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Postgraduate Medical Education

Residency Training

After the first postgraduate year comes specialization. The function of this extended period of training has changed greatly since its start a century ago. At that time a residency was a special period of additional clinical education for a few promising and scholarly young physicians who wished to become the teachers or leaders in medicine. Residency training since the period after World War II has become standard for the average physician and more than 1,500 American hospitals offer such programs. Completing an approved residency and passing a written and/or oral examination given by a specialty board are the basic requirements for certification as a specialist.

In the early 1900s, nearly half of all medical school graduates entered general practice. By the 1960s this figure had shrunk to about 20%. A recent study concerning medical specialization showed that there has been a significant increase in interest in primary care/family practice over the past several decades (see page 393). Economic factors are comparatively minor in determining medical specialization, while up to 87% of the sampling indicated intellectual interests to be a major determining factor. Most recruits are entering internal medicine, surgery, psychiatry, obstetrics/gynecology, and pediatrics. Women physicians have generally favored fixed-schedule specialties (anesthesiology, radiology, psychiatry, pediatrics, public health) and work settings (state hospitals and industry).

The length of residency training varies among the different specialties and is indicated in Table 12.1; their characteristics are outlined starting on page 430.

It is possible to apply for a residency in a manner comparable to AMCAS. This is by means of the AAMC-sponsored Electronic Residency Application Service (ERAS). Offices of Deans of Students at medical schools (both allopathic and osteopathic) can provide the necessary material needed to apply. Canadians can also use ERAS.

It should be noted that many of the specialties listed have subspecialties that may require two to three years additional fellowship training beyond that listed in Table 12.1.

Securing a Residency

Appointments to residency positions are competitive and usually made through the Resident Matching Program (page 428). Your ranking by the Resident Program Director largely depends on three considerations:

  1. medical school performance;
  2. summary of recommendations from clinical clerkship supervisors; and,
  3. residency interview performance.

The success of the interview can impact decisively on your future career. For this reason, we offer advice on preparing for your residency interview in this section.

Obtaining a residency appointment is not a hit-or-miss affair. Careful planning can avoid many pitfalls and improves your chances for success. Medical students frequently underestimate the importance of residency selection. The training program determines the specialty tract, and within the program, the curriculum and its monitoring staff can profoundly influence your career path. In addition, each program has its own philosophy and work environment. In selecting a program, a determination is made as to the amount of time that you will have to devote to meet the program's requirements over a period of several years. The residency interview provides a possible means of enhancing your chances for securing a house staff appointment as well as finding out if it is the right one for you.

Training Period (years)
Specialty Nature of Work Prerequisite Year(s) Training Area Minimum Maximum
Aerospace Medicine Care for individuals involved in space travel One Preventive Medicine Two Two
Allergy and Immunology Treatment of illness due to hypersensitivity to a specific substance or condition Three Medicine Two Three
Anesthesiology Producing a partial or total loss of pain by use of drugs, gases, or other means One Clinical Base Three Four
Cardiovascular Disease Diagnosis and treatment of heart and blood vessel diseases Three Medicine Three Three
Child and Adolescent Psychiatry Treatment of emotional disorders of children and adolescents One General Psychiatry Four Four
Colon and Rectal Surgery Treatment of diseases of the lower bowel Three General Surgery Two Two
Dermatology Treatment of skin diseases One Medicine Three Three
Diagnostic Radiology Use of specialized X-ray techniques for diagnosis One Clinical Base Four Five
Emergency Medicine Diagnosis and treatment of acute and life-threatening illnesses One Medicine Two Three
Family Practice (Primary Care) Evaluating total health needs and providing routine treatment Three Three
Forensic Pathology Use of pathological methods in criminal investigations Three Pathology One Two
Gastroenterology Diagnosis and treatment of disease of the digestive tract Three Medicine Two Three
Hand Surgery Treatment of injuries to the hand Five General Surgery One One
Internal Medicine Treatment of diseases and organs with medications Three Three
Neonatal-Perinatal Medicine Treatment of infants and high-risk newborns Three Pediatrics Three Three
Nephrology Diseases of the kidneys Three Medicine Two Three
Neurosurgery Surgery of the nervous system One General Surgery Five Five
Neurology Treatment of nervous system with medications One Clinical Base Three Four
Neuropathology Diagnosis of pathological conditions of the nervous system Four Pathology One Two
Nuclear Medicine Use of radioactive substances in the diagnosis and treatment of diseases Three Medicine, Pathology, or Radiology Two Three
Obstetrics and Gynecology Care during pregnancy and labor and treatment of diseases of genital and reproductive system One Clinical Base Three Four
Ophthalmology Care and treatment of eye diseases One Optional Three Four
Orthopedic Surgery Treatment of skeletal deformities and injuries of the bones and joints One General Surgery Three Four
Otolaryngology Treatment of ear, nose, and throat diseases One General Surgery Three Four
Pathology Diagnosis of structural and functional changes in the body tissues due to diseases One Optional Four Four
Pediatrics Care of infants and children and treatment of their diseases Three Four
Pediatric Cardiology Treatment of heart diseases in children Three Pediatrics Two Two
Pediatric Nephrology Treatment of kidney disease in children Three Pediatrics Two Two
Physical Medicine and Rehabilitation Treatment by physical and mechanical means to permit maximum restoration of function One Medicine and Surgery Three Three
Plastic Surgery Surgery to repair or restore injured, deformed or destroyed parts of the body, especially by transferring tissue Four General Surgery Two Three
Preventive Medicine Prevention of disease for individuals and the public One Public Health Two Two
Primary Care [See Family Practice]
Psychiatry Treatment of mental disease One Clinical Base Four Four
Pulmonary Disease Disease of the respiratory tract Three Medicine Two Three
Radiology Diagnosis of disease by radioactive means One Clinical Base Four Four
Rheumatology Diagnosis and treatment of arthritic diseases Three Medicine Two Three
Sports Medicine Treatment of sports-related injuries Three Emergency Medicine One One
Surgery Treatment of diseases by surgical intervention One Four Seven
Therapeutic Radiology Treatment of diseases by radiation therapy One Clinical Base Four Four
Thoracic Surgery Surgical treatment of chest diseases Four General Surgery Two Two
Urology Treatment of kidney and bladder diseases Three General Surgery Two Two
Vascular Surgery Surgery of blood vessels Five General Surgery One One

The following are important suggestions to help you secure a suitable position. Many of the pointers noted in the premed interview discussion (see page 108) are relevant here as well.

Do Your Homework

Familiarize yourself with the program for which you are being offered an interview. It is risky to go unprepared, since you can make poor choices of places to visit and appear uninformed at the interview. Carefully study published residency program material that was sent to you or a classmate or is on file at your medical school. Such material could provide information concerning facilities, faculty-resident ratio, and the philosophy, curriculum, work hours, and support staff at the teaching hospital.

Setting up a card file on all prospective interview sites is useful. It will help you refresh your memory just prior to a visit. Add new information and your impressions after each visit for possible future reference. Sequence your interview schedule so that the interviews are not so close that you do not have time to recover from one before you present yourself for another and you can arrive fresh and enthusiastic for each interview. A “practice” interview at a program low on your acceptance list is a good way to develop self-confidence. Your highest priority interview should be scheduled in the middle of your interview cycle. By that time you should have an adequate amount of experience and will not be physically drained by this demanding process. Remember that making a good initial impression can be enhanced by a firm handshake and proper grooming.

Know Yourself

It is important at the outset of the entire interview process to define your goals career-wise. Completion of a personality test and discussion with faculty members with whom you are close about your goals, interests, and strengths can be helpful. After this process you should be able to clearly articulate your career plans and defend your choices. This should include knowledge of your choice of a clinical or academic career and the type of the residency you are seeking.

Anticipate Obvious Questions

Although interviews vary widely, many questions asked are standard ones. Among the most favorite ones are:

  1. What are your short- and long-range goals?
  2. What are your strengths and weaknesses?
  3. Why do you seek admission to this program?
  4. What do you want out of life?
  5. Why did you choose medicine as a career?
  6. What have been your most important accomplishments so far?

Practicing answers to these questions is advisable so long as they do not sound rehearsed when you deliver them. Mock interviews with fellow students can prove useful in preparing for the real ones.

Ask Tactful Questions About the Program

You should seek to learn about the program in the context of the interview session by inquiring as to the program's commitments to education versus service obligation. Tactful questions are appropriate; therefore, rather than asking about a program's weakness, phrase your question as an inquiry. You may wish to ask the interviewer if the program has received an unrestricted grant, what areas it would be invested in. The most appropriate questions to ask are those relevant to education and the quality of patient care. In any case, the questions you ask should be determined by the position of the person to whom you are speaking. In other words, when being interviewed by a department head, an inquiry relevant to salary or housing would not be appropriate but should be directed to a resident. Questions about the philosophy and curriculum of a program should obviously be presented to the program director and would suggest a more meaningful interest. Try to leave a positive and memorable impression on your interviewer.

Sample the Residency

The best way to evaluate a program is to spend a senior year rotation at the hospital in which you might consider doing your residency. When this is not feasible, you may be able to spend a day as an observer with residents, following them on rounds (if possible, dressed in whites). First-hand observation on the wards and in the clinics will provide a good window to assess the value of the program. Questioning residents is useful.

Present a Team Player Image

The residency is quite different from medical school; therefore, it is desirable to leave an impression that you can make the transition from working independently to being part of a team. Projecting the sense that you will fit well into the existing team will enhance your chance of securing the residency appointment you are interested in.

Be Yourself

While making a strong effort to project a favorable image, you should also strive to be sure that it is a realistic one. You must balance your desire to get the appointment with a candid assessment of whether the position will fill your own needs. When you leave the interview, you should go away with a positive feeling that this is the place you would like to spend the next several years training, to attain the proficiency you will require in order to succeed in your profession.

Additional topics

Job Descriptions and Careers, Career and Job Opportunities, Career Search, and Career Choices and ProfilesGuide to Medical & Dental SchoolsPostgraduate Medical Education - Incorporating The Residency And Internship, Resident Matching Program, Residency Training, Medical Specialties, Fellowship Training