Categorical PGY-1 vs Prelim Medicine PGY-1

[tealeafexplorer]

I’ve spent a lot of time researching about advanced, categorical, transitional, difficulty of each, how hard it is to get into transtitional....

I have heard very little about how are your PGY-1 year in a categorical PMR program, or if it’s the same or different than a prelim medicine year, but just built into your program so you don’t have to move after the year.

I would assume your PGY-1 at a categorical program would be not as tough in terms of hours because they probably don’t want to abuse you knowing you are still their resident, but I’ve just never heard anyone talk about it.

Can anyone shed insight on the rigors if PGY-1 At a categorical program vs prelim medicine year?

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[sdnuser001]

My program has a pretty cush PGY1 that is more or less a transitional year geared towards pm&r. I interviewed at other programs where the PGY1 was just a prelim medicine year. So for categorical programs it's pretty variable. As for stand alone PGY1 programs, yes transitional would def be more competitive than prelim medicine for obv reasons.

 

[9732doc]

It depends on the program. My home program at a big academic center has a categorical PGY1 that is educational yet gentle, and probably closer to a cush TY than typical prelim year. Other programs just throw you to the IM folks until PGY2, in which case, you're basically an IM intern. I don't think they would treat you worse though than any other intern b/c you're a prelim vs. categorical IM. But it's still IM, which is going to work you hard.

But my general advice is, unless you have a compelling reason to do PGY1 elsewhere (cush TY, stay close to family, stay at your home program for a year), it's overall advantageous to do categorical PM&R and do it all in one spot. Moving sucks, and moving twice sucks more. Also during that PGY1 you have an advantage in that you learn your medical center and meet people in specialities, so that when you go to PGY2, you're already well-acquainted with your local scene. Also, you will have your home PM&R program there to help you out if anything isn't going well during PGY1. Overall, I think categorical is a superior choice for most people if you can get it.

 

[runfastnow]

Agree with 9732doc.

TYs are hard to get into unless you have connections/established pipeline from your medical school since you are competing with the "elite board score specialties" for those spots. Overall very advantageous to do categorical in my opinion as you can start making connections with other residents (inside and outside of your program) that will be helpful down the road, connections with faculty, and don't have the stress of moving cities twice.

That being said - there were still quite a few programs that had their categorical PGY1 year be essentially IM +/- surgical intern year and a PM&R intern got crushed along with everyone else. It is something that is difficult to ascertain until interview day and you get the inside scoop from current residents. Most PM&R programs don't want their residents disgruntled before they even become PGY2s though so they will try to help as best as possible.

 

[tealeafexplorer]

It depends on the program. My home program at a big academic center has a categorical PGY1 that is educational yet gentle, and probably closer to a cush TY than typical prelim year. Other programs just throw you to the IM folks until PGY2, in which case, you're basically an IM intern. I don't think they would treat you worse though than any other intern b/c you're a prelim vs. categorical IM. But it's still IM, which is going to work you hard.

But my general advice is, unless you have a compelling reason to do PGY1 elsewhere (cush TY, stay close to family, stay at your home program for a year), it's overall advantageous to do categorical PM&R and do it all in one spot. Moving sucks, and moving twice sucks more. Also during that PGY1 you have an advantage in that you learn your medical center and meet people in specialities, so that when you go to PGY2, you're already well-acquainted with your local scene. Also, you will have your home PM&R program there to help you out if anything isn't going well during PGY1. Overall, I think categorical is a superior choice for most people if you can get it.

In terms of trying to secure a SM or pain fellowship afterwards (probably more SM), is matching at a mid tier Categorical that much different than matching at a top tier Advanced program in terms of opening fellowship doors?

Or is the most important factor just if your residency program also has those fellowships attached?

Trying to outweigh the pro's/con's, of Advanced and Categorical, relocating, and fellowship opportunities afterwards

 

[tealeafexplorer]

Agree with 9732doc.

TYs are hard to get into unless you have connections/established pipeline from your medical school since you are competing with the "elite board score specialties" for those spots. Overall very advantageous to do categorical in my opinion as you can start making connections with other residents (inside and outside of your program) that will be helpful down the road, connections with faculty, and don't have the stress of moving cities twice.

That being said - there were still quite a few programs that had their categorical PGY1 year be essentially IM +/- surgical intern year and a PM&R intern got crushed along with everyone else. It is something that is difficult to ascertain until interview day and you get the inside scoop from current residents. Most PM&R programs don't want their residents disgruntled before they even become PGY2s though so they will try to help as best as possible.

In terms of trying to secure a SM or pain fellowship afterwards (probably more SM), is matching at a mid tier Categorical that much different than matching at a top tier Advanced program in terms of opening fellowship doors?

Or is the most important factor just if your residency program also has those fellowships attached?

Trying to outweigh the pro's/con's, of Advanced and Categorical, relocating, and fellowship opportunities afterwards.

 

[TheGreatestTrochanter]

In terms of trying to secure a SM or pain fellowship afterwards (probably more SM), is matching at a mid tier Categorical that much different than matching at a top tier Advanced program in terms of opening fellowship doors?

Or is the most important factor just if your residency program also has those fellowships attached?

Trying to outweigh the pro's/con's, of Advanced and Categorical, relocating, and fellowship opportunities afterwards.

Go for the best residency program for you. Doesn't have to have attached fellowships, though this may show that it is a strength of the program and you can also work with and get a letter from a fellowship director, and they all know each other. Unless there is a very compelling geographic reason for a program (and these can be very important), I wouldn't "settle" for a lesser program just because it is categorical. This is the capstone of your whole medical education investment!

 

[runfastnow]

I am against the switch to 2 years, but the argument at AMSSM was that fellows are supposed to be masters at the medical aspect of Sports Medicine, and not just the MSK part. That means EKG interpretation, sports pulmonology, etc. If you are the team physician for a college or pro team, you will need to do a lot of primary care stuff.

In terms of trying to secure a SM or pain fellowship afterwards (probably more SM), is matching at a mid tier Categorical that much different than matching at a top tier Advanced program in terms of opening fellowship doors?

Or is the most important factor just if your residency program also has those fellowships attached?

Trying to outweigh the pro's/con's, of Advanced and Categorical, relocating, and fellowship opportunities afterwards.

Attached fellowships can be helpful in the sense that there are faculty in that subspecialty that can increase your networking power/speed and if you love the city/hospital system you can have an inside track into the fellowship if you want to be with those faculty for another year and the fellowship matches your goals. That being said ... DO NOT pick a residency based on fellowships. Fellowships =/= residency experiences and in some cases can negatively impact your hands on ability as a resident.

Pick the best residency you can based on whatever your interests are and that aligns with your long term goals. SDN rankings =\= your goals and aspirations. Some elite outpatient/sports/pain/spine residencies get ripped around here because the inpatient rehab hospital is average.

I now to sports and spine medicine and I will likely never use my inpatient rehab knowledge again except for MOC, etc. My inpatient hospital was average to above average, but my residency and fellowship were outstanding for sports/spine/pain which serves me well now and for the long term. I feel no regret in not learning the ASIA exam from someone who wrote the ASIA exam ... I rarely, if ever, will use it again.

 

[tealeafexplorer]

Attached fellowships can be helpful in the sense that there are faculty in that subspecialty that can increase your networking power/speed and if you love the city/hospital system you can have an inside track into the fellowship if you want to be with those faculty for another year and the fellowship matches your goals. That being said ... DO NOT pick a residency based on fellowships. Fellowships =/= residency experiences and in some cases can negatively impact your hands on ability as a resident.

Pick the best residency you can based on whatever your interests are and that aligns with your long term goals. SDN rankings =\= your goals and aspirations. Some elite outpatient/sports/pain/spine residencies get ripped around here because the inpatient rehab hospital is average.

I now to sports and spine medicine and I will likely never use my inpatient rehab knowledge again except for MOC, etc. My inpatient hospital was average to above average, but my residency and fellowship were outstanding for sports/spine/pain which serves me well now and for the long term. I feel no regret in not learning the ASIA exam from someone who wrote the ASIA exam ... I rarely, if ever, will use it again.

This was really informative, thank you very much! I always assumed the opposite, thank you