Prelim and Transitional Years applications ERAS 2013

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I am totally unsure how many prelim and transitional years to apply to this coming year. I'm trying to think about things like this, because I'm trying to think about money for ERAS + travel expenses etc.

I'm applying in Anesthesiology with a 240/99 Step 1, some clinical research with hopefully some pubs, should have great letters, really interesting and involved ECs, and I've been told I have a compelling personal statement (dare to dream - who knows, right). Great clinical grades. P/F school, so no rank will show, but I'm hoping I still have a shot at AOA in the fall. Making it my job to kill Step 2.

I don't want my home program's prelim year, because we really want to leave this area, and I don't like the structure. I'd prefer transitional, but I'm doubting my ability to compete for one. I know they are competitive.

How many prelim med years should I apply to? Transitional? I just have no idea what kind of number is rational?

I was thinking I'd apply to 30 anesthesia programs, but mainly because I would like to go to a research-heavy, top-tier, and I am not sure how the chips are going to fall.

Can anyone give me some insight into the prelim/transitional world?

Originally Posted by afteranesthesia

I am totally unsure how many prelim and transitional years to apply to this coming year. I'm trying to think about things like this, because I'm trying to think about money for ERAS + travel expenses etc.

I'm applying in Anesthesiology with a 240/99 Step 1, some clinical research with hopefully some pubs, should have great letters, really interesting and involved ECs, and I've been told I have a compelling personal statement (dare to dream - who knows, right). Great clinical grades. P/F school, so no rank will show, but I'm hoping I still have a shot at AOA in the fall. Making it my job to kill Step 2.

I don't want my home program's prelim year, because we really want to leave this area, and I don't like the structure. I'd prefer transitional, but I'm doubting my ability to compete for one. I know they are competitive.

How many prelim med years should I apply to? Transitional? I just have no idea what kind of number is rational?

I was thinking I'd apply to 30 anesthesia programs, but mainly because I would like to go to a research-heavy, top-tier, and I am not sure how the chips are going to fall.

Can anyone give me some insight into the prelim/transitional world?

Great specialty choice haha!

So when you start doing ERAS and deciding on which programs you want to apply to, you'll see that anesthesia (compared to other advanced specialties) has quite the mix of categorical and advanced positions. You'll have programs that are strictly categorical, mostly categorical with a few advanced, mostly advanced with a few categorical, or strictly advanced. Most applicants decide early on whether they prefer a categorical or advanced position, which is all personal preference. For me, I wanted the option of doing an advanced program with a cush intern year so I took applying to TYs and Prelims pretty seriously.

Figuring out how many to apply to all depends on what route you take. If you are going for cush TYs in high-demand locations, then it's going to very competitive and I would definitely recommend applying on the higher end. If you include cush TYs in less popular locations or slightly tougher prelims in the popular locations, then you can probably decrease the total number and will probably be fine matching.

From my n=1, I applied mostly based on geographical location. I wanted to stay around the area I did med school for personal reasons and luckily there were a fair number of decent TYs and prelims within less than a 2 hour drive. Ended up applying to 11 TYs - 4 of those also had Prelims so I applied to those as well and my home prelim program. Interviewed at 10 TYs and the 5 Prelims. Matched at my #1.

P.S. 30 anesthesia programs will definitely be good if not more than enough. You should be fine.

Above post is pretty good. I think applying to 10 TYs and 5 prelims is probably overkill IMO. I only interviewed at 4 TYs and a couple prelims and matched #1. TYs are competitive, but I think their competitiveness has been inflated a bit. Shoot for around 10 total apps with a few prelim backups and you'll do fine.

Can you guys give me any indication to the TY's or prelim years that are "competitive"? I'm not sure I know which ones are other than taking a stab at some nice places to live...ie. SoCal?

And I should clarify why I ask - not because I necessarily want a competitive or a "cush" one, but I want to make sure I apply to some that are NOT competitive to ensure I match somewhere. Does that make sense? My goal isn't the cushest year possible, but more an idea of which ones are unattainable vs. safety choices.

I echo the same question. And thanks for the advice! And gasblaster - it is a great specialty choice! I'm really excited about it.

Originally Posted by RestoreSight

Above post is pretty good. I think applying to 10 TYs and 5 prelims is probably overkill IMO. I only interviewed at 4 TYs and a couple prelims and matched #1. TYs are competitive, but I think their competitiveness has been inflated a bit. Shoot for around 10 total apps with a few prelim backups and you'll do fine.

Looking back I definitely over-applied, but I was worried about the competitiveness of the TYs like these guys are and it wasn't too much of hassle to go to the interviews.

There are a good amount of cush TYs. It's the location that makes it super competitive. Any of the cush TYs in a popular location is going to be more competitive than a similar one in a lower demand city. Some of the more competitive ones from what I remember off the top of my head

Manhattan - MSKCC
Boston - Brockton, Carney
Philadelphia - Crozer Chester
San Diego - Scripps
Los Angeles - Harbor
Pacific NW - Spokane
South (just plain cush versus location) - Spartansburg, Roanoke, Riverside
Other - Hawaii?

If you are applying in the Northeast, you'll be fine. Out West, the increased competitiveness comes from the supply vs demand.

Originally Posted by gasblaster

Looking back I definitely over-applied, but I was worried about the competitiveness of the TYs like these guys are and it wasn't too much of hassle to go to the interviews.

There are a good amount of cush TYs. It's the location that makes it super competitive. Any of the cush TYs in a popular location is going to be more competitive than a similar one in a lower demand city. Some of the more competitive ones from what I remember off the top of my head

Manhattan - MSKCC
Boston - Brockton, Carney
Philadelphia - Crozer Chester
San Diego - Scripps
Los Angeles - Harbor
Pacific NW - Spokane
South (just plain cush versus location) - Spartansburg, Roanoke, Riverside
Other - Hawaii?

If you are applying in the Northeast, you'll be fine. Out West, the increased competitiveness comes from the supply vs demand.

As far as the east/south, From what I've heard Riverside and Spartansburg are the big two, as far as being "cush" and competitive. MSK is competitive because it's NYC, but it's not very cush.

FYI the TY at Roanoke no longer exists.

This is very helpful - what sort of numbers and app do you need to get the Spartanburg or the Riverside TYs?

I guess I just don't know how competitive I am for them. When I hear "competitive" - I automatically assume I am out of the running, but am I?

Originally Posted by afteranesthesia

This is very helpful - what sort of numbers and app do you need to get the Spartanburg or the Riverside TYs?

I guess I just don't know how competitive I am for them. When I hear "competitive" - I automatically assume I am out of the running, but am I?

Not sure about numbers, but you could check their websites to see the types of interns they have (what specialties they matched and where) to get a rough idea. These types of places often end up attracting people who are not from that area (VA or SC) and are going somewhere completely different for their advanced program. That's usually a sign that people really wanna be there for the cush schedule and/or benefits.

IIRC, when you use ERAS you pay a flat fee for the first 10 programs in each specialty to which you apply. Since TYs and prelim medicines are technically different specialties you can see that applying to both would result in no reason to apply to less than 10 of each and you would have to pay at least $140 (maybe more now?) for internship apps.

Since that would be overkill, one strategy I used was to just apply to 10 TYs that also have a related prelim medicine program (or vice versa). Most (if not all) programs will let you rank both the TY and the prelim program if you interview there.

I found there was a strong geographical bias in internships, so even if you aren't a huge fan of your home city, your best odds are there for the first year. Also, at least half of anesthesia spots now have a built in internship which you may look into, but these are typically more difficult than the classic bogus TY year.

I'd aim for 10 interviews with at least 5 prelim. Since half of your anesthesia programs will be categorical, you can probably go lower.

As long as you include prelims at academic institutions you should be fine (those are less competitive because you will be worked).

afteranasthesia, you are totally competitive for a TY! Not much to add to what gasblaster said. In my field, there are some categorical programs - most go the advanced route. Since in my specialty I was applying all over the country, for my TY/prelim programs I applied geographically close to where my med school was, so I didn't have to move long-distance twice. I applied to 6 TYs (and interviewed at 6), and to 6 prelim (interviewed at 5). I ranked them all (TYs at the top of the list) and matched at my #1. I highly, highly suggest that you go TY route - you get such a broad range of clinical experiences! (caveat emptor, however: some TYs, like Newton-Wellesley, actually operate more like prelims - yes, you do get some surgery time there, but you almost never go into the OR, so you basically spend the entire year either on medical or surgical floors). Go for it!

For comparison, I'm finishing my TY now. I had same step 1 as op and 261 step 2. I'm MD/PhD also with an interesting life story. I was around middle of my class from a big name place.

My opinion: TYs/prelims generally don't care about your research or your life story. Personal statements that stand out are kind of bad. You're expected to be a professional workhorse scutmonkey and too much personality is a liability for them. This is more or less true for residency as well, especially at the big name academic places. You might want to tone down you personal statement and/or have a PD or assistant dean read it for content.

I didn't get invites at most of the cushy, good location TYs mentioned in this thread. I ranked most of the ones I did get near the top and didn't get them. Though some I didn't rank so high because I didn't think they were as cush as word of mouth suggested. I matched at what I now think is probably the nation's best TY, but in a small midwestern city. If you would be interested in applying to a small midwestern city PM me and I will send you the name.

So you have to decide if you're more interested in location or cushness. I picked cushness. I'm not from the midwest. I don't like the midwest. But, it's just a year. I had plenty of vacation time and even did a month away rotation in a cool place. Some people did their aways in the Carrib, Europe, Latin America, etc... There were a lot of other perks that made it well worth it, and it's probably in the top 3 nationally for cushness.

As for how many to apply to, I generally recommend interviewing at about 6 programs, but it depends on your paranoia level. I was really unsure about the differences between programs, so I interviewed at 12 TYs/prelim meds. I did interview at a few combined TY/prelim med places and I really disliked the prelim med programs to the point that I didn't rank some of them. There was only one reasonable prelim med I interviewed at, but it was't associated with a TY program. All this interviewing did help me to decide what I wanted and really compare between some of the places named in this thread and some other places.

Hey guys, I have a similar question.
step 1: 238 with a 1 case report pub, 1 poster from undergrad, 1 school grant received, co pres of club, and quite a few work and research experiences from undergrad.
grades: mostly HP's with 1-2 Honors.

Applying in NYC. I was planning on applying to 2 TY programs and 4-5 prelim surgery programs. would this be enough? should i try to get more programs to add to the list?
thanks!!

Originally Posted by ar2388

Hey guys, I have a similar question.
step 1: 238 with a 1 case report pub, 1 poster from undergrad, 1 school grant received, co pres of club, and quite a few work and research experiences from undergrad.
grades: mostly HP's with 1-2 Honors.

Applying in NYC. I was planning on applying to 2 TY programs and 4-5 prelim surgery programs. would this be enough? should i try to get more programs to add to the list?
thanks!!

Good god, why are you applying to surgery prelims?

Use academic IM prelims as your backups instead. They're tough, but at least they follow hours rules and try to teach you something. And there are easier community prelims.

Very unlikely to get the TYs, there are very few in NYC and there's pretty fierce competition. Most go to radiation oncology + dermatology, with scattered radiology and ophtho people (ie most have better stats). To some extent though, programs are just looking for people who they would like to work with for a year, so there's some randomness (assuming you get an interview).

Feel free to PM me for more info.

medicine makes me want to rip my hair out.. a little bit.. well more than a little. i know the hours will suck but i really enjoyed surgery and will prolly learn a lot about lines and postop management which could be helpful for radiology.

Originally Posted by ar2388

medicine makes me want to rip my hair out.. a little bit.. well more than a little. i know the hours will suck but i really enjoyed surgery and will prolly learn a lot about lines and postop management which could be helpful for radiology.

You will learn nothing. Seriously. Surgical prelims are just abused.

I know several people who thought the way you did (I even was considering it), but they all regretted it.

The ridiculous rounding in medicine is really only an issue at academic centers. It's much more reasonable at small community hospitals.

Seriously though - I don't know a single person who did a surgical prelim who did not regret it.

Originally Posted by ar2388

medicine makes me want to rip my hair out.. a little bit.. well more than a little. i know the hours will suck but i really enjoyed surgery and will prolly learn a lot about lines and postop management which could be helpful for radiology.

You probably wouldn't need more than a month for this. 1 month of surgery is not worth an entire year of prelim surg.

Originally Posted by johnnydrama

You will learn nothing. Seriously. Surgical prelims are just abused.

I know several people who thought the way you did (I even was considering it), but they all regretted it.

The ridiculous rounding in medicine is really only an issue at academic centers. It's much more reasonable at small community hospitals.

Seriously though - I don't know a single person who did a surgical prelim who did not regret it.

If you have to be in NYC, use prelim medicine as a back up. If at all possible, opt for a cush TY outside of the city. It's only 1 year.

That sounds like st lukes...

Originally Posted by Neuronix

For comparison, I'm finishing my TY now. I had same step 1 as op and 261 step 2. I'm MD/PhD also with an interesting life story. I was around middle of my class from a big name place.

My opinion: TYs/prelims generally don't care about your research or your life story. Personal statements that stand out are kind of bad. You're expected to be a professional workhorse scutmonkey and too much personality is a liability for them. This is more or less true for residency as well, especially at the big name academic places. You might want to tone down you personal statement and/or have a PD or assistant dean read it for content.

I didn't get invites at most of the cushy, good location TYs mentioned in this thread. I ranked most of the ones I did get near the top and didn't get them. Though some I didn't rank so high because I didn't think they were as cush as word of mouth suggested. I matched at what I now think is probably the nation's best TY, but in a small midwestern city. If you would be interested in applying to a small midwestern city PM me and I will send you the name.

So you have to decide if you're more interested in location or cushness. I picked cushness. I'm not from the midwest. I don't like the midwest. But, it's just a year. I had plenty of vacation time and even did a month away rotation in a cool place. Some people did their aways in the Carrib, Europe, Latin America, etc... There were a lot of other perks that made it well worth it, and it's probably in the top 3 nationally for cushness.

As for how many to apply to, I generally recommend interviewing at about 6 programs, but it depends on your paranoia level. I was really unsure about the differences between programs, so I interviewed at 12 TYs/prelim meds. I did interview at a few combined TY/prelim med places and I really disliked the prelim med programs to the point that I didn't rank some of them. There was only one reasonable prelim med I interviewed at, but it was't associated with a TY program. All this interviewing did help me to decide what I wanted and really compare between some of the places named in this thread and some other places.

I think you may get to do more lines, etc in a prelim medicine year than in surgery; I've gotten a bunch on icu. The only NYC prelim surg program I'd consider is Sinai.

Originally Posted by drizzt3117

I think you may get to do more lines, etc in a prelim medicine year than in surgery; I've gotten a bunch on icu. The only NYC prelim surg program I'd consider is Sinai.

I've heard Beth Israel the surgery prelim may be better than IM, but that's only because their IM prelim is malignant.

Originally Posted by johnnydrama

I've heard Beth Israel the surgery prelim may be better than IM, but that's only because their IM prelim is malignant.

yupp, def heard that too...

I am also applying Anesthesia but I am a lower tier applicant, but my question is in regards to Personal Statements.

How many of those who are currently in TY or Prelim-IM's wrote:

1) separate entirely new personal statements
2) modified their pre-existing one to cater towards TY/Prelim Years
3) or used the same exact one they used for their speciality.

Also, how are TY/Prelim Interviews like? Do they ask you about your speciality and such?

Originally Posted by viciouz

I am also applying Anesthesia but I am a lower tier applicant, but my question is in regards to Personal Statements.

How many of those who are currently in TY or Prelim-IM's wrote:

1) separate entirely new personal statements
2) modified their pre-existing one to cater towards TY/Prelim Years
3) or used the same exact one they used for their speciality.

Also, how are TY/Prelim Interviews like? Do they ask you about your speciality and such?

Used my rads PS - no modifications.

Originally Posted by viciouz

I am also applying Anesthesia but I am a lower tier applicant, but my question is in regards to Personal Statements.

How many of those who are currently in TY or Prelim-IM's wrote:

1) separate entirely new personal statements
2) modified their pre-existing one to cater towards TY/Prelim Years
3) or used the same exact one they used for their speciality.

Also, how are TY/Prelim Interviews like? Do they ask you about your speciality and such?

2. Also, anesthesia. Changed the last paragraph of my personal statement to talk about my goals of TY year and its application towards career in anesthesiology. Otherwise, the rest was exactly the same.

Originally Posted by gasblaster

2. Also, anesthesia. Changed the last paragraph of my personal statement to talk about my goals of TY year and its application towards career in anesthesiology. Otherwise, the rest was exactly the same.

Rads, this is what I did too.

Originally Posted by drizzt3117

Rads, this is what I did too.

What did all of you guys use as your letters for prelim/TY years? Just use the same letters as for your advanced specialty?

Originally Posted by Sheldor

What did all of you guys use as your letters for prelim/TY years? Just use the same letters as for your advanced specialty?

Yes. Same letters, same PS, got my first choice prelim.

Originally Posted by Sheldor

What did all of you guys use as your letters for prelim/TY years? Just use the same letters as for your advanced specialty?

Changed it up a little bit because 1) my school's IM department/chair writes a compilation medicine LOR (like a mini-dean's letter) specifically for people applying to TYs/prelims and 2) had a good LOR from medicine attending so thought I might as well use it. I switched out 1 advanced specialty and 1 research LOR for those 2 letters. IMHO, I figured a medicine letter vs a research letter would be much more useful to TY/prelims. Matched at my #1 TY.

Slightly off topic, but for those that applied to Anesthesia, do you think its a bad idea to only apply to categorical programs?

Originally Posted by atkinsje

Slightly off topic, but for those that applied to Anesthesia, do you think its a bad idea to only apply to categorical programs?

It's mostly personal preference. I knew I wanted to do a cush TY for my intern year, because the intern year for most categorical programs is pretty rough comparatively. Although there's been a gradual shift, there still are a fair number of programs that are strictly advanced such as all MGH, Brighams, BID, Hopkins, Mayo, Yale, etc. I think it's possible to only apply to categorical programs, just make sure that the programs you are interested have categorical positions.

Originally Posted by gasblaster

Changed it up a little bit because 1) my school's IM department/chair writes a compilation medicine LOR (like a mini-dean's letter) specifically for people applying to TYs/prelims and 2) had a good LOR from medicine attending so thought I might as well use it. I switched out 1 advanced specialty and 1 research LOR for those 2 letters. IMHO, I figured a medicine letter vs a research letter would be much more useful to TY/prelims. Matched at my #1 TY.

Basically the same for me. Our medicine chair writes a specific TY/Prelim medicine letter (mostly based on our Medicine clerkship performance/CV), so I used that for my TY apps but not Derm apps (had another IM letter from a sub-I that was outstanding, which I used for both TYs and for Derm). I also sent my two Derm letters to TYs. I had a research (non-derm) LOR that was supposedly really good, so I sent that to Derm programs but not to TYs (they don't really care to hear about my research).

TY:
1 IM sub-I LOR
1 IM chair LOR
2 Derm clinical LORs

Derm:
1 IM sub-I LOR
2 Derm clinical LORs
1 non-derm research LOR

.

Originally Posted by afteranesthesia

Bumping this. Got my step 2. 265. That with a 240 step 1- am I safe just applying to 10 transitional? Or do you think I should still rank some prelim meds?

Yeah you should be fine. It'll probably end up being harder to fit in/have the motivation to do 10 TY interviews more than anything. That and finding 10 that are actually cush in an area you want to be.

Originally Posted by afteranesthesia

Bumping this. Got my step 2. 265. That with a 240 step 1- am I safe just applying to 10 transitional? Or do you think I should still rank some prelim meds?

Still rank prelims. It all depends on which transitionals you are applying to though.

Yeah with a good mix of TY programs I would think it would be close to enough. I guess it's always better to be safe and doesn't cost much to add in a couple.

.

Originally Posted by wapwap

what are people's thoughts on applying to a TY and prelim year at the same institution, is this a big no no?

also what is the recommended # for non-aoa, step 1 241, step 2 242, for TY and prelims, I'm looking midwest and cali.

Totally fine. Expected even.

Originally Posted by wapwap

what are people's thoughts on applying to a TY and prelim year at the same institution, is this a big no no?

also what is the recommended # for non-aoa, step 1 241, step 2 242, for TY and prelims, I'm looking midwest and cali.

If a hospital has a TY and prelim year, it's completely fine, routinely done, and even encouraged to apply to both.

The Cali TYs are going to pretty competitive because there are less than a handful of them. Not sure what the prelim programs there are like and haven't heard much about them. Same with the Midwest.

Tough to say how many I'd apply to because I'm not sure how competitive the Midwest ones are, but I would guess not as bad as the coastal programs. I'd go with at least 15+ TYs and 5+ prelims, not counting the Cali ones.

Originally Posted by wapwap

what are people's thoughts on applying to a TY and prelim year at the same institution, is this a big no no?

I did this. I found the prelim medicines to be so different from the TY programs, I ended up not ranking most of them. One of the prelim med interns at one place even told me "I wish I had matched to the TY program..."

.

Originally Posted by wapwap

appreciate all the input, just wanted to make sure 20-25TY with 15-20 prelim wasnt overboard.

15-20 prelims would be a bit overboard.

Originally Posted by wapwap

appreciate all the input, just wanted to make sure 20-25TY with 15-20 prelim wasnt overboard.

Just don't go on more than 10 TY interviews + 5 prelim interviews.

You can add more if convenient, but that's where I would feel comfortable.

The f... I applied to 3 TYs and no prelims my year.

I would say 15 TY is more than enough, esp if your home program has a prelim, you're essentially guaranteed a spot there if they have a decent amount of spots.

Are the east coast TY esp in the SE competitive? What does competitive actually mean anyway for TY?

Originally Posted by johnnydrama

Just don't go on more than 10 TY interviews + 5 prelim interviews.

You can add more if convenient, but that's where I would feel comfortable.

Agree with this. No way you can fit in interviewing at more than this. But leave yourself options because you'll find that available interview days will overlap with your advanced interviews.

Originally Posted by drizzt3117

The f... I applied to 3 TYs and no prelims my year.

I would say 15 TY is more than enough, esp if your home program has a prelim, you're essentially guaranteed a spot there if they have a decent amount of spots.

Haha 3? Someone must've been a ridiculous applicant. I didn't have the cajones for that.

Originally Posted by afteranesthesia

Are the east coast TY esp in the SE competitive? What does competitive actually mean anyway for TY? I.e. is my 240 Step 1 and 265 Step 2 make me someone who would get one of these?

I ask, because I am from the South, and I am guessing I am one of the masses from here who wants one of the few TY here.

My other top choices would be somewhere in the West for my spouse, who wouldn't mind living somewhere fun for a year, but I am guessing those are probably more competitive than anything else.

What I am finding especially ridiculous is how much I am stressing over choosing TY and prelims to apply to vs. my anesthesia programs I have selected and narrowed down to 30. Kind of ironic.

Poor geography skills here. What states are considered the Southeast? MD and down?

I'm mainly referring to charleston, Spartanburg, emory, Newport news, tn ones etc.

I guess Virginia down?

Originally Posted by afteranesthesia

I'm mainly referring to charleston, Spartanburg, emory, Newport news, tn ones etc.

I guess Virginia down?

I've heard that Spartanburg and Newport News TY's are particularly competitive due to super lax schedule. I however, did not interview at either... just what I've heard. I would think that your stats + being from the south would warrant you an interview.