residency (medicine)

Residency or postgraduate training is specifically a stage of graduate medical education. It refers to a qualified physician (one who holds the degree of MD, DO, MBBS, MBChB), veterinarian ( DVM or VMD) , dentist ( DDS or DMD) or podiatrist ( DPM) who practices medicine, veterinary medicine , dentistry, or podiatry, 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. 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, 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'' (in Commonwealth countries), or alternatively, a ''senior resident medical officer'' or ''house officer''. Residents have graduated from an accredited medical school and hold a medical degree (MD, DO, MBBS, MBChB). 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" (i.e., the hospital).

Duration of residencies can range from three years to seven years, depending upon the program and specialty. A year in residency begins between late June and early July depending on the individual program and ends one calendar year later.

In the United States, the first year of residency is known as 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 that 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'' (typically in surgical branches). 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 (typically in internal medicine and pediatrics). In dermatology generally one of the final year residents is chosen as chief, to add administrative duties to the normal learning in the last year.

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'' (in Commonwealth countries). 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 Sir William Osler and William Stewart Halsted at the Johns Hopkins Hospital. 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. By the end of the 20th century in North America though, very 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 twentieth century, residents would often live (or "reside") 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 did residencies.

Afghanistan

In Afghanistan, the residency (Dari, ''تخصص'') 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 (three years for clinical subjects, three years clinical subjects in hospital) 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 (Spanish, ''residencia'') 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 (''especialidad'') 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' (HMO), 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 (post-graduate year 1 or "PGY1"), then, for many training programs, an additional year as a resident (PGY2 onward).
Training lengths can range from 3 years for general practice to 7 years for paediatric surgery.

Canada

In Canada, Canadian medical graduates (CMGs), which includes final-year medical students and unmatched previous-year medical graduates, apply for residency positions via the Canadian Resident Matching Service (CaRMS). The first year of residency training is known as "Postgraduate Year 1" (PGY1).

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 (family medicine, dermatology, neurology, general surgery, etc.), meaning that CMGs applying to these specialties do so directly from medical school. Other residencies have sub-specialty matches (internal medicine and pediatrics) where residents complete their first 2–3 years before completing a secondary match (Medicine subspecialty match (MSM) or Pediatric subspecialty match (PSM)). 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 (typically 5 years).

Colombia

In Colombia, fully licensed physicians are eligible to compete for seats in residency programs. To be fully licensed, one must first finish a medical training program that usually lasts five to six years (varies between universities), followed by one year of medical and surgical internship. During this internship a national medical qualification exam is required, and, in many cases, an additional year of unsupervised medical practice as a social service physician. Applications are made individually program by program, and are followed by a postgraduate medical qualification exam. The scores during medical studies, university of medical training, curriculum vitae, and, in individual cases, recommendations are also evaluated. The acceptance rate into residencies is very low (~1–5% of applicants in public university programs), physician-resident positions do not have salaries, and the tuition fees reach or surpass US$10,000 per year in private universities and $2,000 in public universities. For the reasons mentioned above, many physicians travel abroad (mainly to Argentina, Brazil, Spain and the United States) to seek postgraduate medical training. The duration of the programs varies between three and six years. In public universities, and some private universities, it is also required to write and defend a medical thesis before receiving a specialist degree.

France

In France, students attending clinical practice are known as "externes" and newly qualified practitioners training in hospitals are known as "internes". The residency, called "Internat", lasts from three to six years (it depends on the speciality) and follows a competitive national ranking examination. It is customary to delay submission of a thesis. As in most other European countries, many years of practice at a junior level may follow.

French residents are often called "doctor" during their residency. Literally speaking, they are still students and become M.D. only at the end of their residency and after submitting and defending a thesis before a jury.

Greece

In Greece, licensed physicians are eligible to apply for a position in a residency program. To be a licensed physician, one must finish a medical training program which in Greece lasts for six years. A one-year obligatory rural medical service (internship) is necessary to complete the residency training. Applications are made individually in the prefecture where the hospital is located, and the applicants are positioned on first-come, first-served basis. The duration of the residency programs varies between three and seven years.

India

In India, after completing MBBS degree and one year of integrated internship, doctors can enroll in several types of postgraduate training programs:
D.M. (DOCTOR OF MEDICINE) in: Cardiology, Endocrinology, Medical Gastroenterology, Nephrology, and Neurology.
M.Ch. (MASTER OF CHIRURGIE) in: Cardio vascular & Thoracic Surgery, Urology, Neurosurgery, Paediatric Surgery, Plastic Surgery.
M.D. (DOCTOR OF MEDICINE) in: Anesthesiology, Anatomy, Biochemistry, Community Medicine, Dermatology Venereology and Leprosy, General Medicine, Forensic Medicine, Microbiology, Pathology, Paediatrics, Pharmacology, Physical medicine and rehabilitation, Physiology, Psychiatry, Radio diagnosis, Radiotherapy, Tropical Medicine, and, Tuberculosis & Respiratory Medicine.
M.S. (MASTER OF SURGERY) in: Otorhinolaryngology, General Surgery, Ophthalmology, Orthopaedics, Obstetrics & Gynecology.
Or diploma in: Anesthesiology (D.A.), Clinical Pathology (D.C.P.), Dermatology Venereology and Leprosy (DDVL), Forensic Medicine (D.F.M.), Obstetrics & Gynaecology (D.G.O.), Ophthalmology (D.O.), Orthopedics (D.Ortho.), Otorhinolaryngology (D.L.O.), Paediatrics (D.C.H.) Psychiatry (D.P.M.), Public health (D.P.H.), Radio-diagnosis (D.M.R.D.), Radiotherapy (D.M.R.T.)., Tropical Medicine & Health (D.T.M. & H.), Tuberculosis & Chest Diseases (D.T.C.D.), Industrial Health ( D.I.H.), Maternity & Child Welfare ( D. M. C. W.)

Mexico

In Mexico physicians need to take the ENARM (National Test for Aspirants to Medical Residency) (Spanish, ''Examen Nacional de Aspirantes a Residencias Medicas'') in order to have a chance for a medical residency in the field they wish to specialize. The physician is allowed to apply to only one speciality each year. Some 35,000 physicians apply and only 8000 are selected. The selected physicians bring their certificate of approval to the hospital that they wish to apply (Almost all the hospitals for medical residency are from government based institutions). The certificate is valid only once per year and if the resident decides to drop residency and try to enter to a different speciality she will need to take the test one more time (no limit of attempts). All the hosting hospitals are affiliated to a public/private university and this institution is the responsible to give the degree of "specialist". This degree is unique but equivalent to the MD used in the UK and India. In order to graduate, the trainee is required to present a thesis project and defend it.

The length of the residencies is very similar to the American system. The residents are divided per year (R1, R2, R3, etc.). After finishing the trainee may decide if he wants to sub-specialize (equivalency to fellowship) and the usual length of sub-specialty training ranges from two to four years. In Mexico the term "fellow" is not used.

The residents are paid by the hosting hospital, about US$1000–$1100 (paid in Mexican pesos). Foreign physicians do not get paid and indeed are required to pay an annual fee of $1000 to the university institution that the hospital is affiliated with.

All the specialties in Mexico are board certified and some of them have a written and an oral component, making these boards ones of the most competitive in Latin America.

Pakistan

In Pakistan, after completing MBBS degree and further completing one year house job, doctors can enroll in two types of postgraduate residency programs. First is MS/ MD program run by various medical universities throughout the country. It is a 4–5-year program depending upon the specialty. Second is fellowship program which is called Fellow of College of Physicians and Surgeons Pakistan (FCPS) by the College of Physicians and Surgeons Pakistan (CPSP). It is also a 4–5-year program depending upon the specialty.

There are also post-fellowship programs offered by the College of Physicians and Surgeons Pakistan as a second fellowship in subspecialties.

Spain

All Spanish medical degree holders need to pass a competitive national exam (named 'MIR') in order to access the specialty training program. This exam gives them the opportunity to choose both the specialty and the hospital where they will train, among the hospitals in the Spanish Healthcare Hospital Network. Currently, medical specialties last from 4 to 5 years.

There are plans to change the training program system to one similar to the UK's. There have been some talks between Ministry of Health, the Medical College of Physicians and the Medical Student Association but it is not clear how this change process is going to be.

Sweden

Prerequisites for applying to a specialist training program

A physician practicing in Sweden may apply to a specialist training program ( sv, Specialisttjänstgöring) after being licensed as a physician by The National Board of Health and Welfare. To obtain a license through the Swedish education system a candidate must go through several steps. First the candidate must successfully finish a five-and-a-half-year undergraduate program, made up of two years of pre-clinical studies and three and a half years of clinical postings, at one of Sweden's seven medical schools—Uppsala University, Lund University

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