Frequently Asked Questions: Transitional Year
Transitional Year Review Committee
ACGME
Question
Institutions
What is the Letter of Commitment
(LOC), and how does this differ from
Program Letters of Agreement
(PLAs)?
Answer
An LOC is a warranty between a transitional year program and its sponsoring specialty
programs. These letters originate at the program level and are required from each specialty
program sponsoring a transitional year program. PLAs also originate at the program level, but
differ in that they are agreements between a program and each participating site providing a
required rotation [see Program Requirement I.B.].
[Program Requirement I.A.3.b)]
LOCs provide details similar to what is included in PLAs; however, they also indicate a
sponsoring program's commitment to provide educational experiences for a specified number of
transitional year residents, and a commitment that these residents will receive educational
experiences comparable to those provided to the sponsoring program's categorical residents. A
sample LOC template can be found on the Review Committee web page on the ACGME
website.
What information do LOCs contain? Each LOC must be addressed to the transitional year program director, signed by the program
director of the sponsoring specialty program, and must include:
[Program Requirement I.A.3.b)]
1. the sponsoring specialty program's commitment to the transitional year program in
terms of the number of transitional year residents it agrees to educate during an
academic year on the specialty service;
2. the amount of time each transitional year resident may spend rotating on the specialty's
service, and the names of all sites (if applicable) used for this rotation;
3. the responsibilities the transitional year resident(s) will have while rotating on the
specialty's service;
4. the faculty member(s) who will be responsible for supervising the transitional year
resident(s) and the type of supervision that will be available;
5. how the transitional year resident(s) will be evaluated, and how the resident(s) will
©2016 Accreditation Council for Graduate Medical Education (ACGME)
Updated: 2/2016
Page 1 of 6
Question
Answer
evaluate the rotation; and,
6. a stated commitment ensuring that transitional year residents on specialty service
rotations will receive educational experiences equivalent to those provided to the
specialty service categorical residents.
A sample LOC template can be found on the Review Committee web page on the ACGME
website.
What is the minimum experience for LOCs are required between a transitional year program and all specialty program sponsors,
which an LOC needs to exist
regardless of the amount of educational experience provided.
between a transitional year program
and a specialty program sponsor? A sample LOC template can be found on the Review Committee web page on the ACGME
website.
[Program Requirement I.A.3.b)]
When should LOCs be updated?
LOCs should be updated whenever there are changes in program directors of the transitional
year program or any of the sponsoring specialty programs, changes in resident complement,
[Program Requirement I.A.3.b)]
changes in resident assignments (including duration of rotations), changes in participating sites
used for the sponsoring specialty programs’ rotations, or changes in resident responsibilities, or
if there are any revisions to the items contained in the agreement as outlined above. Absent of
these changes, LOCs must be renewed at least every five years. If nothing in the LOC has
changed at the end of five years, it is acceptable to add an amendment signifying review and
extension of the LOC with requisite signatures.
Program Personnel and Resources
Which rotations are required (or
Some Review Committees, such as Anesthesiology and Diagnostic Radiology, have developed
recommended) by specialty
specific guidelines for PGY-1 curricula to prepare a transitional year resident for entry into the
programs to which residents have
specialty residency. As these guidelines are frequently updated, program directors should
matched upon completion of the
consult the Program Requirements for Anesthesiology, Diagnostic Radiology, Dermatology,
transitional year?
Ophthalmology, or Radiation Oncology to identify what rotations they should be providing as
part of transitional year residents’ educational experiences.
[Program Requirement: II.A.4.s)]
Note that the transitional year program director must forward the transitional year resident’s
performance evaluation to the specialty program director at least twice a year, or as otherwise
specified in the specialty requirements.
©2016 Accreditation Council for Graduate Medical Education (ACGME)
Updated: 2/2016
Page 2 of 6
Question
Answer
How does the ACGME define a
The ACGME Glossary of Terms includes this definition of a transfer resident:
transfer resident, and how does this
definition impact the responsibilities
Residents are considered as transfer residents under several conditions including:
of the transitional year program
moving from one program to another within the same or different sponsoring institutions;
director?
when entering a PGY-2 program requiring a preliminary year even if the resident was
simultaneously accepted into the preliminary PGY-1 program and the PGY-2 program as
[Program Requirement II.C.1.]
part of the match. Before accepting a transfer resident, the program director of the
receiving program must obtain written or electronic verification of prior education from
the current program director. This includes evaluations, rotations completed, proceduraloperative experience, and a summative competency-based performance evaluation.
Educational Program
Is call on other rotations, continuity Call on other rotations is not permitted during the required rotation. Continuity clinic experience
clinic experience, or vacation
is permitted if it is in compliance with duty hour requirements. Vacation is permitted if the 140permitted during the required
hour minimum requirement is met within a continuous four-week block
rotation in emergency medicine?
[Program Requirement IV.A.6.a).(1).
(a)]
If the sponsoring institution does not
sponsor an ACGME-accredited
program in one of the fundamental
clinical skill areas (i.e., emergency
medicine, family medicine, general
surgery, internal medicine,
obstetrics and gynecology, and
pediatrics), can a transitional year
resident rotate in one or more of
these specialties and still receive
credit for a fundamental skills
rotation?
[Program Requirement:
IV.A.6.a).(1).(c)]
Yes. While the Review Committee prefers that each resident's fundamental clinical skills
rotations occur under the auspices of ACGME-accredited programs in emergency medicine,
family medicine, general surgery, internal medicine, obstetrics and gynecology, or pediatrics, it
recognizes that not all hospitals have accredited programs in all of these specialties. In these
situations, an alternate ACGME-accredited program in one of the fundamental clinical skills, in
conjunction with the transitional year program director, can be responsible for overseeing the
quality of the clinical and educational experiences for the transitional year residents. For
example, if a hospital does not have an ACGME-accredited pediatrics residency, but does have
an ACGME-accredited family medicine program, then the family medicine program can be
responsible for overseeing the pediatric rotation. The family medicine program director and the
transitional year program director must have sufficient oversight to ensure:
1. there are qualified faculty members who have expertise in teaching and clinical supervision
and who regularly participate in faculty development in these skills;
2. that transitional year residents are provided with sufficient and high quality teaching,
evaluation, and feedback;
©2016 Accreditation Council for Graduate Medical Education (ACGME)
Updated: 2/2016
Page 3 of 6
Question
Answer
3. that the transitional year residents have equivalent educational experiences as, and the
opportunity to work with, the residents from the responsible ACGME-accredited program(s)
while on the rotation; and,
What clinical experiences meet the
ambulatory/outpatient care
requirement?
[Program Requirement:
IV.A.6.a).(2)]
4. that residents participate in regularly scheduled didactics that correspond to the emergency
medicine clinical experience.
Ambulatory care refers to experiences with outpatients requiring the comprehensive application
of fundamental clinical skills in diagnosis, treatment, rehabilitation and prevention. Ambulatory
care experiences may be in general internal medicine, family medicine, general surgery,
obstetrics and gynecology, pediatrics, or urgent care (but not in emergency care) settings.
Highly specialized experiences with ambulatory patients, or clinic work which focuses almost
entirely on a single organ system (e.g., cardiology, endocrinology, urology, otolaryngology,
etc.), are not regarded as sufficiently broad in experience or responsibility to fulfill the
requirement.
For example, a cardiology, dermatology, or urology clinic would not count towards the required
transitional year ambulatory experience.
Evaluation
Is the Program Evaluation
Committee (PEC) the same as the
old Transitional Year Education
Committee (TYEC)?
Yes. The PEC has the same membership, and functions similarly to the TYEC in the previous
accreditation system.
[Program Requirement: V.C.1.]
How does the Review Committee
define a resident member of the
PEC?
The PEC must include one resident member from the current transitional year class. This peernominated resident represents the residents’ interests during policy and program issue
discussions. It is expected that the resident member will report a summary of deliberations and
decisions enacted by the PEC back to the other transitional year residents. The Review
[Program Requirement: V.C.1.a).(1)] Committee recognizes that a PEC may include more than one resident member; however, it is
important that if more than one resident serves on the PEC, that these resident members are
peer-selected and work together to ensure that the transitional year residents are adequately
represented.
©2016 Accreditation Council for Graduate Medical Education (ACGME)
Updated: 2/2016
Page 4 of 6
Question
What is the requirement for
attendance at PEC meetings?
Answer
Each member of the PEC should contribute meaningfully to the committee's responsibility of
monitoring the activities of the program. The Review Committee expects that the program
director, program directors of the sponsoring programs or their designees, the designated
[Program Requirement:
institutional official (DIO) or designee(s) from hospital administration, and the peer-selected
V.C.1.a).(4).(e)]
resident member(s) should attend at least 75 percent of the meetings. Programs may wish to
consider electing an alternate to the required peer-selected representative(s) in the event of
scheduling conflicts. Program directors of disciplines regularly included in the curriculum (or
their designees) are expected to attend at least 50 percent of the meetings.
Resident Duty Hours in the Learning and Working Environment
What are the requirements for night The Review Committee believes that educational experiences in night medicine can offer
float rotations?
residents valuable educational and professional benefits, and that transitional year residents
should be treated the same as categorical residents on night float rotations. The Review
[Program Requirements: VI.G.6.]
Committee expects that night float or night medicine rotations correspond to the block rotation
to which a resident is currently assigned. Additionally, night float rotations should have a set of
formal goals, objectives, and learning activities that should include strategies for fatigue and
alertness management.
An appropriate level of supervision must be available for all transitional year residents on night
float. The Program Requirements state that transitional year residents must not be scheduled
for more than six consecutive nights of night float. Residents should also not be assigned for
more than four contiguous weeks of night float, and should have no more than six total weeks
of night float during the transitional year residency.
Other
How specific do the block diagrams Block diagrams are intended to provide the Review Committee with a clear understanding of
of rotations need to be?
the educational experiences provided to each resident during the transitional year. Specificity is
essential. If an elective rotation is scheduled on the dermatology service, for example, the
program director should enter “DERM,” not simply “Elective.” In addition, the Review Committee
asks that the program director document each resident’s vacation time in the block diagram.
If a rotation is taken to fulfill the required 28 weeks of fundamental clinical skills experience, the
ACGME-accredited categorical program should be noted. For example, if a general surgery
rotation is taken in an ACGME-accredited family medicine program, the entry should be
designated as “GS/FM”; if taken in an ACGME-accredited general surgery program, the entry
should read, ’GS”. The following abbreviations should be used: IM= general internal medicine,
FM = family medicine, GS = general surgery, PEDS = pediatrics, EM = emergency medicine,
©2016 Accreditation Council for Graduate Medical Education (ACGME)
Updated: 2/2016
Page 5 of 6
Question
Answer
OB/GYN = obstetrics and gynecology.
If a rotation is not at a participating site, or is not in an ACGME-accredited categorical program,
it should be indicated by an asterisk.
How should vacation time be
scheduled during the transitional
year?
Only ambulatory clinical experiences that meet the aforementioned ambulatory/outpatient care
requirement should be documented in the block diagram.
Vacation should be scheduled so that it does not compromise the educational value of the
transitional year clinical experiences and affords the resident an opportunity for rest and
personal time. The only requirement of the Review Committee is that vacation does not
encroach upon the time necessary to complete a required rotation. For example, vacation must
not be taken during an elective if the full elective month is necessary to meet program
requirement specifications or to meet the educational goals of the rotation. Some programs find
it useful to format rotations in 13, four-week blocks to accommodate vacation time.
Vacation leave is essential, should not be forfeited or postponed, and cannot be used to
shorten the total required education period.
Up to one month of the transitional year can be spent away from the program for vacation,
illness, parental or family leave, or pregnancy-related disabilities. The educational program
must be extended to make up any absences exceeding one month per required year of
education.
©2016 Accreditation Council for Graduate Medical Education (ACGME)
Updated: 2/2016
Page 6 of 6