US Medical School Graduate Readiness for the Transition to Surgical Residency: A National Study

Recently, greater emphasis has been placed on the transition from undergraduate medical education (UME) to GME. We evaluated surgical specialties' program directors' (PDs) assessments of readiness of their PGY1 residents (PGY-1s) for residency.

We examined individual- and program-level UME and GME variables in association with PD assessments of their 2020 to 2021 through 2023 to 2024 PGY-1s' readiness for residency, using multivariable logistic regression to identify independent associations between each variable and the outcome of "did not meet" (vs met or exceeded) overall PD expectations in the first 6 months of GME.

Of 6,710 PGY-1s, 229 (3.4%) did not meet overall PD expectations. In a multivariable logistic regression model, odds of not meeting overall PD expectations were lower for PGY-1s who had attended schools with (vs without) required specialty-specific transition-to-residency courses (adjusted odds ratio 0.68; 95% CI 0.52 to 0.90; p = 0.008); higher for noncategorical (vs categorical) general surgery PGY-1s (adjusted odds ratio 2.01, 95% CI 1.44 to 2.82; p < 0.001); and similar for (each vs categorical general surgery) orthopaedic surgery (adjusted odds ratio 0.73; 95% CI 0.45-1.20; p=0.221) and other surgical specialties' (adjusted odds ratio 0.69; 95% CI 0.45 to 1.06; p = 0.093) PGY-1s. Among PGY-1s who did not meet overall expectations, the single most frequently cited specific area in which they failed to meet expectations was "performed tasks in an organized and timely manner."

3.4% of surgical specialties' PGY-1s did not meet overall PD expectations in the first 6 months of residency. Our findings can inform collaborative UME-GME efforts, including a focus on clinical efficiency, to improve the transition to residency for PGY-1s entering surgical GME programs.