Transition From Graduate Medical Education to Independent Practice: A Scoping Review

This study examines the gaps in early career physician readiness for independent practice after graduating from their final graduate medical education (GME) program.

The authors conducted a literature search of 4 online databases (PubMed, Scopus, Health Business Elite, and Education Resources Information Center) using the following terms: population terms ( GME, fellow, resident , and others), early career terms ( onboarding, hiring, early career, ready , and others), readiness terms ( readiness, preparedness, knowledge, skills, competence ), and independence terms ( attending, physician, independent practice ). The databases were searched on March 12, 2024, for articles that explored GME graduate gaps in readiness for independent practice; assessment tools, curricula, or curricular need aimed at gaps in early career physician readiness; or an area where GME graduates need more knowledge and skills. They extracted specific gaps in preparedness and categorized them using existing competency frameworks.

The search returned 116 articles addressing gaps in preparedness for independent practice among recent GME graduates. Surgery yielded more articles than any other specialty (43 [37%]). Overall, 192 individual gaps were extracted; the greatest number of gaps came from patient care (75 [39%]) followed by personal and professional development (44 [23%]). The most frequently identified gaps were procedural independence (10 occurrences), practice management (9 occurrences), and billing (7 occurrences).

Despite advances in GME, learners still struggle when transitioning to independent practice. Personal and professional development is a useful categorization for many gaps and should be considered for inclusion as a GME competency. Systematic assessment of new-to-practice attendings could help stakeholders better understand the true outcomes of GME programs. Concerted investment by specialty societies may drive greater understanding and innovative solutions. Additional study could help address the challenges in the GME-to-practice transition.