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Transitional Yr vs Prelim Yr
Started by 4424
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J
JR
This is a matter of personal preference. However, I think that a good background in IM serves as a good foundation for ophthalmology training. As you may know, many systemic diseases have ocular manifestations and visa versa.
I am on the West Cost now and I can honestly tell you that there are no good transitional programs in So Cal. Most of the ones that are out here, will work you to death and use you to plug up holes in their different services, including Ob/Gyn, Peds, Surgery, etc. So, you can potentially have several malignant months back to back to back. With IM, at least you know what you are getting from the start. Having said that, I think there are some good transitional programs in other areas- programs with plenty of elective time, opportunities for research, etc.
Regarding surgery prelim. I've spoken to several ophtho residents who did surgery prelims and the unanimous opinion was that the surgical skill you acquire in gen surg ( those few surgeries you actually get to scrub into as an intern 🙂 ) do not hugely contribute to you future microsurgical skill as an ophthalmologist.
At the end of the day, for most people, it comes down to what you are willing to put with for a year. If you like switching services, don't mind a little surgery, little peds and have a nice transitional program near by, go for it by all means. If you don't mind IM and ok with dealing with a lot of social bs for a year, then do IM. I actually have a buddy who ended up doing a peds prelim 😱 .
I am on the West Cost now and I can honestly tell you that there are no good transitional programs in So Cal. Most of the ones that are out here, will work you to death and use you to plug up holes in their different services, including Ob/Gyn, Peds, Surgery, etc. So, you can potentially have several malignant months back to back to back. With IM, at least you know what you are getting from the start. Having said that, I think there are some good transitional programs in other areas- programs with plenty of elective time, opportunities for research, etc.
Regarding surgery prelim. I've spoken to several ophtho residents who did surgery prelims and the unanimous opinion was that the surgical skill you acquire in gen surg ( those few surgeries you actually get to scrub into as an intern 🙂 ) do not hugely contribute to you future microsurgical skill as an ophthalmologist.
At the end of the day, for most people, it comes down to what you are willing to put with for a year. If you like switching services, don't mind a little surgery, little peds and have a nice transitional program near by, go for it by all means. If you don't mind IM and ok with dealing with a lot of social bs for a year, then do IM. I actually have a buddy who ended up doing a peds prelim 😱 .
JR said:
I believe this sounds good, in theory, and has been my rationalization for IM vs Transition. However I believe that the majority of these systemic diseases are primarily managed on an outpatient basis (especially rheumatology stuff). So I wonder myself and will find out next year how much I actually learn from inpatient medicine. My future program director told me to go somewhere that is easy and won't burn me out.
4424 said:
Do a transitional year; I can't think of a single rotation that I did during that year that I haven't applied to ophthalmology. I did 3 months of G-surg, and loved it. Much of what you pick up is used in ophtho, but on a much smaller scale. I also looked at it as an experience I'll never have again--my kids won't get excited hearing about the 3rd chest pain that ruled out during my night on call, but they'll probably love hearing about the GSW that dragged himself to my ER at 2 in the morning.
I would highly recommend a transitional year. I'm currently in mine. I've done 4 months of inpatient medicine, and to be honest I don't know what else I would've gotten out of doing another 2 months other than an even greater appreciation that I chose ophthalmology 🙂 and perhaps an ulcer. Even in the lightest transitional year, you'll get 7 months of "medicine" (floor, ICU, outpatient, ER) per ACGME requirements. You can always use your electives to do more medicine rotations if you feel you need to for some reason, but you can't cut back if you pick the prelim year. I can honestly not think of one advantage that a prelim year would have over a transitional year.
Doing a GS prelim year is way too much work for the amount of knowledge you would take away from it (as applicable to ophtho). That said, a TY will give you the option of just doing a few months of surgery. That way, you can pick up some additional OR skills that could help you out in the future if you decide to do oculoplastics, while at the same time not destroying your life for a year.
I think a TY year is definitely the best bet. You'll have the most flexibility, so you'll be able to schedule electives that are more useful toward ophtho then if you do an IM year. For example, if you plan on doing pediatric ophtho, you could schedule more peds time as a TY then you could as an IM prelim. If you're interested in Uveities, you could spend more time doing rheum, etc etc.
Also, don't forget that if you pick a good TY program, you could have a much higher quality of life then in a typical IM prelim program.
I think a TY year is definitely the best bet. You'll have the most flexibility, so you'll be able to schedule electives that are more useful toward ophtho then if you do an IM year. For example, if you plan on doing pediatric ophtho, you could schedule more peds time as a TY then you could as an IM prelim. If you're interested in Uveities, you could spend more time doing rheum, etc etc.
Also, don't forget that if you pick a good TY program, you could have a much higher quality of life then in a typical IM prelim program.
J
JR
Just as I mentioned in my original post, there are NO good transitional programs around where I live now. I know there are some good ones out there, though.
With prelim medicine, you have to be careful which program you choose. You certainly don't want to be at a highly competetive malignant academic program. I nice community-based IM prelim with a good call schedule can do just fine 😀 .
Telling your kids about GSWs is great, but what about being able to advise your family and friends on various medical problems ("I've been having this rash...")? I don't think a surgical internship will teach you more than to manage post-op pain and fluids. Besides, who wants to do 90% of scut on the floor in a field you are not even going into.
just my 2 cents
With prelim medicine, you have to be careful which program you choose. You certainly don't want to be at a highly competetive malignant academic program. I nice community-based IM prelim with a good call schedule can do just fine 😀 .
Telling your kids about GSWs is great, but what about being able to advise your family and friends on various medical problems ("I've been having this rash...")? I don't think a surgical internship will teach you more than to manage post-op pain and fluids. Besides, who wants to do 90% of scut on the floor in a field you are not even going into.
just my 2 cents
I've heard that the application for a transitional can be difficult if you are trying to stay in a large city, like NYC. I think you may need to be slightly flexible about location if you interviewing for transitionals in the northeast.
At first I carried around the Washington Manual. It's kinda heavy though. Eventually (after 1 month) I stopped carrying any books and just had my palm pilot. I don't know how most places are, but in my program the residents (ie non-interns) take care of "emergent situations" such as running codes. I was NEVER left alone in that kind of situation and I always new I had backup if a patient was unstable during an overnight call. It may not be that way everywhere (I would avoid those places).demspawn said:
In my humble opinion, I've found that though medical knowledge is important, being a good intern has more to do with your ability to "work the floor" (working efficiently; getting patients discharged quickly; contacting consultants/family; taking care of social issues; working with social workers to get patients into nursing home or subacute care facility; working with discharge planners to get your DVT patient some outpatient Lovenox and an appointment at a coumadin clinic etc...). You learn that from experience. And if you're like most transitionals, your main goals will be to get patients discharged to keep your patient list short so you can get your work done and get out the door.
There was a study done that showed ophtho residents who did prelim med performed better than those who did transitional. It was mentioned previously in this forum but I never looked up the original research. Anyone heard of this study? I don't see the logic unless prelim med programs attract the real go-getters- like our esteemed moderators?
Andrew_Doan
Ophthalmology, Aerospace Medicine, Eye Pathology
Moderator Emeritus
Lifetime Donor
20+ Year Member
Herbie said:
Some advice from a senior resident:
1) I managed diabetes with sliding scales all the time on the ophthalmology inpatient service.
2) I replenished potassium and other electrolytes on my inpatient ophthalmology service. It's hard not to when you see a K of 2.9.
3) Two months ago, I managed an acute upper GI bleed and stabilized the patient until internal medicine took over 6 hours later. Passed the GI tube and started pRBCs.
4) I've managed sepsis from orbital cellulitis, and watched the patient improve while medicine looked on as consultants.
5) Your medical internship is the one major thing that separates ophthalmology from optometry. I recommend that you learn as much as possible during the internship and NOT just look for "red eyes". For those looking for an "easy way out", I can guarantee that there are optometrists who are ready to complete the hard internships. Just something to think about. BTW, I do like transitional years because they provide broad experience. I completed an IM year, however.
6) Detecting systemic illness is important. If you think ophthalmologists don't diagnose and detect systemic illness, then read these cases:
http://webeye.ophth.uiowa.edu/eyeforum/case1.htm
http://webeye.ophth.uiowa.edu/eyeforum/case17.htm
http://webeye.ophth.uiowa.edu/eyeforum/case35-metastaticlungca.htm
http://webeye.ophth.uiowa.edu/eyeforum/case6.htm
http://webeye.ophth.uiowa.edu/eyeforum/case20.htm
http://webeye.ophth.uiowa.edu/eyeforum/case9.htm
http://webeye.ophth.uiowa.edu/eyeforum/case24.htm
Andrew_Doan said:
i really don't think i would have a problem with doing either. i was just more unfamiliar with a TY so it's good to hear different thoughts.
the other question i had was if ophthalmology programs ever offer the first year to be at the same institute, either TY or PRelim? thank you
Andrew_Doan
Ophthalmology, Aerospace Medicine, Eye Pathology
Moderator Emeritus
Lifetime Donor
20+ Year Member
Look at Utah and on www.sfmatch.org (lists programs with combined prelim years).
There are also a number of programs that aren't officially combined but if you match at one institution, you are ranked much more favorably at the TY/Prelim place if you let them know your intentions. I was told this at several spots when interviewing. Unfortunately, there is no list of these and you just find out as you interview. If there are ophtho places you really like you can find out where residents did internships and that usually gives a clue. Or you can just apply to programs in the area. If you matched ophtho they are going to realize you are likely a good candidate and then are more likely to come there if they rank you. It also helps to find out some of this info in advance so you can schedule intern interviews on the same trip to save travel expenses.
4424 said:
I'd just like to say that the difference can be very minimal and the experience is very program dependent. At the hospital where I did my internship, the transitional residents did an additional month of Emergency medicine instead of inpatient medicine, and had two elective months instead of one. That was the primary difference between transitional and internal medicine. Transitional residents still had to do inpatient medicine, critical care, medicine subspecialties, outpatient clinic rotations.
I've seen some quote a study reportedly suggesting that residents with medicine internships were better trained residents than those with transitional internships. This is silly. The experience is entirely location dependent....there are some very "cush" transitional programs and there are some very tough ones....same as medicine.
I thought the most important thing was finding a program with the rotations I wanted, residents and attendings that were happy and committed to teaching, safe location, satisfactory facilities....etc Common sense stuff. Some require pediatrics, some require general surgery, some require ob/gyn...look at the curriculum, decide what you want out of the year. There is no right answer or best way to do it.
JR said:
I beg to differ! Scripps Mercy's transitional program in San Diego is a dream come true. It is a private hospital with a county hospital population. This gives one the advantage of seeing a wide pathology, in addition to using the lastest high tech methods. Auxillary services are amazing - MRI's are usually done within a couple of hours of ordering them.
TY's spend 5 months on Medicine wards (one of which is a float month), which can be very busy, but overnight call is Q10. One month is spent in the ER, where you work 15 shifts. Four months of electives, such such as Ophtho, Rads, Surgery, CT Surgery. When on electives you do not have patient care responsiibilities or call - i.e. you just go to as many surgeries as you can. Of course if you really want you can spend your electives doing extra time in the ICU or on Cards or Renal. Two months of peds, which are pretty light. One month of primary care clinic.
Teaching is amazing. Morning report ranks above most that I have seen at the big academic institutions. Did I mention the free lunch at noon conference every day is really good? Plus we have a lounge with free breakfast and coffee every morning.
San Diego is absolutely gorgeous, with plenty to do and amazing weather most of the time. I strongly encourage anyone going into ophtho to apply here. It is a great year. When I get a chance I will write it up on scutwork.
J
JR
Sorry, I forgot about that one. What I actually meant say was there are no good TY programs in LA area. I heard good things about Scripps; I did however see an unfilled spot this year.
Being through nearly 9 months of my transitional year. I don't feel that I would be any less competent at taking care of such issues as the categorical medicine interns at the same location. For the most part, the advantage of a TY is that you get a few extra elective months. If it is a GOOD program, you won't be treated any differently than the prelim or categorical medicine interns and there will be no significant difference between what you experience. I can't speak for what it would be like at a community program, however, as I'm in an academic environment (LOTS of teaching).Andrew_Doan said:
JR said:
Yep-It was apparently due to a glitch - if you want details you can PM me. It makes me wonder how many other problems there are with the match. Look what happened with the urology match. The whole thing is kind of scary when you consider how such little mistakes can affect people's lives.
J
JR
I am positive this was due to a glitch. That spot was probably filled 5 seconds after the match results were released 🙂. Fortunately, I don't have to worry about the match anymore. I am finishing a very nice medicine year at a community program and if I had to do it again I'd definately go to the same place.
I agree that the match can be a very scary experience; especially for us because we have to go through it twice 😱.
I agree that the match can be a very scary experience; especially for us because we have to go through it twice 😱.
fovea said:
chibi said:
I am currently a TY at NY hosp queens: what I know - there were 4 unfilled spots. I was very surprised to learn this as it is arguably the most competitive prelim/TY program in NYC to get. My year all of us ranked it #1, except 2 who ranked it #2. The rumor is that program director created a VERY short rank list & thus 4 spots unfilled. This is only a rumor, I havent heard anything further.
To comment on the program: it is great! I was looking for an easy year, & boy did I get it. 4 months of electives (which can be done as aways), 1 amb month (3 afternoons a week), 1 peds ER (very light), 3 mdcn months (7:15-3pm), 2 surg months. Hard to beat this schedule.
How competetive are TY programs? I'm trying to determine if I have a decent shot matching within a given geographic location, or if I have to apply broadly for a good TY program. I don't want to be stuck in the middle of Kentucky or somewhere (no offense to anyone from here), just because I'm trying to avoid 2 extra months of medicine floor scutmonkeying. But at the same time I really want to try to avoid as much scutmonkeying as I can. And, this crap is going to cost mucho $$$ on top of the billions I'm going to spend applying to Ophtho programs. 🙁
which geographic location are you looking to apply in?
rubensan said:
Maybe CA, or Northeast (I already looked into Hawaii's program, and all their residents are from Harvard, UCSF, et... 😱 ) But I would just prefer to be in a decent city, because there's no point in doing any easy transitional year and having all this free time if there is nothing fun to do 😀
DilatedPeoples said:
I can only speak for the LA programs. Although there are a lot of prelim progrmas in LA, the only TY program is at Harbor-UCLA medical center. It seems very popular, though I don't really know much about it. What you might find interesting is that the interview process is not mandatory. You don't have to interview to match at that program! So if CA location and TY are what you are looking for, I would apply!
