# of residency years

[MDpride]

Whass the history behind # of years of residency in a given field ?

is there any evidence behind how long residency in a particular field should be for being competent in that field to practice independently ?

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[wooster201106]

Whass the history behind # of years of residency in a given field ?

is there any evidence behind how long residency in a particular field should be for being competent in that field to practice independently ?

I've wondered this too. I can only guess, especially with surgical/procedural specialties and subspecialties, that the length of training is determined by how many years it is estimated it would take to fulfill the ACGME/RRC or ABMS mandated number of procedures to become board eligible in that specialty. I don't know that anyone really knows the answer to your question, and, oddly, I rarely hear anyone question it. How any ABMS board comes up with their required number of procedures or length of training seems completely arbitrary. I have never seen any evidence behind the numbers or length of training set by any board.

In the recent past, the ABIM increased the number of continuity clinic hours required to become board eligible, but I highly doubt that was based on any solid evidence. There have been attempts to institute some reform. The ACC proposed to reduce the total length of training to complete a general cardiovascular medicine fellowship to 5 years by eliminating a year of internal medicine residency training. Of course, the APDIM and others made a big stink about it arguing 2 years is certainly not enough time to adequately train someone to become an internist but completely lacked any evidence as the basis for their opinion. They were more likely motivated by financial concerns and the loss of funding and general upheaval that would result from the significant attrition of residents going into cards.

GI and cards used to be 2-year fellowships. Of course, you could always argue that there have been major advancements in those fields (esp cards) over the past 2-3 decades and the increased complexity merits additional training. However, a general cardiologist who completed fellowship in the early 80s in 2 years is still expected to provide the same standard-of-care and have the updated knowledge of a general cardiologist finishing fellowship today. So, is that additional year in training really necessary for a general cardiologist if a practicing cardiologist who graduated decades ago is expected to bridge the knowledge gap while in practice? Ditto for GI. The procedural advancements requiring additional training are a different story.

Another related but slightly off-topic thing I have always taken issue with is the indefinite certification for those who certified in certain specialties and subspecialties prior to a certain year while newer diplomates are required to recertify every X number of years. That, to me, is completely bogus and I cannot understand how they are allowed to get away with their double standards.

 

[Law2Doc]

Whass the history behind # of years of residency in a given field ?

is there any evidence behind how long residency in a particular field should be for being competent in that field to practice independently ?

I don't know the history of it, but I can tell you that in certain specialties, you are going to come out of what externally seems to others like a long residency feeling like you barely touched the surface in a lot of the required sub-fields. Basically a 3-7 year path seems like a long time until you get several years into it and start feeling like your time working with a net is too rapidly coming to a close. Basically residency length is a compromise between the amount of time needed to become a good practitioner, and the amount of time folks will endure being an apprentice.

 

[wooster201106]

...Basically residency length is a compromise between the amount of time needed to become a good practitioner, and the amount of time folks will endure being an apprentice.

I don't think anyone really has a good answer to the question, probably because there isn't one. That's probably also why no one is responding to this thread. Your take is as good as any I've heard though.

 

[gutonc]

I don't think anyone really has a good answer to the question, probably because there isn't one. That's probably also why no one is responding to this thread. Your take is as good as any I've heard though.

I can come up with some rational sounding reasons for several specialties:

FM: 1y each of peds, adult and OB
IM and Peds: 1y to pull your head out of your butt, 1y to get the new interns to pull their heads out of their butts, 1y to put it all together
Gen Surg: 1y to pull your head out of your butt, 1y to cover the ICU and ER consults, 3 years to learn how to operate.
Derm: 1 year to learn it all, 2 years to golf and study for the boards.

I could keep going..but I won't. The reality is probably more like what L2D stated...a combination of "when I was your age, blah, blah, blah" and keeping people from quitting because you're making them train too long.

 

[wooster201106]

I can come up with some rational sounding reasons for several specialties:

FM: 1y each of peds, adult and OB
IM and Peds: 1y to pull your head out of your butt, 1y to get the new interns to pull their heads out of their butts, 1y to put it all together
Gen Surg: 1y to pull your head out of your butt, 1y to cover the ICU and ER consults, 3 years to learn how to operate.
Derm: 1 year to learn it all, 2 years to golf and study for the boards.

I could keep going..but I won't. The reality is probably more like what L2D stated...a combination of "when I was your age, blah, blah, blah" and keeping people from quitting because you're making them train too long.

And the hits keep comin'. I know everyone takes digs at derm, but seriously, how can one justify the same length of training for a field like derm compared to something as broad-based as IM or FM. I don't think anyone could ever sell me an argument on that one. Maybe it's to assuage some of the guilt?

 

[Law2Doc]

And the hits keep comin'. I know everyone takes digs at derm, but seriously, how can one justify the same length of training for a field like derm compared to something as broad-based as IM or FM. I don't think anyone could ever sell me an argument on that one. Maybe it's to assuage some of the guilt?

The advanced fields all do a year before their residency starts, out of the theory that you need to be a bit of a generalist before you can be a good specialist. As a result most advanced paths are going to be more years than IM or FM. You can specialize from those fields as well, which means a fellowship and more years. All specialists tend to spend more years of training than the generalist, which in part justifies charging more of a fee, and in part reflects that someone who is an internist is expected to know a little about a lot, and consult specialists for the details, but the advanced specialists are expected to have far fewer gaps in their knowledge base for which they will be allowed to be calling others.

 

[adagio]

Interesting discussion. Thank you very much for the input

@Gutonc:

you are an eternal cynic ... I am starting to get convinced that you are a pathologist in disguise

 

[Skinceutical]

And the hits keep comin'. I know everyone takes digs at derm, but seriously, how can one justify the same length of training for a field like derm compared to something as broad-based as IM or FM. I don't think anyone could ever sell me an argument on that one. Maybe it's to assuage some of the guilt?

The derm board exams cover basic science (mostly structure and function of skin and immunology), clinical dermatology, dermatopathology, and cutaneous surgery in relatively persnickety detail. It ends up being a fairly "broad based" curriculum as well.

 

[Cooperd0g]

At least most specialties have what seems to be standardized lengths. Then there is EM with both 3 and 4 year programs.

 

[Law2Doc]

At least most specialties have what seems to be standardized lengths. Then there is EM with both 3 and 4 year programs.

That's because that is still a relatively new specialty trying a fairly new approach to shift work, and lots of disagreement as to what the field ultimately should look like. Lots of specialties have gone through changes in years and at times straddled multiple year approaches.

 

[Arcan57]

At least most specialties have what seems to be standardized lengths. Then there is EM with both 3 and 4 year programs.

There are actually 3 configurations: PGY 1-3, PGY 1-4, and PGY 2-4. The last is fading away as most are being consolidated into PGY 1-4 to meet the specific needs of the EM resident. Essentially the model is 3 yrs, +/- minus a prelim year. There are a number of threads in the EM forum regarding the merits between the two formats.

 

[gutonc]

There are actually 3 configurations: PGY 1-3, PGY 1-4, and PGY 2-4. The last is fading away as most are being consolidated into PGY 1-4 to meet the specific needs of the EM resident. Essentially the model is 3 yrs, +/- minus a prelim year. There are a number of threads in the EM forum regarding the merits between the two formats.

You forgot to mention that all of those threads boil down to "I went to an X year program and it is absolutely the only way to do it. Y year programs are dumb."

 

[Law2Doc]

You forgot to mention that all of those threads boil down to "I went to an X year program and it is absolutely the only way to do it. Y year programs are dumb."

While there is certainly some component of that, There are certainly some valid arguments for showing up to an advanced residency having had a broad prelim year experience, where you learned how to put in lines and got a decent sense of what you need to hear from the ED when they are trying to admit a patient onto your service. There are fewer arguments to suggest someone who didn't have this experience is better off, except in terms of shorter training. And there are some in EM that worry that training with short shift hours is otherwise a bit too short, considering the amount you ought to know in EM is growing, not decreasing, as the emergency room becomes the nations primary source of care for certain populations.

 

[deuist]

While there is certainly some component of that, There are certainly some valid arguments for showing up to an advanced residency having had a broad prelim year experience, where you learned how to put in lines and got a decent sense of what you need to hear from the ED when they are trying to admit a patient onto your service. There are fewer arguments to suggest someone who didn't have this experience is better off, except in terms of shorter training. And there are some in EM that worry that training with short shift hours is otherwise a bit too short, considering the amount you ought to know in EM is growing, not decreasing, as the emergency room becomes the nations primary source of care for certain populations.

In EM at least, I think that a 3 year program plus a fellowship is a much better training timeline than 4 years in a residency program