Program Directors’ Assessments of US Medical Graduates’ Transition to Residency
Authors: Douglas Grbic, Dorothy A. Andriole, Lindsay Roskovensky, Mark Speicher, Keith A. Horvath, Lisa Howley
Journal: JAMA Network Open (2025)

Importance Medical school graduates across specialties should be prepared for the start of postgraduate year 1 (PGY-1). Assessments by program directors (PDs) may offer insight to differences in preparedness across medical specialties. Objective To investigate whether PD assessments of their PGY-1 residents’ performance during the transition to residency differed by specialty category. Design, Setting, and Participants This retrospective, cross-sectional study used Resident Readiness Survey (RRS) data collected from PDs from 2020 through 2023. Annually, eligible PDs (ie, PDs training PGY-1 residents who had graduated from US medical schools included in the RRS process) were invited to respond. A deidentified, individual-level database of PGY-1 residents for whom PDs were asked to complete standardized RRSs was created to examine the association between graduate medical education (GME) program specialty category (among other variables) and PD response to the RRS item “During the transition to GME (0-6 months of PGY-1 year), did this resident meet overall performance expectations?” The response options included exceeded, met, and did not meet expectations. Analyses included χ 2 tests to measure bivariate associations and multivariable logistic regression analyses to test independent associations with this outcome. Exposures PGY-1 in a specialty program during the first 6 months of GME. Main Outcomes and Measures The main outcomes of interest were PD assessment of PGY-1 residents’ overall performance (dichotomized as met or exceeded expectations vs did not meet expectations), PGY-1 year, and GME program specialty category. Results The PD RRS response rate varied by year (1786 of 2847 [62.7%] for 2020-2021, 2107 of 3406 [61.9%] for 2021-2022, and 2835 of 3659 [77.5%] for 2022-2023; P &amp;amp;lt; .001). Responding PDs provided overall performance ratings for 29 461 PGY-1 residents, including 934 (3.2%) who did not meet expectations and 28 527 (96.8%) who met or exceeded expectations. The percentage of PGY-1 residents who did not meet expectations varied by specialty category (range, 11 of 1482 [0.7%] for transitional year to 235 of 3775 [6.2%] for family medicine; P &amp;amp;lt; .001). In multivariable regression, compared with internal medicine, the odds of residents not meeting (vs met or exceeding) expectations were higher for PGY-1 residents in family medicine (adjusted odds ratio [AOR], 2.09 [95% CI, 1.70-2.58]), general surgery (AOR, 2.05 [95% CI, 1.62-2.58]), and obstetrics and gynecology (AOR, 1.64 [95% CI, 1.24-2.15]); in contrast, the odds were lower for PGY-1 residents in other surgical specialties (AOR, 0.60 [95% CI, 0.42-0.84]), other nonsurgical specialties (AOR, 0.61 [95% CI, 0.44-0.85]), and transitional year (AOR, 0.22 [95% CI, 0.12-0.42]) vs internal medicine. Conclusions and Relevance Findings from this cross-sectional study indicated that most PGY-1 residents met or exceeded PD expectations. Specialty-specific interventions may further optimize the transition for all US medical graduates.