UME/GME Program Resources

Fellowship Training and Orientation Activity: No Earlier than July 1

AAIM believes that requiring residents to report for fellowship prior to the completion of residency training is disruptive to medical education, creates unnecessary stress on the residents, and risks violating federal labor laws and/or CMS graduate medical education funding rules. Adoption of July 1 as the earliest start date for all training and in-person orientation activities would resolve conflicts for residents created by variations in timing for institutional orientation programs. 

In-Person Physical Exams and Drug Testing

Residents are not available to begin fellowship activities prior to July 1, as dictated by regulations related to CMS funding support of residents. However, some institutions are instructing residents to report early for onsite requirements, including physical examinations and drug testing. This recent change places unwarranted pressure on programs and residents alike; residents incur extra expense (and illness exposure) for travel, face disruption in their scheduled rotations, and require coverage from colleagues whose schedules are then also disrupted. The ripple effect creates significant challenges for programs to maintain fairness and equity in end-of-year rotation scheduling.

Virtual Onboarding/Orientation

The Alliance encourages fellowship programs to consider what aspects of the onboarding process can be conducted virtually. Critical orientation activities scheduled prior to July 1 can be prerecorded or executed using virtual platforms, provided they are administered independent of resident required duty hours at their current institution. Using commercial services with multiple national and international locations for drug testing and health screening would not require early travel to a new institution.  Some large employers have used these services for many years.

Explain the Impact of Pre-July 1 Start

AAIM developed a letter template to notify fellowship program directors about the repercussions; programs should enhance this correspondence by articulating the pandemic’s impact on their particular institution and learners, as well as support the use of virtual platforms and remote health screening and drug testing services instead of in-person orientation requirements.


The Alliance continues to educate members and encourage alignment with a fellowship start date that is no earlier than July 1. If you have any questions or comments about this guidance, please contact the Education and Research team at or (703) 341-4540.

AAIM Perspectives (June 2015): Adoption of a Uniform Start Date for Internal Medicine Fellowships and Other Advanced Training: An AAIM White Paper