Ready for Residency, but Not Career

By the end of graduation, how prepared should a medical student feel for their career or residency? That’s one of the questions students answered in the Medscape Medical School Experience Report 2024. Their answers, by and large, suggest normative experiences and expectations. But there’s also plenty of preparation stress to go around and varying levels of satisfaction with their schools.

When asked how prepared they felt for the United States Medical Licensing Examination assessments, 51% said “prepared,” while just 18% said “very prepared.” Still, only 9% and 2% claimed to feel unprepared or very unprepared, respectively.

The preparation stress showed through when students responded to whether they feel ready to be a competent doctor:

• 43% said “sometimes”
• 30% said “rarely”
• 14% said “frequently”

Just 2% of respondents said they “constantly” feel competent.

But it’s quite normal for a student to find the concept of readiness for their careers out of reach, said Kim Lomis, MD, vice president of medical education innovations at the American Medical Association. “It’s a huge responsibility and as a student, it can be quite difficult to know where you’re headed, so it’s appropriate to have doubt,” she said.

Preparation for residency is a different story, however.

“That’s much more proximal to a student and they understand what they’ll be asked to do,” said Lomis. “They have the core EPAs (entrustable professional activities) to guide them.”

The survey results about residency preparedness confirm this idea. Some 56% of students feel “somewhat prepared,” and another 17% rate themselves as “very prepared.” 

While those numbers are encouraging, the American Association of Medical Colleges (AAMC) conducts its own annual survey of medical school graduates. Their findings reveal that 93% of students report confidence in their skills to begin residency.

“It would be nice if it were closer to 100%, but this is a good number,” said Lisa Howley, PhD, MEd, senior director, transforming medical education at the AAMC. “We’ve been tracking these numbers for years, and we’re seeing an increasing number of med students who feel ready for the next phase.” 

There’s likely not one reason for the sense of improved readiness, said Howley, but several. The pandemic had a negative impact on learning, for one, and programs have therefore been working to transition students from med school to residency. “We have a number of initiatives underway, as do other specialty organizations,” she said.

Residency Readiness 

If there’s one big, positive takeaway from the survey results, it’s that overall, students report feeling ready for residency.

“So much of medical education is on-the-job training,” said Lomis. “All those experiences are out there in the field, and we are structured to allow residents to have real encounters or simulation.” 

For med students, having a focus on the immediate step in front of them — residency — is the key.

“Medicine has evolved to be a continuous process of learning,” said David Lambert, MD, senior associate dean of medical school education at the University of Rochester Medical Center in Rochester, New York. “There are guidelines for supervising residents and a process in place to survey learners to ensure the process is working.” 

Even so, the system isn’t perfect, as the evolution of the delivery process has meant that clinicians might not have the time for residents they once might have. While efficiency has become the name of the game, the faster pace can “take up cognitive whitespace,” said Lomis. This pushes out opportunities for students/residents to share what they’re thinking.

Some student respondents in the Medscape Medical News survey expressed concerns about their preparation for residency.

“I believe my school dives too deep into content in the first year and doesn’t allow for a good overall understanding before moving into what they admit is more than residents are expected to know for each specialty.” 

In recognition of these potential gaps, many medical schools and specialty organizations have added “transition to residency” courses, some mandatory and others voluntary. The courses cover any number of issues and serve as both refreshers and introductions to new material.

They may include tools for communicating patient needs, physical exam techniques, procedures if focused on a specialty, electronic health records and more. There’s also a component focused on patient safety, one of the big concerns for new residents as they move along in their journey.

“Students like the courses,” reported Lomis. “They are quite receptive to them and see them as reinforcement to their training and readiness.” 

There is also an effort to increase the continuity between mentors and learnings in care settings during residency. This is designed to ensure learners of all types have space to immerse themselves and not fall through any cracks, said Lomis.

Career Readiness 

The sentiment of feeling career ready lags behind residency readiness, but educators say that’s okay.

“The public shouldn’t be alarmed to see doubt from the students,” said Lambert. “That feeling won’t impact their ability to care for patients once they finish up residency.” 

Some students appear to understand that, despite some imposter syndrome.

“I am a perfectionist and always have to remind myself that I am in training, and this path requires lifelong learning and improvement,” was the comment made by one Medscape Medical News survey taker. Another mentioned that, “I know I have much to learn before I will be in the position where I am solely responsible, but I have all the resources I need.”

Students also need to remember that they have had a limited glimpse so far of what their jobs will eventually entail. There are multiple different field rotations and that can leave a student feeling unsure of where they are headed. Residency will help them sort that out. As Lambert reminded, “a switch doesn’t go off when you graduate from medical school.” 

Instead, he added, “You have the ability to choose areas of specialty, and the system will ensure you are ready for residency training. You are making independent choices for yourself, but you’re still not at the finish line.” No one expects you to be there, either, he said.

If you fall into that category of not feeling ready for your career, remember that you have 3-plus years of learning ahead of you before you actually take the reins in earnest.

“Ask questions, be proactive, and seek clarification when you don’t understand something,” said Lomis. “Even a busy clinical supervisor takes reward from the educational relationship. People will make the time for you.”