David Vandenberg

David Vandenberg

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David Vandenberg


Why Do We Have Residency Training?

Surely every resident has had the experience of trying to explain to a patient or family what, exactly, a resident is. “Yes, I’m a real doctor… I just can’t do real doctor things by myself.”

In many ways, it’s a strange system we have. How come you can call yourself a doctor after medical school, but you can’t actually work as a physician until after residency? How – and why – did this system get started? In the event that you think you need to write my paper on medical residency this article is the ideal asset for it.

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These are fundamental questions – and as we answer them, it will become apparent why some problems in the medical school-to-residency transition have been so difficult to fix.

In the beginning…

Go back to the 18th or 19th century, and medical training in the United States looked very different. Medical school graduates were not required to complete a residency – and in fact, most didn’t. The average doctor just picked up his diploma one day, and started his practice the next.

But that’s because the average doctor was a generalist. He made house calls and took care of patients in the community. In the parlance of the day, the average doctor was undistinguished. A physician who wanted to distinguish himself as being elite typically obtained some postdoctoral education abroad in Paris, Edinburgh, Vienna, or Germany.

But there was another, less noble motivation for restricting elite positions to physicians who had trained in Europe. Obtaining training abroad was a privilege that only a few young physicians could afford. Limiting opportunities to those who had obtained it was a convenient way to restrict the upper echelons of the medical profession to a certain social class.

So when – and why – did U.S.-based residency training programs become a requirement for practice? It turns out that the development of residency training closely parallels two other trends in medicine.

The rise of the hospital

Before the Civil War, hospitals in the U.S. were few and far between. There just weren’t many places where you could get residency training, even if you wanted it.

But between 1870 and 1914, new hospitals sprang up everywhere. Although rural areas still relied on physicians making house calls, most larger cities had several hospitals. Combined with the increasing urbanization of America, this meant that the majority of Americans now lived in close geographic proximity to a hospital.

But caring for patients in a hospital is complicated. They need attention at all hours of the day.

And in the telegraph era, it wasn’t practical to summon a doctor from the community every time that a patient needed their bandages changed or a new order for tincture of opium. You had to have a doctor on premises all the time. This fine quality paper writing service likewise writes splendid essays on significant themes like medical residency and numerous others.

This, of course, is the origin of the term resident. Resident physicians were so called because, yes, they lived in the hospital or on the grounds.

In Valentine Mott Francis’ 1859 A Thesis on Hospital Hygeine, which served as a blueprint for the construction of new hospitals, it was recommended that a hospital of 100 beds be staffed with two medical and two surgical residents.