Essential Guide to Choosing Your Preliminary Year for Dermatology Residency

Understanding the Role of the Preliminary Year in Dermatology

If you’re applying to dermatology residency, your preliminary year is not just “the year before derm.” It’s a foundational period that shapes your clinical skills, work habits, and reputation long before you set foot in a dermatology clinic as a resident.

Dermatology in the United States is structured primarily as:

• 3-year advanced dermatology residency (PGY-2 to PGY-4)
• 1-year internship (PGY-1) before dermatology, which can be:
  • A prelim medicine year
  • A prelim surgery year
  • A transitional year (TY)
  • In some cases, a categorical medicine or surgery PGY-1 if the derm program accepts it as equivalent

Your choice of preliminary year can influence:

• How competitive your overall application appears
• Your day-to-day quality of life before derm
• Your procedural and inpatient skills
• Your readiness for dermatology call, complex medical derm, and consults
• Your professional network and letters of recommendation

Because dermatology is highly competitive, thinking strategically about your internship year is part of planning for a successful derm match.

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Types of Internship Years: Prelim, Transitional, and Categorical

Understanding your options is the first step in choosing wisely.

1. Prelim Medicine (Preliminary Internal Medicine)

Structure and focus

• One-year, non-advanced internal medicine position
• You complete the core PGY-1 IM rotations:
  • General medicine wards
  • Night float
  • ICU (often)
  • Ambulatory clinic
  • Subspecialty rotations (varies by program)

Why dermatology-bound residents often choose prelim medicine

• Dermatology programs generally prefer or even explicitly require an internal medicine–focused internship, especially academic derm programs with strong complex medical dermatology services.
• You get robust exposure to:
  • Systemic disease
  • Inpatient consults
  • Polypharmacy and chronic disease management
  • The workup of undifferentiated complaints (rash + systemic symptoms)

Strengths

• Directly relevant to inpatient and consult dermatology
• Teaches you to:
  • Present efficiently
  • Manage acutely ill patients
  • Communicate with multidisciplinary teams
• Strong foundation for:
  • On-call telederm triage
  • Managing hospitalized patients with severe psoriasis, SJS/TEN, bullous diseases, vasculitis, drug eruptions

Potential drawbacks

• Often more intense workload than transitional year programs
• Less elective time
• May be more demanding call schedules and longer hours

Bottom line

If you want to maximize your internal medicine skills and many derm program directors’ preferences, prelim medicine is usually the safest, most broadly accepted choice.

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2. Prelim Surgery

Structure and focus

• One-year, non-advanced surgery internship
• Rotations may include:
  • General surgery services
  • Surgical subspecialties (plastics, ENT, vascular, etc.)
  • SICU
  • Trauma
  • Pre-op and post-op care
  • Some non-surgical rotations (e.g., anesthesia, ICU, emergency medicine)

Why some future dermatologists consider prelim surgery

• Dermatology, especially procedural and Mohs surgery–focused careers, involves:
  • Excision of skin cancers
  • Flaps and grafts
  • Nail surgery
  • Scar revisions and cosmetic procedures (in some settings)
• A prelim surgery year can sharpen:
  • Hands-on procedural skill
  • Confidence using instruments
  • Wound care and post-op management

Strengths

• High-volume procedural exposure
• Comfort in the OR and with sterile technique
• Strong time-management and OR etiquette skills

Potential drawbacks

• May offer less directly relevant systemic medicine training than prelim medicine
• Some dermatology program directors may view prelim medicine or transitional year as more tailored to dermatology’s overall needs
• Hours and stress can be intense, especially on busy surgical services
• Fewer electives and usually less clinic time

Bottom line

Prelim surgery can be a good choice if:

• You are strongly interested in a procedural-heavy dermatology career
• The derm programs you’re targeting accept and are comfortable with surgical internships
  But in general, it is less commonly chosen than prelim medicine among derm-bound students.

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3. Transitional Year (TY)

Structure and focus

• Flexible, broad-based PGY-1 year
• Mix of:
  • Medicine wards
  • ICU
  • Emergency medicine
  • Outpatient clinics
  • Various electives (radiology, anesthesia, dermatology, etc., depending on the program)

Why dermatology applicants like TY programs

• Typically more elective time than straight prelim medicine or prelim surgery
• May offer:
  • Dermatology electives
  • Research time
  • More predictable hours at certain sites
• Seen as a “lighter” year at some institutions, allowing:
  • More time for board study
  • A smoother transition into dermatology

Strengths

• Variety of experiences: inpatient, outpatient, subspecialties
• Potential for derm rotations during PGY-1
• Often better work–life balance in well-designed TY programs
• Opportunity to explore interests (e.g., rheumatology, allergy, pathology, radiology) that relate to complex derm care

Potential drawbacks

• Huge variability between TY programs—some are just as intense as medicine internships
• A few derm programs may still prefer a full prelim medicine year over TY, especially if the TY has minimal inpatient medicine exposure
• You must ensure your TY meets your derm program’s ACGME and program-specific requirements

Bottom line

A strong transitional year that includes meaningful internal medicine exposure and possibly dermatology electives can be an extremely good fit for many derm applicants—particularly those who value balance and diverse clinical skills.

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4. Categorical Medicine or Surgery Used as a PGY-1

Some students:

• Matched into categorical internal medicine or surgery
• Later match into dermatology
• Or apply to dermatology from within a categorical program

If the PGY-1 content matches ACGME requirements, a categorical year may be accepted as the “preliminary year.”

Key considerations

• Must confirm in advance with the dermatology program and the GME office that your prior training counts
• Transition logistics can be complex:
  • Release from one program
  • Contract timing
  • Credentialing

Bottom line

This is less about deliberate preliminary-year “selection” and more about making a career shift; it can work, but has its own administrative complexities.

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How Dermatology Programs View Different Preliminary Years

When planning for the derm match, it helps to understand how program directors think about internships.

Program Requirements vs Preferences

1. Explicit requirements
   Some dermatology programs specify in their materials:

   • “Requires one year of ACGME-accredited preliminary or transitional training in internal medicine, pediatrics, or surgery.”
   • Others say “preference given to applicants who complete a prelim medicine year.”

2. Implicit preferences
   Even without written rules, there can be strong culture-based preferences:

   • Academically heavy, medically complex derm programs may lean toward prelim medicine or robust TY programs.
   • Programs with high surgical volume and close ties to plastics or Mohs surgery may be more open to prelim surgery backgrounds.

Action item:
For each derm program on your list, read their website and FREIDA entry closely and, if unclear, email the coordinator or program director to ask what types of preliminary years they accept and prefer.

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What Program Directors Generally Want from Your Internship

Regardless of type, dermatology PDs want your preliminary year to produce:

1. Strong generalist competence

   • You can manage common inpatient emergencies
   • You understand when to escalate care
   • Your notes and handoffs are safe and reliable

2. Consultation skills

   • You know how to frame a consult question
   • You appreciate the perspective of consulting teams
   • You arrive in dermatology understanding how the hospital ecosystem works

3. Professionalism and resilience

   • You’ve worked nights, weekends, and handled stress while staying reliable
   • You can work in teams across disciplines

4. Solid evaluations and letters

   • A strong letter from your IM or TY program director or a core faculty member is a powerful signal for derm programs
   • Good evaluations from your internship reassure derm faculty that they’re inheriting a competent PGY-2

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How the Type of Year Interacts with Competitiveness

While your internship choice alone won’t make or break your derm match, it can add subtle value:

• Prelim medicine at a respected academic hospital:
  Signals robust training in complex patients; may align well with academic derm programs.

• Transitional year with derm electives and good lifestyle:
  Can let you publish, attend conferences, or strengthen academic productivity, which matters in derm.

• Prelim surgery at a strong surgical center:
  Shows procedural orientation and comfort with OR environments; can be advantageous if you’re aiming at surgically heavy programs or future Mohs fellowship.

However, derm program directors care far more about:

• Medical school performance (MS3/4 rotations, letters)
• USMLE/COMLEX scores (if still relevant for your cycle; Step 1 now pass/fail, Step 2 CK more important)
• Research productivity and genuine interest in dermatology
• Interview performance and fit with the program culture

Your preliminary year is a piece of the puzzle, not the whole picture.

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How to Choose the Right Preliminary Year for Your Goals

Selecting your internship is part strategy, part self-awareness.

Step 1: Clarify Your Priorities

Ask yourself:

1. What kind of dermatologist do I envision becoming?

   • Academic vs community
   • Medical derm vs procedural/Mohs-heavy
   • Interested in complex inpatient consults vs mostly outpatient clinic

2. What kind of year will protect my long-term well-being?

   • Are you resilient in very high-intensity environments, or do you function better with more balance?
   • How important is having time for relationships, family, hobbies, and health during your PGY-1?

3. What does my derm program target list look like?

   • Do many of my top programs state a preference for prelim medicine or TY?
   • Do any of them explicitly disallow certain types (e.g., “must complete an internal medicine or transitional year”)?

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Step 2: Evaluate Program-Level Factors

Not all prelim medicine or TY programs are created equal. Where you do your prelim year matters as much as what type it is.

Key variables:

1. Clinical volume and exposure

   • Will you see a wide range of common conditions?
   • Are there ICU and night float experiences to build real-world competence?

2. Support and supervision

   • Are seniors and attendings present and approachable?
   • Is the culture punitive or supportive?

3. Schedule and lifestyle

   • Frequency of 28-hour calls or night-float blocks
   • Number of days off in a row
   • Vacation policies and ease of scheduling

4. Elective time

   • Does the program allow dermatology electives?
   • Can you do research or outpatient subspecialty rotations that complement derm (rheum, allergy, ID)?

5. Reputation and structure

   • Is this a well-organized, longstanding prelim or TY program?
   • What do current and recent interns say about it?

Actionable tip:
Search for alumni feedback, talk to current residents (including any dermatology residents at that institution), and ask during interviews about typical schedules and intern wellness.

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Step 3: Align with Dermatology Program Expectations

If you already have a strong sense of where you’d like to match:

1. Check those derm programs’ stated policies on internship types.
2. When possible, choose a prelim or TY at the same institution as your dermatology program or within the same system. This can:
   • Ease the transition (same EMR, credentialing)
   • Give you face time with the derm faculty
   • Improve continuity with patients and consult services

However, matching derm and prelim at the same place can be logistically complex because:

• Some derm programs are advanced only; you rank a separate prelim list.
• Some are joint or “linked” with a specific prelim program, meaning:
  • If you match derm there, your prelim is pre-arranged or highly advised.

Always read ERAS and NRMP descriptions carefully to see if a derm program also offers a linked internship option.

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Step 4: Consider Strategic Pairing for a Competitive Derm Match

For many applicants, a balanced strategy might look like:

• Apply broadly to prelim medicine and transitional year programs that:
  • Have reasonable workloads
  • Provide solid medicine training
  • Are in locations you could realistically live in for a year
• Include a few prelim surgery programs if:
  • You genuinely like procedural work
  • You’re targeting procedurally heavy derm programs
  • You understand the intensity and are prepared for it

When making your rank list, consider:

• Putting the internships you’d be happiest in high on your separate prelim/TY list, not just the ones “closest” to your top derm programs.
• Remember that you’ll still learn a tremendous amount, and strong performance in any well-structured internship is more valuable than a miserable year at a “prestigious” site that burns you out.

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Practical Tips for Navigating the Derm Match with Your Preliminary Year

Coordinating Applications: Derm and Internship

Because dermatology is an advanced specialty, you will usually:

• Apply in ERAS to:
  • Dermatology programs (advanced positions starting PGY-2)
  • Internship programs (prelim medicine, prelim surgery, or TY) starting PGY-1

Key points:

• Timelines overlap; you will be interviewing for derm and prelim/TY around the same season.
• The NRMP rank lists are separate but must be considered together strategically so that:
  • If you match derm, you have a compatible prelim/TY match.
  • If you don’t match derm on your first attempt, you still end up with a solid internship position.

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Using the Internship Year If You Don’t Initially Match Derm

Some applicants do not match derm on the first cycle and reapply during or after their internship year.

Your preliminary year can become a bridge to a stronger derm application if you:

• Excel clinically to secure outstanding letters of recommendation
• Use elective time for:
  • Dermatology rotations
  • Research with derm faculty
  • Presentations or publications

In this scenario, prelim medicine or a well-structured TY with strong academic mentorship can be especially valuable.

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Balancing Wellness and Skill-Building

Dermatology residency is demanding, and burnout is real. Your internship year should:

• Challenge you enough to grow
• Not be so punishing that you start derm already exhausted and disengaged

Concrete strategies:

• On interviews, ask:
  • “What does a typical intern schedule look like in a representative month?”
  • “What wellness or support systems are in place for new interns?”
  • “How often do interns get full weekends off?”
• Reflect honestly on your personal bandwidth. Wanting to “prove yourself” is admirable, but thriving for the next four years is more important than surviving one awful year.

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Examples of Thoughtful Preliminary Year Choices

Example 1: Research-oriented derm applicant

• Strong publication record, loves complex medical derm
• Plans for academic career
• Chooses a university-based prelim medicine with:
  • Robust inpatient experience
  • Elective time in rheumatology and infectious disease
  • Opportunities to maintain her research connections
• Derm programs view this favorably as aligned with her academic and inpatient-focused goals.

Example 2: Procedurally focused future Mohs surgeon

• Enjoys OR and procedural clinics
• Strong Step 2, solid but not heavy research
• Applies to both prelim medicine and prelim surgery, ultimately ranking:
  • A prelim medicine program with derm electives and minor procedures very high
  • A moderate-intensity prelim surgery program with plastics exposure as a second-tier option
• He matches prelim medicine and uses elective time for derm clinic and small procedures—ideal preparation for a procedural derm career.

Example 3: Applicant prioritizing balance and geographic stability

• Couples matching with a partner in internal medicine
• Values being in the same city and having manageable hours
• Ranks transitional year programs in the same metro area as top choices, prioritizing:
  • Reasonable call
  • At least some internal medicine experience
  • A supportive environment
• She matches a TY that allows a derm elective with a local faculty member, helping her integrate into the regional derm community.

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Frequently Asked Questions (FAQ)

1. Is a prelim medicine year required for dermatology, or can I do a transitional year instead?

Most dermatology programs accept either a prelim medicine or a transitional year, as long as it is ACGME-accredited and includes adequate internal medicine exposure. Some programs:

• Explicitly prefer prelim medicine
• Some are entirely comfortable with TYs and even have linked TY positions in their institutions

Always check the specific requirements of the derm programs you apply to, and if in doubt, email the program coordinator or director for clarification.

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2. Will doing a prelim surgery year hurt my chances of matching dermatology?

A prelim surgery year does not automatically hurt your derm chances, especially if:

• The derm programs on your target list accept both medicine and surgery internships
• You perform very well and secure strong letters of recommendation
• You can articulate how surgical skills relate to your dermatology goals

However, many dermatology program directors are more accustomed to and comfortable with prelim medicine or TY backgrounds. If you lean toward prelim surgery, confirm that your top programs are open to it and understand that this path is less common among derm residents.

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3. Should I prioritize reputation or lifestyle when choosing my preliminary year?

Aim for a balance:

• A well-respected program with excellent teaching and supervision is important; it signals strong training and supports your clinical growth.
• But an extremely grueling, unsupportive environment can hinder your wellness and make your first year of dermatology harder.

Ask yourself:

• “Will I be well-trained and safe at this program?”
• “Will I realistically be able to maintain my health, relationships, and enthusiasm for dermatology here?”

If both cannot be maximized, prioritize safe, solid training and a sustainable lifestyle over pure brand-name prestige.

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4. If I don’t match dermatology on my first try, can my preliminary year help me reapply?

Yes. Your preliminary year can significantly strengthen your reapplication by:

• Providing outstanding clinical evaluations and new letters of recommendation
• Giving you elective time in dermatology to:
  • Build relationships with faculty
  • Participate in clinical research or quality improvement
  • Demonstrate commitment and growth
• Enhancing your maturity, resilience, and clinical judgment—traits that derm PDs value

If you’re in this situation, coordinate early with a derm mentor during your internship to strategically plan your reapplication, research, and letters.

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Choosing your preliminary year is an important step on your path to dermatology, but it’s not a singular make-or-break decision. Focus on finding an internship that will:

• Train you well as a physician
• Support your growth and well-being
• Align reasonably with the expectations of the dermatology programs you’re targeting

With thoughtful planning and honest self-assessment, your preliminary year can be a powerful launchpad into a successful and fulfilling dermatology residency.