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Anyone applying/aiming for prelim surgery spots? It seems like everyone is going for TY/medicine spots...Just wondering.
Prelim Surgery
- Thread starter usmlesuccess
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I strongly discourage you from pursuing this route. You may think that you are going to gain valuable "surgical" experience, perhaps in the hope of helping you to learn how to manage patients in your eventual surgical sub-specialty (ophthalmology). In reality you will be run ragged performing constant scut. You will seldom see the inside of an operating room. The PGY-2's and up will in all likelihood resent you. Even were you to gain a valuable experience dealing with postoperative patients, you will seldom need this in your career as an ophthalmologist. As an ophthalmologist, 99.9% of your surgery will be out-patient based. You won't need to worry about Foley management, wound management, wound vacs, etc.
Please spare yourself a year of misery and pursue a medicine pre-lim (more educational) or even better, a transitional year spot (more fun). Honestly, one of the best years of my life was my TY year. I met great people who were interested in similar pursuits. We were able to socialize outside the hospital. Most importantly, we got that first year out of the way with as little pain as possible and we moved on to what we all really wanted to do with our lives (ophtho, derm, rads, etc.) The only people I've spoken to who did surgical prelim's greatly regretted it. There is a reason why the majority of these spots go unmatched.
Just my two cents. Take it for what it's worth.
Please spare yourself a year of misery and pursue a medicine pre-lim (more educational) or even better, a transitional year spot (more fun). Honestly, one of the best years of my life was my TY year. I met great people who were interested in similar pursuits. We were able to socialize outside the hospital. Most importantly, we got that first year out of the way with as little pain as possible and we moved on to what we all really wanted to do with our lives (ophtho, derm, rads, etc.) The only people I've spoken to who did surgical prelim's greatly regretted it. There is a reason why the majority of these spots go unmatched.
Just my two cents. Take it for what it's worth.
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I agree mostly with what was said above. I don't have a Cush TY, but I'm doing IM and it's not all scut and we have conferences and teaching that engage me enough to get me through it.
Most surgery prelims predominantly manage the floors with little education supporting what you're doing. You may attend surgery conferences but they will be irrelevant to what you're having to do on the daily, because you will not see much of an OR.
I know someone who did a surgery prelim and it was a unique situation where he got to scrub in regularly. If you insist on doing a surgery prelim I urge you to seek out one of those years that is known to have significant OR time.
Most surgery prelims predominantly manage the floors with little education supporting what you're doing. You may attend surgery conferences but they will be irrelevant to what you're having to do on the daily, because you will not see much of an OR.
I know someone who did a surgery prelim and it was a unique situation where he got to scrub in regularly. If you insist on doing a surgery prelim I urge you to seek out one of those years that is known to have significant OR time.
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I also agree that a surgical prelim year before ophtho is unlikely to be the best use of your time. If you are able to get significant experience in plastic surgery or suturing, that would be helpful, but absent that, it is likely to be very little bang for your buck. I did a TY at a community hospital and loved it. Some months were very busy, but enabled me to do a lot of procedures (>40 central lines on my own, e.g.), and other elective months were less rigorous, shall we say.
Everyone gets well-trained over the 3 years of ophtho residency, but having surgical experience during internship gives you a head start in the OR as a first/second year, and many attendings have commented on this. Especially since first/second year you'll be doing plastics/strab cases, which draw from many general surgical principles. Most of us get surgical experience through surgery blocks in TY internships, which are often at community programs where the relative paucity of categorical surgical residents allow TY interns to be first assist on many cases. I think in terms of usefulness for ophthalmology, TY > surgery > medicine. I agree though, that if you're at a surgical program but just managing floor patients, that's a waste of time (probably more likely to be the case at larger academic centers, but obviously depends on the program) in which case a medicine year would be better. Do TY with surgical exposure if possible.
Here's a good thread from 10 years ago (2004 was 10 years ago? wow) where some would disagree with me about the utility of learning macroscopic surgery during internship: http://forums.studentdoctor.net/threads/prelim-surgery.100168/
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Thank you all for your reply! This is why sdn is the best! I am leaning towards a surgery year for various reasons, including good program and good city. If anyone has any other input please post!
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Don't do surgery. Find the easiest transitional year program you can find and do that. Any possible dexterity advantage you might gain from a year of surgery will likely be erased by the time you start your second year of ophthalmology, assuming you spend any significant time in the OR at all.
Many TY programs offer surgical electives. I had a month of plastic surgery during mine and was in the OR Monday through Friday suturing alongside the attending. I even learned some liposuction; it was great.
Many TY programs offer surgical electives. I had a month of plastic surgery during mine and was in the OR Monday through Friday suturing alongside the attending. I even learned some liposuction; it was great.
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I did a prelim surgery intern year prior to starting ophthalmology - it's not for everyone, but here's some more thoughts for conversation.
It really depends on what you're looking to gain from your intern year. Just keep in mind this is really the last time you'll be taking full medical care of inpatients and doing more than just primarily outpatient and day surgery the rest of your life. Keep an open mind about your intern year in that it is an opportunity instead of just "a wasted year" prior to doing what we all really love doing - operating on eyes! Use it as an opportunity for doing things outside of medicine if you opt to go the cush route.
Full disclosure - I applied to a limited number of cush TY and community IM programs seeking a laid back year in a specific geographic region because like many others that post on SDN, I figured my QOL will be much better if I'm working 55-65 hrs/week instead of 75-85 hrs/week. Your QOL and attitude probably would be much better at the cush programs if you never considered having a busy residency/career. I almost applied to neurosurgery because I actually enjoy being in the operating room, waking up early and taking care of sick surgical patients much more than medical patients.
I didn't match into a cush TY program because I only ranked two competitive programs with great benefits that I thought I had a great chance of matching at and actually thought the residents enjoyed taking care of patients at these programs vs. the other places where everyone was just trying to do as little work as possible. I ended up at a prelim surgery program that I had looked into a fair amount prior to deciding on applying to just TY and IM programs. I never in a 100 years would have done an academic prelim IM program - you work 70-80 hours on average except clinic months at most of these programs and spend the vast majority of time writing notes, working on dispo issues and rarely get to do procedures. Surgery notes are brief, to the point and not a waste of time. Brief notes never killed anyone.
I totally agree that you will probably have more time to be a normal human and pass through the year like a 5th year of medical school doing a TY program in terms of pressure and amount of work. That was my thought too. As I interviewed and spoke with most residents at these programs, the sentiment was just that, try to get through the year doing as little as possible. That's OK IMO if this is your goal. It was my intention at first, but given certain location restrictions, plan B for me was prelim surgery at a place where I get to operate some if I didn't land a spot at the cush programs I actually liked. I was OK with doing a surgery year from the get go.
My year:
I definitely got to operate at my program, logged 135 cases, 30+ central lines, 25+ a-lines and about two dozen chest tubes. Also fixed numerous lacs in the ED and on trauma patients. Surgery residents were well respected at my program and I never felt any angst from my fellow residents or prelim residents. I became more at ease doing procedures with my hands, suturing, etc.
My fellow residents respected me for doing a surgery year, albeit out of necessity when I didn't formally apply for prelim surgery in the original match. I had my fair share of intern level cases (lap appys, lipoma excisions, vascular cath cases), but did some other great procedures like ORIF of ZMC fracture with plastics, several cranis with NSG on trauma patients, and multiple AV fistulas with transplant where you get you use vascular instruments commonly used in ophtho. I feel much more comfortable in the OR compared to my co-PGY2s who did medicine and TY programs. My PD has mentioned it several times.
Pros:
--There is an advantage of doing prelim surgery if you're doing ophtho - maybe not so much for derm or radiology (unless you want to do VIR).
--You will get to the OR at many of the programs for intern level cases. Seek out those programs - if you end up at a program with only scut work (e.g. Harvard/JHU gen surg), you will hate it. I have surgery friends at top programs who never get to operate (they do have fancy wet labs/training facilities, though) and were surprised how much I got to operate. Ask programs if they fill their prelim surg spots through the match or through a scramble?
--You will work hard - makes your transition to ophtho much more pleasant because you all the sudden have this extra time you didn't have last year.
--You see the difference between medicine and surgery. Enough said.
--Mild improvement in using non-dominant hand when operating. Really only noticed it in laparoscopic cases where I had to use both hands equally. Don't think that this is the main goal of the year.
--You learn to manage electrolytes, change antibiotic coverage as needed, hone physical exam skills, manage SICU patients just like medicine residents do for MICU patients. A lot of these intern learning objectives spread across all the specialties. I would rather learn how to make my skin closure more symmetric than the different classes of heart failure.
Cons:
--You work very hard and start before everyone else. The first few months were not fun in that regard. Then you get used to it and it was fine. I have a family and we adjusted. Again, makes you appreciate not having to get up at 4am anymore during your ophtho time even though I probably still get up very early because I got used to it last year.
--I averaged about 75 hours/week the entire year - I'm willing to bet my 75 hours were much busier than IM 75 hours. We didn't and couldn't cap our census, and often felt very exhausted. You'll have good days and bad days. you'll have good and bad weeks (several 55 hour weeks and several 90 hour weeks)
--You need to have a surgeon attitude if you want to consider prelim surgery. If you never got along with surgery residents in medical school, then it's not for you. You need to enjoy getting up early and taking care of surgical patients.
--The hierarchy in surgery is evident at every program. It's there because we operate and we do stuff in addition to taking care of floor patients. It can be a little upsetting when your chief or senior leaves you to manage the service at 2pm - don't know how often this happens in medicine but I will admit this happens often and will likely never change.
--Some programs differentiate prelims from categoricals - avoid these. Always ask if prelim residents get treated the same 100% or not.
In the end, most will not choose surgery because of inertia and because of lifestyl/QOL choices. I think it's an individual decision - don't think academic IM programs are laid back compared to surgery. They often put in as many hours, though they may be not as busy/stressful as the reputation surgery has. I valued my surgery year and think it has made me a better ophthalmology resident (may have little effect on the end outcome once practicing) at the very least than if I had done a TY. Decide if you would rather take care of a medical patient every morning or a surgical patient, and then find the program that will fit you and your educational needs. What you don't want is to end up at a program where you ONLY do floor work and see consults - because then it's basically like doing medicine but just busier.
It really depends on what you're looking to gain from your intern year. Just keep in mind this is really the last time you'll be taking full medical care of inpatients and doing more than just primarily outpatient and day surgery the rest of your life. Keep an open mind about your intern year in that it is an opportunity instead of just "a wasted year" prior to doing what we all really love doing - operating on eyes! Use it as an opportunity for doing things outside of medicine if you opt to go the cush route.
Full disclosure - I applied to a limited number of cush TY and community IM programs seeking a laid back year in a specific geographic region because like many others that post on SDN, I figured my QOL will be much better if I'm working 55-65 hrs/week instead of 75-85 hrs/week. Your QOL and attitude probably would be much better at the cush programs if you never considered having a busy residency/career. I almost applied to neurosurgery because I actually enjoy being in the operating room, waking up early and taking care of sick surgical patients much more than medical patients.
I didn't match into a cush TY program because I only ranked two competitive programs with great benefits that I thought I had a great chance of matching at and actually thought the residents enjoyed taking care of patients at these programs vs. the other places where everyone was just trying to do as little work as possible. I ended up at a prelim surgery program that I had looked into a fair amount prior to deciding on applying to just TY and IM programs. I never in a 100 years would have done an academic prelim IM program - you work 70-80 hours on average except clinic months at most of these programs and spend the vast majority of time writing notes, working on dispo issues and rarely get to do procedures. Surgery notes are brief, to the point and not a waste of time. Brief notes never killed anyone.
I totally agree that you will probably have more time to be a normal human and pass through the year like a 5th year of medical school doing a TY program in terms of pressure and amount of work. That was my thought too. As I interviewed and spoke with most residents at these programs, the sentiment was just that, try to get through the year doing as little as possible. That's OK IMO if this is your goal. It was my intention at first, but given certain location restrictions, plan B for me was prelim surgery at a place where I get to operate some if I didn't land a spot at the cush programs I actually liked. I was OK with doing a surgery year from the get go.
My year:
I definitely got to operate at my program, logged 135 cases, 30+ central lines, 25+ a-lines and about two dozen chest tubes. Also fixed numerous lacs in the ED and on trauma patients. Surgery residents were well respected at my program and I never felt any angst from my fellow residents or prelim residents. I became more at ease doing procedures with my hands, suturing, etc.
My fellow residents respected me for doing a surgery year, albeit out of necessity when I didn't formally apply for prelim surgery in the original match. I had my fair share of intern level cases (lap appys, lipoma excisions, vascular cath cases), but did some other great procedures like ORIF of ZMC fracture with plastics, several cranis with NSG on trauma patients, and multiple AV fistulas with transplant where you get you use vascular instruments commonly used in ophtho. I feel much more comfortable in the OR compared to my co-PGY2s who did medicine and TY programs. My PD has mentioned it several times.
Pros:
--There is an advantage of doing prelim surgery if you're doing ophtho - maybe not so much for derm or radiology (unless you want to do VIR).
--You will get to the OR at many of the programs for intern level cases. Seek out those programs - if you end up at a program with only scut work (e.g. Harvard/JHU gen surg), you will hate it. I have surgery friends at top programs who never get to operate (they do have fancy wet labs/training facilities, though) and were surprised how much I got to operate. Ask programs if they fill their prelim surg spots through the match or through a scramble?
--You will work hard - makes your transition to ophtho much more pleasant because you all the sudden have this extra time you didn't have last year.
--You see the difference between medicine and surgery. Enough said.
--Mild improvement in using non-dominant hand when operating. Really only noticed it in laparoscopic cases where I had to use both hands equally. Don't think that this is the main goal of the year.
--You learn to manage electrolytes, change antibiotic coverage as needed, hone physical exam skills, manage SICU patients just like medicine residents do for MICU patients. A lot of these intern learning objectives spread across all the specialties. I would rather learn how to make my skin closure more symmetric than the different classes of heart failure.
Cons:
--You work very hard and start before everyone else. The first few months were not fun in that regard. Then you get used to it and it was fine. I have a family and we adjusted. Again, makes you appreciate not having to get up at 4am anymore during your ophtho time even though I probably still get up very early because I got used to it last year.
--I averaged about 75 hours/week the entire year - I'm willing to bet my 75 hours were much busier than IM 75 hours. We didn't and couldn't cap our census, and often felt very exhausted. You'll have good days and bad days. you'll have good and bad weeks (several 55 hour weeks and several 90 hour weeks)
--You need to have a surgeon attitude if you want to consider prelim surgery. If you never got along with surgery residents in medical school, then it's not for you. You need to enjoy getting up early and taking care of surgical patients.
--The hierarchy in surgery is evident at every program. It's there because we operate and we do stuff in addition to taking care of floor patients. It can be a little upsetting when your chief or senior leaves you to manage the service at 2pm - don't know how often this happens in medicine but I will admit this happens often and will likely never change.
--Some programs differentiate prelims from categoricals - avoid these. Always ask if prelim residents get treated the same 100% or not.
In the end, most will not choose surgery because of inertia and because of lifestyl/QOL choices. I think it's an individual decision - don't think academic IM programs are laid back compared to surgery. They often put in as many hours, though they may be not as busy/stressful as the reputation surgery has. I valued my surgery year and think it has made me a better ophthalmology resident (may have little effect on the end outcome once practicing) at the very least than if I had done a TY. Decide if you would rather take care of a medical patient every morning or a surgical patient, and then find the program that will fit you and your educational needs. What you don't want is to end up at a program where you ONLY do floor work and see consults - because then it's basically like doing medicine but just busier.
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^wow. thank you for the nice post!
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I did a prelim surgery year as well because honestly I hated rounded multiple times a day. I strongly disagree with the earlier posts as they are not based on actual experiences. What I can say is the other residents I work with in my Ophtho residency did not have any advantage in terms of medical knowledge that set them apart from me. In fact, most did cush TY years and were traumatized when they had to take heavy home call in the beginning. What I can say is that I was in the operating room all the time and these skills did set me apart from the other Ophtho residents. From early on I was able to show my dexterity and skills in the OR; I had my first primary surgery ( an evisceration ) by early October my first year. There was still a learning curve with operating under the microscope but I had countless hours with the robotics training. Even as a third year, my attendings consider my performance to be more advanced then my coworkers in the OR. One thing you can not learn from a book is surgical skills. If you do a surgery prelim year, you will basically have your pick of where you want to go so you can avoid going to programs where you will be "scutted out." I did get harassed by my surgery residents, but it was all in good fun and there was no resentment. I choose a location I was familiar with and worked out a deal to get 5 elective months with the PD prior to agreeing to take the spot. That's not too bad, some TY's wont give you 5 elective months.
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All I can think of is " You know, like nunchuck skills, bo hunting skills, computer hacking skills. Girls only like guys who have great skills."
A first primary surgery by October is nothing to write home about in my opinion. Surgical experience will be highly program dependent and won't have any correlation as to what internship one did.
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any suggestions for programs that do let you operate during prelim surg year?
bump
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MUSC, Mass General, Mount Sinai, UVA, Montifiore, Wake Forest, and many others. I interviewed at MGH prelim surgery and really loved it. Would've been my #1 if not for personal reasons. Also, many branch programs will have you in the OR and may have better environments: Baylor-Dallas, UT-Knoxville, Tufts-Baystate, Mayo-Jacksonville, etc. It's a myth that you won't operate anywhere, and some people that rationalize med prelim in that manner simply don't want to do the more difficult year. You just have to be careful with your selection of programs, otherwise they'll be right and you'll be miserable.
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To those of you who are doing prelim surgery years, God bless your souls. Not going to talk anyone out of it, but I had a integrated internship with no non-ophthalmic surgery, and I loved it. I felt fine surgically and was comfortable in the OR after residency. If you have that much desire to operate, go for it, but in my opinion it just doesn't help that much in the long run. You'll probably forget most of what you learned as an intern after you're done with residency. And really, if it's microsurgery or plastics that you want to be proficient in, do a fellowship if you feel residency isn't enough.
Very strange. The thread was bumped from 2014.
In medical school, I did a rheumatology rotation which I thought would be great for uveitis background but it was a complete waste of time, the least useful rotation of medical school.
In medical school, I did a rheumatology rotation which I thought would be great for uveitis background but it was a complete waste of time, the least useful rotation of medical school.
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