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Team Members - Resident Physician
Who is a Resident Physician?
A Resident Physician is a medical school graduate who is participating in a program of graduate medical education and training in a specialized area of medicine. Resident Physicians—or Residents, as they are more commonly called—have a dual role in the health care system in that they are simultaneously students and medical care providers.
What does a Resident Physician do?
In their role as medical care providers, Residents work in concert with other members of the health care team to provide direct medical care to patients. As physicians, one of their primary responsibilities is diagnosing patients’ medical problems and devising appropriate management and treatment plans. They also perform medical procedures on patients appropriate to their medical specialty and level of training.
In describing what Resident Physicians do, it is essential to understand the concept of graduated levels of responsibility. Residents undergo several years of training; depending on the medical specialty they are pursuing, their training will last from three to seven years. With each advancing year of training the Resident is given increasing levels of responsibility. Hence, a procedure performed independently by a senior Resident may not be appropriate for a more junior Resident to perform, or it may require the direct supervision of a senior Resident or attending physician.
What education, training, and experience must one have to function as a Resident Physician?
All Resident Physicians must have a Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), or other acceptable final medical diploma such as an MBBS. These degrees all signify the successful completion of a medical school curriculum of at least four years of study.
As part of their medical school curriculum, Residents may have had variable amounts of direct clinical experience. This will have included the rudiments of taking a medical history; performing and interpreting physical examination; and communicating with patients, families, and other members of the health care team. They may also have had some experience with ordering and interpreting diagnostic studies and may have performed some medical or surgical procedures under close supervision.
Some Residents, particularly international medical graduates (IMGs), may have had prior training or practice in the same or another specialty or may have had extensive clinical practice experience in another country. Residents also may have completed clerkships, electives, or observorships in the specialty they are currently pursuing or in related specialized areas while still in medical school or, in the case of IMGs, after completing medical school. Therefore, perhaps the only thing that can be said with certainty regarding the experience that Residents bring with them when they begin their training is that it is highly variable and the safest course is to make no assumptions.
How and by whom is a Resident Physician supervised?
Residents are supervised by more senior Residents and by attending physicians. Consistent with the principle of graduated responsibility, first-year Residents are most closely supervised, but as Residents progress in their training they are granted more autonomy and begin to assume responsibility for supervising junior Residents. The ultimate responsibility for supervision of Residents lies with attending physicians, who may also be referred to as faculty physicians.
Supervision of junior Residents by more senior Residents is more constant, while supervision by the attending physician is generally more sporadic, occurring mainly during daily rounds and patient case presentations. An exception to this would be surgical Residents who are directly supervised by attending physicians while working in the operating room.
What are the typical day-to-day activities of a Resident Physician?
Residents provide direct patient care and participate in ongoing educational activities, including teaching rounds, morning report, and formal conferences. They take medical histories, perform physical examinations, order and interpret diagnostic studies, and perform medical procedures appropriate to their level of training and experience.
Residents typically first interact with newly admitted patients either in the Emergency Department, on the ward, in a special care unit, or in an operating room. An admitting Resident, often the more junior Resident, does a comprehensive admission history and physical exam, develops a differential diagnosis or problem list, and proposes a diagnostic workup and treatment plan. These plans are generally reviewed and refined by more senior Residents or attending physicians before implementation.
Much of Residents’ work, as well as much of their education, occurs during rounds. During rounds, the team of physicians and sometimes other members of the health care team proceed from patient to patient to assess progress, response to treatment, and diagnostic developments, and to refine treatment plans. When not rounding, Residents may be involved in performing diagnostic or treatment procedures or conferring with consultants and other members of the health care team. Surgical Residents spend significant amounts of time in the operating room; time in the operating room increases with advancement in the surgical residency.
Residents spend much of their time seeing patients in outpatient clinics or in supervising physicians’ offices. Primary care Residents usually see patients over an extended period of time, developing an ongoing physician-patient relationship, which often involves communication with the patient’s family and coordination of care and services with other members of the health care team.
Finally, Residents spend a great deal of time taking part in educational activities. Although rounds are a primary venue for education, Residents are also required to attend formal educational conferences such as morning report, noon conferences, and morbidity and mortality conferences. These duties require that Residents be absent temporarily from clinical areas, but Residents should always be available by cell phone or beeper if emergencies develop with their patients.
Must a Resident Physician be licensed or certified to function in his or her role as part of the health care team?
In most states, Resident Physicians must be granted a license from the state or jurisdiction in which they practice in order to provide patient care. As physicians-in-training, junior Residents may have restricted “training” licenses. At some point they must obtain full unrestricted licensure if not to advance in their training then to enter practice.
Residents may receive certification in a medical or surgical specialty after completing accredited training and passing a specialty board examination. Surgical Residents may also be required to submit logs of surgeries performed or in which they have participated. Specialty certification is granted by the appropriate member board of the American Board of Medical Specialties.
What types of patients would benefit from the care of a Resident Physician?
All types of patients benefit from the care of Residents in a hospital or clinic setting.
How and when does a Resident Physician become involved in the care of a particular patient?
Residents assume care of inpatients when patients are admitted to the inpatient physician team. Residents assume care of outpatients in clinics as patients are assigned to them or in Emergency Departments as patients present for care.
