Surgery residencies/ pyramid system?

[2003doc]

Hi everyone-
I'm about to start my 4th year of medical school at the end of June. I want to do surgery and have been checking out programs on the web. I've noticed mention of the pyramid system in some programs- I guess I'm not crazy about the idea. How can you find out what programs have/do not have the pyramid system or do you ask that at interviews?
Also, any advice on what to look for in programs or things that you've learned after starting your internship that you wouldn't have known to look for as a student?
Thanks in advance for the help!

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[droliver]

Pyramidal systems as such do not exist anymore, it is strictly taboo by the RRC

 

[Whisker Barrel Cortex]

The reason a lot of programs look like pyramid systems (for example on FREIDA) is that they have a certain number of preliminary surgical interns who matched into a one year program in preparation for another specialty (e.g. ENT, neurosurg, etc). So there is a big drop off in numbers after the first year. I've noticed that some programs also have a couple less residents in the upper years. This is mostly due to people that dropped out for one reason or another (we had 2 people drop out of my schools surgery program after 2 years).

Sorry I can't help for other info since I'm not going into surgery.

 

[Winged Scapula]

As droliver and WBC note, pyramidal residencies do not exist anymore with the exception of military residencies (as I'm told).

WBC is absolutely correct in that some residencies may *appear* to be pyramidal with several Prelims included in totals, and different numbers of residents per year due to some being in the lab but this is not the "dreaded" pyramidal system you've heard about.

This does not mean you can't get fired, but if you've been offered a Categorical spot chances are excellent that you will complete the entire residency, and generally at the place you started.

Hope this helps.

 

[Careofme]

Can someone help me out - What is a "pyramidal residency"???

Thanxs!

care

 

[Neurogirl]

Just like it sounds...many begin, but only a few actually finish.

pgy-1=5 residents, one gets fired,
pgy-2=4 residents, one gets fired,
pgy-3=3 residents, one gets fired,
pgy-4=2 residents, one gets fired,
pgy-5=1 resident...THE LUCKY WINNER!

I'm so glad to hear that they are no longer allowed...it always seemed so unfair!

 

[2003doc]

Thanks for responding to my post- I didn't realize that pyramids no longer exist. That's good news; I would rather have a residency class that worked together and helped each other out; not one where everyone would be stressed out over who won't be able to go on to the next year.
How did you search for residency programs/ decide where you want to apply? Did you do any externships? Also, are there programs that don't really want women?
Any advice that you all have is very helpful; I've been rooting through FREIDA, scutwork.com, and the ACS site trying to learn about programs.

 

[Winged Scapula]

The decision WHERE to apply is highly personal. Probably the two biggest factors are program type (University vs Community) and geographical location.

Usually the latter is easier to choose - say you wish to live in the NE, you can select programs in the NE area from the FREIDA database and then whittle from there by choosing University or Community (or a mixture of both).

Externships are a great way to learn about programs but you can't possibly do very many so most of us end up at programs where we did little more than apply and interview. Your medical school Surgery PD should be a great source of information on programs attractive to women, which serve your needs and which he/she feels have a good reputation.

The FREIDA database as well as some program websites should give you information on the percentage of females. Anything even near 30% would be considered "good". I'm sure there are some programs out there who do not prefer females but since it is illegal to do so, I'm doubtful you'll find any information (except anecdotal) about this. Finding several females in the residency program is usually a good indicator of the receptiveness of the program.

Things like salary, benefits can make or break a residency. Not everything on FREIDA is accurate and don't be wowed by a huge (comparatively) salary if you still can't afford to live in Manhattan or are stuck in the middle of no-where with nothing to spend it on and no one to spend it with.

Are you single? If so, larger programs in urban areas will probably be more your style because you will frankly meet more potential dates (assuming that someday you will want to change your status).

At any rate, take some time to ask yourself what's important to you in a residency program. Apply to as many programs as you can afford and interest you and then glean more information when you interview. Residents are usually happy to provide any additional information on their program provided the questions are brief and direct.

Hope this helps.

 

[Careofme]

So under this old "pyramid" scheme what would become of the fired residents? Would they go into another program picking up where they left off or would they have to restart?

Sounds archaic and crazy.

care

 

[Winged Scapula]

•••quote:•••Originally posted by Careofme:
•So under this old "pyramid" scheme what would become of the fired residents? Would they go into another program picking up where they left off or would they have to restart?

Sounds archaic and crazy.

care•••••They would either a) find an open spot elsewhere, 2) restart or 3) quit and find another line of work or another type of residency.

 

[drusso]

There are still osteopathic surgical pyramid programs in existence, especially in orthopedics.

 

[Careofme]

This just doesn't sound very fair (or appealing) -How does one know if they are entering such a program? I'd hope that all the programs that employ this method would publicize it. I would hate to do 3 years a of a surgical residency only to be fired and have to restart....just doesnt sound right!

care

 

[Toadkiller Dog]

Allright, so if pyramid programs don't exist anymore, why does the "So you want to be a surgeon" web page (web version of the 'blue book'?) clearly state that some programs are still pyramidal, and that these are easier to get into?

The web page/book is well known, and put out by the American College of Surgeons, or something similar.

 

[droliver]

It must be old information still in the text on from that publication. Pyramidal programs are STRICTLY prohibited for a number of years now

 

[grkbuckeye]

Whisker Barrel,
i sent you a PM.

 

[Winged Scapula]

•••quote:•••Originally posted by Toadkiller Dog:
•Allright, so if pyramid programs don't exist anymore, why does the "So you want to be a surgeon" web page (web version of the 'blue book'?) clearly state that some programs are still pyramidal, and that these are easier to get into?

The web page/book is well known, and put out by the American College of Surgeons, or something similar.•••••The information in the "hard" (ie, paperback) copy version of the book is horribly outdated - I wouldn't be suprised if the web site was as well.

As droliver notes, the RRC has PROHIBITED pyramidal residencies for some years now.

 

[Winged Scapula]

•••quote:•••Originally posted by Careofme:
•This just doesn't sound very fair (or appealing) -How does one know if they are entering such a program? I'd hope that all the programs that employ this method would publicize it. I would hate to do 3 years a of a surgical residency only to be fired and have to restart....just doesnt sound right!

care•••••Ok...since we have been told that *some* DO residencies are still pyramidal (presumably under different regulations than allopathic programs), the best way is to a) check for stats on the number of CATEGORICAL residents starting a program and the number of CATEGORICAL residents finishing a program. A loss of 1 or 2 a year would not be unusual but a pattern of such, especially leading to very few chief residents would be a tell-tale sign.

 

[Careofme]

Thanks Kimberli!

care

p.s. did you get my message on the "other" thread?

 

[2003doc]

Hi gang-
Thanks for the input- I'm in school way down south on the Gulf Coast, so I know a little about the local programs (ones in Florida, Georgia, Alabama, and Louisiana) and none of the ones I know of do pyramids, although I wasn't sure if they existed in other parts of the country.
People taking years out for research didn't occur to me when I first read through the Freida stats, but it definitely makes sense.
I know a vascular surgeon here from the old school who actually did get bumped out of the pyramid and was set back a few years- that possibility scared me and I'm glad to hear (that at least in Allopathic g.s. residencies) that pyramids aren't around anymore.
I am hoping to do residency up North or out West- although the South can be nice, it's VERY conservative, and being a 24-year-old single female can be dull here. Any knowledge of surgery programs around the country or any other advice is greatly appreciated!

 

[droliver]

2003doc,

?, do you go to University of South Alabama (the only gulf coast med school I know of)? I am class of 1998 from Mobile

 

[Winged Scapula]

•••quote:•••Originally posted by Careofme:
•Thanks Kimberli!

care

p.s. did you get my message on the "other" thread?•••••Hmmm...not sure. I read dozens a day. Care to provide the URL?

 

[2003doc]

Hi droliver-
I am from Univ. of South Alabama- about to begin 4th year in a week. I'm interested in general surgery- I had it this March/April and it was my favorite rotation. I've been doing a lot of searching about programs online- I'm not sure if I would want to go into clinical practice or do a fellowship when I'm finsihed.
So you're from the class of 1998? I bet we know a lot of the same docs in the surgery and medicine departments. Sorry it took me so long to get back on this post. If you want to chat about old South AL, e-mail me at [email protected]

Alicia, Class of 2003