The decision about whether prelim medicine or transitional year is a better choice for internship depends on the individual. I would first suggest thinking about what are you looking to get out of the year? Secondly, the distinction between some prelim medicine programs and transitional year programs are often very blurry. Some prelim programs offer nearly as many elective months as transitional programs. In regards to transitional, I also found that there was quite a bit of variation in the distribution of the number of medicine, surgery, ob/gyn, and peds months. Most programs do not give you three months of each. Most are weighted towards medicine and usually require at least one month of surgery (a few require no surgical months). At many places you will never even do a peds or an ob/gyn rotation. Furthermore, what you actually do during your surgery months is very program dependent. When I interviewed, I found that most transitional interns did not spend very much time in the OR during their general surgery months. You were often expected to care for the patients on the wards, while the rest of the team was in the OR. This is not absolute, but something to think about and inquire about when you interview.
I also just wanted to give some of my thoughts on internship. I know many rad onc residents and attendings at several progarms, and the vast majority don?t feel they are frequently using knowledge gleaned from intership. You just don?t use a lot of it on a daily basis, and consequently you forget it. Just think how quickly most people forget the information on Step I. I agree with Stephew that internship is reflexive. I thought way more as a med student than as an intern, mainly because I had the time. In internal medicine residency, residents are the ones reading the literature, not interns. Furthermore, I don?t think that most internships (whether transitional or prelim) are going to provide you with knowledge that is going to make you a better radiation oncologist. During med school, one of the rad onc attendings told me that internship provided her with four things that she found useful in rad onc: 1) It gave her confidence when she started her first year of rad onc (you go into internship feeling like a med student, but come out of it feeling like a doctor), 2) It helped her identify truly sick patients 3) it gave her experience in treating pain 4) Internship made her appreciate her worst days in radiation oncology.
If you love learning something in-depth, and just feel that you will not be complete as a physician unless you do one of the high-powered academic medicine prelim programs, then by all means, feel free to do that. Just realize that one?s choice for internship for most intents and purposes is not going to make you a better radiation oncologist. Your time and effort during rad onc residency is what is going to make you a great radiation oncologist.
As for prelim medicine providing onc sub-specialty months that are helpful for residency, I don?t know about that. From an internal medicine/med onc perspective, the most useful experience would be outpatient med onc clinics. This is where most of the diagnostic and chemotherapy decisions are made. Yet, interns at most programs are assigned to inpatient oncology ward months, which consist of taking care of really sick cancer patients with serious medical problems such as PE?s, neutropenic fever, etc.(some onc related conditions and some not). Or you are on the Bone Marrow Transplant (BMT) service where you learn that most of your patients die, BMT is really expensive, and you pray to god that nobody you love ever has to go through this. By and large though, you are not learning about med onc diagnosis and treatment, which is what most of us, I imagine, would hope to get out of any med onc time during internship. Some internships do offer the outpatient onc month as an elective, but most programs that require an onc month are usually referring to an inpatient onc month as I have described above.
As for those who want a really easy year, this can be had in both prelim medicine and transitional years. On the whole, transitional years tend be easier, but there are also some cushy prelim programs too. Virginia has two transitional programs that are cushier than even I would design (one is in Roanoke and the other is near Williamsburg). On the downside, you may learn very very little.
As for where you will learn the most, I would not say that would necessarily be at the prestigious academic centers. You will learn at these places, but they will work you to the bone. Their conferences are great, but you will be skipping them to get work done or sleeping through them. Most categorical interns feel they learn how to treat and what to do during their intern years, but learn the evidence or lack there of for these decisions during the second and third years of internal medicine residency. These internal medicine programs are not optimized for maximizing intern learning. I think somewhere in between the uber academic centers and the ultra cushy prelim years are both transitional and prelim years that offer a good learning experience. They do this by having faculty and residents that want to teach, by having a broad patient population so that you can get exposed to wide variety of medical problems, and by providing a decent schedule so that you actually have time to read when you get home from the hospital. (Regardless what anybody says about I learn by seeing patients and not from a book, you need both. Yes, there are times when it would be nice to read as an intern if you were not so exhausted.) These programs do exist. Some are at academic centers, while others are at community hospitals.
I would also like to second AnnK73 about the onc focused prelim years. MD Anderson, MSKCC, and Medical College of Wisconsin all offer them. For MD Anderson, you have to match there to do their prelim year. This is not the case for the latter two. These programs all give you a broad exposure to medical and/or surgical oncology. I do think these internships are the exception to the rule about most of what you learn in internship not being applicable to your life as a radiation oncologist.
My advice on some other things to think about when choosing your intern year:
1) Be somewhere where you think you will be the happiest or depending on your personality the least miserable. Internship is a hard year. Screw all that stuff about being a better person and that anal-retentive urge to do the hardest possible internship. For most of us, internship is about simply surviving.
2) You most likely will not be able to apply or interview for internships in every city where you will interview for rad onc. I applied to a few prelim programs in cities that had rad onc programs I both hoped to match at and where I honestly thought I had a chance to match. This way I could make new friends, become acquainted with the city, avoid having to move after internship, and become familiar with the non-rad onc departments in the hospital. Many of you will end up matching at rad onc programs in cities where you will know almost no one when you arrive. This has happened to several friends and myself as well. Rad onc departments do not have many residents, and you may quickly find yourself very lonely and with more free time than you would like to read about radiation oncology. You just meet and are exposed to so many residents during internship (whether prelim or transitional) that this really provides ample opportunity to make new friends. Internship can be so grueling at times that friendships and bonds that are formed can be very deep. Some of your friends from internship will be friends for life. Thus, by doing internship in the same city as your rad onc residency, you will have increased significantly your chances of having a social life through all of residency.
3) I applied to a few programs that were close to friends and families. This way, regardless of where I ended up for my categorical residency, I would have a built-in support network
4) Apply to programs in the city where you went to medical school. This reduces the number of times you have to move (because moving stinks), and you will have friends there too.
5) There is nothing wrong spending a year in Hawaii, Miami, San Diego, etc. My friends who did the Hawaii prelim or transitional year thought it was one of the best experiences in their whole life. They are the only normal people I have ever met who were actually sad to see internship end. If you are anywhere else, and you are sad that internship is over, then you need to see a psychiatrist.
6) I think internship can be a great time to try out a new city. When else will you have just one year to do this. I applied to some programs in areas in which I thought I may want to settle down, but I knew very little about. I would rather find out I can?t handle the rain in Seattle during internship, than take a job there after residency and realize I don?t like the area.
Other random thoughts:
When you are interviewing for rad onc, play it safe when they ask you about your internship plans and say that you are planning to do prelim medicine at an academic center regardless of what you really want to do. Saying anything else could hurt your chances.
Apply to a few of the high-powered prestigious prelim programs in case you don?t match in rad onc. Doing your prelim year at UCSF, Wash U, Harvad, Jonhs Hopkins, etc. is going to help when you reapply. Program directors are not going to care whether you are transitional or prelim in regards to you saving them money, but going to UCSF for prelim medicine will matter. Secondly, if you don?t get into rad onc after reapplying, then many prelim programs will try to get you a categorical spot in their program. Most transitional year interns have far fewer options.
