Medical Residency Throughout the Ages

Medical residents are doctors that are undergoing postgraduate training. They can also be called resident physicians, senior house officers, senior resident medical officers, or house officers. Regardless of how they are called in their country, they all graduated from an accredited medical school, holds a medical degree, earned a license, and basically performs the same functions in the hospital.

Medical residency programs started in the late 19th century. These were informal programs that aim to provide additional training for any area that a person is interested in. the first formal residency programs, however, were initiated by William Steward Halsted and Sir William Osler who are both from Joh Hopkins Hospital. After that, medical residencies turned to be formal and institution-based programs for specialization in the early 1900s. Despite this, residency programs were not considered necessary for general practitioners so only a few physicians joined.

Instead of expanding the residency program, by the time it was the 1940’s, physician specialty boards start to find alternative ways so that the time it takes to become a doctor will be shorted. Things changed in the 1950s and 1960s. Along with the rise of new technology was the increase in the number of patients. This resulted in many types of errors. With this, faculty physicians were forced to focus on fixing problems on machines, so the residents were the ones who remained in the wards.

In the mid-20th century, residents were often hospital-based so they “reside” in housing provided by the hospital. That is how they were called residents. They are also on call or in the night duties of the hospital. Residents during that time experienced to have a lower salary that was beyond board and lodging and laundry services. This was because it was assumed that young residents only have a few obligations aside from their medical training.

The first year of residency or practical patient-care-oriented training or the first year after medical school is popularly known as internship. Interns used to be on separate hospitals from residents until the mid-20^th century. Later on, interns started to assume more responsibilities and worked in the same hospital with the residents.

Before the 20^th century ended, many doctors started to enter residency training programs because a few doctors were able to go straight to private practice after graduating from medical school. This was because most state and local governments started requiring at least one year of postgraduate training before one can take the medical licensure exam.

Since medical residency became mandatory, it was observed that doctors who have undergone such programs developed better work habits and attitudes. For instance, residents are more thorough and spend enough time to study each problem in depth. They do not just go from patient to patient by they reflect on each. Residents also have much attention to detail and follow their patients from they are admitted until they are discharged. What makes them busy is not the job entirely but because they are very thorough. Perhaps, a contributory factor to this behavior is that they are continuously monitored by faculty physicians, so they are afraid to commit mistakes.

Doctors have always been experiencing hectic schedules and work overload. Because of this, it is very common for physicians to experience burnout. Burnout has been a term that was present since the 1970s but until now, doctors are still experiencing it. The cause of this is very obvious, but there seems to be no action done by the faculty and medical institutions. This has caused unrest among the residents.

The government and the medical institutions tried to alleviate the problem by created new payment models since the 1980s. this includes diagnosis-related groups and duty-hour limits. This truly made a difference to residents until today. However, what is needed today is to create solutions that are holistic and encompassing. When drafting medical regulations, it is also important to always keep in mind that lessening physician burnout ensures doctors’ professional satisfaction and improves their competence in performing their duties.

The hospital or clinic is both the workplace and the learning environment of medical residents. With this, it is important to make this place a positive space for everybody where there is a good relationship between interns, medical residents, fellows, and faculty physicians. Also, this environment must be good for the intellectual stimulation of everybody, but reasonable patient loads must also be considered.

For many years, residents have been crying for help. They were too exhausted that their feeling of satisfaction in their work has declined significantly. Improving work conditions is the key to molding more productive doctors. It is not just all about lessening the work hours but the entire work setup.

Because of these, many groups are making efforts to improve medical residency systems. One is the Graduate Medical Education (GME) board that came up with an Institute of Medicine report on how to finance programs to help medical residents. The American Medical Association (AMA), through its AMA Council on Medical Education, has also made initiatives to solve issues on residency burnout. AMA also partnered with the Accreditation Council for Graduate Medical Education (ACGME) and other stakeholders in drafting an ideal medical education continuum. AMA’s policy on-duty hours of residents also encourage more research to be done to identify different problems that may be encountered in the duty-hours of doctors.

After about 125 years, there were many changes in the medical residency system. Examining the history of residency programs throughout the century including its challenges, allows medical institutions and doctors including medical residents to be inspired to do better tomorrow as they are inspired by yesterday.

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