Transitional Year and Preliminary Year Application Tips
Written by Andrew Woods, DO
For many of us that have the misfortune of falling in love with a specialty that requires a transitional year or preliminary medicine year, our application cycle becomes increasingly stressful and complicated as we navigate not only our specialty applications, but also figure out what to do about the first year of training. Have no fear though, after surviving the process this past year, I’m here to help!
Terminology
Before we discuss any tips, let’s make sure we’re on using the same language. Transitional and preliminary medicine years are very similar, but there are some differences to note. The transitional year has also been called a “rotating internship,” which is a better description in my opinion because you rotate through a variety of specialties to gain a breadth of knowledge. This often leads to an “easier” PGY-1 year as you (usually) get more outpatient exposure or have less demanding rotations. The preliminary medicine year, while you still gain a breadth of knowledge, is typically more focused on inpatient medicine and the ICU, providing residents with a deep knowledge of medical management. For example, the transitional year that I matched to has two months of Medicine, one month of ICU, OB/GYN, Cardiology, Night Float, Emergency Medicine, Surgery, and Outpatient Medicine, as well as four months of electives. Most of the preliminary medicine programs that I interviewed with had four to six months of Medicine, a couple of months of ICU, and a couple of months of electives. At the end of the day, I believe you will have a solid foundation to build your PGY-2 years and beyond on, so it is applicant dependent on preference.
Supplemental Application
The new Supplemental Application, in my opinion, was a fantastic addition to the application process. These programs are receiving thousands of applications from a variety of specialties, and so it makes sorting through those applications very difficult. The Supplemental Application created a method of “signaling,” in which you could indicate the region that you preferred to match in and let up to five programs know that you were especially interested in them. Of the five signals I had, I received three interviews from them, none of which I had any connection. In addition, most of the interviews I received corresponded to the region that I had signaled. Is it possible that I would have received these interviews regardless? Sure, but the ability to add additional context to your application and to indicate to programs a desire to be there certainly cannot be discounted. I recommend signaling regions and programs that you may not have a direct connection to, as this will allow them to see your legitimate interest. Programs will often favor regional applicants, so signaling Northeast programs if you live in the Southeast may open more doors, as the Southeast programs are more likely to extend you an interview just based on proximity, while the Northeast programs that see you have signaled their region will see you’re willing to move there.
Methods of Applying
So the most difficult thing to decide is which programs to apply to, and there are a couple of methods that I used to narrow programs down. First and foremost, I applied to programs that were closest to my favorite PM&R programs to hopefully only have to move once. Remember that these applications are submitted at the same time as your primary specialty, so you don’t know where you will be interviewing, but this is a start to the narrowing. The next thing I did was apply to all of the programs within driving distance of where I was living already, with the hope that I wouldn’t have to move until my PGY-2 year started. Lastly, I applied to programs near family that I would be able to live with for the year. Intern year will be incredibly stressful, and so the ability to live with my support system while saving money on living expenses was worth the extra couple hundred dollars to apply to those programs. The last strategy, and this is more for those of you that can write your ticket anywhere (aka not me as explained by my red flag post), is to apply to destination cities to enjoy the time off that you do you. Want to go to Las Vegas/Los Angeles/New York City/Miami/etc. for a year? There are programs in all of those cities! Just remember, cool places to live are going to drive more applications, and so those become incredibly competitive programs to get.
Ranking
Just a note here as it was something I did not know until later on in the interview process, but you can create a customized rank list for each program in your primary specialty. While you can use the same rank list if you want, I was able to individualize my preferences based on the PM&R program that I was ranking, meaning that I could rank the PGY-1 years near Louisville at the top for if I matched to Louisville (as I did, yay!), while ranking the programs near Philadelphia at the top if matched a PM&R program there instead. Another strategy that some will employ is to rank these programs at the end of your primary list, meaning that if you go unmatched in your primary specialty, you can still match at the PGY-1 program and then reapply next year. A cautionary tale of this strategy though, as matching a PGY-1 program without a primary specialty will remove you from the ability to scramble into a non-advanced program, ultimately reducing the number of programs in your primary specialty available in the SOAP.
Scrambling
One final note to ease some of your fears and concerns, lots of PGY-1 programs go unfilled every single year. While the SOAP is a miserable thing to have to go through, there are options available if you do not match your primary specialty. This does not guarantee you a position, as we have unfortunately seen how many qualified applicants go fully unmatched every year, but there are many more options through the scramble for a transitional year and preliminary medicine programs than for any other specialty.
**Andrew is currently a PGY-1 resident and the advice provided throughout this post does not reflect the official stance of any organization that he represents or participates in. Engage with Andrew on Twitter @TheAndrewWoods.
