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by Jan Szafranski on April 21st, 2004

Jan Szafranski

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What is the hierarchy in a US teaching hospital? What's the difference between 1st, 2nd, 3rd year med students, residents, attendings, etc?

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  • by rhetoric on January 19th, 2008

    rhetoric

    As you might expect, a 1st year medical student is lower than a 3rd year. This is true for American allopathic schools (ones that give MDs rather than DOs). In most cases - Duke University being an exception - students receive training in "basic" sciences during the first two years, with the focus on "normal" and pathologic being the backbone of 1 and 2. Many students now are given clinical opportunities, either shadowing or directly contributing to patient care. A 3rd year student (sometimes called a clerk) works through most services in a hospital - surgery, medicine, pediatrics, psych - to expose them to different career options and to help put their classroom hours into context. They often still have classroom time. A 4th year student also primarily works with patients and may be treated like a "sub I" meaning sub-intern.

    Internship is the first year of residency, and residency programs (or the time a student actually specializes, since there are no "majors" in med school) last between 3 to 5 years. After the first year of residency, the student loses his/her "intern" designation and is simply called a resident. Sometimes you may hear residents being referred to as house staff, because they effectively live at the hospital. Now after a student has finished his/her residency, he/she can either go on to a fellowship (where he/she will be known as a fellow) or look for a job, at which case he/she becomes an attending physician. Sometimes a student will apply for another year of residency - not so much to be a student but to be a teacher. These people are called chief residents, and in charge of their less-experienced peers. Chief residents often do this to help them get a fellowship or teaching position in the future.

    There is a hierarchy with attendings, as well, and as you might expect, a department chief is more powerful (but not necessarily older) than the attendings below him/her...

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