Development of a systems-based framework for transition from a one- to two-year medical internship program

Background: The transition from a one-year to a two-year medical internship program represents a significant shift in medical education, aiming to improve training quality and clinical readiness. While these reforms are increasingly adopted, they face challenges that must be addressed to support successful implementation. This study examines faculty perspectives on the transition process, focusing on key challenges and opportunities associated with extended internship programs. Methods: We conducted a cross-sectional, survey based study from October 2022 to October 2023, using both quantitative and qualitative methods. A total of 319 faculty members from 17 medical schools participated, providing insights into critical aspects of the transition. Results: The study revealed several challenges: 68% of faculty reported infrastructure inadequacies for a two-year program, with public colleges and training hospitals highlighting limited physical and technological resources. Furthermore, 73% of respondents identified a need for qualified supervisors and emphasized upskilling existing faculty for effective mentorship. Concerns over training quality were also noted, with 65% rating the current one-year program as “fair” or “inadequate.” Ethical considerations were highlighted by 90% of respondents, who were uncertain about clear guidelines for intern well-being, while 98% indicated an absence of effective information systems to track intern progress. From these findings, we developed a systems-thinking framework across three levels macro (national policies and strategies), meso (institutional resources and quality assurance), and micro (program-specific supervision and curriculum). This framework addresses these challenges comprehensively, offering strategies for sustainable improvement. Discussion: The results indicate that transitioning to a two-year internship requires substantial resource investments, robust supervision structures, and ethical safeguards. The systems framework provides a multi-level approach that can guide similar reforms in diverse settings, focusing on quality improvement and coordinated efforts among stakeholders.