residency - what is it like?

[Guest rubberoduck]

I've heard of many horror stories about med residency, so I'm hoping that someone can tell me some facts about residency/internship

 

so far, the only fact i know is that students are required to work a 28-hr shift every four days

 

during this 28hr shift, are you supposed to stay in the hospital or just be on call? If you stay in, where do you sleep, if you get to sleep at all?

[Guest Kirsteen]

Hey there,

 

Although I'm not a resident yet I've seen a number at work. There are "on call" rooms at the hospitals where the residents can sleep when on call overnight. The amount of sleep depends on the service and how busy it is on any given night. For some services there is "home call" which means you are on call but you can roam outside of the hospital, e.g., stay at home, as long as your pager is on and you are alert enough to come in when paged.

 

Cheers,

Kirsteen

[Guest rubberoduck]

i know a lot of medical students like to live around the school/hospital. I'm wondering if this has to do with being on call, i.e. so they can quickly go home to wash up/sleep and come back when they're paged.

 

what is it like to be on one of those extended shifts? I suppose that it's natural to not get much sleep. is it usually just one resident/intern at a time, or are there several available to rotate?

[Guest Kirsteen]

Hi there,

 

Some medical students prefer to live close to the school/hospital as they can be close to the facilities, but also, they can save time and money that would have been spent on public transit or parking. Others prefer to live a little further (at least out of eyesight of the site) so that they don't feel that they're never away from work/school.

 

In terms of the overnight shifts (extended shifts normally involve a night) I'll give you an example from my night on the labour ward last night. The clerk was present until around 5pm. She left and then a PGY-5 resident (fifth year) and a staff obstetrician came on shift at 6pm. The resident was expected to stay on the ward all night and the staff obstetrician left after a C-section was performed at around 7pm. Only if a problem arose that the resident didn't feel she could handle alone, would the staff member be called in for assistance. There is a schedule that is arranged for staff, residents and clerks. The amount of call varies per institution but many residents take 1 in 4 call or so, i.e., 1 night in 4 will be spent on call.

 

This is similar on other services. For example, on surgery, at least one resident will be present on the floor overnight and generally one staff member will be on call to assist in a dire situation as described above.

 

Cheers,

Kirsteen

[Guest therealcrackers]

So far in four months of residency, it's been a little varied in terms of call.

 

To start, two months of general internal medicine/geriatrics meant 9 calls in 9 weeks, in house, on average 29-30 hours. There were a couple of weekend calls where I showed up at 8 on Saturday and went home at 10 on Sunday, and there were a couple of weekday calls where I started at 7:30 on a Wednesday and left about 3 on a Thursday afternoon; there was still stuff to be done and no one else to do it.

 

This was followed by a month of general internal medicine community call meant 7 call shifts where I was in hospital on pager until I got done all the consults, and then on pager at home (and maybe back to the hospital) until midnight. I had to put in a full day the next day (no post-call day).

 

Then there was a month of oncology and slotted into a cross-cover call schedule, doing 3 overnight in house call on nephrology and hematology inpatients.

 

Now it's cardiology, inpatient, in house, 7 calls in one month, about 28 hours/shift so far with post-call afternoon off.

 

Most first-year residency call is in house; you stay overnight in a call room. It is frowned upon for residents on in house call, where there is a call room for you, to go home unless you live RIGHT across the street. How long and how frequent your call shifts are depends on the service you're covering; General Surgery junior resident call is about 1 night in 4, but you might stay the whole day post-call because of your case load. OB and anaesthesia call is in-house overnight, but you're off call at 8 the next morning (and that's it). Orthopedics call for junior residents may be home call, but you could still be tremendously busy one night and get 8 hours of sleep the next.

 

Senior call (PGY-2 and up for medicine, often PGY-3 and up for surgical specialties) is a mix of home and in-house call; ICU and CCU is in house, busy, but you're done early the next day (after rounds, if not sooner) because you've likely been up all night. It varies on other rotations; but just because it's home call doesn't mean you won't have to come in.

 

As far as the rest of being a resident goes, it's been pretty good. No more co-signed orders. You can write scripts (for inpatients and clinic patients only!) A paycheque. You're a clerk with expanded responsibilities, teaching in some instances, learning (and a heck of a lot) in most of the rest. It's a chance to learn as much as you can about your chosen field, and in areas that support your chosen field (ie. there's a Phys Med and Rehab resident tonight doing a month of Gen Surg, who'd had two months of Medicine, 2 months of geriatrics, and has two months of Orthopedics coming up). You are immediately responsible for more than you had as a clerk, but you're still not ultimately responsible for anything yet. Residents live at the hospital, because that's where they get the practical experience they need.

 

I'm PGY-1 internal medicine. You'll probably get a totally different perspective from residents in other specialties and at other levels of training.

[Guest rubberoduck]

thanks kirsteen and therealcrackers for your generous replies. I've often heard practicing physicians say how their resident years were literally "h*ll", and it seems so mysterious and daunting. where can I find more information about internship/residency? I have questions like: when do you start, how many years do you have to spend on them, and which years do you get paid?

[Guest Kirsteen]

Hi there,

 

If you'd like some more information about Canadian residency then go to the CaRMS website. There you will find descriptions of each of the residency programs offered by each school as well as the salaries and benefits negotiated for each province.

 

With respect to some of your questions, year 1 of residency begins each year on July 1st if you have successfully matched to a residency. Medical students apply for the CaRMS match at this time each year, are invited for interviews in December or so and complete those interviews in January, generally. The match results are then dispersed on one day in February and it is on that day when students discover if they've been successfully matched to a program and where that program will be. If they have been matched then they have a few months to prepare before the July 1st start date.

 

Residency length will differ depending on the career path and program. For example, for a family medicine residency most (if not all) are 2 years' duration. For medicine or surgery most programs are 5 years long, although a couple of surgery programs are 6 years long. Some programs may end up being extended if the resident wishes to undertake graduate training during the course of the residency, e.g., to complete a Masters or PhD. Another factor that can extend residency is if a fellowship is undertaken after the initial residency is complete. So, for example, a General Surgery resident can complete a 5-year Gen Surg residency, write their Royal College exams at the end of it to gain their Royal College certification and then launch into a 2-year fellowship in Vascular Surgery. Thereafter they would be able to practice as either a General Surgeon or Vascular Surgeon.

 

In terms of pay, a salary is received for each year of residency. This salary generally starts at around $42,000 (but this differs per province) and increases with each year spent in residency. The CaRMS website provides a listing of the salaries for each PGY (post-graduate year) per province.

 

As to the residency years being less than fun I've heard that the hours are long, but those are the years in which you learn your craft. So as long as you select the program and career path that fits you best, you should derive some pleasure and satisfaction from the time spent in residency.

 

Cheers,

Kirsteen

[Guest UWOMED2005]

I love residency. You get to rotate through many interesting specialties and treat patients with backup and without major threat of lawsuit.

 

You FINALLY get a salary (not huge but enough to live on) and are capped (in Alberta) at working a maximum of 28hrs straight. Compare this to a medical student - I remember working 36-37 hours straight for NOTHING (at the time - since then they've introduced stipends for clerks. . . works out to about $1-$2/hr of work!)

 

I think residency pay and working conditions have improved greatly over the last 20 years thanks to CAIRO, PARA, PAIRO, etc. You work hard and you don't get paid great, but it's better than life as a medical student.

[Guest hickfromsticks]

What is it like as a clerk? I thought that it was more of a 9-5 type of thing with a night shift here and there... but a 36-37 hour shift! Wow!

[Guest JSS02]

I don't remember very many 9-5 days during clerkship, with the exception of psych, geriatrics, and oncology. Most rotations started around 8 and ended between 5 and 6. The surgical rotations tended to start pretty early, probably about 6:30 on average for me. Frequency of call also varied depending on which rotation you were on. General surgery was 1 in 3, internal was 1 in 5 to 1 in 6, and some rotations had no call at all. Post call policies vary a lot depending on your rotation, supervisor and senior resident. Internal is pretty good about getting you out by noon, but surgery usually is not, despite what the official post-call policies say. I was fortunate enough to be on a team for gen. surg. where I was free to go home post-call without being thought of as lazy, etc... if I had a hectic night on call I tended to go home early, but otherwise I would stick around for the day (i.e. the 36 hour shifts UWOMED was talking about).

[Guest Lactic Folly]

In cases where there are several possible sites in a city for a rotation.. how much is location a factor? For example, does the extra 20 min + 20 min commuting there and back make a significant difference in terms of time that could have been spent sleeping or reading?

[Guest aneliz]

The extra commute time doesn't make that big of a difference... it is a hassle post-call to have to drive 25 minutes home when people at another site are a mere 5 minutes from your home. However, there is more variability in what the experience is like at different sites that is more the issue than the commute. Surgery as a clerk at one hospital can be very different from surgery at another.

 

I too remember very few 9-5 days during clerkship. Even psych rounded at 8 and you occasionally had to come in for ECT at 7. The day usually ended around 5-5:30 in psych. Most people had call ~1:5 for psych as well. Medicine always started at 8 with sign in rounds... but the good clerk was there by ~7:30 to print team patient lists and check bloodwork. The day was usually over ~5:30-6. Call was ~1:5 on medicine. On my ICU elective, teaching started at 7 every morning, rounds ended ~6 every evening. Surgery, rounded ~6 every morning, sometimes as early as 5 or 5:15. The day usually went until at least 6:30 and sometimes as late as 9 when not on call. Call was 1:3, and there was no post-call going home (or you would be thought of as the ultimate lazy clerk!!!! - even if you got zero sleep). Those were the 37 hour days. (In at 6 AM out at 7 PM the next day) Peds... started at 7:30 for CTU, end of day ~5:30. ER you worked shifts - either days or evenings (clerk shifts covered from 8 AM - 2 AM, 7 days a week). Ob/Gyn... depends on the site you were at but rounds were at 7 AM daily and 6 AM on Wed. End of day was usually ~6 PM. Call was 1:3 - 1:6 depending on site. Family was highly variable depending on where you were - some people worked 9-3 and had Fridays off... other people rounded in the hospital at 6:30 every morning and worked clinic until 5:30-6 PM. I started ~8 every morning and was usually done ~5. Call (to cover the rural ER - 24 hour shift- was ~ 1:5).

[Guest UWOMED2005]

Residency for me in Calgary is very much more 8-5 with extra call shifts. 28 hr cap on call.

[Guest rubberoduck]

36hr shifts sound terrifying. how do you guys get used to that? I recently read in this forum that sleep-deprivation can seriously impair a resident's judgement. when you first started residency, did you have problems with feeling tired and unable to concentrate? what did you do to get over that? coffee? tea?

[Guest aneliz]

As long as you are busy and you keep moving, you forget what time it is and lose track of how long you have been there. Time is a very elastic concept when you are inside a hospital... especially one with limited windows that let in natural light! However, if you should sit down/lay down/go home, you will realise just how tired you really are. It is always best to keep moving until you are ready (and able) to take a nap!

[Guest therealcrackers]

When you're busy, time flies. When you're not, it sags. Best thing to do is get a nap or sleep when you can, to stockpile it for the nights you won't get any.

 

Tonight, for example, I had four admissions and one unstable chest pain patient in the space of 4 hours; now it's quiet, but all of these people are going to have ECGs and lab work early in the morning that I'll have to check over before morning report. If we get admissions in the middle of the night, I'll have to get up and do them (even if the patient will stay in emerg because there are no beds). Being a clerk meant answering the bell and doing a steady job despite the long hours and fatigue got you noticed. Being a resident and doing the same means you're doing your job.

[Guest Jochi1543]

I'm dating an internal medicine resident. We see each other a grand total of 2x a month.|I Granted, we also live 2 hours from each other, but nevertheless.