Senior year PGY3

What Defines PGY-3

You are the senior on the team. Interns and junior residents look to you. Your confidence — and your humility — set the tone for the entire service. How you model clinical thinking, how you treat nurses and staff, how you handle uncertainty in front of your team: all of it is being watched and absorbed.

You are preparing for independent practice. The safety net of residency is still there, but you’re moving toward the edge of it. Start making decisions as if you’re the attending. Ask yourself not just “what would I do” but “why” — and make sure you can defend it.

You are closing out your training program. ABIM board eligibility, fellowship graduation (if applicable), job searches, credentialing — the administrative side of becoming a practicing physician starts in full force this year. Stay organized.

Clinical Focus for PGY-3

Complex and undifferentiated patients. By senior year, you should be gravitating toward the most challenging cases — the ones that don’t fit a clean diagnosis, the ones that have stumped the team. These are where your diagnostic reasoning gets its final sharpening.

Systems thinking. Great attendings don’t just manage individual patients — they think about the unit, the team dynamics, patient flow, and quality improvement. Start developing that wider lens now.

Transitions of care. As a senior, you often oversee the discharge process for your team’s patients. The quality of those transitions — how clearly instructions are communicated, how well follow-up is arranged — directly impacts patient outcomes. Take it seriously.

Teaching rounds. Your morning rounds should be efficient and educational. Ask teaching questions, not just management questions. Explain your reasoning out loud. Build a team that thinks, not just one that executes.

Preparing for the ABIM Boards

The American Board of Internal Medicine (ABIM) certification exam is the milestone that marks the end of residency training. Most residents sit for it in the summer or fall after graduation.

Key resources:

MKSAP — The single most important resource for ABIM prep. If you’ve been working through it systematically since PGY-1, you’re in excellent shape. If not, now is the time to be strategic — prioritize your weakest areas first.

Amboss ABIM Qbank — Strong question bank with good explanations and analytics to identify weak spots.

UWorld Internal Medicine — Another solid qbank for board preparation.

BoardVitals — A useful supplementary question bank, especially in the final weeks of prep.

Strategy: Don’t try to learn everything from scratch. At this point, you’ve seen most of it clinically — your goal is to organize and consolidate what you already know. Do questions daily, review explanations carefully, and focus relentlessly on your weak areas.

Job Search & Fellowship — What to Know

If you’re going into fellowship: Applications were submitted in PGY-2, interviews happened in the winter, and by the time PGY-3 begins most fellowship spots are decided. Focus on finishing strong, honoring your current program, and preparing for the transition.

If you’re entering practice: The job search typically begins mid-PGY-2 through PGY-3. For hospital medicine specifically, the market is strong — but take your time to find the right fit. Consider: academic vs. community, shift structure, geographic location, teaching opportunities, and values alignment with the group you’d be joining.

Negotiate your contract. This is not optional and not rude — it is expected. Understand your base salary, shift expectations, RVU targets if applicable, malpractice coverage (occurrence vs. claims-made), tail coverage, PTO, CME allowance, and non-compete clauses. Have a healthcare attorney review any contract before you sign.

Credentialing takes longer than you think. Start your hospital credentialing process early — it can take 3 to 6 months and requires your medical license, DEA registration, board scores, training verification, and more. Don’t let paperwork delay your start date.

Essential Resources for PGY-3

MKSAP — Your primary board prep resource. Use it systematically and consistently.

Harrison’s Principles of Internal Medicine — For deep dives on complex topics you’ll encounter as a senior.

Journal of Hospital Medicine / Annals of Internal Medicine — Start reading primary literature regularly. Developing the habit now will serve you for the rest of your career.

The Curbsiders & Core IM — Keep going. These podcasts will remain relevant well into your attending years.

NEJM Evidence — Excellent for keeping up with landmark trials and evidence-based updates.

The Transition to Attending — What Nobody Tells You

The day you finish residency and start your attending job, the rules change in ways that are hard to anticipate.

The safety net disappears. There is no fellow above you, no attending to co-sign your decisions. This is both terrifying and liberating. Trust your training — it was more thorough than it felt from the inside.

You will still feel uncertain. Imposter syndrome doesn’t end at graduation. Every good physician continues to question themselves — that’s part of what makes them careful. The difference is that you’ve now built enough experience to know that uncertainty is not the same as incompetence.

How you treat people matters more than ever. As an attending, your behavior sets the culture of your team. The way you speak to nurses, residents, students, and patients will shape their experience of medicine. Take that seriously.

Find your mentors — and become one. The people who helped you along the way deserve your gratitude. Pay it forward. Be the attending who makes time for the medical student who’s struggling, the intern who’s lost, the resident who needs someone to believe in them.

You made it. After everything — the USMLE, the applications, the interviews, the sleepless nights of intern year, the long middle stretch of residency — you made it. Give yourself a moment to feel that before you dive into what’s next.

— Dr. Joyce Cheng, MD, MPH, MHA, FACP, Internal Medicine Hospitalist | Clinical Assistant Professor