A Field Guide to the Medical Team

Many of the posts on this humble blog have to do with my day-to-day experiences, and central to the day-to-day experience of a medical student is the carefully-defined hierarchy of the medical team. So here's a brief guide to who's who in the group of white-coated strangers that wakes you up at 5:30 in the morning when you're in the hospital to ask you if you know what year it is and to please describe your last bowel movement.

The Attending Physician (a.k.a. "Staff," "Attending," "The Doctor") is the boss. At an academic medical center this would be a faculty member. The Attending is ultimately responsible for every patient on the particular service. When someone mentions "the doctor" without a qualifier, this is who they're talking about.

The Senior Resident (a.k.a. "Senior") is a resident physician in the last (or, sometimes, penultimate) year of residency training. Since they are just finishing their training, Seniors are generally extremely knowledgeable about the details of their specialty and the procedures of their particular hospital and floor. They're often the most relaxed and confident member of the team after the Attending, because everything's fresh in their memory and they're almost finished with the gruel-o-thon of medical training. You can usually count on them to have the answer to any question. They are responsible for making sure that the team runs smoothly and can answer any question and perform any task that the Attending requests regarding any patient.

Other Residents (a.k.a. "Mid-Levels," "Junior Residents," just plain "Residents") are between the first and last year of residency training. They are knowledgeable and gaining confidence and are responsible for an enormous amount of the physician care that happens in the hospital.

The Intern (a.k.a. "First-Year") is in the first year of residency training. This year has a tremendously steep learning curve and is considered to be one of the most demanding periods of medical training. Over the course of the year interns progress from being medical students to being in the thick of things. They are expected to know everything a doctor should know, and they're picking it up as they work. Interns start their year on July 1; when you talk to an intern remember that that person has not slept since that date, regardless of what today's date is.

The Medical Student (a.k.a. "Student," "Hey, you," "Get out of my way") is usually in the third or fourth (and final) year of medical school. They desperately try to learn everything they can, run down the halls to keep up with the team, and live under the constant threat of public humiliation. They can be identified by their short white coats. If there are multiple students on a team a strange dynamic can develop based on camaraderie in a trying situation and competition for the grades that are the life's blood of medical school.

Elaborate rules govern the behavior and interaction of members of the team. For example, the most junior member present is traditionally expected to present the patient to the most senior member present. The most senior member present will pose questions (called "pimping") to the most junior members (e.g. "what is the classic triad of signs and symptoms of the patient presenting with normal pressure hydrocephalus?"); if the students can't answer it the interns are expected to, and then the junior residents, and on up the food chain.

A classic and more complete (albeit slightly crude) description can be found here.