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J Grad Med Educ. 2017 Oct;9(5):634-639. doi: 10.4300/JGME-D-16-00689.1.

Characteristics and Outcomes of an Innovative Train-in-Place Residency Program.



Physicians who make a midcareer specialty change may find their options for formal training are limited. Here, we describe a train-in-place program, with measureable outcomes, created to train midcareer physicians who desire formal training in occupational medicine.


We evaluated educational outcomes from a novel residency program for midcareer physicians seeking formal training and board certification in occupational medicine.


Physicians train in place at selected clinical training sites where they practice, and participate in 18 visits to the primary training site over a 2-year period. Program components include competency-based training structured around rotations, mentored projects, and periodic auditing visits to train-in-site locations by program faculty. Main outcome measures are achievement of Accreditation Council for Graduate Medical Education Occupational Medicine Milestones, American College of Occupational and Environmental Medicine competencies, performance on the American College of Preventive Medicine examinations, diversity in selection, placement of graduates, and the number of graduates who remain in the field.


Since inception of this program in 1997, there have been 109 graduates who comprise 7.2% of new American Board of Preventive Medicine diplomates over the past decade. Graduates scored competitively on the certifying examination, achieved all milestones, expressed satisfaction with training, and are geographically dispersed, representing every US region. Most practice outside the 25 largest standard metropolitan statistical areas. More than 95% have remained in the field.


Training in place is an effective approach to provide midcareer physicians seeking comprehensive skills and board certification in occupational medicine formal training, and may be adaptable to other specialties.

[Available on 2018-10-01]

Conflict of interest statement

Conflict of interest: The authors declare they have no competing interests. This article is based on an oral presentation at the International Conference on Residency Education, Ottawa, Ontario, Canada, October 18–20, 2012, and on a poster presentation at the American College of Occupational and Environmental Medicine Conference, San Antonio, Texas, April 27–30, 2014.

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