What Is Transitional Year Residency?

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Starting residency is an exciting time! During this time, some specialties may require you to do a modified intern year before continuing to your “advanced” residency. This specifically applies to applicants going into anesthesiology, dermatology, ophthalmology, neurology, physical medicine and rehabilitation (PM&R), radiation oncology, radiology including interventional radiology (IR), and in some cases, urology and psychiatry programs. The process of applying to these “transitional year” residency programs can understandably be confusing. We’ll walk you through the nuances of navigating this to make sure you’re ready when it’s time to apply.

What is transitional year residency?

Over the course of your internship, you’ll immerse yourself in patient care and transition from medical student to physician. You’ll expand on what you learned in medical school, understand the nuances of health are, and engage in patient care coordination. However, the specifics of what you do day-to-day as an intern will depend on the type of program.

First, there are two types of intern years: transitional years and preliminary years. Transitional year is a more well-rounded experience in which you rotate through specialties for short periods of time to gain exposure to many different fields of medicine. It’s akin to your clerkship year in medical school.

In contrast, preliminary year usually focuses on a specific area to gain more experience in a narrower field of practice. These programs tend to be for internal medicine, surgery, or pediatrics. Most people will align their preliminary year training with what their advanced residency would be (e.g., a medicine preliminary year if you’re pursuing neurology or a surgical intern year if you’re going into IR).

Should you pursue a transitional year program?

Deciding between a transitional year and a preliminary year ultimately comes down to what you’re looking for. If you want a broader experience across many areas, you may consider a transitional year. For more targeted in-depth training, however, you should consider a preliminary year.

If you’re still deciding which path to pursue, that’s fine too! You should talk to advisers and seek out the perspective of residents who went through these programs to learn more. If you have an interest in both, you can apply to preliminary and transitional year programs in the same cycle.

Another important distinction to consider is between advanced and categorical residency programs. In contrast to an advanced residency that you’d complete after an initial intern year, many specialties offer categorical residencies in which the intern year is a part of your training. In other words, the preliminary year and advanced residency are packaged together into one program. This significantly simplifies the process since you will apply to and interview for both programs together, but it does take away some flexibility if you wanted to do a preliminary year elsewhere.

This is important because transitional years usually aren’t an option for categorical residencies. Some specialties like anesthesiology and neurology have many categorical programs, while others like dermatology have only a few. A tip to determine whether a program is categorical or advanced is the alphabetic code at the end of an ERAS Accreditation ID (i.e., A for advanced and C for categorical).

How do you apply to transitional intern years?

You’ll have to apply to transitional and preliminary programs separately from advanced programs, so budget time and resources accordingly. The Electronic Residency Application Service (ERAS) has codes for intern year programs to add to your application list. Because the cost for the first ten programs per specialty is $99, you will have to pay this fee for both transitional or preliminary programs and your advanced programs. There are additional expenses for every program over the first ten per specialty.

You will also have separate transitional or preliminary program interviews. During the COVID-19 pandemic, most of these interviews were virtual to streamline the process and minimize the necessity of travel. However, the situation continues to evolve, and some interviews may revert back to an in-person format in the future.

Pro tip: if you’re offered an in-person interview for both a transitional or preliminary position and an advanced position at the same institution, cluster the interviews together to avoid traveling back and forth. You may also consider inquiring about the option of doing a virtual interview all the same. Programs recognize interviewing requires a significant amount of travel and may be able to accommodate this request.

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How do you rank transitional intern years?

After you finish interviewing, you finally will enter the exciting final phase of generating your National Resident Matching Program (NRMP) rank order list (ROL). The process is slightly more complex if you need to secure an intern year and an advanced position. Specifically, you will first make a primary ROL of advanced programs in order of preference. Embedded into each individual entry of the primary ROL will be a supplementary ROL of preliminary or transitional programs. The matching algorithm will first run through your primary ROL and match you to an advanced program. This will “activate” the supplemental ROL you made for that program in the primary ROL to then match you to a transitional or preliminary program.

Where you do your advanced training understandably can influence where you choose to do your intern year (e.g., you may want to stay in the same city or same health system). The supplemental ROLs help you express preferences for where your intern year will be without knowing yet where you will match for your advanced training. If this is confusing, don’t worry! The NRMP has many helpful resources, and it will make much more sense when you’re actually creating these lists.

Of note, if you’re applying into ophthalmology, you will have to submit two different applications: the ERAS application (used by most transitional and preliminary programs) and the SF Match application (used by advanced ophthalmology programs). Because these two systems are not integrated, you will not have the ability to nest your supplemental ROLs into your primary ROL. However, because you will match with your advanced ophthalmology program before the ROL, you can rank intern year programs already knowing where your advanced training will be.

Trust the process

Applying and starting your intern year can seem daunting, but with the right preparation, you’ve got this! Think about what you hope to gain from your intern year experience, create a list of transitional year and/or preliminary programs you’re interested in, and trust the process to start off your first year of residency right.

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By Michael Stephens, MD

Originally from the Kentucky suburbs of Cincinnati, OH, Mike finished his undergraduate degree at a small Kentucky liberal arts school called Thomas More University. From there, he attended medical school at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, PA, where he was involved in the Medical Student Government, Dermatology Interest Group, and University City community clinic. He completed a preliminary internship in Internal Medicine at Brigham and Women's Hospital in Boston, MA and is currently a dermatology resident in the Harvard combined program. Outside of medicine, Mike enjoys hiking, playing tennis, and just generally being outside. Though the Patriots and Eagles might have Super Bowl wins behind them, he will always be a Bengals fan at heart.