Research shows that despite how busy PGY-1s are and how stressed they might feel during their internship year, the overwhelming majority are meeting residency program directors’ expectations. For the few who aren’t, the largest issue—time management—is a skill they can hone.
“The beginning of internship is very intimidating and if you feel like you're struggling, people probably are perceiving you as struggling,” said Kimberly D. Lomis, MD, the AMA’s vice president of medical education innovations. The key, she said, is “awareness,” and then asking yourself whether you’ve had the opportunities that will prepare you to thrive. If you haven’t, “seek them out, get some feedback and practice. If you're struggling as an intern, get some advice.”
Dr. Lomis helps lead the AMA ChangeMedEd Initiative, which works across the continuum with visionary partners to create and disseminate innovations to better train physicians to meet the needs of patients today and in the future. She said that PGY-1s who find themselves feeling in over their heads can turn to the experts—their fellow residents—as they learn how to navigate the new world they will explore after medical school.
Potential trouble spot revealed
Recent research shows that the overwhelming majority of U.S. medical school graduates enter residency prepared. But of those who do struggle, it’s likely one of these areas in which they are having trouble: time management and organization.
For a study published in JAMA Network Open last year, researchers from the Association of American Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM) analyzed annual survey data collected from residency program directors from 2020–2023.
The researchers analyzed data collected via the AAMC Resident Readiness Survey, which asked of program directors: “During the transition to GME (0–6 months of PGY-1 year), did this resident meet overall performance expectations?” The choices were that the individual resident met, exceeded or did not meet expectations.
The responding program directors provided ratings for 29,461 PGY-1 resident physicians who were U.S. medical school graduates. Of those, only 3.2% of the residents were rated as not meeting expectations, compared with 96.8% who met or exceeded expectations.
Though there was some variation by GME program, there did not appear to be a link between perceived competitiveness of a particular specialty and the percentage of interns determined by program directors to have met or exceeded expectations.
Of the 934 interns that residency program directors said were not meeting expectations, the top area of difficulty was “performed tasks in an organized and timely manner.” More than 72% of those not meeting overall expectations were assessed as failing to meet expectations specifically in that area.
Navigating new world of residency
The small share of interns who struggle to meet program directors’ expectations might be academically prepared, Dr. Lomis said, while still being overwhelmed by the sheer volume of tasks they face in residency.
She said residents can ask themselves, “In your fourth year [of medical school], did you really ever carry more than six patients at once and how did you manage that? … Students, strategically, to get better grades want to control their workload, and programs often limit student caseloads so they can study and prepare.”
One of the study’s authors was Dorothy A. Andriole, MD, who is senior director of medical education research at the AAMC. She said that, depending on a resident’s specialty, they may have had a much smaller patient load during medical school than they will in their internship year.
“If they’re expected to handle 12 patients, day-in and day-out for a month and they've only ever handled a few patients at a time, there's a big experience gap there,” Dr. Andriole said. There can also be an issue with experiences that are difficult to duplicate without firsthand knowledge. Simulations may not fully prepare you for all the challenges you will face.
“If they [residents] enter internship never having taken overnight call, that’s a rough transition,” she said. “They’re going to find that very challenging.”
Learn more with the AMA about the five skills residency program directors expect on day one.
Practice makes progress
Dr. Andriole said medical students can and should “take a very critical self-assessment about the experiences they've had as they're getting into their fourth year compared to what the likely expectations will be during internship in terms of pace of work, patient load, setting, night call, and ask themselves whether or not they have had experiences that give them a very realistic expectation and prepare them for that.”
But if you suspect you haven’t had enough or the right kind of opportunities, it’s not too late. The chances to practice are key. Dr. Lomis said the assessments of struggling residents are often “less so that you’re not good at it and more: Have you been given the opportunity?”
The AMA’s Facilitating Effective Transitions Along the Medical Education Continuum handbook looks at the needs of learners across the continuum of medical education—from the beginning of medical school through the final stage of residency. The learner sections help resident physicians acclimate to the various settings and expectations in the medical training environment. Download the handbook now.
Seek feedback and help
As time passes in residency, and you acclimate to the new workload, you will likely get up to speed in the natural course of things. If you don’t, it’s time to turn to your fellow residents for advice. Being honest will yield more positive results than struggling in silence.
“It’s better to ask for advice from a senior resident ... ‘How do you juggle all this? I'm struggling to manage my load,’ rather than to limp along and then not seek help,” Dr. Lomis said. “Help-seeking is generally seen as a sign of growth and people will encourage you and help you.”
Learn more about the AMA Reimagining Residency grant program, which was launched in 2019 and is transforming residency training to best address the workplace needs of the nation’s current and future health care system. It supports bold and innovative projects that provide a meaningful and safe transition from undergraduate medical education to graduate medical education, establish new curricular content and experiences to enhance readiness for practice and promote well-being in training.
