Everyone's story is different, and unfortunately that story will predetermine your chances of success in obtaining a categorical position. My story was simple-- being from the East Coast, I only applied to programs east of Chicago. In February last year my husband was essentially transferred to Seattle-- after program rank lists were already in, not to mention after application deadlines! My PD here was very gracious and genuinely interested in making my personal situation work, and she offered me the two-yr prelim position. So, on ERAS, I ranked the 2-yr prelim first, with all of the (categorical) programs I'd interviewed at afterwards.
When I showed up at UW for intern orientation, I was admittedly very sensitive about being perceived as a sub-par intern (primarly from other residents, less so from attendings). I was also afraid that people would secretly think I wasn't very devoted to surgery, or to my career, since I was willing to "jeopardize" it in such a way. Orientation is tough for prelims-- whereas everyone else is celebrating having "arrived," having a place where they will belong, being taken out by senior residents/attendings, you sort of feel stateless. Like the Palestinians of post-graduate medical education.
But I have had a fabulous experience here so far. I think UW is uniquely open-minded regarding its prelims. For starters, when you get the inevitable "why didn't you match?" questions with each new set of attendings/seniors, my story was actually extremely well-received. In terms of operative experience, there is no difference-- I logged 113 cases last year, which is above our average. In terms of schedule,
all prelims, both designated and non-designated, have slightly different schedules here from the categoricals, but they try to closely approximate the 2-yr prelims' schedules to categorical ones. And honestly, many of the differences are in our favor, as I got to rotate through subspecialties which categorical residents did not, and as a result have a very useful knowledge base which they do not have.
I will not lie though-- no matter what the circumstances that cast you into this particular boat are, there is an ever-present overhanging cloud of anxiety about your ultimate "dispo." You are, like it or not, basically on a 1-year-long (or two, in my case) sub-i. You have to always be on your toes. You are always being evaluated, much as you were as a 4th yr med student trying to impress. No matter what happens to me, if I stay at UW or have to go somewhere else, I will *never* forget what this feels like.
I'm not sure if I'm a great position to give advice about how to succeed as a prelim, as I don't know if I'll be a success story or not, but the first year went well. Firstly, I'd say that the previous advice to be indistinguishable from the categoricals is incorrect. You should try to be better than they are. In certain areas where they can slack off, you can't. You need to be more anal, more on top of things, more well-read, more X than they are. You should be better-prepared for clinic and the OR than they are. You should try to stand out amongst the crowd, such that people take notice.
Also important is to develop good rapports with attendings. This year I've become close with several attendings, just naturally due to normal interpersonal factors. I've had several people tell me that they want me to stay at this program and will advocate on my behalf for a position with the PD when it's appropriate. And, should things not work out here (after all, there might not even be a position to compete for, not to mention they could always select someone else), it's nice to have a lot of people who are willing to write letters and make calls for you.
So I think you should attempt to tick all the boxes. These are ideals and we all fall short, but the boxes are: 1) outstanding clinical performance-- each rotation's evaluation should be glowing; 2) solid opinion of your abilities and trustworthiness amongst senior residents; 3) good rapport with multiple attendings, achieved by being ultra-prepared for clinic and OR, as well as being a normal human being who can be fun to talk to; 4) assertive and confident, not afraid to advocate for your viewpoint, your diagnosis, your plan, etc while still accepting correction or being overridden gracefully; 5) good ABSITE scores-- at least better than most people in your program; 6) keep on your program director's good side.
I have had moments when thinking about this whole prelim thing where I feel it should almost be illegal. Why is it OK to offer residency positions that don't lead to board-eligibility? And the philosophy of many programs-- not mine, but many back in NYC at least-- to take poorly experienced FMGs who are very poor Match candidates (not just for Surgery, but for anything) and ask them to serve as functioning doctors in a high-stress, high-stakes field like surgery is a very bad idea. I took my job as a surgery intern very seriously. I know it's not the hardest or most important job in the hospital, but I still felt that I had a good measure of responsibility. There were many decisions made over the year, many procedures performed alone, many diagnoses that I had to make... I just feel it is criminal to take someone whom a program director would never in a million years train as their own resident, and expect them to take good care of their patients. And it's really leading that poor FMG on, too.
Anyway, let me know if anyone has any questions.
