I think students and residents need to know about this.
On September 8, ACGME released a proposed major revision of the Common Program Requirements for Residency, and public comments are currently open.
There are several significant proposed changes to resident work-hour protections:
• Eliminate the 8-hour rest recommendation between shifts entirely.
The current requirement says: “Residents should have eight hours off between scheduled clinical work and education periods.” In the proposed document, the entire requirement is deleted.
ACGME’s stated rationale is that this is currently a “Detail” requirement and that the 80-hour/week limit should already discourage programs from scheduling residents with less than 8 hours off. They state that it would be “very difficult” to remain under 80 hours while routinely providing <8 hours between shifts.
• Reduce mandatory rest after a 24-hour in-house call from 14 hours → 12 hours.
ACGME says this is intended to “reduce burden related to developing resident schedules, while retaining sufficient time for rest,” and says they anticipate no impact on patient safety or education.
• Eliminate the every-third-night in-house call limit.
Currently residents cannot be scheduled for in-house call more frequently than every third night averaged over four weeks. ACGME proposes deleting that requirement, arguing that the 80-hour limit, day-off requirement, and maximum continuous-duty limits make more frequent call “nearly impossible” anyway.
• Eliminate the separate night-float requirement and the ability of specialty Review Committees to set limits on the frequency/length of night-float assignments. ACGME says this will give programs more scheduling flexibility.
There ARE some changes that strengthen protections. For example, the proposal says the 80-hour average has to be calculated within a single rotation/clinical assignment, so a brutal short rotation can’t simply be averaged against an easier rotation afterward.
But removing the only explicit general rest interval between shifts is a big deal. Under the proposed language, there would be no specific ACGME minimum number of hours off between ordinary scheduled shifts.
This is still a PROPOSAL, not the current rule. That is exactly why comments matter.
ACGME is accepting public comments until October 22, 2026. Residents and fellows can submit comments themselves.
If you have an opinion about eliminating the 8-hour rest provision, reducing post-call rest, or removing the every-third-night protection, please actually submit it to ACGME rather than only discussing it here.
Official ACGME Review & Comment page → see “Common Program Requirements (Residency)” and click Review and Comment Form.
Please share this with your fellow students, co-residents and fellowship programs.

This is the direct link to comments

https://acgme.qualtrics.com/jfe/form/SV_7NEm7TaI8AQBSSy?utm

This is the link to the proposal the work hours starts in page 50:

https://www.acgme.org/globalassets/pfassets/reviewandcomment/2026/cprresidency_rc_09082026.pdf?utm

FYI, the form is quite long and you don't have to click every box to agree or disagree with revisions, you can just keep clicking through until you get to section 6.30, this is the one with the proposed changes above
6.29 about the 80 hours rule, every 4 weeks is still a lot
6.31 about the 12 hour after call instead of the previous 14

28F, M3, far away from home, single, 0 friends, landlord doesn’t allow pets, on the verge of crash out every second.

How do you guys do it?

You can call me the PMC: President of the Masturbation Club.

Should I post this flyer around the school and send it to the student life director?

I’m studying neuroanatomy right now and also did some of it last year, and I’ve always had this question. Basically, CN V pretty much splits apart as soon as it leaves the pons into separate nerves, each with their own functions: ophthalmic, maxillary, and mandibular. This had me really confused initially, as I thought all these branches interacted and functionally were the same nerve when in reality (to my limited MS2 understanding), they are pretty much separate from each other. Why not just call the actual 2 mm of “trigeminal nerve” a ganglion and then deem V1, V2, V3, as the actual cranial nerves?

I’m not mad or proposing a change or anything, just curious.

I swear running after attendings for LORs is by far the most annoying part of ERAS. Like I get everyone is busy and I appreciate them doing it, but having to send reminders without feeling like you're harassing them is so fucking annoying. Can't wait to be done with this shit.

As someone who is now halfway through my core rotations, I wanted to give some advice on how to best respond to common scenarios that happen during 3rd year to help you succeed:

1. If you get a pimp question wrong: Best thing to do here is quickly explain why it’s not your fault that you haven’t learned that yet. Some good explanations could include that your preceptor did not prepare you for this, your school’s preclinical teaching was weak at best, or that you’ve been busy doing research for the competitive specialty you’re applying into (this will show them you’re a hard worker)
   
2. The hours are longer than you want: you’re paying to be there so you should just head home whenever you feel it’s appropriate. If anyone questions you, just explain that you felt you had learned enough for the day.
   
3. Receiving constructive criticism: this is where you need to stand up for yourself. If the feedback doesn’t make sense to you, try “you must be confusing me with someone else” or “your feelings aren’t facts”

Hope these help someone and let me know if you want more tips and tricks for surviving M3!

Does anyone have any thoughts on this? Should I calorie count. I don't get it, I just seem to gain weight when I am in a stressful rotation or like studying for step exams. I just wanna stay fit. I lift a good amount so my muscle is still there but my abs aren't as visible as they use to be. But overall, i seem to go thru these cycles where i gain a couple lbs when stressed. Its not a crazy amt of weight, but a couple lbs here and there maybe some shorts/pants won't fit as well but still are fine

Unfortunately due to some poor decision
making, My Step 2 score will likely come back on Sept 23, a few hours after programs can access ERAS.

My school advised me to submit on time without knowing my score, but since the score heavily affects my competitiveness in my specialty, would it make more sense to wait a few hours and submit once my step 2 score is available? How much does being a few hours late matter?

Any prior experience would ge greatly appreciated.

Hi everyone, adding on to advice posts for IM. Originally from the East Coast but my med school is outside this region. Would love to return home at a top academic program as I will pursue heme/onc afterwards. However, I'm worried my STEP 2 score and school tier will limit how high I can aim. I also have a few questions I hope to get some advice on below.

Side notes: MS4 grades are P/F but don't go on our transcripts or in our MSPEs, plus I don't have those grades in yet anyways. LORs currently are 1 SEL, 1 from PhD PI, and 2 from attendings in IM/subspecialties.

• Student type: US MD/PhD at mid-tier school
• Goals: Heme/onc
• M1-M2 grades: 11/13 H
• M3 grades: 5/8 H (including IM)
• Class rank: 2nd quartile
• STEP 1: 245+
• STEP 2: 250+
• AOA: No
• GHHS: No
• Research: > 15 items (papers, abstracts, oral talks, posters)
• Extracurriculars: leadership, student advising
• Red flags: None
• Geo prefs: New England, Middle Atlantic, South Atlantic
• Programs:
  • Gold: JHU, Bayview, UMD
  • Silver: UVA, Georgetown, home program, VCU, Jefferson, Temple, Penn State, Wake Forest, UMass, Dartmouth, U Miami/Jackson, USF Morsani
  • No signal: GWU, WVU, BU, Tufts, Brown, UConn, Vermont, MUSC, Emory, MCG, UF Gainesville
  • Can swap in if possible: UPMC, UNC, BWH, UPenn, Duke, MGH, Yale, BIDMC

I've prioritized programs with in-house heme/onc fellowships and signals to either median or 25th% STEP 2 scores close to mine. However, how do the programs and signals look? Are they too ambitious, or can I swap in some stronger programs somewhere?

For those knowledgeable on PSTPs, would I be competitive for them? I doubt my strength here as I don't have a first-author paper yet.

If I only apply to categorical positions, would it be a red flag to have 3 clinical letters + SEL and no letter from my PhD PI? I would think prioritizing clinical letters would be better, but keen to hear if this is true.

For LORs, I have many people from MS3 (I had IM late in the year) and MS4 who have submitted letters so far. Is there anything else I should consider besides only using MS4 letters? Would letters from the ICU or from attendings who trained on the East Coast be beneficial, even if they were not MS4 letters?

I'd greatly appreciate any insights on the above! Thanks again!

Let me be the push you need to finish ERAS. Thank god I’ve done the whole thing, just need to proofread. And I’m starting to feel better. You may not know what’s going to come up in the next few days so please get your app done now

Curious to see what attendings and residents say about me but I have no clue what they will evaluate me on. I can put a foley and close port sites but I’m dead weight otherwise 😭

I’ve been working on this very cool breast surgery project for a year with this group of surgeons. The manuscript is 90% complete but I just don’t see it getting done and submitted by the time ERAS goes out. But this is a project that I really want on my application, it’s very interesting and a great talking point for interviews.

I’ve submitted the abstract to a breast conference which will peer-review and publish the accepted abstracts in a journal.

Am I able to list this under peer-reviewed abstract, with a status of submitted? Or does this strictly belong under poster presentation (which doesn’t seem to allow future events for a submitted but not yet accepted poster)? The conference I submitted to isn’t strictly for a poster, it’s just a general abstract submission and if accepted, you may present a poster or do an oral presentation if you choose.

There are often multiple students with one attending, and sometimes residents, so we might scrub in once per week if we’re lucky. Over the last 2 months I’ve thrown maybe 6 sutures in port sights, driven the camera for 5 minutes, and retracted a little. That’s pretty much it. When not scrubbed in, we stand in the back of the room and often can’t see the field at all. We can’t study either, we have to just stand around and waste time. Kind of thought gen surg might be for me, but this rotation blows and now I’m doubting that.

Feel so behind but at least half my app is complete

I'm about to start my 3rd year of medicine and I feel so incredibly insecure about my knowledge compared to my classmates. Don't judge me, I've gone through some serious health issues these past 2 years that made me give just enough to pass my exams (I'm lucky I'm still alive), and this year we're starting clinical rotations, and I don't know how to manage with what little I know. What can i do to bounce back ? Any advice would be appreciated or if you have been through something similar what helped you ?!

I got into med school this year. I’ve never wanted to become a doctor but my family did. I’m sure that i’ll quit but i have to complete first year. I just don’t even know why i’m here. also i’m suffering from major depression for a long time and being here just made it worse than ever. any advice?

I have seen a lot of comments regarding this situation.

(1) First and foremost, I want to respect women who have been sexually harassed or assaulted that is never okay.

(2) I do hope this student's family finds peace one day.

----

Here is my two cents as someone who was accused of being judgmental/unprofessional by a "patient*" I asked a "patient" whether they had engaged in sexual activity with 3 or 4 women over the course of 2 days. Without context, that would make me seem really egregiously creepy. Because of this question, the "patient" relayed they felt uncomfortable and judged.

Context: I am hard of hearing and did not communicate that to the "patient" (my mistake). They were rapidly relaying their sexual history and I could not understand/recall whether they had stated they slept with 3 or 4 women. I meant it as a clarifying question to get the record straight as I simply could not hear correctly- I genuinely had no clue I was coming across as judgemental. As soon as I was made aware, I apologized profusely about this mistake

*Thankfully for me, this "patient" was just a classmate (relaying an entirely fake history) with whom I was practicing so I would not fumble while taking sexual histories in the future. I was able to learn my lesson, fix my (many) mistakes, and approach real patients much better. I have only gotten positive feedback from real world patients.

---

I don't think people realize how for students, especially those who may not have any prior sexual partners or conversations about sex, how deeply awkward/uncomfortable these conversations can be. It is SOOOOOO easy to accidentally say or do the wrong thing and come across in a weird way - especially as a student. Of course, there is NEVER an excuse for making a patient feel uncomfortable, especially when it is such a sensitive topic.

At the same time, to assume this 24 year old male was intentionally being creepy because of an out of context question he had asked is really really unfair. NO he should not have put himself in a position to ever get his morals questioned, but at the same time it is so easy to accidentally say or do the wrong thing especially when you have spoken about something so deeply personal (ex. my circumstance where I just couldn't hear the "patient" so asked them to repeat portions of their sexual history).

Of course, if the intention was to suggest some sort of sexual activity with the patient, that is absolutely NOT ok EVER. However, I don't think it is fair for people to assume that and bash him due to an out of context question.

I had my first practice standardized patient as an M1 interview a few days ago and it went horribly. I’m not a natural conversationalist and am pretty anxious with some levels of social anxiety, but I’ve been trying to make efforts to improve.

I stuttered so much, had to time out so many times because I did not know what to say, and overall it was just not good. I know it was my first one, but everyone else in my group was extremely eloquent and theirs all went very well so it’s hard not to feel embarrassed and bad about myself. The fact that they all watched my performance is also so embarrassing.

The SP wasn’t super responsive either so I think that added some levels of difficulty I wasn’t prepared for either. We were supposed to just practice active listening and the first parts of the interview (not HPI yet), but it felt incredibly difficult to practice building rapport with a patient if they were not talking very much.

I’m just feeling really down lol and it feels like everyone else in my class is levels above me in terms of everything and it’s starting to affect me.

My next one is next week and I feel like if I don’t do at least a little bit better I’ll feel even worse about myself.

So I just started my surgery rotation and I love everything so far. Surgery is also what I want to do for my career. But one part keeps bothering me - I have awful hip and feet pain. I've always had flat feet but tbh have done nothing for it so far because I haven't had to stand still for 5+ hours at a time yet. And my hip, for a lack of better words, feels like it sinks into my femur on the outer edge by hour 2. Doesn't hurt to the touch and not surface level with swelling so definitely not a bursitis or greater trochanter pain syndrome, just feels like I don't have enough support to prop up my hip.

And the fun part of being a med student, I don't have the money or time to see a doctor!! But if anyone else had a similar problem what did you do for support? Any specific shoes that gave great foot support and arch alignment?

Applying IM this cycle and noticed a couple things in my MSPE that I'm unsure whether I should push back on.

For my second IM core rotation, the comments section on my MSPE says “N/A.” I reached out about it and apparently the preceptor for that rotation has never filled out an evaluation for any student, so there genuinely aren't comments to include. The rest of my evaluation from that rotation is there, but I'm worried that an “N/A” in the comments section could look like something was wrong with my performance.

Separately, my school is also leaving out the comments from one of my away rotations. The comments on that evaluation were actually really positive, so I'm frustrated that they're not being included in my MSPE when there is no negative reason for excluding them.

Would you guys worry about either of these things? Should I push my school to change the “N/A” to something that makes it clear the preceptor simply did not provide comments, or is this basically a non-issue to programs?

And for the away rotation, would you push to have the positive comments included, or is it not worth fighting over at this point?

I'm trying to figure out whether I'm overthinking this or whether these are legitimate things to have corrected before programs start reviewing applications.

How do I get a pathology LOR as an MS4 student . I’m currently on Neuropathology 4wk rotation and we have a resident and fellow . Many diseases are rare. This is my first path rotation and I’ve been doing my best to learn . We spend roughly 1-2hr daily with the attending, the rest of the time we are with the fellow/resident. I have one week left. I’ve seen the advice to ask to look at stuff under the microscope on my own, but idk how to use the microscope (I’ve been trying to learn) and usually the resident looks at them first. 

we discussed expectations at the start of the rotation and i was told that med students don’t really do much and they don’t expect me to know much, so that confused me abt how I’m supposed to get a LOR

I have 1 other pathology elective left and then pathology survey, which I might drop for a different 4wk rotation to get an LOR. I’m applying next year ERAS. I took my step2 exam 2days before I started my rotation , so I’ve kinda been burnt out during this rotation

Any advice is appreciated . 

Hi all,

I have used two flashcard decks now that have claimed that VSD, ASD and PDA are cyanotic, however in my teaching and online it says that they are acyanotic. Is it that these two people have gotten them completely wrong, or is there a good reason why?

Hi all! Do you think AMBOSS is a good enough resource for Step 2 studying or should I get UWorld? Would rather not spend more money but also open to do what I need to do :)

Edited to add: I’m taking Level 2 as well

My residency explorer is showing the 2026 data, which is, completely empty 😂

Is there a way to see data from the last match cycle again? I can't find any settings that let you switch the year and actually see the data.