Post-Graduate Year 1: The Internship
The Post-Graduate Year 1 (PGY1) is the first year of residency training completed by a physician after graduating from medical school. This year represents the transition from a student who observes patient care to a doctor who actively manages it. This period of intense, supervised practice is required for a physician to become fully licensed and board-certified.
Defining the PGY1 Role
The PGY1 year is widely referred to as the “internship,” signifying the trainee’s initial step into direct patient care responsibility. Completing this year is the final academic requirement for many medical school graduates before they can obtain a state-issued training license. This license permits them to practice medicine under the supervision of senior physicians within the hospital setting. Interns begin to manage patient cases from admission to discharge, applying their theoretical knowledge to real-time clinical scenarios. The year is structured to ensure the intern gains broad, hands-on experience across various medical settings.
Clinical Responsibilities and Supervision Hierarchy
The intern’s daily work involves a wide range of clinical tasks focused on managing patient care under close observation. Responsibilities include admitting new patients, performing initial history and physical examinations, creating initial treatment plans, ordering diagnostic tests, and writing daily progress notes. Interns communicate directly with nurses and other members of the healthcare team, serving as the primary coordinator for their patients’ care.
Supervision is structured to maximize patient safety while providing graduated responsibility. Interns are supervised by a clear hierarchy: typically PGY2 and PGY3 residents, a Chief Resident, and ultimately an Attending Physician. The Attending Physician, a licensed specialist, holds the final authority and directs the overall care plan.
The Accreditation Council for Graduate Medical Education (ACGME) enforces strict duty hour limits to prevent fatigue. PGY1 residents are restricted to duty periods of no more than 16 hours and must receive at least eight hours free of duty between shifts. The total work week is capped at 80 hours, averaged over a four-week period.
The Structure of PGY1 Training
The PGY1 curriculum is structured to ensure all trainees develop a broad foundation of general medical skills, regardless of their eventual specialty. Programs require mandatory rotations in core areas like internal medicine, general surgery, and ambulatory care. This rotational model exposes the intern to diverse patient populations and clinical environments, building competency in managing common and acute illnesses.
The specific rotations depend on the program type. A categorical program leads directly into a specific specialty, while a preliminary or transitional year provides a general, rotating curriculum. For example, a future dermatologist might complete a preliminary PGY1 year focused on broad-based medicine before starting specialty training in PGY2. The ACGME requires a minimum of 10 months of direct patient care in both inpatient and outpatient settings for many programs.
Progression to Full Residency Status
Successful completion of the PGY1 year signifies that the physician has attained clinical competence and is ready to assume greater independence. The transition to PGY2 involves a significant increase in autonomy and a shift toward the specific requirements of the chosen medical specialty. The PGY2 resident also takes on a supervisory role, guiding the incoming PGY1 interns.
A major milestone tied to PGY1 completion is the eligibility to sit for the United States Medical Licensing Examination (USMLE) Step 3. Passing Step 3, along with completing the PGY1 year, is often required by state medical boards to obtain a full, unrestricted medical license. This license allows the physician to practice medicine without the supervision limitations imposed on a trainee.