Chances are that if you have been a patient in a large metropolitan hospital or are regularly treated in a teaching clinic, you have interacted with a resident doctor. Medical residency is that crucial period between our first days as newly-certified doctors and emerging as full-fledged, licensed physicians.
When describing residency training to my friends and family, I get a lot of questions, such as, "Are you still in school? I thought you finished medical school!" or "Is residency like a work term?" I'll aim to clarify some of these misconceptions by speaking to what goes on during residency, and by describing some of the roles that I, and other resident doctors, take on during our training.
Resident doctors are medical doctors
Resident doctors are physicians engaged in supervised medical training prior to independent practice. Residents are indispensable to modern health care; we are involved in all aspects of medicine, from pre-natal care and delivering babies, to managing profoundly ill patients and engaging in preventative health care.
Residency is akin to an apprenticeship, and the training time is longer than most people might believe. A 2011 report titled "Shifting Public Perceptions of Doctors and Health Care," showed that over 70 per cent of the general public underestimated total duration of training for physicians. After completing high school, it takes a minimum of nine years to become a practicing family physician, and 13 to become a cardiologist. During residency, we complete training in a variety of clinical placements to gain the skills and knowledge necessary to work independently.
Resident doctors work in variety of settings
Resident physicians are integral to delivering health care in many settings that span across hospitals and outpatient clinics. We also do specialized training in areas such as refugee and Aboriginal health. Residents are a core part of health care teams dedicated to working with patients of all demographics, from adolescents to pregnant women to the frail elderly. Some residents will train internationally as well, completing rotations in high-, middle-, and low-income countries.
In these settings, residents deliver health care commensurate with their previous experience and level of training, always under the watchful eye of a supervising physician.
Resident doctors are first-line responders in the hospital
When things go from bad to worse in the middle of the night in many hospitals, a resident doctor will often be called to respond. Whether it is managing an elderly man's chest pain or evaluating patients who require imminent surgery, resident doctors are often in-house overnight, ready to respond to the call.
Residents are teachers and learners
Residency is a balance between delivering health care and structured learning activities. Required educational activities include patient rounds, academic days, and assessments. These are needed to ensure to ensure that all residents learn core components of their curriculum. For example, every psychiatry resident will have opportunities during their training to learn and demonstrate knowledge about depression, anxiety, psychotherapy and other skills relevant to their specialty.
As a resident doctor, I look forward to teaching junior residents, medical students as well as patients and their families. Lifelong learning is an integral part of keeping up-to-date as a physician, and it begins in residency. Most importantly, the best learning truly comes from our patients. Managing individual patients' health care needs in all complexity benefits resident doctors as much as patients.
Residents doctors chose their specialty and the specialty chose them
Near the end of medical school, students select a field of medicine in which they wish to specialize in during their residency training, before becoming a fully-licensed physicians in that field. After placements in hospitals and clinics are completed, reference letters are written, and audition interviews are held; a dossier for each medical student helps programs select which ones they want to take on as resident doctors. That pediatrics resident taking care of an ill child was selected by the residency committee for such a privilege. Surgery programs will want resident doctors with good hands while a resident training to become an emergency physician will sure have to be good under pressure!
Residency training evolves over time
Since 1889, when medical residency was conceptualized by Canadian-born doctor Sir William Osler, residency programs have been continuously re-engineered in their structure and content. New residency programs have emerged and requirements in existing medical programs have evolved over time.
Recent decades have seen the expansion of sites in which resident doctors can train, an increased emphasis being placed on resident wellness, and more opportunities for global health training. Resident doctors have several other roles in addition to patient care; when not caring for patients or studying, resident doctors are active in teaching, research, advocacy and leadership.
Resident doctors wear many hats.
Though residency training is often busy and sometimes stressful, the privilege to go to work every day as a resident doctor is nothing if not rewarding.
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Many women start to feel like they're dragging in their late 30s and 40s. They're losing testosterone, which may act as an antidepressant, and experiencing a flux in their levels of estrogen and progesterone, which may also influence mood and energy. One of the most effective tactics for perking up comes down to how you plan your meals. "Many of my clients seem to think that by filling one meal with energy-generating nutrients -- say, a green smoothie for breakfast or a salad at lunch -- they've done their duty for the day," says dietitian Ashley Koff. "But your body needs several energy pit stops so you can refuel." Koff suggests small meals every three hours that combine a variety of nutrients. Her energy-boosting meal plan: Breakfast: Oatmeal with hempseeds. A.M. snack: Half cup of cottage cheese with berries. Lunch: Half a turkey sandwich with salad. P.M. snack: Half cup of tuna salad with wheat crackers. Dinner: Wild salmon with nonstarchy veggies.
Two free surefire solutions: diet and exercise. Losing even a few pounds can provide tremendous relief. One study found that for every pound you drop, you take four pounds of pressure off your knees. "Low-impact exercises -- walking, swimming, cycling -- help maintain a healthy weight and muscle mass as well as release endorphins, all of which can lead to a decrease in pain," says Roxanne Wallace, MD, an orthopedic surgeon at Marshfield Clinic in Wisconsin.
Down, girl. As long as you have no open wounds, you can welcome Sparky's affection. "A healthy immune system is strong enough to fight off most bacteria in a pet's saliva," says Jennifer Gabriele, a vet at Heart of Chelsea Animal Hospital in New York City.
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Sorry, cupcake, it doesn't look good. Too much of the sweet stuff can wreak havoc on your entire body. Added sugars have been associated with inflammation, a condition linked to obesity, type 2 diabetes, and heart disease. In fact, a 2014 study found that people who consumed 17 to 21 percent of their daily calories from added sugar had a 38 percent higher risk of dying from heart disease than those who got only 8 percent. For most women, the American Heart Association recommends no more than 100 calories from added sugar daily.
You can ignore the old eight-glasses rule: Six is typically plenty to hydrate you and keep everything in working order, according to a review in the European Journal of Clinical Nutrition.
You may have small intestine bacterial overgrowth (SIBO), a condition common among those suffering from chronic bloating. SIBO can occur when bacteria in the colon migrate up into the small intestine and ferment the carbs passing through, creating gas. Consider switching to a diet low in fermentable foods (which include dairy, wheat, and high-fructose fruits) so the bacteria will have less to feast on, says Johns Hopkins gastroenterologist Gerard E. Mullin, MD, author of The Gut Balance Revolution. Research has shown that the plan works: A study in the journal Gastroenterology found that the majority of subjects with irritable bowel syndrome reported significantly less bloating when they followed a diet low in bacteria-loving foods.
"If you misrepresent the facts, you limit what your doctor can do for you," says Lissa Hirsch, MD, an obstetrician and gynecologist at Lenox Hill Hospital in New York City. Some of your lies will be revealed by your blood work or the number on the scale, but otherwise your doctor has nothing to go on but what you report -- and that could be dangerous. Say you fib and tell her you're following a diet and exercise program to lower your blood sugar. When your "plan" doesn't seem to be working, she may prescribe medication you don't need, unwittingly putting you at risk for unnecessary side effects. In other words, when your pants are on fire, you'll be the one who gets burned.
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Of course no one has a magic formula, but Marie Bernard, MD, deputy director of the National Institute on Aging, has a few ideas: See your doctor regularly. "At the turn of the 20th century, the average American life-span was about 45 to 50 years," says Bernard. "Today people live well into their 70s and beyond, and many experts believe that increase is due in part to preventive health measures." Maintain friendships. A new Brigham Young University review revealed that social isolation increases your risk of mortality by up to 32 percent -- on par with obesity. Learn a new skill. A recent University of Texas at Dallas study found that people who mastered a new and challenging skill (like digital photography or quilting) showed greater gains in memory than those who performed passive activities, like crossword puzzles. So get out there and start learning!
Follow Dr. Boluwaji Ogunyemi on Twitter: www.twitter.com/OgunyemiMD