top tier prelim surgery or lowest tier categorical?

[597622]

I am an IMG from Europe now done with the interview trail for gen surg. I have very mixed emotions after finishing all my interviews and am having a really tough time figuring out how to rank. The top of my list is easy, I would love to go to these places but it's definitely a long shot and was probably interviewed without being strongly considered. Then as I get to 5th program down or so these are places that are bad. I mean community programs in inner cities that cannot attract US grads so usually caribbean grads or IMG's with really high boards scores end up there. I think that I could survive being in a place like this, but it is not in line with my career goals. I want to be an academic surgeon at a big center down the road.

What are people's opinions on ranking a very top tier prelim place that has a good track record at people getting very good categorical placements versus playing it safe and matching to a less than desirable community program in a crummy part of NY?

On the interview trail every single person I have talked to has highly advised against ranking a single prelim no matter how good above a categorical place. I have a really hard time wrapping my head around this. Yes, you have less job security as a prelim but I'm not talking about being a prelim at a community hospital, I'm talking about going to a top-tier place with a small chance of being kept on there and a bigger chance of being able to transfer PGY2 or 3 to another good program. It's a big dilemma for me. I don't want to make the mistake of going to an aweful 5 year program and regretting it. I also don't want to be a prelim and face the reality that I may never be a general surgeon (although the places I would consider being a prelim that really happens less frequently than success stories).
Any input will be greatly appreciated.

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[597622]

Categorical every time

Thanks for your opinion. What is your take on ranking a low-tier established community program versus new university-affiliated programs? that being a program that hasn't filled all the way through PGY-5 because they opened within a few years. I went to two places like this that are in nice academic hospitals, do research, higher quality surgical care. The downside of them being that A) they are new and not established and B) tend to be in more remote areas of the country and not near NYC or Detroit etc. Thx

 

[Mad Jack]

Categorical, FOR THE LOVE OF GOD, CATEGORICAL!!!!!!!!

 

[Mad Jack]

Thanks for your opinion. What is your take on ranking a low-tier established community program versus new university-affiliated programs? that being a program that hasn't filled all the way through PGY-5 because they opened within a few years. I went to two places like this that are in nice academic hospitals, do research, higher quality surgical care. The downside of them being that A) they are new and not established and B) tend to be in more remote areas of the country and not near NYC or Detroit etc. Thx

You're an IMG. Beggars can't be choosers. Take a categorical if you can get it, and a prelim if you can't. Don't be entitled, or you'll get tossed out in the streets after running 3 prelims in a row.

 

[597622]

You're an IMG. Beggars can't be choosers. Take a categorical if you can get it, and a prelim if you can't. Don't be entitled, or you'll get tossed out in the streets after running 3 prelims in a row.

I definitely understand your argument. And I agree beggars can't be choosers. Believe me I don't feel entitled to anything, and I am not a hot shot that thinks he can come from abroad and waltz into Mass Gen. This is just a very long-term career choice. I really just don't want to burn out before my career has even started because I chose to be at a place where I am miserable. And I agree that prelim years are risky and come with less job security particularly if done at mid-tier places but I can guarantee you that the guy who did a prelim at Columbia etc. and is now a categorical resident there doesn't regret his/her decision and now might go into surgical oncology versus if they went to a small community program won't have a chance at 80% of fellowship placements.
The other thing is a lot of US grads don't understand this dilemma because they haven't interviewed at the really low-tier places. They haven't interviewed at places that are virtually bankrupt and are all around pathological places to work and be a patient in, with an exclusively indigent patient population that doesn't give a **** what you do for them.

 

[597622]

Hard to say not knowing any of the specifics of the programs. That would have to be a case by case basis.

I don't consider proximity to NYC or Detroit a positive.

LOL, yeah I love NYC and have family there, but I know what you mean about Detroit.
In general how undesriable of a situation is it to be in a new program? Let's assume that it seemed great at the interview, all the residents (PGY1 to 2) liked it and were happy and it is an academic place with more faculty than a small community program Is it still better to be at an established low-tier place because it still might have name recognition for fellowship placements or is a new program that is academic and seems solid for the future a better choice and the fact that it is new won't matter much for fellowships?

I know I am bombarding you guys with this, but there simply is no info on dilemmas like this out there. And I'd rather ask a question on a forum and know I educated myself as best I could on a really big career decision than to regret not trying to garner the info.

 

[Mad Jack]

I definitely understand your argument. And I agree beggars can't be choosers. Believe me I don't feel entitled to anything, and I am not a hot shot that thinks he can come from abroad and waltz into Mass Gen. This is just a very long-term career choice. I really just don't want to burn out before my career has even started because I chose to be at a place where I am miserable. And I agree that prelim years are risky and come with less job security particularly if done at mid-tier places but I can guarantee you that the guy who did a prelim at Columbia etc. and is now a categorical resident there doesn't regret his/her decision and now might go into surgical oncology versus if they went to a small community program won't have a chance at 80% of fellowship placements.
The other thing is a lot of US grads don't understand this dilemma because they haven't interviewed at the really low-tier places. They haven't interviewed at places that are virtually bankrupt and are all around pathological places to work and be a patient in, with an exclusively indigent patient population that doesn't give a **** what you do for them.

That's a lot of hospitals. Seriously though, high-tier prelim =/= matching mid-tier or even low-tier surgical later. A lot of people recognize that at higher tier residencies, the categorical residents are going to get all the good stuff, while you'll be left with scraps at best. So it helps, but not nearly as much as you'd think. There's a few research papers on the placement rates of prelim residents out there you should take a look at. Sure, a good prelim might have a 60% chance of going categorical down the road (a lot of ours at my prestigious hospital actually had to switch specialities because they couldn't find a categorical spot to take them) but that's still a 40% chance you'll end up either nowhere or in rural FM or IM. Why take that when you could go categorical and have a 100% chance of being a surgeon?

 

[597622]

That's a lot of hospitals. Seriously though, high-tier prelim =/= matching mid-tier or even low-tier surgical later. A lot of people recognize that at higher tier residencies, the categorical residents are going to get all the good stuff, while you'll be left with scraps at best. So it helps, but not nearly as much as you'd think. There's a few research papers on the placement rates of prelim residents out there you should take a look at. Sure, a good prelim might have a 60% chance of going categorical down the road (a lot of ours at my prestigious hospital actually had to switch specialities because they couldn't find a categorical spot to take them) but that's still a 40% chance you'll end up either nowhere or in rural FM or IM. Why take that when you could go categorical and have a 100% chance of being a surgeon?

Right. I agree with everything you said. And surgery being a dream career, it tends to be something I am reluctant to gamble on. The prospect of not being a surgeon at all is a lot worse than not being able to go into a good fellowship because I went to a small community program that I will likely be unhappy at for 5 years.
I definitely know about the stats on outcomes for prelims. I have read most if not all the literature that exists on that. There is a good paper on it out of Mayo clinic. At any rate, there are a very select few places where I have interviewed where most if not all of the prelims end up in surgery. yes, some end up at the very places I am debating about (lower tier) but isn't the experience of working in an ivy league hospital for 1-2 years and then transferring and finishing categorical at a low-tier place worth it. I mean yeah it comes with stress and you have to work your ass off as a prelim anywhere to impress etc. but I consider being a resident, even if prelim, at a world-renowned top 5 surgery program to be a once in a lifetime opportunity even if just for the surgical experience, forget career chances etc.

 

[Mad Jack]

Right. I agree with everything you said. And surgery being a dream career, it tends to be something I am reluctant to gamble on. The prospect of not being a surgeon at all is a lot worse than not being able to go into a good fellowship because I went to a small community program that I will likely be unhappy at for 5 years.
I definitely know about the stats on outcomes for prelims. I have read most if not all the literature that exists on that. There is a good paper on it out of Mayo clinic. At any rate, there are a very select few places where I have interviewed where most if not all of the prelims end up in surgery. yes, some end up at the very places I am debating about (lower tier) but isn't the experience of working in an ivy league hospital for 1-2 years and then transferring and finishing categorical at a low-tier place worth it. I mean yeah it comes with stress and you have to work your ass off as a prelim anywhere to impress etc. but I consider being a resident, even if prelim, at a world-renowned top 5 surgery program to be a once in a lifetime opportunity even if just for the surgical experience, forget career chances etc.

No one cares where you did your prelim dude. They know prelims are made of scut work and fail.

 

[597622]

No one cares where you did your prelim dude. They know prelims are made of scut work and fail.

Yeah I'm not saying I would do a prelim to improve my CV for a fellowship, I am saying that it's an opportunity to get world-class training (for my own benefit) if even for 1-2 years. Like you live once, and we can talk about this all in terms of career chances etc but at some point you have to think about your own happiness and you want certain life experiences. I tend to agree with you and am playing devil's advocate, but I think arguments can be made for both sides of my original question. That's why it's a dilemma for me. If it wasn't I'd just certify my list prelims at the bottom and leave you guys alone to do whatever it is that SDN posters do on snowy Thursday nights... SDN

 

[Mad Jack]

Yeah I'm not saying I would do a prelim to improve my CV for a fellowship, I am saying that it's an opportunity to get world-class training (for my own benefit) if even for 1-2 years. Like you live once, and we can talk about this all in terms of career chances etc but at some point you have to think about your own happiness and you want certain life experiences. I tend to agree with you and am playing devil's advocate, but I think arguments can be made for both sides of my original question. That's why it's a dilemma for me. If it wasn't I'd just certify my list prelims at the bottom and leave you guys alone to do whatever it is that SDN posters do on snowy Thursday nights... SDN

I knew a DO that went to a top 10 prelim. Let's just say that he was disappointed to say the least. That's why I highly recommend against it- it didn't help him in the long run, and he ended up doing BS grunt work most of the time while the categorical residents got anything worth seeing. Do what you want, obviously, but going for a top-tier prelim is basically volunteering for a gilded sweatshop.

 

[597622]

I knew a DO that went to a top 10 prelim. Let's just say that he was disappointed to say the least. That's why I highly recommend against it- it didn't help him in the long run, and he ended up doing BS grunt work most of the time while the categorical residents got anything worth seeing. Do what you want, obviously, but going for a top-tier prelim is basically volunteering for a gilded sweatshop.

gotta love your sense of humor. Yeah I think you're right, that SOME of the top-tier programs are like that. I knew someone who did a prelim at Penn who literally was broken after the first week. He said that he didn't get to go to the OR virtually at all and had his work ethic questioned on a daily basis and spent 75% of his time correcting potassiums and other monotone floor work, while the categoricals got to scrub Whipple's and got a lot of OR time. That is definitely the case at a lot if not most of the top-tier places. I am aware of that. There are a select few places I have been and I won't mention their names that are top 5 or top 10 programs where the prelims there legitimately felt treated equal to categoricals and even on the contrary often even felt more supported than the categoricals because the faculty wanted them to land jobs down the road, and the consensus, throughout the program from all the residents to the highest ranking faculty, was that the prelims are not there for cheap labor. They are there to have a chance to prove themselves and get experience and the faculty definitely mentored them, were happy to write letters and make calls. Yes, one or two per year didn't make it to surgery over the last few years and ended up in IM, but that was usually because they didn't want to be surgeons anymore rather than couldn't find a spot (from what I heard). The national attrition rate for surgery is already 20%, that figure certainly applies to prelims as well (and I mean attrition due to not wanting to be a surgeon not not being able to become one).

 

[597622]

Ok. For clarification I'm about as Ivory tower as they get on here. I'm at one of the perennial "top whatever" residencies. The kind that don't even interview DOs or IMGs.

Even given my somewhat deserved reputation as a prestige *****, I'm telling you, without a shadow of a doubt, that a bird in the hand is worth two in the bush. It is plain outright stupid to rank a prelim year higher than a categorical.

Posters like you have done this same song and dance for over a decade on this site. The advice is always the same, from a number of people with experiences at top programs, bottom programs, and everywhere in between.

If you want to backhand insult the site in your closing remarks and do something stupid, go right ahead. But it's still stupid.

Come on man, I certainly wasn't trying to insult the site. I F-ing LOVE SDN. It's literally one of the best things on the internet. I too am one of those people on SDN on snowy Thursday nights and am saying it more as a fellow user than as someone who would look down on SDN. Trust me I love SDN and I am beyond thankful to every single person who has ever helped me and given me advice on here. Sorry if the phrasing of what I wrote sounded condescending. Seriously didn't mean that. I genuinely appreciate your opinion, and what I needed is very stern, decisive advice like that which I got on this thread to prevent me from what everyone is in agreement would be a big mistake.

 

[ThoracicGuy]

gotta love your sense of humor. Yeah I think you're right, that SOME of the top-tier programs are like that. I knew someone who did a prelim at Penn who literally was broken after the first week. He said that he didn't get to go to the OR virtually at all and had his work ethic questioned on a daily basis and spent 75% of his time correcting potassiums and other monotone floor work, while the categoricals got to scrub Whipple's and got a lot of OR time. That is definitely the case at a lot if not most of the top-tier places. I am aware of that. There are a select few places I have been and I won't mention their names that are top 5 or top 10 programs where the prelims there legitimately felt treated equal to categoricals and even on the contrary often even felt more supported than the categoricals because the faculty wanted them to land jobs down the road, and the consensus, throughout the program from all the residents to the highest ranking faculty, was that the prelims are not there for cheap labor. They are there to have a chance to prove themselves and get experience and the faculty definitely mentored them, were happy to write letters and make calls. Yes, one or two per year didn't make it to surgery over the last few years and ended up in IM, but that was usually because they didn't want to be surgeons anymore rather than couldn't find a spot (from what I heard). The national attrition rate for surgery is already 20%, that figure certainly applies to prelims as well (and I mean attrition due to not wanting to be a surgeon not not being able to become one).

In the end, you are still a prelim. Those places may say that they really want their prelims to get spots, but when it comes down to it, they are dedicated to their categoricals, not their prelims. Prelims come and go. They are there for 1 year, 2 years max. They get put on the worst rotations. They don't get much OR experience on average,especially as an intern. Even if you went to some "Ivy League" prelim and then went to a lower-tier categorical spot, your time at they Ivy League won't mean much of anything. Fellowships won't really care. Your future jobs won't care. What does matter is that you finish and are able to be board certified.

So yeah, choose categorical every time and twice on Sundays.

 

[rokshana]

you're an IMG...european, caribbean, asian...doesn't matter...you're are not an AMG...for surgery, you are not competitive...if you were blessed to get any cat gen surg interviews, those are the ones you rank at the top..that is of course if you want to guarantee that you will become a surgeon.

prelim, even at the best place is going to be scut for you...the ranking should be the better prelim over the crappy prelim...but should never trump a categorical spot...even the most FMG place is better than prelim at MGH...if you don't get, well...

 

[597622]

you're an IMG...european, caribbean, asian...doesn't matter...you're are not an AMG...for surgery, you are not competitive...if you were blessed to get any cat gen surg interviews, those are the ones you rank at the top..that is of course if you want to guarantee that you will become a surgeon.

prelim, even at the best place is going to be scut for you...the ranking should be the better prelim over the crappy prelim...but should never trump a categorical spot...even the most FMG place is better than prelim at MGH...if you don't get, well...

Why are people on here thinking that I feel entitled to anything. At what point did I give off a sense of self-entitlement?! I know I am an IMG, and I don't need reminders that surgery is competitive. Thanks for that, duly noted.
And I wrote that I am from Europe just to give some background context, not to differentiate myself from anyone else. And by the way you are wrong there is a difference between someone who went to Cambridge versus someone who went to the Caribbean. But I certainly didn't say I was from Europe for that reason, nor is that remotely relevant. I'm not asking about my chances of getting interviews or matching, I am asking about ranking strategy and long-term outcomes. Now that I have interviewed at all of my places and have everything on the table, I have every right to rank the best possible way for myself, why wouldn't I? I'm not going to rank a certain way because you think it's insulting to those who couldn't get those interviews. You're like the ubiquitous person who just has to comment on someone throwing food away after they're full "ya know kids in Africa are going hungry cause of you".

 

[Mad Jack]

Why are people on here thinking that I feel entitled to anything. At what point did I give off a sense of self-entitlement?! I know I am an IMG, and I don't need reminders that surgery is competitive. Thanks for that, duly noted.
And I wrote that I am from Europe just to give some background context, not to differentiate myself from anyone else. And by the way you are wrong there is a difference between someone who went to Cambridge versus someone who went to the Caribbean. But I certainly didn't say I was from Europe for that reason, nor is that remotely relevant. I'm not asking about my chances of getting interviews or matching, I am asking about ranking strategy and long-term outcomes. Now that I have interviewed at all of my places and have everything on the table, I have every right to rank the best possible way for myself, why wouldn't I? I'm not going to rank a certain way because you think it's insulting to those who couldn't get those interviews. You're like the ubiquitous person who just has to comment on someone throwing food away after they're full "ya know kids in Africa are going hungry cause of you".

Everyone is just trying to make sure you don't do something that qualifies as extremely dumb, objectively. Rank your categoricals best to worst, then your prelims best to worst. There is no other right way to do this. You do not want the double taint of IMG and prelim hanging over your head.

 

[597622]

Thanks everyone. I'm mostly just playing Devils advocate to understand why the overwhelmingly objective opinion is do X and not Y. It seems pretty clear to me now that the arguments for Y are a lot worse than for X.
Appreciate the input and I will rank accordingly. I will make sure to post my match outcome and long term opinion on that if anyone is interested. But yeah I got the point and this info is difficult to acquire without opinions like that on SDN because those studies that we re talking about are written by te very people who propagate the prelim workhorse system.

 

[rokshana]

Why are people on here thinking that I feel entitled to anything. At what point did I give off a sense of self-entitlement?! I know I am an IMG, and I don't need reminders that surgery is competitive. Thanks for that, duly noted.
And I wrote that I am from Europe just to give some background context, not to differentiate myself from anyone else. And by the way you are wrong there is a difference between someone who went to Cambridge versus someone who went to the Caribbean. But I certainly didn't say I was from Europe for that reason, nor is that remotely relevant. I'm not asking about my chances of getting interviews or matching, I am asking about ranking strategy and long-term outcomes. Now that I have interviewed at all of my places and have everything on the table, I have every right to rank the best possible way for myself, why wouldn't I? I'm not going to rank a certain way because you think it's insulting to those who couldn't get those interviews. You're like the ubiquitous person who just has to comment on someone throwing food away after they're full "ya know kids in Africa are going hungry cause of you".

this...(and if "everyone" here voices that opinion, you may want to re-read your posts...)
and no i'm not that person...i'm very well aware of what it takes to get a residency in the US as an IMG...and you may LIKE to think that being an IMG from a European country somehow makes you better, but in the eyes of most PDs...FMG is FMG...the only ones that will differentiate are those that are used to dealing with FMG candidates...

ranking strategy as practically everyone here has said to you is cat gen surg 1st no matter how "low "tier you may consider it...but don't go in with the chip that somehow you have been at a "better" place...we have all had to deal with "that" resident..

 

[597622]

this...(and if "everyone" here voices that opinion, you may want to re-read your posts...)
and no i'm not that person...i'm very well aware of what it takes to get a residency in the US as an IMG...and you may LIKE to think that being an IMG from a European country somehow makes you better, but in the eyes of most PDs...FMG is FMG...the only ones that will differentiate are those that are used to dealing with FMG candidates...

ranking strategy as practically everyone here has said to you is cat gen surg 1st no matter how "low "tier you may consider it...but don't go in with the chip that somehow you have been at a "better" place...we have all had to deal with "that" resident..

Dude I understand what you are saying, and I really didn't want to get into this. There is absolutely a difference between an IMG and an AMG no matter where the IMG went to school I agree with you 100% but amongst those spots left over for IMG's there is absolutely a difference where you went to school and if you went to a prestigious European med school you have a higher chance of getting the scraps left over after AMG's provided the rest of your app is ok. There is a goddamn reason Cornell Qatar is matching people to ****ing orthopedics at Cleveland Clinic! The arguably number one ortho program in the country took an IMG last year because even though an IMG, the fact is that the school has an affiliation with Cornell (even though the school is a cash cow set up by extremely wealthy Arab investors) and where you went to school absolutely matters. There are other intangible factors that go into all of this as well, but trust me someone with a PhD from Oxford will absolutely not be treated like an IMG from a 3rd world country. It's not debatable it is a fact that I have seen over and over again. The other things is most people from the prestigious European schools aren't trying to come to the US because they are happy where they are, but when they do apply to the US they have a bit more options than the rest of the IMGs they just aren't posting on forums because they're matched and not desperately trying to land a job.

 

[Law2Doc]

Dude I understand what you are saying, and I really didn't want to get into this. There is absolutely a difference between an IMG and an AMG no matter where the IMG went to school I agree with you 100% but amongst those spots left over for IMG's there is absolutely a difference where you went to school and if you went to a prestigious European med school you have a higher chance of getting the scraps left over after AMG's provided the rest of your app is ok. There is a goddamn reason Cornell Qatar is matching people to ****ing orthopedics at Cleveland Clinic! The arguably number one ortho program in the country took an IMG last year because even though an IMG, the fact is that the school has an affiliation with Cornell (even though the school is a cash cow set up by extremely wealthy Arab investors) and where you went to school absolutely matters. There are other intangible factors that go into all of this as well, but trust me someone with a PhD from Oxford will absolutely not be treated like an IMG from a 3rd world country. It's not debatable it is a fact that I have seen over and over again. The other things is most people from the prestigious European schools aren't trying to come to the US because they are happy where they are, but when they do apply to the US they have a bit more options than the rest of the IMGs they just aren't posting on forums because they're matched and not desperately trying to land a job.

1. For someone taken aback that people think they come off as entitled you didn't exactly allay fears with this post.
2. While European schools are usually better than Caribbean schools, the connections graduates of Caribbean schools have is often far better. Many of the Caribbean grads do rotations in the US and have US attendings pulling strings. So it rarely comes down to a "my foreign school is better than yours". It comes down to, if we are going to take a flyer on a foreigner, who comes recommended by someone we know.
3. I agree that most grads from the better European schools are happy and don't try to come to the US, but that actually heightens suspicion when someone wants to come -- hed better have a pretty good story or we have to assume there's an issue there. By contrast we get to pick and choose the best grads from the offshore schools. Wed rather have the best grad of a crappy med school than the washout from a good one. So your pedigree can hurt you.
4. I suspect if you try to single out individual people at individual programs that you are "better" than, you'll always lose. You don't know what went into the decision to accept a given applicant, but you had better believe that if someone got an ortho spot in a Competitive field/year he beat out lots of US applicants (as well as ALL the Europen ones) so I'm not sure what your point is. he didn't get it from a loose affiliation some foreign school has with Cornell, he got it because something on his app made him the better applicant. Guess what, you can't follow that. At a minimum picking out one person at random as "not deserving" makes you seem petty. There's a lot of ugly arrogance in your post and I suspect it will not serve you well in this PAth or in life. You aren't better than this guy or any of the dozens of Caribbean grads who will get better residencies than you. Get humble fast. The "market" will decide where you belong.
5. You are going into a path where for a decade you are going to be scutted out by people who you may regard as not as classically educated as you. Get over it. You aren't anything yet.
6. The worst categorical program is a Better opportunity then the best prelim. most prelims are dead end, particularly for foreign grads. You can have an amazing career coming out of some no name categorical community program, or you can be back in the match after a big name program abused you for a Year and kicked you aside. Many people who come from foreign schools and do such a prelim end up doing another prelim and lose a year. Whatever improved pedigree you think you get by having a big name on your training certificate is dwarfed by losing a year.
7. Your last post came off so over the top that it's screaming troll. But if not, you had better not come across this way in person or you are toast.

 

[597622]

1. For someone taken aback that people think they come off as entitled you didn't exactly allay fears with this post.
2. While European schools are usually better than Caribbean schools, the connections graduates of Caribbean schools have is often far better. Many of the Caribbean grads do rotations in the US and have US attendings pulling strings. So it rarely comes down to a "my foreign school is better than yours". It comes down to, if we are going to take a flyer on a foreigner, who comes recommended by someone we know.
3. I agree that most grads from the better European schools are happy and don't try to come to the US, but that actually heightens suspicion when someone wants to come -- hed better have a pretty good story or we have to assume there's an issue there. By contrast we get to pick and choose the best grads from the offshore schools. Wed rather have the best grad of a crappy med school than the washout from a good one. So your pedigree can hurt you.
4. I suspect if you try to single out individual people at individual programs that you are "better" than, you'll always lose. You don't know what went into the decision to accept a given applicant, but you had better believe that if someone got an ortho spot in a Competitive field/year he beat out lots of US applicants (as well as ALL the Europen ones) so I'm not sure what your point is. he didn't get it from a loose affiliation some foreign school has with Cornell, he got it because something on his app made him the better applicant. Guess what, you can't follow that. At a minimum picking out one person at random as "not deserving" makes you seem petty. There's a lot of ugly arrogance in your post and I suspect it will not serve you well in this oath or in life. You aren't better than this guy or any of the dozens of Caribbean grads who will get better residencies than you. Get humble fast. The "market" will decide where you belong.
5. You are going into a path where for a decade you are going to be scutted out by people who you may regard as not as classically educated as you. Get over it. You aren't anything yet.
6. The worst categorical program is a Better opportunity then the best prelim. most prelims are dead end, particularly for foreign grads. You can have an amazing career coming out of some no name categorical community program, or you can be back in te match after a big name program abused you for a Year and kicked you aside. Many people who come from foreign schools and do such a prelim end up doing another prelim and lose a year. Whatever improved pedigree you think you get by having a big name on your training certificate is dwarfed by losing a year.
7. Your last post came off so over the top that it's screaming troll. But if not, you had better not come across this way in person or you are toast.

I am a troll for expressing an opinion? Seems like the one who doesn't have humility is the one who would accuse someone of not having any. As I wrote ten times in earlier posts I am humble. I really think you failed to see my argument in my previous post. I wrote that IT DOES matter where you went to school. At no point did I write that I am better than anyone else. Please show me where I wrote that and I will gladly apologize. Rokshana argued that med school doesn't matter at all and that simply is not the case through various experiences that I have had and seen, objectively. That point had nothing to do with me or where I went to school. That is why I wrote I don't want to get into this topic, but he is wrong.
And I am not saying that Europe is better than anyone else, I am saying it absolutely does matter what specific place you went to. It's not just as simple as img=img=img=img. People go to interviews, they interact with PD's. This entire process is determined by individual PD's in offices, not some giant governmental agency screening robots with bar code scanners. These PD's are absolutely in tune to where someone went to school. They do research internationally, they know people all over the world in their respective fields and they know the caliber of people coming out of a lot of schools, not just American ones. My single point was it does matter where someone went to school. It's not a prime reason someone matches somewhere but it certainly is a deciding factor.

I said it before and I will say it again, I remain humble throughout this process. I have already been on the interview trail so sarcastically saying you better find humility and fast doesn't change anything. This is an internet forum not a grand ball. Questioning someone's humility and thinking you should tell them what their attitude should be or thinking you have the right to do so is a lack of humility in and of itself. I think that was unnecessary. I came here for help with career tips, not anything else. And for everyone who has written an actual constructive opinion, I genuinely appreciate it.

My final point; I wrote it as literally as I could have but I guess I have to do it again. I REALIZE NO ONE CARES where you did a prelim year. I wrote that three times above. I said the experience of being there FOR MY OWN BENEFIT (i.e. learning something as a citizen of the earth) might make it worthwhile. Yes, I got an overwhelming response of "no it is not worth it and don't do it because you will regret it", and that is why I asked the question. So thank you for cementing that on this thread. That is all I wanted to know. Thank you.

 

[Law2Doc]

I guess everyone else has to also rewrite three times the point you cant seem to grasp --that NO, FOR YOUR OWN BENEFIT there is NO value to doing a prelim over a categorical. Seriously you will learn a lot more during that year at a more hands on and short staffed no name and less erudite program for the simple reason that prelims in the big name academic programs don't get into the OR and tend to be scutted out for a year, not treated as future colleagues. At those programs it's all about the categoricals. The prelims are just not worth anyone's effort, most will be gone in a year. As for the rest of your post --seriously reread your prior threads, trying to appreciate how someone who doesn't know you will read them -- you do not come off at all humble and certainly do seem to suggest that you are somehow better than this guy from Quatar. In fact your saying "I wrote ten times in prior posts that I m humble" is about the least humble thing one could ever type, (reminiscent of the guy in Office Space screaming at the Bobs that he's "a good people person, why can't you people understand that!!"). You come off as absurdly arrogant in your prior posts, almost a caricature, and that's why my trolldar is going off bigtime. I apologize if I'm wrong, but it's been pretty accurate over the past decade. If you aren't a troll you've got a LOT of work to do to change how you present yourself.

 

[rokshana]

first off, i'm not a dude...i'm a dude-ette..in other words a girl...
and lets see...you are a student that has spent your medical education time in a country other than the US, telling those of us who are currently IN the US, IN US residencies and fellowships, involved in the the resident and fellow selection process how our PDs think and what knowledge they have of foreign schools and the quality of their students...hmmm AND your humble? right?

as L2D stated...offshore students rotate in the US...they have 2 years to present themselves to attendings and prove themselves...and programs in the end want someone they know will fit in and do the work...a person they know from a middling off shore school they know will trump someone they only know on paper and met once for 15-30 mins...

we can all give examples of I/FMGs matching into unbelievably hard, prestigious programs coming from our schools...3 of my classmates matched ortho...one at UofT in Canada...and trust me the Canadian match is far more IMG unfriendly than the US...and a Grad of my school matched Rad Onc at Hopkins...doesn't make my school all that and a bag of chips...it means that those people worked their asses off and went above and beyond...and they were rewarded with a chance at their dream residency.

please...DO pick that "prestigious" prelim surgery program over the mediocre cat gen surg programs...it would be a waste of the spot for you to get it...better that the eager caribbean grad who just wants to have the chance to become a surgeon and will be over the MOON to match at that low tiered program.

 

[597622]

first off, i'm not a dude...i'm a dude-ette..in other words a girl...
and lets see...you are a student that has spent your medical education time in a country other than the US, telling those of us who are currently IN the US, IN US residencies and fellowships, involved in the the resident and fellow selection process how our PDs think and what knowledge they have of foreign schools and the quality of their students...hmmm AND your humble? right?

as L2D stated...offshore students rotate in the US...they have 2 years to present themselves to attendings and prove themselves...and programs in the end want someone they know will fit in and do the work...a person they know from a middling off shore school they know will trump someone they only know on paper and met once for 15-30 mins...

we can all give examples of I/FMGs matching into unbelievably hard, prestigious programs coming from our schools...3 of my classmates matched ortho...one at UofT in Canada...and trust me the Canadian match is far more IMG unfriendly than the US...and a Grad of my school matched Rad Onc at Hopkins...doesn't make my school all that and a bag of chips...it means that those people worked their asses off and went above and beyond...and they were rewarded with a chance at their dream residency.

please...DO pick that "prestigious" prelim surgery program over the mediocre cat gen surg programs...it would be a waste of the spot for you to get it...better that the eager caribbean grad who just wants to have the chance to become a surgeon and will be over the MOON to match at that low tiered program.

Ok sure, let's all settle down here. I'm sure you have lot's of knowledge of the process, as I am sure others do too, and I am grateful that you all shared it. I wanted to have it explained exactly why one is a bad decision and one isn't.
I too have had a decent amount of exposure to it (definitely not as much as you), through various experiences with multiple programs that I won't delve into because that is not the point of my OP, and my objective experience has been what I wrote before, maybe I'm wrong. My example of the guy from Qatar wasn't to show that I am better than him, the example was to show that the name on your diploma absolutely matters in the process, amg or img. That, solely, was my point of that example.
Your example of U of T isn't the greatest one if I am being honest, because as well all know Canada has designated img spots. While the competition for those limited number of places is absolutely fierce as you know I am sure, the fact is that every year an img is guaranteed that spot. From plastics to gen surg to family medicine. Ortho in Canada also is not what it is in the US, it is actually quite a dramatic difference. Ortho is considered an overpopulated specialty. My cousin who is an orthopedic surgeon in Canada had to do 3 fellowships waiting his turn to finally get hired. That is the most common scenario if you ask current fellows and senior residents, and many Canadian grads are steering clear of Ortho. For that reason, at my cousin's program, every year even a few of the Canadian places fill up with img's. They come from many places, not just the caribbean. From the most recent Carms stats, family medicine was more competitive than ortho, interestingly enough. It's hard to swallow that considering just south of the boarder it is one of the most sought after specialties.

 

[597622]

Previous posts are off topic, and apparently lacking humility. Thank you to everyone who shared their opinion. I have certified my ROL in the exact ranking fashion that everyone on here has recommended and will post in a few years to share my thoughts on that.

 

[597622]

first off, i'm not a dude...i'm a dude-ette..in other words a girl...
and lets see...you are a student that has spent your medical education time in a country other than the US, telling those of us who are currently IN the US, IN US residencies and fellowships, involved in the the resident and fellow selection process how our PDs think and what knowledge they have of foreign schools and the quality of their students...hmmm AND your humble? right?

as L2D stated...offshore students rotate in the US...they have 2 years to present themselves to attendings and prove themselves...and programs in the end want someone they know will fit in and do the work...a person they know from a middling off shore school they know will trump someone they only know on paper and met once for 15-30 mins...

we can all give examples of I/FMGs matching into unbelievably hard, prestigious programs coming from our schools...3 of my classmates matched ortho...one at UofT in Canada...and trust me the Canadian match is far more IMG unfriendly than the US...and a Grad of my school matched Rad Onc at Hopkins...doesn't make my school all that and a bag of chips...it means that those people worked their asses off and went above and beyond...and they were rewarded with a chance at their dream residency.

please...DO pick that "prestigious" prelim surgery program over the mediocre cat gen surg programs...it would be a waste of the spot for you to get it...better that the eager caribbean grad who just wants to have the chance to become a surgeon and will be over the MOON to match at that low tiered program.

And your stereotype of the super-passionate hard working caribbean grad who's only life's dream is to become a surgeon is definitely not the rule. I have definitely met several people like that on the interview trail, and have definitely met numerous who's summating attitude was "I really didn't decide to apply to surgery until a couple of weeks ago, I figured why not?" so definitely both types exist, and it certainly has nothing to do with going to the caribbean or any other school. You will find people who worked their tail off to land those interviews (myself included believe it or not) and also the people who just give off the impression that they just want any residency and don't care if it's surgery or any other field.

 

[rokshana]

...

 

[rokshana]

And your stereotype of the super-passionate hard working caribbean grad who's only life's dream is to become a surgeon is definitely not the rule. I have definitely met several people like that on the interview trail, and have definitely met numerous who's summating attitude was "I really didn't decide to apply to surgery until a couple of weeks ago, I figured why not?" so definitely both types exist, and it certainly has nothing to do with going to the caribbean or any other school. You will find people who worked their tail off to land those interviews (myself included believe it or not) and also the people who just give off the impression that they just want any residency and don't care if it's surgery or any other field.

trust me...caribbean grads know what is possible and what is a reach...and given that cat gen surg has been pretty difficult to go into for the last few years for everyone (only 2-4 unfilled spots on average in the last 5-7 years) and nearly impossible for caribbean students, the chance of the off shore student applying only to cat gen surg, much less on a lark...is not accurate.

there is no particular stereotype for caribbean students....some are slackers in med school just like they were before which is what got them into the option of having to go to a caribbean school in the 1st place....others screwed up somewhere along the line which kept them from going to a US med school, realized the implications of that and worked to their real potential and having busted their butt, have the chance to get a residency...we are a motley crew no question...but as L2D stated before, don't hang your hat that coming from a "prestigious " foreign school is going to get you through the US match... in the eyes of the US programs, you're a foreign grad, simple as that...sure if a program has had some experience with your school then you may get a leg up over a school that the program hasn't heard of, but in the end a foreign student has to prove themselves to succeed in the US system...

and actually i do believe it...because being an FMG (and if you are visa needing, God help you) you had to excel...but if the attitude that you display here seeped into your interviews, well it can make you DNR for programs...we had a applicant who went to a German school , as she said by choice over a US school, who then proceeded to comment over dinner how it was so much better than going to a caribbean or DO school...not realizing that at the table the chief present was a DO, the upcoming chief present was a Caribbean grad and that the program was pretty evenly spilt with AMG, I/FMG(including carib), and DOs...she was DNRed by all of us at the dinner...

 

[597622]

smh

Because I wrote that there are people who are passionate about surgery and there are people who aren't as passionate or not at all? I'm not sure why you'd be shaking your head... is your experience different? Isn't this the case in any field?

 

[rokshana]

Ok sure, let's all settle down here. I'm sure you have lot's of knowledge of the process, as I am sure others do too, and I am grateful that you all shared it. I wanted to have it explained exactly why one is a bad decision and one isn't.
I too have had a decent amount of exposure to it (definitely not as much as you), through various experiences with multiple programs that I won't delve into because that is not the point of my OP, and my objective experience has been what I wrote before, maybe I'm wrong. My example of the guy from Qatar wasn't to show that I am better than him, the example was to show that the name on your diploma absolutely matters in the process, amg or img. That, solely, was my point of that example.
Your example of U of T isn't the greatest one if I am being honest, because as well all know Canada has designated img spots. While the competition for those limited number of places is absolutely fierce as you know I am sure, the fact is that every year an img is guaranteed that spot. From plastics to gen surg to family medicine. Ortho in Canada also is not what it is in the US, it is actually quite a dramatic difference. Ortho is considered an overpopulated specialty. My cousin who is an orthopedic surgeon in Canada had to do 3 fellowships waiting his turn to finally get hired. That is the most common scenario if you ask current fellows and senior residents, and many Canadian grads are steering clear of Ortho. For that reason, at my cousin's program, every year even a few of the Canadian places fill up with img's. They come from many places, not just the caribbean. From the most recent Carms stats, family medicine was more competitive than ortho, interestingly enough. It's hard to swallow that considering just south of the boarder it is one of the most sought after specialties.

actually the smh should have been here...
noticed you didn't knock the Hopkins match...

 

[597622]

actually the smh should have been here...
noticed you didn't knock the Hopkins match...

At my cousins program they have 150 people applying per spot, so it's definitely an achievement to match. I don't know much about rad onc so I wouldn't knock it and in my country rad onc isn't a separate specialty so I have no exposure to it (no pun intended). I know ortho in the US is crazy competitive, but being as how I had a family member who is part of the ortho matching process in Canada I just started a discussion about it, that's all. Not knocking it. It certainly is very difficult for an img to match to ortho in Canada, as it is to match to anything in Canada. All I was saying is that it is interesting that just over the boarder Ortho can go from a specialty that is almost unattainable for imgs to one that is often sought after by img's because Canadian grads are statistically applying to it in much lower numbers than 10 years ago.

 

[Medstart108]

3. I agree that most grads from the better European schools are happy and don't try to come to the US, but that actually heightens suspicion when someone wants to come -- hed better have a pretty good story or we have to assume there's an issue there. By contrast we get to pick and choose the best grads from the offshore schools. Wed rather have the best grad of a crappy med school than the washout from a good one. So your pedigree can hurt you.

Washouts from the UK (and likely most of Europe) never head to the US. It is usually the best students that seek to go abroad. This is because foundation years are given to every graduating medical student in the UK and those who are washouts in the UK are never going to be able to write the USMLE well enough to land anything good. Think about it, if you can't make it in your own country how the hell can you expect to make it in another, especially one where you are expected to have better stats than local students?

 

[597622]

Washouts from the UK (and likely most of Europe) never head to the US. It is usually the best students that seek to go abroad. This is because foundation years are given to every graduating medical student in the UK and those who are washouts in the UK are never going to be able to write the USMLE well enough to land anything good. Think about it, if you can't make it in your own country how the hell can you expect to make it in another, especially one where you are expected to have better stats?

Agreed 100%, that has been my experience as well. No matter where you are coming from, to land a spot in the US you really have to be the cream of the crop from your medical school and country in general whether that be in Europe, Asia, South America etc.

 

[597622]

trust me...caribbean grads know what is possible and what is a reach...and given that cat gen surg has been pretty difficult to go into for the last few years for everyone (only 2-4 unfilled spots on average in the last 5-7 years) and nearly impossible for caribbean students, the chance of the off shore student applying only to cat gen surg, much less on a lark...is not accurate.

there is no particular stereotype for caribbean students....some are slackers in med school just like they were before which is what got them into the option of having to go to a caribbean school in the 1st place....others screwed up somewhere along the line which kept them from going to a US med school, realized the implications of that and worked to their real potential and having busted their butt, have the chance to get a residency...we are a motley crew no question...but as L2D stated before, don't hang your hat that coming from a "prestigious " foreign school is going to get you through the US match... in the eyes of the US programs, you're a foreign grad, simple as that...sure if a program has had some experience with your school then you may get a leg up over a school that the program hasn't heard of, but in the end a foreign student has to prove themselves to succeed in the US system...

and actually i do believe it...because being an FMG (and if you are visa needing, God help you) you had to excel...but if the attitude that you display here seeped into your interviews, well it can make you DNR for programs...we had a applicant who went to a German school , as she said by choice over a US school, who then proceeded to comment over dinner how it was so much better than going to a caribbean or DO school...not realizing that at the table the chief present was a DO, the upcoming chief present was a Caribbean grad and that the program was pretty evenly spilt with AMG, I/FMG(including carib), and DOs...she was DNRed by all of us at the dinner...

I am telling you that I have met people specifically like this, and not just one or two but several. They were from the more well know Caribbean schools. I have also met non-caribbean imgs with that attitude as well. Not every caribbean grad knows exactly what is a reach and what isn't, and some apply just for the heck of it, which isn't that bad of an idea. They were able to secure categorical interviews so clearly that attitude paid off.

 

[Law2Doc]

...My example of the guy from Qatar wasn't to show that I am better than him, the example was to show that the name on your diploma absolutely matters in the process, amg or img. That, solely, was my point of that example...

Problem with this example is you think he got in because of his med school rather than in spite of it. I suspect it was the latter.

 

[bobow98]

Cat>Prelim.
You will get the same answer over and over. No one is attacking you personally.
If you want to give up the cat spot to someone else go right ahead. World keeps spinning. This thread will come up again next year, and the year after.

Stop responding to responses.