Getting kicked out of residency?

[time md]

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I posted this in the gen residency forum, but it may belong here. Thanks for your answers in advance.

I'm starting med school in august. A requirement of my scholarship is a summer program. For this summer program I have to choose a field that I'm interested in and then they assign me a preceptor in that field to shadow for three weeks. I'm fairly certain that I want to go into surgery, but I am very open because I need much more experience before deciding. I was looking at some residency programs that I may potentially wish to pursue some day via the AMA website. I noticed that many of the surgical residencies offered several more positions for the first (and sometimes second year) than they did for the remainder of the required years. Why is this? Do some people get kicked out? Do you just start over in another residency? I would sure hate to go through four years of med school, finally choose which field I want to pursue, get into a residency, complete one or two years only to have to start over with residency again.

 

[Smurfette]

There are more PGY1 and 2 spots due to preliminary positions. i.e. people who do not get a 5-year spot (called a categorical position). Categoricals are hired with the intent of staying and completing an entire residency in that program. Preliminary residents are hired with the intent of completing one year in that program.

There are designated prelims (in general surgery programs, these include ortho, ENT, GU, plastics and sometimes ophtho interns). Designated prelims have a categorical position in their specialty which requires them to do a year (or more, depending on the structure of their program) of general surgery training before doing the remainder of their training in their designated specialty. These individuals, when they match into their categorical positions, get the general surgery prelim year automatically.

There are also undesignated prelims. These are for individuals who either did not match into a categorical program OR who did not match into an intern year (such as a transitional year) and need to do 1 year of training prior to pursuing the remainder of their training in the program they did match into (i.e. anesthesia, ER, other 4 year programs that require a prelim year in something). Sometimes, a prelim intern can be hired to stay in the same program if a categorical resident vacates a spot...but it's not guaranteed. Prelim interns have no job security beyond that year.

Medicine and pediatrics also have preliminary years available...so people pursuing anesthesia, ER, PMR and others can also try and do a year in medicine before completing their training (in other words, this is not unique to surgery).

Hope this helps.