While it’s impossible to learn everything in medical school, mastering certain skills before starting residency is key — and even expected by residency program directors.
Fortunately, medical schools are more intentional about teaching clinical skills, said Jennifer Kogan, MD, senior associate dean, undergraduate medical education at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia.
“Medical education has really changed in terms of what we teach medical students now, compared to what we taught 35 years ago,” she said. “I think we are more deliberate around teaching clinical skills explicitly as opposed to just like, ‘You’ll go into the hospital, and you’ll see it done, and you’ll learn it through osmosis.’”
Mastering certain skills during medical school does make the transition to residency easier, said Elizabeth Benge, MD, a faculty member in sleep medicine at Harvard Medical School, Boston. “I’m grateful I focused on mastering clinical reasoning and diagnostic skills early on,” said Benge. “These are universal competencies that apply across all specialties.”
Topping the List: Taking a Patient History
The first item on the Association of American Medical Colleges (AAMC) list of 13 Core EPAs (Core Entrustable Professional Activities) for Entering Residency is gathering a personal history and performing a physical examination.
Perhaps it’s no surprise that learning how to take a patient history is one of the most important skills many physicians say they learned in medical school.
Taking a patient history is more than just asking a list of questions. It includes listening to patients and using that crucial information to help in formulating a differential diagnosis after a clinical encounter, which is second on the AAMC’s list of core EPAs.
In fact, learning how to listen was the most important skill that Sammie LaMont Moss, MD, learned in medical school at the University of Colorado, Denver, Colorado.
“What I mean by listening to your patient is actually looking at them, paying attention to the nonverbal communication that they are presenting,” said Moss, who graduated from medical school in 2012 and now practices psychiatry at Kaiser Permanente in Colorado. “Body language conveys a lot to you as a provider beyond what the patient is saying verbally. Essentially, verbal and nonverbal cues are necessary to understand and properly treat the whole patient.”
Jill Schenk, MD, CPE, practiced rural family medicine with obstetrics for 20 years after graduating from medical school in 2001. Learning how to listen and letting the answers guide the rest of the patient encounter were also essential skills she learned during medical school — and ones she would encourage today’s medical students to master, too.
“Don’t stop asking questions until you’re nearly certain of the diagnosis,” said Schenk, now an assistant professor in the Department of Family Medicine at Marshall University’s Joan C. Edwards School of Medicine in Huntington, West Virginia. “Patients will tell you what’s wrong with them if you ask enough questions.”
In addition to getting comfortable with history taking, physical exams, and common medical procedures, Benge suggested medical students focus on mastering some time management skills. “Residency is intense, so learning to prioritize tasks and maintain personal well-being is vital,” she said.
Learning basic skills like using a stethoscope and doing a physical exam helped Susan Besser, MD, when she was a medical student in the late 1970s and early 1980s in Jackson, Mississippi. But she wishes she’d learned more about nutrition, a topic that she regularly addresses as a family medicine physician with Mercy Personal Physicians at Overlea in Baltimore.
“That’s a good skill set to have, especially in this day and age, when obesity is such an epidemic,” she said. “We all need to learn to advise our patients on what to eat and how to eat.”
However, while every medical student can benefit from mastering basic clinical skills prior to residency, some skills may be more useful if they plan to pursue a specific residency.
For example, students interested in a residency in pathology could benefit from familiarizing themselves with using microscopes to view tissue samples, rather than relying solely on digital images, said Donald Karcher, MD, FACP, professor and immediate past chair of Pathology at George Washington University and the current president of the College of American Pathologists, Washington, DC.
Refining Skills During Residency
Kogan also recommends that students ask someone to observe them during a task and provide feedback. It can be uncomfortable, but it’s an excellent learning opportunity to have someone say, “This part, you’re doing right, but you may have better outcomes if you try this differently next time,” she said.
However, even skills that are “mastered” in medical school can be improved upon during residency, many physicians agree.
“In residency, I realized I needed to refine my efficiency in connecting with patients quickly,” said Elisha Peterson, MD, MEd, who graduated from Rush Medical School in Chicago in 2010 and then pursued a residency in anesthesia, followed by two fellowships. “While medical school taught me to build rapport, residency required me to do this within a shorter timeframe due to the fast-paced environment.”
“I wish I had dedicated more time to procedural skills, especially those specific to internal medicine, like central line placement or lumbar punctures,” said Benge. “While those are often taught during residency, having early exposure and confidence can reduce the learning curve.”
But medical students shouldn’t fret if they didn’t learn a specific skill or if they change their minds about their residency plans. Karcher completed a year of an internal medicine residency before changing to pathology, and he’s never regretted the experience.
“They can always catch up on the technical skills,” he said.
Kogan agreed. “I don’t think there’s something that happens between the first and third year of medical schools that if you didn’t do it, that door is closed to you,” she said.
Plus, residency provides numerous opportunities to practice skills.
Schenk remembers being uncomfortable as a first-year resident and wishing she’d learned more about admitting patients to labor and delivery when she was a medical student. “Happily, by the time I graduated residency, I had plenty of practice,” she said.
OB/GYN Keemi Ereme, MD, MPH, who graduated from Howard University College of Medicine in Washington, DC, in 2019, also remembers feeling a bit overwhelmed when she began her intern year, despite all of her hard work in medical school. Fortunately, residency provided many opportunities to master skills like cervical exams and managing labor — and she hopes to reassure future residents that they will master the necessary skills during residency, too.
“Learning how to practice respect and empathy will take you far in whatever specialty you decide,” she said.