What M4s should know to address skill gaps before intern year

AMA News Wire

What M4s should know to address skill gaps before intern year

Dec 13, 2023

Starting physician residency on the right foot begins with doing the legwork in medical school, particularly during your M4 year.

A study published this fall highlights perceived gaps in preparedness that ob-gyn residency program directors and residents felt existed upon beginning their training.

The study, published in the Journal of Surgical Education, comes out of work that is part of a project on transforming the undergraduate medical education (UME) to graduate medical education (GME) transition. The "Right Resident, Right Program, Ready Day One" project that is part of the AMA Reimagining Residency grant program.

The study’s lead author, Karen George, MD, offered insight on the UME-GME transition and how students can work to make sure their transition is not a rocky one.

The study’s overwhelming conclusion is one that has been a central theme in efforts to remake medical education: More formal planning ahead is needed to make the transition between medical school and residency smoother.

While self-assessment is a good place to start, Dr. George said that finding your knowledge and skills gaps cannot be an entirely introspective exercise. Speaking to faculty and even your peers who observe you in the clinical setting can be helpful to identify what you should work on in the final months of medical school.

“A lot of this is speaking to faculty members and specialty advisers and spending time in the simulations suites with your classmates who are also going into a specialty to work on the skills needed to care for patients at the start of residency,” said Dr. George, associate dean for students at the University of Vermont Larner College of Medicine.

Another valuable resource Dr. George highlighted: current residents. Speaking with those in residency now about what they did to get ready for training and what they recommend a soon-to-be intern can do is a very helpful exercise.

If you feel uncertain about your ability to perform a certain procedure, Dr. George advised working with your specialty mentors to spend additional time in the clinical setting to hone your skills.

“If you're worried about delivering a baby or having a difficult conversation with a patient about end-of-life care, talk to your specialty adviser or find a faculty member to shadow,” Dr. George said. “If you feel like it’s been a while since you’ve done an ultrasound, go to the ultrasound suite and refamiliarize yourself with how the machine works so that you're not doing it under pressure the first time in your residency.

“A lot this is muscle memory. You are refamiliarizing yourself with skills you already have and haven’t used in a while.”

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In speaking to residency program directors and residents, the study asked each group to identify perceptions of lack of readiness for specific activities. The biggest gap between resident and intern perceptions was time management, which nearly 60% of program directors surveyed felt required more attention—compared with about 30% of residents. 

While there are things students may be able to do to work on their time management, such as familiarizing themselves with their medical school’s EHR, the fact remains that responsibilities in the EHR will change considerably as a resident. The biggest time-management issue, Dr. George said, is that the workload is considerably heavier for interns compared with medical students and it takes time to develop organizational systems to be more efficient.

“There are things you can do as a student—like make lists of what you have to do each day during rotations and keeping those lists up to date,” said Dr. George. “Some of this is going to come down to reps. You get better with it as time goes on, but it is helpful to seek best practices in time management from resident and attendings at the front line.”

In terms of where new residents felt least prepared, the survey found that medical knowledge in inpatient topics topped the list, with more than 50% of resident respondents indicating they felt they needed additional preparation. However, only about one-quarter of responding program directors found inpatient medical knowledge to be lacking.

Dr. George’s explanation for this variance was that program directors expect incoming trainees to have some knowledge gaps.

“Sometimes it is an issue of confidence,” she said. “New residents can be a bit hard on themselves.

“Program directors know it is their responsibility to train residents in their in their specialty, and don’t expect interns to have all the knowledge when there are so many situations they simply haven’t yet been exposed to in their training.”

To hone your knowledge, skills, and abilities, Dr. George encouraged students to pursue any residency readiness opportunities a medical school may offer, such as specialty-specific boot camps. She also highlighted the importance of consuming any resources your future residency program suggests after you match.

“Program directors will often send a list of recommended reading or skill-building assignments to complete before residency starts—take full advantage of these,” she said. “Reach out to program directors if you don’t get this type of list to ask for recommendations.”

In the end, your medical school experience is likely to have put you in a place to succeed as an intern. The majority of program directors surveyed for the study indicated that their incoming residents were ready on the first day. As a former program director, Dr. George said that aligns with her experiences.

“The vast majority of students come into residency feeling prepared and their program directors agree,” Dr. George said. “That should be encouraging.”