The American Training Model

The American model of training can be quite different from other systems you might have been exposed to. Once a student has completed high school, he or she continue their education enrolling into a post-secondary undergraduate school (college), 4 years in length. Once this has been completed, they undergo medical training in “medical school” that is another 4 years long. Once they are in their 4th year of medical school, they start interviewing for residency positions and undergo the match.

American residency (specialization) training is structured as follows:

  • Internship: 1 year, corresponds to post-graduate year 1 (PGY-1)
  • Residency: 3-5 years
  • Fellowship: 1-3 years

Each year of training is often followed by the acronym PGY. This means “post graduate year” and, as the words say, it indicates at what year in training you are after graduation from medical school. PGY-1, the first year of training past medical school graduation, corresponds to internship. This is 1 year of training in either general internal medicine, general surgery or a mix of both (known as a transitional program). Even if you have graduated a long time before (as an IMG), years of training are still described as PGYs and you can essentially consider them the equivalent of post-match years.

Residency programs are divided as follows:

Preliminary training

This is a 1 year long training contract, with no intention to renew the contract after its expiration. Preliminary positions are usually internship programs (PGY-1), although some general surgery programs offer preliminary PGY-2 positions also.

Preliminary positions can be standalones (for applicants who didn’t match into categorical or advanced programs) but are also required to continue into advanced programs that start as PGY-2 positions (for example, Diagnostic Radiology, Ophthalmology, Urology, Radiation oncology, etc). Many Internal Medicine, Surgery and some Pediatrics programs offer separate PGY-1 positions specifically for those who are doing a preliminary PGY-1 year knowing that they will then continue their training into Advanced positions.

While a PGY-1 positions is typically in Internal Medicine or General Surgery, there is also the possibility of applying for a Transitional Year, where the intern is exposed to both Internal Medicine, General Surgery, SICU, MICU and anesthesia).

Categorical training

Traditional 3-5 year programs that allow residents to train up to board eligibility (internal medicine 3 years, general surgery 5 years). Internship (PGY-1) year is incorporated. Only a minority Diagnostic Radiology and Integrated IR offer Categorical positions, which means that by matching into the program you’re guaranteed a PGY-1 internship spot before you start your PGY-2 radiology year (R1). Most offer Advanced positions. The benefit of applying to a Categorical radiology program is that you only have to match once, since it combines internship and subsequent training years. Otherwise, you will have to apply for internship and the advanced program separately (but during the same match cycle).

Advanced training

The first year in these programs is the PGY-2 year, considered also the first year of your real residency training and, therefore, name R1. Completion of an internship separately is required to enter these programs. The internship can be in the same or different hospital.

Duration varies (for example, 4 years of Diagnostic Radiology and Radiation Oncology, 3 years for Anesthesia, Ophthalmology and Neurology).

Matching into these programs must happen at the same time of matching into internship. For example, in order to start your PGY-2 advanced position in July 2020, you must apply in the 2018-2019 Match cycle and start your PGY-1 position in July 2019).

The majority of Diagnostic and Interventional Radiology Residencies offer advanced positions.

Fellowship training

Focuses on a particular area within the specialty, for example interventional radiology (until 2020), endocrinology, gastroenterology, cardiology, surgical oncology, cardiothoracic surgery, critical care. Doing a residency is a prerequisite to match into fellowship and what residency you complete restricts what fellowship you can apply to. For an Interventional Radiology fellowship (the name will be changed to “Residency” in 2020), you must complete a Diagnostic Radiology residency.

Radiology training is currently divided into diagnostic radiology residency and the new integrated DR/IR residency (diagnostic radiology/interventional radiology).

You will need to complete an internship year (medicine, surgery, transitional) before starting your Diagnostic Radiology training. You match into both at during the same match season (either preliminary position + advanced, or categorical) - your internship will start in July of your match year and your radiology residency will start 1 year after that.

How is the current IR training organized? What are the pathways to continue IR training after Diagnostic Radiology residency? Refer to the article “Past, Current, and future IR Training Models”.