The Landscape of Transition to Residency Courses in the United States: Results of a National Survey

Abstract Purpose This study examined the current landscape of transition to residency (TTR) courses in the United States. Method A nonincentivized survey was distributed electronically from October 2023 to March 2024 to contacts at 187 accredited US medical schools (153 allopathic and 34 osteopathic schools). The survey inquired about the presence of a TTR course or plans for implementation. For schools with a course, respondents were asked about course requirements, content, structure, duration, resources used, assessment framework, grading, remediation, professionalism concerns, and faculty support. Results Of the 187 surveyed medical schools, 132 (70.6%) responded; 115 (87.1%) have a TTR course, with 8 of the 16 medical schools (50.0%) without a TTR course planning to implement one in the next 3 years. Ninety-one courses (79.1%) are required. The median (range) duration of the shared TTR course is 2 (0-10) weeks. The most commonly used external resources are MedEdPORTAL (40 [34.8%]) and the TTR compendium (37 [32.2%]). Sixty-seven schools (58.3%) structure the course using Accreditation Council for Graduate Medical Education core competencies and/or milestones. Grades are predominantly pass/fail (108 [93.9%]); 21 schools (18.3%) incorporate remediation. Topics include responding to common inpatient issues, pages from nurses, and rapid responses and codes. A total of 105 respondents (91.3%) reported at least one student in their course with professionalism concerns. Respondents with knowledge about full-time equivalent faculty support (75 [65.2%]) revealed that the total median full-time equivalent support for all TTR faculty is 0.1 (interquartile range, 0-0.3; range, 0 to >2). Conclusions Most medical schools have a TTR course, but aspects of the course vary. Future directions to improve the national TTR experience include the creation of standardized content, validated assessments, and collaborative research examining the impact of TTR courses on interns and the programs to which they match.