Prelim Medicine vs Prelim Surgery

[undecided05]

Can anyone make a strong case why one would be better than the other or in effect why one would be worse than another. Thanks.

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[Skip Intro]

Can anyone make a strong case why one would be better than the other or in effect why one would be worse than another. Thanks.

Everyone I've asked says do NOT do preliminary surge, basically, for two reasons: (1) they scut the hell out of you, and (2) you don't get enough time/exposure/prepartion for Step 3.

I'm applying only to prelim med and transitional programs.

-Skip

 

[HomerSimpson]

I did a medicine prelim. I have buddies who did surgery and they seemed to perform better in the OR environment. Plus they got an early intro to placing lines and using sterile technique which you will do quite often in residency. You also get an idea about a surgeon's mentality and get to know a few of them which may prove useful as contacts later on. The advantages in doing medicine is are also plentiful and I feel well trained regardless, but if I could do it all over again I would choose surgery. Hope that helped

 

[UTSouthwestern]

I did medicine before anesthesiology and those in my class who did medicine have had a better grasp of pathology and physiology and made an easier adjustment to the perioperative aspect of anesthesiology. Admittedly we did not feel comfortable in the OR in the early going, but that passed quickly and I felt that our understanding of the physiology of each situation allowed us to reacti more quickly and appropriately to adverse outcomes.

My friends who did a surgery prelim or residency felt that while they knew a lot about what the surgeons expected, they felt less prepared in terms of understanding the medical comorbidities of patients and being able to preoperatively assess their patients.

I think what would concern me the most with a surgery prelim is that you can be a pure scut monkey for a surgery program with no true responsibilities placed on you in some places. A prelim medicine spot at almost any program will require you to think analytically on just about every service you are involved with.

 

[powermd]

I did medicine before anesthesiology and those in my class who did medicine have had a better grasp of pathology and physiology and made an easier adjustment to the perioperative aspect of anesthesiology. Admittedly we did not feel comfortable in the OR in the early going, but that passed quickly and I felt that our understanding of the physiology of each situation allowed us to reacti more quickly and appropriately to adverse outcomes.

My friends who did a surgery prelim or residency felt that while they knew a lot about what the surgeons expected, they felt less prepared in terms of understanding the medical comorbidities of patients and being able to preoperatively assess their patients.

I think what would concern me the most with a surgery prelim is that you can be a pure scut monkey for a surgery program with no true responsibilities placed on you in some places. A prelim medicine spot at almost any program will require you to think analytically on just about every service you are involved with.

I would agree with all of this.

The word I got from program directors on interviews was that prelim surg CA-1s came up to speed in the OR faster, but that by 6 months it evens out. I can offer that from 4 weeks of ward medicine and 2 weeks of night float that my prelim medicine experience has given me impressive levels of autonomy in decision-making and opportunities for analytical thinking. A young woman in my building who has been doing prelim surgery is miserable with it. She is completely scutted out, and looking to transfer to medicine with the hope of getting an anesthesiology spot.

I love the OR and like the fact that I will have a good understanding of sick patients before managing them under anesthesia.

I would certainly recommend going either prelim med or transitional. Don't bother with prelim surg unless you are desparate to be in a particular geographic region, and you are unable to match med/transitional in that area.

 

[HomerSimpson]

Respectfully,

What all of what my collegues have said are true. You probably do get better exposure to the perioperative issues concerning patient care like optimising cardiopulmonary function for non-cardiac surgery, BUT most of your care will have nothing to do with surgical patients. As you know from med school most of your admissions to the hospital are concerning long term medical problems like Diabetes and CHF. To me the understanding of these disease processes is essential in managing a surgical case BUT again IM docs usually do not manage surgical patients in an academic setting surgeons do. For instance let's say you have a patient with DM in Acute Cholecystitis in DKA likely secondary to the Gallbladder. IM response: transfer to surgery. Surgical response, you need to likely place a Percutaneous Cholecyctostomy tube, IV antibiotics and management of the DKA before attempting to take out the GB. As a IM doc I may be very good at treating DKA or giving abx BUT putting all this together in a case like this may be a little confusing at first. This understanding helps you as an anesthesiologist because your care for surgical patients(usually) You WILL likely catch up in a few months if you do medicine it took me a little longer as well but why get behind in the first place.

As far as the scutting, it does happen, but it happens in IM residencies too. Therefore be very selective in your process of finding a good prelim program. The truth is it will not make you or break you either way. With the implementation of the 80 hour work week for residents, the likelihood of being overscutted is also less.

Just my opinion though

 

[andwhat]

During my Anesthesiology elective in NY, I spoke with an Anesthesiology attending physician regarding this matter, he actually told me that residents who only had surgical experience (Preliminary Surgery) came in and performed horribly at the PGY - 2 level in Anesthesiology, which was quite a surprise, because I had always assumed the opposite.... He also told me that the best option is to do a Preliminary Medicine year, and spend most of the time working in the ICU... this is what he recommended, I cannot say which one is better, Medicine or Surgery for the Preliminary year, but the overwhelming majority say Medicine, this is just based on my experiences, even the Surgical Interns quoted a Surgical Internship as 'suicidal'.... I can attest to this, as I saw firsthand how things went down... its a rough life being the first year Surgical Intern.... the Intern always got the crappiest cases, and got the most horrible scut work, and worked the worst shifts.. man in my opinion HANDS DOWN the best option is to do a Transitional year... that is very cush. Now I am not saying that easier is better, I am just saying that learning at youre own pace, and being in a comfortable environment is important for physical and mental well being, especially when you are not going to do it for the rest of youre life.

 

[Wahoowa]

I am doing a four-year program with my prelim year on an "anesthesia" track. I do rotations in general surgery, ENT, OB, ER, neuro, medicine, and several ICU's. I get a taste of both surgery and medicine, but it is heavy on ICU. I think that this is good for anesthesia--especially with the heavy ICU experience and dealing with critically ill patients since I have heard several times that the OR is like a one-patient ICU.