Transitional internship before neurology residency?

[honkfactory]

Anyone out there go into a PGY-2 neuro residency after doing a Transitional internship? I know the usual route is IM internship --> neuro PGY-2.

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[TUGM]

Yes, this is possible. I am currently in my transitional year, and have an advanced position in neurology.. There are strict ACGME requirements if you choose this way.

 

[honkfactory]

That you for replying. What are the strict ACGME requirements?

 

[TUGM]

Article IV.A.4.b.1 ACGME

• 8 months in IM w/ primary responsibility in patient care OR
• 6 months in IM w/ primary responsibility in patient care AND at least 2 months time comprising one or more months of pediatrics, emergency medicine, internal medicine, or family medicine
• NO MORE THAN 2 months of Neurology during this time.

 

[TUGM]

Note that these "months in IM" include subspecialty rotations, e.g. Cardiology, Rheumatology, Pulmonology, Nephrology, Gastroenterology, Infectious Disease, etc. If you want to work harder in your TY make sure to get some cardiology, infectious disease, pulmonology, and/or rheumatology experience.

 

[medstudent7860]

What is the difference between a transitional year, prelim year, and intern year?

 

[TUGM]

They all fit into the category of internship. Intern year is usually every resident's PGY-1. You're at the bottom of the food chain, and you'll have to do some scut and prove yourself to your seniors and attendings before you get some of that good ole RESPECT. For people moving on to specialities, it serves as a bridge to get some general training prior to starting in whatever you're going into (e.g. neurology, radiology. anesthesia, etc). In this scenario, it is called a "preliminary" year.

Preliminary years come in many varieties - preliminary medicine, preliminary surgery, transitional, preliminary pediatrics, preliminary OB/Gyn, etc... I'll speak from a neurology training standpoint, as that is most pertinent on this forum.

Most neurology programs will want you to do a preliminary medicine year. This is usually the same as being a medicine intern. Preliminary surgery years do NOT count for neurology training. Transitional year is another type of preliminary year that has much more elective time. To a certain extent you can pick what rotations you want to take, and they are usually a bit more "cush." For neurology trainees, it hardly makes a difference, because of ACGME requirements - you're still going to do a bunch of medicine rotations.

Therefore, in summary:

Internship = PGY-1 = Preliminary year (if you are matching an advanced program/specialty - derm, ophtho, rads, gas, neuro, etc.)
Prelim years can be divided into TY, medicine, and surgery - which one you do depends on what you're going into.

 

[danielchess_MD]

Can Preliminary Programs for PGY1 still call you for interviews if you are NOT applying for Advanced NEURO in same institution?

 

[TUGM]

Yes.

 

[medstudent7860]

What if you are applying for both Neuro and IM (as a backup) at the same institution? Since Neuro has the prelim, would that IM program find out that you applied both specialties?

 

[TUGM]

What if you are applying for both Neuro and IM (as a backup) at the same institution? Since Neuro has the prelim, would that IM program find out that you applied both specialties?

That's when things get complicated and it's all pretty much shades of grey. Is there any particular reason you're applying to IM as backup? Neurology is honestly no more competitive than IM at academic centers, and it may serve you better to commit to one or the other. There are a couple of IM/Neuro combined programs (e.g. MCW).

If, for whatever your reason, you have to apply to both IM and Neurology at the same program, then you send in your app for Neurology categorical and advanced, IM prelim, and IM categorical. The program directors would most likely be aware of your application to all of these programs, but there is really nothing you can do about that - except have a very good reason why you are applying to both IM and Neurology.

I guess my point is, if you want to do Neurology, just apply for Neurology and a decent number of IM preliminary programs. Categorical IM as a backup really isn't necessary.

 

[danielchess_MD]

Good point! One problem that I have is that many institutions offering Advanced Neurology are not offering (at least I can't find anywhere) preliminary Medicine or transitional PGY1. So, I thought that if I apply to there IM categorical program, if I am call to interview in Neurology I can explain why I applied to their IM program, and I hope they will talk to IM to grant me and interview for that transitional year there.

 

[TUGM]

If there are any particular programs, I can try to help locate some information.

A little bit of history to add perspective - Neurology actually used to be a direct subspecialty of internal medicine. It was an additional fellowship after completing an IM residency. Many years, back this was changed, and training became contracted. The neurology component remained a 3-year training program. Therefore, historically, all programs were advanced, requiring one year of preliminary medicine. More recently, more and more programs are becoming categorical. Some older institutions, especially those in the east coast, yet hold to that previous tradition.

More pertinent to your concern, many of these programs have some arrangements with internal medicine programs. A certain number of spots in the IM department will be reserved for Neurology applicants, or Neurology applicants will be preferred. It is rare for a program to not offer ANY preliminary spots, so it may be a question of just further investigation or inquiry. I would be pro-active and voice your concerns to the Neurology departments in question, as they will be the most accurate resource.

 

[afugazzi]

Following up on the transitional year question: does anyone know which programs DON'T allow transitional years? So far I've seen that Columbia explicitly states it is not allowed. Any others people know of? Also, is it looked down upon or discouraged from doing these even when they are allowed? I'm currently planning on applying to several but I'm not sure if it's a good plan.

 

[TUGM]

Following up on the transitional year question: does anyone know which programs DON'T allow transitional years? So far I've seen that Columbia explicitly states it is not allowed. Any others people know of? Also, is it looked down upon or discouraged from doing these even when they are allowed? I'm currently planning on applying to several but I'm not sure if it's a good plan.

This is the kind of research on programs you should be doing on your own. Reliable data on this kind of information doesn't exist in one big document. Check websites of specific programs and email institutions if you want to confirm or not.

As far as I know, TYs are not discouraged, assuming you adhere to the ACGME guidelines for neurology preliminary years. I'm on TY and doing 8-9 blocks of medicine rotations. The remaining 4-5 blocks are electives. So far it's been excellent, and has given me an opportunity to get Step 3 out of the way, start on some research proposals/case reports, and get further acquainted w/ subjects like radiology, spine surgery, pain management, etc in conjunction w/ general medicine, cardiology, ID, etc. Most programs probably want you to do medicine years so they don't have to worry about you not meeting requirements, but there's nothing wrong with well-rounded training.