The transition from Undergraduate Medical Education (UME) to Graduate Medical Education (GME) is a key phase in the development of every aspiring physician. This transition is filled with challenges and opportunities, as learners go from the classroom to residency. These transitional challenges are not exclusive to students, as they also extend to educators and program heads.
At the MedHub 2025 Virtual Medical Education Summit, twin sessions focused on the UME-GME transition. The first session was led by Dr. Jeanne Farnan, MD, MHPE, Associate Dean for Undergraduate Medical Education at the University of Chicago, and Dr. Yoon Soo Park, head of the Department of Medical Education at the University of Illinois Chicago College of Medicine. In a follow-up session, Dr. Farnan moderated a panel featuring Colonel Ashley Maranich, MD, MHPE, FAAP, FIDSA, Dr. Jonathan Amiel, Samantha Cascone, MPA, and Dr. Patricia Sexton, MS, DHEd, FNAOME.
Competing Priorities Between UME and GME
The shift from UME to GME involves not only the students themselves but also the transfer of their performance data, competencies, and readiness as they progress from learners in UME to practicing physicians in GME. This transition is complex and often plagued by incomplete, inconsistent, and delayed communications between medical schools and residency programs.
A significant barrier in the UME-GME transition is the lack of standardized communication. Dr. Farnan says a lack of a standard language can hinder the progression of students from medical school to residency, making it harder for them to adjust to their new roles.
“There is really no common language and framework currently in use between UME and GME…every medical school speaks a different language. Every medical school really has its own set of competencies, and we certainly don’t speak the same language as GME,” she said.
In addition to communication issues, tensions also exist due to the competing priorities of medical schools, residency programs, and students. Dr. Farnan noted, “Medical schools want to get their students graduated and matched into programs that they desire, and they will need to communicate in a way that achieves those goals. GME wants safe and effective physicians who are going to flourish in their residency program. Sometimes those goals are not necessarily aligned.”
Despite the presence of task forces and best practices, panelists say there is significant pressure in the field to meet accreditor requirements, such as reporting match rates. This pressure can lead schools to focus on showcasing students in the most favorable way, which may sometimes compromise transparency. Dr. Sexton advocated for a “buyer beware” approach to MSPEs (Medical Student Performance Evaluations) and for evaluators to be brutally honest about student strengths and weaknesses.
“The best case would be that programs really know what they’re getting so they know how to prepare to help those people thrive,” she said.
Recent reforms, such as the Coalition for Physician Accountability and the UGRC (Undergraduate to Graduate Medical Education Research Consortium), have recommended greater equity and standardization in the application process. The AAMC’s foundational competencies aim to bridge the gap, but adoption has been slow due to challenges in measurement and specificity.
Dr. Farnan discussed the shift toward Competency-Based Medical Education (CBME), noting its resource intensity and the reality that “not every medical school is doing it correctly.” The lack of uniformity in grading and performance descriptions further complicates holistic review by residency programs.
Data, Feedback, and Professionalism
Meaningful feedback and feed-forward mechanisms emerged as crucial for enhancing student development and performance. Dr. Farnan stressed the need for transparency in sharing developmental assessment benchmarks, exam performance, and professionalism lapses, which are often the strongest predictors of future performance:
“Professionalism lapses are certainly things where we see these things continue to persist in residency training…medical knowledge is easy to remediate, professionalism is not,” she said.
Dr. Farnan also critiqued the 2022 change of USMLE Step 1 to pass/fail, calling it “the worst decision in modern medical education post Flexner,” and says the residency cycle has turned into a “shadow economy” where students focus on extracurriculars to distinguish themselves, sometimes at the expense of medical knowledge.
“Medical students are certainly now so concerned about their ability to match into specialty that instead of engaging in curricula across the country, they are busy in their pre-clerkship time frame engaging in all of these other activities to distinguish themselves for residency training programs…they aren’t investing in their medical knowledge and are using third party resources to just pass Step,” she said.
Throughout both sessions, speakers emphasized the need for ongoing dialogue, data-driven decision-making, and flexibility in medical education. Dr. Park spoke about research done with Medical School Outcomes Milestone Study Group, a group of seven medical schools working on consortium-level studies to better understand the UME-GME transition, using ACGME milestones as outcomes and feedback.
“Because we’re able to make the connection between UME to GME…we can now use this information as feedback from medical schools. So, there’s now this feed forward signal on clinical skills, and then there is also the feedback signal. And with this cycle, we are able to now continue with our dialogue in terms of enhancing the UME to GME transition,” he said.
The Fourth Year Debate
The UME community frequently debates the necessity of the fourth year versus a potential three-year consolidation. Dr. Sexton argued that shortening the curriculum risks losing critical interpersonal and professional identity formation.
“[Readiness] may not even happen in four years. So now to conceive that for all the medical students across the nation, it could happen in three years. Something has to give, and it’s probably going to be some of those interpersonal skills, some of the nuanced and the identity formation,” she said.
Dr. Amiel agreed, describing the fourth year as “peak motivation time for students to really think about forming relationships, about identifying some of their gaps…to consolidate that professional identity in preparation to be an intern.”
Much like the training provided in civilian medical education, the military also imposes specific requirements to ensure its medical students are thoroughly prepared, particularly during their fourth year. As Colonel Ashley Maranich explained, “We have pretty strict requirements for our students to…continue to have a robust clinical experience…all the way up until graduation. We know that our learners, after they graduate from whatever residency they may do, may be asked to go out into situations where they’re providing general medical care for troops. Whether they did a three-year pediatric residency, a pathology residency, anesthesia, whatever it may be, we know that we still need to develop those…base medical physician skills for them.”
Solving the Residency Application “Industrial Complex”
In 2025, the Match reached record highs, with 52,498 applicants vying for 43,237 positions. This surge in prospective residents has made the application process increasingly stressful for both students and program directors. Panelists say that because the process is often fueled by fear and uncertainty, students over-apply and program directors are left to grapple with overwhelming amounts of data. Dr. Amiel emphasized the need for programs to be more transparent about their selection criteria and encouraged students to prioritize finding a good fit over chasing prestige.
“If we as a profession can actually focus a little bit more…on fit and a good enough match, and then use all of the extra unknowns that we have to make sure that we’re filling all of our training spots so we can train the doctors that we desperately need, I think we’d be in a much better situation,” he said.
In the 2025 Match, nearly 6% of residency positions went unfilled. Panelists described the application cycle as a “residency application industrial complex,” with Dr. Amiel noting that “learners are spending too much money and time on it. Program directors are spending too much time and money on it. And at the end of the day, we have programs that are going unfilled.”
Dr. Cascone added, “If that dream candidate is interviewing at 40 locations, we have a problem, right? Because that candidate, if they don’t get something in their top three, the system has failed. The whole system has failed.”
Innovations and the Path Forward
Despite the troubles, the future of medical education is bright. Dr. Amiel discussed the excitement around the potential of using artificial intelligence, especially large language models, to personalize learning and assessment.
“The era of large language models and precision assessments is incredible. They’re not there yet, but instead of using assessments to measure everyone the same way and ensure they all meet the same standard, we should flip the script and use assessments to identify each individual’s gaps so they can focus their own learning,” he said.
Dr. Amiel says this personalization would be a significant shift toward individualized, growth-oriented feedback, and would allow educators to tailor their guidance to each student’s unique strengths and areas for improvement.
“Historically, we couldn’t even imagine doing that because it was too human-intensive. But now, if we’re smart about it, precision assessments can actually help each of us identify what parts of medical knowledge we need to improve and where our communication skills need tweaking,” he explained.
Institutions are experimenting with individualized learning plans, flexible scheduling, and specialty-specific boot camps. This process helps ensure that new interns are not only clinically competent but also prepared for the realities of patient care and teamwork. Dr. Amiel notes that the hope is that, as these technologies mature, they will help uncover blind spots, guide remediation, and support the development of both clinical and professional skills.
“If we as an education culture can prepare ourselves for that, where we truly value this kind of feedback and dedicate time to addressing these gaps, we’ll be in a much better position by the end of our training programs,” he said.
Colonel Maranich agreed, and says that actively involving learners in the planning process empowers them to take ownership of their education.
“We are having our learners sit down and decide, ‘Hey, this is what I had planned for my electives, and do I now need to change this?’ So this idea of building an individualized learning plan… and we are then encouraging them to come back with one or two rotations left with the idea that we would love for you to then give this to your program director.”
Ultimately, the path forward calls for a culture of trust, transparency, and collaboration. By leveraging new technologies, embracing flexibility, and prioritizing the holistic development of future physicians, the medical education community is poised to create a more effective, equitable, and learner-centered continuum from undergraduate to graduate medical education.