Everything You Need to Know About the Transitional (TY)/Preliminary (PY) Residency Programs

After a long road, you are finally embarking on the residency application process! When planning your application and future training goals, information, and new “lingo” on the different types of residency positions out there can be overwhelming. It may be hard to know where to begin. From categorical versus advanced positions, to transitional versus preliminary residency programs, this blog aims to demystify these terms, and provide a comprehensive guide to help get you kick off a successful match cycle!

Categorical versus Advanced Residency Positions

Before delving into a discussion on preliminary and transitional year programs, it’s essential to understand the differences between two main types of residency positions offered by ACGME (Accreditation Council for Graduate Medical Education). These positions are categorical positions and advanced positions.

Categorical Position

Categorical positions in residency programs offer the “full package” of residency training for your primary specialty. This includes the preliminary and following years of training in that specialty. At the time of applying, these positions will begin the year of Match. For example, applicants for Match Day in Spring 2024 will start their categorical position Summer 2024. 

Advanced Position

Advanced positions in residency programs are non-categorical positions that provide training for a specialty after completing preliminary training. The required preliminary training refers to completion of either transitional or preliminary year(s). To avoid confusion with the term “preliminary year”, preliminary training will be referred to as the internship year, or post-graduate year 1 (PGY-1) for the rest of this article. This may be done at the same institution or at different institutions as the advanced position. At the time of applying, these advanced positions will begin the year after Match. For example, applicants for Match Day in Spring 2024 will start their advanced position in Summer 2025. 

The year between Match and starting the advanced program will be the time to complete the required PGY-1 training. There are also “Reserved” positions, also known as “physician” positions. This refers to advanced position-type spots available for physicians who have already completed PGY-1 training and will begin the advanced program the year of Match Day. 

Some programs only offer advanced positions, meaning you need to complete your internship year through a different program. Other programs only offer categorical positions, meaning the internship year is included. Meanwhile, some places offer both categorical and advanced positions within the same specialty/residency program. For example, at the time of writing, the Mayo Clinic (Minnesota location) Dermatology residency offers a few categorical positions where residents would automatically complete their internship with the Mayo Clinic internal medicine department, but also a few advanced positions where residents would join the dermatology residency after completing their internship elsewhere. 

Specialties that offer advanced positions include anesthesiology, dermatology, diagnostic radiology, physical medicine and rehabilitation (PM&R), radiology oncology, ophthalmology, neurology, psychiatry, and urology. Of note, some of the aforementioned specialties now primarily involve residency programs with categorical positions only. 

Who Should Consider Transitional or Preliminary Year Residency Programs?

Applicants may choose between a preliminary or transitional year if they don’t intend to pursue a categorical position. This often occurs when applying to primary specialties with programs exclusively offering advanced positions, necessitating PGY-1 training separately. Alternatively, during SOAP, unmatched or partially matched applicants often find standalone preliminary or transitional year positions.

It is important to note that preliminary and transitional year positions do not provide full residency training. To be able to complete residency training for a specialty, the prelim or transitional year must be followed by training with an advanced position or reapplication to a categorical position in a future match cycle.

Preliminary Year versus Transitional Year Programs

Preliminary years are specialty-specific and are designed to provide the fundamental training for said specialty. The two most common types of prelim years are Internal Medicine and Surgery, with a few institutions also offering prelim year positions in pediatrics and OB-GYN. The rotation schedule/work-load is equivalent to doing an internship year in that specialty, and typically prelim interns work along with categorical interns in the same program. 

Transitional years are generally organized separately from an individual specialty department. Programs are designed to offer a well-rounded experience throughout medicine. Often compared to clerkship years in medical school, the transitional year includes rotations across different disciplines (medical specialties, surgical specialties, emergency medicine, etc depending on the program curriculum). Traditionally this translates to more elective time, with the ability to tailor the internship experience more towards your interests. 

So which one is better?

Depends on what you are looking for out of your intern year. Traditionally, transitional years are considered to be “easier.” With more elective time or lenient rotations, they are generally highly sought after. However, it is important to note that not all programs are created the same! There may be certain transitional year programs with a more demanding rotation schedule or workload compared to certain preliminary year programs, and vice versa. 

Another factor to consider is whether you still need to find future advanced training during your PGY-1 year. Typically prelim years are with programs with advanced residency positions, with an opportunity for advanced training (PGY2+) the following year. For example, after completing a PGY-1 preliminary internal medicine year, the program may extend an offer for an advanced position to continue internal medicine residency with them. Transitional years lack this option, as their training doesn’t equate to a categorical year internship. Nonetheless, depending on the program, a transitional year might offer a more flexible schedule, allowing for away rotations or elective time to enhance your application for the next match cycle.

It is important to research the schedule and policies of each program. Former upperclassmen or current residents at your institution are additional resources for recommendations or information about individual programs that may not be found online.

Frequently Asked Questions on Transitional and Preliminary Residency Programs

Can I apply to both transitional and preliminary year residency programs?

Yes, there are no limitations to applying to both types of programs. 

How does the application and ranking process work for transitional or preliminary year programs?

Application process

You apply to transitional and preliminary years separately through ERAS, in addition to applying to your advanced programs. Categorical positions/programs are where you do not need to apply for your internship year separately. 

The application content for transitional and preliminary years is generally similar to the content for advanced positions. Applicants may choose to slightly modify their personal statement to address their intern year goals, what they hope to gain or contribute to those programs. Some may also choose to switch in a letter of recommendation specifically for the transitional or preliminary year. Alternatively, traditional applicants have also been successful without making changes to their applications. Programs understand that their intern year is ultimately a stepping stone toward training in another primary specialty of choice.

Ranking

When it comes to the ranking process, your main rank list consists of your primary specialty programs. For the internship year programs, you can create and link a unique rank list to each advanced program. This allows you to customize your ranking of intern year based on the advanced program that you end up matching at. Many people use this tool to prioritize staying in the same city where they match for their advanced program. For example, ranking intern year programs located in New York at the top of the linked list if you match to an advanced position in New York.

You can also rank internship year programs on the main rank list after your primary specialty programs. This enables you to potentially secure a PGY-1 position alone if you don’t match an advanced position, though it’s important to recognize that this strategy may restrict your options during the SOAP process, as your PGY-1 year commitment is already set. Nonetheless, it offers the advantage of greater control over your intern year experience, reducing the risk of scrambling into a less desirable position during SOAP.

How do I know which position types are offered at which programs/institutions?

Information on type and number of available positions can be found on the ERAS application portal under each program. FREIDA, the AMA run database for residency and fellowship programs under ACGME, also lists the information under the headlines “requires previous GME” (“yes” meaning advanced only positions available) and/or “offers preliminary positions”.

Will the type of internship year I complete affect my advanced program placement?

Most advanced programs accept either transitional year or internal medicine/surgery prelim year training. If you’ve secured an advanced position, the completed internship shouldn’t affect your long-term standing or training in your primary specialty. However, it’s advisable to verify with the advanced program if they have any restrictions on accepted internship years. If you intend to apply for an advanced position during or after your internship, certain specialties or programs may prefer a specific type of intern year. For instance, surgical specialties typically favor the completion of a surgical prelim year.

For additional guidance, your medical school advisors and physician mentors can be a good resource to help navigate residency applications. You can also check out more residency advising resources from our team at EMP. Schedule your complimentary consultation to learn more.