What Are Categorical, Preliminary, Transitional and Advanced Years in Residency?
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.
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 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 programs can be thought of as a sampling of 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 slated 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, at the time of this writing, 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! 🙂