A couple weeks ago I wrote a post about some of my favorite resources for researching residency programs. You can find that here.

Since then, I’ve had the pleasure of hanging out with several MS4s who are headed to radiology. I often chat with them about their plans for intern year. A couple weeks ago, one of them told me, “I think every doctor could benefit from spending a year in internal medicine. What do you think?”

I politely nodded for as long as I could. Eventually the look on my face betrayed my body language. Even behind a mask in a dimly lit reading room.

I responded with, “Have you heard of a transitional year?”

According to the ACGME, “a TY residency is a broad-based program of graduate medical education in multiple clinical disciplines designed to facilitate the choice of and preparation for a specific specialty.”

This translates to a minimum of 24 weeks (6 months) of fundamental clinical rotations in the primary specialties of EM, FM, Gen Surg, IM, OBGYN, Peds, or Critical Care. At least 8 weeks of which must involve direct care of inpatients. And you must have a minimum of 8 weeks of elective rotations. They also mention that you need at least 140 hours of outpatient and EM experience (140 of each) as a part of your core rotations.

A TY year is an option for residents whose programs start at the PGY-2 year and therefore require you to complete a PGY-1 intern year first. These are called “advanced positions”. If your program includes the intern year in the match, it’s called a “categorical position”. Common advanced position residencies include radiology, dermatology, anesthesiology, and physical medicine and rehab.

The other intern year options out there would include completing a year as a preliminary medicine or preliminary surgery resident. You basically function as an internal medicine or a general surgery resident and work alongside the “categorical” residents. Which…you know…is typically horrible.

Technically you could complete a year in family medicine, pediatrics, or emergency medicine and fulfil the requirement, but I never came across programs offering preliminary positions in these specialties.

All three of these options are surprisingly competitive, but I exclusively recommend doing a TY year. I don’t care what your advanced position is.

They always tell IR folks they need to do a surgery year to learn “surgical technique.” Unless the “technique” they are referring to is the technique of spending sleepless nights asking people about their bowel movements and hating your life, I think you can get what you need in a TY year.

I mentioned my process for researching programs in the post I linked at the top. The criteria for finding a “good” transitional year does depend on what you want. Most people prefer a TY because it lends itself to a better schedule and (relatively) easier year. You will still work hard for at least 6 months of the year but can count on several months of electives to help you recover.

Some people prefer it because they like both medicine and surgery and want a little of both. Or you really do want to build your “surgical technique” but you also value showing up at 7AM and leaving by 4PM.

In any case, I’ll give you my definition of a great TY program so you know what filter I was using to collect programs.

Things tend to change quickly in medical training, especially in the COVID era. So be sure to do your own research. Even my own TY program was forced into doing extra call and crap to assist the non-residency hospitalist services. So, add “COVID surge practices” to the list of intelligent questions you ask during interviews.

You’ll notice a heavy Midwest presence in my list. That’s because I was targeting smaller and more affordable cities. Even if you aren’t super interested in the Midwest, this list should help because just like everyone says, “apply broadly”, because TYs are competitive. Freakin derm applicants.

Hopefully this gives you some ideas and a place to start.

This is data taken straight from the spreadsheet I used while comparing TY programs. I haven’t updated anything so there may be some outdated info (salaries).

A few of these programs sounded really good on paper, but when I interviewed, I wasn’t too impressed. A couple that come to mind are Intermountain Medical Center and Bassett. But they’re still better than a medicine or surgery year.

This list should get you started. If I had to give you my short list, it would be the following:

I really liked all of these programs when I interviewed with them. I also heard good things from residents who had done them. Spokane was my program and it really had everything I was looking for. After talking with my cohort here at Duke, it’s clear I had the chillest intern year. (But I didn’t let that stop me from complaining while I was in the midst of it).

Always happy to give the nitty gritty details of my program if you’re curious.

Good luck!