Your Essential Guide to Preliminary Year Selection in Radiology Residency

Understanding the Role of the Preliminary Year in Radiology

For most applicants entering a diagnostic radiology residency, the path includes an initial year of broad clinical training before starting dedicated radiology training. This first year is typically called the preliminary year, PGY-1, intern year, or transitional year, followed by the core diagnostic radiology residency (PGY-2–PGY-5).

Radiology is an “advanced” specialty in the NRMP, meaning that:

• You match into a PGY-2 diagnostic radiology position, and
• You also need a separate PGY-1 clinical year (unless your program is categorical and includes the intern year).

Understanding and choosing the right preliminary year is crucial because it affects:

• Your wellbeing and burnout risk
• Your clinical competence (especially for interpreting imaging in real-world clinical context)
• Your letters of recommendation and professionalism development
• Your ability to study for USMLE Step 3 and start radiology strong

This guide will walk through everything you need to know about preliminary year selection in diagnostic radiology—how to choose between prelim medicine, prelim surgery, transitional years, and others, how to prioritize programs, and how to strategically rank them in the diagnostic radiology match.

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Types of Intern Years for Radiology Applicants

Most diagnostic radiology residency programs accept any ACGME-accredited “clinical base year” that meets American Board of Radiology (ABR) requirements. The common options are:

• Preliminary Medicine (Prelim Medicine)
• Preliminary Surgery (Prelim Surgery)
• Transitional Year (TY)
• Less commonly: Prelim Pediatrics or other tailored clinical years

1. Preliminary Medicine (Internal Medicine)

Structure:

• 12 months of internal medicine–based training (wards, ICU, electives)
• Often indistinguishable from categorical internal medicine interns, just without the long-term continuation to PGY-2
• Mix of inpatient, outpatient, and night float, varying by program

Pros:

• Highly relevant clinical foundation for radiology:
  • You see common imaging indications daily (chest pain, SOB, abdominal pain, fever of unknown origin, stroke workups).
  • You develop a strong sense of what ordering clinicians need from radiology reports.
• Teaches clinical reasoning and patterns of disease that will directly inform how you read images.
• Usually considered a “standard” and widely accepted choice for radiology residency programs.
• Often viewed favorably if you are considering:
  • Possible future fellowship in cardiothoracic imaging, body imaging, neuroradiology, or IR
  • Administrative/leadership roles where broad inpatient experience is valuable

Cons:

• Can be busy and demanding, depending on the program:
  • Night float, long ward months, ICU rotations
  • Less control over schedule early in the year
• Potentially less elective time than some transitional years.

Who tends to thrive in prelim medicine?

• Applicants who want a strong clinical core, are okay with carrying patients and managing complex medical issues, and value a rigorous but clinically rich intern year.

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2. Preliminary Surgery

Structure:

• Primarily surgical services (general surgery, subspecialty services—vascular, colorectal, trauma, etc.)
• OR time, wards, consults, and often significant overnight call

Pros:

• Excellent for developing:
  • Procedural comfort and manual skills
  • Team communication in high-intensity settings
  • Understanding surgical indications and postoperative imaging
• Helpful if you are particularly interested in:
  • Interventional Radiology (IR) or image-guided procedures
  • Trauma imaging and acute care radiology

Cons:

• Typically among the most demanding intern years:
  • Early mornings, late evenings, in-house call, frequent weekends
  • Less flexibility to schedule vacations/electives
• May be physically and emotionally taxing, with less time for:
  • Independent study
  • Early radiology exposure
  • USMLE Step 3 preparation

Who tends to thrive in prelim surgery?

• Applicants with high stamina who enjoy procedural work and a hectic pace, potentially with IR aspirations.
• Those who want intense clinical immersion and don’t mind sacrificing some study time for hands-on experience.

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3. Transitional Year (TY)

Structure:

• A “hybrid” year with a mix of specialties: internal medicine, surgery, emergency medicine, electives, and possibly radiology.
• Often more elective-heavy and, in many cases, lifestyle-friendlier than pure prelim medicine or surgery.

Pros:

• Flexibility: The ability to choose electives (including radiology or subspecialties related to radiology such as neurology, cardiology, or oncology).
• Often better work-life balance:
  • Some TY programs famously have lighter call schedules and more vacation.
• May allow:
  • Dedicated Step 3 study time
  • Early exposure to radiology departments (if electives exist)
• Can be particularly attractive to applicants seeking an easier transition into residency.

Cons:

• Quality and rigor vary widely between programs:
  • Some are excellent, academically strong, and well-rounded.
  • Others may be more service-heavy or have limited educational content.
• Some radiology programs may prefer a robust clinical year over an extremely light TY, especially at highly academic institutions.

Who tends to thrive in a transitional year?

• Applicants prioritizing balance, mental health, and the opportunity to:
  • Explore subspecialties
  • Study for exams
  • Start families or manage major life transitions
• Those who are self-motivated to learn, even if the schedule is lighter.

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4. Other Options: Prelim Pediatrics or Hybrid Years

In select cases, radiology applicants may complete:

• Prelim Pediatrics: Particularly if they are interested in pediatric radiology, or if they match at an institution that accepts peds-based prelim years.
• Mixed or customized clinical base years that meet ABR criteria.

These are less common and should be chosen only after confirming with your diagnostic radiology residency that the year will be accepted for board eligibility.

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How the Preliminary Year Fits into the Diagnostic Radiology Match

The diagnostic radiology match typically involves applying and interviewing for:

1. Advanced radiology positions (PGY-2 start; R1 year)
2. Preliminary or transitional PGY-1 positions

Some programs are categorical diagnostic radiology residencies, meaning:

• They include both the PGY-1 clinical year and the PGY-2–PGY-5 radiology years in a single, unified match position.
• You don’t have to apply separately for a prelim or transitional position.

However, many diagnostic radiology residencies remain advanced programs, requiring you to secure a separate:

• Prelim medicine, prelim surgery, or transitional year position.

Application Strategy: Coordinating Two Matches

In ERAS and NRMP, this means:

• You will rank advanced DR programs (which start at PGY-2)
• And separately rank preliminary/TY programs (PGY-1).

To coordinate:

• Identify where your top radiology programs are geographically.
• Apply broadly to prelim/TY programs in the same region or city, when possible.
• Use NRMP’s supplemental rank lists to link specific prelim programs to specific advanced positions if desired.

Category vs. Advanced: How It Impacts Prelim Selection

• Categorical diagnostic radiology residency:

  • No need to choose a separate preliminary year (the decision is essentially made for you).
  • Still helpful to understand what your PGY-1 will look like when comparing categorical programs.

• Advanced diagnostic radiology residency:

  • You must be proactive in selecting, applying to, and ranking prelim programs that are:
    • Acceptable to your future radiology program
    • Compatible with your lifestyle, educational goals, and geographic needs

Tip:
Always check each radiology program’s website or FAQs to see if they recommend certain types of preliminary years (e.g., “We prefer internal medicine or a strong transitional year with substantial medicine experience.”).

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Choosing Between Prelim Medicine, Prelim Surgery, and Transitional Year

When selecting your preliminary year for radiology residency, consider four main domains:

1. Clinical preparation
2. Lifestyle and wellbeing
3. Geographic logistics
4. Long-term career goals

1. Clinical Preparation: What Makes You “Radiology-Ready”?

Strong radiologists understand disease processes, clinical decision-making, and the implications of imaging findings. Ask yourself:

• Do I want heavier exposure to internal medicine–type patients?
  • If yes, prelim medicine or a medicine-heavy TY may be better.
• Do I want procedural and OR exposure, especially if I’m IR-curious?
  • If yes, prelim surgery or a TY with procedural rotations may suit you.
• Do I want breadth more than depth—some medicine, some surgery, some EM?
  • Then a transitional year may be attractive.

In most cases, program directors in diagnostic radiology value:

• Solid internal medicine skills
• Comfort with inpatient management
• Understanding of acute vs. chronic issues and common imaging indications

This makes prelim medicine and many TY programs highly compatible with radiology training.

2. Lifestyle and Wellbeing: Avoiding Burnout Before Radiology

Some intern years are notoriously grueling. While there is educational value in intense clinical training, excessive burnout in PGY-1 can:

• Make it harder to study for Step 3
• Reduce your enthusiasm as you start your radiology residency
• Impact your mental and physical health

When evaluating prelim medicine vs prelim surgery vs transition year:

• Look at call schedules, night float frequency, and ICU months
• Ask current interns:
  • “How many days off do you typically get per month?”
  • “Are you able to pursue personal interests or rest on your days off?”
  • “How does the program respond to concerns about workload and wellness?”

If your radiology residency is known for being high-intensity (e.g., heavy volume, academic expectations), you may benefit from:

• A balanced intern year that builds clinical skills but still leaves bandwidth for rest and self-directed learning.

3. Geographic Considerations: Minimizing Disruption

You will complete your preliminary year before moving to your diagnostic radiology program (unless they are co-located or categorical). Consider:

• Do you want to stay in the same city/region for both years?
  • This reduces moving stress and helps with housing, relationships, and social support.
• Is it acceptable (or even desirable) to do your prelim year in a different environment?
  • Some people choose a prelim program near family or a partner, then move for radiology.

If you know your approximate region for future radiology residency, target prelim medicine, prelim surgery, or TY programs in that area.

4. Long-Term Career Goals: Tailoring Your Year

Think about your potential path within radiology:

• If you’re interested in interventional radiology (IR):
  • Prelim surgery or a TR/medicine year with strong procedural rotations can be useful.
• If you’re leaning toward neuro, chest, body, or emergency radiology:
  • Prelim medicine or balanced TY will give broad exposure.
• If you’re uncertain and just want a general, solid foundation:
  • Either prelim medicine or a reputable transitional year is often ideal.

Regardless of your choice, you will be expected to function as a fully capable resident on clinical services during your radiology years when you interact with consulting teams. The preliminary year should develop your clinical confidence rather than leave you feeling underprepared.

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How to Evaluate and Rank Prelim and Transitional Programs

Beyond the basic choice of prelim medicine vs prelim surgery vs transitional year, you’ll face specific program choices. Here’s how to evaluate them effectively.

Key Factors to Assess

1. Workload and Culture

• Patient caps, call frequency, and average hours per week
• Presence of night float vs 24-hour call
• Attending supervision and approachability
• Resident camaraderie and program culture (“supportive and team-based” vs “harsh and hierarchical”)

Actionable tips:

• Ask on interview day:
  • “How many admissions per call night?”
  • “How is the workload distributed among interns?”
  • “Do seniors and attendings help actively when things get overwhelming?”
• Talk to current interns, not just chiefs or faculty.

2. Educational Quality

• Structured didactics, morning reports, case conferences
• Protected educational time and how often it is actually honored
• Feedback mechanisms and mentorship opportunities

While your ultimate focus is diagnostic radiology, a strong educational environment in your preliminary year will:

• Build your clinical reasoning
• Improve your ability to understand imaging indications and consequences
• Make you a more effective radiology consultant

3. Flexibility and Electives

• Number of elective months and how they can be used:
  • Radiology electives
  • ICU, EM, cardiology, neurology—even pathology or oncology
• Policies about switching rotations or customizing your schedule

If you can do 1–2 months of radiology as an intern:

• You’ll gain early exposure to workflows, PACS systems, and reading rooms
• You may build pre-existing relationships with faculty, useful for future references or fellowship applications

4. Support for Exams and Administration

• Time and support for taking USMLE Step 3
• Help with:
  • Credentialing
  • Licensing paperwork
  • Visa issues, if applicable

Some programs explicitly protect Step 3 study time or provide a lighter rotation for exam preparation. This can be a major advantage.

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Common Pitfalls and Strategic Recommendations

Pitfall 1: Choosing Solely Based on Reputation

Some applicants fixate on the “most prestigious” prelim or TY program. While prestige can matter slightly, what matters far more is:

• Your day-to-day experience
• The clinical skills you gain
• Your wellbeing and ability to learn

A well-run community hospital transitional year with strong education and good hours may serve you far better than an elite but extremely punishing prelim surgery year.

Pitfall 2: Underestimating a Demanding Prelim Surgery Year

If you are not genuinely enthusiastic about surgical culture and workflow, jumping into a surgically intense PGY-1 can lead to:

• Unnecessary burnout
• Less time for Step 3 and self-study
• Strained morale heading into radiology

If you choose preliminary surgery, be sure:

• You understand the call schedule and expectations
• You are physically and mentally prepared for that environment

Pitfall 3: Overly “Light” Transitional Year Without Clinical Depth

While a light transitional year may sound appealing, you still need enough:

• Internal medicine exposure
• Inpatient management experience

Otherwise, you might start your diagnostic radiology residency feeling:

• Uncomfortable with common medical scenarios
• Less confident when interacting with consulting teams

Solution:

• Look for TYs with meaningful core rotations in internal medicine, emergency medicine, and at least some ICU, while still offering reasonable lifestyle.

Strategic Recommendations

• If you’re undecided and want a “safe” choice with high compatibility for radiology:
  → Prelim medicine or a medicine-heavy transitional year at a program with good culture and reasonable hours.

• If you’re IR-focused and enjoy the OR, procedures, and high-intensity work:
  → Prelim surgery or a balanced TY with significant procedural exposure.

• If you highly value work-life balance and early radiology exposure, and you are self-directed in studying:
  → A reputable transitional year with radiology electives and time for Step 3.

• Always verify that your chosen PGY-1 meets ABR requirements and is acceptable to your diagnostic radiology residency.

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Practical Timeline and Action Plan for Applicants

MS3–Early MS4: Clarify Goals

• Confirm that diagnostic radiology is your intended field.
• Talk to radiology residents and faculty about their intern year experiences.
• Identify whether you might be:
  • IR-leaning
  • Academically focused
  • Lifestyle-focused

Early MS4: Application Season

• In ERAS, apply to:
  • Your desired diagnostic radiology programs (advanced or categorical)
  • A reasonable number of prelim medicine, prelim surgery, and/or transitional year programs, strategically chosen by geography and preferences.
• Use your personal statement and experiences to show that you:
  • Value both clinical medicine and radiology
  • Will be a productive and collegial intern

Interview Season

During prelim/TY interviews, ask targeted questions:

• “What percentage of your interns are going into radiology, anesthesia, or other advanced specialties?”
• “How often do interns feel overwhelmed or burned out?”
• “Is there an opportunity to do an elective in radiology or related fields?”
• “How much flexibility is there in arranging the schedule around taking Step 3 or moving for PGY-2?”

Rank List Strategy

• Rank diagnostic radiology programs first based on your true preferences.
• Rank prelim/TY programs according to:
  • Fit with your goals
  • Lifestyle
  • Geographic convenience
  • Clinical training quality
• Consider using NRMP’s supplemental rank lists to pair specific prelim programs with your top advanced radiology choices when it matters geographically.

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FAQs About the Preliminary Year for Diagnostic Radiology

1. Does my choice of prelim year (medicine vs surgery vs transitional) affect my chances of matching into diagnostic radiology?

For the vast majority of applicants, your prelim choice does not significantly affect your initial diagnostic radiology match if you are applying in the same cycle. Radiology programs primarily evaluate:

• Your medical school performance
• Board scores
• Letters, research, and fit

However, if you later apply for fellowships (e.g., IR, neuro, body), strong clinical grounding from intern year is helpful. Most program directors are comfortable with prelim medicine or a well-structured transitional year, and may only advise against extremely “light” TYs that lack sufficient clinical exposure.

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2. Is a transitional year really easier than prelim medicine or prelim surgery?

Not always. Transitional years vary widely:

• Some are truly lifestyle-friendly, with many electives and manageable call.
• Others are essentially prelim medicine programs under a different label.

You must review:

• Rotation schedule
• Call structure
• Resident feedback

Do not assume TY means “easy.” Confirm the day-to-day reality during interviews and through current residents.

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3. Should I prioritize being in the same city for my prelim year and radiology residency?

It’s ideal but not mandatory. Being in the same city or system can:

• Reduce the burden of moving
• Help with housing logistics and relationships
• Allow you to build early connections with the radiology department (if co-located)

However, many residents successfully complete their prelim year in one city and then move for diagnostic radiology. Decide based on:

• Personal life (family/partner support)
• Cost of living
• Availability of suitable preliminary programs near your desired radiology institution

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4. When should I take USMLE Step 3 if I’m going into diagnostic radiology?

Most diagnostic radiology residents aim to complete Step 3 during the preliminary year or early in PGY-2. Benefits of taking it during the prelim year include:

• Content is fresher (internal medicine, surgery, EM)
• You can enter radiology without another major standardized exam looming

Choose a prelim/TY program that offers:

• At least one lighter rotation or elective block
• Reasonable support for time off to take the exam

Confirm logistics with your intern program once you match.

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Selecting a preliminary year in the context of a radiology residency is more than just checking a box—it shapes your clinical confidence, your wellbeing, and your transition into one of the most intellectually rich specialties in medicine. By understanding the nuances of prelim medicine, prelim surgery, and transitional year options, and by evaluating programs through the lens of both education and lifestyle, you can craft an intern year that sets you up for long-term success in diagnostic radiology.