Although most undergraduate pre-medical students know about the infamous hardships and academic rigor of medical school, many may not realize that after those difficult four years, their training is still not over. Medical school graduates are required by the American Medical Association (AMA) to enter a residency program of training within a specialty before applying for licenses to practice medicine. With over 36 specialties acknowledged by the American Board of Medical Specialties [1], choosing a residency program can be a daunting task. Residency programs vary in length according to specialty. For example, generalized primary care fields such as pediatrics and family practice typically require three years, whereas more specialized areas require up to seven years of training as well as a one- to three-year fellowship.

Here at UIC, there are a variety of residency programs offered in different medical specialties. For example, internal medicine, a primary care specialty, is one of the most frequently entered areas of medicine [1]. Dr. Fred Zar, residency director for UIC's internal medicine program, feels the goals of his program are "to train internists in the principles of humanism and professionalism in addition to having the necessary medical knowledge."

The admissions process for the internal medicine residency program is extremely selective. Residents are selected based on several determinants, including their Electronic Residency Application System (ERAS) applications, United States Medical Licensing Examination (USMLE) scores, letters of recommendation, and personal interviews. According to Dr. Zar, the pool of 3,000 applicants each year is reduced to only 33 selected students.

Although resident life may vary depending on the program and the specialty involved, there is no doubt that all programs involve long hours. Residents at UIC's internal medicine program maintain rigorous schedules, beginning daily at 7AM with the first round of visiting patients. Morning Report follows at 8AM, where the residents gather with an attending physician and discuss new patients from the previous night. The residents are then given time to review patient charts before their next rounds at 10AM, during which they visit patients again under the supervision of an attending physician. Afternoons at the hospital are filled with a noontime lecture on varying medical topics, followed by continued patient visits, ending around 5PM each day [2].

Pathology is another residency program offered by UIC. It is one of the smallest specialized programs, and it is directed by Dr. Michele Raible. Unlike internal medicine, pathology residency is a four-year program that admits only four to five students per year. "Pathology is an intellectually demanding specialty, yet it also requires communication skills in order to efficiently serve our patients and colleagues," says Raible.

A typical day in this residency consists of rotations in both clinical and anatomic pathology, covering areas such as surgical pathology, cytopathology, and hematopathology [3]. While the daily schedules may vary according to rotation, Raible views surgical pathology as the most intense. "In surgical pathology, [residents] are required to respond quickly in situations," states Raible. "For instance, slides may be required of a tissue sample from the operating room, giving the resident a fifteen-minute window to prepare and analyze the slide."

Aside from the difficult task of choosing a residency and successfully completing one, many students entering the medical field are intimidated by various residency horror stories told ubiquitously in television shows such as Scrubs and ER. Tales of immense stress, insufficient guidance, and evil attending physicians may overwhelm young students' minds. Perhaps the most infamous fear of residency is of the sleepless nights on call.

Dr. Adrian Ray, a second-year internal medicine resident, views the long hours as only a fraction of the stress. "Switching rotations each month makes it difficult to feel settled and comfortable in an area before you leave it for something new all over again," comments Ray. "While Scrubs is a great show, nothing can really prepare you for the experience."

Dr Zar explained that, fortunately, the Accreditation Council for Graduate Medical Education recently mandated that a resident spend no more than 30 straight hours in the hospital, allowing six hours after the 24-hour call shift for residents to tie up loose ends before exiting the premises. Furthermore, residents must have one full 24-hour period off and serve no more than 80 hours per week.

Although such regulations are certainly helpful to tired residents, such rules can occasionally impede resident education as well. "It can present a disconnect between what we should do and are allowed to do," says Zar of the new residency restrictions. "Being a doctor is inherently stressful; there are no limitations on a real work week."

Despite all the hardships, residency is an invaluable part of medical education. It allows medical school graduates to define their interests and better envision their futures in the profession. It also helps students discover which specialty is truly right for them. Some students realize after starting a particular residency that it does not suit them and change to another one. For example, chief resident Dr. Larry Jennings initially entered a surgery residency before later switching to pathology. "Pathology is much more a laboratory science than other specialties, which not all doctors enjoy," says Jennings. "But I like the work, and it also allows me to continue my research, as opposed to in other practice-intensive fields."

Although there are many challenges during resident life, there are rewarding moments as well. Ultimately, many view the best part of residency as simply the residents themselves. Undergoing the same stressful situations and experiencing relatively the same phases in life, residents form a unique community and interact closely with each other. According to Dr. Raible, this is particularly relevant in pathology. Since the residency community only comprises approximately twenty doctors, being team players is considered a necessity in order to be an effective group.

Any undergraduate student who has the opportunity to shadow a resident will undoubtedly encounter situations that are less than comforting. However, every difficult experience does come with stories that are informative, inspiring, or something else altogether. For example, while exploring the pathology labs of UIC Hospital, a student may see a resident absentmindedly shake a jar in the grossing room, comment casually "Oh, and this is a thyroid," and continue the tour. When observing a Morning Report session with internal medicine residents, one may witness a conversation that goes from friendly chatter and Viagra jokes to a shocked silence at the sudden death of a patient. The world of resident life is complex, challenging, and constantly changing, but with a strong mind, dedication, and a lot of heart, it may prove to be the most valuable learning experience a newly named MD will have during his or her entire career.