by Erica Alexander, Brown University Class of 2015

In preparation for my radiology application this coming September, I find my decision compounded by the need to decide on an appropriate intern year experience. It’s interesting how mutually exclusive these decisions seem to be. I’ve heard many different arguments for the three different preliminary year experiences from the many radiology attendings that I’ve spoken to and have ultimately decided to pursue a surgery preliminary year. My decision was further reinforced by my recent surgery sub-internship experience which was incredibly informative and challenging. I encourage all medical students to utilize their fourth year sub-Internship experience to determine which intern option will best meet their education needs and also lend itself to some sort of happiness quotient (this is not to dismiss that intern years are notoriously hard and time intensive).

To provide some basic orientation to the application process, I’ll provide an overview of the preliminary or intern year options. A prelim year is separate from most radiology programs; you apply to both a prelim program and a diagnostic or IR/DR program. There are three preliminary options for students pursuing a diagnostic radiology residency, these include medicine, surgery or a transition year- essentially a second go at fourth year of medical school, where students rotate through various specialties. Some people choose to do their prelim at the same institution that they choose for radiology and others choose to go to an entirely new locale for a year. Everyone must do a one year prelim before Radiology. Not all specialties have this; however, urology, radiology, radiation oncology, orthopedics and some other specialties do.

The decision to do one of the three options is very much “operator dependent.” Transitional years are well known to be the easiest/cushiest, but in the end there are plenty of people in top academic programs who complete them and they’re likely no less successful in the long term. Medicine allows you to function like a first year medical resident for one year. You’ll be managing patients and their various medical problems, rotating through some medical specialties, and mostly doing a tremendous amount of rounding and paperwork. This probably will be the most diverse experience and give you a good “clinical” experience prior to starting radiology. Surgery is generally regarded as the most intense of the prelim options; being a surgery intern provides a tremendous amount of pre- and post-procedure experience. You will likely be the first person on your team meeting patients as they come into triage to evaluate if they are surgical patients and to review their relative operative risks. You will be meeting with the radiologists to review the patients’ imaging and you will be helping to monitor and write orders for those patients both pre- and post-operatively. As the new combined IR/DR pathway gains momentum and guidelines for training are established, there appears to be a push to encourage trainees interested in IR to do a surgery prelim year. My rationale for pursuing a surgery prelim year was that It allows trainees to see a lot of imaging and anatomy and, depending on the program, get a fair amount of OR time.

The decision between a surgery and medicine prelim year should ultimately be based how you felt about medicine vs surgery during your rotation experience- you may decide you hate one and love/tolerate the other, which makes the decision a no-brainer. If you’re unequivocal it would be worth talking to residents at your program who’ve done both permutations of training and ask them how prepared they felt for residency and the perceived pros and cons of their intern experiences. The SIR Medical Student Council’s online mentors would be happy to field any further questions (