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Upon graduating from medical school, students earn their M.D. degrees, as well as the title "doctor." But their education is far from complete. For most new doctors, the years after medical school are spent in residencies usually at hospitals where they pursue advanced training in the field of their choice.
Residency is the time when they learn the comprehensive responsibility of the physician. Some medical graduates do not immediately enter a specialty residency program but instead take a transitional year of training designed to give them additional experience in general medicine or surgery. These programs are usually precursors to residencies in specialties like dermatology, ophthalmology, neurology, and others. Residencies can last anywhere from three to seven years, depending on the specialty. The Accreditation Council for Graduate Medical Education approves several thousand programs nationwide. Physicians must complete a residency in order to become certified in a given medical field. At the UI Hospitals and Clinics, approximately 650 residents and fellows are being trained in nearly 160 different training programs.
Like medical school, residency programs are selective and often competitive, requiring formal application, letters of recommendation, and personal interviews. Unlike medical school, they offer salaries and benefits. Many physicians look back on their residencies as years filled with hard work and invaluable lessons. Residents may work up to 80 hours a week, including on-call shifts of up to 24 hours. Their time is spent treating patients, teaching less-experienced colleagues, and completing paperwork and other tasks. It can be a grueling experience, but one that reveals medicine's challenges and rewards.
Residents assume greater responsibilities as they proceed through their programs. The first year of postgraduate medical education is sometimes called internship, though this term is no longer used as widely as in the past. An intern (not to be confused with internist, a term for a physician who practices internal medicine) or a first-year resident is a recent medical school graduate just starting specialty training. Junior residents have advanced to their second year of residency (or their third year in surgery programs).
The next rank, senior resident, usually comes in the third, fourth, or fifth year, depending on the specialty. Finally, the chief resident is a doctor who has completed his or her residency program and is charged with overseeing its daily operations. Physicians who seek even more specialized training may pursue fellowships after their residencies. For example, a doctor who intends to specialize in cancer treatment may complete an internal medicine residency followed by an oncology fellowship. Physicians in these programs are referred to as fellows. More than 150 fellows currently are training in medical or surgical subspecialties at the UI Hospitals and Clinics.
Once their education is complete, physicians obtain certification in their chosen specialties. In the United States, 24 specialty boards establish criteria that physicians must meet in order to be certified in a given field. The certification process requires doctors to demonstrate that they have completed training and to pass a written examination. Some boards require an oral examination as well. Physicians who complete the process become diplomates of their specialty boards.
Medical licensure is a separate process governed by boards established by each state, and procedures vary depending on the state in which a physician intends to practice. Iowa offers several types of medical licenses, including one for residents in postgraduate training programs. After completing their training, doctors must apply for a permanent license to practice.
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