US Health Professionals Residency

Overview

Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree (MD, DO, MBBS, MBChB) and who practices medicine under the supervision of fully licensed physicians, usually in a hospital or clinic.

Whereas medical school teaches medical practitioners a broad range of medical knowledge, basic clinical skills, and limited experience practicing medicine, medical residency gives in-depth training within a specific branch of medicine. A medical practitioner may choose a residency in anesthesiology, sports medicine, dermatology, emergency medicine, family medicine, internal medicine, internal medicine/pediatrics, neurology, obstetrics and gynecology, pathology, Podiatric surgery, psychiatry, physical medicine and rehabilitation, radiology, radiation oncology, or other specialties (e.g., surgery).

In the United States it leads to eligibility for board certification and membership/fellowship of several specialty colleges and academies.

In some states of the United States, medical practitioners may usually obtain a general medical license to practice medicine without supervision after completing one year of internship in the state of their license. Many residents have medical licenses and do legally practice medicine without supervision ("moonlight") in settings such as urgent care centers and rural hospitals. However, in most residency-related settings, residents are supervised by attending physicians who must approve of their decision-making.

Interviews

The interview process involves separate interviews at hospitals around the country, generally 5-15, but up to 30, depending on the specialty. Frequently, the individual applicant must pay for the travel and lodging expenses, but some subspecialties (e.g. neurology, psychiatry) will often sponsor their applicants. In general, an interview consists of a dinner the night before, in a "meet-and-greet" setting. Current residents and/or staff are in attendance, and the air is more relaxed. Formal interviews are held the next day in the subspecialty offices. A one-on-one session is held with the applicant and an attending, but senior residents are often in attendance. Interview questions are primarily related to the applicant's interest in the specific and the applicant's interest in the subspecialty.

Some subspecialties hold interviews in a more competitive format. In certain surgical subspecialties, for example, applicants have been asked to whittle a nose from a bar of soap and to tie suture in a timed fashion. The purpose of these tasks is to force an applicant into a pressure setting and less to test his or her specific skill set.

As an attempt to defray the cost of residency interviews, social networking sites have been devised to allow applicants with common interview dates to share travel expenses. Nonetheless, additional loans are often required for "residency and relocation".

International medical students may participate in a residency program within the United States as well but only after completing a program set forth by the Educational Commission for Foreign Medical Graduates (ECFMG). Through its program of certification, the Educational Commission for Foreign Medical Graduates (ECFMG) assesses the readiness of international medical graduates to enter residency or fellowship programs in the United States that are accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Matching

Access to graduate medical training programs such as residencies is a competitive process known as "the Match." Senior medical students usually begin the application process at the beginning of their (usually) fourth and final year in medical school. After they apply to programs, programs review applications and invite selected candidates for interviews held between October and February. After the interview period is over, students submit a "rank-order list" to a centralized matching service (currently the National Residency Matching Program, abbreviated NRMP) by February. Similarly, residency programs submit a list of their preferred applicants in rank order to this same service. The process is blinded, so neither applicant nor program will see each other's list. Aggregate program rankings can be found here, and are tabulated in real time based on applicants' anonymously submitted rank lists.

The two parties' lists are combined by an NRMP computer, which (theoretically) creates optimal matches of residents to programs using an algorithm. On the third Thursday of March each year ("Match Day") these results are announced in Match Day ceremonies at the nation's 155 U.S. medical schools. By entering the Match system, applicants are contractually obligated to go to the residency program at the institution to which they were matched. The same applies to the programs; they are obligated to take the applicants who matched into them.

International Students

Many IMGs who wish to be licensed as a physician in the United States begin by completing a U.S. residency hospital program. To do so, an IMG must obtain an ECFMG certificate.

Those IMGs who have successfully passed the necessary USMLE exams and obtained the ECFMG certification can then apply to U.S. residency positions via the NRMP and ERAS.

References

ECFMG