The medical education system is complex, especially in the PICU, where learners of all levels and from various specialties can be present. It’s important for you to know who the boss is, who works under supervision, and what duties those individuals are capable of performing.

Medical student: A medical student is exactly that, a student. Usually, in the PICU, they are in their fourth and final year of medical school. They are able to gather information and relay it to the team, but because they have not yet graduated with their degree, they are not allowed to write orders or change the plan of care without speaking to someone else first.

Intern: In the old days, after graduating from medical school, a young doctor would do a year of internship, gaining experience in many different fields over the course of a year. These days, most new doctors go directly into their chosen specialty, beginning their residency training immediately. For the most part, the terms “intern,” “first year resident,” and “PGY 1” (post-graduate year 1) are interchangeable.

Resident: A resident is a young doctor who is undergoing on-the-job training in their chosen field. They are usually some of the first people to see a new patient or to be called by the nurse so that they can gain experience in assessing and treating a patient. A residency can be anywhere from 3 to 7 years long, so there is a lot of variability in the experience of different residents depending on how many years of training they have completed. A pediatric residency is three years long, and most residents in the PICU are in either their second or third year. They are capable of making management decisions and writing orders for some problems, but generally look for guidance from more experienced fellows and attendings for complex issues.

Fellow: Many people decide that they don’t want to do general medicine in their chosen field, and instead would like additional training to focus on something very specific. Someone who likes kids and hearts, for example, would need to complete a three year pediatric residency and then another three year cardiology fellowship. The same is true for PICU fellows…they have already done three years of general pediatric residency and are now doing three more years of pediatric ICU training. They are capable of making complex patient care decisions, managing emergencies, and being team leaders.

Attending/Faculty: An “attending” is a doctor who has completed all of the training required for their chosen field. A PICU attending has completed medical school, residency, and fellowship training. The attending is the ultimate final decision-maker and team leader. They provide direction to all members of the team, take their suggestions into account, and supervise the activities of the residents and fellows.