PGY 2 prelim spots

[Goneril]

Can someone clarify the utility of a non-designated PGY2 prelim position?

If a PGY1 non-designated position is often a dead end, than I'd imagine a PGY2 spot would be a deader end?

I noticed a few of those spots on APDS and I wonder if programs can reallocate the funds to support a PGY2 spot into a PGY1 spot if the initial positions aren't filled.

See I still need a position and was wondering why those spots don't get turned into internships.

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[SLUser11]

Can someone clarify the utility of a non-designated PGY2 prelim position?

If a PGY1 non-designated position is often a dead end, than I'd imagine a PGY2 spot would be a deader end?

I noticed a few of those spots on APDS and I wonder if programs can reallocate the funds to support a PGY2 spot into a PGY1 spot if the initial positions aren't filled.

See I still need a position and was wondering why those spots don't get turned into internships.

A non-designated preliminary PGY-2 spot is an even more dead end. You are correct.

It's not always clear why programs seek out preliminary PGY-2s....it's likely multifactorial, but I think there are 2 main reasons:

1) It provides extra sets of expendable hands for the clinical workload.
2) It provides backup plans/buffers in case categorical residents quit or get fired.

If it is a desirable and well-balanced program, there usually isn't a need for those extra sets of hands, since the education to service ratio is balanced. There usually isn't a need for buffers, either, since people don't quit or get fired from good programs as often (in theory).

In general, those PGY-2 positions are in undesirable locations. On top of that, there's a reason why there are so many remaining open positions....

I'd be interested to hear a different perspective from someone with more intimate knowledge of the process.

 

[celling]

It's not a 100% dead end, but pretty close. I only know of a few people who got categorical positions after a PGY-2 preliminary position. If you do a PGY-2 prelim position, do not do it at the same hospital as your PGY-1 prelim year. There is a reason that they didn't offer you a categorical position and that's unlikely to change. Go somewhere else, get a fresh start, and try to wow them. That's your best shot.

 

[Buzz Me]

Some programs want the full two years to evaluate a prelim before offering a categorical position - it may be hard to judge an intern's clinical skills and judgement since they have limited exposure to all patients. By the PGY-2 year, though, you'll see how that resident deals with ICU patients, consults, and even more complex cases in the OR.

 

[thedrjojo]

we have between 2-4 PGY2 prelims a year at my program. We cover a lot of services, are spread out among 3 hospitals, and have minimal PA's/APN's, so it does help spread out the work load to have more PGY2's. It is sorta like the old pyramid type of thing, you need more grunts/juniors than you need seniors to cover the teams and the smaller cases, calls, etc.

The PGY2 prelim is not necessarily a dead end. Our program allows 0, 1, or 2 years in the lab, which creates uneven numbers at times. Our PGY5 class has 8, our PGY4 class has 5, our PGY3 class has 9, and our PGY2 and 1 have 7 each. This coming year, I think there are 5 of us going into the lab and 4 coming out, so they gave a PGY2 prelim a PGY3 spot. They also gave a PGY2 prelim a PGY2 categorical spot (not sure how that works out). In the past we have had PGY2 prelims get PGY3 spots (one of the current 3's was a prelim 2), one of next years administrative chiefs was a prelim 2, did 2 years in the lab, then was offered a PGY3 spot. Another was PGY2 prelim then lab, and is now a Urology 3 (was given a urology 2 spot). Another went from PGY2 prelim to anesthesia 2. Another PGY2 prelim is back in India cause we couldn't find anything anywhere.

 

[SLUser11]

Some programs want the full two years to evaluate a prelim before offering a categorical position - it may be hard to judge an intern's clinical skills and judgement since they have limited exposure to all patients. By the PGY-2 year, though, you'll see how that resident deals with ICU patients, consults, and even more complex cases in the OR.

I think you know after one year if a resident is going to make it or not. They should have seen plenty of consults by then. I doubt you're letting your PGY-2 prelims do a lot of complex OR cases, so it would still be difficult to predict who has unteachable hands.

If they could not be evaluated after intern year, it's likely because they were too busy doing scutwork to put their medical knowledge and clinical skills on display. That's not a great situation for the prelims.

The PGY2 prelim is not necessarily a dead end. Our program allows 0, 1, or 2 years in the lab, which creates uneven numbers at times. Our PGY5 class has 8, our PGY4 class has 5, our PGY3 class has 9, and our PGY2 and 1 have 7 each. This coming year, I think there are 5 of us going into the lab and 4 coming out, so they gave a PGY2 prelim a PGY3 spot. They also gave a PGY2 prelim a PGY2 categorical spot (not sure how that works out). In the past we have had PGY2 prelims get PGY3 spots (one of the current 3's was a prelim 2), one of next years administrative chiefs was a prelim 2, did 2 years in the lab, then was offered a PGY3 spot. Another was PGY2 prelim then lab, and is now a Urology 3 (was given a urology 2 spot). Another went from PGY2 prelim to anesthesia 2. Another PGY2 prelim is back in India cause we couldn't find anything anywhere.

That sounds pretty complicated. The prelim's chance of converting to categorical is completely dependent on how many categoricals are coming out of the lab....so regardless of their quality as a resident, their fate is determined by something that is out of their control. Also, I couldn't imagine the stress of spending 2 years as a prelim, then 2 years in the lab, then hoping to secure a possible PGY-3 spot.

I think you said it best in your first paragraph. It's nice to have extra sets of expendable hands to help with the heavy workload. If it ends up being convenient for the program, you can use those hands to later fill empty categorical spots. Otherwise, if you have enough categoricals already, you can simply send them back to India. Even if the program has the best intentions, that is a bad situation for the prelims.

 

[blue2000]

My program had several 2 year prelim spots. It certainly lightened work loads considerably; there would be no way to handle all the work without them. My program had a pretty excellent track record of placing these two year prelims in categorical positions, not just within the program but in solid general surgery programs across the nation, surgical subspecialties, anesthesia and emergency medicine (to name some recent grads off the top of my head). They were treated like all other residents (schedules were not unequal, opportunities for operating weren't unequally distributed, etc) and for the most part were totally integrated into the program. Some left surgery for other fields, usually because after two years of surgery residency they realized that they didn't want it that bad. Rarely people left because it was clear that they didn't have a future in general surgery.

I know from my friends who were prelims that it was an exhausting, stressful two years because they felt like they could never mess up, always had to be perfect and were auditioning for a job the entire time. The upside to a 2 year prelim is that you have a year to establish yourself before you start looking for your next job. Faculty can write better letters if they've known you for over a year rather than a few months. 2 year prelims also don't have to simultaneously figure out had to be an intern and look for a new job at the same time.

As I said, my program has a good track record of placing people after a two year prelim position, but I'm not sure that is typical. Also, I would assume that doing a PGY1 prelim spot at one program and doing a prelim PGY2 position at another program is a loser.

 

[45408]

At both my current program and med school surgery program, people were picked for PGY3 spots. I don't know what everyone's prior background is, but I know a few of them did two prelim years.

 

[ImmunoDude]

It could be useful for those who need to get their two years of clinical training before they're eligible to apply to a DIRECT pathway program. What better clinical training could there be for a future IR then GS. Majority of IR's cases come from surgery, and having a good relationship between the two means better patient care. Plus the operative and critical care skills would be useful in IR trauma cases.

 

[doc05]

Plus the operative and critical care skills would be useful in IR trauma cases.

Really? I didn't realize pgy-2's had any operative or critical care skills.

 

[Winged Scapula]