Thanks again for the response. I did check into St. Joe's and saw they had alot of Prelimary surgery positions. What exactly is the difference between taking one of these positions versus directly matching into a specialty. Is this the same thing that you mentioned about the 15 intern positions or is this part of the 3 categorical positions. Im completely confused about the whole deal with internships, transitional years, categoricals and Preliminary years. Are some of these the same thing?
Most surgical programs have 4 types of positions:
1) Categorical - these are designed for people who are completing the entire training in the same specialty, presumably at the same program. Generally includes the Intern Year. This is the pathway for general surgery.
2) Advanced - these usually start PGY2 after an preliminary internship in general surgery; these advanced positions are for surgical subspecialties and lead to completion of the training and BE in such fields as ENT, Urology, etc.
3) Designated Preliminary - these are first year positions designed or "designated" for those going into an Advanced position, often at the same program. The match for the designated spot and the advanced spot usually occurs at the same time. It is not required to do your prelim year at the same program as your advanced, but it is desirable for many reasons (only move once, start making friends and contacts from day one, etc.). These positions are not open to those without an Advanced position usually.
4) Non-designated Preliminary - these are the positions most people think about when discussing preliminary surgery positions. These are 1 year positions for those who have not matched into a advanced or categorical position, or who choose to do a surgical prelim year when given the choice between medicine and surgery (ie, Anesthesiology is the most common). For those who do not match into either a Categorical general surgery or Advanced subspecialty position, they may take a non-designated prelim spot in hopes of getting experience and making contacts for the match in the following year. These are not popular positions as there is no guarantee or responsibility from/for the program to find you a position for the following year, but as general surgery becomes more competitive, there are less open positions in the scramble (but there are still several hundred).
Transitional years are an option for some specialties, but generally not for surgery, as they do not offer enough surgical training during the year to be accepted by most surgical programs. Therefore, those who do a TY after medical school generally have to repeat their intern year if going into a surgery training program.
Students often make the mistake of assuming a program has a pyramidal structure by seeing that there are 15 interns and only 3 PGY-2 residents. This is a function of having 12 prelim residents (both designated and non-designated). My residency program, for example, had only 4 categoricals per year, but 19 interns - most were designated for ortho, ent, urology, plastics, and neurosurg, but there were a few non-designateds.
