Prelim in surgery or IM?

[In2b8]

I am a 3rd year med student with a question about the prelim year.
Do residency programs require that the prelim year be done in a specific field, IM or surgery? Is there an advantage to doing one over the other?

Any thought would be appreciated.

Thanks

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[Apollyon]

My own preference...prelim IM. Prelim surgery doesn't fill year after year for a reason...

Surgery, being a 5 year program, brings you into the family. If you're only there one year, you're like the red-headed stepchild.

If you do prelim sx. for practice or to see if it's for you, that's one thing. If you do it to go into another field, that's crazy.

Mind you, this is just my opinion (of course), but, unless you loved your rotation, and have a vocation for surgery, you will be spending a year of hell.

I can't comment on the people who do it, so they "are in the OR". It seemed to me like the sx residents had their hands full in the OR.

 

[em MD]

I would also cast my vote in favor of prelim IM (that was my choice) - as an anesthesiology resident it will be much more useful to have some practical experience with medical management of patients, rather than the knowledge of a surgical intern (there are enough surgeons in the room)...

 

[beezar]

You know, I thought the same thing before... that prelim IM was the way to go.

But I've heard numerous times from attendings on the interview trail that people who do surgery prelims do extremely well in anesthesia... something about how efficient they are, how quickly they think and act when things go south during during a case (as an anesthesiology resident)

Don't know now...

 

[em MD]

With re. to efficiency - if you choose a decent IM program - you most certainly will learn to be efficient. I think that is ridiculous to suggest that former surgical interns learn to be more efficient, or handle anesthsia crises in the OR more effectively than those who do IM. By the time I finish my internship, I will have done 4 months in the ICU (MICU, CCU and 2 Subacute units), Cardiology and Pulmonary rotations, in addition to General Medical floors - I expect that experiences such as these, will serve me very well when "things go south" in the OR.

I have not heard the same from Anesthesiology attendings with regard to surgical prelim year - I would say about 85-90% encourage IM over surgery. Those who don't probably have some affliation with a surgical prelim program.

The bottom line is - in medicine, you will learn to handle patients that are unstable or crashing in terms of their respiratory and cardiovascular status, you will deal with a lot more physiological data, learn how to interpret it and how to manage the patients. This will be much more useful in Anesthesiology as compared to doing surgery scutwork on the floor, retracting and suturing in the OR...

 

[droliver]

Originally posted by em MD
I would say about 85-90% encourage IM over surgery. Those who don't probably have some affliation with a surgical prelim program. /B]

I disagree completely with this statement. The trend by graduating medical students towards avoiding surgical internships is a fairly recent phenomena & I think reflects the elevation of lifestyle over quality of training issues in many instances. I don't think IM or surgery neccessarily is better as a prerequisite (you both learn basic patient care your PGY-1 year), but I think the discipline & perspective you get working with surgeons (and surgical patients)ends up being MUCH more valuable for anesthesia training. Learning to understand how surgeons think (and vice versa) is a very undervalued part of residency training. We have anesthesia residents here that do IM, surgery, or recently a hybrid (of the two) year for their intern year. It may be a self-selecting population, but there has been a tremendous difference in the caliber & effectiveness of our rotators who have done the transitional surgery route & this has been noticed by the Anesthesia Staff as well. The best compromise is likely one of the hybrid years I think (about 6 months of surgery & various rotations on the CCU,ER, ans ward medicine service). Many of the anesthesia residents have also chosen to do their intern year after their first clinical anesthesia year, an option I think makes a lot of sense (I don't know how common that is @ other programs)

I have made a similar argument that Emergency Medicine benefits from this type of exposure to the various surgical fields. I know some of the 4 year programs have incorporated this, which makes for better trained and more capable physicians IMO

 

[em MD]

Dr. Oliver states - "I think the discipline & perspective you get working with surgeons (and surgical patients)ends up being MUCH more valuable for anesthesia training. Learning to understand how surgeons think (and vice versa) is a very undervalued part of residency training. "

The enigma of "how surgeons think is an undervalued part of residency training!" From the perspective of a surgeon, no doubt! How characteristic.


Sorry, but somehow I still believe that I am putting my prelim year to more productive use!

 

[Tenesma]

unfortunately i have to disagree with Dr. Oliver on this topic

while a surgical internship can provide a few things that a medicine internship can't, on the whole i still believe that internal medicine is better...

1) reasons why surgical year is better:
- bonding time with surgical residents
- seeing post-operative issues
- increased exposure to procedures

2) reasons why internal med year is better:
- better understanding and more training on the medical aspect of patient management.
- the intricacies of medical optimization
- a broader spectrum of patients and illnesses

all in all you will be getting exposure as a medical intern that won't be repeated as an anesthesia resident... and many of the benefits of a surgical internship are voided when you do an anesthesia residency and get to do TONS more procedures and get to see TONS more post-operative issues in the PACU and the ICU setting.

so the only point that Dr Oliver has, would be the bonding experience with surgical residents... that is of course, if you end up doing your internship at the same place as your residency...

 

[beezar]

Well, I just asked another attending about this issue, and they told me the same thing: CA-1's coming from a surgery internship make better anesthesiologists, at least in the beginning. Then he said it evens out by the CA-2 year. So I guess it doesn't matter...

But the reasons he said were because prelim surgery people were much more efficient then prelim IM people, because they have to handle a lot more sick patients at the same time. Also he said that prelim surgery people were more decisive, and understood postop issues a lot better.

His opinion, not mine...

 

[Tenesma]

i have to agree with your attending beezar....

surgical prelims tend to mimic the surgical mindset (which is very similar to the anesthesia mindset - regarding patient management) a lot more.... quicker decisions, more confident....
but things really do start evening out over time