6 Ways to Thrive as a Family Medicine PGY-2 Resident

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Congratulations! Intern year is finally behind you. At this point, you’ve likely learned more medicine and worked more hours than you previously would’ve thought possible, and it’s only been one year!

The road ahead will be exciting, but challenging. PGY-2 year of family medicine residency will be a time to refine your clinical skills, develop leadership abilities, and explore academic pursuits such as a fellowship. You’ll spend more time in your continuity clinic managing your own patient panel and rotating through various subspecialties. This year won’t be easy, but with the right mindset and strategies, it can be one of the most rewarding stages of your training.

Now, as you fill your shoes as a second-year resident, you step into a new role with greater autonomy, more complex patients, greater responsibilities, and a bigger presence in your program. Here are some tips to help you thrive in your second year!

1. Optimize your workflow.

Intern year provides you with a foundation, but second year is when efficiency becomes key to your development. With a heavier patient load in the clinic and on the wards, as well as additional teaching and patient care responsibilities, a streamlined workflow can save you time and mental energy.

To become more efficient during PGY-2, it’s important to:

Master your EMR.

Whether your institution uses EPIC, Cerner, Meditech, or other electronic medical records, learning keyboard shortcuts and customizing templates will dramatically improve your efficiency. Set up smart phrases for common conditions (e.g., diabetes management, well-child visits, and depression follow-ups).

If your co-residents have time-saving templates, ask to borrow and modify them to your liking. Better yet, create your own and share them with colleagues. These seemingly small changes—such as pre-populated assessment and plan sections—can save minutes per patient, which add up significantly over time.

Develop a structured patient approach.

Before seeing each patient, quickly review their past visits, active problems, and current medications. Have a system for note-writing that allows you to document efficiently without sacrificing quality. For example, some residents dictate notes immediately after visits using voice recognition software, while others prefer to type structured SOAP notes during patient encounters. By doing so, you can efficiently chart on each patient prior to their arrival.

Use your support staff wisely.

Your nurses and medical assistants (MAs) are invaluable. Build strong working relationships with them by communicating effectively and delegating when appropriate. For example, if you have a patient with hypertension, ask your MA to obtain a manual blood pressure reading while you finish reviewing their history. Or if someone comes in with chest pain, have the nurse or MA prep them for an EKG while they are rooming the patient.

Know thyself.

If certain patient encounters take too long, analyze why. Are you getting stuck on chart review? Struggling with difficult conversations? Identifying bottlenecks will help you adjust your approach. A good habit is to set achievable and measurable goals, such as completing charting within 20 minutes of finishing a patient visit. Use your outpatient clinical months to work on these goals and then set new ones for your inpatient rotations.

2. Keep learning.

A career in medicine requires a commitment to lifelong learning. Now that you have a stronger foundation, take your patient encounters as opportunities to refine your clinical knowledge and skills. You’re moving from broad strokes to fine details at this point.

To stay on top of your medical education during PGY-2, be sure to:

Set learning goals.

Each month, pick a clinical topic to focus on. For example, if you’re on a cardiology rotation, commit to reviewing recent hypertension guidelines and familiarizing yourself with common cardiac medications. Keep a running list of conditions and cases you encounter frequently, and review them in your downtime to really master a topic.

Engage in active learning.

Whether you learn with podcasts like “Curbsiders” during commutes or by reading up on unusual and interesting cases, be sure to review important material. Maybe even teach your interns what you’ve learned.

For example, if you diagnose a patient with hemochromatosis, take five minutes to review treatment guidelines and teach your team about screening in first-degree relatives. This will be good for them, and it’ll really help you get ready for your in-training-exams (ITEs) and that ABFM board exam around the corner.

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Stay current.

Family medicine evolves year to year, guidelines are updated, new medications and patents arise, etc. Get in the habit of skimming journals like AAFP’s American Family Physician or JAMA for new practice-changing studies. Attend journal clubs and participate in discussions, even if you’re not presenting, to keep current.

3. Consider a fellowship.

PGY-2 is the time for family medicine residents to start considering fellowship options. By this stage, residents have adjusted to residency life, refined their clinical skills, and gained a clearer sense of their interests.

If you decide to go for a fellowship, be sure to do the following:

Get started early.

Many fellowships, such as sports medicine, geriatrics, or addiction medicine, have competitive application processes with deadlines in PGY-3. Starting in PGY-2 allows ample time to secure strong letters of recommendation and acquire relevant experiences, such as volunteering for high school and college football games if you’re interested in sports medicine.

Tailor your rotations and electives.

PGY-2 is a great time to arrange electives in subspecialties of interest, strengthening both your application and confidence in your chosen field.

Engage in networking and mentorship.

Engaging with mentors and faculty early can provide guidance on the best fellowship options. They can share details about fellowship programs you may be interested in, such as the quality of training, and gauge your competitiveness as a future applicant.

Do long-term career planning.

Fellowship training should be pursued in a way that aligns with long-term goals, whether in academic medicine, specialized clinical practice, or research.

If you’re even slightly interested in doing a fellowship, start exploring now. Shadowing, speaking with fellows, and attending conferences can help clarify whether a fellowship aligns with your career vision!

4. Step into leadership.

Second year is when you transition from learner to leader. You’ll be supervising interns, making independent clinical decisions, and taking solo calls. This can feel overwhelming at first, but embrace it as part of your growth.

As you assume more of a leadership role in your program, be sure to:

Be a resource for interns.

Think back to how lost you felt as an intern. Be the upper-level who is approachable, patient, and willing to help. Small actions—like explaining how to place an urgent consult or guiding an intern through a difficult discharge summary—go a long way in earning their trust.

Practice clear communication.

Whether you’re presenting to attendings, giving sign-out, or speaking with consultants, conciseness and clarity are key. For example, when discussing a patient with a specialist, use a structured SBAR (Situation, Background, Assessment, Recommendation) format to ensure efficient communication.

Embrace the responsibility of call shifts.

You’ll now be the decision-maker in urgent situations. At first, it may feel daunting, but with each shift, you’ll gain confidence. When in doubt, use your attending as a backup—they expect you to ask questions, not to know everything. Take notes on tricky cases you encounter so you can review them later and be better prepared for the next call.

5. Pursue your academic and career goals.

Your second year offers more flexibility, making it the perfect time to explore career interests beyond patient care. PGY-2 is a good time to:

Engage in research or quality improvement projects.

Whether it’s quality improvement, public health initiatives, or clinical research, find a project that aligns with your interests. For example, if you’re interested in sports medicine, consider analyzing injury patterns in local high school athletes or developing a return-to-play protocol.

Join professional organizations.

The American Academy of Family Physicians (AAFP) and state chapters offer leadership roles, advocacy opportunities, and networking events. Many residency programs also have resident councils where you can influence policy and education.

Attend conferences.

Check out the Family Medicine Experience (FMX), an AAFP FUTURE conference, or a specialty-specific event. Conferences are a great way to gain knowledge and connect with potential mentors. If you have research, consider submitting an abstract for presentation.

6. Consider running for chief resident.

As you near the end of second year, you’ll have the chance to apply for chief resident. Chiefs play a crucial role in program leadership, acting as a liaison between residents and faculty while also managing schedules and educational initiatives.

If you decide to run for chief, be sure to do the following:

Ask current chiefs about the role.

What are the time commitments? What are the challenges and rewards? Shadow them for a day to get a sense of their responsibilities.

Assess your interests.

If you enjoy leadership, teaching, and advocacy, this could be a great fit. For example, if you find yourself naturally mentoring younger residents or organizing workflow improvements, chief residency may be a good step.

Consider the career impact.

Chief year strengthens your resume, especially if you’re considering a fellowship or academic medicine. Even if you don’t pursue chief residency, taking on small leadership roles—such as running a residency wellness initiative—can be valuable.

For more insight based on my own experience as chief resident, check out these other posts:
⭐ Should You Run for Chief Resident?
⭐ How to Become Chief Resident: Advice From a Former Chief

Final Thoughts

Your second year of family medicine residency is a time of growth, both clinically and professionally. It’s easy to get caught up in the daily grind, but remember why you chose this path in the first place.

Yes, there will be overwhelming days filled with complex patients, backlogged inboxes, and long hours. But there will also be moments when you confidently diagnose a condition, when a patient thanks you for listening, or when an intern seeks your advice. These moments make the hard work worth it.

Take each challenge as an opportunity, build strong relationships with your team, and never stop learning. Residency isn’t just a training program—it’s your chance to shape the kind of physician you’ll become.

Welcome to PGY-2. Use these tips and it’ll be a great year for you. Time to thrive!

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By Mike Ren, MD

Mike is a driven tutor and supportive advisor. He received his MD from Baylor College of Medicine and then stayed for residency. He has recently taken a faculty position at Baylor because of his love for teaching. Mike’s philosophy is to elevate his students to their full potential with excellent exam scores and successful interviews at top-tier programs. He holds the belief that you learn best from those close to you in training. Dr. Ren is passionate about his role as a mentor and has taught for much of his life–as an SAT tutor in high school, then as an MCAT instructor for the Princeton Review. At Baylor, he has held review courses for the FM shelf and board exams as Chief Resident. For years, Dr. Ren has worked closely with the Office of Student Affairs and has experience as an admissions advisor. He has mentored numerous students entering medical and residency and keeps in touch with many of them today as they embark on their road to aspiring physicians. His supportiveness and approachability put his students at ease and provide a safe learning environment where questions and conversation flow. For exam prep, Mike will help you develop critical reasoning skills, and as an advisor, he will hone your interview skills with insider knowledge to commonly asked admissions questions.