Preliminary Year Strategy

[BloodySurgeon]

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Please bare my ignorance in this process.

I tried using the search and was not able to find the exact answers I was looking for. I am considering applying for a preliminary year in surgery if I do not match into the surgical specialty I desire. My questions are:

1. Can I apply to both a categorical and preliminary residency at the same time and also to the same program? Does a program frown upon the dual application if its in prelim surgery?

2. I understand that there are both 1 year programs and 2 year programs. Would there be a disadvantage for entering a 1 year program. Is there enough time to re-apply for a categorical spot, half-way through the year?

3. Are preliminary spots in a desired locations like california more or less difficult to match than a categorical spot in general surgery there? Who would have a better shot at matching at a competitive program in general surgery, the preliminary resident or the medical student, or are they considered equal?

4. When applying after your preliminary year, are step 1 and 2 scores strongly considered for matching to the same degree as applying as a medical student?

I love surgery but I would like to try my best to get into the surgical sub-specialty I desire. I already took a year off for research and willing to take another for a preliminary year, but after that I don't think I can do any more. I am wondering how I should plan my application to not hurt me severely in the future.

Thank you for your reply in advance.

 

[Smurfette]

1. Yes, but that's not smart. Why would they match you to a categorical spot if they could match you to a prelim spot and find a second, equivalently good candidate (who did not apply to the prelim spot)to fill the categorical spot? It's a win-win for the program who gets two good interns instead of one good intern, but you lose out on job security beyond 1 year. Plus if you are competitive for a surgical subspecialty, you should be competitive for a categorical position.

2. Many places will not necessarily match someone as a prelim for 2 years straight out of the gate. They match you to a one year spot and then keep 1-2 of these interns to fill a prelim PGY 2 spot the following year. Usually the prelim second year residents are the best prelims, and the program offered to keep them another year. This also is a possibly extra opportunity to slide right into a categorical spot if somebody in your year of training (or the year below you) quits, or if an extra person is going into the lab---if you're well-liked and a good resident, they may offer you this position and *voila* you are now a categorical resident.

3. Generally speaking, prelim spots are not competitive and they go unfilled in the match in relatively large numbers compared to other spots. These spots generally fill by people who need to scramble into a position, rather than via the first round of the match. A med student has a better shot if all things (such as board scores, etc.) are otherwise equal; the assumption would be that a prelim failed to match before and can be viewed as a bit of a red flag.

4. Most programs initially screen by step scores, so yes. They also can screen for year of graduation, which puts prelim residents at a disadvantage.

 

[thedrjojo]

1. Yes, but that's not smart. Why would they match you to a categorical spot if they could match you to a prelim spot and find a second, equivalently good candidate (who did not apply to the prelim spot)to fill the categorical spot? It's a win-win for the program who gets two good interns instead of one good intern, but you lose out on job security beyond 1 year. Plus if you are competitive for a surgical subspecialty, you should be competitive for a categorical position.

2. Many places will not necessarily match someone as a prelim for 2 years straight out of the gate. They match you to a one year spot and then keep 1-2 of these interns to fill a prelim PGY 2 spot the following year. Usually the prelim second year residents are the best prelims, and the program offered to keep them another year. This also is a possibly extra opportunity to slide right into a categorical spot if somebody in your year of training (or the year below you) quits, or if an extra person is going into the lab---if you're well-liked and a good resident, they may offer you this position and *voila* you are now a categorical resident.

3. Generally speaking, prelim spots are not competitive and they go unfilled in the match in relatively large numbers compared to other spots. These spots generally fill by people who need to scramble into a position, rather than via the first round of the match. A med student has a better shot if all things (such as board scores, etc.) are otherwise equal; the assumption would be that a prelim failed to match before and can be viewed as a bit of a red flag.

4. Most programs initially screen by step scores, so yes. They also can screen for year of graduation, which puts prelim residents at a disadvantage.

1. I'm going to disagree with your logic some. If you apply to a place as both categorical and prelim, you rank the two slots differently. So if I rank program a categorical #1, a bunch of other cat spots, then program a prelim #25,the program doing your strategy must hope I don't mat at 2-24. Plus, they won't know where other apps are ranking, so if they like him enough as a cat, they will rank him in the cats higher than ones they don't like... Prelim may cost him a spot or two on the list, but probably not.
2) the great majority of programs, as smurfette stated, are 1 year prelims. Most prelims will be applying places that year. That being said, for the subspecialties, it's almost impossible to get it if you don't on the first go. I've seen success stories, but the are exceptions, not the rule.
3) I think this is becoming less true unfortunately. Scrambling sucks and only sucks more now. I'd have to look at the stats, but there is becoming a derth of available prelim spots. My advice is plan on getting something thru the match, not the scramble.
4) what smurfette said. Your experience may help offset a score ever so slightly, but it's more of a negative /flag than it is a help.

Usually the recommendation is subspecialty and categorical surgery spots. Talk to your advisors, dean's, and get a realistic outlook.

 

[Winged Scapula]

Yes we didn't (and don't ) interview specifically for prelim spots.

 

[ram006]

Usually the recommendation is subspecialty and categorical surgery spots. Talk to your advisors, dean's, and get a realistic outlook.

For once, we agree 100% on all your points.

As an addition, I've mentioned a couple times on this forum that I've looked at switching into integrated PRS and failed three times despite having what I consider to be a strong CV (aside from a mediocre step 1 score - which seems to be all any cares about, but that's another rant...) and a legitimate argument for being a good applicant. It's much less stressful knowing I have a job. Of course, you have to be open and honest about exploring options but if you can get people(i.e. your PD) to support your career aspirations it's worth the initial awkward/stressful convo. I've been very fortunate in that regard.

If you're looking to switch into something else like ENT or Ortho, for example, being a categorical might not be a "safer" alternative now that the Ortho/Ent intern years are sort of their own thing. Not even sure if you'd get credit for it. The only people I know that have gone GS to Ortho had to re-do their intern year. Overall, the odds of switching from GS to a surgical subspecialty are almost nil. In many cases, there's a degree of dumb luck when it happens. X program has a Urology resident get fired so X prelim slides in to their spot.

Have you considered doing a lab year and re-applying? That may actually be a better option considering doing a prelim year adds little to nothing to your CV except a widely variable "experience."

I wouldn't considering matching categorical surgery as the end of the world either. Overall, it's still a coveted position to be in and I've actually begun to reconsider my career goals. I'm not even entirely convinced I'll pursue the independent route to PRS.

 

[thedrjojo]

For once, we agree 100% on all your points.

As an addition, I've mentioned a couple times on this forum that I've looked at switching into integrated PRS and failed three times despite having what I consider to be a strong CV (aside from a mediocre step 1 score - which seems to be all any cares about, but that's another rant...) and a legitimate argument for being a good applicant. It's much less stressful knowing I have a job. Of course, you have to be open and honest about exploring options but if you can get people(i.e. your PD) to support your career aspirations it's worth the initial awkward/stressful convo. I've been very fortunate in that regard.

If you're looking to switch into something else like ENT or Ortho, for example, being a categorical might not be a "safer" alternative now that the Ortho/Ent intern years are sort of their own thing. Not even sure if you'd get credit for it. The only people I know that have gone GS to Ortho had to re-do their intern year. Overall, the odds of switching from GS to a surgical subspecialty are almost nil. In many cases, there's a degree of dumb luck when it happens. X program has a Urology resident get fired so X prelim slides in to their spot.

Have you considered doing a lab year and re-applying? That may actually be a better option considering doing a prelim year adds little to nothing to your CV except a widely variable "experience."

I wouldn't considering matching categorical surgery as the end of the world either. Overall, it's still a coveted position to be in and I've actually begun to reconsider my career goals. I'm not even entirely convinced I'll pursue the independent route to PRS.

Hey, I think we agree more often than just this one time 😉

I had a friend do a prelim intern year and then get an ENT 2 spot that she had applied for the previous year, didn't match (couples match fiasco - we all blame him as she was probably the best applicant for any residency in our program) and the PD at the other program was shocked she wasn't matched and scoped her up for the PGY2 ENT spot, counting her prelim intern year. Another friend did 2 prelim surgery years, 2 years in the lab, and when an Urology 2 spot opened up at our program, slide right into it and was given credit for the 2 prelim years to count as his intern year. If you go through the match into these programs they will usually make you redo that prelim year.

PRS is a special situation that you have plenty of PRS fellowships. BUT, you have similar options for other specialties. Head and Neck fellowships exist for the aspiring ENT's. Fellowships like Hand or some soft tissue cancer fellowships exist to satisfy some of your ortho desires. Urologist wannabes can do Transplant and still play around with kidney's.... clearly not perfect, but you can find a silver lining in any situation

 

[BloodySurgeon]

Have you considered doing a lab year and re-applying? That may actually be a better option considering doing a prelim year adds little to nothing to your CV except a widely variable "experience."

I have already done a year of research and have continued doing research since. I have plenty of publications, but don't think it will off-set the competitiveness of some of the surgical sub-specialties. I have an average step 1 score and clinical grades. I do have outstanding LORs with people offering to make phone calls and ask to write me a letter and I am willing to work hard and spend more time getting into a program but I've heard from many residents that in most cases that wont help without a good step score.

It would be unfortunate if I spend 1-2 years doing a preliminary year of surgery in addition to my previous year of research and end up starting as a PGY1 general surgeon. I don't believe I will have difficulty matching as a categorical general surgeon so I dont want to regret my decision in the future.

Also, do i apply for preliminary surgery the same way as any other specialty on ERAS or do I have to not match and scramble into a prelim spot?

 

[ram006]

I have already done a year of research and have continued doing research since. I have plenty of publications, but don't think it will off-set the competitiveness of some of the surgical sub-specialties. I have an average step 1 score and clinical grades. I do have outstanding LORs with people offering to make phone calls and ask to write me a letter and I am willing to work hard and spend more time getting into a program but I've heard from many residents that in most cases that wont help without a good step score.

It would be unfortunate if I spend 1-2 years doing a preliminary year of surgery in addition to my previous year of research and end up starting as a PGY1 general surgeon. I don't believe I will have difficulty matching as a categorical general surgeon so I dont want to regret my decision in the future.

Also, do i apply for preliminary surgery the same way as any other specialty on ERAS or do I have to not match and scramble into a prelim spot?

I actually do think knowing the right person matters quite a bit.

Examples of blatant nepotism completely aside, my med school had around 20 people match into Ortho. Not all of them were junior AOA 260 type studs but our home program is one of the elite places in the country and getting a letter from one of the heavy hitters probably meant a great deal. If I remember correctly the median score for those students that matched was something like 242, but there were a few people far below that mark (one step 1 failure).

Overall, you seem to have a realistic idea of where you stand. Being average means your odds aren't great but they're not zero. You need to decide whether you're willing to take a categorical GS spot or you'd rather deal with the uncertainty of being a prelim and having no gaurantee of a sub-specialty or GS position.

As has been stated many times, switching into a sub-specialty is not common so if you decide on categorical GS you have to be ok with the idea of being a general surgeon and never making a switch (unless it's PRS and you can just wait it).

When we interview we have sort of an unofficial prelim day mostly for FMGs, but interviewing for a categorical position means you can rank a prelim spot if you. I ranked both tracts because I only ranked one program for geographic and personal reasons. The program codes are different for categorical and prelim tracks at the same institute. Here we have prelim, 5 year and 7 year options all with different codes so you can match them however you want.

 

[BloodySurgeon]

Thank you all for your wonderful responses. This was very helpful and after my away rotations I will make an informed decision on my application for surgery. I understand there are many tracks with various outlier, but overall they are the exception and not the rule. In the end I am still grateful to be practicing medicine and if I were to be a general surgeon it will still be a great honor. I appreciate everyone's time in responding to this thread.

 

[svst02]

Yes we didn't (and don't ) interview specifically for prelim spots.

Hi!

I am a radiology applicant waiting on surgery-preliminary interviews with no success yet. Would you recommend applying to more or doing something different? I have already emailed all the coordinators reaffirming my interest in the programs and updating my application.
Your help is much appreciated.

 

[Winged Scapula]

Hi!

I am a radiology applicant waiting on surgery-preliminary interviews with no success yet. Would you recommend applying to more or doing something different? I have already emailed all the coordinators reaffirming my interest in the programs and updating my application.
Your help is much appreciated.

My advice is to be patient.

It's way too early. Many, if not most surgical programs do not place emphasis on interviewing for preliminary positions. However you may wish to contact the individual programs. assess whether they actually do interview for those positions or interview late versus waiting for SOAP.

 

[doc05]

Hi!

I am a radiology applicant waiting on surgery-preliminary interviews with no success yet. Would you recommend applying to more or doing something different? I have already emailed all the coordinators reaffirming my interest in the programs and updating my application.
Your help is much appreciated.

as an aspiring radiologist, you will be better off doing a prelim medicine year, or transitional year. there is no benefit in the year of surgery internship.