Advance Anesthesiology Spot + Prelim Surg

[CaptainVantasi]

I am applying to both categorical and advanced anesthesia. If I can do an advanced anesthesia, I want to do it with prelim surg

Does anyone know if it is looked upon favorably if I apply for all 3 positions (advance anesthesia and categorical anesthesia and prelim surg) in the same place?

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[partydoc]

no big deal. if they have advanced positions they know you have to do a prelim somewhere

 

[GlowInTheDark]

I’d wonder what was wrong with you for applying to a prelim surgery position.

 

[deleted171991]

I’d wonder what was wrong with you for applying to a prelim surgery position.

The same thing that was wrong when applying to anesthesia.

 

[Nivens]

Curious what your reasoning is.

Reason I ask, (and obviously this is n=1), but my wife's intern year as a prelim surgery resident was mostly clerical in nature. Surgeons do most of their teaching in the OR, and the surgical programs I am familiar with don't integrate their interns into the OR to any significant degree. This isn't to say you won't learn anything- you will, if for no other reason than you're finally actively involved in taking care of patients- but why not go the medicine route where the floor work and teaching often go hand-in-hand?

 

[CaptainVantasi]

During my anesthesia rotation I find that there is a lot of miscommunication between the anesthesiologist and surgeon so I want to get better at that. I also want to get some pre and post op patient care experience early. Multiple attending told me that I need to know the surgery to be a good anesthesiologist, so I want to be more familiar with the procedures. I know surg prelim is a hard life and I am willing to work very hard. I have asked the PD of my program and the president of our state ASA, they both say it does not matter if I do a surg or med prelim.

 

[GlowInTheDark]

During my anesthesia rotation I find that there is a lot of miscommunication between the anesthesiologist and surgeon so I want to get better at that. I also want to get some pre and post op patient care experience early. Multiple attending told me that I need to know the surgery to be a good anesthesiologist, so I want to be more familiar with the procedures. I know surg prelim is a hard life and I am willing to work very hard. I have asked the PD of my program and the president of our state ASA, they both say it does not matter if I do a surg or med prelim.

That’s all true. And none of it requires a surgical prelim. You will rarely set foot in OR. 98% chance you will be a warm body to hold the pager, take call, and to manage the floors.

I have big fat textbook that teaches me the major parts of surgical procedures I need to be aware of. I spent 5 months of my Intern year on surgical services and almost none of it was OR.

If you’re going to be stuck managing the floors you might as well be on a Medicine service being taught something. Anesthesiology is the acute practice of medicine in the end.

You’re right. Med vs surg doesn’t matter. One is more likely to leave you feeling without purpose and hating life more.

 

[CaptainVantasi]

That’s all true. And none of it requires a surgical prelim. You will rarely set foot in OR. 98% chance you will be a warm body to hold the pager, take call, and to manage the floors.

I have big fat textbook that teaches me the major parts of surgical procedures I need to be aware of. I spent 5 months of my Intern year on surgical services and almost none of it was OR.

If you’re going to be stuck managing the floors you might as well be on a Medicine service being taught something. Anesthesiology is the acute practice of medicine in the end.

You’re right. Med vs surg doesn’t matter. One is more likely to leave you feeling without purpose and hating life more.

I talked with my PD extensively about this and she does say there are plus and minus of both internship and its all based on personal preference in the end. She say there is no difference, there are many switched from surgery and start directly at CA 1. I do like surgery more than internal medicine in the end.

 

[JOHNBROCHILL]

How to communicate as an anesthesiologist with a surgeon isn't a skill picked up as an intern doing scut work for surgery. As for familiarity with the procedures, as posted above you will spend very little time in the OR. Pick the prelim with the (likely)better hours, more friendly personalities, and more manageable workload...that's medicine. Sounds like your PD is being neutral. I still recall my buddy getting to the hospital at 4am to start pre rounding on their 100 patient trauma census. I'm not sure those attendings knew his name until he was a pgy3.

 

[JOHNBROCHILL]

I talked with my PD extensively about this and she does say there are plus and minus of both internship and its all based on personal preference in the end. She say there is no difference, there are many switched from surgery and start directly at CA 1. I do like surgery more than internal medicine in the end.

This should be a clue

 

[UnoMas]

During my anesthesia rotation I find that there is a lot of miscommunication between the anesthesiologist and surgeon so I want to get better at that. I also want to get some pre and post op patient care experience early. Multiple attending told me that I need to know the surgery to be a good anesthesiologist, so I want to be more familiar with the procedures. I know surg prelim is a hard life and I am willing to work very hard. I have asked the PD of my program and the president of our state ASA, they both say it does not matter if I do a surg or med prelim.

TY closeby> CBY> TY far away> prelim med>>>>> prelim surg.

Trust me you won't learn how to communicate better with the surgeons by holding the b**** pager for 80+ hours a week for 10+ months putting in diet orders, post-op pain control, bowel regimen, rounding on 40+ patients and writing endless DC summaries. Save the motivation for your CA years and delay the burnout. Being a prelim surg is probably the worst of the worst, compared to the PGY1 surgical categoricals, they are putting in their time as tradeoffs for operative time in the later years, as a prelim you are just there to do the bitch's work. The program owns you nothing. In addition, most of them are notoriously malignant

A month of Acute Care Surgery during intern year/CBY is already way too much for me.

Also you'll learn real medicine from the medicine docs on the IM rotations: HTN, CHF, liver disease, lung disease ect. Between you and the surgeon, someone has to know these things well for the patient laying on the OR table. The scuts are equally annoying but less patients to round on, less notes to write, more time to sit down and digest and reinforce the information. Also you'll need time to study for Step 3.

 

[Nivens]

During my anesthesia rotation I find that there is a lot of miscommunication between the anesthesiologist and surgeon so I want to get better at that. I also want to get some pre and post op patient care experience early. Multiple attending told me that I need to know the surgery to be a good anesthesiologist, so I want to be more familiar with the procedures. I know surg prelim is a hard life and I am willing to work very hard. I have asked the PD of my program and the president of our state ASA, they both say it does not matter if I do a surg or med prelim.

Sounds like you've made up your mind. Best of luck.

 

[CaptainVantasi]

Sounds like you've made up your mind. Best of luck.

I think I did but just trying to figure is it OK to apply to (categorical, advance and prelim surg) all in the same institution or the prelim surgery should be somewhere else.

 

[Mman]

I have asked the PD of my program and the president of our state ASA, they both say it does not matter if I do a surg or med prelim.

They are correct in that nobody cares and neither will make you a better anesthesiologist. It is what it is, pick an intern year you can tolerate and rank them as such.

 

[deleted875186]

Agree wth above. Doesn’t matter what intern year you choose. Pick surgery and yoj will learn nothing for a year, and likely have a horrible year. You won’t be in the OR, routine post op care is write some fluids, pain medicine, bowel regimen, replete some electrolyte, nothing you need to learn.

Do medicine, learn how to manage medical problems. Don’t be fooled, covering night float and admissions for medicine wards is a lot of work as well, but much more rewarding and you will actually learn medicine. And yoj will see some acute things in medicine, and probably sicker patients overall than if you did a surgical year. Just my opinion, yoj have one intern year, why waste it.

 

[Ronin786]

I talked with my PD extensively about this and she does say there are plus and minus of both internship and its all based on personal preference in the end. She say there is no difference, there are many switched from surgery and start directly at CA 1. I do like surgery more than internal medicine in the end.

Sounds like the usual PD spiel. Lots of talk without much substance to avoid hurting someones feelings.

 

[pocafx]

Do not do surgery. Please listen to all these people telling you the same advice

 

[GaseousClay]

Do not do surgery. Please listen to all these people telling you the same advice

lets him/her/nonbinary do surgery prelim if they want. They seem to have done enough research on the subject. To answer the OP original question, it is probably looked favorably upon but not to any degree that it matters.

 

[deleted171991]

Do not do surgery. Please listen to all these people telling you the same advice

A sucker who chooses anesthesiology in 2019 is not sucker enough without a surgery prelim.

 

[deleted171991]

Sounds like the usual PD spiel. Lots of talk without much substance to avoid hurting someones feelings.

Absolutely the right thing to do. No good deed goes unpunished.

 

[Jayhow92]

Current prelim in surgery. Don’t do it man. I just hold the pager and do scutwork on the floor. Do a TY and enjoy life.

 

[aimedicine]

Agree avoid surgery prelim if you have the option. I did it and hated it. Didn’t feel like it made me a better anesthesiologist. Maybe I was a little more prepared to place aline and central lines but that’s about it. The negatives far outweighed the positive

 

[nimbus]

In medical internship you spend at least an hour, often 2-3hrs, in teaching rounds discussing diseases, diagnosis, treatment, natural history, etc. In my experience, surgical rounds were much more pragmatic-I/O’s, bowel function,NG output, labs, etc done as quickly as possible so the attendings and seniors could get to the OR ASAP.

 

[Cefazolin]

I feel like I lucked out with my surgery prelim. 7 out of the 12 rotations I'm the only resident on service, so I scrub in a ton of cases and do more than just retract or close skin. They also tailored my year to be a bit more relevant to anesthesia. I got 2 months of SICU, but the hours are pretty protected (8a-6p, M-F, alternating weekends, no call/overnight). And that was in lieu of some of the busier, service heavy rotations that the categoricals take.

I've done chest tubes, a-lines, central lines, excised skin cancers and cysts in clinic, a decent amount in the OR. And thus far I haven't gone over 70 hrs/wk worked, averaged closer to 55 (although the first half of my schedule were the chiller rotations). There are about 3 service heavy rotations for the year, rest is pretty manageable.

Honestly feels more like a transitional year. Although my program is structured that even the chiefs agree the intern year is relatively chill with above average OR exposure. The only downside has been that I agree with others in this thread regarding teaching. The teaching is there if I ask questions or ask for help, but otherwise I'm kind of left to my own devices.

I would agree overall to avoid surgery years because I think my program is more the exception rather than the rule.

 

[vector2]

I feel like I lucked out with my surgery prelim. 7 out of the 12 rotations I'm the only resident on service, so I scrub in a ton of cases and do more than just retract or close skin. They also tailored my year to be a bit more relevant to anesthesia. I got 2 months of SICU, but the hours are pretty protected (8a-6p, M-F, alternating weekends, no call/overnight). And that was in lieu of some of the busier, service heavy rotations that the categoricals take.

I've done chest tubes, a-lines, central lines, excised skin cancers and cysts in clinic, a decent amount in the OR. And thus far I haven't gone over 70 hrs/wk worked, averaged closer to 55 (although the first half of my schedule were the chiller rotations). There are about 3 service heavy rotations for the year, rest is pretty manageable.

Honestly feels more like a transitional year. Although my program is structured that even the chiefs agree the intern year is relatively chill with above average OR exposure. The only downside has been that I agree with others in this thread regarding teaching. The teaching is there if I ask questions or ask for help, but otherwise I'm kind of left to my own devices.

I would agree overall to avoid surgery years because I think my program is more the exception rather than the rule.

What kind of surgery program only has a prelim surgery intern as the only resident on service for 7 rotations a year?

 

[deleted875186]

What kind of surgery program only has a prelim surgery intern as the only resident on service for 7 rotations a year?

Probably a small community hospital without a surgery residency themselves.

Even if you get this experience, none of this experience in the OR is going to benefit you. You will never need to excise skin things, put in chest tubes, or do things in the OR. This is wasted time, and it’s at the expense of learning medicine. I understand some people really hate medicine, but if you put up with it for one year it will greatly benefit you. You’ll do plenty of lines in anesthesia residency, so intern year experience is irrelevant for these procedures.

 

[deleted171991]

Also, what is s/he learning? Procedures? Is s/he going to become a surgeon or an anesthesiologist? Protected SICU with no call? WTF is that? Instead of becoming an expert of co-existing diseases, s/he'll be a master of suturing.

Back on-topic: anybody who hates internal medicine enough to choose prelim surgery should not go into anesthesia. Second hand education from wannabe doctors who can't treat even a diabetic ketoacidosis (I learned that in my friggin' internship) and many other basic stuff ("Call Medicine!"). All internships (at least in anesthesia, if not in ALL specialties, should be internal medicine-based). We have enough monkey see monkey do people.

 

[Pharmado]

OP, residency is hard. It’s a large chunk of the best years of your life. Your desire to be the best is admirable, but ask yourself this “why are surgeons generally considered to be narcissistic a$$h$$$?” You’ve gone to school with many future surgeons. I’ll bet you are friends and can’t imagine them turning into horrible OR demons. Yet many, possibly even the majority of them will. Why? Because surgical residencies are soul-sucking, life altering, humanity ending nightmares. Pick the residency that suits you best, but I recommend you pick whatever program has the least hours. You can spend your extra time studying anesthesia. Don’t sacrifice a year of your life for minimal return.

 

[deleted875186]

OP, residency is hard. It’s a large chunk of the best years of your life. Your desire to be the best is admirable, but ask yourself this “why are surgeons generally considered to be narcissistic a$$h$$$?” You’ve gone to school with many future surgeons. I’ll bet you are friends and can’t imagine them turning into horrible OR demons. Yet many, possibly even the majority of them will. Why? Because surgical residencies are soul-sucking, life altering, humanity ending nightmares. Pick the residency that suits you best, but I recommend you pick whatever program has the least hours. You can spend your extra time studying anesthesia. Don’t sacrifice a year of your life for minimal return.

It’s not a year with minimal return. It’s a year with no return, and a large investment of your time and happiness.

 

[Mman]

It’s not a year with minimal return. It’s a year with no return, and a large investment of your time and happiness.

I thought my intern year was a great learning experience on how to be a doctor and treat diseases patients have that I encounter regularly in the OR.

 

[deleted875186]

I thought my intern year was a great learning experience on how to be a doctor and treat diseases patients have that I encounter regularly in the OR.

You did a surgical intern year?

I did a medicine year, and would agree it was an excellent year.

 

[Mman]

You did a surgical intern year?

I did a medicine year, and would agree it was an excellent year.

I did a transitional year with a little surgery, a little medicine, a little ER, a little peds, and a lot of ICU

 

[deleted171991]

I did a transitional year with a little surgery, a little medicine, a little ER, a little peds, and a lot of ICU

Aka the Mambo No.5 internship.

 

[Mman]

Aka the Mambo No.5 internship.

thankfully no OB on that mambo, 4 weeks as a med student was more than enough for me

 

[ranvier]

I feel like I lucked out with my surgery prelim. 7 out of the 12 rotations I'm the only resident on service, so I scrub in a ton of cases and do more than just retract or close skin. They also tailored my year to be a bit more relevant to anesthesia. I got 2 months of SICU, but the hours are pretty protected (8a-6p, M-F, alternating weekends, no call/overnight). And that was in lieu of some of the busier, service heavy rotations that the categoricals take.

I've done chest tubes, a-lines, central lines, excised skin cancers and cysts in clinic, a decent amount in the OR. And thus far I haven't gone over 70 hrs/wk worked, averaged closer to 55 (although the first half of my schedule were the chiller rotations). There are about 3 service heavy rotations for the year, rest is pretty manageable.

Honestly feels more like a transitional year. Although my program is structured that even the chiefs agree the intern year is relatively chill with above average OR exposure. The only downside has been that I agree with others in this thread regarding teaching. The teaching is there if I ask questions or ask for help, but otherwise I'm kind of left to my own devices.

I would agree overall to avoid surgery years because I think my program is more the exception rather than the rule.

I did surgery by choice and also had a great experience. You are taking care of surgical patients including learning from pulm, cards, neph consultants. My internship was a county hospital strong in burn, sicu, trauma. Like many things it just depends on the institution.