To the people choosing to do prelim surgery, why?

[odyssey2]

For anyone applying to advanced positions (rads, derm, ophtho, gas, PMR, neuro) why did you choose to apply to a prelim surgery year instead of a cush TY or prelim med?

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[theonlytycrane]

I was on the fence about applying prelim surgery (was going to look for a community place where I wouldn't be scutted out, I could take care of floor chores without rounding for 5 hours, and I could scrub into cases if possible).

I ended up settling for applying to TYs (hopefully I'll land a cush one). I got scared that I would end up at a hellish surgery spot. I would say people go surgery prelim if they hate IM rounds with a passion, or they realize that a lot of TYs = prelim IM in disguise.

Having interviewed at both IM prelim and TYs this cycle, IM prelim sounds miserable. It sounds like being on IM clerkship for 1 year.

 

[radsisrad]

You're going to spend your days in the hospital either way. Would you rather scrub into cases and deal with drains, or spend your days ordering benzo tapers for alcoholics and titrating long-acting, medium-acting, and short-acting insulin Isn't the latter fascinatingly intellectual?

 

[Angus Avagadro]

Looking for a cush Pgy1 is a very personal decision. Depends on what kind of Doc you want to be. If you see yourself in an out patient setting, maybe. If Rads, Gas, or Optho, maybe consider the more procedural oriented surgical. I did a traditional Pgy1, 6 mos of medicine and 6 mos of surgery and felt way ahead of my colleagues as a Pgy2. My wife did a med transitional and still did 3 mos of surgery and a month in CCM.

 

[slowthai]

You're going to spend your days in the hospital either way. Would you rather scrub into cases and deal with drains, or spend your days ordering benzo tapers for alcoholics and titrating long-acting, medium-acting, and short-acting insulin Isn't the latter fascinatingly intellectual?

But I've heard that depending on the program, you can end up just being a scutmonkey and never setting foot into the OR.

 

[ciestar]

But I've heard that depending on the program, you can end up just being a scutmonkey and never setting foot into the OR.

This is absolutely true

 

[RangerBob]

Regarding PM&R, there’s minimal reason to do pre-pI’m surgery. Most PGY1 surgery residents rarely set foot in the OR as far as I understand, and they’ll always have preference over a prelim. So you’re really just pulling drains-otherwise I don’t think you get that much more procedural exposure than IM, which has ICU rotations as well. You certainly get more post-op experience though, which is helpful for trauma patients, amputees, etc.

Best of both worlds is go to a decent TY (be careful with Cush TYs-some you won’t learn much at. A Cush TY with good exposure/education and time to rest is golden), and do a few months of IM (it’s critical at least in PM&R), then spend a month with ortho, nsurg, and/or trauma, plus some others like psych, palliative care, neuro, etc. Much better experience than prelim IM or surgery.

Many TYs are at smaller hospitals, so the odds are higher they don’t have surgical residents and you may work directly one on one with the attending surgeon and actually meaningfully assist in cases. Maybe...

 

[Redpancreas]

For anyone applying to advanced positions (rads, derm, ophtho, gas, PMR, neuro) why did you choose to apply to a prelim surgery year instead of a cush TY or prelim med?

Masochism...seriously though there can be many different reasons. While the TY is a very desirable year to do it is next to useless in terms of merit and I would imagine that not all residencies accept it as an intern year. It's basically a glorified selection of electives whereas a preliminary year is literally an intern year and can advance someone's career by a year in another field. Also, it depends what kind of doctor you want to be in your field. Some people who really have a passion and want to get exposure to surgery because they think it will make them a better gas doctor may opt for prelim surgery.

1.) For Dermatology/Ophthalmology applicants worried they may not match, they may want to have something that looks more challenging than a TY after one year so they can have credit for a year and look better when they reapply (Ophtho mainly) or switch to EM, General Surgery. I've heard EM likes a prelim surgery year as opposed to medicine. Not sure exactly why.

2.) If you're interested in the IR part of radiology, I can see how doing a preliminary surgery year may offer some good training for post-operative evaluation, etc. Also, surgeons often review films with radiologists so there's a lot of cross-talks across the fields, but IM does the same.

3.) Anesthesia is not terrible competitive so I fathom that some may feel gen surgery would be better overall prep than medicine. From a practical point, it makes sense as while PGY-1s are not the most involved in the OR, they do a lot of perioperative care (pre-OP, PACU stuff). I think a medicine year would have a lot to offer anesthesiology residents as well but many Gas/EM residents chose their fields over medicine because they hated medicine rounds.

4.) I'm not really sure why PM&R would do prelim surgery, I think medicine would allow a much better perspective of the whole placement, PT/OT stuff and most don't have to do a prelim in the event they don't match because PM&R isn't too competitive. I suppose if you're particularly interested in post-operative rehabilitation it could be a good idea.

5.) For truly interested in neurology, prelim IM is the better option no matter how you slice it given the similarity of the fields.

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Also this is a bad reason in my opinion but I know some applicants who feel that if they don't match their hypercompetitive field (derm), they want to salvage their prestige by doing gen surg->fellowship (ex. plastics), etc. Terrible idea but some people think like that.

 

[Redpancreas]

You're going to spend your days in the hospital either way. Would you rather scrub into cases and deal with drains, or spend your days ordering benzo tapers for alcoholics and titrating long-acting, medium-acting, and short-acting insulin Isn't the latter fascinatingly intellectual?

Sounds like you just don't like IM. Agreed that both are hospital scut but I wouldn't paint it as a preference. There's no good reason to do a surgery prelim unless you really feel what you learn will be translatable or if you need it to get what you want. Prelim Medicine is far less stressful.

 

[Neopolymath]

The consensus for anesthesiology attendings on SDN (of which there are many) is that a prelim medicine year is far more foundational, educational, and important to development as an anesthesiologist than a prelim surgery year. Most say it's a myth that a surgery year is helpful at all. I didn't know that until I saw it repeated ad nauseum over the past 10 years on that subforum.

 

[You shall know the Truth]

But I've heard that depending on the program, you can end up just being a scutmonkey and never setting foot into the OR.

If that is the case, I would zoom around the hospital with a cape as the half scut half monkey half ms5 doctor with a fanny pack

 

[mehc012]

Regarding PM&R, there’s minimal reason to do pre-pI’m surgery. Most PGY1 surgery residents rarely set foot in the OR as far as I understand, and they’ll always have preference over a prelim. So you’re really just pulling drains-otherwise I don’t think you get that much more procedural exposure than IM, which has ICU rotations as well. You certainly get more post-op experience though, which is helpful for trauma patients, amputees, etc.

How often you set foot in the OR depends on how often you GET yourself to the OR. Even as a prelim, I've been in the OR every day this week, while I know some categorical PGY1s who can't say as much. At smaller programs, it's even more skewed.

 

[Splenda88]

You're going to spend your days in the hospital either way. Would you rather scrub into cases and deal with drains, or spend your days ordering benzo tapers for alcoholics and titrating long-acting, medium-acting, and short-acting insulin Isn't the latter fascinatingly intellectual?

Seriously!

 

[njtrimed]

How often you set foot in the OR depends on how often you GET yourself to the OR. Even as a prelim, I've been in the OR every day this week, while I know some categorical PGY1s who can't say as much. At smaller programs, it's even more skewed.

How often you set foot in the OR depends on which rotation you’re on and your senior residents. If you’re on services like thoracic or transplant, it’s likely that your seniors will cover most of the cases while you’re managing the floor. On general surgery, you may be in the OR fairly often. It generally doesn’t matter whether you’re prelim or categorical, unless you’re prelim anesthesia/rads and not actually very interested in scrubbing.

 

[mehc012]

How often you set foot in the OR depends on which rotation you’re on and your senior residents. If you’re on services like thoracic or transplant, it’s likely that your seniors will cover most of the cases while you’re managing the floor. On general surgery, you may be in the OR fairly often. It generally doesn’t matter whether you’re prelim or categorical, unless you’re prelim anesthesia/rads and not actually very interested in scrubbing.

At some programs, prelim vs categorical changes which rotations you do.
And yes, there is WIDE variation from service to service, but even within that, effort matters. It's easy to not go to the OR and have a chill day once you get used to floor work.