The reason a physician in graduate medical education training is called a “resident” is because back in the day, they *literally* lived in the hospital.
(a short thread)
One text recommended two medical and two surgical residents per 100 beds, a number which would “prove sufficient for all purposes.”
(If you’re wondering why the residents lived on the upper floors, it’s because “in case of fire, they, being in good health, could easily escape.”)
But that’s not all.
A century ago, residency had no fixed time endpoint - training could last any amount of time.
Most programs also had a ‘pyramid’ structure, in which many interns competed for fewer resident positions at each level and ultimately just one chief resident spot.
Once you were chief, you stayed until a suitable faculty position became available.
For example:
Dr. Kenneth Blackfan - one of the most accomplished pediatricians of the era - served as a chief resident for 11 YEARS before becoming faculty.
The AAMC has recommended that residency programs offer only virtual interviews for the upcoming season.
Who wins, and who loses? Let’s find out!
(thread)
WINNER: Homegrown applicants.
Every year, many students choose to stay at the same institution for residency. Many PDs will be eager to snap up these “known quantities” from an otherwise more uncertain applicant pool.
LOSER: DOs and IMGs, who may not have a “home” program.
WINNER: Student travel budgets.
Previously, many applicants spent upwards of five figures traveling to in-person interviews. You gotta try *really* hard to spend that kind of money sitting in your living room doing Zoom and WebEx interviews.
Well, another residency application season is in the books.
And in 2019, the average residency applicant (all comers) submitted 92 residency applications.
Yes.
NINETY-TWO.
And each year, this number creeps higher and higher.
We need to talk about this.
(thread)
First:
Can we please stop defending application inflation by saying that applicants *HAVE* to apply to so many programs because the number of residency programs isn’t growing at the same rate as applicants?
It’s not true.
Statistically-speaking, there’s never been a better time IN THE PAST 50 YEARS for a graduating U.S. medical student to get a PGY-1 position.
But don’t take my word for it - let’s get it straight from @TheNRMP.
Since the announcement that Step 1 will go pass/fail, there’s been a growing false narrative that USMLE scores allowed IMGs to compete on a level playing field with U.S. MDs for competitive residencies.
Here is the uncomfortable truth - and what to do about it.
(thread)
Even with a scored USMLE Step 1, DOs and IMGs were not “beating out” U.S. MDs for competitive residency positions or specialties.
Does this look like a level playing field?
Almost all IMGs match in specialties in which there are not enough U.S. MD graduates to fill the available positions. The number of IMGs who match in competitive fields (like surgical subspecialties) is vanishingly small.
It’s striking to me how the interviewee poignantly shares his own story of burnout from his internship - which occurred “before duty hours were truly implemented” - but seems largely oblivious to the fact that *systems* contribute to student burnout today.