Anybody do prelim. surgery?

[hematogone]

Before starting my Radiology residency, I will be doing a Prelim. Surgery year.

Anybody here actually do prelim surgery? All I've been hearing is that it is gonna suck. However, these words are from people who haven't actually done it.

Is it as bad as everybody says? What's the best attitude to have going into it? How does one make the best of the year as well as use the surgical year as an advantage going into Rads?

From what I gather, the prelims at my program don't get much OR time and spend most of the time on the floors. (Probably the norm I imagine.)

Thanks.

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[davidjones]

2 people in my program who are starting July 1st did prelims at big university programs. I always encourage people to either do surgery or at least a tough medicine year. It will definitelly help for both DR and IR.

Learn floor management of pts, it's very similar to IR.

The best approach is pretend you are a categorical surgery resident, read surgery not radiology. Read anatomy, go to radiology and discuss cases.

All residency sucks, but you have that 16 hr workday thing, so it won't be so bad .

 

[badasshairday]

Quite a few people do it. Talking to some residents on the interview trail who did it, they all said it pretty much sucked. I met one who didn't have anything bad to say about it and seemed like he liked it. One of the residents told me that it was tough and not worth the trouble, however if you are thinking IR it may be helpful to get your confidence over procedures. She was not going into IR so she felt it was a waste and the only advantage was that she had like a 6 month edge on procedures over her fellow residents at the start of residency. In the end it all balanced out. Another one that did it said that maybe it helps you become a better diagnostic radiologist, but he wasn't too sure.

I think if you find a good one it can be okay and probably not "worse" than a prelim medicine. Seems like the medicine interns at big academic hospitals stick around the hospital just as much as the surgeons. Some people like the surgery internship better because while they do a lot of scut work, they feel like they are getting more work "done" than the medicine folks.

Some people really do just do them because they want to do a surgery year over medicine. One of my classmates is super hardcore, during 4th year of med school he did a MICU, SICU, Trauma surgery, and some other intense rotations and is going to do a prelim surgery.

 

[shark2000]

Overall, it is tough compared to the medicine internship. You may have to tolerate some pathologic weird characters only found on surgery. The ward work may not be whole different than medicine in nature, but will be tough because you have to meet the unreasonable expectations of senior surgery residents. Also It is very variable from program to program. With the new hours, it may be better than before.

IMO, one year internship, either medicine or surgery is a waste of time. You are just the low end glorified secretary or social worker. The only part that I find helpful is if you want to do IR. Try to get comfortable with running codes and stabilizing the sick patients like giving fluids, pressors, .... The technichal part is not useful as first of all they will not let you do a lot of procedures as an intern and also you will do enough of that as IR fellow. The thing that may be missing in IR is dealing with hemodynamic instability, bleeding, correcting electrolytes and coagulopathy, giving fluids and blood products in a CHF patient, ...

Though these are not tough to learn, you need to have some understanding of them. You can take advantage of your ICU months to learn some of these and you will find yourself good at them in few weeks in a busy program.

Now some people may argue that internship is useless and they are probably right. Whatever it is, tough or easy, useful or useless, good or bad, it is one year that you are doomed to pass. Just try to take the most out of it and take it easy. Try to rest as much as you can and enjoy your vacation time and spare time as much as you can.You will be done with it sooner than you can imagine.

Good Luck.

 

[hematogone]

Overall, it is tough compared to the medicine internship. You may have to tolerate some pathologic weird characters only found on surgery. The ward work may not be whole different than medicine in nature, but will be tough because you have to meet the unreasonable expectations of senior surgery residents. Also It is very variable from program to program. With the new hours, it may be better than before.

IMO, one year internship, either medicine or surgery is a waste of time. You are just the low end glorified secretary or social worker. The only part that I find helpful is if you want to do IR. Try to get comfortable with running codes and stabilizing the sick patients like giving fluids, pressors, .... The technichal part is not useful as first of all they will not let you do a lot of procedures as an intern and also you will do enough of that as IR fellow. The thing that may be missing in IR is dealing with hemodynamic instability, bleeding, correcting electrolytes and coagulopathy, giving fluids and blood products in a CHF patient, ...

Though these are not tough to learn, you need to have some understanding of them. You can take advantage of your ICU months to learn some of these and you will find yourself good at them in few weeks in a busy program.

Now some people may argue that internship is useless and they are probably right. Whatever it is, tough or easy, useful or useless, good or bad, it is one year that you are doomed to pass. Just try to take the most out of it and take it easy. Try to rest as much as you can and enjoy your vacation time and spare time as much as you can.You will be done with it sooner than you can imagine.

Good Luck.

Thank you for your input. Yea, it is reassuring that even the tougher times can fly by. My hope is that I can get something helpful out of the surgical year, but I do understand it will be rough and perhaps not seem rewarding. Do you happen to have any book recommendations for a surgical intern year?

 

[shark2000]

Thank you for your input. Yea, it is reassuring that even the tougher times can fly by. My hope is that I can get something helpful out of the surgical year, but I do understand it will be rough and perhaps not seem rewarding. Do you happen to have any book recommendations for a surgical intern year?

Really not. I did medicine myself.
I think you do not need to read a whole lot. Try to get familiar with day to day practice of inpatient work, including admission, fluids, electrolytes, pain management, DVT prophylaxis, Blood sugar control and also get familiar with managing sick patients including CPR, Pressors, ... and all of these are true if you want to do IR.
On the other hand, try to know the management of some bread and butter common surgical entities. It can help you esp with your body imaging rotation as half of the cases of body are general surgery and half are oncology.
Don't take it too serious. Get the job done, make friends, enjoy your spare time and save energy for R1.

 

[kubIR]

I did a prelim surgery year at a big academic hospital. A lot of my friends said I was crazy, but I had a good time..in fact I was close to staying. Surgery is more fun then medicine for me and I do think it helps for IR, just being more comforatble in cases and staying cool when things go wrong - having a systematic way to approach problems. I also think it is more in line with the level of clincal pratice we need to be proficient at. IR needs more surgical mindset, so I wanted to learn from the source. I guess it also depends if you operate at you internship. The place I went I was able to log 320 ish cases as first assist (which is pretty much doing them at the end). I still had some scut to do after 5 and had nights and call, but during the day we got to operate (with exception of thoracic, but you do the bronchs). You can still learn a lot on the floors, but try to insert yourself in cases if possible. Some programs may treat prelim's differently, but if you are good at what you do and make yourself an integral part of the team, you will be respected and rewarded with OR time/clinic time.

On the other hand, most of my rads freinds did TY years and were out at 2pm with months of electives, and they are also very good. In end, it will depend what you take from it, but in my expereince, I wouldn't change that year for anything else. Good luck.

 

[tco]

Would you do your prelim year at a private hospital? The interns here hardly ever get in on cases. They end up returning pages in the OR and running the floor.

Sorry I bumped such an old thread, but I'm interested to hear what your experiences were.

 

[shark2000]

Would you do your prelim year at a private hospital? The interns here hardly ever get in on cases. They end up returning pages in the OR and running the floor.

Sorry I bumped such an old thread, but I'm interested to hear what your experiences were.

What is your final goal?

If you want to be an IR doctor, doing it in a place where you work hard may be helpful.

For DR, it is a waste of time.

In academic places, there are a whole group of fellows, upper level residents and junior residents. As an intern you don't get to do a lot.

In pp groups, there is a huge difference between different places. You may get to do more.

In general, you will not do a lot as intern. That is the reason I think it is a waste of time. Internship was designed to have cheap labor to do paper work and social issues. Most of your time is spent doing these mundane useless things, so the hospital can bill the insurance.

 

[UTMBMD2012]

I'm towards the end of my prelim surgery year now at a very academic place. Granted, I applied ENT last year and didn't match. This year applied rads, but didn't want to be without a job next year, so I am doing prelim medicine next year and radiology training for the subsequent 4 years. As such, I will be able to compare medicine v. surgery intern year better in a year, but...

Surgery intern year is a lot of work. You will be working much longer hours than your medicine collegues. You will be very good at handing out narcs like candy. If you want to Body CT, you learn surgical anatomy. You learn what the important things to know for the surgeons are for pre-op planning, etc. I suppose if you are interested in MSK, trying to do a ortho elective would be good. Same goes for neuro. If you can swing a vascular surgery rotation, that'd be great experience for pre and post op care of vascular patients (i.e. experience what to do in complications/issues such as lability of BPs after carotid stent placements, being comfortable with anticoagulation regimens, pressor drips, dopplering for pulses etc). Also, you get to learn the different reasons surgeons may consult you for body image procedures such as nephrostomy tubes, abscess drainages, and learn how to be a better consultant by being in "their shoes" so to speak. All in all, I think given how anatomical the nature of radiology and how dependent our surgical collegues are on imaging, a surgical year is a great learning experience. I think someone interested in any modality of radiology would benefit from a surgical year, if you're up for the challenge. For those of you that aren't procedurally inclined, this gives you a chance to break out of your comfort zone, but as mentioned in previous posts you won't be forced to be in the OR much. In fact you may find yourself, wishing you were in the OR more.

That is about all I have at the moment, now I must get back to admitting my new liver transplant patient.

Feel free to PM if you have any other questions.

 

[TheRealDrDorian]

Would you do your prelim year at a private hospital? The interns here hardly ever get in on cases. They end up returning pages in the OR and running the floor.

Sorry I bumped such an old thread, but I'm interested to hear what your experiences were.

What is your final goal?

If you want to be an IR doctor, doing it in a place where you work hard may be helpful.

For DR, it is a waste of time.

In academic places, there are a whole group of fellows, upper level residents and junior residents. As an intern you don't get to do a lot.

In pp groups, there is a huge difference between different places. You may get to do more.

In general, you will not do a lot as intern. That is the reason I think it is a waste of time. Internship was designed to have cheap labor to do paper work and social issues. Most of your time is spent doing these mundane useless things, so the hospital can bill the insurance.

I am finishing my prelim medicine year at a small community hospital with only 10 new residents a year (10 IM, 10 FM), and it has been the best of both worlds. I plan on doing IR, and have been able to do surgery, urology, and anesthesia electives. It's been hard work and I've had a lot of independence working up patients, but since it's a smaller hospital I usually get done by 3/4pm still (which has given me time to go back to the OR if and when I want).

If you have any thought of IR down the road, I think a community or at least smaller program is beneficial as you wont be lost among the categorical surgical/medical residents. If you're not thinking IR, I'm not sure how much it matters.

 

[MPSIII]

Where are people able to find lists of programs which offer prelim years? Looking through the Freida online program, I can find 'transitional year' listings, but it doesn't seem like a comprehensive list, nor does it indicate 'prelim surgery' or 'prelim medicine,' because a TY is different correct?

 

[UTMBMD2012]

Where are people able to find lists of programs which offer prelim years? Looking through the Freida online program, I can find 'transitional year' listings, but it doesn't seem like a comprehensive list, nor does it indicate 'prelim surgery' or 'prelim medicine,' because a TY is different correct?

Select General Surgery, click on a program. Then click on General Information tab (some programs do not fill out the survey, so some programs will not have that option). Below the Total program size table, the 5th line is Offers preliminary program - yes or no.

 

[greg1184]

I am doing prelim surgery, not because I had a choice. Prelims spots were difficult to get this year (thanks to the all-in policy). Definitely did not schedule my 4th year to prepare myself for a surgical internship (did a medicine sub I, easy urology rotation, etc). Not interested in IR and not a procedure person, but maybe I will get experience on some basic procedures like I&D, suturing wounds, etc. Being in a large academic program (Albert Einstein/Montefiore), I probably won't see the OR much, but that is fine with me. I want to get my work done and get the year over with. I hear I will get plenty of experience in blood drawing, foley and IV placement. Maybe it will make up for my med schools disappointing lack of procedure experiences during my rotations.

It is amazing at how variable med students' procedure experiences are.

 

[WellWornLad]

Although of dubious significance due to low response rate, this paper is interesting reading:

http://www.ncbi.nlm.nih.gov/pubmed/18692762

"Although 70% of respondents maintained that their internship year was necessary for their development as a physician, only 49% indicated that it was necessary for their development as a radiologist. Of respondents who graduated from surgical internships, 72% claimed that their PGY-1 was important for their development as a radiologist, compared to 44% of former transitional year interns and 49% of internal medicine interns (P<.001). When disaggregated by subspecialty career choice, participants were evenly divided about their perceptions of their intern year. However, among those considering interventional radiology, 67% of respondents considered their internship important to their development as a radiologist (P<.001)."

Personally, I feel that a surgical prelim year was the best decision for me. I am definitely more surgical-minded, however, and a lot comes down to the people you work with - which you can't effect or predict to any significant degree beforehand. I was certainly lucky in that respect, and it probably has colored my whole experience more positively. It was (very) tough work sometimes and I definitely felt stretched to my limit on a few occasioans, but I got a lot of experience with procedures - not just in the OR, but with central/arterial lines, chest tubes, intubation, ultrasound-guided thoracentesis, ACLS/ATLS, etc. Not sure I would have felt like a "doctor" if I was just filling out scripts and discharge summaries like all my medicine friends complained about.

 

[badasshairday]

Although of dubious significance due to low response rate, this paper is interesting reading:

http://www.ncbi.nlm.nih.gov/pubmed/18692762

"Although 70% of respondents maintained that their internship year was necessary for their development as a physician, only 49% indicated that it was necessary for their development as a radiologist. Of respondents who graduated from surgical internships, 72% claimed that their PGY-1 was important for their development as a radiologist, compared to 44% of former transitional year interns and 49% of internal medicine interns (P<.001). When disaggregated by subspecialty career choice, participants were evenly divided about their perceptions of their intern year. However, among those considering interventional radiology, 67% of respondents considered their internship important to their development as a radiologist (P<.001)."

Personally, I feel that a surgical prelim year was the best decision for me. I am definitely more surgical-minded, however, and a lot comes down to the people you work with - which you can't effect or predict to any significant degree beforehand. I was certainly lucky in that respect, and it probably has colored my whole experience more positively. It was (very) tough work sometimes and I definitely felt stretched to my limit on a few occasioans, but I got a lot of experience with procedures - not just in the OR, but with central/arterial lines, chest tubes, intubation, ultrasound-guided thoracentesis, ACLS/ATLS, etc. Not sure I would have felt like a "doctor" if I was just filling out scripts and discharge summaries like all my medicine friends complained about.

I can see how a surgical internship is useful. For example looking at body CT and recognizing discrete surgical pathology like appendicitis. However, I am completing a TY year, which I think I had a good feeling of being a "doctor". Involved myself in 10+ codes. Put in fem lines, IJ lines, fem art lines, rad art lines, chest tubes, intubated several times. I'm not sure how useful surgery is except for maybe vascular for IR. You will not be doing much post op wound management as your wounds are just small holes. Also you will not be "awaiting return of bowel function either" because your procedures are minimally invasive. You will need to know a little bit of medicine knowledge to admit to your own service, rather than surgery knowledge. Just my honest opinoin.

 

[shark2000]

Bottom line: internship is a waste of time. Do the easiest you can.

 

[WellWornLad]

Bottom line: internship is a waste of time. Do the easiest you can.

I certainly think it has the potential to be a waste of time - but you have to do the time no matter what. If it was a question of doing or not doing an internship it would be a much more interesting question, but seeing as we're all stuck in the same boat, it's probably best to find a place that isn't a waste of your time...

 

[WellWornLad]

I'm not sure how useful surgery is except for maybe vascular for IR. You will not be doing much post op wound management as your wounds are just small holes.

Small holes can turn into pseudoaneurysms and big holes pretty easily. While it's true that today we'll probably hand these problems off, I think the long-term future of IR depends on us branching out into greater post-procedure management - including cut-down arterial repairs, thrombin injections, and EVD/ICP bolt placement in NIR. If we can't handle the most common complications of our procedures, it will be hard to justify any significant degree of independence.

Also you will not be "awaiting return of bowel function either" because your procedures are minimally invasive.

There's not much skill involved in awaiting return of bowel function no matter what you're going into, I wouldn't have listed it as an asset in the first place...

You will need to know a little bit of medicine knowledge to admit to your own service, rather than surgery knowledge. Just my honest opinoin.

Why would we need to know "a little bit" of medicine knowledge? Surgical services admit all the time without it.

 

[greg1184]

Well it is almost here. Hopefully the year goes quickly.... and without too much damage.

 

[shark2000]

Small holes can turn into pseudoaneurysms and big holes pretty easily. While it's true that today we'll probably hand these problems off, I think the long-term future of IR depends on us branching out into greater post-procedure management - including cut-down arterial repairs, thrombin injections, and EVD/ICP bolt placement in NIR. If we can't handle the most common complications of our procedures, it will be hard to justify any significant degree of independence.
.

Wrong.

If you want to keep the turf you have to change the referral pattern. Post procedure management is important but not as much as you say. You don't need to be able to handle the complications to keep the turf. The key is getting referral from PCPs.

I don't know any GI doctor who can take care of colon rupture. Also don't know any cardiologist who can take care of his complications. The same for OB and hysterectomy.

This is what other groups claim to take away our turf. Rather than putting that much emphasize on technical skills and taking care of complications, we have to put emphasize on pre procedure aspect of it.

 

[badasshairday]

Wrong.
we have to put emphasize on pre procedure aspect of it.

Yup. If somebody develops a hematoma after cardiac cath that gets out of control, better call a surgeon. The most a cardiologist is going to do is tell the nurse to hold pressure, start fluids, check H&H, if dropping transfuse some blood. If it gets worse, or hemodynaic instability, get a CT, and if retroperitoneal bleeding, call a surgeon. Oh yeah, I did all of the above minus having to get the CT and calling a surgeon for a post cath hematoma in a lady with NSTEMI cardiogenic shock s/p LAD stent, while I was on call for IM.

I think surgery internship is better for imaging purposes. But I think it is too much work for the return you get. I rather do a TY and do a couple of surgical rotations at a community hospital than a surgery prelim at an academic center where you act as scut monkey and barely go to the OR.

 

[badasshairday]

Yup. If somebody develops a hematoma after cardiac cath that gets out of control, better call a surgeon. The most a cardiologist is going to do is tell the nurse to hold pressure, start fluids, check H&H, if dropping transfuse some blood. If it gets worse, or hemodynaic instability, get a CT, and if retroperitoneal bleeding, call a surgeon. Oh yeah, I did all of the above minus having to get the CT and calling a surgeon for a post cath hematoma in a lady with NSTEMI cardiogenic shock s/p LAD stent, while I was on call for IM.

I think surgery internship is better for imaging purposes. But I think it is too much work for the return you get. I rather do a TY and do a couple of surgical rotations at a community hospital than a surgery prelim at an academic center where you act as scut monkey and barely go to the OR.

If I do interventional, you can believe I will be calling a hospitalist for consult if the diabetes or htn gets out of control. Sure I will start sliding scale and maybe some basal insulin, or give some labetalol or put on a clonidine patch, but beyond that not much. If someone goes into afib-rvr, I will do some IV dilt and start a dilt drip and call a cardiologist or hospitalist. I will have two moves, like most surgeons, for most medical issues then if it doesn't resolve, call a consult. It is better for patient care.

 

[badasshairday]

we have to put emphasize on pre procedure aspect of it.

Which means being in a radiology group that has clout in the hospital. You need to do vascular diagnostic studies. Do grand rounds in the hospital and make it known what services you can provide. You have to get referrals directly from the internist for PVD after the ABI is done. You have to market yourself to the med-onc for chemoembo/radioembo rather than referring to rad-onc for external beam radiation. Tell family docs you will follow up the patients aortic aneurysm with q6month ultrasound and do the procedure or punt it to a surgeon if not amenable to endovascular repair. Pre-procedure is where it truly is at.

 

[badasshairday]

Why would we need to know "a little bit" of medicine knowledge? Surgical services admit all the time without it.

Right. Except when I saw my community hospital VIR guys admit there own patient because of contrast allergy for obs s/p illiac stents and when her nausea/htn/dm got out of control... time to consult the hospitalist. Nausea/htn they got, give anti-emetics and restart home meds with prn hydralazine. The dm, was the problem due to the pre procedure steroids.