Confused about PGY1

[TheMan21]

So I'm a bit confused about the PGY1 (intern) year. I always thought that after graduating medical school, doctors went directly to residencies. Is PGY1 simply the first year of residency? Maybe I'm misinterpreting what I've recently read, but it seems as if PGY1 is separate from residency and is more of a transitional year from school to real-world practice. After doing a PGY1 at a certain institution, is it a given that a doctor will complete his or her residency at the same institution? Thanks for the clarification.

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[Ludicolo]

PGY1 is the first year of residency, period. There are specialties - internal medicine, general surgery, family medicine, pediatrics, OB/GYN, emergency medicine, pathology - where you start with internship and simply move forward from there. But there are other specialties that traditionally begin in the PGY2 year: examples include PM&R, anesthesia, dermatology, radiology, radiation oncology, neurology, psychiatry, and ophthalmology. For these specialties, a separate first year program to provide base training is required. This can be satisfied with a preliminary medicine or surgery program, or a transitional year program. These are distinct one-year programs. They can be located at the same institution where you ultimately complete your residency, but not necessarily.

To confuse you further, some programs have integrated the first year into their curriculum, so you don’t need to separately apply for a prelim year. These are termed categorical programs. Programs that still require you to complete a prelim year prior to starting are termed advanced programs. Some institutions will offer both advanced and categorical options for the same specialty.

 

[Law2Doc]

So I'm a bit confused about the PGY1 (intern) year. I always thought that after graduating medical school, doctors went directly to residencies. Is PGY1 simply the first year of residency? Maybe I'm misinterpreting what I've recently read, but it seems as if PGY1 is separate from residency and is more of a transitional year from school to real-world practice. After doing a PGY1 at a certain institution, is it a given that a doctor will complete his or her residency at the same institution? Thanks for the clarification.

Agree with the prior post. To try to clarify, PGY-1 is intern year, the first year of residency. You are a resident, you are functioning as a doctor, they give you the long white coat, weekends are a distant memory, your life sux that year.

Some specialties have intern year built in (such that you will continue on for X number of years at that same hospital), but some make you do it separate, often at a different hospital (of your choosing during the match) altogether. The programs where it is not integrated are what are called "advanced" programs -- meaning you match into second year (the "advanced" year), but still have to line up a first year through the match. So to go into the fields the above poster mentioned, you generally have to go on two sets of interviews (advanced, and prelim) and match into two different programs (advanced and prelim). When you do your first year separately, there are basically three choices -- prelim medicine, prelim surgery or transitional. Transitional is a hodge-podge of rotations in different fields, and these TY programs tend to be snapped up by the more competitive specialty folks because they are often regarded as "cushier"/easier. You'd probably only do a prelim surgery path if you were going into something surgically related after intern year (optho, IR?), or if you miscalculated in the match, as this is generally regarded as the harder of the paths. Hope that clarifies. It will seem pretty clear once you are in the thick of it.

the short answer is that prelim year, transitional year, the first year of a categorical residency all = intern year = your first year of residency. There is no "transition" to the real world -- you get thrown into it. The learning curve is steep, but you will know a whole lot once you get through it.

 

[TheMan21]

PGY1 is the first year of residency, period. There are specialties - internal medicine, general surgery, family medicine, pediatrics, OB/GYN, emergency medicine, pathology - where you start with internship and simply move forward from there. But there are other specialties that traditionally begin in the PGY2 year: examples include PM&R, anesthesia, dermatology, radiology, radiation oncology, neurology, psychiatry, and ophthalmology. For these specialties, a separate first year program to provide base training is required. This can be satisfied with a preliminary medicine or surgery program, or a transitional year program. These are distinct one-year programs. They can be located at the same institution where you ultimately complete your residency, but not necessarily.

To confuse you further, some programs have integrated the first year into their curriculum, so you don’t need to separately apply for a prelim year. These are termed categorical programs. Programs that still require you to complete a prelim year prior to starting are termed advanced programs. Some institutions will offer both advanced and categorical options for the same specialty.

Is it generally better to match into the categorical programs? I suppose that doing so would eliminate the hassle of having to do 2 sets of interviews (one for PGY1 and one for the rest of residency), but are there other advantages? If one does not get matched into their residency of choice during M4, is it possible to go ahead and do the intern year wherever possible, excel, and then try to match into a desired specialty again? Thanks again for the advice.

 

[Law2Doc]

Is it generally better to match into the categorical programs? I suppose that doing so would eliminate the hassle of having to do 2 sets of interviews (one for PGY1 and one for the rest of residency), but are there other advantages? If one does not get matched into their residency of choice during M4, is it possible to go ahead and do the intern year wherever possible, excel, and then try to match into a desired specialty again? Thanks again for the advice.

Yes, assuming we are talking IM or surgery, if you are going into such a field which has both prelim and categorical, it's generally better to match the categorical. You only do a prelim path for three reasons that I can think of (1) you need it for an "advanced" path, or (2) you didn't get categorical and are hoping to match in that specialty without redoing the internship by proving yourself, (3) you didn't get what you want and are using this as a fallback, and are going to apply through the match again with some residency experience in your ECs. There are many cases where someone didn't get into, say, surgery, and so did a prelim in surgery, reapplied to the match and matched into categorical surgery (sometimes having to start internship over again). You do what you gotta do. But no, prelim is rarely a target, generally just a means to an end. You either need it for an advance program, or you need it to prove yourself in a year where you didn't land categorical. Nobody comes out of med school shooting to do prelim.

 

[Doctor Bob]

You only do a prelim path for three reasons that I can think of (1) you need it for an "advanced" path, or (2) you didn't get categorical and are hoping to match in that specialty without redoing the internship by proving yourself, (3) you didn't get what you want and are using this as a fallback, and are going to apply through the match again with some residency experience in your ECs.

Reason #4: you get into 4th year of med school and still have no idea what residency you want to pursue, so you do a prelim year after graduating as a way to give yourself more time to think things through without committing yourself to a categorical program.

 

[RxnMan]

I'm still a bit confused about it being called internship if you're a PGY-1. I guess because the US and mexican systems are so different. My intern year was one where you rotate different services (in fact everyone's internship in Mexico is like this, the difference is that students with better grades on selection day have a wider selection of hospitals to do it in). Some rotations were cushy and I was able to slack and take naps a lot because there's so little real work, others were killers where you were moving nonstop for 2 months, but let you have a taste of everything.

I assume if I got into a US residency I'd be "repeating" internship again, but in the case you do an IM or surgical PGY-1, I wonder if it's similar to how first year mexican residencies work or more how my internship was like. I guess I won't know unless I actually live it.

If for example, you go for OB/GYN, which of the two internship years do you do? Or is it OB/GYN from the start??

In the US, you do a college degree (BA, BS, whatever). Then you do four years of medical school. At that point, you're called Dr, and should you be in a residency, you'll have a license to practice. We refer to that first year of residency as our internship or PGY-1 (post-grad year one).

Your're getting caught up on the name. Our use of the word internship is different from your's. We are a HO during our 'internship,' where your 'internship' sounds similar to the clinical rotations we do during our MD degree. The content and level of responsibility is completely different.

As another example - I did an internship as an engineer following my first years out of undergrad. Should I do an internship after med school? Of course, because the job description and responsibilities are completely different.

In the US, each specialty training path is different. OB/Gyns do a total of 4 continuous years, the first year is referred to as intern year. Radiologists and anesthesiologists do three years, but they have you do a one-year internship before you start residency (i.e. 1 + 3). You'd have to investigate each training path to make sure you're applying correctly.

 

[N-Surge]

Reason #4: you get into 4th year of med school and still have no idea what residency you want to pursue, so you do a prelim year after graduating as a way to give yourself more time to think things through without committing yourself to a categorical program.

TY might be better in this case. But you will still need to figure things out during the first part of the TY. Prelim options that I know of include a full year of either IM (with some scattered IM specialty rotations) or Surgery. TY allows for more options, kind of like an M5 year imo.

 

[howelljolly]

Is it generally better to match into the categorical programs? I suppose that doing so would eliminate the hassle of having to do 2 sets of interviews (one for PGY1 and one for the rest of residency), but are there other advantages? If one does not get matched into their residency of choice during M4, is it possible to go ahead and do the intern year wherever possible, excel, and then try to match into a desired specialty again? Thanks again for the advice.

Again, this depends on the specialty. E.g, OB/Gyn only has categorical programs. E.g. Surgery as categorical and prelim. E.g, Emergency Med has Categorical and advanced E.g. Ophthalmology has only advanced (lets say, for the sake of explanation) If you wanted OB/Gyn, you'd only be applying categorical, and this would be a non-issue. Your first year of OB/Gyn residency would be considered your Internship. If you wanted Surgery, you'd apply to categorical surgery. You might also apply to prelim, but this is another long story, and not really a good idea. IF you didnt match into categorical Surgery, you can scramble into prelim surgery, and re-apply for categorical surgery for the following year. If you wanted Emergency Med, you can apply to either, or, or both. If you apply to only categroical, its one stop shopping. If you apply to advanced or both, you'd also have to apply to a Prelim medicine, Prelim surgery, or Transitional to get your Intern year done. If you want optho, you would apply to advanced optho as well as prelim surgery (or other PGY-1/internship) simultaneously. I suppose that asking about advantages would only come in the Emergency Med type scenario.... I think the only real advantage might be that the specific program you like the most just happens to be advanced rather than categorical. Second question... Yes.... see the above Surgery example.

 

[howelljolly]

I'm still a bit confused about it being called internship if you're a PGY-1. I guess because the US and mexican systems are so different. My intern year was one where you rotate different services (in fact everyone's internship in Mexico is like this, the difference is that students with better grades on selection day have a wider selection of hospitals to do it in). Some rotations were cushy and I was able to slack and take naps a lot because there's so little real work, others were killers where you were moving nonstop for 2 months, but let you have a taste of everything.

I assume if I got into a US residency I'd be "repeating" internship again, but in the case you do an IM or surgical PGY-1, I wonder if it's similar to how first year mexican residencies work or more how my internship was like. I guess I won't know unless I actually live it.

If for example, you go for OB/GYN, which of the two internship years do you do? Or is it OB/GYN from the start??

Yes, as others have said your definitions are different - Internship means different things in the US and Mexico.... and this difference is what caused the formation of the Fifth Pathway program in the US.... for American students who went to med school in Guadalajara.

In the US, one gets a Bachelors Degree, then goes to med school for an MD which takes 4 years (M1-M4). Next they do Internship AND/OR residency (PGY1-PGYx)

In Mexico (and some other countries), an "internship" is required for graduation from Med school... you have M1 to M5. M1-M4 are similar to the US, and M5 is your Internship. Then you get your MD. Then you start PGY-1 I suppose.

The Fifth Pathway was started so that Americans can return stateside after their M4 in Mexico, and do the 5th pathway for one year. What they did in the US was similar to what they would have done in their M5 "internship" in Mexico. After they completed the 5th Pathway, the US (via the NY Dept. of Education) would send their certificate to Guadalajara, and their MD would be granted.

So, they are two different things. In Mexico, the internship is part of med school, whereas in the US its part of post-graduate training. In Mexico its a rotating internship which is similar in content to an American Transitional Year. American Prelim years are either in general adult Medicine or General surgery. In Mexico, an Intern is still a med student. In the US, an Intern is a physician.

If you want to do OB/Gyn... all the programs are categorical. You'd only apply to OB/Gyn. Your first year of residency = PGY-1 = OB/Gyn internship

 

[Law2Doc]

... In Mexico, the internship is part of med school, whereas in the US its part of post-graduate training. In Mexico its a rotating internship which is similar in content to an American Transitional Year. ...

I don't know -- from what Vasca described (paired with other things I've heard), it sounds a whole lot more like "rotations", aka "clerkships" than a transitional year. Honestly, if you are still a student, your experience is night and day different than it would be if you were a doctor because the expectations are so different, the support/back-up system is so different. So I'd say in mexico internship sounds like it equals clerkship, and internship in the US is PGY-1 regardless of whether you do it as a prelim, TY or categorical. Night and day. I think folks are getting hung up on the semantics of the word internship, which exists as different things both in and out of medicine. In medicine in the US it is your PGY-1 year, the year with the steepest learning curve, the one where you are worked hard and your life is in the hospital, whether you want it to be or not. Nothing before you graduate from med school is going to compare, regardless of where in the world you are doing med school for the simple reason that students are always going to be treated/protected/coddled like students, whereas doctors have a level of expectation, duty and responsibility above and beyond this threshold, which basically changes the job description in immeasurable ways.

 

[howelljolly]

I'm heavily surprised the Guadalajara students would even be able to get their MD in just 5 years...

4 years really (+1 in the US, at an American med school) The required "internship to graduate" AND the year of required rural/under-served medicine was are/were covered by the Fifth Pathway program.

Actually one of the reasons for the foundation of the Fifth Pathway back in '71 was because doctors were getting killed while on their year or social-service. Just last year I heard from a UAG student that this is still an issue.

 

[smq123]

Hrm... I rotated hospitals and did call a few times as a student, and being a mexican style intern is more like a transition between a clerkship and a resident.

Yep, what you described is pretty much what I did as a 3rd/4th year medical student. I took call (more than just a "few" times ). I saw consults. I did procedures. The only things I didn't do was take vitals (which is what techs and MAs do), and I didn't do anything to the patient without having the attending see the patient first (which is a medico-legal thing).

But otherwise, it really does seem like a Mexican "intern" is basically equivalent to a US MS3/MS4.

 

[SouthernSurgeon]

But otherwise, it really does seem like a Mexican "intern" is basically equivalent to a US MS3/MS4.

Yes. Based on all vasca's past posts I would def agree. The experiences she describes as a mexican M3/M4 are vastly different than what we do during our clinical years, and their "internship" is similar to the clinical years of an MD program in the states.

 

[thedrjojo]

Is it generally better to match into the categorical programs? I suppose that doing so would eliminate the hassle of having to do 2 sets of interviews (one for PGY1 and one for the rest of residency), but are there other advantages? If one does not get matched into their residency of choice during M4, is it possible to go ahead and do the intern year wherever possible, excel, and then try to match into a desired specialty again? Thanks again for the advice.

i think what is being asked is for programs with advanced and categorical is it better to get a categorical or advanced? i think mostly it is preferable to get the categorical because like you said less interviews and less moving (once vs twice). the biggest thing for advanced might be for those that because of family dont want to move until year 2(spouse in med school year earlier... maybe less than 1% of students... of the 160 in my class i know of 3 such couples but none of them are doing advanced programs...) or if you want an easier 1st year (categorical program may be straight im or include icu or surgery while most transitional years are considered easier).