From Resident to Attending: Shifts in Responsibility

Transitioning to Roles that Assume and Distribute Responsibility

Medical career transitions involve increasing clinical responsibility and changes in how practitioners seek help and supervise other team members. When medical students become interns, participating in teamwork and gaining recognition as team members become crucial. When residents become attendings, they take responsibility for both final clinical judgments and junior colleagues’ learning. An attending is a physician who holds final responsibility for patient care while supervising residents. Preparation for these transitions includes acquiring clinical knowledge and skills, as well as practicing how to assume responsibility, make judgments, request support, and delegate tasks to others.

Conditions for Intern Workplace Adaptation and Help-Seeking

The ‘Intern Voice’ project explored the gap between medical school education and intern duties through the experiences of recent graduates (Sturman et al., 2017). Six final-year medical students from the University of Queensland selected junior doctors from their personal networks who had worked in varied settings and had diverse experiences. They conducted semi-structured interviews. There were 15 participants, comprising 11 men and 4 women; 12 worked in Queensland and 3 in North America. The interview footage totaled 12 hours. Two clinical educators and one researcher who was an intern at the time of analysis independently read the transcripts. They developed themes through iterative, inductive comparison and consensus. Analysis began after the interviews concluded, and no new themes emerged after the first 10 cases.

Participants felt well prepared in clinical knowledge and skills but faced new learning demands in administration and task management. Daily tasks included completing forms and medical records, providing ward cover, resolving conflicts, and reprioritizing amid repeated interruptions. Participants also described situations in which academic achievement during medical school competed with participation in clinical teams. Shadowing interns during their daily routines and on-call shifts was considered a useful learning experience. While making decisions and giving orders for patient care, junior doctors occupied the lowest level of the hierarchy. They learned to navigate differences in team members’ roles and practice styles. Supportive teams and teaching from their immediate senior colleagues helped them cope with diminished confidence and physical and emotional burnout.

Participants advised promptly reporting concerns about a patient’s condition and asking senior colleagues for help. However, none reported seeking help beyond family and friends for their own health issues. Stigma, lack of time, concerns about increasing colleagues’ workloads, and insufficient information about available services were identified as barriers. Because the interviews were conducted by junior students who were personal acquaintances and video excerpts could be made public, participants’ accounts are best interpreted in light of both the trust these relationships afforded and the burden of potential disclosure. Proposed support included task management and conflict resolution in preparatory training and pathways for personal health support, such as relationships with independent and trusted general practitioners.

Participation and Professional Identity Around Medical School Graduation

A longitudinal qualitative study in South Africa tracked how feelings of preparedness at graduation changed after graduates assumed clinical responsibilities (Pattinson et al., 2026). The research team used Communities of Practice (CoP) as an interpretive framework within a social constructivist perspective. The analysis examined the legitimacy associated with recognition as a community member and professional identity formation (PIF). From a cohort of 345 final-year students at one university, 22 volunteered and were placed across 13 hospitals in 6 provinces. The research team collected audio diaries and conducted interviews before and after a 7-month period encompassing the final 3 months of medical school and the first 4 months of internship. Twenty participants submitted a total of 129 audio diaries, 17 completed the entire study, and the diary recordings totaled 14 hours and 28 minutes. The research team conducted narrative analysis in Atlas.ti, using the final clerkship and exams, graduation, the first on-call shift, and department rotations as temporal reference points.

As students, participants found that exams and lectures took priority over clinical participation or that they were given no role within the team. After graduation, a gap emerged between the title of ‘doctor’ and their self-perception. In early internship, the first on-call shift, patient deaths, staff and supply shortages, broken equipment, and sleep deprivation amplified the burden of responsibility. Sharing tasks with colleagues and dividing responsibilities with supportive seniors helped build confidence and a sense of belonging. Caring for patients from admission to discharge and observing their recovery also helped. Administrative tasks were accepted as work that advanced the team’s shared goals. Efficiency, reliability, teamwork, and communication emerged as competencies recognized in the workplace.

The research team presented four participants’ narratives, which were rich in reflection and emotional expression, to illustrate the overall pattern in the data. These four trajectories overlap and recur rather than forming stages that all graduates pass through in the same order. The findings are limited to early internship among graduates of a single university. Resource shortages and uneven supervision in the public healthcare system also shape their interpretation. Preparedness for transition encompasses readiness to continually renegotiate relationships, uncertainty, legitimacy, and identity within changing communities, alongside readiness to perform at graduation. Supportive measures include giving students clear roles and opportunities to participate in patient care and assigning responsibility in stages. They also include senior supervision, mentoring, feedback, and coaching on self-care.

Conditions Where Observation and Feedback Lead to Subsequent Delegation

A multiple-case study in Ireland analyzed how individual supervisory activities connect within residents’ supervised workplace learning (Wiese & Bennett, 2026). The research team purposively sampled 4 departments—Geriatric Medicine, Vascular/Gastrointestinal Surgery, General Paediatrics, and Infectious Diseases—which differed in specialty culture, team continuity, patient populations, and hospital types. The 50 participants comprised 38 residents and 12 supervising attendings. Data from face-to-face semi-structured interviews were managed using NVivo. Drawing on realist context–mechanism–outcome (CMO) configurations, the analysis used six mechanisms—delegation, help-seeking, monitoring, modeling, sense-making, and feedback—as sensitizing concepts. Within-case thematic analysis and cross-case configuration analysis characterized the degree to which mechanisms aligned and reinforced one another as coupling.

In Geriatric Medicine and Surgery, mechanisms were tightly coupled, but resident responsibility was adjusted in different directions. In Geriatric Medicine, care for patients with complex conditions occurred amid pressures related to patient turnover. Monitoring followed a 40-year tradition emphasizing supervision by attendings. Deficits identified through observation led to reduced delegation. Immediate corrections and brief coaching followed, and senior residents’ autonomy increased only to a limited extent. In Surgery, where skills could be directly observed and tasks divided, participation expanded from initial tasks such as skin incisions, port insertions, and camera operation. Intraoperative corrections influenced subsequent opportunities to participate, forming a cycle of participation→opportunity→skill→trust. However, residents who expressed interest and willingness in ways familiar within that culture had an advantage in gaining opportunities. Tight coupling between supervisory activities could both maintain existing levels of supervision and expand the responsibility assigned to residents.

In Paediatrics, relationships sustained within a small team for 6 months supported individualized supervision and psychological safety in seeking help. Modeling also covered interactions with parents and breaking bad news. Feedback decreased for senior residents, and the extent to which autonomy increased varied across supervising attendings. In Infectious Diseases, relational continuity was weak because of 3–4 month rotations, frequent absences and transfers, beds scattered across multiple wards, and staffing gaps. Help-seeking and feedback occurred in response to acute deteriorations or errors, and delegation decisions were situation-dependent. These findings describe relationships between workplace conditions and supervisory experiences captured through interviews at a single time point. When implementing and assessing CBME and EPAs, the authors proposed examining both the frequency of observation and feedback and how they alter subsequent delegation and opportunities to participate. Adequate staffing and rosters that preserve shared working time and relational continuity were also proposed as support conditions.

The Transition to Jointly Handling Final Clinical Judgments and Resident Supervision

A multicenter qualitative study in Swiss General Internal Medicine (GIM) explored the responsibilities newly assumed in the transition from resident to attending (Roten et al., 2022). GIM specialist training consists of 3 years of basic training and 2 years of advanced training. The research team purposively sampled 2 university hospitals and 10 affiliated teaching hospitals in the German- and French-speaking regions. The 35 participants included 16 attendings, 14 residents, and 5 department heads. Seven focus groups, held separately for residents and attendings, involved 3 to 6 participants per group and lasted 60 to 90 minutes. Department heads participated in individual semi-structured interviews. Working from a social constructivist perspective, 6 core researchers iteratively analyzed the data. They deductively applied categories such as medical expert, teacher, and manager from CanMEDS and other sources before inductively deriving themes. Situated learning theory was used to interpret learning through activities and social relationships.

The findings were organized into four themes: formulating care plans that integrate stakeholder opinions, making final decisions amid uncertainty, supervising residents, and managing multiprofessional teams. Clinical judgment centered on reviewing specialty recommendations alongside patient wishes, family views, and options for testing and treatment. Developing plans for patients with complex conditions required prioritizing recommendations and considering quality of life and the possibility of excessive medical intervention. The burden of uncertainty also increased as physicians moved from waiting for a senior colleague’s answer as a resident to making the final decision as an attending. Assuming responsibility in practice and discussing cases with experienced colleagues helped build confidence in those judgments.

In supervision and management, a central challenge was trusting residents and delegating to them. New attendings tended to tighten supervision to ensure patient safety, whereas residents valued supervisors who accepted approaches different from their own. Alongside supervising residents, attendings coordinated the work of nurses and other members of multiprofessional teams who operated within separate hierarchies. They also managed conflicts between patients and staff and addressed organizational and operational issues. Few participants received regular, structured professional coaching, but those who did found it useful. These accounts of adaptation did not track changes in the same physician over time. Differences between countries in training and duties also shape the findings’ applicability. To support the transition, the authors proposed guided participation, with complex tasks and responsibilities assigned gradually in line with the resident’s developmental level, alongside designated mentors who offer regular advice.

Reading notes

The difference between Geriatric Medicine and Surgery shows that detailed supervision alone does not fully explain how autonomy expands. The scope of subsequent tasks after observation and feedback also needs examination. The difference between asking questions about patient care and seeking help for personal health shows that relationships that enable requests for support vary with task type, hierarchy, time, and career-related pressures. Workplace learning research in HRD and medical education can track how task assignment, shared working time, and changes in responsibility after feedback relate to career adaptation and professional identity formation.

References

• Pattinson, S. R., Savelberg, H., & Atherley, A. (2026). ‘Like an infant … trying to run a marathon’: A longitudinal audio‐diary study exploring the transition from medical school to internship. Medical Education, 60(10), 1130–1142. https://doi.org/10.1111/medu.70221
• Roten, C., Baumgartner, C., Mosimann, S., Martin, Y., Donzé, J., Nohl, F., Kraehenmann, S., Monti, M., Perrig, M., & Berendonk, C. (2022). Challenges in the transition from resident to attending physician in general internal medicine: A multicenter qualitative study. BMC Medical Education, 22(1), 336. https://doi.org/10.1186/s12909-022-03400-z
• Sturman, N., Tan, Z., & Turner, J. (2017). “A steep learning curve”: junior doctor perspectives on the transition from medical student to the health-care workplace. BMC Medical Education, 17(1), 92. https://doi.org/10.1186/s12909-017-0931-2
• Wiese, A., & Bennett, D. (2026). From mechanisms to systems: Reconceptualising supervised workplace learning in postgraduate medical education. Medical Education, 60(10), 1143–1153. https://doi.org/10.1111/medu.70208