Residency (medicine)
Residency or postgraduate training is a stage of graduate medical education. It refers to a qualified physician, veterinarian, dentist, podiatrist, optometrist,
pharmacist, or Medical Laboratory Scientist who practices medicine or surgery, veterinary medicine, dentistry, optometry, podiatry, clinical pharmacy, or Clinical Laboratory Science, respectively, usually in a hospital or clinic, under the direct or indirect supervision of a senior medical clinician registered in that specialty such as an attending physician or consultant.
The term residency is named as such due to resident physicians of the 19th century residing at the dormitories of the hospital in which they received training.
In many jurisdictions, successful completion of such training is a requirement in order to obtain an unrestricted license to practice medicine, and in particular a license to practice a chosen specialty. In the meantime, they practice "on" the license of their supervising physician. An individual engaged in such training may be referred to as a resident physician, house officer, registrar or trainee depending on the jurisdiction. Residency training may be followed by fellowship or sub-specialty training.
Whereas medical school teaches physicians a broad range of medical knowledge, basic clinical skills, and supervised experience practicing medicine in a variety of fields, medical residency gives in-depth training within a specific branch of medicine.
Terminology
A resident physician is more commonly referred to as a resident, senior house officer, or alternatively, a senior resident medical officer or house officer. Residents have graduated from an accredited medical school and hold a medical degree. Residents are, collectively, the house staff of a hospital. This term comes from the fact that resident physicians traditionally spend the majority of their training "in house". The similar term residency is named as such due to resident physicians of the 19th century residing at the dormitories of the hospital in which they received training.Duration of residencies can range from two years to seven years, depending upon the program and specialty.
In the United States, the first year of residency is commonly called an internship with those physicians being termed interns. Depending on the number of years a specialty requires, the term junior resident may refer to residents who have not completed half their residency. Senior residents are residents in their final year of residency, although this can vary. Some residency programs refer to residents in their final year as chief residents, while others select one or various residents to add administrative duties to the normal learning in the last year of residency.
Alternatively, a chief resident may describe a resident who has been selected to extend his or her residency by one year and organize the activities and training of the other residents.
If a physician finishes a residency and decides to further his or her education in a fellowship, they are referred to as a "fellow". Physicians who have fully completed their training in a particular field are referred to as attending physicians, or consultants. However, the above nomenclature applies only in educational institutes in which the period of training is specified in advance. In privately owned, non-training hospitals, in certain countries, the above terminology may reflect the level of responsibility held by a physician rather than their level of education.
History
Residency as an opportunity for advanced training in a medical or surgical specialty evolved in the late 19th century from brief and informal programs for extra training in a special area of interest. The first formal residency programs were established by William Osler and William Stewart Halsted at Johns Hopkins Hospital in Baltimore. Residencies elsewhere then became formalized and institutionalized for the principal specialties in the early 20th century. But even mid-century, residency was not seen as necessary for general practice and only a minority of primary care physicians participated.The expansion of medical residencies in the United States experienced a significant surge following World War II. In the post-war landscape, the demand for skilled physicians escalated, necessitating a robust training infrastructure. The G.I. Bill, a landmark piece of legislation, played a pivotal role in fueling this expansion by providing educational benefits to returning veterans, including those pursuing medical careers. The increased financial support facilitated a surge in medical school enrollments, spurring the need for expanded residency programs to accommodate the growing pool of aspiring physicians. This period witnessed the establishment of numerous new residency positions across various specialties. In
1940 there were approximately 6,000 residency positions available, but by 1970 the available spots had increased to more than 40,000. At the same time, the daily operation of the hospital increasingly relied on medical residents.
By the end of the 20th century in North America, few new doctors went directly from medical school into independent, unsupervised medical practice, and more state and provincial governments began requiring one or more years of postgraduate training for medical licensure.
Residencies are traditionally hospital-based, and in the middle of the 20th century, residents would often live in hospital-supplied housing. "Call" 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 did residencies.
In the United States, the Libby Zion case, which led to the Libby Zion Law, garnered attention in 1984, shed light on the demanding work hours imposed on medical residents. Responding to this concern, the Association of American Medical Colleges released a position statement in 1988, recommending a cap of 80 work hours per week for residents. Subsequently, in 1989, New York became the first state to address this issue by implementing regulations through the Health Code, marking a pivotal moment in the regulation of resident hours. These regulations, integrated into the state hospital code, included duty hour limits and supervision enhancements advocated by the Bell Commission. However, despite the issuance of regulations, compliance was slow to materialize, and a decade later, site visits revealed widespread noncompliance with the established limits. The efforts to address and regulate resident work hours culminated nationally in 2003 when the ACGME mandated these limits across the United States.
Residency around the world
Afghanistan
In Afghanistan, the residency consists of a three to seven years of practical and research activities in the field selected by the candidate. The graduate medical students do not need to complete the residency because they study medicine in six years and one-year internship and they graduate as general practitioner. Most students do not complete residency because it is too competitive.Argentina
In Argentina, the residency consists of a three to four years of practical and research activities in the field selected by both the candidate and already graduated medical practitioners. Specialized fields such as neurosurgery or cardio-thoracic surgery require longer training. Through these years, consisting of internships, social services, and occasional research, the resident is classified according to their residency year as an R1, R2, R3 or R4. After the last year, the "R3 or R4 Resident" obtains the specialty in the selected field of medicine.Australia
In Australia, specialist training is undertaken as a registrar; The term 'resident' is used synonymously with 'hospital medical officer', and refers to unspecialised postgraduate medical practitioners prior to specialty training.Entry into a specialist training program occurs after completing one year as an intern, then, for many training programs, an additional year as a resident.
Training lengths can range from 3 years for general practice to 7 years for paediatric surgery.
Canada
In Canada, Canadian medical graduates, which includes final-year medical students and unmatched previous-year medical graduates, apply for residency positions via the Canadian Resident Matching Service. The first year of residency training is known as "Postgraduate Year 1".CMGs can apply to many post-graduate medical training programs including family medicine, emergency medicine, internal medicine, pediatrics, general surgery, obstetrics-gynecology, neurology, and psychiatry, amongst others.
Some residency programs are direct-entry, meaning that CMGs applying to these specialties do so directly from medical school. Other residencies have sub-specialty matches where residents complete their first 2–3 years before completing a secondary match or Pediatric subspecialty match ). After this secondary match has been completed, residents are referred to as fellows. Some areas of subspecialty matches include cardiology, nephrology, gastroenterology, immunology, respirology, infectious diseases, rheumatology, endocrinology and more. Direct-entry specialties also have fellowships, but they are completed at the end of residency.