Not yet ready for internship: national study exploring readiness for postgraduate training in multiple specialties by types of medical school

Purpose Medical schools are expected to prepare graduates for postgraduate year (PGY) 1. In the Accreditation Council for Graduate Medical Education Milestones 2.0 Assessment System, residents may be rated as not yet completed level 1, indicating a lack of preparedness. This study explores the prevalence of not yet completed level 1 among US MD-granting school graduates, US DO-granting school graduates, and Caribbean and other international medical graduates (IMGs). Method This retrospective study compares PGY-1 competency assessments for graduates from different types of medical schools in internal medicine (IM), family medicine (FM), surgery, and pediatrics who graduated in 2021 and 2022. Results The study included 47,310 PGY-1 students (10,402 FM, 5,866 surgery, 24,438 IM, and 6,604 pediatrics). At midyear in FM, there were significantly more other (312 [25%]) and Caribbean (449 [27%]) IMGs compared with US MD graduates (693 [18%]) rated as not yet completed level 1 (P < .001). In surgery and pediatrics, 1,444 (25%) and 1,264 (19%) of midyear PGY-1s, respectively, were rated not yet completed level 1 without significant differences by school type. In IM, Caribbean IMGs (198 [9%]) and other IMGs (660 [10%]) were less frequently rated as not yet completed level 1 than US MD graduates (1,608 [14%]) (P < .001). For FM at midyear, other IMGs were more likely to have not yet completed level 1 (odds ratio, 2.10; 95% CI, 1.51-2.92) compared with US MD graduates. However, these differences at midyear were attenuated by the end of PGY-1 (odds ratio, 1.05; 95% CI, 0.28-867). Conclusions At 6 months into internship, the fields of FM, IM, surgery, and pediatrics had significant numbers of PGY-1 residents rated as having deficiencies in at least one competency domain. These residents may require additional support during residency transition to ensure preparation for the expected milestone performance.