Residency Program

The term residency as a descriptor of medical education first appeared in the American Medical Association (AMA) Council on Medical Education's publication “Essentials” in 1928. Early residency programs were designed to provide physicians with at least one year of practical experience under faculty supervision after internship. The residency program allowed graduate physicians to assume increasing responsibility in the care of patients.

Prior to the 1880s, graduate physicians in the United States often went directly into the private practice of medicine. Some graduate physicians apprenticed with a practicing clinician, frequently in Europe, and an elite minority served a one-year internship at a university hospital under attending physicians. Physicians entered the internship through personal connection or from affiliation agreements with medical schools. The value of internships in providing practical clinical experience became increasingly evident in the early 1900s. By 1914 about 80% of medical graduates entered internships and by the late 1920s nearly all graduates did. In 1914 the AMA developed a list of approved internships and produced “Essentials” for internship approval.

The concept of a physician specializing in an area of medicine led to residency program development. By 1915, 80% of graduate physicians sought specialized training either through on-the-job training, formal specialist education, or university degrees. Beginning in the late 1880s, a few university graduate medical schools offered specialized instruction in branches of medicine. The development of specialty boards formalized the course of study leading to certification in a discipline of medicine. Prior to 1917 when the American Board of Ophthalmology defined the type of training and content of the certifying examination there were no standardized requirements to practice a discipline of medicine.

The American Board of Medical Specialties was formed in 1937 by those medical disciplines having certifying boards and the Association of American Medical Colleges, the Federation of State Medical Boards, the Council on Medical Education and Hospitals of the AMA, and the National Board of Medical Examiners. This board sought to advise graduate medical education (GME) programs on the coordination of medical education and certification by medical specialties. Following World War II, residency review committees (RRCs) were formed to oversee the training programs of individual specialties. Concern about the control and quality of GME raised from special reports of organized medicine in the mid 1960s resulted in the Liaison Committee on Graduate Medical Education (present Accreditation Council on Graduate Medical Education, ACGME) being given authority for residency programs. The ACGME, whose membership is taken from its five parent organizations, established general requirements for GME and develops procedures for the accreditation process. The RRCs develop the special requirements for residency education in their specialty areas and accredit residency programs. Currently, there are 26 RRCs.

Functionally, residency programs provide the clinical infrastructure for faculty to teach graduate physicians the skills incumbent in their specialties and facilitate research performance. Each residency program is administered by a program director. Residency education is funded through a combination of federal Medicare dollars, research grants, endowments, and clinical practice revenues. With the exception of some community primary care residency programs, almost all programs are university based.

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