Good prelim years

[jackets5]

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What programs offer a good spot for prelims with a chance to move on to a categorical spot at the same place or somewhere else. I know U of Washington has a very good 2 year program with a good placement rate and has spots open every year. Any others besides UW, looking more for 2 year spots.

 

[Winged Scapula]

Mayo has a good track record of placing their Prelims into Categoricals (not necessarily at Mayo).

 

[mikeGR]

Hopkins has a very favorable tradition with prelims.

 

[BlondeDocteur]

I think the only other place that offers 'handshake' 2-yr prelims is UNC Chapel-Hill. It's not like UW, where there is a Match position with a separate program # and everything for 2 years, but they don't cull like most places between PGY-1 and PGY-2.

I'd say do NOT do anything in NYC. Maybe Columbia, since they only take 2-3 PGY-1 prelims [have no idea about their placement afterwards], but the others are houses of pain where the prelims are grossly overlooked and overworked.

 

[BlondeDocteur]

Hopkins has a very favorable tradition with prelims.

I've definitely heard that, too. Dr Freishlag is supposedly very active in placing her prelims.

 

[Dan Plainview]

Mayo has a good track record of placing their Prelims into Categoricals (not necessarily at Mayo).

Seconded. Historically one (sometimes two) prelim has been taken into the incoming categorical class. The PD is very active in placing all of our prelims, however.

 

[Poiu86]

I've definitely heard that, too. Dr Freishlag is supposedly very active in placing her prelims.

Lipsett, their PD, was very complimentary of the prelims on interview day. I got the impression that they do quite well. I talked to a few who seemed happy and had great things to say abt. the program.

 

[OncSurg]

Just read one post in SDN that only 20% of Prelim positions progress to any kind of categorical match later. Is this correct? then thats really bad statistics for IMG's. But I feel odds are still better with a year of prelim under your belt than nothing. Also, amongst prelims, 2 yr prelim spots seem to be better as odds for getting a PGY3 is better than a PGY2 spot.
One more Question: Is ACS Clinical congress, the best academic meeting for Surgery in general. I mean will this give the best audience for your paper/poster presentations (especially to network with some PD's)

 

[thinker]

I know U of Washington has a very good 2 year program with a good placement rate and has spots open every year.

But they require you to have passed an 8 week subinternship AFTER you have graduated from medical school (and providing ECFMG and Step1 and 2ck) in order to be eligible to apply to the non-designated 1 or 2 year prelim program (if you are an IMG).. is this a firm rule? or do people still apply and get in without this requirement?

 

[BlondeDocteur]

Yes, it is a firm rule for IMGs. If you do well on the 8-wk sub-i (which is entirely non-operative: it measures your clinical knowledge, English skills, and patient presentation skills on the wards and in the clinics), then you are offered a 2-yr NDP position.

AMGs scramble in, typically. IMGs are not accepted in the scramble/SOAP.

 

[diphenyl]

http://www.ncbi.nlm.nih.gov/pubmed/16373169

good overview of what happens to mayo prelim's in this article.

 

[Adam184]

http://www.ncbi.nlm.nih.gov/pubmed/16373169

good overview of what happens to mayo prelim's in this article.

Mayo does everything possible to help surgery prelims.

 

[Knightmd]

I'd say do NOT do anything in NYC. Maybe Columbia, since they only take 2-3 PGY-1 prelims [have no idea about their placement afterwards], but the others are houses of pain where the prelims are grossly overlooked and overworked.

Yep... heard that about NYC... It's only good if a program is about to close, and the categorical residents are leaving. Then, the ACGME will have to place you elsewhere if you nab an empty categorical spot right before the program closes.

 

[kemper6036]

as a product of mayo's prelim program, now in a 5 year program, i agree with the above sentiments. if you go there however, don't have delusions of grandeur that you will stay on in their program. the utility of going there is to get good LORs from big name faculty which was greatly helpful to me in the (re) interview process.

 

[thedrjojo]

I'm gonna toot my program's own horn, New Jersey Medical School in Newark (soon to be Rutgers New Jersey Medical School....), as I said in another post, 5-6 straight years a prelim 1 has matched into our categorical program, and this year, of the 5 prelim 1's, 2 matched here for surgery, 1 matched elsewhere for surgery, 1 matched into IM, and the last is now looking to go into a prelim 2 spot. Seems typical of the 5-6 prelims we have, at least one stays here, another few match surg somewhere, a few go into other specalities via the match (last years interns I know one went Anesthesia here, two years back we had 1 got OB, 1 got gas, 1 got IM, 1 got ENT (special situation... prelim surg 1, then categorical ENT 2 spot elsewhere...). So as long as you can put up with New Jersey we seem to be fairly viable for prelims, and for the most part they don't get treated differently than categoricals (they have slightly different rotation schedules, but on each rotation as far as I can tell there is no different considerations)

 

[blkprl]

Does anyone have an idea of the outcomes of the UW 2 year NDP spots?

 

[Winged Scapula]

Does anyone have an idea of the outcomes of the UW 2 year NDP spots?

That has not been released by the NRMP yet.

 

[blkprl]

That has not been released by the NRMP yet.

thanks for the reply. I actually meant the outcomes of the folks who actually match into the program.
I found the answer in another forum. Blond docteur had posted the answer previously 🙂

 

[je355804]

This is an interesting topic and I wish there was more info on it... although for my sake, perhaps it's good there isn't. I interviewed at several categorical positions and only 1 of them consistently took their prelims. In fact, over the past 4 years they've taken both of their prelims every year. This program however is not at the level of a Mayo etc, and therefore will never be discussed on these forums!

 

[blkprl]

I think the shear numbers of preliminary positions makes it impossible for all prelims to find a spot after the internship year. However, I disagree with various posts on SDN that prelims spots are complete dead end. I personally think that a paid rotating internship year or two should be required of all medical school graduates (this is probably not feasible with the number of graduates in the US) to reduce the amount of attrition in the surgical specialties like ob/gyn and gen surg. there are also a lot of people that feel they ended up in the wrong field but stick it out to end because of the hassle of switching mid-residency, plus the funding issues etc. The experience in medical school is not enough for students to decide exactly what field they want to specialize. So for instance in the UK, the foundation year 1 &2, provide several months experience in each broad category before application for sub-specialty training application. This way, students get to feel the actual experience of being a doctor in the field rather than "acting internships" that we do here in the U.S.

There are a few articles in pubmed including one from Mayo & MGH about the outcomes of the students who matched into their prelim program. Yes, not every can match into a prelim spot at these top places and most likely the students that matched there are very desirable for various reasons. But I agree with you it will be a good idea to get information about all other good general surgery programs that take their own prelims into their categorical program.

 

[southsurg]

This is indeed an interesting topic. I wonder if anyone has concrete data on the outcome of Johns Hopkins prelims. I was very impressed with JH and Dr. Lipsett during the interview, and even was seriously considering ranking JH prelim above several categorical options (it's hard to not be impressed with JH and Dr. Lipsett's approach to resident training). However, it was wiser to rank most cats before any and all prelims, including JH, and I ended up ranking most categoricals above JH prelim (and ended up matching into my #1, categorical university program. I got incredibly lucky 🙂🙂).
However, I find it remarkable that JH's approach is completely different than all other prelim options (which intend for you to re-enter the match and repeat your PGY1 year somwhere else, unless they want to keep you as a categorical next year). At JH's they intend for you to do 2 prelim years to then transfer into PGY3 at another institution, (due to the 20% attrition rate nationwide) and not have to go through the match again. From what I heard from some of the prelim residents and the faculty at JH, their success rate is simply outstanding (apparently it approaches 100%).
Being an IMG, I feel very blessed to have interviewed at 16 programs (a mix of Cat and Prelim), and I certainly didn't see the same regard of prelims anywhere else (not even Mayo, which seems to be the "next best" in terms of prelims that might actually lead to a cat spot somewhere in surgery). At JH's they don't seem to view their prelims as "warm bodies", unlike almost every other program, and instead believe they are affording an opportunity for the best and brightest foreign grads to "enter the system". Perhaps they have a high opinion of their prelims as they usually get stellar foreign applicants? This may or may not be the same experience with prelims at other programs, perhaps?

 

[southsurg]

Sounds to me like they want a bunch of folks to drink the kool-aid and lock in their warm bodies for 2 years rather than one...

That may very well be the case, it seems to be vox populi that this is indeed how the system works. Their prelims seemed to be very happy with their decision however (some of them ranked JH prelim above smaller community categorical options).
I guess it was an illusion (or perhaps we all drank a bucket of kool-aid) that some program would actually take a different approach to their prelims...

 

[thedrjojo]

Just read one post in SDN that only 20% of Prelim positions progress to any kind of categorical match later. Is this correct? then thats really bad statistics for IMG's. But I feel odds are still better with a year of prelim under your belt than nothing. Also, amongst prelims, 2 yr prelim spots seem to be better as odds for getting a PGY3 is better than a PGY2 spot.
One more Question: Is ACS Clinical congress, the best academic meeting for Surgery in general. I mean will this give the best audience for your paper/poster presentations (especially to network with some PD's)

I hate to respond to a year old question, but I don't think ACS is the best meeting in general for everything. It is, from what I've heard, it's more geared towards practicing physicians than overly academic, therefore, the level of academics is slightly lower than at a fields specialty conference. That being said, for networking and such, it's the best broadly, but if you want to do something specific, networking at that big meeting will be better as well

 

[DermViser]

I've definitely heard that, too. Dr Freishlag is supposedly very active in placing her prelims.

And firing and maligning them. Just ask Oscar Serrano.

 

[BlondeDocteur]

I know aaaallll about that. No further public comment.

 

[BlondeDocteur]

Yes. 🙂

 

[Knightmd]

As an IMG, my only pathway to a full surgical program was doing a prelim beforehand. Now there are many factors to contemplate when deciding how to rank your prelim programs. However, it will come down to this: The purpose of the prelim is to make way for a full program. Resident happiness? Scutwork? Big name? It all doesn't matter. It all comes down to where the program's prelims have ended up going (or not). It's only one year. You can be unhappy for a year, you can push patients for a year, and you can tolerate psychotic attendings for a year if it meant you have a higher chance at ending at a advanced surgical program after said year.

For me, I had two strong "big name" programs on my list. One was an Ivy League where they didn't bother give the prelim interviewees a presentation of the program, had visibly unhappy residents who complained about how they wished they had better operative skills, and attendings that were relatively difficult to deal with (the PD was super friendly though). The other program offered significantly better clinical training, better prelim treatment, less scut work, better overall facilities, and the residents were incomparably happier.

Tell you what. This all didn't matter; it's just one year. It came down to this: The Ivy League program had a much lower rate of prelims ending up in advanced positions, they didn't even want to divulge this information in the program overview. The other program had an almost 100% rate of prelims ending up in advanced surgical positions over the past 6 years. I ranked them first, even though coming from an Ivy League theoretically makes it easier to land advanced positions, and even though all my friends lived there and I knew the hospital better. But the only number that counted -prelim advancement- was not in its favor. Time will tell if I made the right decision.

 

[Knightmd]

As an IMG, my only pathway to a full surgical program was doing a prelim beforehand. Now there are many factors to contemplate when deciding how to rank your prelim programs. However, it will come down to this: The purpose of the prelim is to make way for a full program. Resident happiness? Scutwork? Big name? It all doesn't matter. It all comes down to where the program's prelims have ended up going (or not). It's only one year. You can be unhappy for a year, you can push patients for a year, and you can tolerate psychotic attendings for a year if it meant you have a higher chance at ending at a advanced surgical program after said year.

For me, I had two strong "big name" programs on my list. One was an Ivy League where they didn't bother give the prelim interviewees a presentation of the program, had visibly unhappy residents who complained about how they wished they had better operative skills, and attendings that were relatively difficult to deal with (the PD was super friendly though). The other program offered significantly better clinical training, better prelim treatment, less scut work, better overall facilities, and the residents were incomparably happier.

Tell you what. This all didn't matter; it's just one year. It came down to this: The Ivy League program had a much lower rate of prelims ending up in advanced positions, they didn't even want to divulge this information in the program overview. The other program had an almost 100% rate of prelims ending up in advanced surgical positions over the past 6 years. I ranked them first, even though coming from an Ivy League theoretically makes it easier to land advanced positions, and even though all my friends lived there and I knew the hospital better. But the only number that counted -prelim advancement- was not in its favor. Time will tell if I made the right decision.

Just a quick update to my post here.

I'm now three months into my prelim year. I don't know how things will work out at the end (i.e. the match), but so far, it seems that I made a terrible mistake. You want to be in the most reputable program you can land as a prelim, regardless of prelim match rates. The bigger the program, the more likely you'll be offered interviews elsewhere. The bigger the program, the more likely the faculty will be connected. Almost all Ivy League programs will have nearby housing included in the deal, and that will save you a lot of time and money looking for a place to live, furnishing it (only to find yourself needing to sell everything near the end of this single year of employment), in addition to car woes. I had a shot at an Ivy League program where I was ranked to match as a prelim, and I threw it away.

Many prelims and even categoricals in my program are having breakdowns, and I myself have began reconsidering my career -not as a surgeon- but as a doctor. Our evaluations are horrible, and the PD wouldn't even write letters for us. It's just that it's hard to imagine it being any worse at another program, so might as well be in a big name program. So there's the scoop: Rank according to name recognition. You're only there for a year, you're not ranking based on which program will make you a better surgeon.

 

[surgicel]

Do the traditional names still stand as best places to do prelim? Like mentioned previously!

JH, mayo, UW, MGH

 

[SLUser11]

I think the important points that almost all of us would make are as follows:

1. If your goal is to complete a general surgery residency, a categorical spot at an average institution is much better than a preliminary spot at a top institution.
2. Prelims are not treated as equals to the categoricals
3. The majority of people who do prelim surgery do not end up as board certified general surgeons, but a large minority do.
4. Prelim years at places that have high attrition rates may lead to that resident filling a vacant spot, but there's usually a reason why the attrition rate is high.
5. Prelim years at prestigious institutions have definite advantages.
6. Prelim years in New York are very uncomfortable, and are often dead-ends, but this is not universal.

I would agree with the comments re: the PD at JH being very supportive for her prelims, and working hard to secure a spot for them. This has been my exact experience with her.

 

[surgicel]

Thanks for the insight

 

[funkydrmonkey]

As a prelim who was offered a categorical spot, PM me if you have any questions. BTW, I went to an average program for my prelim year and got multiple interview offers when reapplying.