Number
121
Name
From Intern to Senior: A Qualitative Study Examining the Transition, Key Characteristics, and Professional Fulfillment in Internal Medicine Residents
Date & Time
Sunday, June 7, 2026, 5:30 PM - 7:00 PM
Location Name
Oglethorpe Ballroom
Speakers
Authors
Saloni Sachar, Cleveland Clinic Foundation
Tess Calcagno, Cleveland Clinic Foundation
Sakthi Surya Prakash, Cleveland Clinic Foundation
Jordan Alpert, Cleveland Clinic Foundation
Vicente Velez, Cleveland Clinic Foundation
Presentation Topic(s)
Assessment
Description
PURPOSE
Internal medicine senior residents (PGY2–3) supervise care, coach interns
and students, and coordinate consultants, yet the transition from intern to
senior is poorly defined. We examined residents’ understanding of the senior
role, perceived characteristics of effective seniors, and experiences of the
transition to inform a resident-centered leadership curriculum.
METHODS
We conducted a qualitative study using six 60-minute PGY-stratified focus
groups (two per PGY level) at a large academic internal medicine residency.
Sessions were recorded, transcribed, and coded using a consensus codebook
developed by three investigators, with discrepancies resolved until thematic
saturation was reached.
RESULTS
Twenty-seven residents participated. Seniors were described as
“mini-attendings” responsible for the big-picture hospital
course—communication with consultants, order oversight, disposition planning,
and sign-out—while protecting intern ownership of daily tasks. The transition
to senior was perceived as abrupt, largely learned “by osmosis,” with
persistent uncertainty about expectations, including who calls consultants
and how to balance autonomy with supervision. Effective seniors were calm,
organized, and explicit about priorities; they allowed autonomy for routine
decisions, remained readily available, and stepped in during high workload
periods. Interrupting intern presentations in front of attendings was viewed
as harmful to confidence, whereas running the list together, sharing
real-time feedback, and visibly advocating for interns fostered psychological
safety. Residents reported that they mainly learned senior skills by
observing role models manage complex tasks such as coordinating case
management, managing medically complex patients, and troubleshooting
overnight issues.
CONCLUSIONS
Residents experience senioring as a pivotal but under-supported transition,
with key leadership and communication skills acquired almost entirely
informally. Findings support the need for a structured curriculum that
clarifies expectations for interns and seniors, teaches communication and
feedback skills, and creates graduated opportunities to “practice being the
senior” before PGY2 to improve preparedness, confidence, and team culture.
Internal medicine senior residents (PGY2–3) supervise care, coach interns
and students, and coordinate consultants, yet the transition from intern to
senior is poorly defined. We examined residents’ understanding of the senior
role, perceived characteristics of effective seniors, and experiences of the
transition to inform a resident-centered leadership curriculum.
METHODS
We conducted a qualitative study using six 60-minute PGY-stratified focus
groups (two per PGY level) at a large academic internal medicine residency.
Sessions were recorded, transcribed, and coded using a consensus codebook
developed by three investigators, with discrepancies resolved until thematic
saturation was reached.
RESULTS
Twenty-seven residents participated. Seniors were described as
“mini-attendings” responsible for the big-picture hospital
course—communication with consultants, order oversight, disposition planning,
and sign-out—while protecting intern ownership of daily tasks. The transition
to senior was perceived as abrupt, largely learned “by osmosis,” with
persistent uncertainty about expectations, including who calls consultants
and how to balance autonomy with supervision. Effective seniors were calm,
organized, and explicit about priorities; they allowed autonomy for routine
decisions, remained readily available, and stepped in during high workload
periods. Interrupting intern presentations in front of attendings was viewed
as harmful to confidence, whereas running the list together, sharing
real-time feedback, and visibly advocating for interns fostered psychological
safety. Residents reported that they mainly learned senior skills by
observing role models manage complex tasks such as coordinating case
management, managing medically complex patients, and troubleshooting
overnight issues.
CONCLUSIONS
Residents experience senioring as a pivotal but under-supported transition,
with key leadership and communication skills acquired almost entirely
informally. Findings support the need for a structured curriculum that
clarifies expectations for interns and seniors, teaches communication and
feedback skills, and creates graduated opportunities to “practice being the
senior” before PGY2 to improve preparedness, confidence, and team culture.