Studying In Residency

[ACHQ]

Didn't know where else to place this so I just posted here.

 

We all know that residency training is what truly makes a physician. I'm just curious as a CC3 going through clerkship, how is the "academic"/self study work load for residents? I know in clerkship we are frequently studying for exams and OSCE's, but from what I gather you still have this in some residency programs? I feel that I myself studying a lot during clerkship (especially when I'm not on call), which obviously interferes with life, so I wonder if/how this changes in residency?

 

I know its probably program dependent but any thoughts from residents/fellows/staff would be helpful!

[A-Stark]

It's even harder. Residency rotations are longer, call is very very different, and you don't have regular exams every few weeks to motivate you.

 

So it becomes a challenge to find time to read but you do here and there.

[rmorelan]

It's even harder. Residency rotations are longer, call is very very different, and you don't have regular exams every few weeks to motivate you.

 

So it becomes a challenge to find time to read but you do here and there.

 

yeah - it is worse no question. You just learn how to do it.

[Lactic Folly]

The focus and motivation change. You are not studying primarily for exams and OSCEs (although they definitely exist in all residency programs - if you don't pass the exam at the end, you don't get to practice independently). You are studying because in a few short years, you will be practicing on your own, and if you've never heard of something, you can't diagnose it, or use it to treat your patient. As your clinical exposure depends on what rolls in the door, you must supplement with your own studying to ensure that all bases are covered, especially rarer conditions.

 

It's ok not to know everything, but for safety's sake it's vital to know what you know, and know what you don't know (and therefore need to consult someone else for) - somewhat ironically, this becomes easier the more you know (since your understanding of the field is deeper). Having a better knowledge base also makes your life easier, as your work will be more efficient and higher quality. As well, as a resident, you are responsible for teaching medical students and junior residents, which necessitates you knowing the material even better to teach it well.

[thatonekid]

So it becomes a challenge to find time to read but you do here and there.

 

 

yeah - it is worse no question. You just learn how to do it.

 

How? (serious question)

[Lactic Folly]

Fortunately, most of the learning is quite practical, and it's probably most effective to read around your cases as you encounter them. For the more systematic learning, try to read a little every day. Make use of downtime (today's technology makes it easier). Other than family time, for most people, other things take a back seat during residency.

[ACHQ]

Fortunately, most of the learning is quite practical, and it's probably most effective to read around your cases as you encounter them. For the more systematic learning, try to read a little every day. Make use of downtime (today's technology makes it easier). Other than family time, for most people, other things take a back seat during residency.

 

So then my question really becomes, how much does your family/social life suffer in that case? I feel like I'm already sacrificing much of it and I'm only in clerkship!

[Lactic Folly]

I do not look at the time devoted to training as something that is pitted against family time. Our family unit is a team that works together to support my medical training, which will ultimately benefit us all.

Time with extended family and friends outside of medicine did suffer a bit, but it becomes a matter of quality versus quantity. On the plus side, time spent isn't taken for granted.

I was also fortunate to have a collegial and supportive residency cohort that I enjoyed spending time with, so work time also doubled as social time in a sense.

[NLengr]

So then my question really becomes, how much does your family/social life suffer in that case? I feel like I'm already sacrificing much of it and I'm only in clerkship!

I'm in a 5 year surgical specialty.

 

The first couple years of residency are better IMO. You are very busy with work, but the pressure to study is less (at least in my program), especially when you are off service. Sure, you probably read for a few hours on the weekend days and maybe an hour or two at night some weekday nights, but overall it's pretty leisurely. And you can pick and choose what you read because: 1. Everything is new to you 2. You don't have the Royal College pressure yet.

 

Third year is ok, although the reading load picks up.

 

4th year is worse. In my program, pressure for the royal college exam starts to build. You are trying to read 2-3 hours a night, plus read on the weekends. You have a lot of responsibility at work (since you are running the day to day show) which causes even more of a time crunch. Social life/family can start to suffer for sure.

 

5th year is hell. Basically if you aren't operating (or in clinic) you are reading. All the time. Our 5th years would come to work at 7. Do AM rounds and then operate till say 12 (whenever the big chief level case for the day finished). Then they would go study in the hospital until around 6. Home for supper for 30 - 60 minutes. Back to studying for another few hours until bed (except Friday nights off). Weekends would be study Saturday from 11-6 (after Xmas it was 11-6, then 7-10) and Sundays from 9 - 5 (and after supper once it was January or later). That was the whole year. Our guys would routinely go days without seeing their kids. I think I managed to do a social activity with my two 5th year buddies 3 evenings over the whole year. It's a miracle marriages survived (although we haven't had a divorce ever as far as I know).

[ACHQ]

I'm in a 5 year surgical specialty.

 

The first couple years of residency are better IMO. You are very busy with work, but the pressure to study is less (at least in my program), especially when you are off service. Sure, you probably read for a few hours on the weekend days and maybe an hour or two at night some weekday nights, but overall it's pretty leisurely. And you can pick and choose what you read because: 1. Everything is new to you 2. You don't have the Royal College pressure yet.

 

Third year is ok, although the reading load picks up.

 

4th year is worse. In my program, pressure for the royal college exam starts to build. You are trying to read 2-3 hours a night, plus read on the weekends. You have a lot of responsibility at work (since you are running the day to day show) which causes even more of a time crunch. Social life/family can start to suffer for sure.

 

5th year is hell. Basically if you aren't operating (or in clinic) you are reading. All the time. Our 5th years would come to work at 7. Do AM rounds and then operate till say 12 (whenever the big chief level case for the day finished). Then they would go study in the hospital until around 6. Home for supper for 30 - 60 minutes. Back to studying for another few hours until bed (except Friday nights off). Weekends would be study Saturday from 11-6 (after Xmas it was 11-6, then 7-10) and Sundays from 9 - 5 (and after supper once it was January or later). That was the whole year. Our guys would routinely go days without seeing their kids. I think I managed to do a social activity with my two 5th year buddies 3 evenings over the whole year. It's a miracle marriages survived (although we haven't had a divorce ever as far as I know).

 

Thank you for your honest assessment.

 

so my question now is HOW does one study during residency, especially in Internal medicine?

[JohnGrisham]

I'm in a 5 year surgical specialty.

 

The first couple years of residency are better IMO. You are very busy with work, but the pressure to study is less (at least in my program), especially when you are off service. Sure, you probably read for a few hours on the weekend days and maybe an hour or two at night some weekday nights, but overall it's pretty leisurely. And you can pick and choose what you read because: 1. Everything is new to you 2. You don't have the Royal College pressure yet.

 

Third year is ok, although the reading load picks up.

 

4th year is worse. In my program, pressure for the royal college exam starts to build. You are trying to read 2-3 hours a night, plus read on the weekends. You have a lot of responsibility at work (since you are running the day to day show) which causes even more of a time crunch. Social life/family can start to suffer for sure.

 

5th year is hell. Basically if you aren't operating (or in clinic) you are reading. All the time. Our 5th years would come to work at 7. Do AM rounds and then operate till say 12 (whenever the big chief level case for the day finished). Then they would go study in the hospital until around 6. Home for supper for 30 - 60 minutes. Back to studying for another few hours until bed (except Friday nights off). Weekends would be study Saturday from 11-6 (after Xmas it was 11-6, then 7-10) and Sundays from 9 - 5 (and after supper once it was January or later). That was the whole year. Our guys would routinely go days without seeing their kids. I think I managed to do a social activity with my two 5th year buddies 3 evenings over the whole year. It's a miracle marriages survived (although we haven't had a divorce ever as far as I know).

And this is why my partner doesn't want me to do a surgical specialty unless I absolutely can't see myself doing anything else haha. 

 

Kudos to you and your colleagues for getting through that or working towards getting through it. A miracle indeed that marriages survive that ultra-heavy 5th year. A year goes by fast though in some senses, and spouses can and do adapt! 

 

Can't be hurt if you don't expect anything i suppose.

[goleafsgochris]

I'm in a 5 year surgical specialty.

 

The first couple years of residency are better IMO. You are very busy with work, but the pressure to study is less (at least in my program), especially when you are off service. Sure, you probably read for a few hours on the weekend days and maybe an hour or two at night some weekday nights, but overall it's pretty leisurely. And you can pick and choose what you read because: 1. Everything is new to you 2. You don't have the Royal College pressure yet.

 

Third year is ok, although the reading load picks up.

 

4th year is worse. In my program, pressure for the royal college exam starts to build. You are trying to read 2-3 hours a night, plus read on the weekends. You have a lot of responsibility at work (since you are running the day to day show) which causes even more of a time crunch. Social life/family can start to suffer for sure.

 

5th year is hell. Basically if you aren't operating (or in clinic) you are reading. All the time. Our 5th years would come to work at 7. Do AM rounds and then operate till say 12 (whenever the big chief level case for the day finished). Then they would go study in the hospital until around 6. Home for supper for 30 - 60 minutes. Back to studying for another few hours until bed (except Friday nights off). Weekends would be study Saturday from 11-6 (after Xmas it was 11-6, then 7-10) and Sundays from 9 - 5 (and after supper once it was January or later). That was the whole year. Our guys would routinely go days without seeing their kids. I think I managed to do a social activity with my two 5th year buddies 3 evenings over the whole year. It's a miracle marriages survived (although we haven't had a divorce ever as far as I know).

 

Very similar to my non-surgical 5 year specialty (neuro).

 

Years 1 and 2 were easier than clerkship.  Most people study minimally to not at all--you essentially don't study for your off service rotations, and when youre on service you try and study related material.  You are still busy at work, but otherwise its mostly free time, and feels like a normal 8-5 real person job.

 

3rd year picks up because royal college slowly starts to get in sight.  People try and study hard the relevant material for the rotations they are on, and sort of try and make a study plan.  4th year is similar but increases.  I would say 3-4th year studying (for us) is 10-20hours a week, more to 15-20 in 4th year--like think one full weekend day, and maybe 2-3 evenings 1-3 hours.

 

5th year like above is crazy.  Study every night maybe except fri and sat, for probably 4-5 hours.  Saturday all day, sunday all day, almost every weekend.  2nd half of the year is worse, like think the night before an exam in undergrad but constant all the time.  Most programs will give you a month or 2 of right before the exam, which helps.

 

Summary: year 1-2 easier than clerkship, you just work, year 3-4 maybe similar to clerkship or a bit worse depending on how hard you worked in clerkship, year 5 is a "wasted year" of hell.

[Borborygmi]

5th year like above is crazy.  Study every night maybe except fri and sat, for probably 4-5 hours.  Saturday all day, sunday all day, almost every weekend.  2nd half of the year is worse, like think the night before an exam in undergrad but constant all the time.  Most programs will give you a month or 2 of right before the exam, which helps.

 

 

Is there any way you could suggest to mitigate this? If you start studying harder in earlier years, would that make any sort of difference? Or is there really no other choice and we just need to be prepared for a year that's a total write-off?

[Lactic Folly]

Is there any way you could suggest to mitigate this? If you start studying harder in earlier years, would that make any sort of difference? Or is there really no other choice and we just need to be prepared for a year that's a total write-off?

In radiology, we were told to read regularly from day one. Leaving studying to the last minute would be a recipe for disaster. You would still be studying most of your free time in PGY-5, but having a solid background would allow you to focus on consolidating and rounding out your knowledge, not filling in gaps in a panic.

[rmorelan]

Is there any way you could suggest to mitigate this? If you start studying harder in earlier years, would that make any sort of difference? Or is there really no other choice and we just need to be prepared for a year that's a total write-off?

 

yeah now matter what you do you are going to be studying your ass off for the final exam - the trouble is you can really not be overprepared, and never know if you know enough. It seems a bit random as well to what you need to know.

 

All the fifth years here worked their asses off (I mean seriously every spare moment time of studying) for the test and still when asked post test the collective comment was "well we did not over study for that".

[Capucine]

How is studying for family med? 

[MD2015:)]

In family medicine you do a lot of off service rotations (like peds, emerg, medicine, surg, etc) and so you can study just before the rotation starts to review the basics. Then as you proceed through the rotation you can look things up during the day/at home that you didnt know about the cases you saw. Mostly you are trying to be useful and not look stupid so you also read for that. You also get more responsibility and get to do more procedures if they think you are competent so a little studying can help you out a lot. 

 

In family medicine clinics you can pick a topic or two per day based on the patients that you saw and read up on a guideline or review article about something you didnt know well that day. Personally I do not study every day and I didnt even really do that in clerkship either. I do write down in a little notebook or on my phone a list of things that I dont know very well from the patients I see and then I just work through the list for a few hours a week when I find the time/energy to get some studying in. If you are not a daily studier in preclerkship and clerkship then realize that you may never be one. I look things up a lot during the day while at work and I just study a couple topics from my list when I get a chance. For me this works very well. I dont like to force myself to study 2 hours per night or something because if I am on a busy rotation I want to sleep when I am tired and relax when I want to and be social when I have the chance. so I fit studying around everything else that makes me feel like I have wellness/balance.

 

You also kind of learn how residents study when you are in 4th year because you are learning to do well on electives and because you probably like the content of your electives, rather than to study for a block exam. You can play around with how you study best during electives.

[medhope15]

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[NLengr]

Once you are staff, you have much more control over your life. Most staff I know are busy, but less than a resident. They still can spend time with family, travel etc. Some staff work crazy 80 hour weeks, but to some extent, that's their own fault for letting their practice get that way. It's a choice they have made.

[FeministKilljoy]

My husband is a surgical fellow and my career is in allied health. We met in his first year of residency while both working at the hospital.

 

I could never imagine having kids as all of the work would fall onto my shoulders and I would become quite resentful. I do about 95% of the unpaid work in our household and I work part-time in order to make time for the unpaid work.

 

During residency, he had 1 in 3 call - that definitely was challenging. It was also difficult to see him get run into the ground. R5 was pretty bad.... But he passed, so that's all that really matters. Now it's a distant memory 

[mononoke]

My husband is a surgical fellow and my career is in allied health. We met in his first year of residency while both working at the hospital.

 

I could never imagine having kids as all of the work would fall onto my shoulders and I would become quite resentful. I do about 95% of the unpaid work in our household and I work part-time in order to make time for the unpaid work.

 

During residency, he had 1 in 3 call - that definitely was challenging. It was also difficult to see him get run into the ground. R5 was pretty bad.... But he passed, so that's all that really matters. Now it's a distant memory 

Out of curiosity, does all surgery have 1:3 call? What kind of surgery was he in?

[sleeping_sickness]

most junior call (on surgical rotations and otherwise) is 1:4 these days. in a 4 week block you'll do 7 calls.

home call is 1:3 but these rotations are rare. 

[W0lfgang]

So far in residency, I am under far greater pressure to study than I was during med school. This pressure is mostly internally derived because I want to achieve a high level of expertise and graduate with guns blazing. You only train once! 

[NLengr]

Wait till you get to your final year and are staring the exam down. You stop caring about graduating with guns blazing and just pray you pass at all.

 

/my current life

[liszt]

Wait till you get to your final year and are staring the exam down. You stop caring about graduating with guns blazing and just pray you pass at all.

 

/my current life

 

This shall pass -- and so will you!

Soon enough you will have those five precious letters after your name, and this will all feel like a distant nightmare