Practical Insights From a Pilot Program: Off-Cycle Residency Start During the COVID-19 Pandemic

The COVID-19 pandemic presented an unprecedented opportunity to pilot off-cycle graduate medical education (GME) entry at Oregon Health & Science University. This educational case report analyzes stakeholder perspectives on implementing an early start to residency initiative through semistructured interviews with program directors, GME operations leadership, and departmental education leaders. Three GME programs participated in the pilot: an urban academic anesthesiology program, an urban academic emergency medicine program with community rotations, and a rural community-based university-administered family medicine program. Thematic analysis of interviews conducted 9-15 months postimplementation revealed key logistical factors that facilitated or hindered implementation. Programs with flexible scheduling systems adapted more effectively, whereas those heavily dependent on resident coverage or external rotations faced greater challenges. The pilot demonstrated that staggered entry could potentially distribute novice learners throughout the year, and early start residents often emerged as peer mentors. However, programs needed to carefully manage professional identity formation and cohort integration. Whereas implementation required no direct additional costs, perceived effort of implementation varied based on program structure and setting. Drawing from educational administrative stakeholder insights across varied training settings, this report describes the administrative and structural elements observed during off-cycle GME entry, offering practical implementation guidance for interested programs.