Preparing for Residency

How to make the M4 to PGY-1 jump a smoother one

Marc Zarefsky , Contributing News Writer

Now a few months into their first year of residency, America’s medical and surgical interns may finally be starting to feel a little less out of their depth in the transition to graduate medical education (GME).

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But that transition could—and should—be better, said John Andrews, MD, vice president for GME innovations at the AMA. In that role, he oversees the AMA Reimagining Residency grant program, which supports bold and innovative projects that provide a meaningful and safe transition from undergraduate medical education (UME) to GME, establish new curricular content and experiences to enhance readiness for practice, and promote well-being in training.

Medical students “are somewhat less prepared for residency than they used to be," Dr. Andrews said during an interview filmed on site at the ChangeMedEd® 2023 conference. "The transition is a less well-informed process than it could be."

In a recent episode of “AMA Update,” Dr. Andrews detailed how the AMA is fostering innovative approaches to help ensure the transition to GME is a smoother one.

There are multiple factors behind the reality that too many interns show up for their first day underprepared for the tasks demanded of them in residency.

"There's much more anxiety about securing a residency position," Dr. Andrews said. "Therefore, students, to some degree, are more focused on that than they are on their professional development as a physician. And perhaps as a result of that, there's less sharing of information from medical school to residency."

With less information shared, students are not as prepared for their GME experience, and residency program directors in turn have to spend more time understanding gaps in preparation and teaching the skills necessary for PGY-1s to be effective. This cycle also contributes to imposter syndrome among interns, Dr. Andrews said, leading some to question whether they will be able to succeed in the field.

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There is a disconnect between UME and GME regarding whose responsibility it is to fill that preparation gap. Ultimately, Dr. Andrews said, both should be held accountable.

Too many residency programs “have a fantasy that medical students will be prepared to, essentially, act almost independently in the clinical environment when they arrive," he said. "And medical schools think that their responsibility is to provide a basic foundational set of skills to students, and then the real clinical training will take place in residency when they get there.

"I think there's some shared responsibility for medical schools to better prepare students for residency and for residencies to have realistic expectations about what their responsibility is to upskill their residents once they arrive," Dr. Andrews said.

One way to address the rocky UME-GME transition is targeted coaching in which medical students reflect on their skills and educational journey in an effort to understand where their gaps may exist. That knowledge can then lead to professional guidance about how to address those gaps.

"You identify gaps in your preparation, you take advantage of experiences to address those gaps, and then you repeat that cycle throughout your career to make sure that you're advancing and providing the best care possible to your patients," Dr. Andrews said.

Dr. Andrews also touted the value of specialty-specific, just-in-time training. This training can be a crash course in skills necessary for a certain specialty. It can be taught prior to or at the beginning of the residency journey to help interns begin their residency with more confidence in their own abilities.

In addition to specialty-specific skills, there are more general lessons students should be knowledgeable of, ranging from effective electronic medical record documentation to managing sleep deprivation. These and other topics are offered to students through the AMA GME Competency Education Program.

"If we can make this process smoother," Dr. Andrews said, "it will actually accelerate the development of our physicians, make them feel more confident, and allow them to focus on very specific specialty-skill areas sooner in their training."

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