Reimagining the transition from medical school to residency

By: Brent Thoma, MD PhD and Dorothy Baker, MD

Despite significant changes to medical education assessment over the past twenty years (1), little has changed about the transition between medical school and residency (2). While CBME espouses the importance of a developmental continuum, trainees continue to experience significant disruption as they transition from medical students to residents (3). Recent descriptions of the current state of this transition have described it as “inconspicuous” and described conflicting expectations and a lack of trust and transparency (3). Is the Interim Associate Deans of Undergraduate and (Post)graduate Medical Education at a new medical school we have been pondering the question:

If we had the chance to reimagine the medical student to residency transition, what would it look like?

Over the past year we have been considering how we could smooth the transition between these two phases of medical education for students at the Toronto Metropolitan School of Medicine. This new institution, situated in Brampton, Ontario, Canada, will welcome its first cohort of medical students and residents in 2025. With a commitment to CBME that spans undergraduate and (post)graduate medical education, we are considering what it would take to ease this transition, in part by reimagining the management of assessments at the end of medical school with the goal of supporting learners through this transition.

Facilitating access to assessment data

The sharing of assessment data within medical education has historically been hampered both by a reluctance to share trainee data between institutions and a lack of technological and governance structures capable of securely transferring this sensitive data (4). However, the primary purpose for the collection of this data is to support trainee development and inform progression decisions. The hoarding of data by institutions deprives developing physicians from using this data to support their transition to residency. We are exploring approaches to data management that will allow our medical students to access and transition assessment data relevant to their ongoing training to their new residency training program.

Increasing assessment cohesion

Traditionally, medical school and residency assessment systems are not harmonized, providing little consistency for learners in transition. However, with the widespread adoption of workplace-based assessments such as entrustable professional activities within both Canadian UGME (5) and (P)GME (6) has decreased the variability between approaches. As North American medical students spend much of their senior year traversing the continent completing ‘electives’ in areas that are relevant to the (post)graduate training that they plan to pursue, additional synergy is possible. We are considering allowing senior medical students who have demonstrated the competencies expected of a postgraduate trainee (resident) to be transferable to relevant junior entrustable professional activities in residency.

Embracing Competence Committees

As competency-based approaches to medical education have been embraced, Competence Committees have played a growing role in the interpretation and translation of assessment data (7). These bodies would be the perfect recipient of medical student’s assessment data. The consideration of these assessments by Competence Committees could change the focus of medical students in their senior year, provide improved insight to their residency program regarding their development, and potentially accelerate their progression through the early stages of residency training.

Conclusion

While the formal implementation of these changes is several years away, we see the establishment of a new medical school as an opportunity for this kind of experimentation to flourish. If implemented as described, we would hope to see medical students requesting the transfer of their senior assessments to their residency program for review and decision making by its Competence Committee. Such harmonization across the CBME continuum would benefit all parties.

About the authors:

Dorothy Bakker is an Associate Clinical Professor and the Interim Associate Dean of UGME at Toronto Metropolitan Universit. Brent Thoma is a Clinical Professor and the Interim Associate Dean of PGME at Toronto Metropolitan University

References

1. Schuwirth LWT, van der Vleuten CPM. A history of assessment in medical education. Adv Health Sci Educ Theory Pract. 2020 Dec;25(5):1045–56.
2. Germann, CA. Transition from Undergraduate to Postgraduate Medical Education: A Scoping Review. Master’s thesis, University of Illinois at Chicago, 2018  https://indigo.uic.edu/articles/thesis/Transition_from_Undergraduate_to_Postgraduate_Medical_Education_A_Scoping_Review/10827011
3. Caretta-Weyer HA, Park YS, Tekian A, Sebok-Syer SS. The Inconspicuous Learner Handover: An Exploratory Study of U.S. Emergency Medicine Program Directors’ Perceptions of Learner Handovers from Medical School to Residency. Teach Learn Med. 2023 Feb 15;1–9.
4. Grierson, L., Kulasegaram, K., Button, B., Lee-Krueger, R., McNeill, K., Yous􀁔ef, A., Cavanagh, A. Data-Sharing in Canadian Medical Education Research: Recommendations and Principles for Governance. Hamilton, Ontario: Jan. 6, 2022. Available from: www.dataconnection.ca
5. Touchie C, Boucher A. AFMC Entrustable Professional Activities for the Transition from Medical School to Residency. Association of Faculties of Medicine of Canada; 2016.
6. Frank JR, Karpinski J, Sherbino J, Snell LS, Atkinson A, Oswald A, et al. Competence By Design: a transformational national model of time-variable competency-based postgraduate medical education. Perspect Med Educ. 2024 Mar 18;13(1):201–23.
7. Oswald A, Dubois D, Snell L, Anderson R, Karpinski J, Hall AK, et al. Implementing competence committees on a national scale: design and lessons learned. Perspect Med Educ. 2024 Feb 6;13(1):56–67.

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