What Are Categorical, Preliminary, Transitional and Advanced Years in Residency?

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For those looking to match into a U.S. residency, there’s some lingo that should be understood about the first year of post-graduate training as a resident (the “intern year”). There are three internship possibilities: a transitional year (TY), a preliminary year (prelim), or a categorical year. For the non-categorical applicants, the TY/prelim year is followed by advanced years in residency.

Categorical Year

Trainees complete their intern year and residency at the same institution. Consequently, applicants don’t have to secure an intern year separately from their residency. Their program offers the full training necessary to acquire board certification in that particular discipline. Some popular residencies with many categorical programs include internal medicine, psychiatry, pediatrics, emergency medicine, family medicine, anesthesiology and ob/gyn.

So what’s the advantage to categorical programs? All your training is at one institution. You don’t have to worry about finishing an intern year and then having to move somewhere totally different for your residency. The application is also way easier (especially if you’re couples matching).

Advanced

Advanced residencies can be thought of as the “actual” residency in non-categorical programs after the completion of a compatible intern year (either prelim or TY). Applicants apply for both their intern year and advanced residency simultaneously but separately. The application fees and interview trail costs can be compounded compared to categorical applicants. Additionally, because some of the more competitive applicants (from derm, radiology, etc.) also require a TY/prelim, the highly-coveted intern years tend to be extremely competitive.

So what happens if one doesn’t match to an advanced program? They might at least match to an intern year and then attempt to improve their application to reapply in the following year’s residency match. A stellar intern might improve his or her chances to match at the same institution for an advanced residency spot. Or so logic says. 😉

Popular advanced residencies include diagnostic radiology, radiology oncology, anesthesiology, dermatology, ophthalmology, and urology. Again, remember that you have to complete a separate intern year (and apply separately)

Transitional Intern Year (“TY”)

Transitional programs can be thought of as a buffet of sampling many disciplines. Trainees rotate through medical and surgical rotations including oncology, pulmonology, anesthesiology, dermatology, radiology, rheumatology, neurology, infectious diseases, obstetrics/gynecology, and ophthalmology. Transitional years are for specialties where a thorough understanding of basic pathophysiology and procedures is needed.

Preliminary Intern Year (“prelim”)

In comparison, prelim programs are either in internal medicine or surgery and saturated with rotations in those fields. Medicine prelims spend most of their year on general medicine wards, medicine electives, or the MICU/CCU. Surgical prelims rotate through various surgical subspecialties – general, vascular, plastic, pediatric, trauma, colorectal, etc. Naturally, surgical prelim years are for those entering surgical fields like urology.

Categorical & Advanced Spots

Some programs offer both categorical spots as well as advanced spots for the same speciality. For example, I’m a categorical resident in anesthesiology at Baylor College of Medicine (BCM). I’m doing my intern year as well as my three years of anesthesiology within the same hospital system; however, there are several “advanced” spots reserved for applicants who did their intern TY/prelim elsewhere and will matriculate to BCM for three years of anesthesia residency. In other words, BCM has both advanced and categorical positions for anesthesiology. There are several other residencies which follow a similar application structure. Some programs only offer advanced spots (thereby forcing you to find an intern year elsewhere). Some are only categorical. I strongly recommend using FREIDA to research program structures!

Please let me know if you have questions in the comments section below! 🙂

19 COMMENTS

  1. hi sir, thank you so much for your post. I am an IMG aspiring to become a cardio surgeon or neurosurgeon, I heard its like 5 years surgery and then 2 years of fellowship, does that mean I should concentrate only in surgery for now and get LOR and do research mainly from surgery and not cardio surgery so that my chances for surgery residency are increased? could you also outline the specialities am qualified to apply if I do surgery prelims and TY? and also outline the process to get neurosurgery?

    • Traditionally, neurosurgery is its own seven year residency whereas cardiothoracic surgery is five years of general surgery followed by three years of cardiothoracic surgery fellowship. I’d say do research in whatever (with the goal of being published in reputable journals) and find people who will write you strong LORs. Surgery prelims go on to various fields including urology, anesthesiology, radiology, and of course general surgery.

      • thank you, I came across a post recently saying that cardio surgery is declining and I should try for interventional cardiology as they intervene before referring to cardio surgeons and clear most of the cases. is that true? what is your opinion, sir?

        • Although interventional procedures are gaining popularity due to their minimally invasive techniques, people have said cardiothoracic surgery is a dying field for decades, and it hasn’t gone anywhere! CT surgeons do incredible work and will always be needed for complex cardiac surgery, intrathoracic non-cardiac (ie, lung resections), and even trauma. I’d say do whatever makes you happy. There will be work for everyone. 🙂

  2. Hey, it is a very helpful and awesome work you are doing.

    I have few queries:
    1. Will it be easy to get into the preliminary internal medicine program than to enter in the categorical? Is there a lot of rush or not?
    2. Do we get paid in the preliminary program? If, yes approx. how much?
    3. You said you need to apply for the advanced as well as preliminary program at the same time. So,

    a. If I am selected for the preliminary internal medicine program and categorical internal medicine program then can I leave the preliminary and directly enter into categorical?

    b. If I am selected for the both the prelims and the categorical and I choose to do the prelims, then do the entry for the categorical will be saved for me in the next year that is after completing the preliminary can I directly enter in the categorical program which selected me at the first time?

    c. If I do the preliminary internal medicine then can I apply again for the categorical after I complete it? And whether my chances of getting into categorical internal medicine program is increased and I can get into good residency program at the reapplying in match(reapplying is possible??) after doing my preliminary internal medicine program?

    I will be grateful to you. Thanking you in advance.

    • Hey Aditya,

      If you’re looking to do internal medicine, there’s no such thing as an “advanced spot.” Internal medicine programs everywhere are categorical. If you’re doing a speciality like dermatology, diagnostic radiology, radiation oncology, PM&R, neurology, psychiatry, anesthesiology, or urology, THEN you have the option of doing a prelim year at one program and then an advanced residency in that speciality elsewhere.

      You’ll get paid throughout residency (increases a little bit each year). At our program, first year residents start around $53,000 per year.

      Hope this helps! 🙂

      • Thanks Rishi, you are so helpful and frankly speaking I appreciate your working status and then also sparing time and doing this kind of stuff..bless you..

        Actually I had failed step1 and also I am IMG, so my chances of getting selected in the first try is quite low and definitely not in the good center .. So I was thinking to entering in the preliminary year once (also it is good as compare to sit the whole year ideal) and make my overall credits, including USCE strong….

        Also, plz tell, Will it be easy to get into the preliminary internal medicine program than to enter in the categorical? Is there a lot of rush or not?

        And the following:
        a. If I am selected for the preliminary internal medicine program and categorical internal medicine program then can I leave the preliminary and directly enter into categorical?

        b. If I am selected for the both the prelims and the categorical and I choose to do the prelims, then do the entry for the categorical will be saved for me in the next year that is after completing the preliminary can I directly enter in the categorical program which selected me at the first time?

        c. If I do the preliminary internal medicine then can I apply again for the categorical after I complete it? And whether my chances of getting into categorical internal medicine program is increased and I can get into good residency program at the reapplying in match(reapplying is possible??) after doing my preliminary internal medicine program?

  3. Hi, I want to apply to anesthesia residency, I have applied to some categorical positions! However i read your post, and have a confusion in my mind.
    -If I also apply through the non categorical route, ie, apply for a prelim year in IM, should I apply for advanced anesthesia programs right now!
    – And if I match into an advanced program now, does that mean that I am already matching into the pg year after my prelim year is over
    -one more confusion, if i match into advanced program but no prelim yr, then what are the choices or options!

    • Great questions, Kim! If you’re applying for separate prelim years, then yeah, you should apply for advanced anesthesia spots (otherwise what are you planning on doing once your intern prelim year is finished?) You’ll match to a prelim program *and* an advanced program separately, so you know where you’ll be for intern year and your anesthesia years on Match Day.

      If you match into an advanced program but no prelim year, then you will likely enter the “scramble” for an open prelim year. It’s better to apply broadly now, so you have a better chance of matching somewhere you like.

      • Many thanks for clearing my confusion! And that too so quickly!
        One more question, in the ERAS application, while applying for categorical anesthesia positions, I should also opt for advanced positions, but are these advanced positions for the anesthesia 1st residency yr starting july 2016.
        You said -separate prelim yrs!
        Unless i match into a categorical position in anesthesia, I shall have to apply for prelim yr in IM or Surgery! please correct me, if I am wrong!

        • The advanced positions you apply for are binding contracts beginning with your PGY-2 year. And you’re correct – matching into a categorical program in anesthesia means you’ll do your entire residency (intern year and anesthesia residency) in the same place. Otherwise, you need to match into a prelim year (PGY-1 year in either medicine or surgery) and separate advanced anesthesia program (PGY-2 through PGY-4). Hope this helps! =D

          • Hi Rishi!
            How r u doing! I was a lil worried! Next week is Match week. And I have something to ask you! I might have to apply to preliminary programs or transitional year programs during SOAP, and I want to know, that being an IMG, and with a maximum of 45 applications, what kind of programs may help more- preliminary or transitional!
            -If preliminary, then medicine or surgery?
            – And do personal statements be modified according to or surgery prelim yr, or transitional year!
            I shall be grateful if you reply soon!
            Regards

          • Hey Kim!

            I’d say that your decision to pursue a surgery or medicine prelim depends on your residency choice. For example, if you’re doing radiology, medicine is probably going to help more.

            Now comparing transitional years to prelim years… I honestly don’t know the data for IMGs (as far as which one has higher match rates). Maybe have an equal number of each to meet your maximum of 45?

            I would definitely modify your personal statement slightly just to make it more applicable to the position you’re applying for. You don’t need to change much, but at least avoid skewing your personal statement in a completely different direction from your prelim/transitional year.

  4. Thank you for the post. I’m interested in either surgery or anesthesiology. Do I have to apply to the residencies and transitional at the same time? Thanks

    • I definitely would apply to both your transitional and advanced residencies together. This way you know on Match Day whether or not you have a job after intern year. =D

  5. So, if a program only offers advanced spots, do you apply for those now or after you finish intern year?

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