While both are crucial aspects of your medical training, medical school and residency a very different. Learn about the key differences between med school and residency so that you can best prepare yourself for both types of training.
Medical School vs. Residency Differences
| 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 clinical 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 | – $250,000 average medical student graduate debt | – $50,000 to $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 3 (easiest Step exam)
– Annual In-service (only content of your specialty is tested) – Boards exam when you graduate |
1 | Structure
The first key difference between medical school and residency is right there in the name. In medical school, you are in school. You’re a student paying tuition to earn your MD. In residency, you’re working a job. Yes, you’re 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 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 ultimately the one responsible for their care. All residents require attending physicians to supervise them and ensure quality care. As the years progress, you are expected to rely less and less on the supervision of attendings and be more independent. By the end of residency, you should be ready to take care of patients on your own out in the real world.
2 | Length
Medical school is generally 4 years. However, many students opt to take an additional year to conduct research or earn another degree, such as their 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 residency 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.
The second two years of medical school are your 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 so 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 lower. There are no grades. You’ll take a yearly in-service exam specific to your specialty, and you’ll be evaluated by your attendings, but overall, it’s not as high-stakes.
4 | Cost & Finances
The most recent figures place the average medical school graduate debt at approximately $250,000. This includes both college and medical school loans.
I have good news and bad news about residency. The good news is you’ll be making money and can start paying off your loans. The bad news is you’ll likely be making minimum payments and accruing significant interest since resident salaries are usually around $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 it’s 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 wellbeing depend 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 you’re operating on an emergency trauma patient and your shift is over, you don’t leave the operating room. You stay to finish the surgery and wait until care has been transitioned.
Learn more: 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 and Step 2 CK. In residency, you’ll just take Step 3, then a yearly exam known as the In-Service, and finally, a formal licensing exam at the end of your training, which is known as the boards exam.
Bottom Line: You’re No Longer a Student
At the end of the day, the most important difference between medical school and residency is being a resident is the first time in your life that you are taking care of patients as their own doctor. You’re no longer a student. 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 the doctor you’ve always dreamed of being.
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Looking to the future and remembering my goal in stressed times I think will help a lot. Thanks for the tips and reminder