Selection, mentorship, and subsequent placement of preliminary residents in an academic general surgery

residency program

University of Colorado School of Medicine Department of Surgery

University of Colorado Anschutz Medical Campus

We have no disclosures.

University of Colorado School of Medicine Department of Surgery

University of Colorado Anschutz Medical Campus

Background

• Goals for Academic Medical Centers• ACGME work-hour restrictions• Hospital Workforce Needs

– Physician extenders– Categorical residents– Preliminary residents

Background

• Why non-designated preliminary residents (NDPR)?– Increasing medical school enrollment– Relatively unchanged amount of categorical

resident positions – Potential for a symbiotic relationship

Methods

• University of Colorado General Surgery Residency Program 2002-2012

• Reviewed 64 non-designated preliminary residents – Selection Process– Original Goals– Mentoring Process– Ultimate Fate

FIGURE 2: Medical schools of origin for UC Denver preliminary residents

Selection of NDPRs

• No prelim interviews• Target unmatched general surgery,

orthopedics, and urology applicants• USMLE scores > 200• Avoid Favors• Scramble & Telephone Interviews• SOAP (supplemental offer and acceptance program)

USMLE Scores

Mentoring NDPRs

• Introductory Meeting with Program Director (July)– Debrief match failure– Discuss individual issues (debt, family)– Analyze portfolio– Discuss realistic plans– Re-enter match?

Scramble Week (March)Job Search for current preliminary residents (see bottom)

Selection criteria for new preliminary residents Competitive medical school graduates

Unmatched in Gen Surgery, Ortho, Urology USMLE Step 1 scores > 200

Stick to basic principles & avoid favors

Program Director Meetings (July)Debriefing about prior match

Review overall climate for prelim residentDebt load

Family dynamicsCareer goals

Reattempting NRMP Match$1000 registration fee

Obtain new LORs early during prelim year

Meet PDs of relevant specialty on campus

ABSITE will not be relevant

Interview Season (Nov-Jan)Target less competitive

programsPrepare for acceptable alternatives if NRMP is

unsuccessful

Match Day (March) Scramble/SOAP Days

Recruit/Select new preliminary residents (see top)

Unmatched existing preliminary residents scramble (March-June)

Preparation for prompt communication at anytime

(cellular, e-mail, fax)

Pursuing Residency Outside MatchFrequent meetings with program director (PD)

Frequent Search for Job PostingsMeet PDs of relevant specialty on campusDecide what specialties/opportunities are

acceptableProgram Director availability

Surgery Programs

APDS websiteABSITE prep

& Testing (January)

Anesthesia/Medicine

Cold Calls/emails/Lett

ersContact with outside PDs

Mentoring NDPRs

• Outside Match– Frequent PD meetings– If Surgery…

• ABSITE• APDS Website

– If non-surgical…• Cold calls/e-mails • Contact outside PDs

• Re-entering the Match– Letters of Reference– Meet relevant PDs– Target less competitive

programs– Be prepared if unmatched

again

RESULTS

• NDPRs completing first prelim year- 95%• NDPRs obtaining categorical position

immediately after 1st year - 75%• NDPRs ultimately obtaining categorical

position- 84%

How did they get there?

Preliminary Residents n=64

Finished Year/transferred to categorical program

n=61

Obtained Categorical Training

n=48

Remained at UC Denver n=14

Categorical Training Elsewhere

n=34

Did Not Obtain Categorical Training n=13

Preliminary R2 Year n=4

Research Year n=5

Other Employment

n=2

Lost to Follow Up n=2

Did Not Finish Year n=3

Categorical Training n=1

Other Employment

n=2

Categorical Training

n=2

Still Lookingn=2

Categorical Training

n=3

Still Lookingn=2

Firs

t Year

Secon

d Y

ear

Categorical Positions• General Surgery n=7 (15%)• Surgical subspecialties n=31 (65%)

– Anesthesia– Orthopedics– Urology– ENT

• Non surgical specialties n=10 (20%)– EM– Medicine– ObGyn– Radiology

Original specialty interests of preliminary residents at UC Denver

Conclusions• Non-designated preliminary residents are a

valuable group of physicians in need of work and opportunity

• Academic training centers can benefit from the support of NDPRs

• Mentorship by surgery program directors builds a rewarding relationship with NDPRs

• Successful Placement of NDPRs is possible with a well organized and executed plan for the preliminary year

Thank You!Special Thanks

Drs. Mark Nehler & Paul Montero

Claire TravisUniversity of Colorado School of Medicine

Department of SurgeryUniversity of Colorado Anschutz Medical Campus