Is Residency Harder Than Medical School?

Undoubtedly yes. But it's also very different!

For those of you soon to embark on a medical residency, you may be wondering whether being a resident will require more stamina, discipline, and dedication than what has already been asked of you. And though you already have a good idea that with further training comes more responsibility and hard work, what may surprise you is how gratifying the experience can be.

As a third-year student rotating on the medical service in 2003, I was given a 1-month schedule with excruciatingly detailed appointment times for lectures, conferences, and even where to meet for rounds. Showing up on time, enthusiastically posing questions, and offering to help your resident with the nitty-gritty work like blood draws and rectals was usually enough to guarantee a good evaluation, or at the very least, a few pats on the back. If I forgot to check up on blood culture results or calculate a FeNa on a renal failure patient, there was always an intern or resident to back me up. Occasionally feeling responsible for a patient's care was a nice feeling, but it was not a requirement.

Now, as a second-year medicine resident, my day-to-day experience is considerably different. I no longer can indulge in only the occasional sense of responsibility for a patient's welfare, as residency demands ongoing attention to every aspect of patient care. Although this may seem intimidating at first, the transition is gradual and the rewards plenty.

Unlike a medical student, a resident can dramatically affect patient care. We are responsible for everything from interpreting the daily nuances of blood chemistries to appropriately delegating tasks to other members of the care team, to acting as the point person for patients' families, who often look to us for comfort and advice. In essence, we act as both patient advocate and micromanager.

As a student, I used to leave the hospital to go home and read so that I could do well on the exam that awaited me at the end of each rotation. As residents, we are responsible for yearly in-service exams and, ultimately, certification exams. But something else is different. Leaving the hospital after a long day's work is not just about getting time off to relax, but also about finding time for reflection. Work becomes increasingly relevant as the responsibility for patient welfare becomes more personal.

Although you feel like the same person, during medical school you were the student, and in residency, you are suddenly the doctor. The routines and hours are similar to those in many clerkships, but the emotional and intellectual commitment is on a whole new level. Does that make it harder? Thankfully, you are used to the daily routine and to spending so much time in the hospital. But the nighttime thought process about your patients and their diseases takes on a meaning completely different from that during your education.

I still have a schedule of lectures and conferences to attend in addition to the increased demands of caring for an entire service of patients. And yes, at times it is more challenging to be a resident compared with being a medical student. I sometimes long for the days when I could "escape" to the library to read up on a topic. Sill, my experience over the last year and a half has been incredibly satisfying and rewarding -- hard work and all.

My advice for those of you about to embark on a residency is to always maintain perspective. Take one day at a time, enjoy the ride, and remind yourself that there are tens of thousands of student doctors just like you struggling to make the next transition -- in this case, to resident. With each part of the journey, we fear the unknown and wonder whether the next part could be harder. The same way that I feared the reality of residency, I now think about moving on to become an attending with a whole new set of responsibilities and expectations. I often have found it helpful to think about all of those other people when I am nervous or feeling overwhelmed. For instance, when rotating through the ICU and feeling like things could never get more difficult, I thought about the other residents in my program who had already been there. They got through it, and so could I.

Medical education and training is a unique experience. It is grueling, and at each step along the way, it is common to think that you cannot imagine anything worse. Suddenly, a year has gone by and you have achieved the next milestone in your career. You will get through this process, and by asking questions like this, you will continue to navigate the road well and with success.

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