Surgery FAQs

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IOE

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hi ppl...I am a first year medical student (starting next fall)....and I am kind of confused about the surgery residency....what is the difference between a categorical residency and a prelim?? and why is it much easier to get a prelim position?? and I have read in previous posts that it is possible to transfer from a prelim to categorical...does this happen often??

If anyone can answer these questions for me I will be most grateful.

thnx

IOE
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Categorical: Residency leading to board certification in general surgery (i.e., a 5-year or longer residency).

Preliminary: Internship (or another year of residency) that does NOT lead to board certification in general surgery. These are 1- to 3-years long and only prepare the resident for another residency that requires previous graduate medical education (GME), such as ENT, orthopedics, urology, etc.
 
Originally posted by Geek Medic
Categorical: Residency leading to board certification in general surgery (i.e., a 5-year or longer residency).

Preliminary: Internship (or another year of residency) that does NOT lead to board certification in general surgery. These are 1- to 3-years long and only prepare the resident for another residency that requires previous graduate medical education (GME), such as ENT, orthopedics, urology, etc.
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so you have to apply for residency all over again if you do prelim? Or are you automatically accepted into the surgical residency after you finish the first transitional years?
 
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so you have to apply for residency all over again if you do prelim? Or are you automatically accepted into the surgical residency after you finish the first transitional years?
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Well, it depends if you're a preliminary-designated or a preliminary-nondesignated. Some schools have "designated" prelim spots, which means people who fill those have already secured residency positions for the PGY2 year (usually ENT, Urology, sometimes anes). If you are nondesignated, you must reapply as you have no guaranteed spot after you finish your prelim year(s).
 
It all depends on what you applied for/scrambled into.

If you are doing an orthopedics/ENT/urology residency, you will do one or two prelim gen surg years as part of your program and will not apply separately for the years following your prelim year. They are considered the first part of your training and are integrated into your program.

If you applied for categorical gen surg but ended up scrambling into prelim gen surg, you will have to apply again the following year for something. You will have done a non-designated prelim residency, which ends with your first or second year.

Programs tend to have both designated prelim years (for their residents continuing on into something else) and non-designated prelim years (for people who aren't sure they want to commit to the five+ years or who didn't match into the categ programs). People might also apply for the non-designated prelim positions if they are applying to another program that requires a separate internship that is not attached to that program, like ophtho, anesthesia, radiology, etc. These people will have applied separately to each program during their initial application process, but assuming they match for both their prelim year and their primary program, do not have to apply again in following years.
 
Any input on what you get to do if you're a preliminary-nondesignated? Say you're pretty sure you want to go into family or internal, but would like to have some cool surgical experience before you commit your life to mental gymnastics.

Is the additional year going to give you some good experience with surgery, or will it be a year of 6am retractor-holding jobs?
 
That said, the catagorical interns do their fair share of retractor holding and camera driving (UGH).

If you are truly undecided, a prlim year will at least expose you to the surgical mindset, the surgical patient population and lifestyle. So if you are really undecided, it might be a way to help you decide. If you are considering it for actual hands on surgical experience, forget it. Even the categorial interns don't do a lot of that. I've been able to log about 40 cases so far, and they are so varied that I haven't done that many of any one thing.
 
Daaang - that's about as unattractive a situation as I can imagine.

I want to work in rural areas and overseas, so I'd like to be as well-rounded as possible. Out on some desert in Ghana, I'd like to be able to do an appy to save someone's life if I needed to.

Doesn't sound like this is the way to go, though. No wonder so many of these spots go unfilled each year. Yuck!
 
I'm currently a third-year med student, finishing up my last two rotations (psych and peds). I'm planning to apply to General Surgery residency programs this fall, and would really appreciate any help or advice in planning my first few rotations.

Basically, I have July, August, October and November free for rotations/electives. (I'm planning on leaving December and January free for applications/interviews). I'm also planning on taking Step 2 CK early on, and Step 2 CS in late August. I'm hoping to do an away rotation in Boston (possibly MGH or BWH) and at UCLA or USC.

Should I do General Surgery sub-internships at both hospitals? Should I also do a subinternship here in Hawaii, early on? (If so, in surgery? internal medicine? surgical ICU?)

I know that a subinternship is more intense than a simple "elective," and my goal is to show the attendings/residents that I'm a hard-worker, as well as to obtain a strong letter of recommendation.

Thanks in advance!
 
I'm with Blade. I have similar questions. Help would be greatly appreciated.
 
Your application should be done before Novemeber first. That's when your school will release your transcript and your dean's letter. Programs can download your materials before that so you may even want to have it done earlier. ERAS is straight forward if you personal statement is done. Essentially you are just entering you CV information into the computer. You should try to keep some time in Novemenber free for interviews too. This all depends on how competitive you are as an applicant and where you are applying. You can only interview at two - three programs per week, so plan accordingly.

Get those away rotations in before November 1st if you can, it may have an impact on whether they will interview you.

Good luck

Ed
 
Originally posted by edmadison
Get those away rotations in before November 1st if you can, it may have an impact on whether they will interview you.

Good luck

Ed
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For the away rotations, better to do a Sub-I or elective?
 
My two cents ...

I think away electives are a bad idea. It is difficult to shine so strongly that your chances of matching go up significantly. You will only interact with a small number of people - very few of whom will have direct input into the match list. Conversely, it is very easy to look bad. Even one intern telling a faculty member that you shouldn't be ranked could really hurt your chances. And there are so many ways to mess up - especially since you will not know the layout of the hospital, computer system, local politics, etc. Save yourself the time, money and effort.
 
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Originally posted by Pilot Doc
My two cents ...

I think away electives are a bad idea. It is difficult to shine so strongly that your chances of matching go up significantly. You will only interact with a small number of people - very few of whom will have direct input into the match list. Conversely, it is very easy to look bad. Even one intern telling a faculty member that you shouldn't be ranked could really hurt your chances. And there are so many ways to mess up - especially since you will not know the layout of the hospital, computer system, local politics, etc. Save yourself the time, money and effort.
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Anyone else share this thought?

We are actually encouraged to do "aways" especially since we have a small program. I HAVE heard not to go to your first choice place in case you botch the experience. However, I think I'm going to work with the theory of doing atleast two aways -- one at a fabulous place that might be out of my leauge in terms of matching in order to get the LOR, and another rotation someplace a bit more realistic on my list. I have the time to do a third away, but I'm not sure it's worth the money.
 
I disagree entirely, I believe that away rotations are a good thing - if you can shine.. Study, teach the third years, be enthusiastic and positive.. I did a few of them and I KNOW they helped me! Front load your year with surgery to learn and experience different programs. Your friends will have cushier schedules in the 2nd semester but you'll be better prepared - even though you're working the MICU while they're sitting at home.. Take Step 2 early - if you are going to do well..

Goodluck,

Sachin
 
Do your aways after you've done a Sub-I at your home school. Your home school will be much more forgiving about an M4 learning the ropes. You want to hit the aways hard.
 
Originally posted by maxheadroom
Do your aways after you've done a Sub-I at your home school. Your home school will be much more forgiving about an M4 learning the ropes. You want to hit the aways hard.
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Yup, planning on doing either a General Surgery or Surgical ICU sub-internship first.
 
Write your personal statement NOW. The ERAS application was a breeze because I used an edited version of an essay I wrote during second year. Then, post your application as early as possible. You WILL get interviews in November, so be prepared!
 
Originally posted by almostmd2
Write your personal statement NOW. The ERAS application was a breeze because I used an edited version of an essay I wrote during second year. Then, post your application as early as possible. You WILL get interviews in November, so be prepared!
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I should apply to the various programs as soon as they allow apps? I know different programs have different "first day to accept applications" days.
 
the ERAS post office opens on the first couple of days in september but you can start working on your application about 1 month before that. You should have it ready and submitt your application on the first day the post office opens up. That way when the programs go to download their first batch of applications you will be in that set. Earlier is always better because as the application period goes on, not only will they be getting more applications but also they will be running out of interview spots so they will be tougher and tougher to get.

That was my experience anyway.

Good luck!
 
Originally posted by aboo-ali-sina
the ERAS post office opens on the first couple of days in september but you can start working on your application about 1 month before that. You should have it ready and submitt your application on the first day the post office opens up. That way when the programs go to download their first batch of applications you will be in that set. Earlier is always better because as the application period goes on, not only will they be getting more applications but also they will be running out of interview spots so they will be tougher and tougher to get.

That was my experience anyway.

Good luck!
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Iserson recommends scheduling interviews late (end of January or in February), that way you'll be memorable, as well as the fact that they have tougher grading schemes early on (the rationale being, the interviewers want to leave some leeway for potentially better applicants later on).

Any truth to this?
 
Originally posted by Blade28
Iserson recommends scheduling interviews late (end of January or in February), that way you'll be memorable, as well as the fact that they have tougher grading schemes early on (the rationale being, the interviewers want to leave some leeway for potentially better applicants later on).

Any truth to this?
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I don't know about this. I think that someone who is on the other end of the decision making table (like a chief resident) would be better suited to answering this question (I hope one of them reads this thread).

But regarding actually getting the interviews, I know that the sooner you apply the better your chances at getting an interview.

I've heard both things about the interviews. Some books say do it early some say late. I suspect that it is institution dependant. Some places will generate a rank list and score for each interview date and then meet one last time when all is said and done (and just before the rank lists are due) to merge the lists into one. Others will save it all to the end.

Some community programs that interview >200 applicants have many interview dates and it can become very hard to remember applicants.

While I know that Duke and Hopkins only interviewed ~55 making it easier to remember everyone.

Any way I hope this helps
 
Originally posted by maxheadroom
Do your aways after you've done a Sub-I at your home school. Your home school will be much more forgiving about an M4 learning the ropes. You want to hit the aways hard.
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I agree... learn as much as you can at your home institution Sub-I. I think it is an excellent plan to do one sub-I at a dream-hospital, and one at a within-your-reach hospital. If you do a less than stellar job, then you are out. But, if your credentials are on the weak side, then getting to know and impressing the program can make you a shoe-in. Get to know the chairman and program director as much as you can (get in the OR with them as much as possible and cover as many of their patients as possible to maximize your chances to get friendly with them and impress them with your knowledge and hard work). It is absolutely critical that they find you to be 1) extremely friendly and good to work with 2) extremely knowledgable and 3) an animal (i.e. working your A$$ off!!). Take extra calls. It will be a few months of torture, but if you do it right, it could get you into a program that you would otherwise not have been considered. I have seen very mediocre students do this, resulting them getting into super-competitive programs that wouldn't have looked at them based on their grades/recs/scores.
 
Originally posted by Blade28
Iserson recommends scheduling interviews late (end of January or in February), that way you'll be memorable, as well as the fact that they have tougher grading schemes early on (the rationale being, the interviewers want to leave some leeway for potentially better applicants later on).

Any truth to this?
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This is very controversial... and I don't know the answer... but one thing that I know for sure, is that a good number of programs keep a running list of applicants that they plan to rank. Thus, it is somewhat easier to get on this list if you are among the first to be interviewed. Additionally, once the list is full, it is easier for them to NOT add a person to the list than to drop a person already on the list. I heard this from a chief resident who was involved in the process (not surgical).

But, I have also heard that some programs assign a numerical score to each applicant, then at rank time they all sit down and make a preliminary rank list based on the score, then move people around on the list based on each interviewer's opinions. Therefore in this case it is to your advantage to be remembered better by whoever interviewed you.

Yet another issue is that your first interviews will invariably be the most awkward, since you will have the least amount of experience with interviewing with surgeons. After about 5 interviews you become a pro. However, nearer to the end, I remember being so freakin sick of interviews, and I couldn't pull off faking enthusiasm, etc.

Therefore, back when I interviewed, I put a few "safety programs" at the very front, and scheduled everything else somewhat randomly, but tried to put my top choices somewhere in the middle. Like someone else mentioned, if you could get some insider info from a resident, you could be much more strategic about things.
 
Thanks for the tips, all...they're very much appreciated! I definitely plan on applying early, though I have an away elective scheduled for the month of October...and I should have sent in my ERAS by then?
 
I agree with the advice on doing your "home" senior sub-I prior to an away elective to really buff up. I think just as valuable for you is the chance to see what some of these programs are like up close & personal. You might be surprised with how much you really don't like a place. I had one of my better students who was dead set on rotating @ a North Carolina program despite my advice (and 2 people who'd done fellowships there) that it has just a so-so reputation academically & was pretty mediocre training. He went & did a sub-I, hated the culture of the program, and didn't rank it for the match. I know I didn't rank UAB high after my sub-I there in 1997, but they've changed enough now that I always recommend it to my students. One of my classmates in school didn't rank or interview @ either of the two high-power programs he did sub-I's at.

In comparison to some of the other specialties (ortho, ENT, & especially Plastics) I don't think it's quite as important to do away rotations. A school with a good name, an outstanding CV, effusive letters by a big name(s), & USMLE I scores really can carry the day if other programs do their list like we did ours. An outstanding away rotation CAN make a huge difference if you on the fringe. I know of a couple people who came here the last few years & did great jobs & were well liked, one an IMG & one a German FMG who were both ranked.
 
I disagree with Ollie about the need for sub-Is in the specialties. It's generally accepted that in order to increase your chances exponentially of matching at program A, you should rotate there. I speak mostly for PRS, but my friends who are in the other specialties seem to have similar opinions. Most PRS (integrated/combined) programs take 1-2 candidates per year. Given this, programs tend to rank people whom they know much more highly than strangers. After sitting through my program's rank meeting this spring, I can tell you that it's very important to rotate at a program if you're serious about wanting to do your residency there.
 
Just for another perspective to confuse everyone even more: I did not do a single away elective my fourth year, and to speak for the guy at my school who matched into plastics, neither did he. Both of us matched into our number one programs, the univ of washington for me. I also come from a middle tier medical school whose reputation I'm sure did not bolster my application. So for what it's worth, it's definately not essential that you do away electives, but if you are REALLY interested in a particular program then it makes a lot of sense, as it does if you are clueless about what you want in a program.
 
Originally posted by maxheadroom
I disagree with Ollie about the need for sub-Is in the specialties.
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Max,

I think you misunderstood me.... i said UNLIKE the sub-specialty surgery fields, for gen surgery away rotations are much less important & expected. If for no other reason then there are a good deal more positions available per program.
 
Well, I'm shooting for a General Surgery categorical position...only a decent-name med school, decent grades, above-average Step 1, several publications/presentations. I hope that doing the away elective will allow me to check out the program, as well as obtain a good letter of rec (and gain some experience!).
 
Blade, I'm about in the same boat (decent school, great clinical grades, okay Step 1 and preclinical scores, no publications). I've planned an advanced surgery sub-I at my home school this May and hopefully two aways in July and August (maybe October as well). I know I certainly need to see surgery someplace else before I sign my life away. I'm not jumping up and down at spending the money or extending M4 any more than I have to, but I think aways are for the best in my case. Good luck to us and everyone else stepping up to be the Match's next victims.
 
Originally posted by keraven
Blade, I'm about in the same boat (decent school, great clinical grades, okay Step 1 and preclinical scores, no publications). I've planned an advanced surgery sub-I at my home school this May and hopefully two aways in July and August (maybe October as well). I know I certainly need to see surgery someplace else before I sign my life away. I'm not jumping up and down at spending the money or extending M4 any more than I have to, but I think aways are for the best in my case. Good luck to us and everyone else stepping up to be the Match's next victims.
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Good to hear! I'll be in a similar situation...sub-i at my home program in July, away rotations in August and October, surgical ICU sub-i in November.
 
Just to reiterate what has already benn said for 3rd years wanting to apply to Gen Surg:

You can submit your ERAS application as early as the first week of september. The site will be open by the end of July so you can work on your application during August and have it ready to submit by Sept.

Start NOW by constructing your CV. When you fill out your ERAS application, it'll be simple cut and paste.

If you have time, consider a rough draft of your personal statement which you can slowly edit over the course of the next few months.

Do intense sub-I's at your own institution first, early in summer. Get some letters of recommendation after each rotation so they will be in your file and you don't have to hunt around for some 4 months later.

September/October are good months to do away rotations if you want to do one. I personally didn't do any surgical away rotations but instead did some other away rotations to get a feel for a place and a city without being pressured about performing well within a surgical rotation. However, if you have your heart set on a given place, I would recommend doing a month there. And if you don't know a city but are intereted in the program, another reason to do a month there.

You can interview in Dec or January. I think its sort of even which month you choose. I did December and studied for Step 2 at the same time. There are probably more available dates in January cause there is only New Year's Day as a holiday.

Consider doing an away month in November at a city you are interested in and may get an interview but not a rotation in surgery - something easier. You can check out the city adn be around if you get invited for an intervivew. You could probably also try to round with a surgical team while you are there too.

I matched in categorical surgery position at a university program that is reasonably competitive and am happy I did cause I didn't realize how competitive the year was going to be. I don't consider myself a superior applicant:

average basic science grades
mostly average clinical year grades with a couple honors (but not in surgery)
fourth year almost all honors in courses (that were seen by admission committees, this included several surgery sub-I's, med sub-I's)
AVERAGE Step 1 scores (above 200)
probably great letters of rec (I couldn't see them but I think they were awesome)
I had prior research experience
Non-AOA
 
Lura, Thanks for the complete and fabulous advice!
 
Originally posted by lura
Start NOW by constructing your CV. When you fill out your ERAS application, it'll be simple cut and paste.

Do intense sub-I's at your own institution first, early in summer. Get some letters of recommendation after each rotation so they will be in your file and you don't have to hunt around for some 4 months later.

September/October are good months to do away rotations if you want to do one.
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That really is great advice...thanks for taking the time!

I'm planning a similar schedule...my July rotation will be a G-Surg Sub-I here in Honolulu, followed by an away rotation at UCLA in August and one in Boston in October. I love the programs in both cities, and want to do well and get good letters before application time.

I just asked my surgery rotation advisor for a letter, and will do the same with my surgery research mentor. I may end up not even using either of them, but I figure it can't hurt to start. Of course I plan to ask the attendings from wherever I do my Sub-Is.

The last draft of my CV was completed in October last year, so I'll be updating it soon. I first started working on it after first year, and have been modifying it from time to time.

Congrats on getting what sounds like a great categorical position...my resume sounds very similar to yours (minus the fourth year grades, which I hope will be similar! :) ).
 
I have heard through some prelim friends that they are being treated far worse than categorical residents with regard to vacation, operative experience, scut, the works.. . . any thoughts and or experiences?
 
This will be totally program and resident dependent. At our program, the preliminary residents are treated exactly the same as the categorical residents. This is in the OR and out. If you do a good job, you should be treated the same. Most of our prelim residents can finish a lap chole under 45 minutes by the end of their year.
 
any thoughts to this practice specifically in the well-regarded Boston programs?
 
Prelims and categoricals seem to be treated the same in Hawaii programs as well.
 
MOST gen surg programs treat prelims like shi#..its a well known fact...the prelims are scutted like hell moreso than any categorical intern
 
My friend who is finishing a prelim year will have done 7 months out of 12 in cardiothoracic. He wishes they would have given him more opportunity to learn in gen surgery rotations. So I would say, no, they aren't treated the same.
 
The funny thing about the 4th year grades is that the programs are only going to see the grades from the first 2 or 3 rotations that you do during your 4th year. Make those early rotations count. After you hit block 4, your grades during 4th year don't really matter. I have heard some people send updated transcripts but I don't know how many. I'm not sure if this really helps. Taking Step 2 early and doing well can help you if you didn't rock step 1.
 
in most programs i've been to, prelims are treated worse than categoricals (especially designated prelims who are definately not going into general surgery). They will get placed on the rotations that categoricals don't like being on. They are less likely to operate.

The justification (I think) is that these residents are not going to be general surgeons and so the good rotations should be saved for the people who will be general surgeons.

In regards to vacation time, in most programs , that all depends on the administrative chief resident. So if the Admin Chief does not like prelims, they will probably get the short end of the stick when it gets to vacation time
 
prelims are treated like garbage at most programs ive seen...yes theres always the few instances all is nice and dandy
but that is not the norm

prelims get all the garbage rotations with the heaviest call schedules and are many times the ones who are put on call on holidays.

so if any1 is considering a prelim yr choose wisely!
 
not everywhere. There are some programs where the subspecialty residents doing prelims are treated rather well. These places tend to have strong departments who exert influence in teh GS dept. (Uro/Ent/Ortho/Nsurg) and won't allow their residents to be treated like dirt during their internship.

Now I have no knowledge of people who are only one year prelims - sound like disposable manpower to me.
 
My medical school has an abreviated basic science component which means my "third" year started midway through my 2nd year. This meant my "fourth" year started in March of my 3rd year. All this translated into more courses my fourth year (about 4 more clinical rotations as a "4th yr student") which residency programs did get to see the grades from. So for me this was great and most other students think its awesome cause they would have a few more months to figure out what they wanted to do if they were unsure.
 
Originally posted by Masonator
The funny thing about the 4th year grades is that the programs are only going to see the grades from the first 2 or 3 rotations that you do during your 4th year. Make those early rotations count. After you hit block 4, your grades during 4th year don't really matter. I have heard some people send updated transcripts but I don't know how many. I'm not sure if this really helps. Taking Step 2 early and doing well can help you if you didn't rock step 1.
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Hmmm...yeah, I see that. Well, I'll be at Harvard in October, so hopefully I'll get a recommendation by the end of the month.

I also plan to take Step 2 early (early July) to make up for a Step 1 score that's not ridiculously high (250+). :)
 
Hopefully the step 2 helps, but you don't need 250+ to get into gen surg. The boards are used as screening for interviews. Usually they want a 90 or higher on the two digit score. This only gets you the interview, then they look at your grades, letters, etc.
I know someone with a 254 Step 1 who didn't match. I also know another classmate with average boards who didn't get an inteview at the program she wanted(Georgetown). She had the chairman at our school make a phone call to get an interview and she ended up matching there!
 
Our prelims have exactly the same rotations (save for those required by their respective departments for the Designated Prelims) as the Gen Surg Categoricals. No thought is given to ones Prelim vs Categorical status when making the call schedule; its pretty evenly divided.
 
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