Rethinking Competencies: Building a Seamless Bridge from Medical School to Residency
A new intern walks into the hospital on July 1st. Within hours, they’re told. “Forget what you’ve learned in medical school. Residency is a whole new game. “
It's a familiar refrain, but should it be?
Just as we need to break silos between medical schools and health centers, we also need to rethink the ways competencies are introduced, measured, and trusted across undergraduate medical education (UME) and graduate medical education (GME). The transition from student to physician-in-training should not feel like a reset. It should be a continuation of a journey.
The Gap Between UME and GME
Competencies such as communication, teamwork, and clinical reasoning, are introduced early in UME, but they’re often assessed differently or inconsistently compared to GME. As a result, learners face repeated evaluation on skills they’ve already demonstrated. Instead of moving forward, they’re asked to prove themselves again, creating frustration and inefficiency.
Shared Frameworks Are Emerging
The good news is that bridges are already being built. Entrustable Professional Activities (EPAs) were designed as a framework to guide expectations across the UME-GME continuum. Some schools and residency programs are experimenting with aligned millstones, shared assessment tools, and competency-based portfolias that follow learners into residency.
These early models show what’s possible when UME and GME co-own competencies.
Why Alignment Matters
For learners: Clear expectations and less anxiety during transitions.
For educators: Reduced duplication and richer longitudinal data.
For patients: Safer care, delivered by interns who are trusted and ready from day one.
When competencies are aligned, the handoff from student to resident becomes more seamless, more supportive, and more effective.
What Needs to Happen Next
To truly close the gap we need
Partnerships between UME and GME leaders to co-design competency frameworks.
National alignment across LCME, ACGME, and AAMC to incentivize continuity.
A cultural shift toward viewing medical education as a continuous journey, rather than two separate silos.
The Takeaway
Imagine our new intern again. Instead of being told to start from scratch, they arrive with a portfolio of competencies already trusted and recognized. Their residency doesn’t erase medical school, it builds upon it.
If we want to break silos in medical education, rethinking competencies is the next step. Competencies must become the shared language that unites UME and GME, for the benefit of our learners, and ultimately, for our patients.
Great suggestions for a transition that is notoriously bumpy in medical training!