Supporting the Transition to Pediatric Residency: A Transitional Elective Block for International Medical Graduates

Background International Medical Graduates (IMGs) entering U.S. residency programs often encounter challenges during the transition to internship, including unfamiliarity with the U.S. healthcare system, clinical workflows, electronic medical records (EMRs), and expectations within graduate medical education. Despite these challenges, structured onboarding interventions designed to support IMG transition remain limited. Objective To describe the implementation of a Transitional Elective Block (TEB) designed to support IMG pediatric interns during the transition to residency and to evaluate its early educational outcomes using quantitative self-reported measures and qualitative participant feedback. Methods A four-week transitional elective block was implemented for incoming IMG pediatric interns during the summers of 2024 and 2025 at a university-affiliated pediatric residency program. The curriculum emphasized supervised clinical exposure, mentorship, patient presentations, handoff communication, electronic medical record (EMR) navigation, and clinical workflow acclimation. Program evaluation used a mixed-methods approach, including baseline and follow-up surveys assessing self-reported confidence using five-point Likert scales and open-ended responses. Quantitative analyses were exploratory and performed using nonparametric statistical methods, while qualitative responses were analyzed using rapid content analysis. Results At baseline, TEB participants reported lower self-reported confidence across multiple domains than non-participants. By three months of internship, participants demonstrated greater relative improvements in confidence, partially narrowing baseline differences. All TEB participants reported that they would recommend beginning residency with the elective. At follow-up, participants reported higher self-rated clinical skill and comfort across several domains, whereas EMR use and system navigation remained common challenges across the intern cohort. Qualitative responses highlighted improved confidence, a clearer understanding of residency expectations, and the value of structured mentorship and early clinical exposure. Given the pilot study design and small sample size, quantitative findings should be interpreted as exploratory and hypothesis-generating. Conclusions The Transitional Elective Block was feasible to implement using existing residency resources and was well accepted by participants. These preliminary findings suggest that a structured transitional elective may enhance perceived preparedness for the transition to residency among international medical graduates. Larger multicenter studies incorporating objective measures of clinical performance are needed to evaluate the effectiveness and generalizability of this educational model.