its a big decision where you spend that pgy-1 year
you go all categorical you get no choice in the year that comes with it, could be humane, could be a nightmare, the bigger decision here is the anesthesia years.
i interviewed at some big academic programs that offer the first year, but everyone applies to the advanced program anyways, since the included year is harder than the neighboring community/transitional options.
what im trying to say is, take any categorical program, you can almost always find a better prelim year in the same city than the first year in included in that program. meaning your overall four years is better. this is just for a half day of your time. interview smart but i would think this would limit you. trust me no one wants to move twice, put in the work and pick a few locations and do both prelim and anesth interviews, you will likely end up all in the same place but at neighboring institutions.
I agree that your overall biggest decision is where you do Anesthesia.
I'll also agree that you can sometimes find better (intern year) programs in a given area, but not always. I would say that, however, you can't "almost always find a better prelim year". Easier? Probably, but not necessarily better. And I definitely don't think the intern years in Categoricals are the worst thing you'll find. For example, you would certainly work much harder (and likely not get that great of an education) by doing a Prelim Surgery year. I think most people would recommend doing a CBY (that's the term for your first year in a Categorical program...sorry if you already knew that, just wanted to be clear) over a Surgery Prelim year.
Many (but not all) CB years are designed specifically with Anesthesia in mind, therefore you get ICU, internal medicine, surgery, plus some Emergency, possibly some Pain, and usually a month of Anesthesia. I'd say in general they will be "harder" years than your run-of-the-mill Transitional Year, however they will also likely be more relevant (relatively speaking) to Anesthesia than a TY, or even a straight-up prelim Medicine year.
Also, don't discount the advantages of 1) moving once; 2) meeting and befriending other residents in other programs (whom you will continue to work with to some degree throughout your training); 3) learning the hospital/procedures/quirks/etc before you start your Anesthesia training. While none of these factors are make-or-break alone, combined they can add/detract to your overall quality of life.
I guess the take-home here is to really look in to what you're getting yourself in to either way: the disparities between the various prelim years and the various CB years can be huge so you really have to read the fine print before making your rank list. I wouldn't say Prelim years are inherently better than CB years, or vice versa.
