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The Preliminary Match

What is the difference between Preliminary, Advanced, and Categorical positions?

Preliminary, Advanced, and Categorical are residency position designations defined by the National Residency Matching Program (NRMP).

  • Preliminary positions are stand-alone PGY-1 only positions, unattached to an advanced residency program in the NRMP Main Match.
    • Advanced positions begin at the PGY-2 level and offer the rest of the required specialty training, unattached to a Preliminary position in the NRMP Main Match.
    • Categorical positions combine a PGY-1 Preliminary position with a PGY-2 Advanced position in the NRMP Main Match and offer an entire training course in that specialty.

Applicants who are matched to Advanced positions must complete a Preliminary year, whether that is a separately matched Preliminary position or part of a combined integrated position. Applicants who match to Categorical positions match for both the preliminary and the advanced residency training years (“one stop shopping”). It’s also important to understand that many specialties offer both Advanced and Categorical positions.

Which advanced residency training pathways require a Preliminary training year?

Advanced residency programs are training pathways that require completion of a Preliminary training year prior to starting residency training. Advanced residency pathways that may require a Preliminary year include the following: Anesthesiology, Dermatology, Diagnostic and Interventional Radiology, Neurology, Physical Medicine & Rehabilitation, and Radiation Oncology, among others.

What Preliminary position training pathways exist?

Graduates must choose to train in one of the following approved Preliminary training pathways (though some advanced residencies may prefer a given pathway): Medicine-Preliminary, OB/GYN-Preliminary, Pediatrics-Preliminary, Surgery-Preliminary, or Transitional Year. In the 2022 NRMP Main Match, the following 4,581 Preliminary residency positions were offered: 1,774 Medicine-Preliminary, 18 OB/GYN-Preliminary, 23 Pediatrics-Preliminary, 1,150 Surgery-Preliminary, and 1,616 Transitional Year.

Note should be made, however, that these numbers can be misleading – they only tell part of the story. Not all Preliminary positions are offered through the NRMP Main Match. First, the PGY-1 portions of Categorical positions are not typically included in the total number of Preliminary positions reported by the NRMP. For example, there are several Medicine-Preliminary positions at IUSM that are associated with advanced program positions. Because of their association with Advanced positions, those Medicine-Preliminary positions are not available or identified in the NRMP Main Match as independent Preliminary positions. Be sure to learn which advanced programs offer preliminary positions in the Match!

How competitive is the Preliminary match?

Highly competitive! A high demand for PGY-1 Preliminary positions exists in the US. While most are aware of the highly competitive nature of advanced residency positions (e.g. Dermatology), many students fail to recognize the competition inherent in the Preliminary match. Potential trainees for all advanced training pathways are vying for the same Preliminary training positions! Add non-US graduates and applicants who are applying in their second, or even third, match cycles, and one can start to appreciate the vast competition for Preliminary positions (in 2022, only 61% of Transitional Year applicants were allopathic senior students).1 It is worth reiterating this importance: applicants who successfully match into advanced residency positions cannot begin training without completing a Preliminary training year – prioritizing the Preliminary match is important!

As an example of just how sneaky Preliminary match competitiveness can be, let’s examine the 2022 NRMP Main Match data for Transitional Year positions alone. Among all applicants who ranked Transitional Year positions (including applicants who matched to Transitional Year positions and those who did not), the NRMP totaled an average of 10.5 ranked Transitional Year programs per applicant.1 Application to Preliminary programs warrants effort similar to Advanced programs and serious consideration.