Prelim Medicine/Transitional Year Advice

[KnicksDO]

Current 4th year DO applying anesthesia. I've been able to use residency explorer/freida to narrow down my programs for anesthesia but am having a harder time making a list for my prelim/TY years if I dont match into a categorical program. I appreciate any advice or input!

I can supply my board scores/med school location if this information is needed.

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[anesthesiadoc]

IMHO Transition year is not a great idea for future anesthesiologists and may put you behind your peers both procedurally (central lines, suturing, etc) and in your knowledge base. A real internship (prelim med or prelim surgery) will provide a better learning experience.

 

[KnicksDO]

Would you mind expanding on that? I've always had the idea that they were more or less the same (prelim medicine vs TY, not prelim surgery)

 

[Katheudontas parateroumen]

Prelim medicine is the way to go in my opinion. They are tough but they treat you as an actual resident rather than those surgery prelims. Also, you need a solid foundation of knowledge from a medicine standpoint.

 

[JiPo]

Prelim medicine is the way to go in my opinion. They are tough but they treat you as an actual resident rather than those surgery prelims. Also, you need a solid foundation of knowledge from a medicine standpoint.

I echo this. You need strong medicine foundation to excel in Anesthesiology. You want as much medicine and ICU (preferably MICU) experience during intern year as possible where you learn a ton during rounds.

I sometimes resented rounding for hours in ICU, but looking back, rounding with attendings that genuinely enjoyed teaching was extremely educational. Medicine prelim work hours are usually reasonable which will give you time to read on your own time. You need to read throughout intern year (and throughout residency).

Not every medicine prelim year is the same, and some will just use you as labor instead of teaching you, so you need to pick the right program to get the most out of intern year.

And dont worry about procedures such as suturing, placing central lines, IV during intern year. You will get these experiences in any intern program, but even if you dont, these are skills that you can easily learn in residency. You should already know how to suture and place IVs from medical school anyways.

 

[anesthesiadoc]

The thing about transition years is the discontinuity (read: less ability to track your progress) as you move through the year. A resident hierarchy (chiefs/ seniors to keep an eye out for you/ mentor you) isn't as solid because your bouncing between medical services. At certain points in mine it felt like a repeat of MS4. Since you're always the 1 month rotator, people have less long term investment in giving you the feedback and teaching to make you better. If I had it to do all over again I would have chosen either a surgery prelim or a medicine prelim just for the ability to grow as a physician more before arriving at my CA-1 year.

 

[deleted697127]

IMHO Transition year is not a great idea for future anesthesiologists and may put you behind your peers both procedurally (central lines, suturing, etc) and in your knowledge base. A real internship (prelim med or prelim surgery) will provide a better learning experience.

This was not true for me. I did way more lines in my TY than my coresidents who went to big name intern years and categorical programs. At the big name programs you’re competing for lines with a bunch of people who want to do them. At TYs, youre competing with derm, optho, radiology, and internal medicine interns who frankly would prefer not touching patients.

It is also false that these programs don’t have good teaching or didactics. We had excellent teaching with guest lectures multiple times per week from fancy universities and an hour of legitimately protected lecture/lunch on a daily basis. We had a ton of free food and drinks.

We had 3.5 months of elective time to do whatever rotations we wanted. This is a stark contrast to some of my coresidents who had to make up required rotations during their anesthesia residency because their intern year did not allow them enough time in the ED or ICU.

Categorical programs can provide you some protection from abuse like not completing your required intern year coursework (6 months inpatient, 2 months ICU, 1 month ED) or being abused with holiday call schedules. However, a lot of university programs are known for having absolutely brutal overwhelming intern years without teaching, didactics, or time to breathe. These are the same rotations you will be doing.

If you do your homework, you can figure out what the right decision is for you. Not all intern years are created equally. Some categorical are excellent. There are even some prelim surgery programs that are not abusive, actually let you in the operating room, allow elective time, do not have absurd censuses, and allow you time to have a life. No one cares about your intern year. Survive and advance.

 

[deleted875186]

Prelim medicine, the medicine year will make you a doctor. Need to do many months of floors and ICU, night float will be invaluable, get good cards and pulm exposure.

the year of knowledge cannot be emphasized enough. Get good practice treating common medical problems, Afib, CHF, PNA, AKI, DKA, etc, common medical workups, common ICU problems, learn to read EKGs like a boss, learn to read chest films like a machine, these are the things that are important. Don’t be that guy who can’t read an EKG unless it’s anything but a STEMI. I’ve seen anesthesia residents like this, it looks bad, we’re supposed to know this stuff, not cardiology level, but definitely IM level.

I felt the same way about procedures after my intern year. I did medicine and was very disappointed I didn’t put in a single line. That stuff is easy to learn, looking back after completing residency, people perseverate on the procedural stuff. It’s as if that’s all they think anesthesia is. You have three years to do procedures, yes they are fun, but they’re also easy to learn. A surgical year will probably just make you think less like an IM doctor, which is a disservice to you as an anesthesia resident.

 

[deleted875186]

I will also say that IM will have some truly sick patients. Surgical patients are much easier. You just get more from medical patients as a trainee. The downside is the MICU is really depressing.

 

[deleted697127]

I felt the same way about procedures after my intern year. I did medicine and was very disappointed I didn’t put in a single line. That stuff is easy to learn, looking back after completing residency, people perseverate on the procedural stuff.

People tend to come up with excuses to justify gaps in their training...i agree with everything you’re saying but it doesn’t have to be that way

Reminds me of people getting salty hearing about junior residents getting loads of thoracic epidurals and blocks outside of the powerhouse residency programs...

No need to sugar coat that i thought it was annoying at my program that blocks were mainly on block rotations not spread throughout residency. Not everything has to be perfect. Programs can have advantages and disadvantages. It is possible for lesser known programs to offer competitive training experiences.

 

[deleted697127]

There are anesthesia residents that run into their first central line or arterial line 6 months into ca1 year while on call. Attendings, albeit unrightfully so, do tend to get annoyed that resident doesn’t have more experience. It is what it is. Early exposure is definitely an objective benefit.

 

[Katheudontas parateroumen]

Honestly, I’ll put a plug in for my prelim program at UC Irvine. They worked me hard but I loved it. The culture was prelim medicine were treated no different than the categoricals in terms of expectations. I did about 13 weeks of MICU and 3 weeks of CCU, so about 4 months worth of ICU experience which was amazing. I honestly could say I learned so much during that time and got lots of procedures including para, intubations, central and art lines. Probably 20+ which made my transition to anesthesia pretty seamless. The rest of the time was wards which sucked my soul but I still learned a lot from my attendings and seniors. Only negative was we didn’t have much elective time because we as prelims basically covered the categorical residents while they had their clinics and such. But I did get a chance to do preop clinic, US rotation both super chill of course and call free. Overall, I was really even close to staying as an IM resident but decided I didn’t want to do clinic or wards... Im grateful for my prelim medicine year. So I personally think as others have said, look for a place with plenty of ICU. You want that experience. And if permits, elective time to decompress and learn some sub specialty things. I’m biased as I’m going into an ICU fellowship lol but it is my opinion that anesthesiologists should be the intensivist in the OR. Don’t become just another procedure monkey as a resident and future attending that just moves the meat *ahem patients. It’s all fine and dandy to coast through and make your money, I get it and understand. You’re so much more than that though. Anesthesia is such an amazing and diverse field if you seek to become great. Sorry for the rant lol.

 

[nimbus]

I echo this. You need strong medicine foundation to excel in Anesthesiology. You want as much medicine and ICU (preferably MICU) experience during intern year as possible where you learn a ton during rounds.

I sometimes resented rounding for hours in ICU, but looking back, rounding with attendings that genuinely enjoyed teaching was extremely educational. Medicine prelim work hours are usually reasonable which will give you time to read on your own time. You need to read throughout intern year (and throughout residency).

Not every medicine prelim year is the same, and some will just use you as labor instead of teaching you, so you need to pick the right program to get the most out of intern year.

And dont worry about procedures such as suturing, placing central lines, IV during intern year. You will get these experiences in any intern program, but even if you dont, these are skills that you can easily learn in residency. You should already know how to suture and place IVs from medical school anyways.

I still remember MICU teaching rounds from 28 years ago with fondness.

 

[deleted875186]

People tend to come up with excuses to justify gaps in their training...i agree with everything you’re saying but it doesn’t have to be that way

Reminds me of people getting salty hearing about junior residents getting loads of thoracic epidurals and blocks outside of the powerhouse residency programs...

No need to sugar coat that i thought it was annoying at my program that blocks were mainly on block rotations not spread throughout residency. Not everything has to be perfect. Programs can have advantages and disadvantages. It is possible for lesser known programs to offer competitive training experiences.

Agreed that the OP should shoot for a perfect program. Just saying, in my opinion you should prioritize for knowledge and experience over procedures.

 

[abolt18]

Honestly, I’ll put a plug in for my prelim program at UC Irvine. They worked me hard but I loved it. The culture was prelim medicine were treated no different than the categoricals in terms of expectations. I did about 13 weeks of MICU and 3 weeks of CCU, so about 4 months worth of ICU experience which was amazing. I honestly could say I learned so much during that time and got lots of procedures including para, intubations, central and art lines. Probably 20+ which made my transition to anesthesia pretty seamless. The rest of the time was wards which sucked my soul but I still learned a lot from my attendings and seniors. Only negative was we didn’t have much elective time because we as prelims basically covered the categorical residents while they had their clinics and such. But I did get a chance to do preop clinic, US rotation both super chill of course and call free. Overall, I was really even close to staying as an IM resident but decided I didn’t want to do clinic or wards... Im grateful for my prelim medicine year. So I personally think as others have said, look for a place with plenty of ICU. You want that experience. And if permits, elective time to decompress and learn some sub specialty things. I’m biased as I’m going into an ICU fellowship lol but it is my opinion that anesthesiologists should be the intensivist in the OR. Don’t become just another procedure monkey as a resident and future attending that just moves the meat *ahem patients. It’s all fine and dandy to coast through and make your money, I get it and understand. You’re so much more than that though. Anesthesia is such an amazing and diverse field if you seek to become great. Sorry for the rant lol.

Close friend of mine ended up doing a prelim medicine year at University of Kentucky and speaks VERY fondly of the challenging sick patients and how well he really learned medicine that year. He says his experience was far more valuable than that of his classmates.

 

[KnicksDO]

Any advice as to how to make a list of programs? Lets say UVA was my #1 program for anesthesia. According to ERAS I can apply for both an advanced and categorical position for anesthesia at UVA. Does it make sense to apply to both of those programs and in addition apply to UVA prelim medicine? Or is it implied that if I didnt match the categorical position at UVA that I wouldn't match their prelim medicine program as an advanced match. Thanks everyone!

 

[Katheudontas parateroumen]

Any advice as to how to make a list of programs? Lets say UVA was my #1 program for anesthesia. According to ERAS I can apply for both an advanced and categorical position for anesthesia at UVA. Does it make sense to apply to both of those programs and in addition apply to UVA prelim medicine? Or is it implied that if I didnt match the categorical position at UVA that I wouldn't match their prelim medicine program as an advanced match. Thanks everyone!

No i don't think that it's implied at all if you don't match UVA anesthesia that you wouldn't match their prelim. You make separate match lists for anesthesia programs and prelim/TY programs. So if you match an advanced anesthesia spot, the algorithm will then match you for a prelim spot. Advanced positions are "less competitive" than categorical in that generally less people are competing for those spots because most people prefer categorical over advanced. But as usual, just put your rank list as you prefer!

 

[abolt18]

Any advice as to how to make a list of programs? Lets say UVA was my #1 program for anesthesia. According to ERAS I can apply for both an advanced and categorical position for anesthesia at UVA. Does it make sense to apply to both of those programs and in addition apply to UVA prelim medicine? Or is it implied that if I didnt match the categorical position at UVA that I wouldn't match their prelim medicine program as an advanced match. Thanks everyone!

Also, when you apply to a program that has categorical and advanced positions, it doesn't charge you extra to apply for both spots. It's still counted as a single application.

And when you have numerous advanced positions on your rank list, each advanced rank will have a "secondary rank list" in which you rank the prelim/TY spots, and that list can be different for each advanced position you rank.