"Step-Up" to Internal Medicine: An Experiential Curriculum to Assist with the Transition of Becoming a Senior Resident.

Background: The transition from a postgraduate year (PGY)-1 resident to a PGY-2 resident is often stressful for trainees. Despite various preparatory efforts, the lack of hands-on experiences remains a challenge. In response, we developed the "Step-Up" curriculum, allowing PGY-1 residents to assume the senior resident role in a supervised environment. Methods: During the final blocks of the 2021-2023 academic years, categorical PGY-1 residents divided into eligible and ineligible groups for the "Step-Up" curriculum. Preliminary, off-service and transition-year residents were excluded from the study. Eligible participants were those who rotated on inpatient or specialty wards and received a rubric outlining senior residents' best practices to encourage self-reflection and feedback from supervising attendings and senior residents. The ineligible group were residents that rotated on critical care or outpatient rotations and served as the control group. Pre- and postcurriculum surveys, with 19 Likert-scale questions (rated 1 [strongly disagree] to 5 [strongly agree]), were administered. Two-sample Wilcoxon rank-sum tests compared ordinal measures between the intervention and control groups. Results: Of 76 residents, 49 (64.5%) were in the intervention group and 27 (35.5%) were in the control group. No significant differences in survey responses were noted before the curriculum. Following it, participants displayed increased confidence in various competencies compared to nonparticipants. "Step-Up" participants also felt significantly more confident transitioning to the senior resident role. Of the 42 completing the curriculum, 39 (93%) agreed that the curriculum facilitated their transition. Conclusions: Our study highlights the effectiveness of a hands-on curriculum where PGY-1 residents assume the senior resident role, offering a satisfying experience and enhancing comfort with the role and specific competencies. This novel approach addresses challenges in the PGY-1 to PGY-2 transition, providing valuable insights for medical education programs.