Residency and Match Terminology – The difference in PGY medical training for Categorical, Transitional, Preliminary Residents

If you’re the loved one of a medical student, you are probably used to feeling confused about something called The Match. I’d like to validate your confusion. Six years as a medical wife, and I am still sitting across the table asking my husband to remind me the difference between Interns and Prelims.

The fact is, The Match is a terrifying process for medical students. I’d like to expound on this process in detail, but before I can even explain all the subtle differences, you have to know what I’m talking about. And for this, I am truly sorry, but I am going to give you a non-alphabetical Dictionary of Post-Graduate Year Training. You can use this as a resource in the future when your medical student is approaching The Match or when they’re describing to you their plans for Match and Residency.

Non-Alphabetical Dictionary of Post-Graduate Year Medical Training

Resident – this is a doctor who graduated medical school and is completing a multi-year training residency to become a fully licensed physician. Once graduated from a residency program, these physicians do not require oversight and may be hired on at a hospital as an attending physician, or join a private practice. The number of years a physician is a Resident is based on the specialty where they match. Within that, the years are sometimes influenced by the hospital’s residency program and the government laws guiding the program’s rules.

The Resident is also a TV program that my husband thinks less of me for watching. But I can’t help myself when I see Matt Czuchry’s (i.e. Logan from Gilmore Girls) smirky smile.

180119-news-the-resident-matt-czuchry
Yea boi

PGY – this stands for “post-graduate year.” I just learned that today. I figured those letters did not mean anything, they were just another way for the medical community to speak in acronyms to keep laypeople confused. Each specialty has a different number of PGY years required. For instance, Internal Medicine will have PGY-1, PGY-2, and PGY-3 residents; Orthopaedics will go up to PGY-5; Neurosurgery will go up to PGY-7.

Categorical Resident – this is a physician who has matched into a residency program and is training in their area of specialty. Most residents you meet fall into this category.

Transitional Resident – this is a physician that must complete a year of general training in either Internal Medicine or General Surgery before proceeding to their specialty. For instance, an ophthalmathology resident must do a year of internal medicine before going to their ophtalmology residency to continue their training as a Categorical.

The difficulty with transitional years is that it requires the medical student to apply to twice as many programs, and then Match twice; once for the transitional year, and once for the categorical residency. Yes, you read that correctly.

To add to this stress, the medical student may Match into their specialty and not Match into their Transitional year (or vice versa). If they are fortunate enough to Match into both, it is likely they will not match into a Transitional Year and Categorical Residency in the same city or state, which means they have to move twice in order to complete their training. I would recommend you give this person in your life your favorite book on minimalist living.

life changing magic
Here’s my favorite: I ❤ you, KonMari

Preliminary Resident – the physician did not match into the specialty they applied for, so they go through a special secondary Match process and spend a year in training as a physician in a different program or specialty. This process is referred to by many as “The Scramble,” but it is preferable to refer to it as the Post-Match SOAP process, which stands for Post-Match Supplemental Offer and Acceptance Program (SOAP). Students are given the opportunity to match into open residency programs, either as Categoricals or as Preliminary residents.

As a Prelim, you are a doctor working for a hospital with “resident status,” but you are not in an official residency program. The year or years you spend as a Prelim may not count toward the Residency program you eventually enter into after you Match as a Categorical in the future. However, some programs will accept their Prelims into their residency programs if they like them enough, and their initial year of training might be granted as their intern year.

Typically people underestimate Prelims because they didn’t Match the first time, but I would put my money on Prelims for coming out as the winner in The Hunger Games, because these doctors have to suffer the most by surviving The Match multiple times.

“There cannot be peace without, first, a great suffering and the greater the suffering, the greater the peace.” – Mission Impossible Fallout, likely written by an M.D. who didn’t Match and who changed careers to screenplay writing

Intern – This is the first year of post-graduate training for a physician. In all respects, Interns are Residents, they are just first year Residents in a multi-year program. Interns are referred to as PGY-1. If an Intern is a Preliminary Resident, they may be an Intern again if they Match into a different program in the future. Transitional residents are an Intern their Transitional year, and then they are considered a PGY-2 once they get to their Categorical Residency. In years prior, the Intern was not yet considered a fully fledged Categorial Resident, although this has changed in the last few decades as programs integrate their years of Residency with the Intern year so that all years are considered “Categorical.”

The Intern year is typically the year that allows newly graduated doctors to study for their Step 3 board exam and complete the required general steps for their overall specialty. The reason for this is so that these new physicians can get the training and exposure they need in a more general setting before becoming specialized in their niche of medicine. Interns learn their hospitals Electronic Medical Records system, get to know the staff nurses and attending physicians, and get the lay of the land. During this time, they may also need to complete other requirements before they are granted additional licensing, like prescribing narcotics. This is the time when you want to befriend a physician.

Fellow – this is a physician who has completed their years of residency and is able to be hired as an attending for their general specialty. The Fellow opts for additional years of training for a sub-specialty and applies to Fellowship programs. An Internal Medicine resident may become a Fellow in Gastroenterology and spend an additional 3 years training to become a Gastroenterologist. A General Surgery resident may become a Fellow in Cardiothoracic Surgery and specialize in heart surgery. An Orthopaedic Surgery resident may do a Fellowship in Upper Extremities and specialize in shoulder replacement surgeries and scopes. Fellowships may go through The Match process, but some require a separate application and interview process. Typically a resident will consider applying for a fellowship in their second to last year of training. These folks are clearly not in medicine for the money, as they are now nearing their mid-thirties, in over $200,000 in debt, and still decide to further their training before making real money.

Congratulations!

Now that you’re an invariably an expert in this terminology, we can next discuss the horrific realities of The Match and all of its potential options. To prepare yourself, you should watch this real life video of students getting Matched:


Nicole Davis is the wife of an Orthopaedic Surgery resident and frequently finds herself explaining the confusing world of Medicine to non-medical people. If you are a burgeoning medical professional or a significant other of a medical student or resident, consider sending these simplified articles to people in your life who would like to understand your journey.

Like this? Check out this article: What is medical school? An Explanation for pre-meds and non-medical people.

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One comment

  1. Very well done! I laughed out loud at the M.I. quote.
    I’m afraid I still cannot explain all of this to someone else, but at least I now have an excellent resource available should the need arise.

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