What is Residency?

A closer look at the path from medical school to independent practice and how residents grow in skill, confidence and autonomy along the way.

For many medical school graduates, the next step in their journey is residency. Before entering residency, students go through an extensive application and interview process, exploring various residency programs to find one that aligns with their interests and professional goals. Residency is specialized clinical training, providing residents with hands-on experience under the guidance of attending physicians. Throughout residency, physicians gradually gain autonomy while developing the confidence and competence needed to eventually practice independently. Susan Culican, MD, PhD, shares her expertise and experiences to provide a firsthand perspective on residency.

The journey to residency culminates in Match Day, which takes place on the third Friday of March each year, when students learn which program they will attend. Near the end of the application season, students submit a ranked list of their preferred programs, while residency programs create their own rankings of applicants. An algorithm then determines the final matches. For many students, Match Day is an emotional and uncertain experience. Dr. Culican says, “It's a very stressful time. Because there's so much unknown, and it feels very high stakes, because this is the place you're going to spend the next 3 to 7 years of your life.”

After Match Day, students graduate from medical school in May and begin residency in July, transitioning into their roles as physicians. Residents are doctors, able to see patients and make medical decisions, but they do not yet practice completely independently. Their decisions and patient care are supervised by attending physicians who have completed residency training and are board certified. As Dr. Culican explains, “They are practicing as a physician, but they're practicing as a physician that requires supervision.” This supervision changes throughout residency as residents gain experience, demonstrate greater competence, and gradually become more autonomous in their patient care.

As residents gain experience, the supervision they receive also changes. Dr. Culican describes three levels of supervision: direct, indirect, and oversight. “All of those play at various different times and different scenarios in residency training.” 

Direct supervision typically occurs at the beginning of residency training. Attending physicians would, “be there side-by-side with [the resident], and would help guide them through aspects of the examination.” As residents progress, they enter the process of indirect supervision, “where a resident will go in, examine the patient, take a history, and present the patient to me.” The attending physician would then see the patient independently and corroborate information provided by the resident. Eventually, near the end of residency training, residents reach oversight supervision, where an attending physician does not need to monitor patient encounters in real-time but is available for review after care is delivered. 

Dr. Culican reflects on her personal experience stating, “When you get far along in your training, you don't know what you don't know.” She emphasizes the importance of always seeing the patient yourself as a supervisor when there is uncertainty, especially when the intern or resident may not have the experience to recognize an issue. 

Residency requires years of training, sacrifice, and continued learning. For Dr. Culican, however, the challenges are worthwhile because of the fulfillment she finds in her work. She credits her mother-in-law, former dean of pre-med students at Bryn Mawr College, for advice that has stuck with her throughout her journey in medicine. “The goal in life is not to be miserable. The goal in life is to take pride and passion in your work, and if you don't enjoy it, you shouldn't be doing it.” She emphasizes the joy she gets from her career, “It is a sacrifice. If it makes you happy to do that work, which it does for me every day, then it's the right fit.”