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Discussion in 'Surgery and Surgical Subspecialties' started by uro, Feb 26, 2007.

  1. uro

    uro Membership Revoked

    Jan 3, 2007
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    Yes, I've searched. I've dug. I've literally beaten those who might have the answers. But alas, still no insight.

    I've come searching for answers.

    How do GS residencies function? Are they pyramid schemes? All of them? I still can't figure it out.


    [FONT=arial,helvetica][SIZE=-1]Institution list[/SIZE]. [FONT=arial, helvetica][SIZE=-1]
    [/SIZE]. [FONT=arial, helvetica][SIZE=-1] Milton S Hershey Medical Center - Hershey, PA[/SIZE].
    [FONT=arial,helvetica]General information.

    [FONT=arial,helvetica][SIZE=-1]Comments:[/SIZE]. [FONT=arial,helvetica][SIZE=-1]Total program size[/SIZE].
    Is this a pyramid? Assuming most of the Yr1 folks are prelims, what in the world happens to the GS residents between Yr2 (7) and Yr3 (5)? What happened to those guys? How about the Yr3 --> Yr4 guy? Out on his ass? Was this planned all along (i.e., did Penn State *know* or require that one of the Yr3 residents would not advance?) If so, is this the definition of a pyramid program?
  2. Tigger14

    Tigger14 Ready to move
    7+ Year Member

    Feb 27, 2002
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    Resident [Any Field]
    While this appears to be a pyramid, it is not. The larger numbers of residents in earlier years are designated preliminary spots, and unless someone leaves the categorical program, those individuals need to find another position for the subsequent year. It goes up to PG3, because some programs (ie plastics) have a 3+3 option.

    A pyramid would be a system in which you do not know from year to year if you will be advancing.
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  3. Winged Scapula

    Winged Scapula Cougariffic!
    Staff Member Administrator Physician Faculty Lifetime Donor Verified Expert Verified Account 15+ Year Member

    Apr 9, 2000
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    Attending Physician
    As a surgery graduate of Penn State, I feel rather qualified to answer your question.

    We have a large number of designated prelims in PGY1 year who go onto further training in Ortho, ENT, Urology, Neurosurgery. The exact number varies from year to year, as some programs take different numbers in alternating years, so I cannot specify what number out of the "17" listed are designated prelims without knowing the year and the number each specialty was taking.

    We have 4 cagtegorical general surgery residents per year.

    We have a few non-designated prelims each year who are hoping to get into a categorical position.

    Thus, the PGY2 year drops by a number of positions because most of the interns go into designated subspecialty training. We have more than the 4 categorical surgery positions because 1 is for plastics and we have a tradition of keeping on at least 1 PGY1 into a second Prelim year before working him/her into the lab or a categorical PGY3 position. Usually we don't have enough room or approval to take more than one non-designated into the PGY2 year. We are only approved for 4 categoricals per year, so cannot make that person (or any other Prelim) a categorical until the number of cagtegoricals falls below 4 (either because someone quit, or moved or stayed in the lab). This usually happens by the 3rd year.

    The number varies in the PGY3 year because people go in and out of the lab. It is not a pyramidal program but rather one that does try and keep some of the good non-designated Prelims and give them categorical spots without having to repeat PGY1.

    It is a violation for programs managed by the RRC to be pyramidal.

    There are lots of SDN threads dealing with this issue, easily found by using the Search function:






    Hope that helps.
  4. hyperbaric

    hyperbaric Cool under pressure.
    7+ Year Member

    Mar 18, 2005
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    Attending Physician
    What do you mean by the 'lab'?
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  5. Syranope2

    Syranope2 Senior Member
    10+ Year Member

    Jan 21, 2004
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    Many surgical residents spend at least one year and often two doing research. This is most often done after second year of residency. Quite a few schools require research from their surgical residents.

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