From student to resident: Tips for transitioning from virtual med school

Two years have passed since the initial outbreak of the COVID-19 virus. The month of March 2020 is still engrained into my memory, clear as if it were yesterday. Spring break started early that month, and many of my peers had ventured off into the world on what would be our last vacations before diving into board preparation and transitioning into clinical rotations.

In the span of that seven-day break, all semblance of normalcy was thrown out the window, and thus began the shelter-in-place mandate.

For the class of 2022, we were pulled from classrooms, hospitals and clinics, both for our protection and to reduce the spread of this constantly evolving virus. Medical students across the country faced a multitude of unknowns and had to face the challenges of learning material in a dispersed, remote, hands-off environment.

Now, two years later, as the world is slowly starting to re-emerge and restrictions are beginning to ease, we are left wondering: how will we transition into residency after having adjusted to 24 months in a virtual-hybrid environment?

This is a complex question, because every medical student about to graduate has had a different experience throughout the pandemic. Some students only had to spend a short period of their core clinical rotations online, while others had to learn medicine through Zoom and self-study.

There is no one-size-fits-all approach to the upcoming transition. Below are is some guidance I gathered from residents and attendings where I have auditioned over the past year. I hope it will help this year’s incoming interns prepare for residency.

Identify your clinical shortcomings

Chelsea Nickolson, DO, MBA, is the current associate program director for the Kettering Health Dayton internal medicine residency as well as an AOA Board Trustee and chair of the AOA Bureau of Emerging Leaders.

When asked about how the Class of 2022 should prepare for residency, she says, “faculty are aware that some clinical experiences may have been replaced with virtual learning during the pandemic and thus clinical aptitude may be affected in the incoming class of residents. I recommend to graduating students to reflect on their abilities and shortcomings. Be honest internally and share this with your teachers, which include faculty, attendings, nurses, staff, fellows and other residents, so they can better assist you and so that patient care is never compromised.”

Self-reflection is required to understand where your clinical baseline is set and there are multiple ways to accomplish this:

• Review evaluations from preceptors, focusing on feedback given about gaps in knowledge or areas for improvement.
• If you have a mentor or an advisor in your specialty who knows your ability, ask them to give you an honest appraisal of your performance as a student. Use that information to identify where you can improve.
• Residencies have expectations on what interns should be able to accomplish as they embark on their first year in residency. The Association of American Medical Colleges (AAMC) has identified 13 core EPAs that new residents should be able to perform. Take some time to review this resource prior to starting residency to learn what areas you feel confident in and which may need some more work.

Focus on in-person interactions

“Fully immerse yourself in direct patient care and embrace the transition from screens to human interactions,” Dr. Nickolson suggests. “Always remember to touch your patients, not only physically via exams and treatments, but also mentally through empathic listening and human connections.”

Let feedback fuel your fire

Feedback can come in many forms: appreciation and positive evaluations are the most palatable, but constructive feedback is where the money is.

Constructive feedback that comes from your attendings, program director or senior residents not only signifies that they are invested in your education, but also that they are challenging you to be the best version of yourself as you continue to develop your skills. By leaning into the feedback you are given, you are showing that you are coachable and that you are as invested in your residency as the residency is in you.

Pursue medical interests outside your specialty

Residency is an opportunity to hone your craft and begin building a base for your career as a physician. Now is the time to be thinking about ways to expand your CV, especially if your goal is to pursue a fellowship or a career in academia. Succeeding in your intern year is the priority, but having a game plan for how you see yourself being involved in the future will set you up for success in the long run.

Education, population health, administration and leadership, quality improvement, advocacy and research are all are areas of interest you can pursue in residency.

Set small but attainable goals for intern year

Many medical students fear they will be unprepared for the expectations and transition of responsibility in their intern year, and it is easy to become overwhelmed.

Matthew Stull, MD, residency director for University Hospitals Cleveland Medical Center’s emergency department, says, “Intern year’s learning curve is steep. Focusing on smaller, more attainable goals can make the progress feel more tangible. Plus, this gives you a chance to celebrate more frequently, which you deserve during intern year!”

Concentrating on the day-to-day tasks and committing to learn at least one new thing during each shift can create a lifelong habit that will serve you in your professional career.

Reading an article about a condition that you were directly involved in managing, speaking with attendings and consultants or doing topic-related practice questions afterwards are just a few ways to cement information into your clinical knowledge. This is also a great time to ask questions when patient cases do not fit the textbook description or workup algorithm, because practicing medicine is a lifelong commitment to learning.

Take some time to improve your financial literacy 

Selena Raines, DO, MPH, associate program director of family medicine and director of osteopathic education for the University of Kentucky Rural (Morehead) Family Medicine Residency Program, has some important advice for medical students.

“Many students have gone through schooling in a very traditional and sequential fashion and may not be familiar with retirement savings and insurance products,” she says. “Residents will hit the ground running, even from the first day of orientation. It is not uncommon for residents to be handed a stack of forms with respect to insurance and investment choices with very little assistance or background information, and  they are expected to have them completed in a very short amount of time.

“Making mistakes and/or uninformed decisions on these forms can cost you money, and there is often a waiting period before being allowed to make changes. Take some time to familiarize yourself with these topics so you can make the best choices for your individual situation. Also have a plan for what you are going to do with your student loans. Depending on what you chose to do, there are processes to follow and forms to be completed. 

“You don’t want to make any mistakes that could jeopardize your eligibility for forgiveness programs, and you do not want to miss any deadlines. The first few months of intern year can be very overwhelming, so having some of this base of knowledge and a plan in place for some of these important administrative tasks can help to alleviate a lot of stress.”

Enjoy some well-deserved free time

Some say that medical school is hard, but residency is harder. Take time to relax, travel with family and friends, read that book you’ve been eyeing on your bookshelf and practice self-care in the ways that are the most meaningful to you, so that when intern year starts, you are well-rested and ready to get to work.

Related reading:

Telemedicine education in the preclinical med school years is critically important, JOM researchers write

How to assess a residency program’s culture virtually