This post is from the perspective of my colleague, Elle S., MD, who completed a transitional year in 2021 and is now in her final year of PM&R residency.

There comes a time in nearly all medical students’ careers when they open ERAS and try to figure out what they’re going to do for the next few years of life. Additionally, the questions, “Which type of intern year should I do?” and “Where should I do my intern year?” may arise too.

I didn’t know that you could choose an intern year until my third year when I selected one of the medical specialties that often require a separate intern year. I faced the question: Do I pick a surgical internship, a preliminary medicine year, or a transitional year?

Know Your Options for Intern Year

If you’re not familiar with the different types of intern years, which specialties require them, or what a transitional year is, you may want to read this “What Is Transitional Year Residency?” article first. In short, a transitional year (TY) allows you to rotate through specialties for short periods of time to gain exposure to many different fields of medicine.

I will provide the disclaimer that every TY is incredibly varied. There are TY programs that are nearly identical to internal medicine preliminary years, and on the other end of the spectrum, I’ve heard rumors of TY programs offering rotations in a ski resort, so your experience can be vastly different depending on the program.

Why I Chose a Transitional Year

Ultimately, I chose to pursue a TY for my PGY-1 experience. To contextualize my situation, I trained in Physical Medicine and Rehabilitation (PM&R). Some PM&R programs are categorical, but most were advanced at the time of applying. There are many aspects of PM&R that overlap with Internal Medicine, so an Internal Medicine preliminary year made a certain kind of sense. I matched into an advanced program at the institution where I completed medical school. If I had gone into an Internal Medicine preliminary year, I could have chosen programs around the country, but most likely would have stayed at my home institution.

I ended up ranking highly and matching at a TY in a different state, near my hometown in a smaller, private hospital. The institution was in the process of growing its various residency programs and left a great impression on me during the interview. This program was staunchly in the “transitional” category, with a generous dose of electives in addition to core rotations. 

There were definitely times when, starting my advanced program, insecurities struck me—what if my TY didn’t prepare me well enough for emergency situations, or very sick patients? I had rotations in ICU, ER, and multiple months of wards, but I didn’t have as many as some of my peers, who did surgery internships or preliminary medicine years. However, after weighing all the pros and cons, a TY year ended up being a great choice for me. I would recommend it, as long as you know what you’re getting into.

My Experience as a Transitional Year Resident

Rotations

What did a day in my life look like as a transitional year resident? Well, that varies depending on your rotation, as is the nature of the program. During my month in ICU, I woke up at 5 a.m. and worked from 6 a.m. to 7 p.m., receiving sign-out, pre-rounding, participating in team rounds, presenting, getting pimped, placing orders, writing notes, performing procedures, putting out fires, admitting and transferring patients, answering family questions, herding medical students, and signing out. It was definitely exhausting, but I learned a lot that month and formed some really close bonds with my co-residents in the trenches. 

Then there were other months, such as on my Rheumatology rotation, when I would show up to the clinic at 8 a.m., talk to patients about their progress with medications, perform joint exams and sometimes a knee or shoulder injection, receive enlightening and personalized teaching from my knowledgeable attending, follow them to the hospital to answer consults, and leave for home usually before 4 p.m.

Whatever nuances I didn’t pick up due to abbreviated time on the wards, the variety of different settings and specialties improved my ability to pivot and reframe my thinking, which gave me the skills to adapt to novel situations. This definitely served me well in the rest of my training. For example, I had a month-long rotation in Radiation Oncology. Going into the rotation, I knew next to nothing about the specialty. Experiencing the work they do with patients deepened my understanding and appreciation for their field, and also came in handy later when caring for cancer rehab patients. 

Electives

I chose a TY because of the opportunity for exposure to different specialties. Truthfully, the TY I attended provided me with more electives than my medical school did. A common thread through the year, regardless of the rotation, included twice-weekly lunch lectures that included residents from other specialties, and educational experiences tailored to the TY program, such as research projects or monthly journal clubs.

Most of the electives I rotated in were pertinent in some way to my field, including PM&R, Radiation Oncology, and Neurology. There were also electives for my co-residents going into other fields which prepared them for their own specialties. My exposure to Rheumatology, Neurology, and PM&R ended up being immensely helpful for boards. My advanced program did not offer those rotations.

Networking

Attending a TY provided a unique networking opportunity that I may not have received if I had stayed at my home institution for medicine. My co-residents went into fields such as Anesthesiology, Radiation Oncology, Ophthalmology, and Radiology at programs around the country. I made connections with talented and diverse young doctors that I still have to this day.

Additionally, I made connections with physicians in my field who practiced in a different setting than what I usually experienced. Coming from and training primarily at a large academic center, I gained a valuable perspective of what a community PM&R practice looks like. I definitely would not have received that kind of experience in a surgery or preliminary medicine year.

Professional Development

The TY operating as its own separate program was also a significant positive. Our program leadership organized research projects and resident-led journal clubs specialized for the TY program, and we joined the other residency programs for teaching and QI projects. Unlike preliminary Internal Medicine programs and surgical internships, where one might feel lost in the mix among the programs’ core residents, we received adequate attention and support to develop ourselves clinically and academically. It certainly helped that the TY program also allowed me enough room to breathe so that I was able to complete my Step 3 exam relatively early in my residency training.

Should You Consider a Transitional Year?

A TY program can definitely be the right choice for you, depending on your priorities. It teaches adaptability and opens up your worldview as a physician, and provides you opportunities that may not be as readily available in other types of intern years. For those who think that a few more months on the wards in the first year is going to prepare them for the next few years of their training so that they can operate on autopilot, the truth is we are all lifelong learners and there are going to be things in residency that nothing can prepare you for. The ability to rise to the occasion, whatever it may be, is always going to be valuable, and from my experience, the TY year definitely prepares you for that.

Further Reading

• Residency Interview Tips & Tricks: The Ultimate Guide
• How Will Residency Consulting Help Me?
• 4 Residency Personal Statement Pitfalls to Avoid
• So, You’ve Matched Into Residency. Now What?
• How to Make Your Residency Rank Order List