Transitional Year questions for ARMY HPSP

[Slevin]

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I'm a 3rd year HPSP student and I'm wondering about doing a transitional year for my PGY1.

If Match time came around and I was still undecided about what I wanted to specialize in would that hurt my chances for the following years match with regards to choosing a speciality? Would I have a higher chance of having to go GMO? If I was selected for a PGY2 residency spot would the transitional year count towards fulfilling one year of my residency training?

Thanks

 

[GeoLeoX]

The internship-trained GMO position is quickly becoming historical in the Army. Most PGY1 transitional spots are categorical for people who are pre-selected to other residencies (derm, rads, etc.) There are probably exceptions to this, but for the most part you are better off deciding what you want to do than taking an additional year to try to figure it out.

 

[colbgw02]

I'm a 3rd year HPSP student and I'm wondering about doing a transitional year for my PGY1.

If Match time came around and I was still undecided about what I wanted to specialize in would that hurt my chances for the following years match with regards to choosing a speciality? Would I have a higher chance of having to go GMO? If I was selected for a PGY2 residency spot would the transitional year count towards fulfilling one year of my residency training?

Thanks

Yes, you would absolutely have a greater chance of becoming a GMO. Most Army specialties designate most of their residency slots for 4th-year medical students. If you apply as an intern, not only are you applying for a fewer number of spots, but you are competing against people who have already done GMO tours.

Obviously if you go into a specialty that allows a transitional internship (rads, derm, ophtho, gas), then your transition can and will be smooth, assuming you're picked up. However, there are quite a few specialties that either cannot or will not permit a transitional internship. These include, but are not limited to, all of the surgical fields (exluding ophtho, obviously). I am fairly confident that the same goes for medicine. People in transitional internships have to repeat their intern year if they end up in those programs. I have seen OB/GYN programs count about half of a transitional internship, allowing residents to graduate off-cycle.

You would be putting yourself at a considerable disadvantage if you cannot choose a specialty or if you change your mind during internship. This is true in the civilian world, but it is even more true in the military. You would be better served to pick a specialty and go for it. If you change your mind, then you'll probably get stuck in GMO land for awhile, but applying only for a transitional internship without a categorical spot is practically begging the Army to make you a GMO.

 

[usma05]

Hi, I feel like I might be able to add to your question. I was in a similar position to you in med school in that I did not feel ready to decide come time to apply. For that, and a couple other reasons (trying to work out with civilian significant other who was two years behind me and a calling while in med school to be a flight surgeon as I had dealt with several friends deaths while they were deployed) I applied straight transitional year. I was accepted to my number one choice as I think I was one of two who did what I did my year group. I worked my rear off my intern year, but I did not apply during it as I wanted the entire year to decide what specialty I wanted instead of 3-4 months of intern year. I figured out in feb that I wanted to do anesthesia. Knowing I wanted to FS, I went for it in the gmo selection process and got where I wanted. I'm currently a FS, and will be deploying shortly for what appears to be a 5-6 month deployment as I was selected for anesthesia this year. I have verified with OTSG and HRC that my timeline will work out.

That being said, the whole process is not peachy-keen. It is quite challenging, and you have to ensure you have everything lined up. I had to be on top of my game for the entirety of intern year, to include specialities that weren't as personally appealing to me. You can be behind the power curve because of people's perceptions of transitionals, particularly those that aren't preselects. But you can change that perception if you work hard and have a good attitude (I know, that's prob a no-brainer).

If you apply for derm, path, anesthesia, or radiology your year should count. You should meet with your program director and verify that the requirements for what residency interest you are met, and work with the elective months to tailor your year. If you wish to pursue surgery, I almost certain that you will have to repeat intern year. Medicine, in my friend's experience counts about have of your year but that will have you graduate late. And I had a fellow obgyn intern who had been a prior transitional who had about half his year count.

In my intern year, there were 5 straight transitionals. One was accepted to urology when he reapplied during intern year, and he is currently repeating his intern year. Four of us went gmo, and out of that I know 3 applied this year and were accepted into radiology, anesthesia, and medicine. I'm not sure if the fourth applied.

Again, you have to game plan this thing. Figure out what interests you the most and get those all important letters for your app. Consider doing research or some other activity outside your intern year, which you should have time to with some of your lighter months. Furthermore, realize that if you truly want to take your intern year to figure out what you want to do then doing a gmo will allow you to do so. Otherwise, you don't have a year, just four months until the app process starts again. I felt what I did worked for me so far, and had several rewarding experiences. It still had it's nerve-wracking moments and you have to work that much harder to alter people's stereotype of trannies. I wish you good luck and if you have any further questions let me know.

 

[dinoprost]

I would like to second usma05's excellent opinion and emphasize the need to avoid a transitional internship like the plague unless you are either forced to take it, or are a pre-select into a specialty such as opthalmology, radiology, anesthesia, or dermatology. One of my friends matched into opthalmology, and he was still treated like crap during his transitional internship. The "trannies," as they are colorfully known, routinely get the worst call schedules as they rotate through the many hospital services, didn't get an office but had to squat in whatever service's call room, and seldom got any attention, for good or ill. If you are assigned to a transitional year after failure to match in the specialty of your choice, it is always a good option to consider an immediate scramble. Some people are able to scramble into a surgical internship, or even categorically into a medicine, family practice, or other unfilled specialty berth. Just my opinion from one GME site, mind you, but probably valid across the Army, as I believe the transitional year is mostly a staging area for GMOs.

 

[WernickeDO]

bump.

My question seems somewhat relevant to this thread. In the specialties that require a transitional year (Oph, derm, anesthesia, et al), do you essentially do a TY anywhere and then go to your matched spot in PGY2? For example, if you match anesthesia at Brooke, do you do a TY at, say, EAMC, then go onto PGY2 at San Antonio? Or do you need to reapply, like in GS?

I also know that you can potentially get bumped in favor of a returning GMO, so matching during 4th year does not guarantee a spot. If you do get bumped, what happens then? GMO land?

 

[psychbender]

bump.

My question seems somewhat relevant to this thread. In the specialties that require a transitional year (Oph, derm, anesthesia, et al), do you essentially do a TY anywhere and then go to your matched spot in PGY2? For example, if you match anesthesia at Brooke, do you do a TY at, say, EAMC, then go onto PGY2 at San Antonio? Or do you need to reapply, like in GS?

I also know that you can potentially get bumped in favor of a returning GMO, so matching during 4th year does not guarantee a spot. If you do get bumped, what happens then? GMO land?

For categorical programs, certain hospitals act as feeders to the primary program. In the above Anesthesiology example, Brooke's Army residents do their internship at either William Beaumont or Brooke, while Reed's do their internship at Tripler, Madigan, Eisenhower, or Reed. You do not have to reapply as an intern, you will sign your continual contract some time in October of your intern year to confirm that you are still going straight through. Once you complete internship, its straight to your new hospital for the remainder of residency.

As for getting bumped by an incoming GMO, that is complete bull****. If you match and sign your contract, they will not just bump you because someone coming from the field wants a spot.

As for TY and surgical specialties, apparently some program directors are counting a few months and not requiring a complete repeat of intern year. I have met a TY who matched to ENT and a TY who went GMO, and will start Ortho next year; both of whom have said that their PDs are giving them credit for half the year (still makes them resiterns for the first half of the year, and they graduate off-cycle, but it beats repeating the entire year).

 

[turkish]

I did an un-matched transitional year at ?AMC, and it wasn't too bad. There were times when "not belonging" to the service I was working for worked in my favor, and times when it did not. For instance, TY interns usually got the night float spot on surgery, which meant no call, very little responsibility, and lots of backup. They just didn't trust us, so they worked harder and treated us like med students. A well-written note seemed to blow their minds, and went a long way towards impressing the team. I'm not sure if this was a plus or a minus, but after showing basic competence, I was treated very well the rest of the month. Also, I got out of a LOT of stupid departmental meetings by playing the "I'm not one of your kind" card. So I had significantly more free time than categorical interns.

On the other hand, doing 5-6 months of medicine (counting MICU) was at times awful. This was the only service where I actually had overnight call (30 hour shifts), but it was only q5. I pulled a total of 23 nights of call my entire intern year. You can't beat that. However, I also had to interview for my civilian residency during intern year, which required me to travel. Because I wasn't theirs, the medicine department didn't give a flying **** whether I needed time off to interview, and refused me outright. I made it work by going on post-call days or my 1-in-7 off days, which was kind of painful, but I wasn't going to let them stall my career because they needed somebody to write notes. Also, on the occasion that something went wrong with a patient (diagnosis, treatment, etc), we all felt much less supported than the categorical interns. They seemed to have lots of freedom in decision-making, whereas we were often scrutinized and criticized for small things. Don't get me wrong, I'm not bitter, but I felt mostly like an anonymous warm body, and almost never like a valued part of the team. I wasn't offered the same degree counseling/explanation or made to feel capable in the event that I didn't completely understand the plan or the diagnosis. At least not from the higher-ups. My R2 and R3s were usually very helpful, especially when approached with a "I really want to figure this out so we can all work together" type of attitude. The LTCs, COLs, and chief residents didn't seem to give a damn, and would come down hard on you and make you feel like a fool for even trying to understand. It seemed different when it was one of their interns making a mistake, giving a ridiculous answer in rounds, or needing help. Such is life, I guess.

All that being said, I know of a few people who did an unmatched transitional year and again did not match that year, then went and did a GMO tour. All of them matched successfully after returning, one into a very competitive "lifestyle" specialty despite a TERRIBLE academic record. He was indeed treated like a misfit during intern year, but in his case it wasn't because he was a transitional year intern...

I think they should rename it. "Transitional" sounds like "rode in on short bus", or "needed a 5th year of med school". Maybe "non-categorical" or "preselect" or "general internship" would be less condescending.

 

[jsmittyund03]

As a categorical transitional, my experience was probably a bit different from an unmatched transitional. However, I was able to see that the title itself does come with a slightly negative connotation. Transitional year has been difficult, mainly due to the wide range of specialties one rotates through. Jumping from IM wards to Pediatric wards to Trauma Surgery to OBGYN brings challenges, mostly from the administrative side. While interns of these services have the first few months of intern year to become familiar with their rounding schedules, the computer systems, their lecture schedules, the fellow residents, and the staff associated with daily work, as a transitional year you are reintroduced to all of these things on a monthly basis. There is very little familiarity. The continuity of systems is alarmingly dysynchronous, and you must juggle this while attempting to transition academically as a physician from one dramatically different specialty to another. That being said, I do agree that generally, less is expected from you, and appropriately so. My last general surgery experience was close to three years ago, expecting us to perform to the standards of a surgical intern who has been in the OR all year is just not possible. However, I feel that these things have made me a very well-rounded physician, and with possible deployment to GMO-land after residency, this is a good thing.