Prelim vs. Categorical IM Interns

[the fat man]

Hey guys, I'm sitting around here with not much to do for the next month, anxiously awaiting the beginning of my internship. I guess I'd be considered a designated IM prelim--I matched as a categorical in a different specialty, but my advanced program basically assigns us into the dept. of medicine for intern year, meaning no custom-designed year that includes a variety of specialties.

The IM program is pretty large; I'd guess there are going to be at least 50 interns from a wide range of career plans: categorical IM, combined specialties (like med-peds), designated prelims like myself, and undesignated prelims who matched to advanced programs elsewhere. The official word out of my advanced program is that we are to be treated like medicine interns, i.e. no meddling from my program to give us better treatment than the other interns. Which I'm fine with. However, I was wondering how IM programs tend to treat prelims compared to categoricals or combined folks because we are gone after a year...such as less preferable schedules (more ICU and/or night float), lower priority for elective choices and vacation requests, and less focus on education. My optimistic guess is that things won't be much different beyond the random variation that occurs in any large department, but it would be nice to hear the thoughts from anyone who's been through this, either as a categorical or prelim. Thanks. And sorry if this was better suited to a different forum such as internal medicine.

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[Law2Doc]

Hey guys, I'm sitting around here with not much to do for the next month, anxiously awaiting the beginning of my internship. I guess I'd be considered a designated IM prelim--I matched as a categorical in a different specialty, but my advanced program basically assigns us into the dept. of medicine for intern year, meaning no custom-designed year that includes a variety of specialties.

The IM program is pretty large; I'd guess there are going to be at least 50 interns from a wide range of career plans: categorical IM, combined specialties (like med-peds), designated prelims like myself, and undesignated prelims who matched to advanced programs elsewhere. The official word out of my advanced program is that we are to be treated like medicine interns, i.e. no meddling from my program to give us better treatment than the other interns. Which I'm fine with. However, I was wondering how IM programs tend to treat prelims compared to categoricals or combined folks because we are gone after a year...such as less preferable schedules (more ICU and/or night float), lower priority for elective choices and vacation requests, and less focus on education. My optimistic guess is that things won't be much different beyond the random variation that occurs in any large department, but it would be nice to hear the thoughts from anyone who's been through this, either as a categorical or prelim. Thanks. And sorry if this was better suited to a different forum such as internal medicine.

It depends on the program. From what I've seen/heard: Some places do a good job of treating everybody the same. At others, you will note very different treatment in terms of teaching. Some attendings don't want to waste their time teaching someone who won't be using the knowledge next year, if they can spend the same breath teaching someone who will. You will tend to see that become progressively more glaring toward the end of the year, when categoricals will be singled out to do the cool procedures and the like. I also would imagine that if a categorical "needed" an elective, they would tend to get it over a prelim, and I think that's actually reasonable. I doubt they do much distinction in terms of vacations, except that if a categorical needs some time off relating to an in-service exam (either before or after) that a prelim doesn't even have to take, the categorical will get the preference. As far as things like night float, and ICU, I think the notion is that the categoricals need the experience as much as the prelims, so you wouldn't likely see it shifted to the prelims. But if there are electives like EM that IM categoricals need but prelims don't, you can expect to be given something other than that if there's a space issue.
You probably won't be treated as second class citizens by other than a few attendings, and won't usually be abused, but there will be an overtone that the categorical is the one is staying and so they get the stroking.

One caveat -- there are some community programs where the categoricals are pretty much all IMGs while the prelims are all native speakers going into advanced programs. In such situations I certainly have heard of prelims being overworked because the attendings all want to deal directly with them rather than someone who doesn't speak english all that well. I'm not sure if this constitutes preferential treatment or not, but it probably will be anything but cushy, even though you will be well respected.

 

[jdh71]

Hey guys, I'm sitting around here with not much to do for the next month, anxiously awaiting the beginning of my internship. I guess I'd be considered a designated IM prelim--I matched as a categorical in a different specialty, but my advanced program basically assigns us into the dept. of medicine for intern year, meaning no custom-designed year that includes a variety of specialties.

The IM program is pretty large; I'd guess there are going to be at least 50 interns from a wide range of career plans: categorical IM, combined specialties (like med-peds), designated prelims like myself, and undesignated prelims who matched to advanced programs elsewhere. The official word out of my advanced program is that we are to be treated like medicine interns, i.e. no meddling from my program to give us better treatment than the other interns. Which I'm fine with. However, I was wondering how IM programs tend to treat prelims compared to categoricals or combined folks because we are gone after a year...such as less preferable schedules (more ICU and/or night float), lower priority for elective choices and vacation requests, and less focus on education. My optimistic guess is that things won't be much different beyond the random variation that occurs in any large department, but it would be nice to hear the thoughts from anyone who's been through this, either as a categorical or prelim. Thanks. And sorry if this was better suited to a different forum such as internal medicine.

My experience is that prelims are treated exactly the same as categorical interns. You might get stuck with an extra floor month, than the categoricals who have an increasingly greater amount of outpatient medicine they need to have to graduate and be BE. And some Gas programs ask that the interns get an extra unit month, so I've seen that happen as well. The nice thing is that you shouldn't have any medicine clinic like the categoricals, which can be a bit of a pain for you if they are gone for rounds one morning, or gone one afternoon while you're doing the work, but for me, my continuity clinic is the large turd floating in the punchbowl that would otherwise be my awesome day. I imagine you'll be worked like the note writing monkey intern that everyone else is.

 

[Bubchik]

Hey guys, I'm sitting around here with not much to do for the next month, anxiously awaiting the beginning of my internship. I guess I'd be considered a designated IM prelim--I matched as a categorical in a different specialty, but my advanced program basically assigns us into the dept. of medicine for intern year, meaning no custom-designed year that includes a variety of specialties.

The IM program is pretty large; I'd guess there are going to be at least 50 interns from a wide range of career plans: categorical IM, combined specialties (like med-peds), designated prelims like myself, and undesignated prelims who matched to advanced programs elsewhere. The official word out of my advanced program is that we are to be treated like medicine interns, i.e. no meddling from my program to give us better treatment than the other interns. Which I'm fine with. However, I was wondering how IM programs tend to treat prelims compared to categoricals or combined folks because we are gone after a year...such as less preferable schedules (more ICU and/or night float), lower priority for elective choices and vacation requests, and less focus on education. My optimistic guess is that things won't be much different beyond the random variation that occurs in any large department, but it would be nice to hear the thoughts from anyone who's been through this, either as a categorical or prelim. Thanks. And sorry if this was better suited to a different forum such as internal medicine.

Totally depends on your program. And be ware if the program director says that "prelims' schedules are very close to categoricals" please check the schedule to see what "close" means. If it was very close he would have said "same" I guess. In my program categoricals are all US graduates, very strong and do speak english. It is an academic internship and comes with its own perks (awesome teaching faculty, conferences, food). However, an average prelim has 80-90 (with an one person having 100) calls during intern year comparing to categoricals with 50-60. Prelims do more unit time (hence more call) and we still have CONTINUITY clinic (what continuity?! if we are leaving in a year) (so in this aspect we are treated as categoricals). We have less outpatient time, therefore more ICU time. On the upside, as far as teaching goes it is outstanding, and by now i am signed off on all lines, taps, punctures, etc. and feel comfortable doing them. Sometimes I wish I chose a prelim at kaiser but after doing a rotation in a small hospital in ICU I am so glad I stayed at academic institution (at least I have a chance to learn evidence based medicine).

As far as night float: all prelims here do it but some categorical do not. That totally does not make sense as they will have to do NF as PGY2s, but I will never ever will have to take care of potassium replacement/poop control/pain control/vitamin H overnight,,,

 

[nockamura]

80-100 calls?! Damn. I have 28. Good luck with that. Our program treats prelims and categoricals EXACTLY the same. If anything, the prelims get a slightly easier year towards the end as categoricals are pushed to prepare to become residents.

 

[Winged Scapula]

80-100 calls?! Damn. I have 28. Good luck with that. Our program treats prelims and categoricals EXACTLY the same. If anything, the prelims get a slightly easier year towards the end as categoricals are pushed to prepare to become residents.

You have 28 calls a year?

Wow...

 

[jdh71]

You have 28 calls a year?

Wow...

That's with NF in place I'm sure

 

[Droopy Snoopy]

Totally depends on your program. And be ware if the program director says that "prelims' schedules are very close to categoricals" please check the schedule to see what "close" means. If it was very close he would have said "same" I guess. In my program categoricals are all US graduates, very strong and do speak english. It is an academic internship and comes with its own perks (awesome teaching faculty, conferences, food). However, an average prelim has 80-90 (with an one person having 100) calls during intern year comparing to categoricals with 50-60. Prelims do more unit time (hence more call) and we still have CONTINUITY clinic (what continuity?! if we are leaving in a year) (so in this aspect we are treated as categoricals). We have less outpatient time, therefore more ICU time. On the upside, as far as teaching goes it is outstanding, and by now i am signed off on all lines, taps, punctures, etc. and feel comfortable doing them. Sometimes I wish I chose a prelim at kaiser but after doing a rotation in a small hospital in ICU I am so glad I stayed at academic institution (at least I have a chance to learn evidence based medicine).

As far as night float: all prelims here do it but some categorical do not. That totally does not make sense as they will have to do NF as PGY2s, but I will never ever will have to take care of potassium replacement/poop control/pain control/vitamin H overnight,,,

I can't imagine that taking q3 call for 10 months could possibly get that person anything resembling a <80 hr workweek. Nor do I see how intern call nights #90-100 would add anything to the educational experience not already gained by the 50-60 call mark. The program as you describe it is abusive -- working a prelim double the call as a categorical, expecting them to maintain continuity clinic, put in additional ICU time, and take the night float scutwork off the shoulders of their categoricals. Your attitude of rationalizing it with (of all things) free food sounds like a fine example of Stockholm syndrome.

 

[Momentum70]

Im a designated prelim. At our program they try and split up teams so they have prelims and categoricals on each one. Also the prelims have an extra month on the wards. But I suppose one advantage is prelims dont have any continuity clinic. Its an academic program and the only IMGs I know are the ones we absorbed when a nearby hospital shut down.

 

[eforest]

Wow, my program treats prelims and categoricals exactly the same. I can't even remember off the top of my head which of my classmates are prelims like me. The one difference is that I don't need to take an in-service exam, but otherwise, I get "continuity" clinic and all the other things that categoricals get. The attendings I work with don't even know off the bat that I'm a prelim- they only know if they ask, which they often don't.