Residency or postgraduate training is a stage of graduate medical education. It refers to a qualified physician (one who holds the degree of MD, DO, MBBS/MBChB), veterinarian (DVM/VMD, BVSc/BVMS), dentist (DDS or DMD), podiatrist (DPM) or pharmacist (PharmD) who practices medicine, veterinary medicine, dentistry, podiatry, or clinical pharmacy, respectively, usually in a hospital or clinic, under the direct or indirect supervision of a senior medical clinician registered in that specialty such as an attending physician or consultant. In many jurisdictions, successful completion of such training is a requirement in order to obtain an unrestricted license to practice medicine, and in particular a license to practice a chosen specialty. In the meantime, they practice "on" the license of their supervising physician. An individual engaged in such training may be referred to as a resident, registrar or trainee depending on the jurisdiction. Residency training may be followed by fellowship or sub-specialty training. Whereas medical school teaches physicians a broad range of medical knowledge, basic clinical skills, and supervised experience practicing medicine in a variety of fields, medical residency gives in-depth training within a specific branch of medicine.

Terminology

A resident physician is more commonly referred to as a resident, senior house officer (in Commonwealth countries), or alternatively, a senior resident medical officer or house officer. Residents have graduated from an accredited medical school and hold a medical degree (MD, DO, MBBS, MBChB). Residents are, collectively, the house staff of a hospital. This term comes from the fact that resident physicians traditionally spend the majority of their training "in house" (i.e., the hospital).^[1][2]

Duration of residencies can range from two years to seven years, depending upon the program and specialty. A year in residency begins between late June and early July depending on the individual program and ends one calendar year later.

In the United States, the first year of residency is commonly called as an internship with those physicians being termed interns.^[2] Depending on the number of years a specialty requires, the term junior resident may refer to residents that have not completed half their residency.^{[citation needed]} Senior residents are residents in their final year of residency, although this can vary.^{[citation needed]} Some residency programs refer to residents in their final year as chief residents (typically in surgical branches), while others select one or various residents to add administrative duties to the normal learning in the last year of residency.^{[3] [4]} Alternatively, a chief resident may describe a resident who has been selected to extend his or her residency by one year and organize the activities and training of the other residents (typically in internal medicine and pediatrics). ^{[citation needed]}

If a physician finishes a residency and decides to further his or her education in a fellowship, they are referred to as a "fellow". Physicians who have fully completed their training in a particular field are referred to as attending physicians, or consultants (in Commonwealth countries). However, the above nomenclature applies only in educational institutes in which the period of training is specified in advance. In privately owned, non-training hospitals, in certain countries, the above terminology may reflect the level of responsibility held by a physician rather than their level of education.^{[citation needed]}

History

Residency as an opportunity for advanced training in a medical or surgical specialty evolved in the late 19th century from brief and informal programs for extra training in a special area of interest. The first formal residency programs were established by Sir William Osler and William Stewart Halsted^[5] at the Johns Hopkins Hospital. Residencies elsewhere then became formalized and institutionalized for the principal specialties in the early 20th century. But even mid-century, residency was not seen as necessary for general practice and only a minority of primary care physicians participated.^{[citation needed]}

The expansion of medical residencies in the United States experienced a significant surge following World War II.^[6] In the post-war landscape, the demand for skilled physicians escalated, necessitating a robust training infrastructure. The G.I. Bill, a landmark piece of legislation, played a pivotal role in fueling this expansion by providing educational benefits to returning veterans, including those pursuing medical careers.^{[citation needed]} The increased financial support facilitated a surge in medical school enrollments, spurring the need for expanded residency programs to accommodate the growing pool of aspiring physicians. This period witnessed the establishment of numerous new residency positions across various specialties. In 1940 there were approximately 6,000 residency positions available, but by 1970 the available spots had increased to more than 40,000. At the same time, the daily operation of the hospital increasingly relied on medical residents.^[6]

Thus by the end of the 20th century in North America though, very few new doctors went directly from medical school into independent, unsupervised medical practice,^[6] and more state and provincial governments began requiring one or more years of postgraduate training for medical licensure.

Residencies are traditionally hospital-based, and in the middle of the twentieth century, residents would often live (or "reside") in hospital-supplied housing. "Call" (night duty in the hospital) was sometimes as frequent as every second or third night for up to three years.^[7] Pay was minimal beyond room, board, and laundry services. It was assumed that most young men and women training as physicians had few obligations outside of medical training at that stage of their careers.

The first year of practical patient-care-oriented training after medical school has long been termed "internship". Even as late as the middle of the twentieth century, most physicians went into primary care practice after a year of internship. Residencies were separate from internship, often served at different hospitals, and only a minority of physicians did residencies.

In the United States, the Libby Zion case, which garnered attention in 1984, shed light on the demanding work hours imposed on medical residents. Responding to this concern, the Association of American Medical Colleges released a position statement in 1988, recommending a cap of 80 work hours per week for residents. Subsequently, in 1989, New York became the first state to address this issue by implementing regulations through the Health Code, marking a pivotal moment in the regulation of resident hours. These regulations, integrated into the state hospital code, included duty hour limits and supervision enhancements advocated by the Bell Commission. However, despite the issuance of regulations, compliance was slow to materialize, and a decade later, site visits revealed widespread noncompliance with the established limits. The efforts to address and regulate resident work hours culminated nationally in 2003 when the ACGME (Accreditation Council for Graduate Medical Education) mandated these limits across the United States.^[6][8]

Afghanistan

In Afghanistan, the residency (Dari, تخصص) consists of a three to seven years of practical and research activities in the field selected by the candidate. The graduate medical students do not need to complete the residency because they study medicine in six years (three years for clinical subjects, three years clinical subjects in hospital) and one-year internship and they graduate as general practitioner. Most students do not complete residency because it is too competitive.^{[citation needed]}

Argentina

In Argentina, the residency (Spanish, residencia) consists of a three to four years of practical and research activities in the field selected by both the candidate and already graduated medical practitioners. Specialized fields such as neurosurgery or cardio-thoracic surgery require longer training. Through these years, consisting of internships, social services, and occasional research, the resident is classified according to their residency year as an R1, R2, R3 or R4. After the last year, the "R3 or R4 Resident" obtains the specialty (especialidad) in the selected field of medicine.

Australia

In Australia, specialist training is undertaken as a registrar; The term 'resident' is used synonymously with 'hospital medical officer' (HMO), and refers to unspecialised postgraduate medical practitioners prior to specialty training.^{[citation needed]}

Entry into a specialist training program occurs after completing one year as an intern (post-graduate year 1 or "PGY1"), then, for many training programs, an additional year as a resident (PGY2 onward).^[9] Training lengths can range from 3 years for general practice^[10] to 7 years for paediatric surgery.^[11]

Canada

In Canada, Canadian medical graduates (CMGs), which includes final-year medical students and unmatched previous-year medical graduates, apply for residency positions via the Canadian Resident Matching Service (CaRMS). The first year of residency training is known as "Postgraduate Year 1" (PGY1).^{[citation needed]}

CMGs can apply to many post-graduate medical training programs including family medicine, emergency medicine, internal medicine, pediatrics, general surgery, obstetrics-gynecology, neurology, and psychiatry, amongst others.^{[citation needed]}

Some residency programs are direct-entry (family medicine, dermatology, neurology, general surgery, etc.), meaning that CMGs applying to these specialties do so directly from medical school. Other residencies have sub-specialty matches (internal medicine and pediatrics) where residents complete their first 2–3 years before completing a secondary match (Medicine subspecialty match (MSM) or Pediatric subspecialty match (PSM)). After this secondary match has been completed, residents are referred to as fellows. Some areas of subspecialty matches include cardiology, nephrology, gastroenterology, immunology, respirology, infectious diseases, rheumatology, endocrinology and more. Direct-entry specialties also have fellowships, but they are completed at the end of residency (typically 5 years).

Colombia

In Colombia, fully licensed physicians are eligible to compete for seats in residency programs. To be fully licensed, one must first finish a medical training program that usually lasts five to six years (varies between universities), followed by one year of medical and surgical internship. During this internship a national medical qualification exam is required, and, in many cases, an additional year of unsupervised medical practice as a social service physician. Applications are made individually program by program, and are followed by a postgraduate medical qualification exam. The scores during medical studies, university of medical training, curriculum vitae, and, in individual cases, recommendations are also evaluated. The acceptance rate into residencies is very low (~1–5% of applicants in public university programs), physician-resident positions do not have salaries, and the tuition fees reach or surpass US$10,000 per year in private universities and $2,000 in public universities.^{[citation needed]} For the reasons mentioned above, many physicians travel abroad (mainly to Argentina, Brazil, Spain and the United States) to seek postgraduate medical training. The duration of the programs varies between three and six years. In public universities, and some private universities, it is also required to write and defend a medical thesis before receiving a specialist degree.

France

In France, students attending clinical practice are known as "externes" and newly qualified practitioners training in hospitals are known as "internes". The residency, called "Internat", lasts from three to six years (depending on the speciality) and follows a competitive national ranking examination. It is customary to delay submission of a thesis. As in most other European countries, many years of practice at a junior level may follow.

French residents are often called "doctor" during their residency. Literally speaking, they are still students and become M.D. only at the end of their residency and after submitting and defending a thesis before a jury.^{[citation needed]}

Greece

In Greece, licensed physicians are eligible to apply for a position in a residency program. To be a licensed physician, one must finish a medical training program which in Greece lasts for six years. A one-year obligatory rural medical service (internship) is necessary to complete the residency training.^[12] Applications are made individually in the prefecture where the hospital is located, and the applicants are positioned on first-come, first-served basis.^[12] The duration of the residency programs varies between three and seven years.

India

In India, after completing MBBS degree and one year of integrated internship, doctors can enroll in several types of postgraduate training programs: D.M. (DOCTOR OF MEDICINE) in: Cardiology, Endocrinology, Medical Gastroenterology, Nephrology, and Neurology. M.Ch. (MASTER OF CHIRURGIE) in: Cardio vascular & Thoracic Surgery, Urology, Neurosurgery, Paediatric Surgery, Plastic Surgery. M.D. (DOCTOR OF MEDICINE) in: Anesthesiology, Anatomy, Biochemistry, Community Medicine, Dermatology Venereology and Leprosy, General Medicine, Forensic Medicine, Microbiology, Pathology, Paediatrics, Pharmacology, Physical medicine and rehabilitation, Physiology, Psychiatry, Radio diagnosis, Radiotherapy, Tropical Medicine, and, Tuberculosis & Respiratory Medicine. M.S. (MASTER OF SURGERY) in: Otorhinolaryngology, General Surgery, Ophthalmology, Orthopaedics, Obstetrics & Gynecology. Or diploma in: Anesthesiology (D.A.), Clinical Pathology (D.C.P.), Dermatology Venereology and Leprosy (DDVL), Forensic Medicine (D.F.M.), Obstetrics & Gynaecology (D.G.O.), Ophthalmology (D.O.), Orthopedics (D.Ortho.), Otorhinolaryngology (D.L.O.), Paediatrics (D.C.H.) Psychiatry (D.P.M.), Public health (D.P.H.), Radio-diagnosis (D.M.R.D.), Radiotherapy (D.M.R.T.)., Tropical Medicine & Health (D.T.M. & H.), Tuberculosis & Chest Diseases (D.T.C.D.), Industrial Health (D.I.H.), Maternity & Child Welfare (D. M. C. W.)^[13]

Mexico

In Mexico physicians need to take the ENARM (National Test for Aspirants to Medical Residency) (Spanish: Examen Nacional de Aspirantes a Residencias Médicas) in order to have a chance for a medical residency in the field they wish to specialize. The physician is allowed to apply to only one speciality each year. Some 35,000 physicians apply and only 8000 are selected. The selected physicians bring their certificate of approval to the hospital that they wish to apply (Almost all the hospitals for medical residency are from government based institutions). The certificate is valid only once per year and if the resident decides to drop residency and try to enter a different speciality she will need to take the test one more time (no limit of attempts). All the hosting hospitals are affiliated to a public/private university and this institution is the responsible to give the degree of "specialist". This degree is unique but equivalent to the MD used in the UK and India. In order to graduate, the trainee is required to present a thesis project and defend it.^{[citation needed]}

The length of the residencies is very similar to the American system. The residents are divided per year (R1, R2, R3, etc.). After finishing the trainee may decide if he wants to sub-specialize (equivalency to fellowship) and the usual length of sub-specialty training ranges from two to four years. In Mexico the term "fellow" is not used.

The residents are paid by the hosting hospital, about US$1000–1100 (paid in Mexican pesos). Foreign physicians do not get paid and indeed are required to pay an annual fee of $1000 to the university institution that the hospital is affiliated with. ^{[citation needed]}

All the specialties in Mexico are board certified and some of them have a written and an oral component, making these boards ones of the most competitive in Latin America.

Pakistan

In Pakistan, after completing a MBBS degree and further completing a one year house job, doctors can enroll in two types of postgraduate residency programs. The first is a MS/MD program run by various medical universities throughout the country. It is a 4–5-year program depending upon the specialty. The second is a fellowship program which is called Fellow of College of Physicians and Surgeons Pakistan (FCPS) by the College of Physicians and Surgeons Pakistan (CPSP). It is also a 4–5-year program depending upon the specialty.

There are also post-fellowship programs offered by the College of Physicians and Surgeons Pakistan as a second fellowship in subspecialties.

Spain

All Spanish medical degree holders need to pass a competitive national exam (named 'MIR') in order to access the specialty training program. This exam gives them the opportunity to choose both the specialty and the hospital where they will train, among the hospitals in the Spanish Healthcare Hospital Network. Currently, medical specialties last from 4 to 5 years.^{[citation needed]}

There are plans to change the training program system to one similar to the UK's. There have been some talks between Ministry of Health, the Medical College of Physicians and the Medical Student Association but it is not clear how this change process is going to be.^{[citation needed]}

Sweden

Prerequisites for applying to a specialist training program

A physician practicing in Sweden may apply to a specialist training program (Swedish: Specialisttjänstgöring) after being licensed as a physician by The National Board of Health and Welfare.^[14] To obtain a license through the Swedish education system a candidate must go through several steps. First the candidate must successfully finish a five-and-a-half-year undergraduate program, made up of two years of pre-clinical studies and three and a half years of clinical postings, at one of Sweden's seven medical schools—Uppsala University, Lund University, The Karolinska Institute, The University of Gothenburg, Linköping University, Umeå University, or Örebro University—after which a degree of Master of Science in Medicine (Swedish: Läkarexamen) is awarded.^[15] The degree makes the physician eligible for an internship (Swedish: Allmäntjänstgöring) ranging between 18 and 24 months, depending on the place of employment.

The internship is regulated by the National Board of Health and Welfare and regardless of place of employment it is made up of four main postings with a minimum of nine months divided between internal medicine and surgery—with no less than three months in each posting—three months in psychiatry, and six months in general practice.^[16] It is customary for many hospitals to post interns for an equal amount of time in surgery and internal medicine (e.g. six months in each of the two). An intern is expected to care for patients with a certain degree of independence but is under the supervision of more senior physicians who may or may not be on location.

During each clinical posting the intern is evaluated by senior colleagues and is, if deemed having skills corresponding to the goals set forth by The National Board of Health and Welfare, passed individually on all four postings and may go on to take a written exam on common case presentations in surgery, internal medicine, psychiatry, and general practice.^[16]

After passing all four main postings of the internship and the written exam, the physician may apply to The National Board of Health and Welfare to be licensed as a Doctor of Medicine. Upon application the physician has to pay a licensing fee of SEK 2,300^[17]—approximately equivalent to EUR 220 or USD 270, as per exchange rates on 24 April 2018—out of pocket, as it is not considered to be an expense directly related to medical school and thus is not covered by the state.

Physicians who have a foreign medical degree may apply for a license through different paths, depending on whether they are licensed in another EU or EEA country or not.^[18]

Specialty Selection

The Swedish medical specialty system is, as of 2015, made up of three different types of specialties; base specialties, subspecialties, and add-on specialties. Every physician wishing to specialize starts by training in a base specialty and can thereafter go on to train in a subspecialty specific to their base specialty. Add-on specialties also require previous training in a base specialty or subspecialty but are less specific in that they, unlike subspecialties, can be entered into through several different previous specialties.^[19]

Furthermore, the base specialties are grouped into eight classes—pediatric specialties, imaging and functional medicine specialties, independent base specialties, internal medicine specialties, surgical specialties, laboratory specialties, neurological specialties, and psychiatric specialties.^[19]

It is a requirement that all base specialty training programs are at least five years in length.^[19] Common reasons for base specialty training taking longer than five years is paternity or maternity leave or simultaneous Ph.D. studies.

Base specialties and subspecialties

Add-on Specialties

Allergology

To train in the add-on specialty of allergology a physician must first be a specialist in general practice, occupational and environmental medicine, pediatric allergology, endocrinology and diabetology, geriatrics, hematology, dermatology and venerology, internal medicine, cardiology, clinical immunology and transfusion medicine, pulmonology, medical gastroenterology and hepatology, nephrology or otorhinolaryngology.^[19]

Occupational medicine

To train in the add-on specialty of occupational medicine a physician must first be a specialist in one of the pediatric class specialties, one of the independent class specialties (excluding clinical pharmacology, clinical genetics, forensic medicine, and social medicine), one of the internal medicine class specialties, one of the neurological class specialties (excluding clinical neurophysiology) or one of the psychiatric class specialties.^[19]

Addiction medicine

To train in the add-on specialty of addiction medicine a physician must first be a specialist in pediatric psychiatry or psychiatry.^[19]

Gynecologic oncology

To train in the add-on specialty of gynecologic oncology a physician must first be a specialist in obstetrics and gynecology or oncology.^[19]

Nuclear medicine

To train in the add-on specialty of nuclear medicine a physician must first be a specialist in clinical physiology, oncology or radiology.^[19]

Palliative medicine

To train in the add-on specialty of palliative medicine a physician must first be a specialist in one of the pediatric class specialties, one of the independent class specialties (excluding occupational and environmental medicine, clinical pharmacology, clinical genetics, forensic medicine, and social medicine), one of the internal medicine class specialties, one of the surgical class specialties, one of the neurological class specialties (excluding clinical neurophysiology) or one of the psychiatric class specialties.^[19]

School healthedit

To train in the add-on specialty of school health a physician must first be a specialist in general practice, pediatrics or pediatric psychiatry.^[19]

Pain medicineedit

To train in the add-on specialty of pain medicine a physician must first be a specialist in one of the pediatric class specialties, one of the independent class specialties (excluding clinical pharmacology, clinical genetics, forensic medicine, and social medicine), one of the internal medicine class specialties, one of the surgical class specialties, one of the neurological class specialties (excluding clinical neurophysiology) or one of the psychiatric class specialties.^[19]

Infection controledit

To train in the add-on specialty of infection control a physician must first be a specialist in infectious diseases or clinical microbiology.^[19]

Geriatric psychiatryedit

To train in the add-on specialty of geriatric psychiatry a physician must first be a specialist in geriatrics or psychiatry.^[19]

Application processedit

There is no centralized selection process for internship or residency positions. The application process is more similar to that of other jobs on the market—i.e. application via cover letter and curriculum vitae. Both types of positions are however usually publicly advertised and many hospitals have nearly synchronous recruitment processes once or twice per year—the frequency of recruitment depending mainly on hospital size—for their internship positions. Zdroj:https://en.wikipedia.org?pojem=Residency_(medicine)
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