agranulocytosis

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A few threads in the past couple months have brought this school's 2-year prelim gen surg program to my attention. I've been trying to look up some information regarding this prelim program, but have come up empty-handed.

Let's say one were to apply next year for a 2-year prelim spot and got in, would said resident then apply to another program for a categorical spot as a PGY-2 or -3? On a similar note, if one were to apply as a PGY-1, would that mean the new program would have to "sponsor" said applicant for their final 2 years of residency because they ate up 2 years of funding in the prelim program?

According to a prior post by aPD:

Here's how it works:

1. Each year of funding "counts". If you do two prelim IM years tandem, that counts as using 2 years of funding.

2. Your total available funding is "set" when you start a "terminal residency" -- i.e. one that results in board certification. All prior years count towards this maximum.

Therefore, in your example, you do a TRI -- this uses one year of funding, but does not set the clock. You then start ortho. This sets your clock at 5 years. However, you have already used one year, so you have 4 years left (and are one year short).

Once the "clock expires" funding does not go to zero -- programs get 50% of DME and 100% of IME. All fellowships are funded "post clock".
http://forums.studentdoctor.net/showpost.php?p=7882974&postcount=7


Does this mean the hospital that one would match into after those 2 prelim years will only get 1/2 of what they normally would for 2 years for a resident that matched categorical from the beginning? It would seem that the new program must really want that resident to be there. But after coming from a UW internship, my guess is that that resident would be very well qualified.

Anyone care to shed some light on this for me/us? I'm applying next year for the match and after looking at the results this year (only 2 spots went unmatched!), you can't help but just be really careful and be very deliberate in all actions.

Thanks. And good luck to the folks in the scramble!
 
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BlondeDocteur

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I have a very vested interest in answering this question. :)

NO you do not match PGY-1 after completing 2 years of surgical training. I mean, you certainly could (in which case the funding year issue you mentioned could become a problem), but why would you want to?

UW is one of a handful of places that offers a genuine 2-yr preliminary surgery program, in that you are guaranteed a PGY-2 spot subsequent to satisfactory performance in internship, and that your training in terms of rotations completed, etc is completely undifferentiated from categorical residents.

You are eligible for PGY-3 spots in surgery at any program in the country with an open spot (and given the high rate of surgery attrition, there are a decent number of PGY-3 spots). You are also eligible to switch into a subspecialty, anesthesia, EM, radiology, etc.

I am actually taking one of these spots and feel that the gamble isn't as big as it otherwise might be. I think UW is a phenomenal surgery program and that it treats its prelims (especially the 2-yr prelims) very well. Feel free to PM me next year if you're still interested.
 

agranulocytosis

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So at the conclusion of the 2 prelim years, you'd matriculate into PGY-2 at UW and PGY-3 anywhere else? As far as I understood, this was the only program in the nation like this. I guess I need to do a bit more research.

One more quick thing: Would this 2-year NDP program be considered at a "higher tier" than the 1-year NDP? It just seems like all the goodies associated with the 2-year NDP make it more desirable than the other.

Thanks. Good luck on Thursday!
 

meathooks

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At Jackson we normally take 9-10 prelim interns. 4 of these are invited to complete a prelim PGY-2. The intern year rotations differ, but the PGY-2 rotations are the same as for catergorical. This year, 2/4 of them have found PGY3 spots at other hospitals. I'm guessing the rest go into a year of research or unaccredited fellowship in order to try again next year. Overall it seems to be a pretty brutal road. Hope your experience at UW is better.

I agree that students outside of New York tend to be coddled a bit more. Ours aren't allowed to show before 6:00 am (making any kind of prerounding impossible), and they only take (optional) call on the 4 weeks they are on trauma. I'm not sure if that means my med school was malignant or this place is too easy on them. However, every intern/resident I've ever met from the northeast stares in slack-jawed amazement the first time a nurse offers to draw blood/start an IV/place a foley for you.
 
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JackADeli

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...UW is one of a handful of places that offers a genuine 2-yr preliminary surgery program, in that you are guaranteed a PGY-2 spot subsequent to satisfactory performance in internship, and that your training in terms of rotations completed, etc is completely undifferentiated from categorical residents.

You are eligible for PGY-3 spots in surgery at any program in the country with an open spot (and given the high rate of surgery attrition, there are a decent number of PGY-3 spots). You are also eligible to switch into a subspecialty, anesthesia, EM, radiology, etc...
Folks need to keep in mind... in the end it is still a prelim position. Most places I know accept you as a first year and "subsequent to satisfactory performance in internship" will offer you a second year prelim should you have no place to go.... It's not unique in that regard. UW tries to advertise its practice of giving a second/PGY2 prelim year "subsequent to satisfactory performance in internship"... Again not unique. It does not guarantee you a categorical at any institution, though I hear UW gives you a fancy diploma. I also hear UW makes a certificate for FMG to further try to validate itself as a special pipeline into categorical life.

Every prelim will be gunning for a categorical position. First, they will look for a spot at the end of their PGY1 yr, at their prelim home institution if possible. If they can not suceed but have worked hard, crossed the "T's" and dotted the "I's", their PD will very likely keep them on as a PGY2 prelim. Then, every PGY2 prelim in the country will be gunning for the categorical spots.... Every PGY2 UW "grad" will be competing with each other for these same spots. This is not magical.

There really is no such thing as a "a genuine 2-yr preliminary surgery program, in that you are guaranteed a PGY-2 spot subsequent to satisfactory performance in internship" Re-read the underlined portion a few times.... In otherwords, UW will continue you as a PGY2 prelim if you do a good job/etc... just like almost any other program in the country. If they feel your performance was unsatisfactory, you are done just like any other prelim in the country.
 
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BlondeDocteur

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Sorry JAD, but you happen to be incorrect on this. UW has a real 2-yr prelim program. You have two years' worth of training, guaranteed, when you sign your match contract. I was told as well during my interview that I was making a 2 year commitment to UW and that searching for a categorical spot at the end of internship is discouraged. The whole "satisfactory performance in internship" bit was something I added because of course promotion to the next year is never automatic. You can get fired for ineptitude if you're categorical, too.

I know that UNC has a genuine 2-yr prelim as well, which you match into. There are quite possibly others.

And yes, the 2-yr spots are more desirable and competitive than the 1-yr spots, for the obvious reasons, though both fall far short of a categorical position.

So at the conclusion of the 2 prelim years, you'd matriculate into PGY-2 at UW and PGY-3 anywhere else? As far as I understood, this was the only program in the nation like this. I guess I need to do a bit more research.
NO-- at the conclusion of two years of training you are a PGY-3, either staying on at UW or anywhere else.

http://depts.washington.edu/uwsurgap/prelim.htm
 

JackADeli

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Sorry JAD, but you happen to be incorrect on this. UW has a real 2-yr prelim program. You have two years' worth of training, guaranteed, when you sign your match contract. I was told as well during my interview that I was making a 2 year commitment to UW and that searching for a categorical spot at the end of internship is discouraged. The whole "satisfactory performance in internship" ...of course promotion to the next year is never automatic...

...NO-- at the conclusion of two years of training you are a PGY-3, either staying on at UW or anywhere else...
"UW has a real 2-yr prelim program." Honestly what does that really mean exactly?????? A real two years of surgical residency...that is so unique? We could argue semantics if you like, but I don't see the point.

As for "guarantee" and "contract"... even categoricals at most places I am aware of are re-contracted at every PGY level. The categoricals are waiting for their new contract, usually a couple months after the in-service. As a categorical, I NEVER signed a five year contract... Maybe UW is different and you actually sign a two year contract.... but that would be more then most CATEGORICALS get.

[at UW] Searching for categorical spot (i.e. cat PGY2) "is discouraged".... I'll leave that to everyone to think about it. In general, a program dependent on quality prelim cadre labor does well to have a 2yr "commitment". This commitment is of primary and first benefit to the program/PD. And again, most programs I am aware of will continue a quality/unmatched prelim into a PGY2 prelim spot without actually discouraging them from achieving a categorical spot during the first year.

At the conclusion of your PGY2 prelim year at UW or anywhere else, you become (if successful) a categorical at whatever level 1-3 you can find. It is very, very common to have to repeat at least one year when jumping from prelim to categorical.... it doesn't matter if you are UW or anywhere else....

While at my General surgery program, where we did regularly continue prelims even into PGY3 if necessary, we interviewed and screened "UW program" applicants (for occasional open cat spots). I am not at UW, never went through its "special preliminary program", but, we have seen folks coming from the other end. I have no doubt one can get good training during prelim years. That has not been the concern of PDs or mine. The concerns have been the generalized perception that somehow UW, printing up special certificates & diplomas, plus/minus "english testing" has some sort of covenant with major institutions assuring categorical achievement at the end. I believe they do not have any such guarantee. You are a prelim. You are guaranteed the opportunity to train one year, and possibly a second year if your performance is on-par. Then, you are an individual with two years prelim training looking for a job. But, that is it, you are a prelim looking for a job/cat spot.

Again, most good programs that uses prelims consistently will consistently promote to PGY2 and sometimes PGY3 prelim spots. The PDs I have spoken with state they just have a little pit in their stomach because they don't want to mislead prelims or waste their time only to see them work hard for 2-3 years and still not get a categorical spot. Any PD worth their salt will be invested in their prelims success if the prelim is also invested...

Final notes.... Yes, categorical can be fired/terminated/not continued at the conclusion of any training year. The difference between a categorical not continuing and a PGY1 prelim not promoting to PGY2 prelim comes down to RRC/ACGME reviews and accreditation. Failure to promote categoricals raises questions and red flags. Not the same with prelims because, well.... your just a prelim and your promotion is not scrutinized in the same manner.
 
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BlondeDocteur

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UW has "P1" residents (traditional preliminary year residents) and "P2" residents (people who are matched into 2 years of training, similar to what urologists did before they changed their residency structure).

Yes, at the end of one year P1 residents might be invited to stay on for a second year. Yes many programs across the country have PGY-1, PGY-2 and even PGY-3 preliminary spots. Perhaps you could say the difference boils down to mere semantics, but to me the surety of having a second, automatic year of training was very reassuring and was the absolute deciding factor in taking the gamble and going for the P2 spot.

I'm sharing the details about being "discouraged" in looking for categorical spots after internship in an attempt to illustrate the difference between these P2 spots and traditional prelims, not to try and cast UW in some anticompetitive light. I'll be just as discouraged from shopping around as any categorical resident would be after their internship-- the program is banking on me continuing on. Me, not someone filling my spot in the roster.

Finally, I believe you are referring to the arrangement they have with Foreign Medical Grads re: the special certificates, English testing, etc. I don't know anything about that.

JAD I know I'm a med student and you're an attending but as I'm the person who researched, interviewed for and accepted this spot while you admit having no affiliation or contact with UW other than occasionally interviewing ex-prelims, you might have to just trust me on this. Perhaps current UW residents could chime in? There are a few on this forum...
 

JackADeli

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...Yes, at the end of one year P1 residents might be invited to stay on for a second year. Yes many programs across the country have PGY-1, PGY-2 and even PGY-3 preliminary spots. Perhaps you could say the difference boils down to mere semantics...

...I know I'm a med student and you're an attending but as I'm the person who researched, interviewed for and accepted this spot while you admit having no affiliation or contact with UW other than occasionally interviewing ex-prelims, you might have to just trust me on this...
I fully understand what you are saying. My point plain and simple is that it is prelim. You, as any other prelim will have to work hard. Yes, there may be something to be said about having a complete year done with an ABSITE score when applying for categorical... thus being PGY2 prelim may have a benefit there as a PGY1 prelim is applying before even completing six months of training. I get all of that. Some find comfort in just heading into a two year plan.

But, long and short, to my understanding of ACGME/RRC prelim attrition is not a significant factor towards accreditation. Thus, prelims have no real guarantees. The other issue of a prelim going to categorical within the same institution... it depends on that institution having some sort of categorical attrition rate. A vacancy must open up or the program must systematically "underfill" its categoricals. Some folks may go into labs... but a vacancy must be there for them to come out into... So, prelim guarantees, math, and conversion... are not secure.

I do not want to discourage anyone from pushing forward even if they did not match. A prelim is a time proven route to getting back into the categorical game. If one wants a two year prelim route, go for it. But, when push comes to shove, no matter how much good will and good intentions, you are a prelim, competing against every prelim in the country, and no matter how fancy a program may dress up their "prelim program"... still a prelim.

JAD
 
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filter07

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Considering you were nearly applying for plastics, I'm sure your credentials are great and you will have many options after completing your prelim years. So what I'm saying will probably not apply too much to you.

But for the others out there, please understand that getting a prelim PGY2 position is about as difficult as having a bowel movement after eating at Taco Bell. I don't know about UW's program, but I am naturally extremely skeptical in general, and I don't give people in power any benefit of the doubt, since they almost always abuse it. In that context, I would personally be very hesitant to sign up for a 2 year prelim commitment, or be swayed in any fashion by things as vague as how nice the PD was, or the "philosophy" or "goals" or a 2 year prelim spot. A 2 year prelim spot is, generally speaking, entirely in the program's favor. If you are good, they get two years of good service out of you, and don't have to dip into the pool of prelims looking for prelim PGY2 spots. This pool is not looked upon very favorably by people, as they are seen as those who essentially failed at least two times to find a categorical spot. So locking in a good resident for two years is obviously in the program's interest. On the other hand, if they don't like you, they have no requirement to keep you.

For others out there, there is usually very little tangeable advantage to a 2 year prelim spot. I can't really think of any for the resident. The only advantage UW has is that it is a general surgery powerhouse with a lot of big names and connections. That has nothing to do with whether you sign up for 1 or 2 years of non-guaranteed training.
 

JackADeli

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"UW has a real 2-yr prelim program." Honestly what does that really mean exactly??????...
...please understand that getting a prelim PGY2 position is about as difficult as having a bowel movement after eating at Taco Bell.

...A 2 year prelim spot is, generally speaking, entirely in the program's favor. If you are good, they get two years of good service out of you, and don't have to dip into the pool of prelims looking for prelim PGY2 spots. This pool is not looked upon very favorably by people, as they are seen as those who essentially failed at least two times to find a categorical spot. ...if they don't like you, they have no requirement to keep you...
My points exactly...
 

SLUser11

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JAD I know I'm a med student and you're an attending but as I'm the person who researched, interviewed for and accepted this spot while you admit having no affiliation or contact with UW other than occasionally interviewing ex-prelims, you might have to just trust me on this. Perhaps current UW residents could chime in? There are a few on this forum...
First of all, BD has stated that her decision was based on uncontrollable personal and geographic reasons. Also, it's obviously too late to change anything. Also, given her competitiveness, she is not a typical or average preliminary resident. That being said, the elephant in the room is that her position is not that secure, and the promises she received are not that unique.

The resident posters are saying is that this scenario is not as unique as it might seem, and any way you try to dress it up, 2 year prelim positions are still a big [email protected]$t sandwich. It is a big gamble for an otherwise competitive applicant, and there are frequent stories here on SDN of residents that have completed 2 years of prelim surgery and are now without jobs.

While they may be targeting BD in particular, I think they're simply pointing out that it's generally not a good idea, regardless of BD's ultimate outcome.
 

Black Surgeon

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Sorry JAD, but you happen to be incorrect on this. UW has a real 2-yr prelim program. You have two years' worth of training, guaranteed, when you sign your match contract. I was told as well during my interview that I was making a 2 year commitment to UW and that searching for a categorical spot at the end of internship is discouraged. The whole "satisfactory performance in internship" bit was something I added because of course promotion to the next year is never automatic. You can get fired for ineptitude if you're categorical, too.

I know that UNC has a genuine 2-yr prelim as well, which you match into. There are quite possibly others.

And yes, the 2-yr spots are more desirable and competitive than the 1-yr spots, for the obvious reasons, though both fall far short of a categorical position.

NO-- at the conclusion of two years of training you are a PGY-3, either staying on at UW or anywhere else.

http://depts.washington.edu/uwsurgap/prelim.htm
I don't get it. You almost went into the plastics match and even took a year off for research, thus I assume your resume must be outstanding. I also assume you must have worked pretty hard to get to where you are(resume wise). You then realize plastic isn't for you, and that general is, but (according to what you posted ealier) you turn down categorical spots to take the prelim spot at UW? What was it about seattle that prompted such a decision? Did you meet the love of your life? (no pun intended)
 

Winged Scapula

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To quote a very good friend of mine who is on surgical faculty at UW:

"anyone who takes a prelim position over a categorical position, even one here at UW, is either a fool, high or sleeping with someone here."

He goes on to tell me that they do place a lot (but not all) of their Prelims into Categorical spots because Pellegrini and the PD are well known in ACS but that in his opinion, it is a mistake to take a position in this track for candidates who have other options, or "a bird in the hand is worth two in the bush" (ie, categorical trumps prelim).
 

JackADeli

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To quote a very good friend of mine ...:

"anyone who takes a prelim position over a categorical position, even one here at UW, is either a fool, high or sleeping with someone here."...
BlondeDocteur clearly has their reasons....

But, I encourage anyone seeking a residency spot in the future or currently taking a preliminary spot to seriously consider what has been written in this thread. Keep your mind focused on what "the point is". A prelim is NOT a "program".... it is a means to an end. That end is to get into a TRUE TRAINING PROGRAM as soon as you can. Thus, you obtain complete training and get on with your career. There is no really good reason for any of us, having gone through the process to encourage someone to pass up a accredited categorical training program for a flowery, glorius prelim year or two.

Furthermore, for those going into prelims and wanting to finish a TRUE COMPLETE TRAINING PROGRAM, be prepared to repeat 1 or 2 years when transitioning to categorical. You may do a PGY1 prelim. Your only categorical option may be to repeat that internship as a categorical. You may do PGY1 & 2 prelim yrs. Again your options for categorical may require starting over as a categorical PGY1. That is life. Numerous programs will fill categorical spots with folks having done some prelim (purgatory) time. Also, many programs will not want you walking in at upper/senior level status. They may want you "tuned down" to allow you to learn their way of doing things and their hospital specific systems. You may have 2 yrs experience doing some cases, taking floor calls, etc.... it doesn't mean you can necessarily function in their environment as a PGY3. Finally, your rotations experience at a given PGY level will likely be different. Maybe you have less or more ICU experience, less or more trauma experience, etc, etc....

So, be prepared to start over at a PGY level less then you may feel deserving based on your prelim experience/s....
 

BlondeDocteur

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My experience and situation are so odd I absolutely don't want to generalize and I certainly wouldn't want to encourage anyone else to make the same gamble. I'm sure it is almost never worth it to turn down secure categorical spots for a prelim, even at a top program.

Trouble is, I found myself believing that "almost never" meant "very occasionally it is worth it..." and for me, it was.
 

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My experience and situation are so odd I absolutely don't want to generalize and I certainly wouldn't want to encourage anyone else to make the same gamble...

...I found myself believing that "almost never" meant "very occasionally it is worth it..." and for me, it was.
With all sincerity and honesty I and, I suspect most everyone else wish you the best of luck. Please do keep us informed on how things go. Based on your plans, you will likely not be applying for categorical positions until ~6 months into your prelim PGY2 year. Please, at that time, come back and let us know how that is going and how it does go for you. It's a long way off... but that information is important experience data for future matchers and prelim residents. We will all want to know if you will be repeating time when transitioning or going straight into a PGY3, etc....

Again, congrats on achieving your goal/plan. Best wishes.
 

BlondeDocteur

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Thanks JAD. Very sweet of you.
 

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My experience and situation are so odd I absolutely don't want to generalize and I certainly wouldn't want to encourage anyone else to make the same gamble. I'm sure it is almost never worth it to turn down secure categorical spots for a prelim, even at a top program.

Trouble is, I found myself believing that "almost never" meant "very occasionally it is worth it..." and for me, it was.
Yes, my comment above was not meant as an indictment of you, as you've shown yourself to be a stellar candidate who is much different than the usual Prelim who cannot get a Categorical.

It was cautionary tale, that even faculty at UW do not advise taking the Prelim position at their own program if you are eligible or can get a categorical one, even elsewhere (less stellar than UW). A route not to be followed by most applicants to be sure.