While a resident physician’s improvement isn’t linear, the journey through training is. Each July brings a step to a new level of training. From the fast pace of intern year to the weight of senior-level decision-making, each transition brings a new set of expectations and responsibilities. 

John Andrews, MD, vice president of graduate medical education (GME) innovations at the AMA, has seen these shifts play out across specialties and institutions. Drawing on his insight—and guidance from The AMA’s Facilitating Effective Transitions Along the Medical Education Continuum handbook— here’s what every resident should know about three of the biggest transition points in training.

New resident physicians will have a volume of patients that is unlike what they experienced as medical students. Even if you did a subinternship rotation during medical school, your patient load as an intern is likely to double. The weighty role new residents take on—often the first decision-maker on a patient’s care plan—is also new. 

In addition to shifts in clinical responsibilities, residents need to hone their interpersonal skills, building strong relationships with nurses, attending physicians, consultants and other team members. Residents also must take charge of their development as self-directed learners. 

Don’t discard your medical school experience—build on it.

“There’s this perception that your professional development kind of stops at the end of medical school and then restarts in residency,” Dr. Andrews said. “There’s a lot of knowledge of your professional development gained through your experience in medical school that ought to inform your experience in residency.”

Turn to the AMA Thriving in Residency series for timely guidance on making the most of your residency training. Get resources and tips about navigating the fast-paced demands of training, getting scientific research published, maintaining health and well-being, and handling medical student-loan debt.

As residency progresses, residents are increasingly independent in their decision-making. With that independence comes added responsibility. Residents should reflect on gaps in their clinical knowledge and actively work to fill them. One strategy recommended in the AMA’s transitions handbook is using elective time or mentorship to hone skills that a mid-resident may have inadequately developed during intern year.

As residents grow in their roles, they also will take on more of a supervisory capacity in relation to junior residents and medical students. This is also a phase of training in which a trainee might want to start to consider their professional identity, which includes thinking about one’s long-term career trajectory. 

Don’t simply go with the flow—actively shape your learning experiences. 

“I went through the first nine months of my pediatrics internship without doing a lumbar puncture on a baby,” he said. “When I finally was presented with a clinical situation I had to say, ‘I haven’t done this yet.’”

“Some trainees may not take an active role in their education to modify the experience in a way that meets their needs,” he added. “You can check the boxes or you can take advantage to seek experiences that you know are going to inform your practice going forward.”

As a senior resident you’ll be making independent decisions without immediate supervision. To do that, the AMA handbook calls on learners to display advanced clinical thinking. That means combining evidence-based medicine with intuition to deliver excellent care. 

Senior residents also have new roles as leaders and instructors. To fulfill these new responsibilities, it is important to model professionalism and manage team dynamics. You are also charged with supporting the development of more junior residents and medical students. 

Instead of micromanaging, delegate thoughtfully. 

“As a senior resident, you are effectively middle management,” Dr. Andrews said. “You have to be able to digest the often somewhat long-winded input of interns and medical students to make succinct presentations to the attending for the purposes of clinical decision-making.”

Even as the leader in the team setting as a senior resident, it’s vital to “encourage some independence for decision-making to more junior residents. That’s balanced against the impulse to act like you know everything or need to have the final say,” he said. “The art of it is giving people a leash—but not too long a leash.” 

The AMA’s Facilitating Effective Transitions Along the Medical Education Continuum handbook looks at the needs of learners across the continuum of medical education—from the beginning of medical school through the final stage of residency. This book was published by the ChangeMedEd Consortium.

The learner sections help medical students and resident physicians acclimate to the various settings and expectations in the medical training environment. The faculty sections then provide blueprints for transition programming, as well as resources to help students and residents navigate challenges in transitions. Download the handbook now (registration required).