The Undergraduate to Graduate Medical Education Transition as a Systems Problem: A Root Cause Analysis

Abstract

The transition from undergraduate medical education (UME) to graduate medical education (GME) constitutes a complex system with important implications for learner progression and patient safety. The transition is currently dysfunctional, requiring students and residency programs to spend significant time, money, and energy on the process. Applications and interviews continue to increase despite stable match rates. Although many in the medical community acknowledge the problems with the UME-GME transition and learners have called for prompt Please see the end of this article for information about the authors.

Exploring Competency-Based Medical Education Through the Lens of the UME–GME Transition: A Qualitative Study

“…A variety of forces have spawned significant increases in the cost, time, and angst for both students and programs during this process. 10 The data provided in this process include the Medical School Performance Evaluation (MSPE), United States Medical Licensing Examination scores, letters of recommendation, departmental letters, and student personal statements. If a school uses grades or class rank, these data will be included as well.…”

“…This onerous, anxiety-ridden transition promotes the overemphasis of metrics such as exam scores and grades, even as medical educators wish to commit themselves to a CBME process that values metrics that better align with patient needs and improved outcomes. 10,12 In 2018, the escalation of tensions wrought by the residency selection process compelled the Coalition for Physician Accountability (CoPA) to form the Undergraduate Medical Education-Graduate Medical Education Review Committee (UGRC), which was charged with crafting recommendations to improve the system for the UME-GME transition. 13 Their recommendations, released in 2021, are aimed at guiding modifications to the transition process in a positive direction.…”

Easing the Transition From Undergraduate to Graduate Medical Education

“…Other recommendations offered by our colleagues are related to developing a common competency framework with aligned assessments, introducing workforce diversity evaluations and equitable recruitment practices, and increasing attention to data-driven studies to improve the UME–GME transition. The authors of several articles 1–4 in this cluster emphasize the need for greater transparency at institutional and national levels and the need for pilot studies of novel programs that could improve matching with preferred programs and, at the same time, produce a more even distribution of physicians and a strengthened medical workforce in the United States.…”

“…In this issue of our journal, we have several articles 1–5 on the transition from undergraduate medical education (UME) to graduate medical education (GME). These articles have been written by and for stakeholders in health professions education, including learners, teachers, and leaders in academic medicine and health systems.…”

“…Challenges to attaining this ideal state in the undergraduate-to-graduate transition, noted by Swails et al 2 (also of CoPA) in their root cause analysis, include bias, limited resources and cost, a competitive culture, poorly functioning systems, a lack of adequate standards, and lack of sufficient alignment across systems and stakeholders, all of which generate an “ineffective” transition.…”