The Neglected Curriculum: A Systematic Review of Financial Literacy in Medical Training

Background: Financial literacy is important for medical professionals, affecting career choices and well-being. Despite its importance, formal financial education remains rarely included in medical training. This systematic review examines how financial literacy progresses from medical school through residency and into attending practice, and evaluates interventions designed to improve literacy at different career stages. Methods: We searched the Semantic Scholar database to identify papers addressing financial literacy in medical trainees. After screening against inclusion criteria, we included 32 papers for full review. We extracted data on study design, participant characteristics, financial literacy measurements, and key findings related to literacy progression. The studies spanned from 2007 to 2024 and the majority utilized cross-sectional survey study design (19). The population covered medical students (7 studies), residents (20), fellows (4), and attending physicians (4). Geographic distribution included the United States (25 studies), India (3), Canada (2), South Africa (1), and Turkey (1). We analyzed financial literacy development throughout the training pipeline and assessed educational program effectiveness at different career stages. Results: Our analysis revealed a clear developmental progression of financial literacy throughout medical training. First-year medical students scored lowest (38-45% correct on assessments), with scores gradually improving through medical school (50-60% by graduation), residency (65-73% for early residents, 70-79% for senior residents), and into practice as attending physicians (75-85%). This trajectory demonstrated that financial knowledge accumulates with professional development. The progression was most pronounced in practical topics like loan management, while complex concepts like investment strategy showed slower improvement. The transition from senior resident to early-career attending represented a critical period where financial literacy either accelerated or plateaued. Physicians entering private practice demonstrated faster growth compared to those in academic settings, likely due to increased exposure to business management responsibilities. Practice type emerged as more influential than specialty choice, with similar literacy challenges observed across specialties. Gender differences persisted across training levels, with male trainees scoring 10-13% higher than females at all career stages. Socioeconomic background significantly impacted baseline literacy, with trainees from middle or higher socioeconomic backgrounds demonstrating better financial knowledge that persisted through training. However, the socioeconomic gap narrowed somewhat during residency, suggesting structured training environments may partially mitigate initial disparities. Training programs offering even minimal structured financial education showed accelerated literacy growth compared to those without formal curricula. Few trainees had received formal financial education before entering medicine (less than 15% in most studies). Interest in financial education was consistently high across all career stages (over 80% in multiple studies), with attending physicians frequently reporting regret about insufficient financial training. The perceived importance of financial education increased significantly as trainees progressed, with senior residents and new attendings rating it nearly twice as important as first-year students. Educational interventions showed effectiveness that varied by career stage. Early medical student interventions produced modest improvements (10-15% increase in assessment scores), while programs targeting senior residents and new attendings achieved more substantial gains (20-30%). The transition to attending practice emerged as a critical “teachable moment” when physicians demonstrated peak motivation for financial learning. Interactive approaches incorporating case-based learning and personalized financial plans showed superior results compared to traditional lectures. Programs with physician instructors having financial expertise demonstrated better outcomes than those staffed by financial industry professionals. The optimal timing for interventions appeared to be during transitional periods: late medical school, final year of residency, and early attending years. Conclusion: Financial literacy demonstrates a clear developmental progression throughout medical training, with scores steadily increasing from medical school through residency and into practice. The trainee-to-attending transition represents a particularly critical period where financial knowledge either accelerates or plateaus depending on the practice environment. Educational interventions show consistent effectiveness when properly timed and designed, with optimal impact during key career transitions. These findings emphasize the need for strategically timed financial education that evolves alongside the physician career lifecycle. Future studies should focus on defining optimal thresholds for competency, as well as topics of high utility at different career stages. Professional societies should increasingly prioritize assisting physicians to bridge the gap in financial education.