What is Residency really like?

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Could you please explain the difference between categorical, transitional and prelim. internship years?

Categorical is when the first year of the residency program is incorporated into the entire residency. While the first year is still more generalized than subsequent years, it is also usually geared a little more towards your chosen specialty. This title is also important for residency matching because if you are applying to categorical programs, then you do not need to worry about securing a internship elsewhere (it is included in these residencies). An example would be most emergency medicine programs, family medicine programs, some anesthesia programs, etc.

Prelim and transitional internships are needed when your specialty requires a separate internship year outside of their specific program. In both cases, during the residency match process you need to apply to two types of programs, the specialty you are interested in (radiology, some anesthesia programs, Derm, etc) and an internship year (transitional or prelim). While these are separate in the match process, it is quite often possible to attain placement at the same institution for both (so in essence you are doing you entire residency at one place).

There are classically two types of prelim years, medical and surgical. In each case, you function exactly the same as an intern that it going into that particular specialty (medicine intern or surgical intern). Regarding transitional year programs, these less strictly adhere to the traditional first year completed by medicine residents. They usually consist of several months on some sort of inpatient or consult medicine rotation as well as electives outside of medicine (like radiology or path). These tend to be less surgically oriented. From these descriptions you could deduce that transitional year programs are usually more tolerable than prelim year programs.

Hope this helps.

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i wish more medical students and residents will contribute like this in the pre-allo forum.

Yes me too. And though L2D pointed out it depends on the topic, I'd like to point out that a lot of topics that really only med students or residents would know are littered instead with pre med insights, though they are often well informed.
 
Categorical is when the first year of the residency program is incorporated into the entire residency. While the first year is still more generalized than subsequent years, it is also usually geared a little more towards your chosen specialty. This title is also important for residency matching because if you are applying to categorical programs, then you do not need to worry about securing a internship elsewhere (it is included in these residencies). An example would be most emergency medicine programs, family medicine programs, some anesthesia programs, etc.

Prelim and transitional internships are needed when your specialty requires a separate internship year outside of their specific program. In both cases, during the residency match process you need to apply to two types of programs, the specialty you are interested in (radiology, some anesthesia programs, Derm, etc) and an internship year (transitional or prelim). While these are separate in the match process, it is quite often possible to attain placement at the same institution for both (so in essence you are doing you entire residency at one place).

There are classically two types of prelim years, medical and surgical. In each case, you function exactly the same as an intern that it going into that particular specialty (medicine intern or surgical intern). Regarding transitional year programs, these less strictly adhere to the traditional first year completed by medicine residents. They usually consist of several months on some sort of inpatient or consult medicine rotation as well as electives outside of medicine (like radiology or path). These tend to be less surgically oriented. From these descriptions you could deduce that transitional year programs are usually more tolerable than prelim year programs.

Hope this helps.

Very helpful

Thank you
 
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It’s not that the docs haven't figured it out yet, it’s that there isn't enough time to do it this way. A nurse has ~6 patients that they sign out in ~30 minutes. A covering doctor can have 40 patients and there isn't enough time for a 3+ hour sign-out at the beginning and end of every shift. It’s an imperfect system.

to elaborate on this a little, there is a signout that occurs at every shift change and any time you will be covering another team's patients. the depth and time spent on signout varies by program/specialty/size of service/etc.

if you're on a 30 hour call, the non-call teams will sign out to you in the evening. generally, the team that's leaving gives the on-call team a patient roster with pertinent info, what to watch for, tasks, and "if X happens then you should try Y" statements. the sickest patients get the most attention in signout (of course) and non-sick patients are sometimes just signed out as "nothing to do, going home tomorrow." signout is generally 1-2 min per patient on average. being responsible for other teams' patients while they're gone is what's referred to as cross-covering. the most i've had to cross-cover is about 60 on general medicine, but more like 35 was average where i was. the biggest problem with signout at my institution was that the signout sheets weren't always updated adequately and signout tends to occur in the evening which can be the busiest time of day for the call team.

then in the morning, the intern from the returning team finds the intern from last night's call team to find out what happened with their patients overnight. a note here for medical students... when you come in the morning you should find either your team's intern or the call team intern to get filled in on what happened overnight. there's usually no formal signout for med students.

btw, i'm talking about "my instutution" in past tense because i was a prelim last year and i'm somewhere different this year. cheers :).
 
I do not know what Law2Doc's experience is with EM programs, but let me reiterate what I posted earlier if any of you are interested in the specialty. This information is repeated from the mouths of several EM residency program directors across the nation as they discussed the future of their programs. I presume that not much is changing with EM programs because they were minimally affected (relatively) by work hour restrictions when they were initiated.

(Sorry to hijack the thread to talk about something only tangentially related, but in the interest of having accurate information here...)

Seconding this response from tremulousNeedle. L2D, I'm not sure what specialty you are training in, but I can't recall seeing you post in the EM forum so I'm assuming it's not EM (I could of course be wrong here and please correct me if I am). The trend over the last several years in EM is in absolutely in the opposite direction to the one you describe -- programs have been getting rid of their advanced status and are becoming categorical. I would be very interested to see any evidence you might have against this trend continuing in the future.
 
I don't understand why people get up in arms about medical shows being a slight deviation from reality.

Because it gets annoying.

"Are your attendings as cranky as House? Heh heh." :rolleyes:

"Does your boyfriend get jealous when you're on call? Does he wonder if you're sleeping with all the other residents? Hah hah." :rolleyes::rolleyes:

"Do you guys really practice surgery on each other??" Now, really. What do YOU think?

Stop asking me dumb questions about residency, like it's some kind of cool soap opera. I have enough drama from the patients and their families - and it's NOT the "cool" kind of drama.

You'll notice that nurses have a fairly good system for dealing with this that docs haven't gotten down pat yet. They have report. If you try to interrupt nurses at shift change, you'll get your head chopped off. This is why CNAs and nurses tend to work slightly different shifts, so that while the nurses are in report, the CNAs can deal with most of the patient needs.

It's not that the "docs" are somehow behind the nurses on the whole "report" thing.

It's just very different when you're signing out 3-7 patients to the nurse coming on for you, and for anything complicated the instruction is to "page the physician." Try signing out 15 patients, half of which are dying, to the oncoming resident, and there is no one to pass the responsibility on to.
 
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It's not that the "docs" are somehow behind the nurses on the whole "report" thing.

It's just very different when you're signing out 3-7 patients to the nurse coming on for you, and for anything complicated the instruction is to "page the physician." Try signing out 15 patients, half of which are dying, to the oncoming resident, and there is no one to pass the responsibility on to.

Also bear in mind that nurses jobs are basically outlined in the doctors orders. They could have no sign out at all and still adequately do their job, because everything they are supposed to do during the shift is written in the chart. The sign out is to highlight things that otherwise might get missed. Sign out for physicians is very different. A lot of what you are signing out isn't written down in the chart that you can just follow. You often need to convey what you are concerned about, what you've tried, what the patient seems to respond to and what they don't. You don't want each shift to try and reinvent the wheel, so you need to convey what you are thinking. Additionally, as mentioned, you will be covering many many times more patients than each nurse -- there will be a dozen or more nurses calling YOU for orders on your patients. And you are the final decision maker, so it's not like after someone signs out to you, you can just check on what to do next if things change. The person signing out to you is going home to sleep, and the attendings don't want to be bothered for things you should have gotten from sign out that they probably relayed to the person on call prior to you. So it's not really that nurses are more efficient, it's that their role in this game is so different.

Think about it, the night float person may be covering 30+ patients, on multiple teams, with multiple pagers. He is the primary decision maker for all those patients overnight. Some patients will be sicker than others, some will require more immediate attention and regular monitoring than others. And the typical sign out time is 30 mins to 45 mins, because the prior team wants to leave, and because to stay within the 80 hour work week most programs budget an overlap of time between the day and night person of an hour or less. So that means you have to learn everything you need to know about each patient from the day person in 1 minute or less. That's a big task. And it should be obvious as to why most risk to patients inherent in the system happens at sign out. Don't kid yourself that there's anything inefficient going on in accomplishing this. If you wanted to do it "right" you'd actually need to spend more, not less time at sign out. The physician sign out is far far more efficient than that of nursing, and it has to be because of what you are trying to accomplish in comparison.
 
Do you residents get free lunch during your shifts?
 
Do you residents get free lunch during your shifts?

Depends on the hospital. Some places offer free meals ONLY while on call, others offer free food all the time, others offer a food stipend. Pretty much every program is required to offer some reasonable access to food within the hospital at reasonable hours of the day.
 
Heres a documentry about pediatric residents

Obviously its just one group of people at one hospital, but I've heard its considered a pretty good portrayal

http://www.msnbc.msn.com/id/21134540/vp/35148653#35148653

I have to tell you, I watched this entire series when it was aired on television with my family and I found it extremely interesting and educational and felt it was the best representation of what residency really entails. I think why a lot of people, myself included, question whether they can be doctors or not and get so much apprehension is because you never really get to see what goes on in residency and do not know what to expect. I found after watching this special that I knew more about the challenges of residency then I've ever read from books or read on the internet.

Since watching it, I feel more then ever that I could be adequately prepared to undertake the most rigorous training a person can go under because I had a little bit better understand of what goes on. I just hope someday I can make it to that level. I've been through so much medically myself that I could really relate to what my patients are struggling and emotionally going through.

I recommend any pre-med or medical student to watch this so that you can see first hand what certain aspects of residency are like and see what some of the residents themselves are emotionally, physically, and mentally going through. Does it show everything that happens in residency, of course not, but I think it gives a great idea of what to expect.

Plus you don't always necessarily have to worry about switching off of patients. When I had my neurosurgery done last year, I was having some pretty nasty side affects from the morphine drip I was on. The floor called my attending who personally came down and saw me at like 3am and gave my nurse, etc all the change in medications he wanted to make me more comfortable without seeing things crawling on the wall. But then again, neurosurgeons practically live in the hospital right? lol.
 
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