The transition from medical school to residency is a tricky period for both educators and learners. COVID-19 could complicate matters even further.

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The current crop of soon-to-be medical school graduates missed weeks, or in some cases months, of key clinical training at the outset of the pandemic last spring. Medical educators have had to innovate to replace that lost training time and help prepare M4s for the challenges that await them in residency.

What is the transition to residency going to look like for the medical school class of 2021? The topic was covered in a recent episode of the “AMA COVID-19 Update” examining the challenges of transitioning to residency during the pandemic.


Even before the pandemic, medical students were limited in their clinical roles.

“Educators on both sides of the continuum—both medical schools and residency programs—have recognized that, over the years, students' roles have been curtailed a bit in terms of what they're able to do,” said Kimberly Lomis, MD, the AMA's vice president for undergraduate medical education innovations. “And in many ways, they don't practice some of the common tasks that they're asked to be able to perform as interns as much as perhaps we historically did.”

The pandemic’s timing may have affected the specialty-specific training of this year’s resident intern class, Dr. Lomis said. There is likely to be a situation in which some upcoming interns had an abridged or missed rotation in a specialty with which they matched or in an area that relates closely to their upcoming duties as interns. That requires individualized attention for members of this class, she said.

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“The particular challenge this year is the variable nature of what was lost for each student,” Dr. Lomis added. “And it's really important to recognize that this is a loss in their experience. They're very capable, and we have full confidence that these students will go on to be fantastic interns. We just need to help them through this period and make sure that we're watching carefully as they adjust.”

Learn with the AMA about 10 keys for success as a resident intern.

To create a more seamless transition for incoming interns, residency programs are getting creative.

“We're seeing some innovative ways they're managing that such as having something called an OSCE [objective structured clinical examination] during orientation week around clinical skills and procedures,” said Eric Holmboe, MD, chief research, milestone development and evaluation officer for the Accreditation Council for Graduate Medical Education.

That can help cover “the can't miss-type diagnoses, how to work with patients who are really ill, those sorts of things—making sure that they're fully prepared.”

From the interns’ side of things, the prevailing concern seems to be that they will enter into a situation for which they are not prepared. Dr. Lomis advocated for new graduates to be honest about their skills.

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“One important step is to acknowledge how hard it can be for interns to disclose areas of uncertainty,” she said. “If we all think about it, no one would go to the first day of a new job and go to your boss and say, ‘Hey, now that you've hired me, by the way, you should know that I'm not feeling so confident about ‘X, Y and Z.’

“That's just not something that people feel very comfortable doing. And so part of our work has been to …  help learners and the GME programs think about how to make this a safe conversation,” Dr. Lomis said.

The AMA has curated a selection of resources to assist residents, medical students and faculty during the COVID-19 pandemic to help manage the shifting timelines, cancellations and adjustments to testing, rotations and other events at this time.

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