Gen Surg "Pyramid programs/prelim spots"

[Dr.SPAC3MAN]

Current 3rd year here trying to put together a program list. I have heard that pyramid programs are a thing of the past, but why do I see many programs with *more PGY1-2s than PGY 3-5s?
Does it have to do with prelim spots?
Can someone explain how I can reliably check a program and stay away from getting myself into a prelim situation? TIA

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[lumya]

I'd guess probably either prelims for people going into subspecialties like ENT/ortho as well as the fact that gen surg still has a pretty bad attrition rate. Prelims and categorical are separated out so you'll know when you get an interview/match which one you're going into.

 

[mrbreakfast]

It's likely mostly due to prelim spots. You'll likely see that IM programs at the same hospital also have more PGY1s compared to upper years. It's more dramatic for surgery because a greater percentage of specialties require a surgical vs medicine prelim year. Also, attrition rates for surgery are higher.

Unclear what you mean by "prelim situation" but (unless you make a major clerical error on your application) you have a zero percent chance of accidentally ending up in a prelim spot.

 

[DOVinciRobot]

Current 3rd year here trying to put together a program list. I have heard that pyramid programs are a thing of the past, but why do I see many programs with *more PGY1-2s than PGY 3-5s?
Does it have to do with prelim spots?
Can someone explain how I can reliably check a program and stay away from getting myself into a prelim situation? TIA

It’s the prelim spots.

If you don’t apply to prelims there is zero chance you end up in a “prelim situation”, unless you don’t match and SOAP into a prelim spot.

Pyramidal programs don’t exist anymore

 

[pazzer2]

I matched into a general surgery categorical spot many years ago. The program touted itself as non-pyramidal. But they had more PGY1+2 vs later years as you describe above. But this can also be explained by natural attrition, prelims and research years. So the number of PGYs for each year is never the same.

Just ask each program director if they have a pyramid. They will be honest.