Prelim-Surgery?

[MedicineMike]

Should I do a prelim-surgery internship? I absolutely HATE everything to do with medicine including the patients (mostly), repetitive disease, ROUNDING for 4 hours, writing long notes, the residents, doing detailed physical exams and debating whether you heard crackles or rales, etc etc. With this being said, I think I will be miserable in an IM environment.

I plan on doing IR (99% sure) and everyone says a prelim-surg yr would give you the best knowledge for IR. This probably isnt true, but I feel that I would like a yr of surgical pts and 10min rounding, abbreviated notes, over anything medicine related. Can anyone that has done a surgical intern year or MS4 who wants to do a prelim-surg year weigh in??

thanks

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[Baller MD]

Search is your friend.

Basically from what I can tell... No, don't do it.

 

[tco]

I can't chime in from a prelim surgery point of view.

IR people have been pushing prelim surgery now for a few years. I'm wondering why it is that they feel that a year of being a surgical scut monkey is better than learning intern medicine? My take on it is as follows:

A surgical intern year is, in theory, better than a medicine intern year. If you're at a good program, you should see the relevant anatomy in the OR and understand how to care for a post-surgical patient. In reality, what I see at my institution is that surgical interns are basically medicine interns with more patients. The attendings and senior residents have less general medical knowledge, even though they'll tell you otherwise. Yes, they can handle the acute post-op patient (however, we manage orthos post-op patients literally every day), but if the BP gets >150/110, they're (rightfully so) calling medicine. As an IR fellow or attending, you're going to remember next to nothing of what you learned in your intern year. Let's say that, for some reason, you do manage to remember basic things from your PGY-1...If you think about the day to day events of a medicine vs surgical residency, IMO, you'll see more things of benefit in medicine than surgery. If your post-procedure patient gets an infection, you'll know far more about appropriate antibiotic coverage from a medical intern year than a surgical one (every other patient is on some kind of antibiotic on wards). If your patient develops a bleed, how are you going to fix it? Either take them to the cath lab or call surgery. Either way, you don't need a surgical intern year for that. Then there's just the benefit of keeping your sanity during a TY or medicine intern year vs a surgical one.

 

[UCLA2014]

Pretty good question OP. One that I found myself asking 1 year ago when I was in your position. Although I'm pretty sure I want to do just diagnostics.

I'm doing a prelim medicine year right now at a VERY intense IM program. At my program the prelims do 9 months of wards (brutal). I, too, hate medicine. I hate rounding, H&P's, pouring over lab data and physical exam findings, the mental masturbation, etc. etc.

Luckily most of my co-interns and residents are pretty cool. The IM attendings are for the most part very laid back. I imagine you get more malignant personalities in surgery. Overall I guess I'm okay with my decision to do a medicine year over surgery prelim.


tldr; DO A TRANSITIONAL YEAR

 

[MedicineMike]

I appreciate the replies. I am kind of restricted on location and don't really want to end up in a random community hospital for a TY. I also am so over rotating this yr that I can't imagine doing it all over again next yr. seems boring. Also, almost all of the prelim-surg years went unfilled in major cities. This is a good thing for me

Can anyone else who has actually done a surg prelim weigh in?

Thx


MS4

 

[MU420]

I appreciate the replies. I am kind of restricted on location and don't really want to end up in a random community hospital for a TY. I also am so over rotating this yr that I can't imagine doing it all over again next yr. seems boring. Also, almost all of the prelim-surg years went unfilled in major cities. This is a good thing for me

Can anyone else who has actually done a surg prelim weigh in?

Thx


MS4

One of my friends matched anesthesia and is currently doing a prelim surgery because he hates IM. Haven't heard from him very much but he seems very busy. His first choice was a categorical program, but he certainly doesn't regret opting for surgical prelim instead of prelim medicine.

Do note that you are still going to be doing a lot of scutwork as a surgical intern, but like you said the surgery rounds tend to be much faster unless you're on surgical ICU.

 

[MedicineMike]

One of my friends matched anesthesia and is currently doing a prelim surgery because he hates IM. Haven't heard from him very much but he seems very busy. His first choice was a categorical program, but he certainly doesn't regret opting for surgical prelim instead of prelim medicine.

Do note that you are still going to be doing a lot of scutwork as a surgical intern, but like you said the surgery rounds tend to be much faster unless you're on surgical ICU.

What do you and everyone else consider scut? Some people consider discharges scut and others consider disimpactions scut? Afterall, isn't scut saved for med students???

 

[Prodromo]

I'm currently doing a TY. I am loving it. The worst months at our TY are better than some of the best months at other prelim programs. I feel like a good TY is the best balance of education and service without overworking you. It really has been excellent so far.

If I were you I would absolutely do a TY. My peers in prelim programs are not loving their lives as much.

 

[Doctor D]

After doing a hard academic prelim medicine year and seeing surgeons hurt their patients by a lack of IM knowledge I would say that a surg prelim has no advantage over IM for a future in IR. I would do TY or IM.

 

[deleted116380]

I'd recommend medicine over a surgery prelim. Less hours for sure at many places. Plus, you still have to do floor work and manage patients other health problems during their hospitalization. I feel the medicine people did that part far better at my prelim program as the med consult people got the most idiotic consults from surgery for simple things we handled. Plus, I have non-medicine buddies that ask me medicine questions that I used to manage day to day without issue. Haven't gotten any questions for surgical advice...

 

[Bradstein]

I vote medicine or a TY that gives you a good (not necessarily hard) medicine experience, for the reasons 49ers said.

 

[MedicineMike]

I don't mind working hard on a surgical prelim just so long as I don't have to do anything with regards to medicine. I have a very surgical mindset and don't like to mentally masturbate on diabetes drugs.


MS4

 

[UCLA2014]

I don't mind working hard on a surgical prelim just so long as I don't have to do anything with regards to medicine. I have a very surgical mindset and don't like to mentally masturbate on diabetes drugs.


MS4

Still don't understand why you're opposed to TYs.... You'll feel like a fool next year if you do wind up in prelim surgery and didn't even apply to transitional years.

 

[deleted116380]

I don't mind working hard on a surgical prelim just so long as I don't have to do anything with regards to medicine. I have a very surgical mindset and don't like to mentally masturbate on diabetes drugs.


MS4

Why do you assume all places (assuming your med school does) go crazy over diabetes medications? You won't have continuity clinic as a prelim and thus don't have to worry about their diabetes meds in the outpatient setting most of the time. In the rare circumstance you do, your attending will come up with a decent plan...that's rare to need that much. Even in a newly diagnosed RA patient with diabetes that we started daily prednisone on, we told them to monitor sugars, call PCP with problems. Otherwise, it's basically sliding scale + their long acting and then adding the sliding scale amounts from prior days to long acting for any large changes (I'm simplifying this as this is a rads forum and don't want to get into all the details).

You learn medicine better in medicine than surgery imo. Our CCU and MICU rotations were great for cardiac and pulm teaching and experience. How many surgery prelims know cards EP that well if at all (not to mention post-MI care as a basic thing as well)? I had to deal with that all the time and enjoyed that aspect (much more than wards). Vent settings I know SICU deals with, but when it comes to ID stuff in the ICU setting, they would end up dumping a pt on us they f'd up. I felt bad for those patients and they were in better hands with us to be quite honest.

Forgetting all that educational crap I'm sure you don't care about, in the rare circumstance you don't end up liking rads, a medicine prelim offers you the chance to return to IM and go onto a specialty where you can avoid hospitalist work or endocrine diabetes management. My prelim program had a guy a few years back drop out of rads and go back to IM at Duke for the remainder of his time (that's not my program). Stuff happens and I think that would be a better backup than 4 more years of surgery if you don't want to be a surgeon and picked surgery prelim only to prepare for rads, which you found out later it wasn't for you.

TY trumps all of those anyway.

 

[MedicineMike]

Still don't understand why you're opposed to TYs.... You'll feel like a fool next year if you do wind up in prelim surgery and didn't even apply to transitional years.

Transitional years are competitive and not really in ideal locations at all. Especially since I have location restrictions (NYC) and I prob have a .0001% chance of matching a TY at MSKCC.


MS4

 

[MedicineMike]

Why do you assume all places (assuming your med school does) go crazy over diabetes medications? You won't have continuity clinic as a prelim and thus don't have to worry about their diabetes meds in the outpatient setting most of the time. In the rare circumstance you do, your attending will come up with a decent plan...that's rare to need that much. Even in a newly diagnosed RA patient with diabetes that we started daily prednisone on, we told them to monitor sugars, call PCP with problems. Otherwise, it's basically sliding scale + their long acting and then adding the sliding scale amounts from prior days to long acting for any large changes (I'm simplifying this as this is a rads forum and don't want to get into all the details).

You learn medicine better in medicine than surgery imo. Our CCU and MICU rotations were great for cardiac and pulm teaching and experience. How many surgery prelims know cards EP that well if at all (not to mention post-MI care as a basic thing as well)? I had to deal with that all the time and enjoyed that aspect (much more than wards). Vent settings I know SICU deals with, but when it comes to ID stuff in the ICU setting, they would end up dumping a pt on us they f'd up. I felt bad for those patients and they were in better hands with us to be quite honest.

Forgetting all that educational crap I'm sure you don't care about, in the rare circumstance you don't end up liking rads, a medicine prelim offers you the chance to return to IM and go onto a specialty where you can avoid hospitalist work or endocrine diabetes management. My prelim program had a guy a few years back drop out of rads and go back to IM at Duke for the remainder of his time (that's not my program). Stuff happens and I think that would be a better backup than 4 more yearsa surgeon and picked surgery

TY trumps all of those anyway.

Funny you say that. I could literally never see myself going into a medicine specialty and I kind of would rather do a surgical prelim bc if for some reason I leave Rads, I would most likely go into a surgical subspecialty.

Again, would I really be happy rounding all the time and discussing which beta blocker to use day in and day out? I really just am not interested in that stuff. Everyone seems to enjoy medicine that goes into rads, which is weird bc I feel like surgery is more important for gaining knowledge on making recommendations aon consults and allowing you to understand imaging of post ip pts


MS4

 

[Baller MD]

Funny you say that. I could literally never see myself going into a medicine specialty and I kind of would rather do a surgical prelim bc if for some reason I leave Rads, I would most likely go into a surgical subspecialty.

Again, would I really be happy rounding all the time and discussing which beta blocker to use day in and day out? I really just am not interested in that stuff. Everyone seems to enjoy medicine that goes into rads, which is weird bc I feel like surgery is more important for gaining knowledge on making recommendations aon consults and allowing you to understand imaging of post ip pts


MS4

Dude you already made your choice and you're clearly not going to change your mind. Just go with it and stop trying to justify your choice despite the fact that everyone else is saying to go IM.

 

[MedicineMike]

Dude you already made your choice and you're clearly not going to change your mind. Just go with it and stop trying to justify your choice despite the fact that everyone else is saying to go IM.

not true. I'm about 70/30 right now. Everyone says how bad a surgical prelim is but all I'm hearing is how much better a medicine prelim is without hearing anything from people who have done surgical prelim.



MS4

 

[shark2000]

Go to a good private practice community hospital for TY or medicine. Most patients do not have a lot of social issues. Even if they have, there is usually a good social worker service at the hospital which will take care of it. Rounding on patients is painful, but is only 2-3 hours a day and the rest of the day is much better than surgery. The hospital has a very good ancillary, PA and nursing staff.

This is how it works at one of the hospitals that we cover. The hospital only has internal medicine residency. Some of the residents rotate with us as their radiology elective and I talk to them if my day is not very busy. Though it is a very busy hospital, still most of the patients are managed by private hospitalists and internists. Interns pretty much do as much or as little as they are interested. The only flip side is that matching here seems very difficult, probably more difficult than matching into the competitive specialties.

 

[Baller MD]

Go to a good private practice community hospital for TY or medicine. Most patients do not have a lot of social issues. Even if they have, there is usually a good social worker service at the hospital which will take care of it. Rounding on patients is painful, but is only 2-3 hours a day and the rest of the day is much better than surgery. The hospital has a very good ancillary, PA and nursing staff.

This is how it works at one of the hospitals that we cover. The hospital only has internal medicine residency. Some of the residents rotate with us as their radiology elective and I talk to them if my day is not very busy. Though it is a very busy hospital, still most of the patients are managed by private hospitalists and internists. Interns pretty much do as much or as little as they are interested. The only flip side is that matching here seems very difficult, probably more difficult than matching into the competitive specialties.

For those of us who can't match into a TY, do you suggest prelim IM in a large or small hospital?

 

[tco]

not true. I'm about 70/30 right now. Everyone says how bad a surgical prelim is but all I'm hearing is how much better a medicine prelim is without hearing anything from people who have done surgical prelim.



MS4

You're not hearing from people at a surgical prelim because they're too busy at the hospital to get on SDN.

 

[cbtk18]

For those of us who can't match into a TY, do you suggest prelim IM in a large or small hospital?

Small

 

[shark2000]

Agree with above. Small private hospital.

 

[seethrough]

Do not do a TY. The new IR/DR certificate is going to mandate a real prelim year. You will be able to move into an IR/DR residency once they are established in a couple of years.

 

[maxxor]

Do not do a TY. The new IR/DR certificate is going to mandate a real prelim year. You will be able to move into an IR/DR residency once they are established in a couple of years.

Are they not going to grandfather in people who had to apply before the certificate was even established? When I was applying, the rumor was that IR/DR would require a general surgery prelim year. But literally no programs had created separate residencies while I was applying and no program director could commit to how the IR shake up would change things.

In short: sources plz.

 

[Bradstein]

You can probably still do a TY, but you need to do clinical rotations and a month of ICU wouldn't hurt.
Attached is a file from SIR detailing the "clinical pathway"
http://members.sirweb.org/members/misc/IRQ/F4_from_IRQWinter2014.pdf
http://www.sirweb.org/clinical/IR_DR_cert.shtml

 

[JoshSt]

Yeah if they're not going to require a general surgery prelim year, I don't see the point of banning/shunning a TY. Some TY's are harder than the easier medicine prelims (not the norm but extreme examples to prove a point).

 

[maxxor]

You can probably still do a TY, but you need to do clinical rotations and a month of ICU wouldn't hurt.
Attached is a file from SIR detailing the "clinical pathway"
http://members.sirweb.org/members/misc/IRQ/F4_from_IRQWinter2014.pdf
http://www.sirweb.org/clinical/IR_DR_cert.shtml

There really isn't anything about internship in those documents.

 

[rule out normal]

Should I do a prelim-surgery internship? I absolutely HATE everything to do with medicine including the patients (mostly), repetitive disease, ROUNDING for 4 hours, writing long notes, the residents, doing detailed physical exams and debating whether you heard crackles or rales, etc etc. With this being said, I think I will be miserable in an IM environment.

I plan on doing IR (99% sure) and everyone says a prelim-surg yr would give you the best knowledge for IR. This probably isnt true, but I feel that I would like a yr of surgical pts and 10min rounding, abbreviated notes, over anything medicine related. Can anyone that has done a surgical intern year or MS4 who wants to do a prelim-surg year weigh in??

thanks

I'm doing a medicine prelim year. I've worked an average of 85 hours per week this month on the renal service. I have to wear a tie every day. Social work, floor nurses, rounding, irrelevant details, presenting H&Ps... Surgery prelim maybe wouldn't have been so bad. The hours would have been about the same.

 

[rule out normal]

For those of us who can't match into a TY, do you suggest prelim IM in a large or small hospital?

Avoid large academic centers at all costs. It's ruining my health and my relationships.

 

[tco]

Yeah if they're not going to require a general surgery prelim year, I don't see the point of banning/shunning a TY. Some TY's are harder than the easier medicine prelims (not the norm but extreme examples to prove a point).

My TY is almost identical to a medicine prelim year. 5 wards months, 1 ICU month, 1 ED month, 1 neuro consult month, 1 ambulatory month, 3 electives.

 

[Morphea]

Hey, since NYC has only 2 TYs, could someone post some good prelim IM and prelim Surgery in NYC? I'd be ok doing surgery over IM, if I get to go to the OR all the time. Also I am not looking for anything competitive... More like hidden gems vs. the places that everybody wants to avoid for a reason.

Any thoughts on prelim surgery at Montefiore, Brooklyn Hospital, Brookdale, NYMethodist, SIUH, NSLIJ(Manhasset). How do they all compare with BI surgery prelim (I know what to expect from that program)?
Thanks!

 

[Morphea]

Also how about ranking prelims by the amount of electives that they get?