As a surgeon at an academic medical center, I often hear patients ask: Why is there a medical student, a resident, or a fellow – or all of these – on my care team? It’s a great question – and the answer gets at the heart and science of what we do here at the UVM Medical Center.
Students and residents are important members of the patient care team. Both patients and trainees benefit from interactions with one another.
That said, it can be confusing for patients when people with different levels of training are involved in their care. Often a patient will meet medical students, residents, a fellow, or all three. What role does each of these learners play?
- Medical Students: In the later years of medical school, a medical student will assume some patient care that is highly supervised by an attending physician. The medical student is likely to examine your medical history, do an exam, and then talk to the physician.
- Residents: Resident physicians have graduated medical school and are doctors who are training for board certification to become primary care or specialty physicians. A first-year resident will perform mainly supervised care, whereas a third- or fourth-year resident is just about ready to go out and practice independently. In their later years residents will have their own patients. They will work with an attending physician, but they care for their own patients.
- Fellows: A fellow has completed medical school and a residency and is undergoing additional training in a subspecialty field. Fellows are usually board certified doctors and could be out practicing on their own. They are doing special training for advanced practice, such as cardiology or a surgical subspecialty. They will care for patients with some supervision but are at an advanced level of training.
Many studies have demonstrated that academic medical centers provide the best care. This is due to many factors, but the presence of students and residents is an integral reason. While some patients may be uncomfortable having students and residents participate in some exams or treatments (and can easily opt out of having them in the room), I believe that this interaction benefits both the trainee and the patient in many ways. Here is my Top 10:
- BETTER CARE: Trainees make me a better doctor. Being an instructor at an academic medical center keeps me up-to-date in a stimulating environment. A constant stream of lectures and conferences keeps me on my toes and abreast of all new developments in my field. For example, every week we have a set of resident lectures on subjects far and wide, from basic science to clinical care to quality improvement.
- FASTER VISITS: The residents allow me to see more patients and to provide better care. Seeing the resident actually speeds up your care. Instead of one of us caring for you, you get to see two doctors. The resident and the attending will often be doing multiple things at the same time, and the coordination of care and documentation in the medical record are much more efficient.
- COMPLEX CARE: Residents and students are crucial to the care of patients with complex illnesses. They assist with coordination of care and work with outside agencies and other health services when you need them. They study the literature for new and innovative therapies. Our most seriously ill patient, a young woman with an overwhelming and severe blistering disease, is under the direct care of one of our senior residents. He has devoted countless hours to the care of this patient – hours that an attending physician might not have.
- GETTING MORE DONE: Trainees can do one procedure while I simultaneously do another one. Often patients come in with multiple skin cancers. On my own I would only be able to tackle one at a time, but with a resident we can treat both. This is both time- and cost-efficient, as multiple procedures done on the same day are discounted. Patients are appreciative of having fewer visits.
- PAYING IT FORWARD: Vermonters gain by having Vermont students and residents treat them and train here. My partner, Todd Holmes, MD, was our second resident and my second dermatologic surgery fellow. He is now a leading dermatologic surgeon. Laura McGevna, MD, came to the Larner College of Medicine at UVM from New York City and has never looked back. She completed her training with us and is now an attending physician. As a woman of color she is a wonderful addition to our unit and adds a level of diversity we would never attain without a training program.
- HELP WHEN YOU NEED IT: When you have a problem in the middle of the night, there are two of us to help you, and help is available 24 hours a day. Having a resident on call at all times improves our ability to help patients in and out of the hospital whenever they need it. Residents all live close to the hospital, and they will be there to help you before I can get in.
- ENERGY AND ENTHUSIASM: Students and residents are full of energy and enthusiasm and work hard. While there is wisdom that comes with a few gray hairs, residents and students bring with them a strong passion that comes from things being new. Residents push us to go the extra mile and allow us to bring a new perspective as we care for patients.
- TWO HEADS ARE BETTER THAN ONE: Residents sometimes pick up on something that I miss. Medicine is complex. Visits can involve multiple problems. Having four eyes and two brains caring for you is better than me alone.
- RELATIONSHIPS: It is often enjoyable for patients to see a resident and receive care from a resident. What may be routine and “old hat” to an attending physician is new and interesting to a resident or student. I have seen many residents when being cared for myself, and I have gotten to know several of them for the wonderful young physicians that they are. When I had a surgical complication, it was the resident who saw me and provided care in the middle of the night.
- NECESSITY: The medical center cannot function without residents. Period.
Some visits may take longer when a medical student participates. Students take longer to take a history and perform an exam than do residents or attending physicians, and having a student involved in your care may mean that a visit will be longer. Residents or students may also take a bit longer to perform a procedure as they are guided by the attending physician.
My own experiences with trainees have been overwhelmingly positive. My first son was delivered by an attending physician. The resident was there, but there were a few complex issues and the attending delivered him. My second son was delivered by a resident physician. The attending was right there, but the resident was calm, competent and certainly up to the task. I have had surgery four times. Two of those procedures were done by residents. Residents and my surgery fellow have operated on my mother and father for multiple skin cancers. When my son severely fractured his leg, it was the resident who sewed up the big laceration and applied the original cast. My parents both have health issues, and they have both interacted with residents on numerous occasions. In fact, as we speak, right now my mother is admitted to the hospital. She is under the care of a team including nurses, students, residents and attending physicians.
We are so fortunate to live in an area with a strong academic medical center where we work with and train excellent students and residents. When you need medical help, they are able and at the ready to be part of your health care team.
Glenn Goldman, MD, is medical director of Dermatology at The University of Vermont Medical Center. He is also professor of medicine and director of the Dermatology Residency Program at the Larner College of Medicine at UVM.