Well, my fourth year of med school I did basically the same things, with the same responsibilities for the same number of hours as I did my first year of reside

Well, my fourth year of med school I did basically the same things, with the same responsibilities for the same number of hours as I did my first year of residency....and paid tuition for the privilege. Residency (and the 4th year of med school?) is cheap labor for American hospitals, coupled with brutal working conditions - ACGME's 80 hour work week restrictions were winked at throughout my training, and I suspect still are a lot. Making decisions after being on your feet 30+ hours is pretty much like making decisions drunk - not sure that four years of that was optimal for anybody, particularly patients. And yeah, we had "protected time" for didactics in residency - it was there that most of us developed the ability to fall asleep instantly.