Arrivals and Departures

Every October, a new class of medical students walks into teaching hospitals across the United States, and every spring, residents finish their training and move on. These annual transitions are so routine that they rarely attract attention, yet they mark some of the most consequential moments in a physician’s professional life. A new essay published in the Journal of General Internal Medicine examines what it means to arrive at and depart from the stages of medical training, arguing that these threshold moments deserve closer reflection from both trainees and the educators who guide them.

The essay, written by Adrian Kalaw and Emily Harris of Harvard Medical School together with Karen Wood of the Center for Education at Atrius Health in Boston, appears in the journal’s Healing Arts section, a venue reserved for reflective and humanistic writing rather than empirical research. Its authors bring complementary perspectives: a medical student navigating the early stages of clinical immersion, and experienced educators who have watched generations of trainees pass through the same doors. The piece draws on that vantage point to explore how medical culture shapes the way young doctors say hello and goodbye.

At the heart of the essay is a simple observation with deep implications: medical training is structured around arrivals and departures. Students arrive on the first day of anatomy, on the first day of clerkships, on the first day of residency. They depart from classrooms, from wards, from the cities and institutions that shaped them. Each transition demands a renegotiation of identity, from observer to participant, from learner to teacher, from trainee to independent clinician. The authors suggest that medicine rarely pauses to acknowledge how disorienting these repeated thresholds can be.

The timing of these transitions is not incidental. The academic calendar of medicine concentrates change into predictable windows, most visibly the July turnover when interns begin and graduating residents leave. Studies of teaching hospitals have long noted seasonal variation in care processes around these handoffs, and institutions have developed structured sign-outs, supervision protocols, and orientation programs to manage the operational risks. What the essay adds is a different lens: the psychological and professional meaning of transition, not just its logistics. Arriving somewhere new, the authors imply, is not merely a change of location but a change of self-understanding.

For medical students, the first arrival that matters is often the anatomy laboratory, where the abstraction of textbooks gives way to the reality of the human body. Later arrivals follow in rapid succession: the first patient interview, the first overnight call, the first time a nurse or attending addresses a student as a future colleague rather than a visitor. Each of these moments quietly rewrites the trainee’s sense of who they are. The essay’s reflective stance invites readers to consider how much of professional identity is formed not in formal curricula but in these accumulated threshold experiences.

Departures carry their own weight. Leaving a clinical team mid-rotation means handing over patients one has come to know, often without closure on their outcomes. Graduating from residency means leaving the safety net of supervision, a transition widely recognized as one of the most stressful in a physician’s development. The authors’ framing suggests that medicine’s culture of relentless forward motion, in which trainees are always moving to the next rotation, the next service, the next stage, can leave little room to process what is being left behind. Unacknowledged departures, they suggest, may contribute to the emotional attrition that accompanies training.

The essay also speaks to the educators on the other side of these transitions. Faculty who teach in academic medical centers experience the same cycle from the opposite direction: every July brings new learners who must be oriented, assessed, and integrated into teams, and every June takes away colleagues-in-training who have become familiar and trusted. The authors, based at institutions that train large cohorts of students and residents, write from within this recurring rhythm. Their acknowledgment section thanks William C. Taylor, MD, for his encouragement and lifelong commitment to medical education, a detail that situates the essay within a tradition of mentorship and reflective teaching at Harvard Medical School and its affiliated teaching practices.

Why does this matter beyond the personal? Research on the therapeutic relationship, health communication, and care systems, the subject categories under which the journal indexes the piece, has repeatedly shown that continuity and relational trust affect patient outcomes. Transitions interrupt continuity. When trainees arrive and depart frequently, the relationships that anchor care are repeatedly rebuilt. A reflective literature that examines how trainees experience these thresholds may therefore connect to patient experience in ways that operational fixes alone cannot address. The essay’s contribution is to keep that connection visible.

The Healing Arts genre itself deserves note. Journals of general internal medicine have long reserved space for narrative, poetry, and essay alongside original research, on the premise that medicine is practiced by whole people whose experiences of meaning, loss, and belonging shape the care they deliver. Work in this tradition does not test hypotheses; it offers testimony and interpretation. Kalaw, Harris, and Wood’s essay joins a body of writing that treats the emotional architecture of medical training as a legitimate subject of professional attention, not a private matter to be set aside at the hospital door.

For readers outside medicine, the essay offers a window into a profession that is, in many respects, a sequence of arrivals and departures compressed into a decade. For those inside it, the piece is an invitation to slow down at the thresholds: to mark the leaving of a team as deliberately as the joining of one, and to recognize that the doctors patients meet are always in motion between who they were and who they are becoming. The full essay is available in the Journal of General Internal Medicine under the title Arrivals and Departures, published on 15 October 2026.

Subject of Research: Reflective essay on professional identity and transitions in medical training

Article Title: Arrivals and Departures

Article References: Kalaw, A., Harris, E., & Wood, K. (2026). Arrivals and Departures. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10909-2

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10909-2

Keywords: medical education, medical training transitions, professional identity, therapeutic relationship, health communication, primary care, general internal medicine, residency, medical students, reflective writing, mentorship, teaching hospitals