Medical School vs Residency Comparison

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Medical School
Residency
Structure
– You’re a student paying money to learn
– In the first two years, attend classroom didactics and small group
– In the final two years, rotate on clincal rotations to learn patient care and apply principles
– You’re now working a job and being paid to take care of patients
– Didactics are less structured and no more than a couple hours per week.
– Self learning and staying on top of your work is critical
Length
– 4 years (5 optional)
– 3 to 7 years depending on specialty
– Some subspecialties require additional training through fellowship
Grading
– Often Pass/Fail in the first two years
– Clinical years often graded Honors/Pass/Fail
– Can be extremely competitive for certain specialties
– No grades
– Yearly in-service exam
– Evaluations from attending physicians
Class Exams
– Multiple exams, sometimes on the same day
– Less content on each exam
– Higher frequency of exams
– Fewer exams, no traditional finals week
– More content per exam
Finances
– $190,000 average medical student graduate debt
– $50,000 – 60,000 per year means you’re making money, finally, but probably only making minimum payments on debt
Work Life Balance
– Flexibility
– Can skip classes or take time from rotations if needed
– Strict time requirements and strict schedule
– Hospital and patients rely on you working
Testing Knowledge & Skill
– Formal exams for blocks, shelf exams for clerkships
– Informal evaluations, primarily verbal from attendings
Standardized Tests
– Step 1
– Step 2CK
– Step 2CS
– Step 3 (easiest Step exam)
– Annual in-service (only content of your specialty is tested)
– Boards exam when you graduate
 

1) Structure

The first key aspect to understand is that in medical school you are in school. You’re a student paying tuition to earn your MD. In residency, you’re working a job. Congratulations, you’re now a doctor, but you still need to hone your craft before you’re fully licensed, board certified, and can practice on your own without supervision. During the first two years of medical school, you primarily learn in the classroom through didactics and small groups. In the last two years, you are on your clinical rotations where you learn how to apply principles to patient care, tune your ability to work in teams, and practice your bedside manner. In residency, you’re no longer a student. You’re now a doctor with real responsibility. You take ownership of patients and are ultimatley the one responsible for their care. All residents require attending physicians to overlook and ensure quality care. As the years progress, you are expected to be more independent and rely less and less on attending supervision. By the end of residency, you should be ready to take care of patients on your own out in the real world. ||Read: Reflecting on the First 6 Months of Residency||  

2) Length

Medical school is generally 4 years. Many students do, however, opt to take an additional year to conduct research or earn another degree (i.e. Master’s). Residency length is highly variable and depends on your specialty. Generally, surgical specialties are longer than non-surgical specialties. For example, the longest is neurosurgery at 7 years, although certain programs are 8 years due to a mandatory research year. I matched into plastic surgery, which is the second longest at 6 years, although a few programs also require a mandatory research year, extending that to 7. Internal medicine and pediatrics are on the shorter end, each at 3 years. While almost all residencies fall within 3-7 years, certain subspecialties require additional training in fellowship, which is essentially part 2 of residency.  

3) Grading & Evaluation

Although many medical schools are transitioning to a Pass/Fail grading system for the first two years, it is still insanely competitive to get into certain specialties. For example, plastic surgery has the highest average Step 1 score, which hovers around the low 250s. Getting the 90th percentile on Step 1 makes you only an average plastic surgery applicant. ||Read: How to Score 260+ on Step 1|| The second two years are you clerkship years, which are generally graded on Honors/Pass/Fail, or some variation of the sort. If you want to go into a highly competitive specialty like plastic surgery, dermatology, or orthopedic surgery, you’ll need to work your butt off to earn an Honors grade. Clinical grades are usually based on a curve such that only a small percentage of the class can earn them, meaning you have to outshine your colleagues. In this regard, medical school is much more stressful than residency. In residency, the pressure to outperform your peers is an order of magnitude lower. There are no grades. You’ll take a yearly in-service exam specific for your specialty, and you’ll be evaluated by your attendings, but it’s overall much less high stakes.  

4) Cost & Finances

The most recent figures place the average medical school graduate debt at approximately $190,000. That’s right, nearly $200,000 to become a doctor. This includes both college and medical school loans. I have good news and bad news about residency. The good news is that you’ll be making money and start paying off your loans! The bad news is that you’ll likely be making minimum payments and accruing significant interest, since resident salaries are usually around $50,000 to $60,000 per year.  

5) Work – Life Balance

One of the biggest differences is how your schedule and time are structured. In med school you have classes (many of which you can skip and watch online, or get notes from a friend), and later you have rotations, where – let’s be honest, if you need to leave early, or take the day off for personal reasons, it’s almost always allowed. But once you reach residency, your free time is no longer totally under your control. You receive a schedule of when you are expected to be at the hospital – whether this is for a daytime shift or a 24 hour shift, and that is where you absolutely MUST be. You aren’t just required by your residency contract – you have patients whose lives and well being depends on you. You’ll start to discover that your time at the hospital doesn’t always end exactly on schedule the way a class would. If I’m operating on an emergency trauma patient and my shift is over – I don’t leave the operating room. I stay to finish the surgery and wait until care has been transitioned. ||Read: Super Human Efficiency and How to Be Productive||  

6) Testing Knowledge & Skill

In medical school, I remember having frequent tests, but in residency, evaluations are much more informal. An intern might finish a surgery and the attending may say – great job, but next time make sure not to pick up the needle with the forceps. Alternatively, attendings may coach resident physicians on medication choice, postoperative instructions, or a multitude of other aspects of patient care. All of these are ways to ultimately help a resident improve their skills and clinical judgment.  

7) Standardized exams

And finally there are standardized tests. In medical school you’ll take Step 1, Step 2 CK, and Step 2 CS. In residency, you’ll just take Step 3, then a yearly exam known as the inservice, and finally a formal licensing exam at the end of your training, known as the boards exam.  

Conclusion

At the end of the day, the most important difference is that being a resident is the first time in your life that you are taking care of patients as their own doctor. It can be stressful, tiring, and even frustrating, but most importantly – being a resident is incredibly rewarding. You’ve spent years and years of studying and hard work – first to get into a good college, then to get into medical school and finally to match into a strong residency program. Residency is the culmination of all of that hard work. This is the moment you’ve been waiting for – you’re finally becoming that doctor you’ve always dreamed of being.  
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