Its pretty poor form to not tell your program that you are leaving...regardless of specialty change or desire to work in another program. Not to say that she has to tell them right when she starts...but certainly a few month prior to the match. A program needs some time to fill the void that is left...and leaving a program shorthanded can put extra strain on the remaining residents. It may work out...as it has in my program, that a prelim medicine person might want to go categorical...therefore, she may want to take the prelim spot, thus problem solved. Anyways, a year in internal medicine might not be a bad thing, since most of the surgeons and surgical subspecialists I have dealt with of late lack even basic understanding of medical diagnosis and therapeutics, which compromise complete patient care.