What new residents do during their initial months of training

Studies completed over the past decade suggest the presence of a gap between what students learn during medical school and their clinical responsibilities as first-year residents. The purpose of this survey was to verify on a large scale the responsibilities of residents during their initial months of training. Practice analysis surveys were mailed in September 2009 to 1,104 residency programs for distribution to an estimated 8,793 first-year residents. Surveys were returned by 3,003 residents from 672 programs; 2,523 surveys met inclusion criteria and were analyzed. New residents performed a wide range of activities, from routine but important communications (obtain informed consent) to complex procedures (thoracentesis), often without the attending physician present or otherwise involved. Medical school curricula and the content of competence assessments prior to residency should consider more thorough coverage of the complex knowledge and skills required early in residency.