The transition from the preclinical
years to the clinical years of medical school is an important time.
Understanding the new responsibilities and the general ground rules
can ease this transition. Here we provide a brief introduction to
clinical medical training for the new student on the wards.
*Based on a concept initially developed by Epstein A,
Frye T (eds.): So You Want to Be a Toad.
College of Medicine, Ohio State University, Columbus, OH.
Most services have some or all of the following team members.
In some programs, the intern is also known as the first-year
resident. This person has the day-to-day responsibilities of patient
care. This duty, combined with a total lack of seniority, usually serves
to keep the intern in the hospital more than the other members of
the team and may limit his or her teaching of medical students.
Any question you have concerning details in the evaluation of the
patient, for example, whether Mrs. Pavona gets a complete blood
count this morning or this evening, is usually referred first to
The resident is a member of the house staff who has completed
at least 1 year of postgraduate medical education. The most senior
resident is typically in charge of the overall conduct of the service
and is the person you might ask a question such as “What
might cause Mrs. Pavona’s white blood cell count to be
142,000?” You might also ask your resident for an appropriate
reference on the subject or perhaps to arrange a brief conference
on the topic for everyone on the service. A surgical service typically
has a chief resident, a physician in the last year of residency
who usually runs the day-to-day activities of the service. On medical
services the chief resident is usually an appointee of the chair
of medicine and primarily has administrative responsibilities often with
limited ward duties.
The attending physician is also called simply “The Attending,” and
on nonsurgical services, “the attending.” (Note: Before we get any more letters—yes,
this is a joke!) This physician has completed postgraduate education
and has become a member of the teaching faculty. He or she is usually
already board-certified in a specialty but may be newly trained
and “board eligible.” The attending is morally and
legally responsible for the care of all patients whose charts are
marked with the attending’s name. All major therapeutic
decisions made about the care of these patients are ultimately passed by
the attending. In addition, this person is responsible for teaching
and evaluating house staff and medical students. You might ask this
member of the team, “Why are we treating Mrs. Pavona with busulfan?”
The fellow is a physician who has completed his or her postgraduate