Ranking Advice- Great Surgical Prelim program Vs Mediocre Medical Prelim

[escape78]

Hello!!
I have spent considerable amounts of time thinking this over and I think I would benefit greatly from some advise.. (Especially from those who have finished your Prelim year)

I am applying into Anesthesiology and I am oscillating between choosing a Great Surgical Prelim vs a Mediocre Medical Prelim for my #1 spot on my Supplemental list.
If I had the option of ranking a good Medical Prelim as my #1, I would have.

I don't mind working hard.
My main goal is to learn as much as possible in my intern year that will help my Anesthesiology career in the future.

I have gathered from previous threads that Surgery=Scutwork and the consensus is usually that a Medicine Prelim will prepare one for a future career in Anesthesiology better than a Surgical Prelim.

Surgical Prelim Program A
Supportive Attendings, great residents, good teaching, OR experience as PGY1 (100 cases!)
and...
Learn to think quickly, how a surgeon thinks, sterile technique, A- lines, Pre and post-op management etc

Medical Prelim Program B
I didn't really click with the Residents or the PD for that matter. The residents didn't seem too enthusiastic.
but...
I will learn medical management and physiology and build a solid foundation and understanding of medical pathology


I am leaning toward the Surgical Prelim as I believe that what I learn on the Surgical floors in a good program may be more than what I learn in a mediocre Medical floor?

Do you think otherwise?

Will I miss out by not doing Medicine?
Or will I learn all the Medical stuff anyway when I start my CA1?

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[dragonfly99]

I'm in internal med, not anesthesia, so take my advice with a grain of salt.
However, from what you have written it sounds like you liked the surgical program a lot better. If you don't mind the hard work, and you feel as you've described above, I'd lean toward ranking the surgery program first. However, are you sure that what you saw and what you were told on the interview day was really the straight dope? I'm sure a lot of surgical prelim places lay it on thick about how the PGY1 is going to get into the OR, but not sure how true that turns out being....I'm just sayin'.

I will also say that being somewhere where you "don't click" with the PD or other house staff is not minor so that is something I think you should take into account.

 

[escape78]

Thanks a load Dragonfly99.


You are right.. your thought about the surgical prelim places 'laying it on thick' is precisely my worry.

Although I feel that I am a 'better fit' for the Surgical Prelim I am also wondering if it is too bold to relinquish all that exposure and learning that one gets on the Medical floors in order to 'enjoy' the first year a little more?

 

[gutonc]

I'd be loathe to recommend a surgical prelim over a medicine year but it's also hard to suggest that you go to a program where you didn't really like your future boss and co-workers. Dragonfly99 is right, programs will certainly blow smoke up your bum re: the real workload, OR time, etc, but they all do that to one degree or another. I'm not sure you'll get inferior training in the surgery program but it will certainly be different. I have 2 friends (a married couple) who are CA-2's now, one did a surg prelim, the other did IM. They both felt well prepared for about 1/2 of their CA-1 year but different halves. The IM trained one was more comfortable in the ICU and in the pre-op evals while the Surg trained one felt better actually in the OR. By this time in their training though, the differences have largely faded.

You mention that you've heard a Medicine prelim is the best intern year for anesthesia. I would argue that the best training would be a rigorous TY (yes, I understand that's an oxymoron). Something where you do a month each of IM/Gen Surg/Peds/OB/ED and then a month each in MICU/SICU/PICU/NICU. That would be your best pre-anesthesia training but I can't imaging too many people signing up for that kind of a year.

 

[escape78]

Thanks for the post guntonc.
You are spot on about the rigorous TY. That sounds ideal (as far as learning is concerned).
I unfortunately don't have any TY's lined up and so my choice is limited to Medical and Surgical Prelims.

I know a couple of programs that are definitely at the bottom of my ROL but these two programs (the Surgical and Medical Prelim) are really making me think about what I want to get out of the PGY1 year.

I feel pretty confident in the OR with IV's,sterile technique, suturing, knots etc but I don't feel like I know a thing about pre-op's and so I am seriously considering the IM Prelim now as I will probably have more to gain from IM.
(I'm a FMG who worked in England before moving here)

I really appreciated your advice.
Thank you!

 

[bigdan]

Escape -

I'm applying in Anesthesiology as well.

Do you have the option of ranking categorical anesthesia programs too? That seems like the absolute best fit; at most programs you belong to the anesthesia department - they design the year, you get medicine and surgery (and ICU, etc) and if you get some beef along the way, you complain to the anesthesia boss.

I didn't even apply to surgery, because of the hesitancy that I have with what you actually get at a prelim surgery year. Working hard is one thing, but getting your balls broken is entirely another. Check the anesthesia forum for some of this discussion - there are folks doing surgical prelim years that seem to rue the day they applied. If you still have access to them, you might wanna see what the interns or medical students in that hospital have to say about the experience.

Either way, good luck with whatever you choose, and good luck with the anesthesia match!

dc

 

[OTD]

Actually I would think the opposite of what you stated. I would think a surgery prelim would better prepare you for passing gas. Medicine knows very little about the surgical patient, risks/benifits/ or even whether or not the patient could tolerate a surgical procedure.

If you go to medicine you will learn how to consult other services in so they can take care of your patient while you write a note "COPD- Pulmonary on board".

If you go into surgery you will take care of all of your patients and consult very sparingly. You will see exactly the effects of htn/dm/copd/chf/cad on the surgical patient and you will treat that patient.

On medicine you will consult endocrine, pulmonary, cardiology, etc etc to take care of the patients for you.

I would think actually taking care of surgical patients in surgery would serve you better than consulting everyone and watching them treat your patient in medicine.

 

[escape78]

Thanks for the advice guys..

For some odd reason I'm only reading this post today! (Post certified ROL!!!)
I eventually ended up ranking the med program ahead of the surgical one after switching them round a countless number of times.

OTD, Thanks for the extremely insightful post. If had read your post earlier on, I definitely would have ranked the Surgical prelim program as #1 as I was looking for a reason to, but thought the Medicine would help me more.. Well. I'll be happy with either so that's a good thing.

BigDan, I do have the option of a couple of Categoricals but because location is the number one factor for me(want to remain where my husband is) I ended up ranking them lower.
I hope you get Pitt!