Preliminary, Advanced, Categorical, What?

Anesthesiology residency, like some other specialties (radiology, ophthalmology, dermatology), has two components: an intern year and advanced training. For anesthesia, we're recommended to do a "preliminary" intern year in adult internal medicine followed by "advanced" training in anesthesia. Some applicants replace the medicine preliminary year with a preliminary year in surgery or a "transitional" year which consists of rotations in many different fields. Other applicants may have completed another specialty and seek to switch into anesthesia; those applicants don't have to redo internship (thankfully). This confusion is compounded by the types of programs out there; some programs integrate the intern year with the advanced training, and these are called "categorical" programs. Most programs have a few categorical positions and a few advanced positions.

The result of all of this is that I am applying to preliminary medicine programs, advanced anesthesia positions, and categorical anesthesia positions. In the next few weeks, I have to figure out how to rank these (another post coming soon about rank lists and the match). There are pros and cons to everything. A categorical anesthesia position makes things easy; I don't have to separately secure an internship, I don't have to move multiple times, and I get to know the hospital and attendings earlier. But there are also benefits to doing a preliminary year followed by advanced training; this would allow me to experience multiple geographic locations and play the role of a true medicine intern (as opposed to categorical programs where the intern year resembles more of a transitional year).

I initially thought it would be nicer for programs to all become categorical; this would greatly reduce the number of interviews I go on (I'm doing 10 preliminary programs in addition to my anesthesia interviews). But now at the end of the interview season, I think the flexibility afforded by having this confusing array of mix-and-match programs might actually be worthwhile. In any case, I wanted to write a post on this to clarify for anyone applying to those specialties and to make future posts on ranking and the match clearer.