Transitional vs. Prelim Med

[MD Dreams]

Which one would you guys recommend? Which one better prepares an individual for a residency in anesthesiology? Thank you.

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[aredoubleyou]

Doesn't make a bit of difference. If you want to do surgery electives or something like that, then a transitional might be better, otherwise they are mostly the same. Usually greater variability between hospital to hospital than transitional vs prelim at the same hospital.

 

[Fastrach]

No question that the transitional year format is FAR superior to the prelim Medicine year.

Reasons why:
1) The more well-rounded experience of the trans year definately improves your breadth of knowledge and thus your performance on Step 3. (My trans year included medicine, nicu, picu, gen surg, ped surg, adult icu, gas, ccu, and ER.)
2) In a trans year, you get to know non-flea residents and attendings who you'll be working with in the OR once you start Anesthesia.
3) You're 100 times less likely to want to slit your throat/become a raging alcoholic after only a few months of Medicine (I did 6) rather than a full year's worth. This, btw, is coming from someone who went into my Medicine months with "an open mind." Only reason to keep an open mind in retrospect is that at least you won't be completely bitter from the outset, therein saving at least some of your sanity.
4) Transitional year is much more relavant to what you'll be doing later, certainly with respect to dealing with surgical disease processes, and especially if you get ICU time to cut your teeth on A-lines, central lines, and intubations. Much more useful than knowing how to write endless, worthless H&P's and soap notes.
5) You'll probably get lucky and be given a gas month in a transitional year which you'd almost certainly be denied in a Medicine year.
6) In a Medicine year you'd likely be stuck doing clinic. I had not one day of clinic in my trans year. Beautiful.
7) My non-medicine rotations were far less labor/scut intensive than my Medicine blocks were. Plus, I actually had many golden weekends, AND I got out before 9am post-call on all non-medicine blocks. Never would these minor luxuries be afforded to me on my medicine months. NEVER.
8) Medicine truly is the root of all that is putrid and evil in the world. Can I make this any more clear?

Hope you make the right choice.

 

[Trisomy13]

wow. aredoubleyou apparently likes the tedium of the IM wards. more power to ya. i am doing ONE month of medicine and not even looking forward to that. a whole year of medicine, let alone a year of medicine as "the anesthesia guy so make him do it" - no effin' way. nada. no thanks.

but that's me if you are a medicine person, or were deciding between IM and gas before you made your decision, etc, then you might enjoy the breadth of IM. if you want more medicine do a TY and schedule some meaningful months with a pulmonary or cardiology consult service or something along those lines.

 

[MTGas2B]

Don't forget about prelim surgery. While it sounds horrible, check out private programs. You may find some pretty good deals, I certainly did. If you were to ask the transitional interns at VM what they would rather have, more medicine months or more surgery months they would say surgery every time.

 

[Arch Guillotti]

No question that the transitional year format is FAR superior to the prelim Medicine year.

Reasons why:
1) The more well-rounded experience of the trans year definately improves your breadth of knowledge and thus your performance on Step 3. (My trans year included medicine, nicu, picu, gen surg, ped surg, adult icu, gas, ccu, and ER.)
2) In a trans year, you get to know non-flea residents and attendings who you'll be working with in the OR once you start Anesthesia.
3) You're 100 times less likely to want to slit your throat/become a raging alcoholic after only a few months of Medicine (I did 6) rather than a full year's worth. This, btw, is coming from someone who went into my Medicine months with "an open mind." Only reason to keep an open mind in retrospect is that at least you won't be completely bitter from the outset, therein saving at least some of your sanity.
4) Transitional year is much more relavant to what you'll be doing later, certainly with respect to dealing with surgical disease processes, and especially if you get ICU time to cut your teeth on A-lines, central lines, and intubations. Much more useful than knowing how to write endless, worthless H&P's and soap notes.
5) You'll probably get lucky and be given a gas month in a transitional year which you'd almost certainly be denied in a Medicine year.
6) In a Medicine year you'd likely be stuck doing clinic. I had not one day of clinic in my trans year. Beautiful.
7) My non-medicine rotations were far less labor/scut intensive than my Medicine blocks were. Plus, I actually had many golden weekends, AND I got out before 9am post-call on all non-medicine blocks. Never would these minor luxuries be afforded to me on my medicine months. NEVER.
8) Medicine truly is the root of all that is putrid and evil in the world. Can I make this any more clear?

Hope you make the right choice.

I agree with what you are saying in principle, but all medicine spots are not created equal. I did a very cush prelim year. I had 6 months of general unpleasantness on the wards but the rest of the months were great. ER plus outpatient crap and then all electives. You could choose to do as little or as much as possible on your electives. There were no call responsibilities during these 6 months and no weekends. So overall I had a great year. There was also a transitional program that was very highly sought after. Not sure if I would have done it over the med. prelim year though because it involved months on surgery and peds, neither of which I like. When started my CA1 year I met others who had done a pure prelim med year like Fastrach is describing and yes their year sucked. Call all the time and hardly any weekends off the whole year. So choose your program wisely.

 

[Trisomy13]

I agree with what you are saying in principle, but all medicine spots are not created equal. I did a very cush prelim year. I had 6 months of general unpleasantness on the wards but the rest of the months were great.

6 months of medicine wards is not cush in my book, no matter what the other half of the year consisted of

 

[Azcomstud]

I apologize in advance if this is a ridiculous question. Do some programs require a prelim year over a transitional year? Thanks in advance

 

[Arch Guillotti]

6 months of medicine wards is not cush in my book, no matter what the other half of the year consisted of

I will readily admit that quite often I felt like slitting my wrists. I still think I would have rather done the medicine months than some of the transitionals who had to do OB and peds where they were required to take call. I also made some great frineds on my ward teams and had plenty of laughs. I was front loaded so that I cruised on autopilot the second half of my intern year and it was GREAT.

 

[VentdependenT]

If you have the option then TY is the way to go.

 

[chicamedica]

I will readily admit that quite often I felt like slitting my wrists. I still think I would have rather done the medicine months than some of the transitionals who had to do OB and peds where they were required to take call. I also made some great frineds on my ward teams and had plenty of laughs. I was front loaded so that I cruised on autopilot the second half of my intern year and it was GREAT.

i actually agree with this. I guess i'm lucky to be in a great prelim med program. The medicine floors are BUSY with complex, sick patients, but i'm finishing up my first month of it as an intern (well 2nd if u count my sub-i at the same place), and i really really enjoyed it. I think one learns a lot of medicine on floor months, and so bragging about how you only had to do one floor month during a transitional year isn't really saying much about the transitional year having been a more educational year. Then again, I am someone who LOVES learning about medicine, and I actually do enjoy working with patients (and i actually feel EVERYTHING is relevant to anesthesiology, not just some of the obvious things--I get so peeved when people start going like "so this is relevant for you to know since you're going into anesthesia" when they allude to certain obvious pre-op or post-op scenarios. It's ALL relevant, man. . .Yeah, even path.) And then again, i'm at a very good program. . .not cush. . .but i didn't want it to be (however, it is relatively humane, thanks to the great chiefs)

So I didn't even consider applying for transitional year for the following reasons
1) I love learning medicine
2) i dont enjoy ob or peds as much
3) surg as an intern doesnt really teach as much medicine as an IM internship
4) I had done several anesthesiology rotations as a med student and didn't really need yet ANOTHER med student-like anesthesiology rotation as an intern. I will have 3 whole years of anesthesiology ahead of me. This is my year to learn medicine.
5) transitionals usually dont "belong" to any dept. (at my program this is not the case however. . .transitionals are under the IM dept and are basically indistinguishable schedulewise from the prelim meds)

 

[Pooh & Annie]

I'm a firm believer in the "to each, his own" philosophy, so I can't say which option is best for each person. But transitional year is best.
If you go with the TY you will not be disappointed as long as you make sure the rotation options where you interview are reasonable to you. I couldn't be happier at mine. I'm finishing a plastics month whick I thought I would hate. But the hours are awesome (no Wednesdays, no weekends, finished by 3 usually), and I basically run the anesthesia for all the cases from start to finish. I'm getting GREAT practice at MAC and GA/LMA cases, and couldn't be happier.
Medicine in theory is awesome, but in practice it doesn't take 12 months to learn how to manage COPD exacerbations or DKA. There are people that have fun in the ward medicine environment, which is great, but I think the learning experience doing a combo of ED, wards, ICU, and anesthesiology months is better preparation for the CA-1 year. And I get paid the same as the interns with 10 months of q4 call.

 

[Trisomy13]

I think one learns a lot of medicine on floor months, and so bragging about how you only had to do one floor month during a transitional year isn't really saying much about the transitional year having been a more educational year.....

I think the amount of learning on floor months varies widely, and can quickly boil down to case management if you aren't lucky. i've said in a different thread that one can make a strong case for a prelim surgery, prelim med, or TY depending on what one wants from that year. am i happy about only having one IM month? you bet i am. am i worried about missing out on education? nope, because those other months will be spent in the MICU, SICU, PICU, neurosurgery, peds surgery, pulmonary med, etc. I agree that a TY can be lacking if one schedules a string of glorified 4th year med student rotations, but if scheduled correctly, it can be as useful as any prelim med or surgery year.

 

[Trisomy13]

I will readily admit that quite often I felt like slitting my wrists.

I think that sums it up.

 

[Binkeee]

I agree...I only applied to transitional programs b/c I knew I wouldnt be happy with a whole year of medicine or surgery. The transitional year gives you flexibility and a broader range of experiences.

TY Resurrection Medical Center: '07-'08
University of Chicago Anesthesiology: '08-'11