Abstract
ObjectivesTo characterize junior residents’ perspectives on the purpose, value, and potential improvement of the final year of medical school.MethodsEighteen interviews were conducted with junior residents who graduated from nine different medical schools and who were in internal medicine, surgery, and psychiatry programs at one institution in the United States. Interview transcripts were coded and analyzed inductively for themes.ResultsParticipants’ descriptions of the purpose of their recently completed final year of medical school contained three primary themes: residency-related purposes, interest- or need-based purposes, and transitional purposes. Participants commented on the most valued aspects of the final year. Themes included opportunities to: prepare for residency; assume a higher level of responsibility in patient care; pursue experiences of interest that added breadth of knowledge, skills and perspective; develop and/or clarify career plans; and enjoy a period of respite. Suggestions for improvement included enhancing the learning value of clinical electives, augmenting specific curricular content, and making the final year more purposeful and better aligned with career goals.ConclusionsThe final year of medical school is a critical part of medical education for most learners, but careful attention is needed to ensure that the year is developmentally robust. Medical educators can facilitate this by creating structures to help students define personal and professional goals, identify opportunities to work toward these goals, and monitor progress so that the value of the final year is optimized and not exclusively focused on residency preparation.
Highlights
Medical schools and residency programs in the United States and abroad are redesigning medical education toward a competency-based, developmental continuum.[1,2,3] This shift may allow movement away from a time-based model of education toward an outcomes-based model in which students would have the option to complete training early or pursue elective training after demonstrating competence in required areas.[4]
Several residents supported defined competencies and milestones for the final year; enhanced mentoring or advising and other strategies to help students develop a curricular plan organized around individual learning goals; and opportunities for synthesis, reflection, and consolidation of knowledge and skills to facilitate the transition to internship
While debates about the purpose, value, and optimal design of the fourth, or final, year of medical school will likely continue in the current era of competency-based education, our study suggests that a developmentally robust final year is a critical part of medical education for many learners
Summary
Medical schools and residency programs in the United States and abroad are redesigning medical education toward a competency-based, developmental continuum.[1,2,3] This shift may allow movement away from a time-based model of education toward an outcomes-based model in which students would have the option to complete training early or pursue elective training after demonstrating competence in required areas.[4].
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