Toughest Residencies To Pursue?

[mononoke]

I'm curious to know what qualities you think make a residency tough? And what residencies exemplify these qualities?

 

- For example, Internal Med I hear is considered a tough residency because of the 26h call

 

I know that all residencies are difficult but what I would like to know is which are more difficult than others and why?

[rmorelan]

I'm curious to know what qualities you think make a residency tough? And what residencies exemplify these qualities?

 

- For example, Internal Med I hear is considered a tough residency because of the 26h call

 

I know that all residencies are difficult but what I would like to know is which are more difficult than others and why?

 

well that is going to be subjective of course

 

I think most people would say that surgical ones do tend to be pretty difficult - culture of hard work, skipping post call days to continue working in many cases despite the rules, high work load, lots of call, physically demanding at times including long stretches, missing meals etc, etc. Of course in a weird way those sort of things can be fun at times. Also often in surgical residency programs there just aren't that many residents which can put pressure on things. Plus add a tight or seemingly absent job market for external stress and another reason you have to perform at a high level......

[ploughboy]

I'm curious to know what qualities you think make a residency tough? And what residencies exemplify these qualities?

 

- For example, Internal Med I hear is considered a tough residency because of the 26h call

 

I know that all residencies are difficult but what I would like to know is which are more difficult than others and why?

Probably either neurosurgery or cardiac surgery would be the flat-out worst. Although anything ending in "surgery" is almost guaranteed to be terrible, at least when you are a junior.

[ralk]

I'd thrown OBGYN in the mix too, they generally work long hours and babies come at all times.

 

Internal (and Peds) have a fair bit of in-hospital call and often hefty workloads, so I don't think anyone would call them "light" residencies, but I'm not sure I'd put them up there with the surgical specialties. Though as rmorelan says, it's all based on personal preferences, and even traditionally cushy residencies can be too much for a mismatched resident.

[rmorelan]

I'd thrown OBGYN in the mix too, they generally work long hours and babies come at all times.

 

Internal (and Peds) have a fair bit of in-hospital call and often hefty workloads, so I don't think anyone would call them "light" residencies, but I'm not sure I'd put them up there with the surgical specialties. Though as rmorelan says, it's all based on personal preferences, and even traditionally cushy residencies can be too much for a mismatched resident.

 

I am pretty sure some of the rad residents I have seen leaving programs over the past few years were in part because of a misunderstanding of the amount and severity of the call. Cannot say I was expecting people to leave rad programs for it but there you go. Things change. 

 

There are also specialties where call can be nuts but it isn't ALWAYS nuts as it were. Neurosurg for instance is always nuts - a slow night would be such a rare thing that you would remember it like some sort of sighting of a unicorn ha. Rads is consistently busy. ICU is usually busy. The medicine CTU team - at least the senior - is consistently busy.

 

It is probably easier to state the ones that are particularly lightish on call - when on service of course. Things like emerg, path, derm, rad onc, non CTU branches of internal medicine often, and to a lesser extent family depending on how it is set up.

[ralk]

I am pretty sure some of the rad residents I have seen leaving programs over the past few years were in part because of a misunderstanding of the amount and severity of the call. Cannot say I was expecting people to leave rad programs for it but there you go. Things change. 

 

There are also specialties where call can be nuts but it isn't ALWAYS nuts as it were. Neurosurg for instance is always nuts - a slow night would be such a rare thing that you would remember it like some sort of sighting of a unicorn ha. Rads is consistently busy. ICU is usually busy. The medicine CTU team - at least the senior - is consistently busy.

 

It is probably easier to state the ones that are particularly lightish on call - when on service of course. Things like emerg, path, derm, rad onc, non CTU branches of internal medicine often, and to a lesser extent family depending on how it is set up.

 

Completely agree, I think the assumption for most residency programs has to be "there will be a lot of call", especially in the early years. The only question is how many blocks will be call-heavy and at what point in training (if ever) do you stop doing those call-heavy blocks.

[medicallyinclined]

Can someone please explain to me how call works? I'm sorry if this question is VERY basic, I'm just curious.

 

I am a first year medical student interested in Radiology.

[NLengr]

Probably either neurosurgery or cardiac surgery would be the flat-out worst. Although anything ending in "surgery" is almost guaranteed to be terrible, at least when you are a junior.

Neurosurg would be my guess.

 

Those guys are always busy operating overnight at my center. Long cases, even in the middle of the night. Terrible outcomes.

[rmorelan]

Can someone please explain to me how call works? I'm sorry if this question is VERY basic, I'm just curious.

 

I am a first year medical student interested in Radiology.

 

well that is my field ha

 

Ok well basically in the evening until morning you are on call during the weekdays, and on the weekend/holidays someone has to cover call for entire days - often 24-26 hour shifts. This shift coverage is for emergency or urgent image reading for studies done over those hours. Someone has to do this work - and at academic hospitals that person is a radiology resident. The following day you are let off work so you can go home and sleep to recover.

 

In its most basic, most original form at 5pm all other radiologists left leaving that radiology resident on call by themselves for the 5pm until say 8am the following morning. Basically you act as the staff radiologist during that time - reading all the imaging yourself, and giving the other services your interpretation. Anyone who needs something done or read in radiology will come to you - and since most things of importance now in a hospital require imaging that means that you can be an awfully popular person That means often no or very little sleep - I good night would be a couple of hours of napping not continuously at my centre for instance.

 

Over time as the demand on radiology have increased various centres have been forced to add variations to this theme - there is often staff now past 5 or fellows to help. A rare few places even have staff 24 hours a day. The over arching theme though remains the same - you given a lot of responsibility to work independently for sick patients. Some places have you review your findings with staff as you go along regularly. At my centre from 11pm and 7am I don't review anything with anyone unless I feel the need to do so (complex case) by waking someone up. You are encouraged to do that when ever you are worried about something - but of course you want to also make sure you don't wake up a staff for completely stupid reason. You also don't want to make a mistake you find out about the next day - you feel like an idiot, and you potentially harmed a patient. You don't feel good about that.

 

The call shifts rotate through all of the residents - at our centre I usually have 5-6 full call shifts a month, and will work 24 hours (one full day) 2 weekends out of four (not necessarily in a row - actually in worst case you can do 4 straight weekends depending on the schedule). This goes on starting in your second year of radiology residency and depending on where you are may tapper down as you move forward and get closer to your exam. Note - in your first year you are off service so you do all your off service call. This is pretty busy as well in many cases.

 

Call is one of the most stressful aspects of residency for anyone - you are tired and working for a lot of hours. There is a lot of pressure to get things right and patients and your staff are counting on you. The work load is often the highest for you. Plus you start it when you are junior and don't know as much.

[mononoke]

well that is going to be subjective of course

 

I think most people would say that surgical ones do tend to be pretty difficult - culture of hard work, skipping post call days to continue working in many cases despite the rules, high work load, lots of call, physically demanding at times including long stretches, missing meals etc, etc. Of course in a weird way those sort of things can be fun at times. Also often in surgical residency programs there just aren't that many residents which can put pressure on things. Plus add a tight or seemingly absent job market for external stress and another reason you have to perform at a high level.....

So would you say that programs with few residents have more pressure? I've heard that with small programs, when everybody knows you and are judging you, there's pressure to perform and 'be on your best behavior' leading to overwork and high-strung residents. I mean, it's important to always try your best, but it's nerve-wracking when everything you do feels like it's being watched

[rmorelan]

So would you say that programs with few residents have more pressure? I've heard that with small programs, when everybody knows you and are judging you, there's pressure to perform and 'be on your best behavior' leading to overwork and high-strung residents. I mean, it's important to always try your best, but it's nerve-wracking when everything you do feels like it's being watched

 

I would say the specialty is the first deciding factor then followed by other things including the number. Often in things like surgery size the program are kind of connected - I mean here in Cardiac for instance I believe there is just one resident a year. So yeah that person is under a lot of pressure to do well ha. The program itself has a lot to do with that though more I would think than the impact of the number of residents.

 

Plus when there are fewer people it is harder to exchange call shifts, get coverage, you are more likely to have to do administration tasks.....

 

by the way not to claim that emerg etc is an easy program - only that emerg is a relatively easier program.

[rmorelan]

not to mention what happens when you are sick - something I a

 

I would say the specialty is the first deciding factor then followed by other things including the number. Often in things like surgery size the program are kind of connected - I mean here in Cardiac for instance I believe there is just one resident a year. So yeah that person is under a lot of pressure to do well ha. The program itself has a lot to do with that though more I would think than the impact of the number of residents.

 

Plus when there are fewer people it is harder to exchange call shifts, get coverage, you are more likely to have to do administration tasks.....

 

by the way not to claim that emerg etc is an easy program - only that emerg is a relatively easier program.

 

not to mention what happens when you are sick etc Ran into that last night on a field where there are few residents - no one to cover the shift means you are coming in - "dead man walking" on that service.

[NLengr]

not to mention what happens when you are sick - something I a

 

 

not to mention what happens when you are sick etc Ran into that last night on a field where there are few residents - no one to cover the shift means you are coming in - "dead man walking" on that service.

It also becomes an issue around exam time, when chiefs are pulling back to try to cram. You need to cover more stuff during the day with fewer people. Meaning there is limited/no ability for other residents to get time off during that time.

[mononoke]

I would say the specialty is the first deciding factor then followed by other things including the number. Often in things like surgery size the program are kind of connected - I mean here in Cardiac for instance I believe there is just one resident a year. So yeah that person is under a lot of pressure to do well ha. The program itself has a lot to do with that though more I would think than the impact of the number of residents.

 

Plus when there are fewer people it is harder to exchange call shifts, get coverage, you are more likely to have to do administration tasks.....

 

by the way not to claim that emerg etc is an easy program - only that emerg is a relatively easier program.

Is it easier because of the fewer hours worked relative to other specialties (especially given the 4th year can be used to do a masters)? By that logic wouldn't PHPM also have relatively fewer hours?

 

What about derm? I keep getting the impression the residency is easy but then people say the studying is very tough

[NLengr]

The studying is tough for all Royal college programs. It's brutal actually.

[rmorelan]

The studying is tough for all Royal college programs. It's brutal actually.

 

yeah I will second that - when we are talking "easier" programs here it is all relative.

 

which brings up an important point -about the "residency is easier but the studying is tough" quote Those are NOT separable. The studying is hours to the residency program - because in those programs you cannot get around that time. So you may look at a program and think well that person gets to go home at 5 that must be so much easier than this one that doesn't, or this one starts at 6am and that one 8am and so on. The fact that some programs need more study time is factored in - some programs you learn by being hands on primarily and augment it with studying - focus on hands on time. Some you need more book learning which is reinforced by the daily work - programs arrange it so you have that study time - but you have to spend that time or you are just going to completely fail. You have to add up the total amount of time to get an idea here. If you look at derm and thing those people only do 8-5x5 days a week mostly (which isn't exactly true anyway) you will miss all the extra time of top of that.

 

Say take rads as it is my field. I do at least 2 hours of studying a night and on those weekends I am not on call another 6+ hours of studying, on top of my 10 hour work days. I am third year now and it will ramp up further from there as I do less call and get closer to the exam. Add research on top of that, call etc and you get a good picture of what we are up to. This is not dissimilar with other fields..

[mononoke]

yeah I will second that - when we are talking "easier" programs here it is all relative.

 

which brings up an important point -about the "residency is easier but the studying is tough" quote Those are NOT separable. The studying is hours to the residency program - because in those programs you cannot get around that time. So you may look at a program and think well that person gets to go home at 5 that must be so much easier than this one that doesn't, or this one starts at 6am and that one 8am and so on. The fact that some programs need more study time is factored in - some programs you learn by being hands on primarily and augment it with studying - focus on hands on time. Some you need more book learning which is reinforced by the daily work - programs arrange it so you have that study time - but you have to spend that time or you are just going to completely fail. You have to add up the total amount of time to get an idea here. If you look at derm and thing those people only do 8-5x5 days a week mostly (which isn't exactly true anyway) you will miss all the extra time of top of that.

 

Say take rads as it is my field. I do at least 2 hours of studying a night and on those weekends I am not on call another 6+ hours of studying, on top of my 10 hour work days. I am third year now and it will ramp up further from there as I do less call and get closer to the exam. Add research on top of that, call etc and you get a good picture of what we are up to. This is not dissimilar with other fields..

Thanks for that answer rmorelan, this hit the nail on its head perfectly. Many talks given by these programs often don't focus on these other factors - time spent studying, research, conferences, paperwork...etc. People talk about certain specialties being "9 to 5" or "it's great hours, we end at 3" which gives a misconception about residency since those seem more like staff hours (and even then, staff don't report all the extra time spent on admin, research etc)

[rogerroger]

There is no question on the hardest.

 

Neurosurg

 

These poor guys have the longest residency, the worst of the worst hours, and tons of horrible outcomes. The pass rate on their exam is pretty depressing as well. Then if you do finish you better have a masters or PhD and a few fellowships to get a job... I have no idea what keeps them going, but whatever it is I admire their ability to do what they do.

[Edict]

I feel like Cardiac Surgery is going to be pretty hard, the attendings work an average of 69 hours a week and call on top of that so can't imagine the residents getting off easy. On top of that there is no program with more than 1 resident a year which probably means a lot of pressure to succeed. 

[rmorelan]

I feel like Cardiac Surgery is going to be pretty hard, the attendings work an average of 69 hours a week and call on top of that so can't imagine the residents getting off easy. On top of that there is no program with more than 1 resident a year which probably means a lot of pressure to succeed. 

 

yeah it is all kinds of tough.

 

should be noted for some of these (kind of obvious) that the residency is hard but also the entire medical school experience is amped up as you try to get into them in the first place. At some point some of these just boil down to permanent lifestyle/culture of a lot of work.

[mononoke]

I would agree, clerkship is difficult to give you a sense of residency. I've heard of many people who were surgery gunners in preclerkship switch into family after they realized the physical demands of surgery

[rmorelan]

I would agree, clerkship is difficult to give you a sense of residency. I've heard of many people who were surgery gunners in preclerkship switch into family after they realized the physical demands of surgery

 

sure - things are easy in abstract. Switches happen all the time - and that is even after only 12 weeks of surgery at ?most places often of which also includes some other areas thrown in. That is enough for many people to change there minds.

 

that is one of the big points of clerkship ha - to really understand what these specialties involve.

[Cerena]

Hoping pathology won't be so bad

[McMasterforever]

I would also say that the surgical residencies are the most difficult in terms of time, workload, and stress but it also depends, of course, on the individual program and the personalities present in the leadership positions. If you have the wrong people in charge, that can seriously affect the culture and environment.