Pandemic to endemic: a longitudinal multinational study on COVID-19’s effects on graduate medical education.

Publication date: Jun 12, 2026

This study applied a resilience engineering framework to understand how international graduate medical educations (GME) programs responded to the disruptions caused by the COVID-19 pandemic. Beyond describing early pandemic disruptions, we offer a multi-year, multi-country analysis of how training functions adapted, which elements durably changed, and what program design features may be associated with recovery. We conducted a retrospective longitudinal study of all 180 ACGME International (ACGME-I)-accredited programs across seven countries. Annual surveys were completed over three years (Year (Y)1 = Academic Year (AY)2021-22, Y2 = AY2022-23, Y3 = AY2023-24), assessing clinical experiences, educational activities, telemedicine use, and training modifications. Data were analyzed using mixed-effects and generalized linear mixed models, with exact logistic regression for small strata. Subgroup analyses compared specialty, training type, and World Bank income classification. Studying ACGME-I programs provides a common competency-based context, allowing us to describe trajectories of disruption, recovery, and persistence. Of 180 programs, most were residencies (68. 3%) and medical specialties (53. 3%), with 87. 2% located in high-income countries. Clinical experiences were most disrupted in Y1, especially ambulatory continuity clinics (estimated marginal means [EMM] 1. 489) and ambulatory rotations (1. 571), both of which recovered by Y3 (1. 863 and 1. 874; p

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