A medical specialist is a physician who has completed the usual four years of medical school plus three to six years of training in a residency program where there is extensive study and preparation for them to care for patients in specific areas of medicine. As a resident the physician spends full time in a hospital or ambulatory care setting under the supervision of teachers. During this time the resident cares for patients, attends conferences, and participates in research in the area of specialty being studied. At the end of the residency the physician must complete a comprehensive evaluation and examination in order to receive certification. Some specialty boards also require re-certification every seven to ten years to maintain the certification. In addition the physician must participate in yearly continuing medical education.