Timing, Salary, and Content Delivered During Internal Medicine Residency Program Intern Orientation: Results from a National Survey

BACKGROUND: In internal medicine (IM) residency, the transitional period between when new interns arrive and when clinical rotations begin is typically considered "intern orientation." The duration of intern orientation varies widely between institutions; descriptions of content and administration are lacking. OBJECTIVE: To describe characteristics of IM intern orientation, including orientation duration, whether salary is provided, and content delivered. DESIGN: Nationally representative, cross-sectional, web-based survey of IM residency program directors (PDs) with membership in an academic professional association. PARTICIPANTS: A total of 263 IM residency PDs from study-eligible programs (55.3%) responded between August and December 2024. MAIN MEASURES: Characteristics of intern orientation, including duration of orientation in days, percentage of programs providing salary support to interns during orientation, which orientation topics were included, and which topics PDs thought, should be included. Multivariate median regression analysis was performed to identify characteristics associated with intern orientation duration. KEY RESULTS: Response rate was 55.3% of PDs from eligible programs (263/476). University-based, longer-established programs were slightly over-represented compared to the complete population (p < 0.05). Orientation duration ranged from 2 to 29 days (median 7; interquartile range 5). Most PDs (77.0%) perceived their orientation duration as "just right." Most programs (216/263; 82.1%) provided full salary during orientation, whereas the remainder offered partial or no salary. A multivariate (median regression) analysis revealed that community-based programs, larger number of core faculty, inclusion of more clinical topics, and full salary provision were associated with an increase in orientation days (p < 0.01 or p < 0.05 for those covariates). PDs reported that more clinical topics and community experiences should be administered than currently included in orientation content. CONCLUSIONS: IM intern orientation duration varies substantially, and nearly one-fifth of residency programs did not offer full salary during orientation. Opportunities remain to ensure robust, paid, and clinically relevant orientations in supporting the transition from medical school to internship.