The State of the Transitional Year: Results From a National Survey of Program Directors

The transitional year (TY) residency program is a rapidly growing and unique program where the Accreditation Council for Graduate Medical Education (ACGME) permits innovations in structure, design, and curriculum delivery. However, little is known about how programs differ within this framework and what constitutes typical TY curriculum. Understanding this variation is important because TY programs serve as the foundational clinical year for residents entering numerous advanced specialties. To our knowledge, there is no study investigating these differences.

To describe TY curriculum variability via a nationwide survey of TY program directors.

From May to August 2024, program directors for each of the 178 ACGME-accredited TY programs were sent a 31-question survey via a web link. The survey included questions about program structure, affiliations, electives, call schedules, and curriculum delivery.

Sixty of 178 TY programs responded to the survey (33.7%). The most common program size was 11 to 15 residents. One hundred percent of TY programs required an internal medicine rotation and 70% (n=42) required a surgery rotation. Most TY programs required an ICU experience (n=46, 76.7%) while fewer required pediatric (n=12, 20%) or obstetrics and gynecology (n=8, 13.3%) rotations. Only 25% (n=15) of respondent TY programs required 24-hour call, but 75% (n=45) required night float.

We describe widespread variation in the delivery of the ACGME-required TY curriculum, elective time, specialty rotations, and call schedules. Based on the survey results, several common curricular features emerged, including ≥70% (n=42) inclusion of internal medicine, general surgery, ICU, and night float rotations and ≤25% (n=15) inclusion of 24-hour call.