Do you need to do a preliminary year during your graduate medical education? The following information will help you determine if a preliminary year is right for you.
Information gathered by Cory Pitre, MD, program director, Methodist Hospital Transitional Year Residency
Which advanced residency training pathways require a preliminary training year?
Advanced residency programs are training pathways that require completion of a preliminary training year prior to starting residency training. Advanced residency pathways that may require a preliminary year include the following: anesthesiology, dermatology, diagnostic and interventional radiology, neurology, physical medicine & rehabilitation, and radiation oncology.
What is the difference between preliminary, advanced and categorical residency positions?
Preliminary, advanced and categorical are all residency position designations defined by the National Residency Matching Program (NRMP).
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Preliminary positions are stand-alone PGY-1 positions, unattached to an advanced residency program in the NRMP Main Match.
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Advanced positions begin at the PGY-2 level, unattached to a preliminary position in the NRMP Main Match.
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Categorical positions combine a PGY-1 preliminary position with a PGY-2 advanced position in the NRMP Main Match.
Applicants who match to advanced positions must complete a preliminary year, whether that is a separately matched preliminary position or part of a combined categorical position. Applicants who match to categorical positions match for both the preliminary and the advanced residency training years ("one stop shopping"). It’s also important to understand that many advanced residencies offer both advanced and categorical positions.
What preliminary position training pathways exist?
Graduates must choose to train in one of the following approved preliminary training pathways (though some advanced residencies may prefer a given pathway): Medicine-Preliminary, OB/GYN-Preliminary, Pediatrics-Preliminary, Surgery-Preliminary, or Transitional Year. In the 2022 NRMP Main Match, the following 4,581 preliminary residency positions were offered: 1,774 Medicine-Preliminary, 18 OB/GYN-Preliminary, 23 Pediatrics-Preliminary, 1,150 Surgery-Preliminary, and 1,616 Transitional Year.
However, these numbers can be misleading — they only tell part of the story. Not all preliminary positions are offered through the NRMP Main Match. First, the PGY-1 portions of categorical positions are not typically included in the total number of preliminary positions reported by the NRMP. For example, there are several Medicine-Preliminary positions at IU School of Medicine associated with advanced program categorical positions. Because of their association with categorical positions, those Medicine-Preliminary positions are not available or identified in the NRMP Main Match as independent preliminary positions. Second, some preliminary positions are “held” for advanced match applicants in some situations and are, consequently, not available in the NRMP Main Match and not reported in published NRMP data. This practice is discouraged, but nevertheless, it exists to some degree. Be sure to learn which advanced programs offer categorical positions in the Match!
How competitive is the Preliminary match?
Highly competitive! A high demand for PGY-1 preliminary positions exists in the US. While most are aware of the highly competitive nature of advanced residency positions (e.g. dermatology), many fail to recognize the competition inherent in the preliminary match. Potential trainees for all advanced training pathways are vying for the same preliminary training positions! Add non-U.S. graduates and applicants who are applying in their second, or even third, match cycles, and one can start to appreciate the vast competition for preliminary positions (in 2022, only 61% of transitional year applicants were allopathic senior students). It is worth reiterating this importance: applicants who successfully match into advanced residency positions cannot begin training without completing a preliminary training year — prioritizing the preliminary match is important!
As an example of just how sneaky preliminary match competitiveness can be, let’s examine the 2022 NRMP Main Match data for transitional year positions alone. Among all applicants who ranked transitional year positions (including applicants who matched to transitional year positions and those who did not), the NRMP totaled an average of 10.5 ranked transitional year programs per applicant. Application to preliminary programs warrants effort similar to advanced programs and serious consideration.
How does the rank order list process work for preliminary programs?
To be able to rank programs in the NRMP Main Match, applicants must first register with the NRMP. Note that this is separate from ERAS (Electronic Residency Application Service), where applicants submit residency applications.
Applicants to advanced programs each create a primary rank order list (ROL) of advanced programs within NRMP — this includes programs with a categorical designation. Each ranked advanced program must have a corresponding supplemental ROL of preliminary programs (with the exception of categorical programs). Remember: the same advanced program may list itself as separate categorical and advanced entities within the Match. In this situation, both the categorical and advanced listing for the same program can be ranked.
Applicants may attach a single supplemental ROL to each ranked advanced program, or applicants may create multiple supplemental ROLs and attach different preliminary program preferences to each advanced program. Why would one consider using multiple different supplemental ROLs? One example might be the desire to pair preliminary preferences with advanced programs based on location (e.g. one supplemental ROL with all Indiana preliminary programs ranked highest to attach to the advanced programs in the Midwest). More information regarding supplemental ROLs can be found on the NRMP website.
Best of luck in the Match, and be sure to discuss questions about applying to preliminary residency programs with an advisor!
Reference 1. Advanced Data Tables, 2022 Main Residency Match. https://www.nrmp.org/wp-content/uploads/2022/03/Advance-Data-Tables-2022-FINAL.pdf.