What's Better For An Anesthesiology Prelim: Surgery or Medicine?

[Bob California]

Any thoughts would be appreciated.

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[gasblaster]

Any thoughts would be appreciated.

This has been discussed in previous threads. In general, most anesthesia applicants tend to go for prelim medicine and transitional years. I have rarely heard of anyone that has electively done a prelim surgery year. Those that do tend to have geographical limitations or other confounding factors.

 

[DrBeaker]

I did a prelim surgery year. I felt it was great. My opinion, if you are going to work in an OR for your career, why waste a year "rounding" for hours on end? I could not stand IM.

Thing you have to do if considering prelim surgery, find one where you actually get to do procedures/operate/be in the OR. Doing prelim surgery and being scut-floor-monkey won't help you at all, much like prelim medicine (that is my bias)

 

[Green912]

Medicine.

For the pt undergoing an appy you need to know how to manage their CAD, COPD, DM, AICD...etc. You don't need to know who to perform the appy or be able to identify the anatomy seen on the screen.

 

[pretenda]

if you want to learn how to properly manage patients do medicine. surgeons cant touch internists intellectually.

if you want to learn how to get ish done do surgery. if you do it at the institution youre doing your residency at you train with the dudes on the other side of the blood brain barrier.

best id say is a categorical where your residency program assigns you your rotations or do a transitional where you can squeeze in a bit of both and do some consult months. honestly i learned the most on consult months.

 

[BLADEMDA]

if you want to learn how to properly manage patients do medicine. surgeons cant touch internists intellectually.

if you want to learn how to get ish done do surgery. if you do it at the institution youre doing your residency at you train with the dudes on the other side of the blood brain barrier.

best id say is a categorical where your residency program assigns you your rotations or do a transitional where you can squeeze in a bit of both and do some consult months. honestly i learned the most on consult months.

The best would be 6 months of Critical Care as a PGY-1 with the remaining months in medical subspecialties. Then, another 6 months in Critical Care as PGY2-PGY-4 allowing you to sit for the Critical Care exam.

The system needs an overhaul.

 

[pie944]

Any thoughts would be appreciated.

Go with location/happiness.

I believe the odds of finding a surgical year where you aren't working brutal hours on meaningless(to you) tasks is a low probability. At best you do a ton of work to get procedures, but is that going to make a difference in the long term? Sure you might be better at the start of CA-1, but after 6 months how many will be able to tell apart you and your co-residents in terms of technical skills? Add another 6 months onto that and the distinction will be even narrower. I don't know for you if slight starting advantage is worth the possibility of a brutal intern year. I know for me it wasn't.

Medicine is medicine, some people enjoy it, some people can only take so much, and some people can't take it at all. I am in the middle, and that threshold became lower as I finished each year of medical school.

I did a TY year. In terms of the scale of complete blow off versus most difficult year ever, it was probably in the middle with a slight tilt towards the easier side. I had my blow off rotations without a doubt, but I also had two ICU months where I managed sick patients and placed lines, etc. I chose the consult months I wanted to do with a nice balance of work/reading time. I had a couple of medicine months that gave me enough background knowledge without the brutal social issues or long hours.

As for categorical vs advanced, look at the year itself(happiness/location) as opposed to the categorical vs advanced label. The categorical vs advance label itself means very little.

 

[TrustMe]

The best would be 6 months of Critical Care as a PGY-1 with the remaining months in medical subspecialties. Then, another 6 months in Critical Care as PGY2-PGY-4 allowing you to sit for the Critical Care exam.

The system needs an overhaul.

Totally agree.

My former residency program is supposedly working on a 5 year anesthesia/CCM integrated program. 12 months of ICU integrated over the 5 years that will allow one to sit for the anesthesia and critical care boards when finished. I hope it works out and is approved. It would be a great boost to the specialty as well as the health care system in general.

 

[lushmd]

Totally agree.

My former residency program is supposedly working on a 5 year anesthesia/CCM integrated program. 12 months of ICU integrated over the 5 years that will allow one to sit for the anesthesia and critical care boards when finished. I hope it works out and is approved. It would be a great boost to the specialty as well as the health care system in general.

He/she is working on a four year or a five year program? Several places (i.e. OHSU, UCSF, etc...) have five year integrated programs in place already.

 

[fakin' the funk]

The best would be 6 months of Critical Care as a PGY-1 with the remaining months in medical subspecialties. Then, another 6 months in Critical Care as PGY2-PGY-4 allowing you to sit for the Critical Care exam.

Yeah, that's not how it works.

 

[fakin' the funk]

Any thoughts would be appreciated.

Medicine, without a doubt, for the reasons listed above.

Every day as an anesthesiology resident I apply something I learned during my preliminary medicine year. That means being the primary doctor with patients with acute/chronic CAD, arrhythmias, heart failure, COPD, pneumonia, shock of all kinds, GI bleeds, stroke, intracranial hemorrhage, DKA/diabetes, renal failure, liver disease/failure, autoimmune disease, etc etc.

What do surgeons do when they have a patient with one of the above? Consult medicine.

Some of it is scut, and a lot of your "bread and butter" admissions won't help you down the road (Granny with a UTI).

 

[PMPMD]

I found my cardiology rotation to be incredibly useful. 2 months of heme/onc - not so much.

 

[sevoflurane]

Any thoughts would be appreciated.

Transitional year with 6 mo. of electives... including cardiac/echo, MICU/SICU/NICU/CVICU/Burn unit, neurology, pulmonary, trauma + a coupla anesthesia months and a coupla radiology-like electives.

 

[maggie086]

I opted to do a mix of TY's with surgical electives and surgical prelim years. Everyone said I was crazy for doing it, I just would rather do surgery months than medicine wards months. That being said, I didn't apply to any crazy malignant surgery prelims.

Also, at the end of the day, so many programs are transitioning to nearly completely categorical that it almost doesn't matter too much anymore. I know plenty of people this year who are doing solely categorical and not even bothering with the whole prelim year situation.

 

[chrisv]

Amen!!!

Does anyone know of prelim surgery program where you can do several SICU months? Or do most just allow you to do a couple of SICUs?

The best would be 6 months of Critical Care as a PGY-1 with the remaining months in medical subspecialties. Then, another 6 months in Critical Care as PGY2-PGY-4 allowing you to sit for the Critical Care exam.

The system needs an overhaul.

 

[ashkenazi1234]

Amen!!!

Does anyone know of prelim surgery program where you can do several SICU months? Or do most just allow you to do a couple of SICUs?

acgme only gives max credit of 2 months of ICU for intern year. so even if you do 6 months of ICU, you only count 2 of those towards your requirements, so you better be lovin those other 4 just for kicks... 🙂

 

[pgg]

Transitional year with 6 mo. of electives... including cardiac/echo, MICU/SICU/NICU/CVICU/Burn unit, neurology, pulmonary, trauma + a coupla anesthesia months and a coupla radiology-like electives.

+1000

The outpatient primary care clinic pain PLUS weekly "continuity" clinic even while away from the IM core were absolute dealkillers for me, I never considered an IM prelim year.


Of course, as fate would have it, after my TY the Navy parked me in the equivalent of a adolescent medicine / sports medicine / doc-in-the-box / psychiatry clinic for 3 years (USMC infantry) before I could go be an anesthesia resident ...

 

[gasblaster]

acgme only gives max credit of 2 months of ICU for intern year. so even if you do 6 months of ICU, you only count 2 of those towards your requirements, so you better be lovin those other 4 just for kicks... 🙂

While also still meeting the other ABA requirements.

 

[chrisv]

well then, maybe not for 6 months, but maybe for 3-4 months. I'm eventually interested in a critical care fellowship, so it wouldn't hurt to have more experience in SICU during intern year.

acgme only gives max credit of 2 months of ICU for intern year. so even if you do 6 months of ICU, you only count 2 of those towards your requirements, so you better be lovin those other 4 just for kicks... 🙂

 

[killerleaf]

ACGME and the ABA are rather strict as to what you have to cover in your intern year. You have to have medicine rotations, sorry, not really a way around it. Have had a couple of people who transferred from Surgery into Anesthesia, and their record of rotations was scrutinzed closely, and one had to take a couple of medicine rotations in their PGY2 year because theirs did not pass inspection.

 

[chrisv]

So does that mean that a preliminary surgery that does NOT have any internal medicine rotations wouldn't meet the ABA and ACGME requirements?

ACGME and the ABA are rather strict as to what you have to cover in your intern year. You have to have medicine rotations, sorry, not really a way around it. Have had a couple of people who transferred from Surgery into Anesthesia, and their record of rotations was scrutinzed closely, and one had to take a couple of medicine rotations in their PGY2 year because theirs did not pass inspection.

 

[gasblaster]

According to the ACGME, you must have at least 6 months of inpatient care which includes internal medicine, surgery, pediatrics, family med, and obgyn. However, critical care is separate and the maximum that's accredited during intern year is 2 months. Over that it takes away from whatevers left. As long as it meets the requirements it's fine. Along with TYs, prelim medicine, and prelim surgery there are residents that I've met that have done prelim pediatrics.

http://www.acgme.org/acWebsite/downloads/RRC_progReq/040_anesthesiology_07012008_u03102008.pdf