Residency or postgraduate training is a stage of graduate medical education. It refers to a qualified physician (one who holds the degree of MD, DO, MBBS/MBChB), veterinarian (DVM/VMD, BVSc/BVMS), dentist (DDS or DMD), podiatrist (DPM), optometrist (OD), pharmacist (PharmD), physical therapist (DPT), or Medical Laboratory Scientist (Doctor of Medical Laboratory Science) who practices medicine or surgery, veterinary medicine, dentistry, optometry, podiatry, clinical pharmacy, physical therapy, or Clinical Laboratory Science, respectively, usually in a hospital or clinic, under the direct or indirect supervision of a senior medical clinician registered in that specialty such as an attending physician or consultant. The term residency is named as such due to resident physicians (resident doctors) of the 19th century residing at the dormitories of the hospital in which they received training. In many jurisdictions, successful completion of such training is a requirement in order to obtain an unrestricted license to practice medicine, and in particular a license to practice a chosen specialty. In the meantime, they practice "on" the license of their supervising physician. An individual engaged in such training may be referred to as a resident physician, house officer, registrar or trainee depending on the jurisdiction. Residency training may be followed by fellowship or sub-specialty training. Whereas medical school teaches physicians a broad range of medical knowledge, basic clinical skills, and supervised experience practicing medicine in a variety of fields, medical residency gives in-depth training within a specific branch of medicine.
Terminology A resident physician is more commonly referred to as a resident, senior house officer (in Commonwealth countries), or alternatively, a senior resident medical officer or house officer. Residents have graduated from an accredited medical school and hold a medical degree (MD, DO, MBBS, MBChB). Residents are, collectively, the house staff of a hospital. This term comes from the fact that resident physicians traditionally spend the majority of their training "in house" (i.e., the hospital). The similar term residency is named as such due to resident physicians of the 19th century residing at the dormitories of the hospital in which they received training. Duration of residencies can range from two years to seven years, depending upon the program and specialty. In the United States, the first year of residency is commonly called an internship with those physicians being termed interns. Depending on the number of years a specialty requires, the term junior resident may refer to residents who have not completed half their residency. Senior residents are residents in their final year of residency, although this can vary. Some residency programs refer to residents in their final year as chief residents (typically in surgical branches), while others select one or various residents to add administrative duties to the normal learning in the last year of residency. Alternatively, a chief resident may describe a resident who has been selected to extend his or her residency by one year and organize the activities and training of the other residents (typically in internal medicine and pediatrics). If a physician finishes a residency and decides to further his or her education in a fellowship, they are referred to as a "fellow". Physicians who have fully completed their training in a particular field are referred to as attending physicians, or consultants (in Commonwealth countries). However, the above nomenclature applies only in educational institutes in which the period of training is specified in advance. In privately owned, non-training hospitals, in certain countries, the above terminology may reflect the level of responsibility held by a physician rather than their level of education.
History Residency as an opportunity for advanced training in a medical or surgical specialty evolved in the late 19th century from brief and informal programs for extra training in a special area of interest. The first formal residency programs were established by William Osler and William Stewart Halsted at Johns Hopkins Hospital in Baltimore. Residencies elsewhere then became formalized and institutionalized for the principal specialties in the early 20th century. But even mid-century, residency was not seen as necessary for general practice and only a minority of primary care physicians participated. The expansion of medical residencies in the United States experienced a significant surge following World War II. In the post-war landscape, the demand for skilled physicians escalated, necessitating a robust training infrastructure. The G.I. Bill, a landmark piece of legislation, played a pivotal role in fueling this expansion by providing educational benefits to returning veterans, including those pursuing medical careers. The increased financial support facilitated a surge in medical school enrollments, spurring the need for expanded residency programs to accommodate the growing pool of aspiring physicians. This period witnessed the establishment of numerous new residency positions across various specialties. In 1940 there were approximately 6,000 residency positions available, but by 1970 the available spots had increased to more than 40,000. At the same time, the daily operation of the hospital increasingly relied on medical residents. By the end of the 20th century in North America, few new doctors went directly from medical school into independent, unsupervised medical practice, and more state and provincial governments began requiring one or more years of postgraduate training for medical licensure. Residencies are traditionally hospital-based, and in the middle of the 20th century, residents would often live (or "reside") in hospital-supplied housing. "Call" (night duty in the hospital) was sometimes as frequent as every second or third night for up to three years. Pay was minimal beyond room, board, and laundry services. It was assumed that most young men and women training as physicians had few obligations outside of medical training at that stage of their careers. The first year of practical patient-care-oriented training after medical school has long been termed "internship". Even as late as the middle of the twentieth century, most physicians went into primary care practice after a year of internship. Residencies were separate from internship, often served at different hospitals, and only a minority of physicians did residencies. In the United States, the Libby Zion case, which led to the Libby Zion Law, garnered attention in 1984, shed light on the demanding work hours imposed on medical residents. Responding to this concern, the Association of American Medical Colleges released a position statement in 1988, recommending a cap of 80 work hours per week for residents. Subsequently, in 1989, New York became the first state to address this issue by implementing regulations through the Health Code, marking a pivotal moment in the regulation of resident hours. These regulations, integrated into the state hospital code, included duty hour limits and supervision enhancements advocated by the Bell Commission. However, despite the issuance of regulations, compliance was slow to materialize, and a decade later, site visits revealed widespread noncompliance with the established limits. The efforts to address and regulate resident work hours culminated nationally in 2003 when the ACGME (Accreditation Council for Graduate Medical Education) mandated these limits across the United States.
Residency around the world
Afghanistan In Afghanistan, the residency (Dari, تخصص) consists of a three to seven years of practical and research activities in the field selected by the candidate. The graduate medical students do not need to complete the residency because they study medicine in six years (three years for clinical subjects, three years clinical subjects in hospital) and one-year internship and they graduate as general practitioner. Most students do not complete residency because it is too competitive.
Argentina In Argentina, the residency (Spanish, residencia) consists of a three to four years of practical and research activities in the field selected by both the candidate and already graduated medical practitioners. Specialized fields such as neurosurgery or cardio-thoracic surgery require longer training. Through these years, consisting of internships, social services, and occasional research, the resident is classified according to their residency year as an R1, R2, R3 or R4. After the last year, the "R3 or R4 Resident" obtains the specialty (especialidad) in the selected field of medicine.
Australia
In Australia, specialist training is undertaken as a registrar; The term 'resident' is used synonymously with 'hospital medical officer' (HMO), and refers to unspecialised postgraduate medical practitioners prior to specialty training. Entry into a specialist training program occurs after completing one year as an intern (post-graduate year 1 or "PGY1"), then, for many training programs, an additional year as a resident (PGY2 onward). Training lengths can range from 3 years for general practice to 7 years for paediatric surgery.
Canada In Canada, Canadian medical graduates (CMGs), which includes final-year medical students and unmatched previous-year medical graduates, apply for residency positions via the Canadian Resident Matching Service (CaRMS). The first year of residency training is known as "Postgraduate Year 1" (PGY1). CMGs can apply to many post-graduate medical training programs including family medicine, emergency medicine, internal medicine, pediatrics, general surgery, obstetrics-gynecology, neurology, and psychiatry, amongst others. Some residency programs are direct-entry (family medicine, dermatology, neurology, general surgery, etc.), meaning that CMGs applying to these specialties do so directly from medical school. Other residencies have sub-specialty matches (internal medicine and pediatrics) where residents complete their first 2–3 years before completing a secondary match (Medicine subspecialty match (MSM) or Pediatric subspecialty match (PSM)). After this secondary match has been completed, residents are referred to as fellows. Some areas of subspecialty matches include cardiology, nephrology, gastroenterology, immunology, respirology, infectious diseases, rheumatology, endocrinology and more. Direct-entry specialties also have fellowships, but they are completed at the end of residency (typically 5 years).
Colombia In Colombia, fully licensed physicians are eligible to compete for seats in residency programs. To be fully licensed, one must first finish a medical training program that usually lasts five to six years (varies between universities), followed by one year of medical and surgical internship. During this internship a national medical qualification exam is required, and, in many cases, an additional year of unsupervised medical practice as a social service physician. Applications are made individually program by program, and are followed by a postgraduate medical qualification exam. The scores during medical studies, university of medical training, curriculum vitae, and, in individual cases, recommendations are also evaluated. The acceptance rate into residencies is very low (~1–5% of applicants in public university programs), physician-resident positions do not have salaries, and the tuition fees reach or surpass US$10,000 per year in private universities and $2,000 in public universities. For the reasons mentioned above, many physicians travel abroad (mainly to Argentina, Brazil, Spain and the United States) to seek postgraduate medical training. The duration of the programs varies between three and six years. In public universities, and some private universities, it is also required to write and defend a medical thesis before receiving a specialist degree
France
In France, students attending clinical practice are known as "externes" and newly qualified practitioners training in hospitals are known as "internes". The residency, called "Internat", lasts from three to six years (depending on the speciality) and follows a competitive national ranking examination. It is customary to delay submission of a thesis. As in most other European countries, many years of practice at a junior level may follow. French residents are often called "doctor" during their residency. Literally speaking, they are still students and become M.D. only at the end of their residency and after submitting and defending a thesis before a jury.
Greece In Greece, licensed physicians are eligible to apply for a position in a residency program. To be a licensed physician, one must finish a medical training program which in Greece lasts for six years. A one-year obligatory rural medical service (internship) is necessary to complete the residency training. Applications are made individually in the prefecture where the hospital is located, and the applicants are positioned on first-come, first-served basis. The duration of the residency programs varies between three and seven years.
India In India, after completing MBBS degree and one year of integrated internship, doctors can enroll in several types of postgraduate training programs: M.D. (DOCTOR OF MEDICINE) in: Anesthesiology, Anatomy, Biochemistry, Community Medicine, Dermatology Venereology and Leprosy, General Medicine, Forensic Medicine, Microbiology, Pathology, Paediatrics, Pharmacology, Physical medicine and rehabilitation, Physiology, Psychiatry, Radio diagnosis, Radiotherapy, Tropical Medicine, and, Tuberculosis & Respiratory Medicine. M.S. (MASTER OF SURGERY) in: Otorhinolaryngology, General Surgery, Ophthalmology, Orthopaedics, Obstetrics & Gynecology. D.M. (DOCTOR OF MEDICINE) in: Cardiology, Endocrinology, Medical Gastroenterology, Nephrology, and Neurology. M.Ch. (MASTER OF CHIRURGIE) in: Cardio vascular & Thoracic Surgery, Urology, Neurosurgery, Paediatric Surgery, Plastic Surgery. Or diploma in: Anesthesiology (D.A.), Clinical Pathology (D.C.P.), Dermatology Venereology and Leprosy (DDVL), Forensic Medicine (D.F.M.), Obstetrics & Gynaecology (D.G.O.), Ophthalmology (D.O.), Orthopedics (D.Ortho.), Otorhinolaryngology (D.L.O.), Paediatrics (D.C.H.) Psychiatry (D.P.M.), Public health (D.P.H.), Radio-diagnosis (D.M.R.D.), Radiotherapy (D.M.R.T.)., Tropical Medicine & Health (D.T.M. & H.), Tuberculosis & Chest Diseases (D.T.C.D.), Industrial Health (D.I.H.), Maternity & Child Welfare (D. M. C. W.)
Italy In Italy, after completing a cycle of 6 years of studies, students get the title of "Medico generico" (generic physician), and are authorized to limited activities, like: teach first aid practices, act as temporary substitute of a primary care physician or issue medical certificates for sports purposes. Later the physicians can complete the studies with a specialization training. Such specialization is required even to practice as family doctor or primary care physician. Resident is translated as: "specializzanda" or "specializzando" according to gender.
Mexico In Mexico, physicians need to take the ENARM (National Test for Aspirants to Medical Residency) (Spanish: Examen Nacional de Aspirantes a Residencias Médicas) in order to have a chance for a medical residency in the field they wish to specialize. The physician is allowed to apply to only one speciality each year. Some 35,000 physicians apply and only 8000 are selected. The selected physicians bring their certificate of approval to the hospital that they wish to apply (Almost all the hospitals for medical residency are from government based institutions). The certificate is valid only once per year and if the resident decides to drop residency and try to enter a different speciality she will need to take the test one more time (no limit of attempts). All the hosting hospitals are affiliated to a public/private university and this institution is the responsible to give the degree of "specialist". This degree is unique but equivalent to the MD used in the UK and India. In order to graduate, the trainee is required to present a thesis project and defend it. The length of the residencies is very similar to the American system. The residents are divided per year (R1, R2, R3, etc.). After finishing, the trainee may decide if he wants to sub-specialize (equivalency to fellowship) and the usual length of sub-specialty training ranges from two to four years. In Mexico the term "fellow" is not used. All the specialties in Mexico are board certified and some of them have a written and an oral component, making these boards ones of the most competitive in Latin America.
Nigeria Medical residency in Nigeria is a structured postgraduate training program designed to produce specialists in various fields of medicine and dentistry. The training is overseen by two primary institutions:
The National Postgraduate Medical College of Nigeria (NPMCN): Established in 1979, NPMCN is responsible for the training and certification of medical and dental specialists within Nigeria. The West African Postgraduate Medical Colleges: These are the West African College of Physicians (WACP) and the West African College of Surgeons (WACS), which coordinate regional training and certification across West Africa.
Entry requirements To be eligible for residency training in Nigeria, candidates must:
Complete a Medical Degree: Obtain an MBBS or BDS degree from a recognized medical or dental school. Housemanship: Complete a one-year internship (housemanship) in accredited hospitals. National Youth Service Corps (NYSC): Fulfill the mandatory one-year national service. Primary Examination: Pass the Primary Fellowship Examination conducted by either NPMCN or WACP/WACS, which assesses foundational knowledge in the chosen specialty.
Structure Residency training in Nigeria is divided into two main phases:
Junior residency (Part I) Duration: 24 to 36 months. Objective: Develop core clinical competencies and foundational knowledge in the chosen specialty. Assessment: Candidates are eligible to sit for the Part I Fellowship Examination after completing this phase.
Senior residency (Part II) Duration: Varies depending on the specialty and institution. Objective: Advanced training with increased responsibilities, including research and teaching. Assessment: Completion of a dissertation and successful performance in the Part II Fellowship Examination.
Available faculties and specialties
National Postgraduate Medical College of Nigeria (NPMCN) NPMCN offers residency training across 16 faculties encompassing medical, surgical, and dental specialties:
Anaesthesia Dental Surgery Emergency Medicine Family Medicine Family Dentistry Internal Medicine Obstetrics and Gynaecology Ophthalmology Orthopaedics Otorhinolaryngology (ENT) Paediatrics Pathology Psychiatry Public Health and Community Medicine Radiology Surgery
West African College of Surgeons (WACS) WACS provides training in various surgical specialties through its faculties:
Anaesthesia Dental Surgery Obstetrics and Gynaecology Ophthalmology Orthopaedics Otorhinolaryngology Radiology General Surgery
West African College of Physicians (WACP) WACP oversees training in medical specialties through its faculties:
Community Health Family Medicine Internal Medicine Laboratory Medicine (including Anatomical Pathology, Chemical Pathology, Haematology, and Medical Microbiology) Paediatrics Psychiatry
Accreditation and regulation Training Institutions: Hospitals and medical centers must be accredited by NPMCN and/or WACP/WACS to offer residency programs. Medical and Dental Council of Nigeria (MDCN): MDCN regulates medical and dental practice in Nigeria, ensuring that residency training aligns with national standards.
Curriculum and evaluation The residency curriculum encompasses:
Clinical Training: Hands-on experience in patient care under supervision. Research: Residents are required to undertake research projects, culminating in a dissertation. Teaching: Involvement in the education of medical students and junior colleagues. Continuous Assessment: Regular evaluations through examinations, logbooks, and performance appraisals.
Challenges and developments The residency training system in Nigeria faces several challenges:
Funding: Inadequate financial support for training programs and research activities. Brain Drain: Migration of trained specialists to other countries in search of better opportunities. Infrastructure: Limited access to modern medical facilities and equipment in some training centers. Efforts are ongoing to address these issues through policy reforms, increased funding, and international collaborations.
Pakistan In Pakistan, after completing a MBBS degree and further completing a one year house job, doctors can enroll in two types of postgraduate residency programs. The first is a MS/MD program run by various medical universities throughout the country. It is a 4–5-year program depending upon the specialty. The second is a fellowship program which is called Fellow of College of Physicians and Surgeons Pakistan (FCPS) by the College of Physicians and Surgeons Pakistan (CPSP). It is also a 4–5-year program depending upon the specialty. There are also post-fellowship programs offered by the College of Physicians and Surgeons Pakistan as a second fellowship in subspecialties.
Portugal In Portugal, a resident physician is one undergoing postgraduate training aimed at obtaining a medical specialty. This training period begins after completing medical school and can last between 5 and 7 years, depending on the chosen specialty. At the end of their residency, physicians attain the status of specialist. The Medical Residency in Portugal is regulated by Decree-Law No. 60/2007, of March 13, and by Ordinance No. 183/2006, of February 22 (Medical Residency Regulation). It is organized into two training periods: the Common Year and the Professional Specialization Area. Until 2004, the residency was divided into General (2 years) and Complementary (3 to 6 years) phases. Upon completing medical school, doctors apply to a national competition for admission into the Medical Residency. This competition determines their placement for training locations and specialties, prioritizing the score obtained in a national ranking exam (a test with one hundred questions and five multiple-choice answers). The second criterion, used only in cases of a tie, is the medical school final grade. There is frequent confusion between a resident physician and an internal medicine specialist, also known as an internist. These terms are not synonymous, even though a resident physician may be pursuing specialization in internal medicine. The Portuguese Medical Association is the entity that regulates medical practice in Portugal, ensuring the technical-scientific postgraduate training of its members through residency programs, which grant physicians specialist status.
Saudi Arabia In Saudi Arabia, an MD must pass the Saudi Medical License Exam (SMLE) to apply for medical residency programs. The competitiveness of residency programs varies by specialty and region, with Plastic Surgery, Ophthalmology, Dermatology, and ENT being the most competitive. Residency durations range from 3 to 7 years, depending on the specialty. All residency programs include an end-of-training medical exam, which is conducted in English, as a requirement for board certification.
South Korea 1-year internship is obligatory to enter 3–4 year residency.
Spain All Spanish medical degree holders need to pass a competitive national exam (named 'MIR') in order to access the specialty training program. This exam gives them the opportunity to choose both the specialty and the hospital where they will train, among the hospitals in the Spanish Healthcare Hospital Network. Currently, medical specialties last from 4 to 5 years. There are plans to change the training program system to one similar to the UK's. There have been some talks between Ministry of Health, the Medical College of Physicians and the Medical Student Association but it is not clear how this change process is going to be.
Sweden
Prerequisites for applying to a specialist training program A physician practicing in Sweden may apply to a specialist training program (Swedish: Specialisttjänstgöring) after being licensed as a physician by The National Board of Health and Welfare. To obtain a license through the Swedish education system a candidate must go through several steps. First the candidate must successfully finish a five-and-a-half-year undergraduate program, made up of two years of pre-clinical studies and three and a half years of clinical postings, at one of Sweden's seven medical schools—Uppsala University, Lund University, The Karolinska Institute, The University of Gothenburg, Linköping University, Umeå University, or Örebro University—after which a degree of Master of Science in Medicine (Swedish: Läkarexamen) is awarded. The degree makes the physician eligible for an internship (Swedish: Allmäntjänstgöring) ranging between 18 and 24 months, depending on the place of employment. The internship is regulated by the National Board of Health and Welfare and regardless of place of employment it is made up of four main postings with a minimum of nine months divided between internal medicine and surgery—with no less than three months in each posting—three months in psychiatry, and six months in general practice. It is customary for many hospitals to post interns for an equal amount of time in surgery and internal medicine (e.g. six months in each of the two). An intern is expected to care for patients with a certain degree of independence but is under the supervision of more senior physicians who may or may not be on location. During each clinical posting the intern is evaluated by senior colleagues and is, if deemed having skills corresponding to the goals set forth by The National Board of Health and Welfare, passed individually on all four postings and may go on to take a written exam on common case presentations in surgery, internal medicine, psychiatry, and general practice. After passing all four main postings of the internship and the written exam, the physician may apply to The National Board of Health and Welfare to be licensed as a Doctor of Medicine. Upon application the physician has to pay a licensing fee of SEK 2,300—approximately equivalent to EUR 220 or USD 270, as per exchange rates on 24 April 2018—out of pocket, as it is not considered to be an expense directly related to medical school and thus is not covered by the state. Physicians who have a foreign medical degree may apply for a license through different paths, depending on whether they are licensed in another EU or EEA country or not.
Specialty selection The Swedish medical specialty system is, as of 2015, made up of three different types of specialties; base specialties, subspecialties, and add-on specialties. Every physician wishing to specialize starts by training in a base specialty and can thereafter go on to train in a subspecialty specific to their base specialty. Add-on specialties also require previous training in a base specialty or subspecialty but are less specific in that they, unlike subspecialties, can be entered into through several different previous specialties. Furthermore, the base specialties are grouped into eight classes—pediatric specialties, imaging and functional medicine specialties, independent base specialties, internal medicine specialties, surgical specialties, laboratory specialties, neurological specialties, and psychiatric specialties. It is a requirement that all base specialty training programs are at least five years in length. Common reasons for base specialty training taking longer than five years is paternity or maternity leave or simultaneous Ph.D. studies.
Base specialties and subspecialties
Add-on Specialties
Allergology To train in the add-on specialty of allergology a physician must first be a specialist in general practice, occupational and environmental medicine, pediatric allergology, endocrinology and diabetology, geriatrics, hematology, dermatology and venerology, internal medicine, cardiology, clinical immunology and transfusion medicine, pulmonology, medical gastroenterology and hepatology, nephrology or otorhinolaryngology.
Occupational medicine To train in the add-on specialty of occupational medicine a physician must first be a specialist in one of the pediatric class specialties, one of the independent class specialties (excluding clinical pharmacology, clinical genetics, forensic medicine, and social medicine), one of the internal medicine class specialties, one of the neurological class specialties (excluding clinical neurophysiology) or one of the psychiatric class specialties.
Addiction medicine To train in the add-on specialty of addiction medicine a physician must first be a specialist in pediatric psychiatry or psychiatry.
Gynecologic oncology To train in the add-on specialty of gynecologic oncology a physician must first be a specialist in obstetrics and gynecology or oncology.
Nuclear medicine To train in the add-on specialty of nuclear medicine a physician must first be a specialist in clinical physiology, oncology or radiology.
Palliative medicine To train in the add-on specialty of palliative medicine a physician must first be a specialist in one of the pediatric class specialties, one of the independent class specialties (excluding occupational and environmental medicine, clinical pharmacology, clinical genetics, forensic medicine, and social medicine), one of the internal medicine class specialties, one of the surgical class specialties, one of the neurological class specialties (excluding clinical neurophysiology) or one of the psychiatric class specialties.
School health To train in the add-on specialty of school health a physician must first be a specialist in general practice, pediatrics or pediatric psychiatry.
Pain medicine To train in the add-on specialty of pain medicine a physician must first be a specialist in one of the pediatric class specialties, one of the independent class specialties (excluding clinical pharmacology, clinical genetics, forensic medicine, and social medicine), one of the internal medicine class specialties, one of the surgical class specialties, one of the neurological class specialties (excluding clinical neurophysiology) or one of the psychiatric class specialties.
Infection control To train in the add-on specialty of infection control a physician must first be a specialist in infectious diseases or clinical microbiology.
Geriatric psychiatry To train in the add-on specialty of geriatric psychiatry a physician must first be a specialist in geriatrics or psychiatry.
Application process There is no centralized selection process for internship or residency positions. The application process is more similar to that of other jobs on the market—i.e. application via cover letter and curriculum vitae. Both types of positions are however usually publicly advertised and many hospitals have nearly synchronous recruitment processes once or twice per year—the frequency of recruitment depending mainly on hospital size—for their internship positions.
Factors Apart from the requirement that candidates are graduates from approved medical programs and, in the case of residency, licensed as medical doctors, there are no specific criteria an employer has to consider in hiring for an internship or residency position. This system for recruiting has been criticized by The Swedish Medical Association for lacking transparency as well as for delaying time to specialist certification of physicians. There are nevertheless factors that most employers will consider, the most important being how long a doctor has been in active practice. After completing nine out of a total of eleven semesters of medical school a student may work as a physician on a temporary basis—e.g. during summer breaks from university. This rule enables medical graduates to start working as physicians upon graduating from university without yet being licensed, as a way of building experience to be able to eventually be hired into an internship. According to a 2017 survey by The Swedish Medical Association, interns in the country as a whole had worked an average of 10.3 months as physicians before starting their internships, ranging from an average of 5.1 months for interns in the Dalarna region to an average of 19.8 months for interns in the Stockholm region. In recruitment for residency positions less emphasis is often placed on the number of months a candidate has worked after finishing their internship, but it is common for physicians to work for some time in between internship and residency, much in the same way as between medical school and internship.
Thailand In Thailand, postgraduate medical training is monitored by the Medical Council of Thailand (TMC) and conducted by their respective "Royal Colleges". Thailand has a significant issue with an imbalance of medical personnel between Bangkok and the remaining 76 provinces. As a primate city, the majority of specialists wish to remain in Bangkok after training. Each year, the TMC outlines the requirements for application to a certain specialty, depending on the needs of the country for staff within that field. Specialities are therefore classified into tiers depending on national demand. The duration spent in the national internship program depends on the specialty the graduate wishes to study. Specialties classified as 'lacking' may require only one year of internship, whilst more competitive specialties often require the full three-year duration of internship to meet the application criteria. Fields classified as 'severely lacking' may not require internship training at all. Application to residency may be done on contract with a government hospital or without a contract, namely 'free-training'. Government hospitals may sign contracts to sponsor residency training for specialist doctors they require. In these cases, the duration for internship required in more popular fields may be reduced. For example, a residency in internal medicine requires three years of internship if applying without contract, but is reduced to two years if applying under contract. However at the end of training, specialists under contract must return to work at that particular hospital for a minimum of the duration of residency. Most residency programs in Thailand consist of three to four years of training. The duration of training may be up to five or six years in certain specialties. Applications are sent to the Royal College overseeing their desired specialty and candidates may apply to no more than five institutes that conduct training in that specialty. As of 2022, there were 40 base specialties and 49 subspecialties. Subspecialty training (fellowship) requires initial training in the respective base specialty and is generally 1–2 years in duration.
Base specialties
United Kingdom
History In the United Kingdom, house officer posts used to be optional for those going into general practice, but almost essential for progress in hospital medicine. The Medical Act 1956 made satisfactory completion of one year as house officer necessary to progress from provisional to full registration as a medical practitioner. The term "intern" was not used by the medical profession, but the general public were introduced to it by the US television series Dr. Kildare. They were usually called "housemen", but the term "resident" was also used unofficially. In some hospitals the "resident medical officer" (RMO) (or "resident surgical officer" etc.) was the most senior of the live-in medical staff of that specialty. The pre-registration house officer posts lasted six months, and it was necessary to complete one surgical and one medical post. Obstetrics could be substituted for either. In principle, general practice in a "Health Centre" was also allowed, but this was almost unheard of. The posts did not have to be in general medicine: some teaching hospitals had very specialised posts at this level, so it was possible for a new graduate to do neurology plus neurosurgery or orthopaedics plus rheumatology, for one year before having to go onto more broadly based work. The pre-registration posts were nominally supervised by the General Medical Council, which in practice delegated the task to the medical schools, who left it to the consultant medical staff. The educational value of these posts varied enormously. On-call work in the early days was full time, with frequent night shifts and weekends on call. One night in two was common, and later one night in three. This meant weekends on call started at 9 am on Friday and ended at 5 pm on Monday (80 hours). Less acute specialties such as dermatology could have juniors permanently on call. The European Union's Working Time Directive conflicted with this: at first the UK negotiated an opt-out for some years, but working hours needed reform. On call time was unpaid until 1975 (the year of the house officers' one-day strike), and for a year or two depended on certification by the consultant in charge – a number of them refused to sign. On call time was at first paid at 30% of the standard rate. Before paid on call was introduced, there would be several house officers "in the house" at any one time and the "second on call" house officer could go out, provided they kept the hospital informed of their telephone number at all times. A "pre-registration house officer" would go on to work as a "senior house officer" for at least one year before seeking a registrar post. SHO posts could last six months to a year, and junior doctors often had to travel around the country to attend interviews and move house every six months while constructing their own training scheme for general practice or hospital specialisation. Locum posts could be much shorter. Organised schemes were a later development, and do-it-yourself training rotations became rare in the 1990s. Outpatients were not usually a junior house officer's responsibility, but such clinics formed a large part of the workload of more senior trainees, often with little real supervision. Registrar posts lasted one or two years, and sometimes much longer outside an academic setting. It was common to move from one registrar post to another. Fields such as psychiatry and radiology used to be entered at the registrar stage, but the other registrars would usually have passed part one of a higher qualification, such as a Royal College membership or fellowship before entering that grade. Part two (the complete qualification) was necessary before obtaining a senior registrar post, usually linked to a medical school, but many left hospital practice at this stage rather than wait years to progress to a consultant post. Most British clinical diplomas (requiring one or two years' experience) and membership or fellowship exams were not tied to particular training grades, though the length of training and nature of experience might be specified. Participation in an approved training scheme was required by some of the royal colleges. The sub-specialty exams in surgery, now for Fellowship of the Royal College of Surgeons, were originally limited to senior registrars. These rules prevented many of those in non-training grades from qualifying to progress. Once a senior registrar, depending on specialty, it could take anything from one to six years to go onto a permanent consultant or senior lecturer appointment. It might be necessary to obtain an M.D. or Ch. M. degree and to have substantial