The first year of medical residency (MR) is a major turning point in physicians’ careers. Evidence shows that the transition to clinical training places substantial professional and personal demands on new residents.

According to the article “Residents with Problems: Everyday and Non-Everyday,” published in Seminars of the Spanish Foundation of Rheumatology, the adjustment period can be particularly intense during the first year.

“The impact on residents entering their four-year training period is enormous. It is especially during the first year that their progress must be closely monitored; in other words, this is the time when tutors should communicate with other tutors and regularly hold tutorials with the new residents,” the authors wrote.

During this stage, residents face challenges such as sleep deprivation, overnight calls, inconsistent supervision, and heavy clinical workloads. These factors can affect both the mental health of residents and patient safety, making them an important focus for evaluation and improvement within MR training systems.

Challenges Before MR

Not all difficulties arise in the clinical environment. Some issues are related to how residents approach this stage of their careers.

Professional online discussions, including those on forums such as Reddit, frequently highlight common recommendations for incoming residents. These include recognizing personal strengths and limitations, finding a trusted mentor, seeking mental health support through services offered by medical associations, and understanding that medical education continues throughout a physician’s career, even after university training ends.

In an interview with Univadis Spain, a part of the Medscape Professional Network, David Montes Cánovas, the vice president of the Spanish Medical Residency Association, discussed the most common mistakes made during the first year of MR.

According to Montes, one of the classic mistakes that occurs even before an MR exam begins is choosing a specialty or hospital without sufficient information.

“Before choosing a specialty and the hospital where we will train, it is essential to gather adequate information. Many times, we allow ourselves to be guided by exam scores or the city itself, but we overlook many aspects that decide what daily life as a resident will be like,” he said.

Montes recommends asking about the actual training program, whether rotations are respected, whether mandatory external rotations exist, whether courses are scheduled within working hours, whether protected educational time is provided, and how tutor supervision is structured.

Work Hours and Clinical Errors

Another critical factor involves on-call shifts and workload. Residents should understand how many shifts they expect to work each month, whether rest days after shifts are respected, and how on-call responsibilities are distributed.

The work schedule is closely linked to medical errors.

A 2022 study published in the BMJ Quality & Safety found that improvements in work-hour policies were associated with a 32% reduction in the risk for significant medical errors reported by residents. The same study reported a 34% reduction in the risk for preventable adverse events and a 63% reduction in the risk for medical errors that contributed to patient death.

Montes also emphasized that residents often underestimate another key factor: the internal culture of the clinical department.

“Residents should pay attention to the working environment within the service and the role they play within the team,” he said. “This can make a major difference in daily experience.”

Errors During Training

Once MR begins, new physicians meet added challenges. Common early mistakes include medication errors, diagnostic errors, communication problems with patients, time management difficulties, excessive or insufficient confidence, and errors in performing clinical techniques. These issues are often part of the learning process.

Survey data from the Spanish Society of Primary Care Physicians illustrated the widespread nature of such experiences among trainees. In the survey, 100% of the residents believed that all physicians made mistakes when caring for patients.

Among the respondents, 88.9% reported having made at least one clinical error during their professional practice. In addition, 62.9% acknowledged making an error within the previous 2 months. Nearly all respondents (96.3%) believed it was possible to make mistakes without realizing it, and 70.3% believed that physicians often underestimated the number of errors they made.

A 2024 analysis published in Archivos de Prevención de Riesgos Laborales noted that clinical errors remain a significant concern for residents and require action at multiple levels.

Recommended measures include improved training in patient safety and error management, as well as structured peer support systems and specialized support programs for healthcare professionals. Occupational health services may also play a significant role in these efforts.

Many first-year errors during residency reflect structural factors rather than individual shortcomings. Preventing them requires better preparation by residents and stronger support from the healthcare systems responsible for their training.

This article was translated from El Médico Interactivo on Univadis, part of the Medscape Professional Network.