Difference between preliminary year and transitional year

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silas2642

silas2642
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I've noticed on match lists that a lot of people enter transitional/preliminary years before they start their residency. Why are there prelim/transitional years, who are they for, do you match to get these spots, is your performance during this year affect your position as a resident the following year? Anyone?
 
silas2642 said:
I've noticed on match lists that a lot of people enter transitional/preliminary years before they start their residency. Why are there prelim/transitional years, who are they for, do you match to get these spots, is your performance during this year affect your position as a resident the following year? Anyone?
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There are two types of residency programs: Categorical and Advanced. Categorical programs begin as a PGY-1, ie, when you graduate med school, you go directly into the program. Programs which are like this include Internal Medicine, General Surgery, Pediatrics, Ob/Gyn, FP, EM, etc. Other programs are Advanced, which means that they don't begin until PGY-2. This means that you have to do either a Prelim or Transitional year as you intern year. Transitional year consist of a year mixed with rotations in all different specialties, like IM, surgery, radiology, EM, anesthesias, etc. It's almost like another year of med school in the fact that you are rotating through all these different departments. A Prelim year consists of a one year program concentrated in a certain area ie an Internal Medicine prelim year, or a Gen Surgery prelim year. Whether you need to do Transitional year or a Prelim year depends on which residency program you choose, some prefer one over the other. Generally, when you apply for residency, you apply for both the the Prelim/Transitional year and the Advanced program at the same time.
 
Bump. Would I end up taking out more loans in a transitional year? Or would I get the standard resident pay (like $40K or somthing)? Or something totally different? 😕

Just curious.
 
pianola said:
Bump. Would I end up taking out more loans in a transitional year? Or would I get the standard resident pay (like $40K or somthing)? Or something totally different? 😕

Just curious.
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You're worrying way too far in advance 😉

A transitional yr (or TY for short) IS like any other internship in terms of accreditation, etc. Many ppl describe it as 3rd yr again, but I beg to differ. TYs differ in what is required, but most have about 6 months of medicine wards. +/1 surgery month(s). =/- pediatric(s) months. Generally, at least 3 months of electives, as much as 5. Some are "cush", and some are as hard as a prelim medicine yr. TYs are great because you can get some exprerience in other fields that are more relevant to your advanced program.

Most advanced residency programs will let you do prelim medicine, a TY, a surgical prelim, or even a peds prelim.
 
pianola said:
Bump. Would I end up taking out more loans in a transitional year? Or would I get the standard resident pay (like $40K or somthing)? Or something totally different? 😕

Just curious.
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Preliminary year is your first year of residency. Ignore the labels. You get paid as a PGY-1, and are a PGY-1, whether you are in a preliminary/transitional or categorical path. You are an intern. You get the same pay the hospital pays for other interns. The only difference is that instead of advancing to PGY-2 in that medicine or surgery program, you will go to another department/hospital for your next year, to start your advanced residency.
 
All PGY-1s at any given program get paid the same amount, regardless of specialty. Transitionals/Prelims fall under this umbrella.
 
Transitional year is much easier in two ways: one, you don't have continuity clinic, so you don't have endless T-cons; and, two, you don't get used to fill in call schedules (i.e. on outpatient rotations were outpatient rotations, so you had weekends off, versus a certain other program where you would be Q3 and Q4 on inpatient call... while in ambulatory clinic) (they managed to square it because post call you can still see clinic as long as it is "continuity clinic" with the assumption you're familiar with them so being up 30-35 hours won't really matter so much ...even if you've never seen your "continuity" patient before) :laugh:

The rough part is you're the red-headed stepchild, so while everyone in the program and staff know each other, you're constantly the new guy and thus sort of ignored in a friendly way (medicine) at best, to being the rotation bitch (surgery) at worst.
 
My preferences:

1. TY program -- cush
2. TY program -- less cush
3. prelim med year -- cush
4. categorical medicine program -- cush

5. quitting medicine altogether

6. prelim med year -- not so cush

7. torture

8. prelim surgery program -- not so cush

9. amputation of one extremity per week, no anesthesia, no pain meds

10. categorical medicine program -- university based

11. lowest level of hell for all of eternity

12. general surgery residency

http://www.youtube.com/watch?v=NA1Oe_akC_0
 
AF_PedsBoy said:
Transitional year is much easier in two ways: one, you don't have continuity clinic, so you don't have endless T-cons; and, two, you don't get used to fill in call schedules (i.e. on outpatient rotations were outpatient rotations, so you had weekends off, versus a certain other program where you would be Q3 and Q4 on inpatient call... while in ambulatory clinic) (they managed to square it because post call you can still see clinic as long as it is "continuity clinic" with the assumption you're familiar with them so being up 30-35 hours won't really matter so much ...even if you've never seen your "continuity" patient before) :laugh:
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I'd say the majority of Prelminary medicine years I looked at did not have a continuity clinic requirement for prelim interns, but I'm sure it happens. There is often a "convenient/prompt care" type outpatient month, though.

I'd say the biggest benefit I've noticed peripherally (not going through it) is that there's a difference of philosophy in how a transitional year vs. prelim medicine resident is approached. Transitional year, they know you're not going into medicine, you want to do radiology or anesthesia or what have you, so they they help you meet your requirements as painlessly as possible. Prelim medicine, you're just "one of the interns" and treated as such, and have equal demands.
 
So... there are actually a lot of opinions on transitional vs prelim. Wanted to put a few things out there before we all jump on the same wagon. 🙂

1. Some attendings feel differently. I've had mentors say, "just do a transitional year to goof around, you'll get all the real training you need later." But I've also had mentors tell me that a prelim year should be required. (I'm going into anesthesia.) One even told me that his program, MGH, only seriously considers applicants who are applying for prelim programs. (Now, I have no idea how they assess that, and his information may be outdated.)

2. My personal dilemma. Two amazing programs in the same location-- one transitional and one prelim. While everyone instinctively seems to know that transitional programs are more cush, I can't get over the absence of overnight call at the prelim. The prelim has gorgeous new facilities, a ton of good tech, and amazing ancillary staff. The transitional program is a county hospital where there are some serious complaints about parking, food and finding charts-- but all the elective time seems to really compensate. Both have amazing didactics, are affiliated with the same major university, and insanely happy interns. The difference in elective time turns out to be 5 wks. What would you do?

Personally, I know where I'm leaning, and that I can't lose if I manage to match to either. But I'd love to hear how much people value elective time and flexibility versus nice amenities, ancillary staff and no overnight call.
 
error404 said:
1. Some attendings feel differently. I've had mentors say, "just do a transitional year to goof around, you'll get all the real training you need later." But I've also had mentors tell me that a prelim year should be required. (I'm going into anesthesia.) One even told me that his program, MGH, only seriously considers applicants who are applying for prelim programs. (Now, I have no idea how they assess that, and his information may be outdated.)
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I had an anesthesia attending say the intern year should have 4 months of ICU and then EM, Cards, IM, etc to prepare for the anesthesia residency. This would be a transitional year right? Are all TY's created equal in terms of particular rotations or is each program different? Can you pick your own rotations in a TY?
 
Scrub MD said:
I had an anesthesia attending say the intern year should have 4 months of ICU and then EM, Cards, IM, etc to prepare for the anesthesia residency. This would be a transitional year right? Are all TY's created equal in terms of particular rotations or is each program different? Can you pick your own rotations in a TY?
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That's neither a transitional or a prelim... that's just a @#%-ton of ICU.

Both prelims and transitionals tend to have 1 - 2 months of ICU. (Many opt for 2 months because many anesthesia folks want to get their ICU requirements started early.) Both tend to have 1 month of EM and at least 1 month of elective (often anesthesia for the anesthesia folks.) Both have at least 2 months of IM, where many prelims have about 6 months and many transitionals have about 3. Transitionals have months of OB, peds and surgical rotations (and sometimes radiology) that prelims don't. Both seem to usually have an ambulatory month or two also.

But all programs are not created equally, and the schedules can vary a lot.
 
error404 said:
That's neither a transitional or a prelim... that's just a @#%-ton of ICU.

Both prelims and transitionals tend to have 1 - 2 months of ICU. (Many opt for 2 months because many anesthesia folks want to get their ICU requirements started early.) Both tend to have 1 month of EM and at least 1 month of elective (often anesthesia for the anesthesia folks.) Both have at least 2 months of IM, where many prelims have about 6 months and many transitionals have about 3. Transitionals have months of OB, peds and surgical rotations (and sometimes radiology) that prelims don't. Both seem to usually have an ambulatory month or two also.

But all programs are not created equally, and the schedules can vary a lot.
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I think I would shoot myself if my transitional program made me do that much. We have 1 month IM, 1 month ICU, 1 month clinic, 1 month EM, 2 more months where you do something else clinical (maybe an extra EM and an extra clinic). Then your other 6 months are electives.

In the end we have 2 sucky months (wards and ICU), 4 that are annoying, but tolerable, then 6 where you can actually do something somewhat relevant to the rest of your life. I am very thankful to be where I am. If I have to waste a year of my life doing this, it should at least be as laid back as possible and pretend to be relevant to my future career.
 
In some cases TY and Prelim medicine programs can be almost exactly the same, when they are at the same institution and have equal call free months.

In general though, the TY programs tend to be at smaller community hospitals and on average have fewer months of inpatient medicine (and less likely to have specialty rotations like Cardiology) and more months of call free electives than Prelim Medicine, which are often at the university hospitals.
 
BTW - Anesthesia and Radiology are ****ing up Transitional Years for everyone with their demands of mandatory ICU months, which the rest of us going into fields like PM&R aren't interested in. The program directors are being forced to cater to this though because they would otherwise miss out on many candidates.
 
I'd go with the nicer facility and better ancillary staff, especially if you toss in no overnight call.
 
Llenroc said:
BTW - Anesthesia and Radiology are ****ing up Transitional Years for everyone with their demands of mandatory ICU months, which the rest of us going into fields like PM&R aren't interested in. The program directors are being forced to cater to this though because they would otherwise miss out on many candidates.
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AFAIK, radiology accreditation makes no such requirement for ICU rotation during internship.

The only stipulation I'm aware of is that you can do no more than 3 months of any combination of radiology, radiation oncology, or pathology and still be eligible for ABR certification.

ABR Initial Certification Requirements
ONE YEAR IN CLINICAL TRAINING

The first postgraduate year must be accredited clinical training in internal medicine, pediatrics, surgery or surgical specialties, obstetrics & gynecology, neurology, family practice, emergency medicine, transitional year, or any combination of these. No more than a total of three months may be spent in radiology, radiation oncology, and/or pathology. All clinical training must be in an ACGME-, AOA-, or RCPSC- approved program (or equivalent).
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Last edited:
Amxcvbcv said:
AFAIK, radiology accreditation makes no such requirement for ICU rotation during internship.

The only stipulation I'm aware of is that you can do no more than 3 months of any combination of radiology, radiation oncology, or pathology and still be eligible for ABR certification.

ABR Initial Certification Requirements
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Is that new(er)? I ask because one of my good friends is now a neurorads and ABR certified, and she did a transitional year with 4 ICU months and 8 electives, and she did variable things in rads, but never the same thing twice, and more than 3. This was 7 years ago, though.
 
Apollyon said:
Is that new(er)? I ask because one of my good friends is now a neurorads and ABR certified, and she did a transitional year with 4 ICU months and 8 electives, and she did variable things in rads, but never the same thing twice, and more than 3. This was 7 years ago, though.
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I honestly don't know. I didn't start looking until about 3 or 4 years ago when I decided on radiology for sure.

By the way, I fixed the link in my previous post, so that it now goes to the source.
 
sorry if this has been asked already, but I know it hasn't been discussed in this thread because I read all of it:

if I want to do neurlogy...I know some neuro programs are already 4 years so I don't have to worry about the whole TY vs. prelim yr. but some neuro programs on FRIEDA are 3 years and start as PGY2...do I need to do a prelim yr. or a TY for those??? or is it program dependent??? b/c I honestly might die if I have to do OB/GYN again!!!!!!!!!

thanks,
 
candyland said:
sorry if this has been asked already, but I know it hasn't been discussed in this thread because I read all of it:

if I want to do neurlogy...I know some neuro programs are already 4 years so I don't have to worry about the whole TY vs. prelim yr. but some neuro programs on FRIEDA are 3 years and start as PGY2...do I need to do a prelim yr. or a TY for those??? or is it program dependent??? b/c I honestly might die if I have to do OB/GYN again!!!!!!!!!

thanks,
Click to expand...

This was as close as I could come to finding out what's required.

http://www.acgme.org/acWebsite/RRC_999/999_SpecialtySpecificRequirementsPGYCBY.pdf

It really comes down to what your specialty board wants you to have in order to meet their standards for initial certification. You can do an transitional year, as far as I know, just make sure your rotations meet the requirements, so you don't have to repeat it.
 
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