How has residency evolved? What to expect in today's world

By Naveed Saleh, MD, MS | Fact-checked by Barbara Bekiesz
Published April 18, 2022

Key Takeaways

  • Residency is known to be grueling, but thanks to reforms that restricted work hours, residency workload is more manageable today than it once was.

  • Self-care is a challenge during residency, but online wellness resources can help. Make time for proper sleep, diet, exercise, and extracurricular activities.

  • Create a structured plan to prepare for the boards, and take advantage of all the e-learning tools out there. And get a jump on state licensure.

For new residents, it’s welcome news that some aspects of residency today are different from days past. Take working hours, for example. Thanks to work reforms, resident hours are not nearly as grueling as they once were.

On the other hand, other aspects of residency remain the same. It's still important to find a mentor, and the nuts-and-bolts of building relationships with team members and patients haven't changed. And at the end of residency, you'll still need to prep for the boards and take steps to ensure a successful future as a practicing physician.

In this article, we outline what to expect as a new resident, including guidance from those who have been there.

Work hours: a change for the better

Prior to 2003, residents routinely toiled away for more than 80 hours a week, and 30-hour shifts were customary.

In response to growing concerns over resident fatigue and resulting medical errors, the US House of Representatives proposed federal work hour limits, and pressed the Accreditation Council of Graduate Medical Education to institute residency work-hour reforms.

Reforms rolled out in 2003 reduced the number of hours residents can work per week to 80 and shifts were limited to 24 hours—not including patient sign-out. Residents are allowed to take call only every third night and must have 4 days off per 28, or one day off per week.

Although there was initial concern that working fewer hours could negatively impact resident training and learning, a 2019 study published in the BMJ found these changes didn’t affect patient death rates, readmissions, or costs of care among first-year internists.[]

Working hours, however, are only one aspect of residency. Other factors impact the residency experience.

Finding guidance and mentorship

As a newly minted physician, you’re not expected to know everything. In an article published by the AMA, Ronald J. Vender, MD, summed it up.[]

"'You don’t know what you don’t know' is something I’ve learned over the years, and that insight would have been helpful as a resident. "

Ronald J. Vender, MD

To expand your knowledge, Vender suggested forming close working relationships with nurses. Many of them know more than even junior residents, he observed, and they may have better clinical instincts.

In addition to nurses, other colleagues are also valuable resources.

Advice highlighted in an article published by the AAFP cites other residents, faculty, social workers, and pharmacists among the people who can guide you.[]

Related: Finding mentors during residency

Prioritizing self-care

Mastering the art of self-care is a crucial skill that will serve you well for the duration of your medical career.

In the AMA article, Bennet Omalu, MD, MPH, described the challenges he faced with self-care. As a resident and young physician, he preoccupied himself with work and professional achievements. He did not devote enough time to sleep and extracurricular activities. Subsequently, he developed depression and became self-destructive.

"I wish someone would have given me a talk or lecture on how to manage my time and life—how to get more sleep and rest, and how to learn to be happy. "

Bennet Omalu, MD, MPH

“It was only after my residency that I realized I had to redefine and reorient my life and begin to learn how to be happy outside my work,” Omalu said.

Self-care encompasses a variety of factors, including getting enough sleep, exercising, staying hydrated, eating a healthy diet, and making time for family and friends. Even if you can't take the time to hit the gym or take a yoga or meditation class, there are plenty of online wellness tools for free (or for purchase), and some are even geared specifically toward medical residents.

Related: How can medical residents strike the best work-life balance?

Prepping for the boards

If you’re interested in pursuing fellowship, your USMLE Step 3 scores are vitally important.

Preparing for boards is a tall order. Fortunately, for today’s residents, there’s a plethora of online learning tools like question banks, quizzes, simulations, flashcards, and online lectures/teaching videos to supplement traditional test preparations.

Still, when you’re seeing patients most of the week and trying to devote adequate time to exercise, nutrition, and sleep, where are the gaps in your schedule for study?

We reviewed expert advice on preparing for the boards, which includes the following:

  • Create and keep a structured weekly study schedule so you are not cramming at the end

  • Make the most of any free time for studyeven a few minutes of downtime at the hospital in between patients can be useful. Schedule a set number of questions to practice each day during these moments.

  • Do plenty of practice questions/computer-based case simulations

  • Work up and study consults closely

  • Focus on biostatistics, a substantial portion of the test

Related: Prepping for the Boards: How to study for Step 3

Obtaining licensure

It may be tempting to wait until the last minute to attain state licensure. But why? Doing so early—say, right after passing Step 3 and completing your intern year—will better prepare you for life post-residency and open you up to work opportunities.

Practically everything you need to know about licensure can be found online these days. The Federation of State Medical Boards website is a useful clearinghouse of information to get you started.

Here are some tips on gaining state licensure, as discussed in an MDLinx article:

  • Keep abreast of all licensing requirements and cooperate with the board for timely verification

  • Provide the state board with your CV early to identify potential issues

  • Fully disclose and explain any issue that could compromise your perceived fitness to practice

  • Be courteous with staff, who are often very busy

  • Keep in mind that peak times at the state board are typically between April and September

Related: Successfully navigating state licensure as a resident

What does this mean for you?

Residency is an exciting and gratifying period of your life. You finally take your knowledge bedside full-time. It’s also a challenging, demanding time. Keeping on top of things, asking for help from colleagues, and maintaining self-care will power you through. With a healthy approach, you'll achieve your dream of providing compassionate, evidence-based care to your patients, their families, and the community.

Read Next: Debunking 5 common residency misconceptions
Share with emailShare to FacebookShare to LinkedInShare to Twitter