Way, way, way back in 1968–1969 I pursued and completed a year of post graduate training which could be considered a prototype of the transitional year experience that approximately one third of prospective radiology residents opt for today. In many ways, my internship provided the perfect introduction for a career in radiology, exposing me to clinical encounters of such diversity and with many insightful interactions that I recall many of them vividly today. My training consisted of 8 months of medicine, including one ER month, and 4 months of surgery. The medical experience also encompassed 4 months of general medicine, 1 month on an oncology service at Montefiore Hospital—a full service academic medical center—and 2 months of medicine at Morrisania Hospital—a now defunct city hospital which served mostly indigent patients from the South and West Bronx. Morrisania was designed, can you believe it, into a series of open wards, 35 patients in one large room. The elevators often did not work and the lab was six flights up. Managing diabetic ketoacidosis patients was like marathon training.

My 4 months in surgery included 1 month in urology, 1 month in vascular surgery, and 2 months of general surgery.

It was rigorous—too rigorous because I was on every other night. There was nothing wonderful and everything wrong about that. My dad died unexpectedly in the sixth week of internship and 4 days later, I was hospitalized with infectious mononucleosis for which they kept me for 3 weeks as an in-patient. Imagine that also. But those particularities aside, the clinical experience that I received in breadth and depth, in variety and intensity involving adult patients, poor, middle class and very well off, was supported by some very excellent teachers and a few poor ones, too. It propelled me to take on responsibility for care although sometimes I was not prepared for it. I witnessed suffering and death engendered by the ravages of disease and in truth, sometimes also occasioned by bad physician management. In most instances that care was ameliorated by compassion and competence exuded by physicians, nurses, and support staff. In sum, I learned about medical diseases and surgical diseases, I learned about the inevitability of physical decline and death as well as to appreciate the manifestations of effective treatment. We even saved a few lives too.

These are not ruminations activated by nostalgia. Rather, I want to create a counterpoise to the present day iteration of what was once called a rotating internship and is now labeled the transition year. I attempt here to examine and to critique how this 12 month period is organized and to relate how current radiologists view it. I also consider the economic advantages conveyed to hospitals that possess a TY program. In contradistinction to the relatively simple format of a rotating internship, the criteria for transitional internships are much more complex. Here are some of the interesting requirements as set forth by the transitional year residency review committee, an arm of the Accreditation Committee for Graduate Medical Educations. For each element I also offer some criticism as to the way it provides an experience for prospective radiologists.

Every transitional program, at least on paper, should have two coincident sponsoring residencies. At least one of those six sponsoring residencies must come from the following six disciplines; Emergency Medicine, Family Medicine, Internal Medicine, Obstetrics/Gynecology, Pediatrics and Surgery. A TY-program must have 24 weeks devoted to one or two of these disciplines. Each rotation should be a minimum of 4 weeks. The requirements also mandate 4 weeks of emergency medicine.