Help me understand internship year?

[deleted849476]

I have general questions about internship years for DO's and found KCOM graduates to be a good model given the match list they release. KCOM's match list. For particular residencies, I see they list an OGME-1P "preliminary internship year" and an OGME-1T "traditional internship year" depending on the specialty. My questions:

1) Do all residency programs (or are they considered internship programs?) draw this same distinction (between 1P and 1T)?
2) If you start in one of the above intern year options, are you functionally/effectively restricted to specialties that typically follow those intern years? (Like if doing an OGME-1T then you must do either Derm or public health?) Or could you theoretically switch without having to do the other's internship year?
3) I did a quick google of specialists, for example, neurosurgeons, from KCOM and found most of them did an "internship year" (listed on their education sections of their employers' sites); however, KCOM doesn't list neurosurgery as a specialty that doesn't require an internship year. Why did they do it? To bolster their neuro app or did something change since they graduated?
4) Do you have to match into internship year, and then match again into your desired specialty? (Or do you match into the specialty once and they simply have you do an "internship year"; I'm guessing the former.)
5) If I'm right about the above, what do people do who did an internship year and then simply don't match their specialty. I imagine someone shooting for derm, doing OGME-1T internship and then not matching derm and just matching IM or something (and kind of "wasting" a year because they could've matched IM in the first place--no intern year.)
6) Are intern year spots as competitive as the residencies they prelude?
7) Knowing that interns are super low on the totem pole, do they focus on clinical skills, research, or mostly observing?

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[paradoc]

Your thought process seems to have a pretty large gap in understanding of the big picture, but quickly,
-TRIs- less competitive, often only offered by former AOA sites, not all provide the necessary rotations to satisfy a true intern year requirement (8-9 months inpatient/wards), can sometimes serve as intern year for medicine-based residencies but often on a case by case scenario. Several of my classmates scrambled into one of these residencies because they were undecided as to specialty or didn’t match, and most of the ones who went through the match the following year started over as PGY1s. Can often pick and choose different rotations to work, with minimal inpatient requirements
-Med internship/prelim: more rigorous and structured than a TRI, will always satisfy requirements for intern year per advanced programs. Competitive as most often filled by derm/rads/etc or other advanced programs. If for some reason someone did a 1 year internship and decided to continue in IM, they’d do so as a second year and not often repeat their internship
-Surg internship/prelim: usually reserved for either advanced surgical specialties ie NSGY to complete a year of gen surg before starting NSGY training, or, more commonly (since most NSGY spots are categorical), reserved as a pool for unsuccessful surgery applicants to work for a year in a surgery resident. Unfortunately, these very rarely result in obtaining a categorical spot, and are more often the scut workers of that particular residency-minimal OR time since this is preferentially given to categorical residents, and more charting, rounding, and other stuff surgeons don’t want to do. This is a generalization but nonetheless the general impression. Some (few) are able to shine and land a categorical spot, but again, not common.
As far as what interns do, I wish you luck in finding out one day. I can promise you that all of things you said are intern duties except ‘just observing’- at the end of the day you are being paid and no one is going to pay you to sit around and just observe for a year. It is a job at the end of the day.

TLDR-use the search function next time.

 

[hallowmann]

So KCOM actually segregated this list in an interesting way, although it mainly overlaps with the way it is segregated among AOA GME. There are effectively a handful intern years that can be done in residency.

1. Categorical residency intern year - many specialties include an intern year in their training, and generally speaking that year is the time during which you get broader training, more time on off-service rotations, typically with some emphasis on medicine or surgery. This is described at OGME-1R for KCOM.

2. Preliminary intern year - these are structured such that they serve as a pathway to certain specialties, segregated into preliminary medicine and preliminary surgery. Certain residencies offer primarily advanced positions (e.g. Anesthesia, Radiology, Neurology, etc.). While many programs may offer categorical training which include an intern year, for many you have to match both an intern year and an advanced position simultaneously. For example if you are class of 2020, you would match an intern year for 2020-2021 and an advanced position for 2021-duration of training. KCOM describes this as OGME-1P because that's generally the case. Generally speaking Preliminary years are actually usually less competitive, because among most US MDs, TYs or Transitional Years are more desirable because they are generally less rigorous/have less scut work than a prelim medicine or surgery year. Prelim medicine is certainly more competitive than prelim surgery, because of the description given by paradoc.

3. Transitional Year/Traditional Rotating Internship - there is a divide here between AOA accredited training (which basically doesn't exist anymore) and ACGME accredited training. TRIs were primarily osteopathic intern years. They could be used as prelim years, training required for licensure in specific states, or as a last ditch effort for people who failed to match so that they could reapply the next year without a gap in training. In addition, for Derm in the AOA system, you could only apply for AOA Derm while in an internship (the same is generally true for Preventative Medicine in both AOA and ACGME training). TYs on the other hand are highly competitive intern years in the ACGME system that can serve as an intern year for most advanced positions, including Derm, Ophtho, RadOnc, Rads, etc. In the ACGME, you apply for both the TY and the advanced position at the same time the same way you would for the prelim year above. TYs are competitive because they are generally "lighter" in the sense of inpatient medicine or surgery months than traditional prelim years with more elective and outpatient time, and the top applicants compete aggressively for those positions. All TRIs that made the transition became TYs, so it'll be interesting to see if the dynamic shifts a bit.

Your funding for GME is mildly affected by where your prelim position is (medicine or surgery), but generally its based on the advanced position. If you have to repeat an intern year, for example going from TRI to categorical intern year, then funding is affected slightly.

You are not necessarily locked into any field, you just may have to extend training if you do not fulfill the requirements of that field's intern year.

There is a possibility of not matching your specialty initially and scrambling or SOAPing into an intern year. This generally means you apply again for residency, and in most cases you will repeat at least some parts of the year. Its even possible that you may match an advanced position, but no internship (something that often happens in Neurology), in which case you have to scramble or SOAP into an intern year to continue training and not lose your spot.

All residents complete an intern year. Its usually one of those 3 above. For DOs, there was a time that many states required completion of an AOA or AOA-equivalent intern year in order to get licensed at all, so many people would do one of these first and then apply for residency. This is actually the old way most physicians were trained prior to the explosion of specialties. Now though, only 2 states (PA and FL) require an AOA or equivalent intern year for DO licensure.

An intern is a resident. Generally they have more work than senior residents (who usually have less work, but more responsibility), but this varies by specialty. You aren't doing much research or any observing during intern year.

 

[ciestar]

Your thought process seems to have a pretty large gap in understanding of the big picture, but quickly,
-TRIs- less competitive, often only offered by former AOA sites, not all provide the necessary rotations to satisfy a true intern year requirement (8-9 months inpatient/wards), can sometimes serve as intern year for medicine-based residencies but often on a case by case scenario. Several of my classmates scrambled into one of these residencies because they were undecided as to specialty or didn’t match, and most of the ones who went through the match the following year started over as PGY1s. Can often pick and choose different rotations to work, with minimal inpatient requirements
-Med internship/prelim: more rigorous and structured than a TRI, will always satisfy requirements for intern year per advanced programs. Competitive as most often filled by derm/rads/etc or other advanced programs. If for some reason someone did a 1 year internship and decided to continue in IM, they’d do so as a second year and not often repeat their internship
-Surg internship/prelim: usually reserved for either advanced surgical specialties ie NSGY to complete a year of gen surg before starting NSGY training, or, more commonly (since most NSGY spots are categorical), reserved as a pool for unsuccessful surgery applicants to work for a year in a surgery resident. Unfortunately, these very rarely result in obtaining a categorical spot, and are more often the scut workers of that particular residency-minimal OR time since this is preferentially given to categorical residents, and more charting, rounding, and other stuff surgeons don’t want to do. This is a generalization but nonetheless the general impression. Some (few) are able to shine and land a categorical spot, but again, not common.
As far as what interns do, I wish you luck in finding out one day. I can promise you that all of things you said are intern duties except ‘just observing’- at the end of the day you are being paid and no one is going to pay you to sit around and just observe for a year. It is a job at the end of the day.

TLDR-use the search function next time.

With prelims looking for categorical spots.. (such as GS), you might only match into a PGY-1 spot, not a PGY-2, and have to be a categorical intern the second time around.

 

[libertyyne]

Nothing to add except neurosurgery doesn’t do a surgical intern year anymore, instead they do intern years at the neurosurgical program. So you only apply to one program and do not apply to a separate prelim year.