Internship

[HeyThereJude]

I originally posted these questions on another thread, but maybe they are more appropriate here. I am a med student and it will be a few years till I apply to internship/residency, but I am a bit confused about a few terms I have heard thrown around, and was wondering if anyone could help clear things up by answering these questions about transitional vs prelim year:

-What specialties do a prelim and which a transitional? Are there some that require one over the other? Is one only for people unsure of what specialty they want to go into?

-If you are a PG-1 are you always either doing a transitional or prelim year, instead of just being in residency?

-Does one look better than the other? Is one more strenuous than the other?

-When is one more useful than the other? Is there a benefit of one over the other?

-Do some specialties require you to do one or the other?

-To my understanding, you apply to either prelim or transitional AND PG2 at the same time. Is this always the case?

-I have heard that the transitional year buys some people time to decide what field they want to go into, but how is this possible if you must apply to both at the same time?

-Who would go into “medicine preliminary”?

-How come so many people do their intern year and PG-2 at the same institution? Does that mean they just happened to get into both programs, or is it because once you get into one program you get into the other (like intern year gets you into residency there or vice versa?)


Some of these questions probably seem simple, but I haven't been able to get a straight answer, I would really appreciate your help!

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[ShyRem]

You just started medical school a few months ago and you're worried about residency? You don't even know what you want to go into yet... (yeah, I know... "but I DO!" 80% of all med students change their minds in 3rd year).

Start with nrmp.org
Then try looking at frieda for program specifics.

Basically, some specialties require a prelim year. Some don't. Your first year (whether in a categorical residency or in a prelim year) is called your intern year. If you need a prelim year and then a residency, it may or may not be at the same place, or even in the same city. Otherwise, for things like IM or FM, you do all your residency years in the same place unless you don't get renewed or transfer out.

You really shouldn't worry so much about this until 3rd year at the very earliest. Worry about grades and step scores for now. Once you figure out what you want to go into while in third year then these questions become much easier to answer since they're more direct and not quite so large in their scope.

 

[SouthernSurgeon]

I agree with shyrem that there is really no point in worrying about all this now; your understanding of the process will naturally increase with time/exposure. That said, here's a crack at most of your questions:

-What specialties do a prelim and which a transitional? Are there some that require one over the other? Is one only for people unsure of what specialty they want to go into?

Prelim years are done either in IM or general surgery. Some types of programs will require a specific type of prelim year (i.e. neurology will require you to do a medicine prelim year).

I don't know of any field that specifically requires a transition year - most fields just require either/or prelim or TY and don't care which you do (fields like ophtho, derm, rads).

Neither of these are for people who don't know what they are going into. Both prelim and transition year are for people who matched into an advanced categorical position in any number of fields (or for people who failed to match at all)

To summarize, backing up a step:

Residencies broadly fall into two categories:
-Programs that start straight away at the PGY-1 level
-"advanced" programs that start at the PGY-2 level but require you to do a (usually separate) intern year in one of the aforementioned categories (TY or prelim IM or prelim surgery). I don't have an exhaustive list of these fields, but they include derm, rads, ophtho, and neurology.

-If you are a PG-1 are you always either doing a transitional or prelim year, instead of just being in residency?

No. For most fields you are just "an intern" in the program; you are not doing either a prelim or transition year.

-Does one look better than the other? Is one more strenuous than the other?

There is not really any "looking better" in these fields since they are just an internship prior to starting your advanced categorical residency (**disclaimer - I am talking solely about designated prelims...see below for a brief overview of undesignated prelims which are a different bag)

Typically, the difficulty level goes: prelim surg > prelim med > TY. However this varies by individual program (i.e. there will be some "tough" transition year programs and some easy prelim programs)

-When is one more useful than the other? Is there a benefit of one over the other?

Largely depends on your interests. Some would argue that if you are going into a "hands-on" field like ophtho you might benefit more from a prelim surgery year.

-Do some specialties require you to do one or the other?

Yes. I am not going into any of these fields so I don't have an exhaustive list. But I know for example that neuro requires a prelim medicine year.

-To my understanding, you apply to either prelim or transitional AND PG2 at the same time. Is this always the case?

Yes, except for the case of the undesignated prelim year

-I have heard that the transitional year buys some people time to decide what field they want to go into, but how is this possible if you must apply to both at the same time?

I think at one point that was the idea behind a TY, but nowadays it's not the case.

-Who would go into "medicine preliminary"?

When you look at a match list and see "medicine preliminary" or "surgery preliminary" and no advanced categorical slot, that typically means that they failed to match into what they wanted to go into, or failed to match into an advanced slot (this is what I meant by an undesignated prelim).

-How come so many people do their intern year and PG-2 at the same institution? Does that mean they just happened to get into both programs, or is it because once you get into one program you get into the other (like intern year gets you into residency there or vice versa?)

There are a variety of reasons.
1) Most fields (IM, surgery, peds, ortho, ENT, neurosurg, the list goes on) do not have a requirement for a separate intern year that you would apply for at a different program - you just apply to the residency there and the PGY1 year is called your intern year. Thus all the people going into these fields will spend all their years at the same institution
2) Some fields that require a prelim or transition year will guarantee you a slot at the home institution (for example, my school's neurology program - all the PGY2 neuro matches do their PGY1 prelim year in our IM department)
3) For programs that don't hook you up with a PGY1 spot - typically applicants wanted to be at that program, so it's not surprising that they would want to be there for the PGY1 year as well.

 

[Law2Doc]

...
3) For programs that don't hook you up with a PGY1 spot - typically applicants wanted to be at that program, so it's not surprising that they would want to be there for the PGY1 year as well.

Yeah mainly it's not so much that you "want to be at that program" for prelim, it's that outside of the big cities there tend to not be that many prelims in a region, and it's a real pain in the ***** to pack up and move for one year and then pack up and move for the next bunch. Better to get a prelim at the same place and then stay for the duration. Even moreso if you have a family. So people try to go to the same place because you don't have to uproot. You will always here about the dude who did a cushy TY in Hawaii or Cali to surf for a year, but many people don't have that kind of geographic flexibility and for them it's more about avoiding the hassle of moving, finding a new apt, etc.