone know if they want to do a residency or a fellowship? What is a fellowship? Are you on the same order as a resident, and how long is it? How many fellowships do people do?

Q: Does a resident have to take certifying exams? If so, how often are we going to need to take these tests and when do we take them (after or during residency)?

Q: Are you paid the same as an intern, resident, and fellow?

Ok, not sure if I can accurately answer your questions, but I'll try my hand.

1. I am under the impression that fellowships occur after a residency. For example, if you want to specialize within a specialty (say derm - pathology), then you do a fellowship. I interviewed with someone in this field and they told me that a lot of people end up just stopping after residency and before fellowships because they get tired of making next to nothing and are ready to settle into a career finally.

2. I know if you want to be board certified there are certain qualifications/exams you must meet. Not sure if they're required, though. Probably varies by specialty.

3. I think you get paid a little more the higher you climb the ladder, but in relation to my answer to question 1 I don't think the amount a fellow makes is significantly higher than that of a resident (someone correct me if I am wrong please)

 

[diosa428]

Pardon my ignorance, but here goes:

Q: Do some med students do a fellowship instead of a residency? How does someone know if they want to do a residency or a fellowship? What is a fellowship? Are you on the same order as a resident, and how long is it? How many fellowships do people do?

Q: Does a resident have to take certifying exams? If so, how often are we going to need to take these tests and when do we take them (after or during residency)?

Q: Are you paid the same as an intern, resident, and fellow?

I only know the answers to the first and third questions:
#1 - You do a fellowship after your residency, if you want to specialize. So for example, you do an internal medicine residency and then specialize in cardiology, gastroenterology, infectious disease, etc. Fellowships last a few years, but I think it depends upon the specialty.

#3 - Usually your pay increases for each year of your residency - so 1st year you make $42,000, 2nd year you make $44,000, etc. I'm not sure how much fellows make.

 

[Rafa]

1. I've got one. What are the lengths of terms in med school? Is it the same as undergrad (September-December, January-May), or are students expected to stay throughout the summer/etc?

2. One more. What's the most stressful part of the first year of med school?

 

[SuzieQ3417]

1. I've got one. What are the lengths of terms in med school? Is it the same as undergrad (September-December, January-May), or are students expected to stay throughout the summer/etc?

Depends on the school....traditional curriculums usually have a 2 month summer break, and a 2-week or so winter break (at least between the first and second year, not sure about the rest though). Other schools, such as Duke for example, have a unique curriculum so the breaks are moved around a little and shorter.

 

[Messerschmitts]

I've got yet another one: Do you take pen-and-paper exams during your third and fourth year clerkships in medical school? Are there textbooks and assigned readings during the clerkships?

 

[superkiwi]

i have a question: is there a date when schools stop interviewing? (is it usually may?) 😕

thanks!

 

[CA_1134]

Hope to see you all at Carver. We'll rock the MERF down!
QUOTE]

GO IOWA!! I love to see it. I have an undergrad class at the MERF.

 

[mantraman1010]

what if the hokie pokie IS what its all about?
-mota

Then that what it REALLY IS all about,
therefore we should all be doing the hokie pokie as if it were needed to stay alive....imagine that....

 

[DF38]

Great thread! I was wondering about that whole intern thing too.

Here's another question:
I need to get some shadowing experience, but I don't have any relatives, family friends, etc. who are doctors. The only doctors I know are the ones in the family practice that I go to. Could I ask them? And how does shadowing a family practice doc work? I feel like shadowing a surgeon or something would be less awkward since it's in a hospital, while these doctors are in a private practice where they usually meet with patients one on one. Anyone have any experiences or words or wisdom?

 

[ND2005]

Great thread! I was wondering about that whole intern thing too.

Here's another question:
I need to get some shadowing experience, but I don't have any relatives, family friends, etc. who are doctors. The only doctors I know are the ones in the family practice that I go to. Could I ask them? And how does shadowing a family practice doc work? I feel like shadowing a surgeon or something would be less awkward since it's in a hospital, while these doctors are in a private practice where they usually meet with patients one on one. Anyone have any experiences or words or wisdom?

I would consider not just shadowing your family practice doc, but asking that person for advice/help.

Generally speaking, doctors know lots of doctors. They could probably introduce you to some specialists who would be willing to let you shadow them.

 

[gbbdoc]

how does medical insurance work for residents? they don't have to pay their own, but rather are covered by the residency program/hospital, right? I can't see someone making what a resident makes being able to pay for the insurance that allows them to practice medicine.

 

[cosmo]

What is the difference between nuclear medicine/radiology/interventional radiology? I think interventional does the procedures, but what? Upper GIs and the like?

 

[tigress]

how does medical insurance work for residents? they don't have to pay their own, but rather are covered by the residency program/hospital, right? I can't see someone making what a resident makes being able to pay for the insurance that allows them to practice medicine.

Yeah, the residency programs cover it. Well, if what you mean is malpractice and all that. As far as medical insurance, like personal coverage, it varies from place to place. Some residency programs cover it completely, others require personal input, and as far as dependents the rules vary also. That's actually one cool thing you can see if you search for residencies using FREIDA.

As far as being licensed in a specialty, I think (but I'm not sure) you have to re-license (re-take the exam) every 10 years for most specialties. It used to be you didn't have to do this; my uncle got grandfathered in, and doesn't have to, but my other uncle does have to.

Exams during 3rd and 4th year: most schools (it seems) have what are called shelf exams (sp?), which you take after each rotation. I actually don't know if these are pencil and paper or computerized or what. Not all schools use them, but they're standardized so I guess it's an easy way to evaluate students. There are usually textbooks available for each rotation type, but I'm not sure what most people do for studying. You can probably check the clinical rotations forum to find out more about that.

I'm sure I have plenty of questions of my own. This is a great thread. I'll post when I can think of my questions 🙂

 

[amand0r]

What about insurance during medical school? do all schools require you to purchase their own "brand"?

 

[Messerschmitts]

There seem to be more questions than answers. 🙁 Maybe I should have posted this on the allo thread instead. (Bunch of bumbling premeds tripping over each other in the dark)

 

[CSLITO]

I have a quick question. What Out of California schools are California resident friendly?
If there is a forum out there that can answer my question any help pointing me in the right direction will be greatly appreciated.

 

[RxnMan]

Great thread! I was wondering about that whole intern thing too.

Here's another question:
I need to get some shadowing experience, but I don't have any relatives, family friends, etc. who are doctors. The only doctors I know are the ones in the family practice that I go to. Could I ask them? And how does shadowing a family practice doc work? I feel like shadowing a surgeon or something would be less awkward since it's in a hospital, while these doctors are in a private practice where they usually meet with patients one on one. Anyone have any experiences or words or wisdom?

I set up a shadowing program for my school. I had contacts, but you don't need them - just talk to your family practice docs. They may know people that are willing to have kids shadow them. Your local teaching hospital is a great place to go to as well. Those docs are used to med student, residents, and fellows following them (if you're in a University hospital, you're probably also a teacher,) so ask around in the departments. I've never offended anybody by asking, so just go out there and make some calls or meet them in person.

 

[RxnMan]

i have a question: is there a date when schools stop interviewing? (is it usually may?) 😕

thanks!

I think there are a couple of other SDN threads that cover this. Most stop in late March, but some go through April. Depending on waitlist movement, some will accept folks well into August.

 

[RxnMan]

Pardon my ignorance, but here goes:

Q: Do some med students do a fellowship instead of a residency? How does someone know if they want to do a residency or a fellowship? What is a fellowship? Are you on the same order as a resident, and how long is it? How many fellowships do people do?

Q: Does a resident have to take certifying exams? If so, how often are we going to need to take these tests and when do we take them (after or during residency)?

Q: Are you paid the same as an intern, resident, and fellow?

On fellowships, you need to board-certified or board-eligible in order to apply for most of these, which means you have to have completed an appropriate residency. IM is the feeder residency for most fellowships: a pulmonologist has gone through a 3-year residency in IM, followed by a 3-year pulmonology fellowship, during which she/he has taken and passed the boards in IM. During this time you may act as an attending (defined as someone who has been through a residency and runs the department for the shift). General surgery residents also feed into fellowships to further specialize (like Cardiothoracic Surgery). To my knowledge, resident pay (including intern/PGY1/prelim year/etc) increases yearly from 40K to ~50K, increasing 10K to 20K as a fellow.

 

[tigress]

What about insurance during medical school? do all schools require you to purchase their own "brand"?

As far as I can tell, most schools just require you to have some kind of insurance. If you're married, for example, and you think you can better or cheaper coverage through your spouse, you can usually use that as your coverage and skip the school's. But the great thing about school coverage is that it's generally very good, and not too expensive. Right now my husband gets as good or better coverage through school than I do through work (in some ways its equivalent, in other ways -- such as not needing referrals -- it's better).

 

[RxnMan]

What's the deal with this? Also, what's the difference between a regular, practising physician and an "attending"? Is an attending just a doctor who teaches in a teaching hospital?

An attending is the guy in charge of the clinical operations of that department for that shift. He's responsible for all of the residents and physicians in that department under him during that time. The department chief is more responsible for the administrative (hiring, firing, etc.) aspects of the department.

A practicing physician could have two meanings. One is that they have a practice, i.e., their own company, outside of a hospital, where they see patients. The other is that their license is up-to-date and they see patients

Stupid Question #2: What do surgeons do when they need to use the bathroom? Do they have to "scrub out", go to the bathroom, then decontaminate and come back in? Or is there some "other" solution?

Nope. They hold it. Many I know work (intentionally) dehydrated to make this easier.

 

[tigress]

On fellowships, you need to board-certified or board-eligible in order to apply for most of these, which means you have to have completed an appropriate residency. IM is the feeder residency for most fellowships: a pulmonologist has gone through a 3-year residency in IM, followed by a 3-year pulmonology fellowship, during which she/he has taken and passed the boards in IM. During this time you may act as an attending (defined as someone who has been through a residency and runs the department for the shift). General surgery residents also feed into fellowships to further specialize (like Cardiothoracic Surgery). To my knowledge, resident pay (including intern/PGY1/prelim year/etc) increases yearly from 40K to ~50K, increasing 10K to 20K as a fellow.

Don't you generally apply to fellowships in the second year of your residency? And then you go straight after the residency. I'm pretty sure that's how it works in general, although lots of people also follow different routes and apply to fellowships later.

I mentioned it before, but FREIDA is the best resource to find more info on resident and fellow salaries. It does differ a bit from region to region. It's looked to me like the resident salaries usually start between $35-$42k and go up to $40-45k, with fellowship pay increasing accordingly.

 

[RxnMan]

Don't you generally apply to fellowships in the second year of your residency? And then you go straight after the residency. I'm pretty sure that's how it works in general, although lots of people also follow different routes and apply to fellowships later.

I know nothing about the application cycle for fellowships. It could very well be a year-long process, which for IM residents, would be during their PGY-2.

 

[Law2Doc]

1. I've got one. What are the lengths of terms in med school? Is it the same as undergrad (September-December, January-May), or are students expected to stay throughout the summer/etc?

2. One more. What's the most stressful part of the first year of med school?

Med school terms vary as widely as snowflakes. Depends whether you are on a block system or not. At some places there is no semblance of semesters. However they spread it out, you end up taking the same courses between August and May. You have a realtively free summer after first year, which a significant percentage of folks spend doing research or other health related jobs or travel. The second summer you have the boards, and so it's basically not an "off" summer. I don't think you really have a summer break after that... for the rest of your life. The most stressful part of med school is the pace.

 

[McMD]

Pardon my ignorance, but here goes:

Q: Do some med students do a fellowship instead of a residency? How does someone know if they want to do a residency or a fellowship? What is a fellowship? Are you on the same order as a resident, and how long is it? How many fellowships do people do?

Q: Does a resident have to take certifying exams? If so, how often are we going to need to take these tests and when do we take them (after or during residency)?

Q: Are you paid the same as an intern, resident, and fellow?

#1: First you do a residency followed by an optional fellowship. Say if you wanted to be an anesthesiologist, you could do your residency in anesthesia and then a year fellowiship in the surgical ICU. I think most fellowships are a year (I could be wrong)...they are optional..basically you are more "specialized" or "trained" when you complete a fellowship. Not to mention the fellows are right underneath the attending physicians and are usually the attending's "right hand man."

The only exams a resident has to take are the boards I think, steps 2 and 3.

To someone else's question previously, an attending physician is the "teaching" physician in residency. A normal doc in a non-teaching hospital can also be called an attending physician, but most of the time they aren't referred to as this...sometimes though.