Surgical Prelim

[brownwolf100]

Hey -

So I'm applying anesthesia and my top choice right now is an advanced position. I've gotten enough TY/internal prelim years, but the locations are less than desirable and they're mostly random community hospitals. I also applied to some surgical prelim programs without knowing a whole lot about them. There are a couple I've gotten invites to at good institutions and in the location I want to be in. I've pretty much only heard people say how awful surgical prelims are, but would location and name be good enough reasons to rank these higher for my advanced program?

Overall, I liked surgery better than medicine in school, but I did not have a very rigorous surgical experience. Has anyone else chosen to rank surgery over medicine higher, or could maybe give me some advice?

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[deleted171991]

Go with an IM prelim, even in the middle of nowhere. It's way more educational (and comes with better hours). You can thank me later. Then transitional, then surgical prelim.

 

[deleted875186]

Unless you have specific program information o say otherwise, the prelim surgery year will be terrible. This is especially true if it’s at a bigger name program.

 

[D4C]

There are good prelim surg spots. Not a ton, but they're out there. Stay away from big name academic centers for surgery prelims if it comes to it. Like FFP said, you'll learn more from a IM prelim almost always.

 

[brownwolf100]

Thanks for the advice. Any thoughts on UC Irvine or ways to determine the nature of the prelim?
If the prelim were at the same institution as the advanced spot, would it make sense to rank it higher to avoid moving, or are surgical prelims that awful that it would be worth moving?

 

[hununuh]

Do. Not. Do. Surgery. Prelim. Year.

 

[deleted875186]

Thanks for the advice. Any thoughts on UC Irvine or ways to determine the nature of the prelim?
If the prelim were at the same institution as the advanced spot, would it make sense to rank it higher to avoid moving, or are surgical prelims that awful that it would be worth moving?

I personally hate moving. I might consider a spot at the same program to not move, but I would still probably put a medicine or transitional year higher on my rank list. You don’t need to live right next to the hosptial, you can live near your advanced spot and drive to your intern year hosptial if it’s within driving distance.

 

[deleted171991]

Thanks for the advice. Any thoughts on UC Irvine or ways to determine the nature of the prelim?
If the prelim were at the same institution as the advanced spot, would it make sense to rank it higher to avoid moving, or are surgical prelims that awful that it would be worth moving?

Do not do a surgical prelim ANYWHERE. It's much easier to suffer during a week of moving than an entire year. And you won't get the same education.

UC Irvine is a categorical program. Most categorical anesthesia programs have a PGY-1 year with a majority of surgical months, and few medical ones. A categorical anesthesia PGY-1 year is usually weaker than a medical prelim (but don't choose your anesthesia program based on this).

Some of my colleagues will disagree, but medicine rotations are the only chances for a future anesthesiologist to learn how to think like a doctor (versus the knee-jerk thinking of others). Again, the quality of the anesthesia program should take priority, so, if a great categorical anesthesia program has a weak PGY-1 year, so be it.

 

[Katheudontas parateroumen]

Thanks for the advice. Any thoughts on UC Irvine or ways to determine the nature of the prelim?
If the prelim were at the same institution as the advanced spot, would it make sense to rank it higher to avoid moving, or are surgical prelims that awful that it would be worth moving?

Are you asking about UCI IM prelim? If so, I did my prelim year there not too long ago. I thought I got great medicine training there for starting my CA years. You basically do inpatient months for the whole year except for maybe 2-3 months. Things may have changed to 3+1 but still, the prelims cover the ICUs very commonly. I did 1 month of CCU, 3.5 months of MICU, an US elective, pre-op clinic, radiology, and rest was inpatient wards. Lots of autonomy on MICU (admissions, decision making, and procedures) and the floors for that matter once you feel comfortable. Procedures wise I think every prelim if they wanted could have 20+ intubations, many more CVCs, arterial lines, some paracentesis, and few thoras/bronchs. Obviously you'll do even more as an anesthesia resident but it's nice to automatically step in CA-1 year confident that you've done this plenty of times before. I thought it was awesome. Don't think you won't work hard for the year though. But educationally, you definitely get it there both with procedures and overall medicine knowledge base. I also really liked my chief residents/most attending a lot, all willing to teach; the leadership was overall nice and program coordinator was helpful in my transition to my advanced anesthesia program. PM for any other questions!

In terms of figuring out about prelims, I only interviewed at 2 prelim IM programs. I think generally you wanna do as much ICU as possible, how many procedures do they do, and also seeing how much autonomy do you have. For instance, UCI had fellows but teams were very resident run. Senior residents were the major workhorses especially overnight both wards and ICU. Also ask how much elective time you have. That's my one gripe about UCI prelim was I didn't get a chance to do ENT clinic/gen cards/pulm/renal/transufusion some of the subspecialties that I think would have broadened my knowledge more as an anesthesiologist. So my opinion is ask about ICU time, elective time, and procedures.

As for the anesthesia UCI program I don't know much. I believe just a couple years back they still didn't have any major cardiac surgeries at UCI, no transplants I believe, and also VA didn't have neuro/CT surgery as well. Not sure about other hospitals they rotate at.

 

[deleted171991]

That's my one gripe about UCI prelim was I didn't get a chance to do ENT clinic/gen cards/pulm/renal/transufusion some of the subspecialties that I think would have broadened my knowledge more as an anesthesiologist.

As an intern, subspecialty rotations are a royal waste IMO. An intern simply doesn't have the knowledge base to really benefit from them. Plus many listed are simply not needed.

As a prelim, there are 2 types of rotations that add a lot for the budding anesthesiologist: MICU/stepdown (dealing with sicker patients) and night float/cross-coverage (putting out fires alone). A medicine prelim also adds a lot to one's knowledge about co-existing diseases, which is essential for anesthesia. Unfortunately, the duty hour-restrictions have f-ed up medical education, especially in internship (interns are way more babied than they used to, hence they have much fewer opportunities to learn).

 

[deleted875186]

As an intern, subspecialty rotations are a royal waste IMO. An intern simply doesn't have the knowledge base to really benefit from them. Plus many listed are simply not needed.

As a prelim, there are 2 types of rotations that add a lot for the budding anesthesiologist: MICU/stepdown (dealing with sicker patients) and night float/cross-coverage (putting out fires alone). A medicine prelim also adds a lot to one's knowledge about co-existing diseases, which is essential for anesthesia. Unfortunately, the duty hour-restrictions have f-ed up medical education, especially in internship (interns are way more babied than they used to, hence they have much fewer opportunities to learn).

I will have to disagree. I did preliminary medicine and thought my subspecialty rotations were very educational. Cards, pulm, and ID electives. I will also say that I think every intern has enough base knowledge to benefit from being woth a sub specialist. I will agree night float and ICU were the best learning experience as FFP said.

My personal opinion, procedures are a waste of time as an intern. You’ll do plenty of procedures in anesthesia. Nobody in internal medicine is going to show you how to get good or efficient at doin any of these. I remember looking for procedures as an intern, now looking back I think it was not a worth while endeavor.

 

[Katheudontas parateroumen]

I tried to basically make my entire prelim year ICU but they didn't let me lol. So i'm sure the subspecialty months are more educational than general floor months with half the list being rocks sometimes with a bunch of social issues, also better hours so you don't feel as burnt out. I think you can actually get pretty good with some procedures as an intern. My IM seniors were pretty proficient at most of the lines. Like I said, it at least makes you feel comfortable to jump in right away as a CA-1.

 

[nimbus]

I had a nice month of combined derm and rheum during intern year. Literally had 20 consults for the entire month. Rounded 3x/week for rheum and 2x/week for derm. Rounds were literally having lunch with my attending while presenting patients, then going to see them. About 10 hours a week plus my continuity clinic for 4hrs on Tuesday’s.

On the other hand, I routinely had 18 patients on service during my ward months, mostly AIDS/MDR TB/crypto/KS/PCP and dropping like flies.

 

[deleted875186]

I had a nice month of combined derm and rheum during intern year. Literally had 20 consults for the entire month. Rounded 3x/week for rheum and 2x/week for derm. Rounds were literally having lunch with my attending while presenting patients, then going to see them. About 10 hours a week plus my continuity clinic for 4hrs on Tuesday’s.

On the other hand, I routinely had 18 patients on service during my ward months, mostly AIDS/MDR TB/crypto/KS/PCP and dropping like flies.

Not sure how this works. I thought ACGME limits interns to caring for 10 patients at a time on a service.

 

[nimbus]

Not sure how this works. I thought ACGME limits interns to caring for 10 patients at a time on a service.

It was 1992. Not sure if there was a rule then but we all had similar loads at my hospital in NYC.

 

[deleted162650]

I thought ACGME limits interns to caring for 10 patients at a time on a service.

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