Surgery prelim a good idea?

[Radiologyreviews2015]

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According UCSD guide to competitive residencies:

"Ironically, a surgery internship is probably the most useful option for later training in radiology, as you will be dealing routinely with anatomy and reviewing imaging on a regular basis....the field of radiology in general seems to be moving toward preliminary surgery training instead of medicine or transitional internships."

"It is important to mention that many radiology programs, especially at the fellowship level, seem to be catching onto the fact that many transitional internships are easier than other types of internship...this consideration might be worth keeping in mind as you decide where to complete your intern year."

Should I actively seek a surgery prelim year? Will this make me a better radiologist? Thoughts?

 

[Radiologyreviews2015]

 

[Radiologyreviews2015]

The video is correct. The guide is wrong.

Some who are IR bound may disagree. Have not meet DR applicants who prefer surgery. There may be a small minority and a group trying to justify after the fact.

 

[Radiologyreviews2015]

To quote shark:

"In order to be a good radiologist you need to have a good understanding of many disease processes, many surgical procedures and ....
After starting your radiology residency, you will find out that the best radiologists are those who understand the disease entities better and in more depth.
Surgery is a key rotation. But whatever you learn as a medical student is not enough. You will end up with a CT abdomen from ED in a patient who has history of Whipple procedure, 3 different bowel anastomosis, and ileal pouch. And now has bowel obstruction and you have to read the CT.

The best MSK radiologists are those who know the concept of many ortho procedures, their indications and the technique.
The same is going for Neurology, Neurosurgery, ortho, GI, OB, ENT, .. .

The best radiologists I have ever seen are not the best film readers and are not the ones who do not miss the small apical lung nodule. They are the ones with best clinical knowledge in addition to imaging skills.

Many 2nd year residents by the end of the year become very good at describing the findings and not missing important ones. But when it comes into the IMPRESSION part of the report which is the clinical judgement, then you see why they are 2nd years and are not attending. It is comparable to clinical medicine. A PA can easily prepare an H&P or a progress note. But when it comes to the assessment/plan part, they lack the skill."

 

[Zakley]

I'm part of that small minority who applied only surgery prelim and can't tell you the shock and horror I get from basically anyone I tell. Some of them take a moment and then go, "Oh, IR, right?" And I nod, but that's not the full story. Yes, I like IR and maybe I'll still like it by the time fellowship applications come around. The surgeons I've interviewed with all think it's a good idea because they like radiologists who already know what surgeons want and how to talk to them. And there might be a case made for knowing how the actual anatomy looks, especially in a post-op case like above:

You will end up with a CT abdomen from ED in a patient who has history of Whipple procedure, 3 different bowel anastomosis, and ileal pouch. And now has bowel obstruction and you have to read the CT."

But the main reason is that I just liked surgery better than medicine. I also think that with the way I'm being told that radiologists need to take a more active role in patient care, I expect the acute/surgical patients are ones that will be on my list to actively participate with. That training seems to be what a surgical intern year is mostly for. It's speculation of course, so I'll find out how right/wrong I am and will have to report back in a year or 5. 😉

 

[Fab5Hill33]

There is no right answer to this because of how variable internship experiences are.

I'm a practicing IR. I did a medicine internship. At my internship, I had my own clinic 1/2 day a week for the entire year. This allowed me to develop skills that are valuable to me in my current practice. I also learned to manage inpatients. Also a worthwhile experience to my current practice. The surgery interns at my internship hospital were pure scut monkeys. They rounded on literally 50-60 patients a day and took care of inpatient floor issues while the more senior and categorical residents did clinic and operated.

I'm not saying this is the standard everywhere. The point is that just because you do a surgery internship does not mean you'll come away with surgical skills. At some places you may very well do so. But it varies place to place. It's an absolute mistake to group all medicine internships or surgical internships as equivalent. There is MARKED variability.

 

[tco]

I see no benefit to doing a surgical intern year. You can search my prior posts for an exhaustive explanation as to why. In short:

A surgical intern is a medical intern who is taught medicine by an attending who knows as much medicine as a June medical intern. At most programs, you're running the floor and giving stool softeners, changing bandages, advancing diets, and consulting medicine when a medical issue comes up.

The surgeons do know a LOT more imaging than the medicine folk, but the difference that will make in your training is really negligible. After a couple of months, I was just as good of a Radiology Resident as those that did a Surgical intern year.

To quote shark:

"In order to be a good radiologist you need to have a good understanding of many disease processes, many surgical procedures and ....
After starting your radiology residency, you will find out that the best radiologists are those who understand the disease entities better and in more depth.
Surgery is a key rotation. But whatever you learn as a medical student is not enough. You will end up with a CT abdomen from ED in a patient who has history of Whipple procedure, 3 different bowel anastomosis, and ileal pouch. And now has bowel obstruction and you have to read the CT.

The best MSK radiologists are those who know the concept of many ortho procedures, their indications and the technique.
The same is going for Neurology, Neurosurgery, ortho, GI, OB, ENT, .. .

The best radiologists I have ever seen are not the best film readers and are not the ones who do not miss the small apical lung nodule. They are the ones with best clinical knowledge in addition to imaging skills.

Many 2nd year residents by the end of the year become very good at describing the findings and not missing important ones. But when it comes into the IMPRESSION part of the report which is the clinical judgement, then you see why they are 2nd years and are not attending. It is comparable to clinical medicine. A PA can easily prepare an H&P or a progress note. But when it comes to the assessment/plan part, they lack the skill."

That's an inspiring quote, but means nothing in this discussion.

There is no right answer to this because of how variable internship experiences are.

I'm a practicing IR. I did a medicine internship. At my internship, I had my own clinic 1/2 day a week for the entire year. This allowed me to develop skills that are valuable to me in my current practice. I also learned to manage inpatients. Also a worthwhile experience to my current practice. The surgery interns at my internship hospital were pure scut monkeys. They rounded on literally 50-60 patients a day and took care of inpatient floor issues while the more senior and categorical residents did clinic and operated.

I'm not saying this is the standard everywhere. The point is that just because you do a surgery internship does not mean you'll come away with surgical skills. At some places you may very well do so. But it varies place to place. It's an absolute mistake to group all medicine internships or surgical internships as equivalent. There is MARKED variability.

This. So much this.

 

[CaptainSSO]

Coming from someone who did it:

Don't.

 

[shark2000]

There is no right answer to this because of how variable internship experiences are.

I'm a practicing IR. I did a medicine internship. At my internship, I had my own clinic 1/2 day a week for the entire year. This allowed me to develop skills that are valuable to me in my current practice. I also learned to manage inpatients. Also a worthwhile experience to my current practice. The surgery interns at my internship hospital were pure scut monkeys. They rounded on literally 50-60 patients a day and took care of inpatient floor issues while the more senior and categorical residents did clinic and operated.

I'm not saying this is the standard everywhere. The point is that just because you do a surgery internship does not mean you'll come away with surgical skills. At some places you may very well do so. But it varies place to place. It's an absolute mistake to group all medicine internships or surgical internships as equivalent. There is MARKED variability.

Agree.

IR has become a different specialty. If you want to do IR, expect to have a clinic, admit your own patients, follow the patients, interact with other medical fields and be a consultant to them, introduce new procedures to them, go to hospital committees, go to multidisciplinary conferences and ...

Whether a medical or a surgical internship is more useful depends on the program. At the end of the day, it is not that important. It is just the beginning of the tale. The most important thing is whether you like to be a surgeon or not. If not, you are not IR type.

I myself do lots of procedures in my group up to 30% of my time. But I am not IR type in a way that for example our new IR guy is. I highly respect what he does but at the same time I don't want to be one. This is the beauty of radiology. You can find your interest and enjoy your work. If you are surgical type, there are lots of opportunities. If not, there are lots of opportunities. And if you want to do some procedures but not real surgery, you can find your way. I have seen people who have done IR for 20 years and now do DR. I have seen people who have done DR for 10 years and now are doing an IR fellowship. In conclusion, the field is fantastic!!!

 

[irwarrior]

I have to agree with the last post. If you want to do IR correctly it is a surgical specialty. We take overnight pages on our patients. I round in the early morning. Set up my elective cases and admit my patients to our service. I have a busy outpatient clinic where I see mostly follow ups but also initial consultations. The surgical day is much more comparable to my day to day existence. The surgical internship will cover a lot of the pathology that you may be consulted on as an IR. I see some vascular disease consults in my clinic (claudicants,wounds, chronic venous disease, superficial venous disease, IVC filters,abdominal, thoracic, and visceral aneurysms). I also see oncology consults (metastatic liver, small renal masses, primary liver).

This requires a clinic, primary consult service (no order entry) and a lot of hard work. If you think a surgical internship is tough, it is a lot harder to build a busy IR practice. Both IM and surgery prelims have their advantages. I would not advocate for a transitional year for those going into IR. In fact during job interviews for our practice I would favor someone who did a busy surgical internship over someone who did a cush transitional internship. Also, I would look for someone who had comprehensive clinical IR training in residency and fellowship (i.e. formal consults, busy outpatient clinic , vascular disease management, pain management, women's health, carotid and stroke, oncology).

If you want to dabble in IR, then it may be best to do a bunch of procedures in residency and mini-fellowship and there are plenty of 50 % IR jobs where they do more minor procedures (paracentesis, thoracentesis, biopsies,drains, arthrograms, breast procedures, g tubes, occasional Ivc filter etc) and read imaging in between.

 

[PL198]

I have to agree with the last post. If you want to do IR correctly it is a surgical specialty. We take overnight pages on our patients. I round in the early morning. Set up my elective cases and admit my patients to our service. I have a busy outpatient clinic where I see mostly follow ups but also initial consultations. The surgical day is much more comparable to my day to day existence. The surgical internship will cover a lot of the pathology that you may be consulted on as an IR. I see some vascular disease consults in my clinic (claudicants,wounds, chronic venous disease, superficial venous disease, IVC filters,abdominal, thoracic, and visceral aneurysms). I also see oncology consults (metastatic liver, small renal masses, primary liver).

This requires a clinic, primary consult service (no order entry) and a lot of hard work. If you think a surgical internship is tough, it is a lot harder to build a busy IR practice. Both IM and surgery prelims have their advantages. I would not advocate for a transitional year for those going into IR. In fact during job interviews for our practice I would favor someone who did a busy surgical internship over someone who did a cush transitional internship. Also, I would look for someone who had comprehensive clinical IR training in residency and fellowship (i.e. formal consults, busy outpatient clinic , vascular disease management, pain management, women's health, carotid and stroke, oncology).

If you want to dabble in IR, then it may be best to do a bunch of procedures in residency and mini-fellowship and there are plenty of 50 % IR jobs where they do more minor procedures (paracentesis, thoracentesis, biopsies,drains, arthrograms, breast procedures, g tubes, occasional Ivc filter etc) and read imaging in between.

come on, you're telling me you're going to look at what internship someone did for a job interview? I mean I guess if literally everything else is similar, but my money says something is going to differentiate two people long before their intern year does.

other attendings say surgery years would look poorly because it likely means 2 things
a) you weren't smart/accomplished enough to match into a medicine year or TY
b) you weren't smart enough to just take it easy on yourself

I have heard a and b multiple times from different attendings with regards to this issue.

 

[badasshairday]

Agreed.

All you need is a pulse for a surgery prelim position at even Man's Best Hospital on any coast or competitive locale. Nobody wants them. I interviewed at one of the biggest brand name places on the coast for one surgery prelim jusst because it was close to family. I couldn't get out of there fast enough and rank it last.

 

[preDoGuy24]

come on, you're telling me you're going to look at what internship someone did for a job interview? I mean I guess if literally everything else is similar, but my money says something is going to differentiate two people long before their intern year does.

other attendings say surgery years would look poorly because it likely means 2 things
a) you weren't smart/accomplished enough to match into a medicine year or TY
b) you weren't smart enough to just take it easy on yourself

I have heard a and b multiple times from different attendings with regards to this issue.

Disagree. Have Heard specifically in regards to IR many programs be blunt in saying they are not looking for people who did a Cush TY for their fellowship programs. Not sure on the hiring end of things BUT you will be asked this at a fellowship interview, gone are the days of IR being a nonclincally oriented specialty.

My opinion is if you are thinking IR go medicine or surgery intern. If you can't stand rounding all day do a surgery prelim that gets you into the OR early and often. Don't go somewhere and be a scut monkey. Be prepared for more call, more hours, and sicker patients.

I think TYs are a waste of Medicare money and should be done away with. I have no idea why we are funding with our tax dollars intern years with multiple research months/outpatient rotations that go from 8am-12.

Someone doing a surgery year, I can say within reasonable certainty I work harder than any TY in the country and probably harder then most any medicine intern especially the ones I have talked to. I see more advanced imaging then a medicine intern/TY does and have the added benefit of a hepatobiliry/trauma/bariatric etc surgeon to go over the imaging with which gives me a perspective of what is important from a surgical standpoint. My level of intelligence has no bearing on why I am doing what I do, but maybe I just wasn't concerned enough in finding ways to "take it easy on myself"-not a good attitude to have in residency in general and definitely one where I can see why you didn't do a surgery year.


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[quirkygator]

Disagree. Have Heard specifically in regards to IR many programs be blunt in saying they are not looking for people who did a Cush TY for their fellowship programs. Not sure on the hiring end of things BUT you will be asked this at a fellowship interview, gone are the days of IR being a nonclincally oriented specialty.

My opinion is if you are thinking IR go medicine or surgery intern. If you can't stand rounding all day do a surgery prelim that gets you into the OR early and often. Don't go somewhere and be a scut monkey. Be prepared for more call, more hours, and sicker patients.

I think TYs are a waste of Medicare money and should be done away with. I have no idea why we are funding with our tax dollars intern years with multiple research months/outpatient rotations that go from 8am-12.

Someone doing a surgery year, I can say within reasonable certainty I work harder than any TY in the country and probably harder then most any medicine intern especially the ones I have talked to. I see more advanced imaging then a medicine intern/TY does and have the added benefit of a hepatobiliry/trauma/bariatric etc surgeon to go over the imaging with which gives me a perspective of what is important from a surgical standpoint. My level of intelligence has no bearing on why I am doing what I do, but maybe I just wasn't concerned enough in finding ways to "take it easy on myself"-not a good attitude to have in residency in general and definitely one where I can see why you didn't do a surgery year.


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What about those who did not know they wanted to do IR until their PGY 3 year? Are they automatically barred from good fellowships because they did a TY or medicine prelim? Come on, this is kinda ridiculous. It just sounds like a bunch of people who did/doing a surgery prelim justifying their decisions to everyone.

 

[preDoGuy24]

What about those who did not know they wanted to do IR until their PGY 3 year? Are they automatically barred from good fellowships because they did a TY or medicine prelim? Come on, this is kinda ridiculous. It just sounds like a bunch of people who did/doing a surgery prelim justifying their decisions to everyone.

Read my post. I said specifically if you want IR you should do a IM or surgery year and fellowships are concerned about this, so much so that its part of the new IR pathway requirements. Every program I interviewed at had or was starting a clinical service within their IR department (rounding, office time, etc) and all expressed interest in having a strong clinical background from their fellows.

TYs are super chill and easy, if that's what you want go for it, my experience is those aren't the kind of people that want IR and certainly aren't the people that could survive a surgery intern year. Soon this will not be a valid pathway into IR and I think that's a REALLY good thing.


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[Zakley]

Agreed.

All you need is a pulse for a surgery prelim position at even Man's Best Hospital on any coast or competitive locale. Nobody wants them. I interviewed at one of the biggest brand name places on the coast for one surgery prelim jusst because it was close to family. I couldn't get out of there fast enough and rank it last.

That's not what I heard from plenty of people I know trying to do a surgery prelim. I, myself, only got a handful of interviews and they were not at the top places. It seems that a lot of places are just waiting to pick people up in the SOAP which I think needs to be addressed by NRMP. Perhaps all prelims should be done during SOAP. It would certainly make sense to know where you're going for the rest of your residency first.

 

[badasshairday]

That's not what I heard from plenty of people I know trying to do a surgery prelim. I, myself, only got a handful of interviews and they were not at the top places. It seems that a lot of places are just waiting to pick people up in the SOAP which I think needs to be addressed by NRMP. Perhaps all prelims should be done during SOAP. It would certainly make sense to know where you're going for the rest of your residency first.

Well. Let me tell you more. I applied to this surgical prelim at one of the biggest named places 1 month after application deadline. I applied because I was not getting enough internship interviews. Anyways I send the big name program an email asking of it is ok if I apply since the deadline was a month prior. They respond quickly saying to apply on eras as the deadline is hard only on categoricals. I get an interview immediately. At the interview it became quite clear that they wanted any soul with an md behind their name since this program along with another big name on the same coast went unfilled for prelim spots.

Look it up on charting the outcomes, it is probably the same. Prelim surgery spots are the scraps picked up in the scramble /s o a p or whatever you call it these days. I was shocked that even at these brand name places they went unfilled.

 

[Zakley]

I had a similar? experience in which I really enjoyed interviews in a city where I hadn't expected to, so I applied to 3 more programs (I think) one of which was also a big name and their deadline had passed. I also emailed them asking to be considered. I only heard back from one - not the big name - which granted me an interview. So it's all anecdotal, and you may have had much better STEP scores than I.

But, I think it's something more complicated - These programs don't seem to care about getting people in the main match. As you said, it can be looked up - hundreds(?) of prelim surgery spots go unfilled at even the top places. Perhaps it's just about the numbers - I had a discussion with a surgeon who said that many of the top programs have a priority to keep their average STEP scores up. So they pick in the SOAP to have more options of those who are very competitive, but didn't match. Or international grads who have great qualifications, but were discriminated against in the main match?

I applied to 50 programs and got 11 interviews I think, whereas I applied to 80 radiology and had about 40. I really thought I would be flush with my pick of anywhere in the country and was sadly mistaken. And if I wasn't even considered because many programs are just picking up scraps in the SOAP, I would really like my money back.

 

[irwarrior]

My lifestyle is more reflective of a surgical day, then a medicine day or transitional day. I have noticed that those who have done surgical internships tend to be (not always) more adjusted to the IR day to day existence. Though surgical prelim may not be hard to get into, you generally have to work pretty hard that year (get up early, stay late, and deal with very sick patients). Medicine with a ton of ICU experience is also quite valuable. Both have their perks, but I would strongly avoid a transitional internship if you want to do IR. In fact, I would frown upon someone who did a TY internship and all things being equal would be less likely to take that individual for fellowship or job as opposed to someone who did surgery or even IM for training. Now if you are boarded in IM, I would take that individual as they can add tremendous value to our clinical IR group.

As others have posted, most of the new IR training pathways are focusing more on surgical internships. Though I did a medicine internship, I realize there are some intrinsic benefits of surgery for those who know for sure they want to do IR.

I would rather take someone as a partner, who has strong clinical skills and acquired them not only in internship but throughout the course of residency. I do realize that there are many who decide late they want to go into IR, but that is becoming the exception . Those choosing to do IR will have to make the decision early on as more and more IR residencies start to become established (at least 20 will be available next year). If you are planning ESIR , then you still will need to make the decision early on and there is a process of selection for those who go into ESIR during residency and so there may be some element of competition if multiple people are applying.

The decision to enter IR is being made earlier and earlier and it is not a lifestyle specialty. In order to succeed in IR, you have to work extremely hard and there is tremendous amount of patient interaction. If you want a lifestyle specialty and do not enjoy your patient interactions, IR is not a good match.

I do not want someone who took a cush way out (i.e. many TY year) as they may not make the best IR partners (there are always exceptions). I want someone who has no fear of work and is willing to come in early and stay late and has no fear of sick patients or hard work.

 

[tobeatrev]

I went the TY route this year and would choose it again. I've spent time on both medicine and surgery. It wasn't "super cush" as someone alluded to previously but it also wasn't as hard as some of my surgery prelim counterparts, I'll admit it. I wanted a good mix of everything and don't feel in any way that it set me back in respect to IR. I think the intern year choice and correlating one vs. another is oversimplifying things just a bit in terms of an advantage in IR. I also don't think someone's work ethic is defined by the intern year they chose. Just my 2 cents.

 

[badasshairday]

I went the TY route this year and would choose it again. I've spent time on both medicine and surgery. It wasn't "super cush" as someone alluded to previously but it also wasn't as hard as some of my surgery prelim counterparts, I'll admit it. I wanted a good mix of everything and don't feel in any way that it set me back in respect to IR. I think the intern year choice and correlating one vs. another is oversimplifying things just a bit in terms of an advantage in IR. I also don't think someone's work ethic is defined by the intern year they chose. Just my 2 cents.

Agreed. I have a co-resident who did surgery prelim and s/he tries to duck out of work more than others. Obviously not going into IR. I did a TY and got a good mix of medicine and surgery (actually went to the OR too!) and felt that it prepped me well to take care of breat and butter inpatients and outpatients. We had an open ICU so I admitted very sick patients and took care of them overnights in the unit too. I managed NSTEMI, submassive PE, A-fib RVR on my own, obviously with attending back up as needed (often on the phone at most, and these became routine too and i was able to manage on my own). I learned how to take care of vasculopaths and those with CAD starting them on appropriate medical treatment. I intubed, did lines in the ICU, although lines are not really a big deal as this skill is easily learned within a few days on IR as a rad resident. Just because you spend more time in the hospital, often times as a scut monkey as a surgery prelim doing discharges and mundane floor work, doesn't mean you will end up clinically superior. I'm looking into getting some ICU time during my mini-fellowship time in my last year of residency or even incorporating neuroICU element into a NeuroIR minifellowship.

I think the new IR residency is going to be awesome because they will incorporate rotations in ICU, vasc surgery, cards, GI/hepatolgy, med and surg onc, gyn, and urology while a resident throughout the years of residency. This is what will truly make a difference. Internship for the most part for the current crop going through traditional fellowship won't matter as much as the trainees own drive to clinically follow up on patients and ask for clinical rotations during mini-fellowship.

 

[DrBowtie]

Agreed. I have a co-resident who did surgery prelim and s/he tries to duck out of work more than others. Obviously not going into IR. I did a TY and got a good mix of medicine and surgery (actually went to the OR too!) and felt that it prepped me well to take care of breat and butter inpatients and outpatients. We had an open ICU so I admitted very sick patients and took care of them overnights in the unit too. I managed NSTEMI, submassive PE, A-fib RVR on my own, obviously with attending back up as needed (often on the phone at most, and these became routine too and i was able to manage on my own). I learned how to take care of vasculopaths and those with CAD starting them on appropriate medical treatment. I intubed, did lines in the ICU, although lines are not really a big deal as this skill is easily learned within a few days on IR as a rad resident. Just because you spend more time in the hospital, often times as a scut monkey as a surgery prelim doing discharges and mundane floor work, doesn't mean you will end up clinically superior. I'm looking into getting some ICU time during my mini-fellowship time in my last year of residency or even incorporating neuroICU element into a NeuroIR minifellowship.

I think the new IR residency is going to be awesome because they will incorporate rotations in ICU, vasc surgery, cards, GI/hepatolgy, med and surg onc, gyn, and urology while a resident throughout the years of residency. This is what will truly make a difference. Internship for the most part for the current crop going through traditional fellowship won't matter as much as the trainees own drive to clinically follow up on patients and ask for clinical rotations during mini-fellowship.

Really curious how these off service rotations are going to work out for IR. Theoretically sounds great but given the rate of clinical medicine atrophy that happens on DR, I suspect it will be limited involvement heading back to an ICU setting

 

[RadsonRads]

I'm currently in the final stretch of my prelim surgery year and I think it is the best decision I have made thus far. I applied to only surgery internships because, in all honesty, I cannot stand medicine, or managing chronic diseases, or even worse - managing chronic diseases in pts who don't care about getting better. I also hate writing extensive notes, rounding for hours, dealing with social work/discharge nightmares, and/or being the dumpster of the hospital. I also have a surgical mindset and do plan on going into IR, so I felt this was the right decision for me. I was more than correct!

I feel that this year has prepared me not only for being a strong physician, but radiology as well. Like a previous poster mentioned, it is one thing to know a surgical procedure, but it is another to actually see/do the procedure in the OR, and see the imaging before and after. It really sticks in your mind. For instance, having an acute appy come in, examining pt, seeing the giant inflamed abscess on CT, and then 2hrs later seeing it in the OR, and then playing with it in your hands afterwards. Or someone coming in s/p roux-en-y w/ a closed loop obstruction, and seeing the imaging, and then seeing what it looks like in the OR. It really is priceless to be able to see this stuff. I can't tell you how often we speak to radiologists about scans and management. It is a daily thing for us.

Furthermore, I am ~8mo into my year and have logged ~100 cases. My OR skills have VASTLY improved over this year and I feel very confident with my hands. I can close massive incisions, do chemoports, or run a subq monocryl as good as anyone can, and I doubt someone doing a medicine year can say the same. There is also nothing that breaks up the monotonous floor work better than spending some time in the OR. The days go by faster and the yr goes by faster as well.

Are there downsides? Of course. I pretty much only get 1 day off a week all year long. But I have 4wks vacation, so it's manageable for a year. I know plenty of medicine internships that work just as hard or harder as I do.

All in all, this year has allowed me to understand surgical anatomy, fine-tune my surgical skills, and learn how to manage peri-operative patients. I feel very comfortable with the aforementioned and I absolutely feel it will help me in the years to come.

Oh, I forgot to mention I had 2 months of vascular surgery as well. They know I want to do IR, so they let me go in on any endovascular case I wanted to. I've done a handful of IVC filters by myself, and got to scrub in on many aneurysm coilings, etc. Definitely don't think medicine gives the same opportunity...

 

[GooseWing]

I'm currently in the final stretch of my prelim surgery year and I think it is the best decision I have made thus far. I applied to only surgery internships because, in all honesty, I cannot stand medicine, or managing chronic diseases, or even worse - managing chronic diseases in pts who don't care about getting better. I also hate writing extensive notes, rounding for hours, dealing with social work/discharge nightmares, and/or being the dumpster of the hospital. I also have a surgical mindset and do plan on going into IR, so I felt this was the right decision for me. I was more than correct!

I feel that this year has prepared me not only for being a strong physician, but radiology as well. Like a previous poster mentioned, it is one thing to know a surgical procedure, but it is another to actually see/do the procedure in the OR, and see the imaging before and after. It really sticks in your mind. For instance, having an acute appy come in, examining pt, seeing the giant inflamed abscess on CT, and then 2hrs later seeing it in the OR, and then playing with it in your hands afterwards. Or someone coming in s/p roux-en-y w/ a closed loop obstruction, and seeing the imaging, and then seeing what it looks like in the OR. It really is priceless to be able to see this stuff. I can't tell you how often we speak to radiologists about scans and management. It is a daily thing for us.

Furthermore, I am ~8mo into my year and have logged ~100 cases. My OR skills have VASTLY improved over this year and I feel very confident with my hands. I can close massive incisions, do chemoports, or run a subq monocryl as good as anyone can, and I doubt someone doing a medicine year can say the same. There is also nothing that breaks up the monotonous floor work better than spending some time in the OR. The days go by faster and the yr goes by faster as well.

Are there downsides? Of course. I pretty much only get 1 day off a week all year long. But I have 4wks vacation, so it's manageable for a year. I know plenty of medicine internships that work just as hard or harder as I do.

All in all, this year has allowed me to understand surgical anatomy, fine-tune my surgical skills, and learn how to manage peri-operative patients. I feel very comfortable with the aforementioned and I absolutely feel it will help me in the years to come.

Oh, I forgot to mention I had 2 months of vascular surgery as well. They know I want to do IR, so they let me go in on any endovascular case I wanted to. I've done a handful of IVC filters by myself, and got to scrub in on many aneurysm coilings, etc. Definitely don't think medicine gives the same opportunity...

Thanks for your input! I'm planning on a surgery prelim as well and your post is encouraging. Any advice on identifying surgery prelims that maximize OR time and minimizing scut?

 

[RadsonRads]

Thanks for your input! I'm planning on a surgery prelim as well and your post is encouraging. Any advice on identifying surgery prelims that maximize OR time and minimizing scut?

This is honestly the hardest part. There are a lot of places that tend to scut interns out and they never see the lights of the OR. You really just have to ask around on your interviews and do your due diligence. In general, try to stay away from large academic centers. They are loaded with residents and fellows and don't care if a prelim sees the OR because a lot of the categorical interns won't even see the OR. Try and find a community hospital or a small academic hospital where you know the interns get OR time. And ask if they treat the prelim interns the same as categorical. At my hospital, all the attendings know I'm going into rads, but they don't care. They still pimp me and expect me to perform like a categorical.


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[Zakley]

I'm currently in the final stretch of my prelim surgery year and ... I also have a surgical mindset and do plan on going into IR, so I felt this was the right decision for me. I was more than correct!

RadsonRads, would you care to share what program you're at? Or at least the kind/area?