Prelim Med vs. Transitional?

RxBoy · Sep 4, 2008

Kind of in a dilemma here. So it sucks for us because half the programs are categorical and the other half advanced... With a lot in between.

Prelim surgery: I hear avoid like the plague.

Prelim Medicine: Harder, more call months, less exposure to OR but easy to match.

Transitional: Easier, less call months, some offer electives in anesthesia but hard to match (in fact harder than anesthesia itself).

I prefer TY so I applied to 10 TY around me. 1/2 my anesth programs that I applied to are categorical (so no need for Prelim). I'm under the mean step 1... Should I apply to 10 prelim med years too or just scramble into prelim med if I don't match transitional and match at an advanced program? Its going to put a huge demand on my interview trail if I add another 10 prelim med places.

Lastly, anyone know of any "cush" prelim med spots?

RxBoy · Sep 4, 2008

I found something really weird with the TY match (for US MD).

Between 201-210 = 56% Match
Between 211-220 = 84% Match
Between 221-230 = 73% Match
Between 231-240 = 70% Match

What gives? An extra variable? Maybe the higher your scrores the more likely you match at a categorical spot? Anyone have any clue?

lord_jeebus · Sep 4, 2008

There is huge variation between prelim med programs. I was lucky enough to get one with 4 ICU months (which I like), no call for the remaining months, and lots of electives.

I would suggest shopping around and applying to the more desirable prelim med programs that meet your geographic needs - they won't be available in the scramble if it comes to that.

gaspasser2004 · Sep 4, 2008

My personal opinion is that prelim medicine is the way to go. Transitional interns are basically fourth year medical students who can write orders. You get lots of different rotations in various specialties, but this leads to superficial experiences. The deeper knowledge and decision making skills gained from an internal medicine internship are more beneficial in the long run. I think the point of internship is to make the transition from student to doctor. You can only do that when you are given true responsibility for your patients. Preliminary internal medicine interns are treated basically the same as categorical interns in terms of trust and responsibility - the main difference is usually prelim interns don't have to bother with continuity clinic. My preliminary medicine year was 9 months of floor (including 1 ICU, 2 telemetry, 2 oncology) and 3 months of elective (pulm, cards, ambulatory). The call was q4 or q5 on my floor months and no call during my elective months. I think being on call, taking care of patients at all hours made me a better doctor when I entered my anesthesia training. Also, I think an anesthesia elective during your internship is a waste of time. By doing an elective in anesthesia, you are giving up valuable time that you could be spending learning from a cardiologist or pulmonologist. No one expects anything out of you the first few months of CA-1 year except for a good attitude and work ethic. I know different people feel differently about this subject and I encourage further discussion.

core0 · Sep 4, 2008

RxBoy said:
I found something really weird with the TY match (for US MD).

Between 201-210 = 56% Match
Between 211-220 = 84% Match
Between 221-230 = 73% Match
Between 231-240 = 70% Match

What gives? An extra variable? Maybe the higher your scrores the more likely you match at a categorical spot? Anyone have any clue?

Is it possible that those with higher scores applied to other specialties and used anesthesia as a back up then chose the other specialty?

rsgillmd · Sep 5, 2008

Short answer: Go with medicine prelim. I view my patients as medical patients with surgical solutions.

"Continuity" clinic will vary from program to program. I had to go when I was at Jersey City Medical Center (NJ). I know prelims at Newark Beth Israel Medical Center (NJ) also had to go. Basically you're cheap labor for a production line clinic. Places where prelims are exempt are probably true continuity clinics. It was very rare for me to see the same patient more than once. Put up with it for year and then move on.

My year at JCMC was rough. I was carrying 16-18 patients on average, with one senior resident. There was only one senior residents who helped me write notes. Half of my day was spent writing notes. (I've heard they've improved since I left -- they have a real non-teaching service, and have implemented a real cap for interns). However, the variety of cases I saw there was amazing. I definitely learned a lot during my intern year -- more than when I did my medicine and peds sub-I's.

I was burnt out at the end of my 1st year. My last month was elective. I took the advice of a friend and commuted to Maimonides that month (although they still made me go back for my weekly continuity clinic). I was able to get used to the system and ease into being a CA-1.

seinfeld · Sep 6, 2008

i did a medicine internship and dont regret it. Building confidence in decision making is about getting experience in making decision. I feel many are looking for the easy way out, and not thinking about what will make them the best doctor. BTW most surgery internships will rarely get you into the OR and i have no idea how being in the OR and doing SQ stitches makes you a better anesthesiologist anyway.

jumpingjax · Sep 6, 2008

Transitional all the way!

Most people who say do medicine or surgery couldn't land a TY spot.

I went to a notoriously "laid back" TY program and do not regret it all.

This is how it breaks down...

Surgery - You will drain ***** abcesses and pull drains all year on the floor, working a minimum of 80 hrs/week. You will NEVER set foot inside an OR. The only positive is that you will get used to being yelled at by surgery residents/attendings who will be yelling at you across the drape the following year in the OR.

Medicine - Slightly better than a surgery year, but still lame. Hours are slightly better - 65ish hrs/wk. Lots of social issues to deal with, tons of paperwork, and lots of phone calls checking and following up stuff. Did you go to med school to be a secretary? You will see some interesting pathology here and there and learn to manage basic medicine, but do you really need 12 months to do that?

TY - Here was my experience. Lets see, 6 months electives, 3 months gen med, some ER and OB, and a lil ICU. The core stuff is the same you get anywhere - learn the basics of med/ER/unit. Then 6 months of "working" a MAXIMUM of 40 hrs/week with q 21 or so call. Did an anesthesia elective as well, took STEP 3, and read all of baby miller and Morgan and Mikhail during my elective months. BTW, went out ALOT, took a bunch of ski trips, and got back into shape. Hmmm, tough call.

You're right, the TY match was MUCH tougher than the anesthesia match, and reread above if you're still wondering why.

BTW, not all TY programs are created equally. They range from super cush to "prelim med/surg" programs in disguise. Do your homework.

Food for thought - ask ANYONE who did a laid back TY year if they regretted it. Yeah, thats what I thought.

Good luck!!

Fastrach · Sep 6, 2008

jumpingjax said:
Transitional all the way!

Most people who say do medicine or surgery couldn't land a TY spot.

I went to a notoriously "laid back" TY program and do not regret it all.

This is how it breaks down...

Surgery - You will drain ***** abcesses and pull drains all year on the floor, working a minimum of 80 hrs/week. You will NEVER set foot inside an OR. The only positive is that you will get used to being yelled at by surgery residents/attendings who will be yelling at you across the drape the following year in the OR.

Medicine - Slightly better than a surgery year, but still lame. Hours are slightly better - 65ish hrs/wk. Lots of social issues to deal with, tons of paperwork, and lots of phone calls checking and following up stuff. Did you go to med school to be a secretary? You will see some interesting pathology here and there and learn to manage basic medicine, but do you really need 12 months to do that?

TY - Here was my experience. Lets see, 6 months electives, 3 months gen med, some ER and OB, and a lil ICU. The core stuff is the same you get anywhere - learn the basics of med/ER/unit. Then 6 months of "working" a MAXIMUM of 40 hrs/week with q 21 or so call. Did an anesthesia elective as well, took STEP 3, and read all of baby miller and Morgan and Mikhail during my elective months. BTW, went out ALOT, took a bunch of ski trips, and got back into shape. Hmmm, tough call.

You're right, the TY match was MUCH tougher than the anesthesia match, and reread above if you're still wondering why.

BTW, not all TY programs are created equally. They range from super cush to "prelim med/surg" programs in disguise. Do your homework.

Food for thought - ask ANYONE who did a laid back TY year if they regretted it. Yeah, thats what I thought.

Good luck!!

Agreed, TY is da bomb... the thought of doing prelim med or surg makes me want to get angry and violent... :diebanana:

gaspasser2004 · Sep 6, 2008

jumpingjax said:
Transitional all the way!

Most people who say do medicine or surgery couldn't land a TY spot.

I went to a notoriously "laid back" TY program and do not regret it all.

This is how it breaks down...

Surgery - You will drain ***** abcesses and pull drains all year on the floor, working a minimum of 80 hrs/week. You will NEVER set foot inside an OR. The only positive is that you will get used to being yelled at by surgery residents/attendings who will be yelling at you across the drape the following year in the OR.

Medicine - Slightly better than a surgery year, but still lame. Hours are slightly better - 65ish hrs/wk. Lots of social issues to deal with, tons of paperwork, and lots of phone calls checking and following up stuff. Did you go to med school to be a secretary? You will see some interesting pathology here and there and learn to manage basic medicine, but do you really need 12 months to do that?

TY - Here was my experience. Lets see, 6 months electives, 3 months gen med, some ER and OB, and a lil ICU. The core stuff is the same you get anywhere - learn the basics of med/ER/unit. Then 6 months of "working" a MAXIMUM of 40 hrs/week with q 21 or so call. Did an anesthesia elective as well, took STEP 3, and read all of baby miller and Morgan and Mikhail during my elective months. BTW, went out ALOT, took a bunch of ski trips, and got back into shape. Hmmm, tough call.

You're right, the TY match was MUCH tougher than the anesthesia match, and reread above if you're still wondering why.

BTW, not all TY programs are created equally. They range from super cush to "prelim med/surg" programs in disguise. Do your homework.

Food for thought - ask ANYONE who did a laid back TY year if they regretted it. Yeah, thats what I thought.

Good luck!!

I'm sure that there are some people out there who couldn't land a transitional year spot and talk up prelim medicine or surgery to make themselves feel better. I can't speak for the other posters on this thread, but that certainly wasn't the case for me.

I understand that it is probably more "cool" to talk about how little one had to work during internship and how much one got to go out to bars, work out, etc. than actually take care of patients. Whether it be school, residency or even a hobby, you get out of it what you put into it. If you aren't putting much into your internship, don't expect to get much out of it either.

The same argument can be made for anesthesia residencies as well. There are some programs out there where you hardly have to work at all. You can go to these programs and just like the above poster said about internship, learn the same "core stuff". You can graduate from these programs having done the least amount of work with the minimal amount of case numbers taking care of the least complex patients available. If you were able to work 40 hours a week or less, go out all the time and get a ripped body, would it be worth it?

NotAMD · Sep 6, 2008

first, take a good look at the TYs, some of them are worse than cush medicine years (community hospitals in upscale suburbs), with 3 months surgery, 3 months medicine, 2 months icu.. no thanks...it is easy to become accredited as a TY compared to meeting the reqs of a med program, so you get all sorts of oddball places, prisons, geriatric places, non-english populations, etc..

but generally they are easier with more elective. but they are few and far between, there may only be two or three in each major city, and only like 5 spots each so unless you are top 15 in ny,la,etc it can be tough.. most of the people who land them with reasonable stats land them in less desireable (home) locations.

i mean is it worth moving twice or driving far to do a slightly easier year? if it was just me yeah but not going to move a family/spouse based on it vs a comparable medicine year. so take all this into consideration, also, does it meet the requirements of your advanced program? does it have x months of whatever? or will you have to make up a month of icu in the future cuz you are lounging now?

if you can make the location work and it is an easier year than the medicine alternatives and it meets your needs then go for it. this can be tough to find though in many areas.

lord_jeebus · Sep 6, 2008

Oh yeah, when looking at TYs, make sure you find out if they have required OB/Gyn months...

I'd rather do 10 months of surgery scut with q3 call than a month of that

climbingdocs · Sep 6, 2008

I

OB

desflurane · Sep 9, 2008

The larger picture is this...it doesn't matter. But med students are inherently neurotic so here goes...

I did a transitional year. I had two or three tough months and the rest was a joke.

As an attending now with a few years under my belt, the big picture is...it doesn't matter.

What you get out of the year is what you put into it...just like most of life.

That being said if I could do it over I would have done a Prelim medicine year at a brand name program. Ivy looks good on CVs even if it's only a year. I might have learned more too instead of being a 5th year med student...and make no mistake, for better or worse that as what Tranny's are.

RxBoy · Sep 9, 2008

I am all about hard work.... as long as its EFFICIENT. The reason I prefer "cush" over strenious is simple... I learn as much as I push myself to learn... And I know I can push myself pretty hard.

I did my surgery rotation at a VA hospital and all I did was work. I worded like a dog... doing various scut work for some resident who cared less if I existed, and an attending who didn't even acknowledge my existence. Got minimal experience, maximal scut. In the end, after destroying my mind and body, the attending and cheif resident gave me some half ass excuse for an evulation... they spent 10 seconds on it max..

Thats why I prefer cush... the opposite is just so devasting, devastating to the point you don't want to learn. Rotations that were cush, I spent countless hours on UpToDate or in a textbook reading thouroghly about each patient instead of filling out discharge papers, and asking nurses why the coag labs have not been drawn. You often learn less on "hard" rotations unless of course you're going to be a medical secretary. I just feel, its not worth it. Sure you might not get as much exposure, but the exposure you do get is worth its weight in gold.

mh82ai3 · Sep 10, 2008

Do prelim medicine if you want to be really good at social work, breaking up fights between family members, knowing all the $4 prescriptions at walmart, and knowing all the intricacies of SNF placement.

just kidding... sorta

Colba55o · Sep 10, 2008

RxBoy said:
Thats why I prefer cush... the opposite is just so devasting, devastating to the point you don't want to learn. Rotations that were cush, I spent countless hours on UpToDate or in a textbook reading thouroghly about each patient instead of filling out discharge papers, and asking nurses why the coag labs have not been drawn. You often learn less on "hard" rotations unless of course you're going to be a medical secretary. I just feel, its not worth it. Sure you might not get as much exposure, but the exposure you do get is worth its weight in gold.

Is spending countless hours on UptoDate or reading a textbook as educational as actually doing procedures, talking to patients, and discussing cases with your team? If there's one thing I hate on clinical rotations its being told to "go read". Of course we should consult the literature on patients, and read when we go home at night, but I don't want to spend my day reading too; after all I'm not going $200K+ into debt to learn what I could on my own.

I won't say I complained on my 1 or 2 cush rotations, but I learned much more on my "harder" ones by far. If for no other reason because I learn better by doing than reading.Fortunately our school has a strict policy re: scutting out students and I've never had to do much of it. In fact, Id rather do some scut than be sent to the library to read

That being said, I'm applying to both prelim medicine programs and TYs and will hopefully get to rank places where the interns seem like they are learning a lot and are not bitter.
.

lord_jeebus · Sep 10, 2008

Colba55o said:
Is spending countless hours on UptoDate or reading a textbook as educational as actually doing procedures, talking to patients, and discussing cases with your team?

It's more educational than spending 15 minutes arguing with a nurse who refuses to draw a Troponin, or calling the radiology tech 5 times to get a stat CXR, or filling out ten redundant pieces of paperwork on a patient developed by some nurse administrator, and then redoing them because the form isn't filled out exactly the way they want it. That's what seems to make my "hard" rotations "hard" - dealing with stupid policies and lazy people.

BLADEMDA · Sep 12, 2008

gaspasser2004 said:
My personal opinion is that prelim medicine is the way to go. Transitional interns are basically fourth year medical students who can write orders. You get lots of different rotations in various specialties, but this leads to superficial experiences. The deeper knowledge and decision making skills gained from an internal medicine internship are more beneficial in the long run. I think the point of internship is to make the transition from student to doctor. You can only do that when you are given true responsibility for your patients. Preliminary internal medicine interns are treated basically the same as categorical interns in terms of trust and responsibility - the main difference is usually prelim interns don't have to bother with continuity clinic. My preliminary medicine year was 9 months of floor (including 1 ICU, 2 telemetry, 2 oncology) and 3 months of elective (pulm, cards, ambulatory). The call was q4 or q5 on my floor months and no call during my elective months. I think being on call, taking care of patients at all hours made me a better doctor when I entered my anesthesia training. Also, I think an anesthesia elective during your internship is a waste of time. By doing an elective in anesthesia, you are giving up valuable time that you could be spending learning from a cardiologist or pulmonologist. No one expects anything out of you the first few months of CA-1 year except for a good attitude and work ethic. I know different people feel differently about this subject and I encourage further discussion.

I did a preliminary Medicine year in an upscale suburb. I took call every 5th night and spent 3 months in the ICU's. I learned a lot and it was one of the best years of my career. I felt very prepared for my CA-1 year at a top 10 Program. I was treated just like every other PGY-1 Medicine Resident. I averaged 50 hours a week. At the end of the that year I gave some serious thought to becoming a Cardiologist instead of an Anesthesiologist. The PD offered me a spot to stay on as a Medical Resident.

I only applied to three Preliminary programs and knew I would match because of my high exam scores. I did not choose TY programs because I thought they were a joke and my goal was to become a the best MD I could be; I though a good PGY-1 year would help me deal with the medical aspects of Anesthesia patients. I was right. I advocate for the BEST learning experience possible PGY-1 through PGY-4. Why not save the "cush" year for your fellowship?

Deac · Sep 13, 2008

Keep in mind that not all TY years are a joke and not all medicine prelim years will make you a better MD. Some TY years are a joke, some are medicine years in disguise, and some are in between. Some medicine years can be a good experience, some are horrible. I went to med school in a city where there was a gen surg residency at a private hospital that had a great internship. Look at the rotations offered at the particular programs.

I'm an intern and ended up in my particular TY program mostly based on location. I was couples matching and needed to be in the same place for all 4 years, so I ended up interviewing at a ton of prelim programs. My TY year has 4 months medicine, 2 months surgery, 2 months ICU, 1 month ED and 3 electives. Call is q3 in the ICU, q4 on surgery and night float on medicine. It's at a private hospital but surgery and medicine residents from the nearby University programs rotate here so there is a lot of resident education. It's not cush like some TYs but I don't have to play social worker and that allows me time during the day to usually make it to noon conference or morning report or whatever. The nurses are paid well and are competent, STAT orders get done reasonably fast, I don't get paged at 3am for diet orders and because of that I can usually sleep some on call.

Find a program, whether it's TY or medicine or surgery, that will allow you the opportunity to learn a bit during intern year. Private hospitals are a good place to start. Harder doesn't mean better and it doesn't mean you'll learn more, it just means harder. That being said, no matter where you end up it's just a year and in the grand scheme of things it's not that big of a deal.

Good luck, the prelim year thing is a headache.

kraphtymac · Sep 14, 2008

A "cush" year = a waste of time. I'm in a "harder" transitional and I love it. 3 months of surg in different specialties, including burns. Sure you work your ass off, but we are primary on a ton of cases. We actually log more cases than categorical surgery residents, no comparison. We also do ICU, and get tons of central lines, art lines, IVs, you name it. Sure, you can go cush, but why when you can come out of intern year knowing how to manage surgical, medical, and ICU patients?

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