Prelim in Surgery or Medicine?

[aimedicine]

So i'm one of the unlucky people that matched into advance position. Now i have to scramble into an internship year, i've been told by some anesthesia residents that a prelim in surgery prepares you better for anesthesia residency....but we all know how miserable that year in surgery is going to be. So my question is, should i accept the prelim surgery or medicine offer?

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[MikeMerk-MtS]

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[kaioukenx]

It probably depends on the specific program. In theory, you can possibly get more experience with placing lines and chest tubes in surgery vs medicine. In practice, you will be likely be maximally scutted out for floor work and the categorical interns (or the prelims actually wanting to go into surgery) will get pretty much do all the procedures. Medicine hours are probably better and some electives can be more high yield.

 

[NoTalentGasClown]

I would likely pick the one closest to my anesthesia residency location. Wouldn't want to move across the country after a year. But I am married with a kid so that is more of an issue for me.

 

[aimedicine]

Its hard for me to do that when i dont know where im going for anesthesia....geographically i can end up anywhere, my list was diverse

 

[wudabum]

Its hard for me to do that when i dont know where im going for anesthesia....geographically i can end up anywhere, my list was diverse

you have the option of calling NRMP to ask what city you matched into if you didn't match into a prelim spot

 

[Icefrog]

All else being equal, I would choose to do a medicine internship. Getting a solid background in medicine in my opinion is more useful to an anesthesiologist because we are primarily providing acute medical care to surgical patients. The floor management of surgical patients is relatively not as complicated as taking care of medical patients (e.g., the surgical patients with many comorbidities tend to get a medicine consult or other subspecialty.) As an anesthesiologist, it really is to your great benefit to become very comfortable with sick cardiac and pulmonary patients.

Also, in my opinion, the procedures you may get as a surgical intern will not be very useful to you in the long run. You may do handful of lines as an intern, but you will do so many lines in residency it won't matter how many you did your PGY-1 year.

You can always learn procedures, but a strong foundation in medicine is something that is difficult to replace or develop as you get further into your training.

 

[G-Man82]

Agree with above. A medicine year is likely more conducive to forming s strong foundation upon which you base your Anesthesiology training. Get good at managing cardiology patients, reading EKGs, go to the cath lab and look at coronary anatomy. Get experience with the bread and butter medicine cases and also learn about some of the weird stuff that exists and is rare. Plus, as a surgical intern you're likely going to be on the floors anyway. Wouldn't you rather learn how to manage a patient and treat disease from an Internist in that regard? Rounds are painful but can be useful.

 

[rakotomazoto]

Medicine, no question. You will have plenty of opportunities to put in lines and do procedures during residency. Don't ask for more punishment than is necessary. Generally speaking, you will have better guidance and closer supervision in a medicine-based intern year than you will as a surgery intern because your seniors are all in the OR doing what they like to do and leave you alone to wander around the floor and figure things out for yourself. No matter how great you were in med school and no matter how smart you are, if you try to figure everything out on your own as an intern, you will be really frustrated at first and on top of that, you will develop bad habits and no one will be around to teach you the proper way of doing things.

 

[ranvier]

I chose to do prelim surgery. I will never doubt my choice of specialty.

 

[aimedicine]

i had to settle for surgery....what can i do to fill in the knowledge void resulting from not doing medicine internship? Should i try to read internal medicine during my surgery internship, that sounds like torture workload.

 

[HalO'Thane]

i had to settle for surgery....what can i do to fill in the knowledge void resulting from not doing medicine internship? Should i try to read internal medicine during my surgery internship, that sounds like torture workload.

Trying to read an IM textbook during your surgical intern year sounds like a huge waste of time, IMHO. If you do have free time I would highly recommend preparing for you CA-1 year by reading Morgan and Mikhail and also reading the bear minimum to survive your intern year, such as a pocket surgery handbook. That, to me, would be a much more high yield.

 

[G-Man82]

No need to read a whole textbook and I think it's still early to read an Anesthesia text. I would just do some focused reading about the medical conditions your patients have and how to manage medically. Uptodate is good for that. If you want a textbook, one of those evidence based review books would be good too. Hot topics to focus on would be Diabetes (I remember as an intern, the surgical intern called me once to help with bread and butter DM management), renal failure, all the cardiac stuff (heart failure both systolic and diastolic, arrhythmias, hypertension, hypertensive emergencies etc) pulmonary diseases like OSA. As long as you take even 15 mins each day to look up something about your patient, you should be good.

Interns are pretty protected these days, so you should have the time.

 

[aimedicine]

I looked up the hours for my surgery prelim program on frieda, it was approx 79hrs per week. I don't think i'm going to be protected nor have the time as an intern. thinking about it now...i honestly don't even know why anyone would suggest surg prelim over medicine, i really don't see the advantage at all...i guess i just have to survive and advance from here on out.

 

[aimedicine]

if any of you are wondering why i'm posting 5 am in the morning....its because i'm on night shift ER...sucks!