sama-sd.org

this how we do our residency which is braodly similar to other places

Acute medical care:

17 months of inpatient care UK equivalent of acute medicine (including 4-5 ICU, 1 HIV service) ; 1/3 as a first year, 2/3 as second & third year (also called senior), call cycle every 4 days, spanning 30 hours, admitting 6-7 patients as first year per day, 10-14 patients as senior, responsible for overall clinical care in a team made up of 1-2 interns, 1-2 seniors, 1 attending.

All patients go under internal medicine, except ICU patients go under Medical ICU service (which is run by Pulmonary/Critical Care attendings), and CCU patients go under Cardiology. in other words if a patient is admitted with acute renal failure, he goes under Medicine and nephrology is consulted, a patient with acute leukemia goes under medicine and hematology is consulted, etc…

Clinical responsibilities: first year of residency you are first oncall with direct supervision of a senior (like HO/SHO), in addition to attending, you are directly responsible for patient care. senior supervises the intern (like registrar), and takes the senior responsiblity of care.

The remaining 11 months

Speciality experience/Procedures: (mandatory)

3-4 months of ICU, 1st month as junior, 2-3 months as senior, unlike UK/Ireland, medical patients are admitted to a medical ICU which is run by Pulmonary/Critical Care, so at the end of training in addition to central line, arterial lines, thoracocentesis, paracentesis, lumbar puncture;  you are comfortable managing a ventilator, extubating patients without anesthesia. those who are interested can also perform a few intubations. Interestingly, chest drains in USA are considered a surgical procedure and are performed exclusively by surgeons, or pulmonary/critical care fellows.

1-2 months CCU, run by Cardiology Service

our program also mandates 1 month of HIV service, 1 month of outpatient urgent care, 1 month of geriatrics/palliative care, 1 month of Emergency Room, women's health (gynecology), cardiology, pulmonary, infectious disease, nephrology, neurology, hematology/oncology, endocrinology, gastroenterology

Speciality experience (optional)

1 month research, dermatology/rheumatology are optional

Outpatient experience:

As a resident you have your own clinic once a week throughout residency, i.e. 140 sessions throughout residency, you initially see 4 patients then at the end up to 10 patients per session. all patients have to be discussed with attending, and in first year, the attending has to physically see the patient, later on he doesn't need to do that but still has to discuss the patient.

Teaching (the usual day)

inpatient medical service:

rounds start at 07:30 AM (every day including weekends), intern is expected to see his patients before rounds, examine them, look up the lab results, and outline a plan for the day, and present the case in the round. last until 09:00 AM led by attending.

09:00 seniors go to the AM report, where they present the cases to a senior attending, this lasts until 10:00 am, after which seniors meet up with interns and go through the day's tasks. until 12:00 pm.

both interns seniors go for teaching from 12:00 pm to 1: 00 pm. 

after 1:00pm at least one member of the team has his own outpatient clinic, the other team members cover the duties until 5:00pm which is time for signout or handover.

on consult services: things are less intense typical day starts at 8:00 am with teaching session, consult rounds are usually late AM 11:00 AM or in the afternoon, with additional clinic duties depending on speciality, e.g. in endocrinology you have very few consults so you do 8 outpatient sessions per week, in nephrology you do 3 clinics, all of this is in addition to your usual weekly clinic in general medicine

Assessment

At the end of every rotation, you are assessed (in writing) by the attending, your seniors (if you are intern), your juniors (if you are senior), if you fail to meet expectations you do not progress in the program and repeat the year. and yes it has happened.

you are assessed twice a year by the program director.

you do an annual exam in preparation for the american board. so before you sit for the board after graduation from residency, you do a mock exam in first, second, third years. if you have poor performance in these exams then this is fixed before hand.

as a result the worst program's pass rate is 90%, and by the way for someone who sat for mrcp and passed it, i can tell you it is harder than mrcp 2.

so you can see that although residency is only 3 years, it equates to 6-7 years in UK/ireland, given that an average day in inpatient service is 9.5 hours for senior, 10.5 for intern, oncall day is 30 hours. during an inpatient month you take 4 days off (includes weekends).

I will give you my take as someone who has trained as an SHO in the united kingdom for 2.5 year, completed MRCP then came to USA.

Generally where and how to pursue postgraduate training outside Sudan is a highly personal decision which includes other not only the quality of training but also the working hours, the country itself, the ease of travel to and from Sudan, the duration of training itself, and finally your aims after completing postgraduate training either return to Sudan, moving to Arabian Gulf or permanent immigration to that new country. In other words, better quality training doesn't necessarily mean better choice.

Anyway, the main difference between USA residency and basic specialist training in UK and ireland is the endpoint. USA residency is NOT the equivalent to the Irish/UK CCBST/MRCP, BUT equivalent to CCT/CCST in Acute/General Medicine.

In other words someone who completes residency in internal medicine in USA is considered an attending/consultant, and NOT a registrar. He can independantly work without supervision, with all the benefits, salary, responsibilities that come with that title.