Common Misperceptions About Residency

Alexa M. Mieses, MD, MPH


July 14, 2017

No Autonomy

Medical students often worry that they will have too much or too little autonomy as a resident. The truth is, it all depends on your level of comfort.

Residents always work under the supervision of an attending physician. However, attendings are more or less physically present and available, depending on the situation. For example, on an inpatient rotation, you will always round with an attending physician in the morning who will approve your clinical plan before you carry it out. However, at night, the attending is often not in the hospital; therefore, you have to carefully consider your clinical plan and also when and for what reason it is appropriate to call the attending physician for help.

The level of autonomy varies not only on the basis of the setting, but also on the time of year. As a green intern, I had to discuss every single one of my clinic patients with my preceptor before sending the patient out the door. My preceptor would also come in to examine the patients with me. However, over time, as I grew as a clinician, my preceptor came in only to examine patients for whom I specifically requested help. Now, as a second-year resident, I am only required to formally precept certain patients whom I select; if a patient is straightforward enough, I can manage them independently—then my attending reviews my clinic note/documentation later in the day or week.

Too Much Paperwork

Again, this misperception is somewhat accurate, but it varies on the basis of the clinical setting and timing. As an intern, my main job on inpatient rotations was to see patients each morning, write progress notes, call consultants, and follow up on test results. This means that, yes, more of my time was spent doing paperwork than seeing patients. However, on an outpatient rotation, such as when I see my own continuity patients in clinic, the only paperwork I have to complete is a note for the encounter. This means that I can spend a significant amount of time speaking with and examining my patient and work on the note simultaneously while in the room.

Speaking and writing a note at the same time is an art form in and of itself. However, I become more and more efficient every day, which allows me to have less paperwork at the end of a clinic day.

Apart from the clinical setting, your level of training and specialty affect how much paperwork you have to do. For example, switching from the role of intern to second-year or third-year resident means that you have more of a supervisorial role. This means that in many cases, residents are not responsible for writing notes (interns are responsible for this), and residents can focus more on leading a team and making independent clinical decisions.

Furthermore, someone like me, who is training to become a primary care physician, will have more intervisit tasks to complete for patients compared with subspecialists. For example, I may have to fill out preauthorization forms for a patient to receive a certain medication, whereas a specialist who sees my patient to perform a procedure, such as colonoscopy or skin biopsy, may have little paperwork to fill out for my patient.

Residency is a great time of change. You will be forced to make decisions about how to spend your time and money and ultimately shape your career trajectory. From one rotation to another, and certainly from one year of training to another, your role on the team and level of expertise will be in flux. Therefore, what may be a misperception about residency to one trainee may turn out to be a truth and reality to another. Your choice of specialty and level of training influences what your residency experience will be like. No matter the training program in which you find yourself, you are certain to learn a lot and evolve as a physician.


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