Interventional Radiology. Does my Prelim Year Matter? Surgery? Medicine? Transitional?

[entrepreneurMD]

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So I will be applying IR this coming year and I've read a lot about this prelim year requirement. More specifically, some programs require a surgical prelim which is fine but others "strongly encourage" or do not specify.

My questions are:
1) How necessary is it to do the surgical prelim year for IR? I really want to take it easy this year and not be a scut monkey.
2) Has anyone done a transitional year?
3) Does it look bad if I say I'm doing surgery to these "strongly encouraged" places and just do a transitional year instead?

 

[IRorBustguy]

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[Naijaba]

So I will be applying IR this coming year and I've read a lot about this prelim year requirement. More specifically, some programs require a surgical prelim which is fine but others "strongly encourage" or do not specify.

My questions are:
1) How necessary is it to do the surgical prelim year for IR? I really want to take it easy this year and not be a scut monkey.
2) Has anyone done a transitional year?
3) Does it look bad if I say I'm doing surgery to these "strongly encouraged" places and just do a transitional year instead?

Hi entrepreneurMD (nice name btw), my personal opinion is that surgical intern year appeals more to people going into IR. I didn't like my medicine rotations (rounding for 4 hours, really?). I once had this IM attending who bragged that his first H&P was 13 pages. I'd much rather get there early and stay later doing procedures than doing H&Ps and writing novels. Again, just my opinion, but if you don't want to do a surgery prelim, do you really want to do IR? The actual attending lifestyle is closer to a surgery intern than a medical intern.

 

[irwarrior]

Surgery reflects the day to day existence of a clinical IR. IR is getting busier and busier and is not a lifestyle friendly field. The number of urgent indications for IR has steadfastly increased. I have office hours where I see patients in clinic. I admit patients to my service and have to round on them before clinic or my IR days. I have my set IR days and I have call. We also deal with a bunch of surgical type issues (bleeding, acute limb ischemia, wounds etc). The surgical technical skill set of suturing and wound care is rather helpful. Surgeons tend to be more aggressive than other specialists. Also, surgery tends to in general be more anatomic in nature and that is the foundation you want for both IR as well as imaging.

If you are interested in more of a 8 to 5 schedule or lighter work load, I would consider mammography or MSK with some minor procedures.

Unfortunately not all surgical internships are the same and some will not give you adequate face time with the attendings etc (especially academic programs with large number of trainees and fellows). Some of the community based preliminary programs will give you more autonomy. Ideally you should be staffing out consults, rounding on inpatients and spending time in the OR seeing anatomy, pathology and working on your manual dexterity. Some interns get a ton of cases. Some key rotations to do include vascular surgery (endovascular skills and clinical evaluation of CLI, aneurysms, ALI , carotid disease), ICU, and trauma.

 

[quirkygator]

I personally don't think a surgical pre-lim is that useful. As a surgical intern you are basically doing scut work the entire day. Sure you get to go in on cases and help, but they are most likely going to be the lame lap appy/choles'. At least in my institution, the seniors and regular surgical interns get priority and choose which cases they want to do, which usually involves the more complex vascular cases. In my opinion, what you need to learn for IR is more the pre-op and post-op care of surgical patients, which doesn't require the entire year. I would recommend doing a transitional year that has both medicine and surgery. I feel like I'm a lot more well-rounded in my thinking by doing both.

 

[Fab5Hill33]

I agree with @quirkygator.

This notion that surgery internship will prepare you as an IR is nonsense:
1) If it was critical to your career as an IR, why didn't they make a surgery internship mandatory prior to the new IR/DR residency?
2) I would wager that most currently practicing IRs never did a surgery internship.

The fact is that internships - whether surgery, medicine or TY - vary wildly. The intern year was not created as some sort of standardized training pathway for all types of residencies. All it is is cheap labor for our health care system that would otherwise be in even worse shape from a financial and labor perspective.

Now, if you can find a good surgery internship that will give you exposure to clinic and OR and experience with post-op care that's all fine and good. You should look for those internships. But the vast majority of internships are just cheap labor. Nobody is teaching you how to run clinic (how many days of clinic do most surgery internships get?). Very few programs are letting you operate on most days. I will concede that most interns will have to manage post-op issues. After all, that's really why you're there. So that you can free up the senior categorical residents to do the surgeries and see their patients in clinic.

There are some medicine and TY programs that let you have your own resident-run clinic, or give you multiple ICU months, or where the medicine team is actually the one doing the heavy-lifting medical management on the inpatient floors. Don't overlook those programs just because they're not "surgery." Those skills are just as useful as the skills you might get in a surgery internship.

Don't fall for the brand-name ("surgery") hype. Find an internship in the geographic area you want to be in, that isn't malignant, and that offers you opportunities to learn clinical skills that might translate to IR. But don't bank on the latter.

 

[IR4thewin]

My guess is that there will be more IR residencies linking up with the surgery program for a prelim year. For now, just do what you prefer. I would much rather do surgery over medicine, mainly because I can't stand medicine rounds.

The only thing you should not do is decline an interview for a surgery prelim spot at an institution where you are interviewing for IR. Just go along with the flow, do the interview, and if you don't want to do surgery then don't put it on your rank list, no one will ever know. There are a few programs I encountered who had he surgery PD meet with us after the rads interview, just go to the interview.


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[entrepreneurMD]

Thanks so much for the response guys! My desire to do IR is unwavering and I don't mind long hours but from witnessing the surgery interns at my home academic program, I can tell you that they get treated like ****, no OR experience and just man the floors day in and day out. That is something that I am just not interested in doing and can't really see being useful for IR.

I will keep an open mind during application cycles and interview for gen surgical, TY and medicine prelims and just pick the one that feels right.

 

[RadsFTW123]

I think if you really enjoy IR, you'll have more fun doing surgery than medicine. And you master the pre and post op care which is what you need if you're going to be admitting your own patients. It's a much more similar mindset you'll learn too. And I think it prepares you better for DR too since surgeons will actually review and understand the imaging the order.

 

[Fab5Hill33]

If you think you'd enjoy being Surgery intern more than a Medicine intern, by all means go for it.

In my experience, it was more fun being an M3/M4 on surgery than being the surgery intern. Remember that you're not shadowing the senior surgery resident and getting to scrub into all the cases like you got to as a med student. You're now the intern.

I'd also point out that IR is probably more like interventional cardiology than general surgery. The former does Medicine as an internship... and I don't think their careers are lacking because of it.

 

[IR4thewin]

When you go on interviews, ask the prelim interns how many cases they've had. A lot of places have 100-150 because the categoricals are required to have 250 by end of pgy2. Hopefully you find a place that treats prelims and categoricals the same. Another thing I found favorable is that the average gen surg residents loathe endovascular cases, so a lot of places would staff the evor with interns. Perfect for us going into IR. The place I matched is also working to get me a month on IR or an extra month with vascular.

But just do what you want to do. If you like medicine, go for it.


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[entrepreneurMD]

Hey @IR4thewin! That sounds like a gen surg prelim I can get down with. I have nothing against surgery like the hours and stuff its the treatment but your program seems great! Any chance you can tell me in a private message?

 

[Gadofosveset]

I knew a couple of advanced surgical residents (PGY-3) who switched into rads and they definitely had an advantage in IR. They had an advantage in the technical aspects, but what they learned in the OR wasn't really the valuable part, the valuable part was that they knew how to interact with the ICU at a leadership level. They had learned to make decisions that could cost them (and sometimes had cost them) rather than just following orders. They were just further along in being doctors. They (of course) tended to take leadership roles on IR rotations.

The benefit of an intern year in surgery is mostly psychological. It allows you to feel superior to your nonsurgical co-residents. It lets you feel the holy fire of dedication and it also allows you to talk in the reading room about "When I was in the SICU…." as if that is impressing anyone. For what it's worth, the PGY-3 surgical residents I knew who switched into rads had zero special feelings for surgical internship rads residents. Zero. That might have been a hold over from their training where a surgical intern got as much respect as a wadded up tissue in the corner of the bathroom.

 

[qwerty89]

My guess is that there will be more IR residencies linking up with the surgery program for a prelim year. For now, just do what you prefer. I would much rather do surgery over medicine, mainly because I can't stand medicine rounds.

The only thing you should not do is decline an interview for a surgery prelim spot at an institution where you are interviewing for IR. Just go along with the flow, do the interview, and if you don't want to do surgery then don't put it on your rank list, no one will ever know. There are a few programs I encountered who had he surgery PD meet with us after the rads interview, just go to the interview.


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I did my TY at a community hospital and rounds were great. Short and to the point. No endless pontificating. Most medicine attendings dont love rounding any more than you do. They want to get the work done and go home. Thats all in academics.

 

[DJNYY]

The work hour difference between prelim surgery and prelim medicine is overstated in my opinion. Surgery gets into the hospital about an hour earlier because they need to finish rounds before cases start (7 am most places). But sign out is usually around the same time in the afternoon for medicine and surgery. Sign out most places is between 5-6 pm on non-call days. Pre-rounding, notes, and most orders are in by the time cases start. The rest of the day is a mix of scut and actually delivering patient care instead of majority scut on many medicine services.

Now the difference between prelim surgery and a cush TY is considerable as the cush TYs allow you many easy elective blocks. Although if you are committed hardcore to a cush TY and get completely turned off by the idea of prelim surgery, then you should think twice if your ultimate goal is high end clinical IR. Clinical practices like Miami vascular, Emory, Northwestern, MCW, Michigan... those attendings (not just fellows) are working like surgeons. Procedures + Peri-procedural care + Clinic = long hours. There's no getting around it. If you want to be some IR at a dialysis center doing fistula work from 8-5 with all your weekends off and never follow your patients long term, then maybe a cush TY is for you.

I'd argue for DR, you should look for TY because your intern year is not nearly as relevant to what you'll be doing long term. IR is a different animal altogether, and a good preliminary surgery experience is invaluable. Many prelim surgery programs are trash, I recognize that

 

[Tiger100]

Do Prelim surgery.

 

[IRorBustguy]

PGY1 prelim surgery now (and heading to IR). hours are brutal, averaging 80 hours/week. Not as much surgery as I would like but learning a ton about periop management. Also, the surgical patients are those that are eventually referred to IR. My medicine colleagues go home around 5-6PM and get in around 7AM. I'm here by 5AM and leave around 7PM. i dont think the "work hour difference between prelim surgery and prelim medicine is overstated".

 

[DrfluffyMD]

PGY1 prelim surgery now (and heading to IR). hours are brutal, averaging 80 hours/week. Not as much surgery as I would like but learning a ton about periop management. Also, the surgical patients are those that are eventually referred to IR. My medicine colleagues go home around 5-6PM and get in around 7AM. I'm here by 5AM and leave around 7PM. i dont think the "work hour difference between prelim surgery and prelim medicine is overstated".

Periop is what you need to learn.

 

[Naijaba]

I'm also in the thick of prelim year. Currently on a 28-hour shift. Per ACGME, interns can work 24 hours (+4 hours for patient hand-off related tasks). My program schedules the full 28 hours. Actually, it's 28.5 hours, because of a discrepancy in the hour charting. Our hours-management system pre-fills 6 am-Midnight on the pre-call day, but we're supposed to do signout at 5:30 am, so that extra 30 minutes is left unrecorded. Not to mention that you generally show up at the hospital 30 min before sign-out.

 

[irwarrior]

If you have the opportunity, I encourage you to also do consults from the ER or the inpatient floor and go to the various outpatient clinics especially surgical oncology and vascular surgery. You want to be able to see a fresh consult for carotid stenosis, leg pain, varicose veins, AAA, thoracic aneurysms, critical limb ischemia , acute limb ischemia , liver resections etc. In the OR you should try to see what anatomy they are viewing and how that corresponds to the CT imaging. You should learn the most common postoperative complications associated with the various surgeries that you assist in. You should learn how to deal with the septic patient and goal directed therapy and which antibiotics and for how long, mass transfusion protocols in the trauma settings, as well as what point they are ready for discharge and when and how often would you follow up with them in the office setting.

 

[qxrt]

I'm also in the thick of prelim year. Currently on a 28-hour shift. Per ACGME, interns can work 24 hours (+4 hours for patient hand-off related tasks). My program schedules the full 28 hours. Actually, it's 28.5 hours, because of a discrepancy in the hour charting. Our hours-management system pre-fills 6 am-Midnight on the pre-call day, but we're supposed to do signout at 5:30 am, so that extra 30 minutes is left unrecorded. Not to mention that you generally show up at the hospital 30 min before sign-out.

Was this a recent change? I did my medicine intern year just a few years ago, and I thought the ACGME requirement was that interns couldn't work shifts longer than something like 14 hours (or somewhere around there). Though, that requirement didn't apply to 2nd years and beyond.

 

[harambe4ever]

Was this a recent change? I did my medicine intern year just a few years ago, and I thought the ACGME requirement was that interns couldn't work shifts longer than something like 14 hours (or somewhere around there). Though, that requirement didn't apply to 2nd years and beyond.

Yes, the intern rules are gone now.

 

[IR4thewin]

Now 2 months into intern year, I would still go back and do surgery again. A lot of this is personal preference, and I can see now how the TY year could be very beneficial by getting some surgery and medicine. At my program, there is some advantage to being prelim or categorical vs someone rotating in (ED and family med rotates through a couple of months), in that the attendings seem to let us do more on the cases. Definitely a lot of scut, and don't underestimate the time commitment, don't know about all other programs, but I've only had 1 week under the 80 hours. Part of the balance is that the more you go to the OR, the later you may have to stay to follow up stuff from the floor. With that said, the days pass quickly, and its not as bad as I was imagining intern year to be.