Medical education is far from over when students complete their M.D.'s. They spend the next several years—the length of time depending on the specialty—as residents at teaching hospitals or academic medical centers. Residents are both learners and providers of care, training and working under the supervision of experienced physicians. As their residency progresses, the new doctors become more experienced themselves and require less direct supervision. There are about 24,000 residency positions in some 3,800 programs across the U.S.; DHMC has 35 programs with a total of 349 residents this year.

It used to be that residents worked 100 hours a week or more. They still work long hours, but since 2003 residents nationwide have been limited to 80 hours a week—with one day out of seven free, a minimum of 10 hours off between shifts, and a maximum of six hours post-call to complete and hand off their work. Residents can be on call no more often than every three days; during on-call stints, they sleep (when they can) in the hospital so that they're available at any hour of the day or night when emergencies arise.

Dr. Hilary Ryder, the resident featured in this photo-essay, received her M.D. from Yale in 2004. She comes from a long line of physicians, including a great-great-grandfather and great-grandfather; a great-uncle; and her father, an epidemiologist who specializes in tropical medicine. Ryder considers her hometown to be Wellesley, Mass., but her father's work meant that she grew up all over the world—in places like Panama, Great Britain, Gambia, and the Democratic Republic of the Congo. DHMC was her first choice for residency, and she plans eventually to specialize in hospitalist medicine.

Ryder arrived at Dartmouth in July 2004 as a first-year resident, or intern, in

internal medicine. She thrived on the hectic pace last year, doing a dozen different rotations and gaining confidence and experience. Residents typically do four-week rotations in various areas within their specialty. Ryder finished her internship on June 25, 2005; got married; honeymooned in Greece; then, without missing a beat, returned to DHMC in July as a secondyear resident. Her first rotation was at the VA Medical Center in White River Junction, Vt. On August 1, she started her second rotation, on an inpatient unit at DHMC. Several teams of physicians provide care to hospitalized patients, and each team is led by a second-year resident. Ryder heads the "red team," which includes Matthew Laquer, a third-year DMS student; Dr.

Sharlene D'Souza, an intern who just received her medical degree from the University of Oklahoma; pharmacy practice resident Lindsay Brooks, who just earned her Pharm.D.; and Dr. Brooke Herndon, the attending physician who supervises the team.

One of Ryder's 24-hour on-call stints on this rotation began at 7:30 on a Monday morning in August. Photographer Patrick Saine shadowed her the entire time, shooting 959 images during the period. Whether Ryder was examining patients, attending meetings, interacting with other caregivers, responding to medical emergencies, teaching the student and the intern on her team, or catching a quick bite to eat, Saine was there as well.