Many of the specialized fields of medicine, such as ophthalmology and anesthesiology, begin residency training at PGY-2. According to NRMP classification, these are the advanced specialties. They require entering residents first to complete 1 year of broad clinical training, which is similar in scope to the old freestanding rotating internship required of all fresh graduates before its demise in 1970. Medical students who select a specialty with advanced positions have some extra work on their hands. Fortunately, the same application and matching system can be used to secure an internship position.
To meet PGY-1 requirements, there are three possible types of preliminary programs from which to choose. You have to decide for yourself what you want to get out of your PGY-1 year.
1. Preliminary Medicine: This track offers a 1-year rigorous experience in internal medicine. In most hospitals, the differences between preliminary and categorical (3-year track) interns on the medicine wards are minimal. They have similar clinical responsibilities, share the same call schedule, and admit the same number of patients. The only distinction is that preliminary interns sometimes are able to secure a few more elective months. Both community hospitals and academic medical centers offer preliminary medicine positions. You will learn a great deal of general medicine and how to take care of sick patients, both on the floors and in the intensive care unit. Stu-
TEN SURE-FIRE WAYS TO GUARANTEE THAT YOU WON'T MATCH!
• Earn a USMLE Step I score of 180 (barely scoring above the 179 pass level).
• Choose a competitive specialty having earned mediocre grades in the corresponding rotation.
• Avoid doing an audition rotation or away elective because you are scared that they will think less highly of you.
• Apply only to the "top ten" programs in your specialty.
• Don't consult with a faculty member, advisor, or dean to help plan a realistic match between you and your possible list of programs.
• Never send a letter of intent to your top program stating that you plan on ranking them as your #1 choice.
• Don't have an advisor or chairperson make any calls on your behalf because you are afraid of inconveniencing the program director.
• Rank fewer than five programs on your rank-order list.
• Shorten your rank list because you received a flattering recruitment letter making you believe that the residency program was going to rank you at the top of their list.
• Don't select a preliminary year or other back-up option to place at the bottom of your primary rank-order list (for very competitive specialties).
dents entering advanced specialties that heavily emphasize internal medicine— like anesthesiology, dermatology, and neurology—often find it extremely helpful to complete their base year in preliminary medicine.
2. Preliminary Surgery:Similar to its medicine counterpart, a position in preliminary surgery offers the exact same experience as that of an intern in general surgery. You will have the honor of rounding very early in the morning, managing postoperative patients on the surgical floors, taking call every third or fourth night, and rarely scrubbing in for cases in the operating room. What new medical school graduate would subject himself to such rigor? The answer is that most preliminary surgery positions are informally assigned outside the Match to applicants who have already matched into an early surgi-
cal specialty (urology, neurosurgery, and otolaryngology). This position serves as their general surgery internship. The remaining positions are sometimes chosen by students who believe that a pseudosurgical internship would best prepare them for residency, such as those in ophthalmology, emergency medicine, and anesthesiology. Realistically, most preliminary surgery positions are last-minute choices picked by scrambling students who failed to match into preliminary medicine or transitional year internships. 3. Transitional Year:Many medical students are confused by the role of transitional year programs. These highly competitive internships provide a diverse clinical experience that is fully accredited by the ACGME. Usually offered by community hospitals, transitional programs are cosponsored by two departments. The curriculum of a typical transitional year requires 4 months (minimum) of internal medicine, 1 month of emergency medicine, and 1 month of ambulatory medicine. Some programs also mandate months of surgery or obstetrics; others require critical care rotations. Regardless, all transitional year internships allow for 2 to 6 flexible months of electives. At some hospitals, the clinical duties of a transitional intern (especially during elective months) are so minimal that they consider themselves fifth-year medical students. Because of these many months without call or weekend rounds, competition for transitional year spots is quite intense. In the 2002 Match, only 8% of the 1062 available positions were unfilled. One word of caution: Unlike preliminary medicine or surgery, transitional years only count for PGY-1 credit in advanced specialties. If you switch later to a categorical specialty (such as internal medicine or pediatrics) during the transitional internship, you will have to repeat another PGY-1 year.
After deciding on one (or more) of the PGY-1 alternatives, it is time to apply. There is one more important item to clarify. Many specialty programs also offer, in addition to their advanced PGY-2 track, several categorical positions that include the PGY-1 internship year, typically at the same institution or affiliated hospital. For example, in 2002, the anesthesiology residency at the University of Chicago Hospitals offered six advanced positions and six categorical positions. All twelve residents started anesthesiology training as PGY-2s, but the advanced residents had to secure their own internships independently, whereas the categorical residents completed their PGY-1 year at the University of Chicago Hospitals. The bottom line: When making your final list of residency programs in these specialties, make sure to check carefully which ones offer both advanced and categorical slots.
The ERAS system makes applying for a PGY-1 internship quite simple. You simply transmit your application file to selected programs as if applying to multiple specialties (e.g., dermatology and internal medicine; ophthalmology and transitional). Here are some final tips for this important part of the application process:
1. When applying to preliminary medicine or surgery positions, look up the program under the categorical listings, but make sure to check the box labeled preliminary track.
2. Most medical students apply for PGY-1 positions either in the location of their medical school or in the anticipated city of their desired PGY-2 residency. Do you really want to move twice? This approach also keeps the interview process simple, sane, and easier on the checkbook.
3. You do not have to write a new personal statement for these positions. Most students either submit the same statement written for their primary specialty, or they modify it slightly to tailor it to preliminary programs.
4. The same letters of recommendation can also be assigned to PGY-1 programs. The directors all know that their interns will be leaving after 1 year. The more competitive preliminary medicine programs, especially those at academic medical centers, often prefer a Chairman's Letter from the Department of Medicine. Consult your advisor on how to obtain one.
5. Apply to a sufficient number of programs to ensure that you will match! Every year, qualified students who do not take this part of their application seriously find themselves unmatched for a PGY-1 position. If you do not want to scramble for a surgery spot, never gloss over the preliminary year as an afterthought. Hospitals are cutting back on the number of preliminary positions. The high numbers of competitive applicants in radiology, dermatology, and other highly desirable departments, are all vying for the same cushy transitional internships. Do not find yourself left out. If you put an equal amount of effort into both the primary specialty and the PGY-1 programs, there should be no surprises on Match Day.
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