The Ultimate Guide for DO Graduates to Research Preliminary Surgery Residencies

Choosing the right preliminary surgery year is one of the most strategic decisions you’ll make as a DO graduate. While a prelim year is, by definition, one year and often not categorical, where and how you train can significantly influence your operative skills, letters of recommendation, and subsequent match prospects—especially if you’re aiming for a categorical general surgery, surgical subspecialty, or another competitive field.

Below is a step‑by‑step guide focused on how to research residency programs as a DO graduate pursuing preliminary surgery.

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Understanding the Landscape: What a Preliminary Surgery Year Really Is

Before you start program research, you need a clear framework for what a preliminary surgery year is—and what it is not.

Preliminary vs Categorical Surgery Positions

• Preliminary surgery residency (prelim surgery residency):

  • One‑year position in a general surgery program.
  • Does not guarantee continuation in that same program.
  • Often used for:
    • Candidates planning to reapply to categorical general surgery.
    • Future surgical subspecialists (e.g., urology, ophthalmology) when required by their field.
    • Applicants who need more US clinical experience or stronger letters.

• Categorical general surgery position:

  • Full 5+ year training track designed to lead to board eligibility.
  • More stable and structured, with built‑in mentorship and progression.

As a DO graduate, you may be using a prelim year to:

• Demonstrate you can excel in an ACGME surgery environment.
• Strengthen your application with strong faculty support, improved test performance, and robust evaluations.
• Keep flexibility open if you’re still refining your specialty choice.

Knowing this context will shape your program research strategy—you’re not simply looking for “any prelim job,” but for a one‑year environment that positions you best for the long term.

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Step 1: Define Your Goals and Constraints as a DO Applicant

Before diving into databases, clarify what you need from a program. This clarity will make evaluating residency programs much more focused.

Clarify Your Primary Goal for the Prelim Year

Common scenarios for a DO graduate:

1. Reapplying to categorical general surgery

   • Goal: High operative exposure, strong clinical evaluations, and personalized letters from reputable surgeons.
   • Priority: Programs known for strong education and advocacy for prelims.

2. Pathway into a surgical subspecialty (e.g., urology, ENT, ortho, neurosurgery, IR)

   • Goal: Build surgical fundamentals and relationships with subspecialists.
   • Priority: Programs affiliated with your target specialty department(s) and strong research or mentorship opportunities.

3. Transitioning to another specialty (e.g., anesthesia, radiology, EM, IM)

   • Goal: Prove yourself in a demanding clinical setting; secure strong letters that attest to work ethic and clinical judgment.
   • Priority: Programs with established history of prelims successfully transitioning to other specialties.

4. Strengthening your CV as a DO graduate

   • Goal: Overcome perceived disadvantages in the osteopathic residency match landscape (limited home program, lower Step/COMLEX, later decision-making).
   • Priority: Environments that actively support DO residents, not just tolerate them.

Identify Your Non‑Negotiables

Make a written list of must‑haves and deal‑breakers. Examples:

• Geographic constraints: Family, spouse, visa, or financial reasons.
• Program structure: Night float vs traditional call, trauma center vs community hospital, academic vs community.
• Lifestyle realities: Cost of living, commute, call intensity, moonlighting (rare but occasionally possible for PGY‑1 in some fields/locations).

This self‑assessment frames how you approach how to research residency programs effectively and prevents you from wasting time on programs that don’t fit your core needs.

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Step 2: Build a Master List of Preliminary Surgery Programs

Once you know what you’re looking for, your next task is to build a comprehensive list of potential programs.

Use Official Databases and Sources

1. FREIDA (AMA Residency & Fellowship Database)

   • Filter for:
     • Specialty: General Surgery
     • Position Type: Preliminary
   • Export or manually list:
     • Program name, ACGME ID
     • Location, size (number of prelim and categorical positions)
     • Contact information, website

2. ERAS / NRMP (for current cycle data)

   • Review:
     • Program participation in the osteopathic residency match era (many now integrated).
     • Past quotas for preliminary vs categorical slots.
   • Note any programs that explicitly mention DO graduates in their descriptions or welcome statements.

3. Program Websites

   • Some sites list:
     • Exact number of preliminary surgery year positions.
     • Whether those prelims are designated for specific specialties (e.g., urology, IR) vs non‑designated.
   • Look at “Current Residents” pages to see if prelims are present and how many.

4. Osteopathic and Specialty‑Specific Organizations

   • AOA, specialty societies, or osteopathic alumni networks can provide informal lists of DO‑friendly programs and insights about the osteopathic residency match history for those institutions.

Create a spreadsheet (Google Sheets or Excel) to serve as your program research strategy hub. Include columns such as:

• Program name and location
• University vs community
• Number of prelim positions
• DO presence (Y/N and percent)
• Trauma level (I/II/III)
• Call schedule notes
• Historical progression of prelims
• Personal notes and red flags

This master sheet becomes the backbone of your evaluating residency programs process.

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Step 3: Evaluate Program Fit Using DO‑Relevant Criteria

Now that you have a list, you need a structured way to compare programs beyond their marketing language. For a DO graduate targeting a prelim surgery residency, the following dimensions are especially important.

1. DO‑Friendliness and Culture

As a DO, you need programs where you’ll be viewed as a physician colleague and trainee, not a second‑tier applicant.

What to look for:

• Current or recent DO residents (prelim or categorical) listed on the website.
• Faculty or leadership with DO backgrounds.
• Program statements that explicitly welcome DOs.
• Rumors versus reality: Ask current DO residents (if present) about their experiences.

Red flags:

• No DOs anywhere in the residency or faculty, despite a large class size.
• Program leadership publicly minimizing COMLEX or speaking disparagingly about DO training.
• Refusal to consider COMLEX without USMLE, if you only have COMLEX.

2. Quality of Prelim Experience (Not Just Existence of Positions)

Not all prelim positions are created equal. Some programs integrate prelims into the educational structure; others treat them as service posts.

Key questions to research:

• Do prelims attend the same didactics and conferences as categoricals?
• Do they get OR time, or are they mostly on floor/ICU/ED coverage?
• Are prelims assigned mentors?
• Are prelims included in simulation labs, skills sessions, and M&M?
• Is there a clear policy for letters of recommendation and advocacy for re‑applicants?

Look for programs that describe prelims as “integral parts of the team” rather than using language that implies they are just filling gaps.

3. Operative and Clinical Exposure

Even as a PGY‑1, your operative and procedural exposure matters—both for your skills and for the credibility of your letters.

Review for:

• Trauma designation: Level I/II centers usually offer broader exposure but can be more intense.
• Call structure: Night float vs 24‑hour call, frequency of weekend coverage.
• Service design: Are prelims spread across multiple services (trauma, vascular, colorectal, etc.) or stuck on one high‑service, low‑op rotation?

Action step: During interviews or virtual visits, ask:

• “On average, how much OR time does a prelim get in a typical month?”
• “Are prelims ever first assist on major cases, or typically second assist/observer?”
• “Is there dedicated teaching on rounds or in the OR for prelims?”

4. Outcomes for Past Prelim Residents

This is one of the most important elements of evaluating residency programs for a prelim year—and often the most under‑researched by applicants.

Ask programs directly:

• How many non‑designated prelims do you have each year?
• In the last 3–5 years, where have prelims matched after this year?
  • Internal transitions to categorical surgery?
  • Switch to other specialties (anesthesia, EM, radiology, IM)?
  • Failure to secure any residency spot?

You’re not just looking for a job—you’re looking for a launchpad.

Green flags:

• Programs that can list multiple DO prelims who went on to strong categorical positions.
• A track record of advocate faculty who make calls and write individualized letters.

Red flags:

• Evasive answers, no data, or a pattern of prelims not securing positions.
• Programs that say “we don’t really track what happens to our prelims.”

5. Lifestyle, Support, and Burnout Risk

A hard year is expected. A toxic or unsafe environment is not.

Research:

• Work hours: Ask residents whether duty hour violations are systemic or rare.
• Support services: Resident wellness resources, mental health support, access to occupational health.
• Culture: Do prelims feel supported or disposable?

Remember: a burned‑out, unsupported prelim will have trouble studying, performing, and networking for the next match cycle.

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Step 4: Dig Deeper – How to Research Residency Programs Beyond Websites

Program websites are curated. To truly understand a prelim surgery residency, you’ll need more than official marketing material.

Use Social and Peer Networks

• Current residents and recent alumni

  • Reach out via:
    • LinkedIn
    • Alumni from your DO school
    • Friends-of-friends in surgery
  • Ask for a 10–15 minute chat and prepare specific questions:
    • “How were prelims treated compared to categoricals?”
    • “What was your call schedule really like?”
    • “Did you feel the program actively helped prelims find future positions?”

• Online forums (with caution)

  • Reddit, Student Doctor Network (SDN), specialty Facebook groups.
  • Use to identify patterns, not to base decisions on single anecdotes.
  • Cross‑check anything concerning with multiple sources.

Attend Virtual Open Houses and Webinars

Since the COVID era, many programs offer:

• Virtual meet‑and‑greet sessions.
• Q&A panels with residents and PDs.

For a DO graduate residency path, these events are an opportunity to:

• Gauge whether DOs are present and visible.
• Ask, “How do you support and advocate for your preliminary residents?”

Take notes immediately after each session while the impressions are fresh.

Analyze Program Documents Systematically

As part of your program research strategy, create a simple rubric (1–5 scale) for:

• DO‑friendliness
• Prelim educational value
• Outcomes for past prelims
• Location/lifestyle fit
• Personal “gut feeling”

After each interaction (website, call, virtual meeting), score the program. This keeps your impressions objective and comparable.

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Step 5: Strategic Considerations for the Osteopathic Applicant

Being a DO applicant adds a few layers of nuance to your research, especially when aiming for a preliminary surgery year.

Understand How Programs View COMLEX vs USMLE

• Some general surgery programs still require USMLE or strongly prefer it.
• Others accept COMLEX alone, especially if they have a history of DOs.

When researching:

• Check program’s stated exam requirements on FREIDA and their website.
• If unclear, email the coordinator with a concise question:
  • “I am a DO applicant who has taken COMLEX Levels 1 and 2 (no USMLE). Are my scores acceptable for consideration for your preliminary surgery positions?”

This helps you avoid wasting applications on programs that will quietly screen you out.

Leverage Osteopathic Strengths

As a DO graduate:

• You often bring:
  • Robust clinical exposure.
  • Strong patient communication skills.
  • Experience with manipulative medicine (even if not used in surgery, it signals extra training and hands-on ability).

In your communications and interviews, frame these as assets:

• “My DO training emphasized whole‑patient care and communication, which I’ve found particularly valuable when managing complex surgical patients pre‑ and post‑operatively.”

When researching programs, note:

• Which faculty or programs explicitly appreciate DO attributes.
• Whether DO graduates in their program seem to be thriving and advancing.

Consider the Balance of Reach vs Safety Programs

Because prelim positions are sometimes less competitive than categorical spots—but can still be selective—plan your application tiers:

• Reach programs:
  • High‑prestige academic centers.
  • May have limited DO representation, but strong prelim outcomes.
• Realistic core programs:
  • Mid‑tier academic or large community programs.
  • Clear track record of supporting DOs and prelims.
• Safety programs:
  • Smaller or more remote community programs.
  • Perhaps lower name recognition but solid training and DO presence.

Your research should help you place each program into reach/realistic/safety categories based on:

• Historical DO match data (from your school and peers).
• Program’s stated selection criteria.
• Informal feedback from residents and mentors.

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Step 6: Putting It All Together – A Practical Research Workflow

To avoid feeling overwhelmed, follow a structured weekly workflow as you research and refine your list.

Week 1–2: Broad Discovery

• Use FREIDA/ERAS to generate a master list of all prelim surgery programs.
• Remove:
  • Programs that explicitly exclude DOs or require USMLE when you don’t have it.
  • Locations that are absolute no‑go for you.
• Begin initial website review:
  • Note number of prelim positions, DO presence, call structure, trauma level.

Week 3–4: Narrowing and Prioritizing

• Schedule short calls or emails with:
  • Alumni from your DO school in surgery.
  • Friends-of-friends currently in surgical residencies.
• Attend any open houses advertised on program websites or social media.
• Start scoring programs on your rubric (DO‑friendliness, prelim outcomes, etc.).

At this stage, you might narrow to:

• 30–50 programs for serious consideration (depending on your competitiveness and risk tolerance).

Week 5–6: Deep Dive and Tailoring

• For top‑tier programs on your list:
  • Read recent publications by faculty, especially in areas that interest you (trauma, critical care, vascular).
  • Learn specific strengths (e.g., “strong burn experience,” “very busy trauma service”).
• Draft tailored talking points and questions:
  • “I noticed your program has robust exposure to acute care surgery. How are prelims incorporated into that service?”
• Confirm exam policies, DO acceptance, and prelim outcomes for any unclear programs via email.

Week 7 and Onward: Finalizing Your Application List

• Based on your research:
  • Confirm a balanced list of reach/realistic/safety programs.
  • Ensure you have a mix of academic and community settings aligned with your goals.
• Double‑check for:
  • Application deadlines.
  • Additional requirements (e.g., surgical case logs, specific letters from surgeons).

By following this workflow, your program research strategy is intentional, data‑driven, and tailored to your needs as a DO graduate pursuing a prelim surgery residency.

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FAQs: Researching Preliminary Surgery Programs as a DO Graduate

1. Are preliminary surgery positions easier to get for DO graduates than categorical spots?

In general, yes—but not uniformly. Many programs use preliminary spots to fill service needs and are more open to a wider range of applicants, including DO graduates, IMGs, and those reapplying. However:

• Some high‑profile academic programs still have competitive prelim positions.
• DO applicants may face additional scrutiny if the program has limited experience with osteopathic graduates.

Your research should determine which programs have a history of accepting DOs and successfully helping prelims move on to categorical positions.

2. How many prelim surgery programs should I apply to as a DO graduate?

The answer depends on your application strength (scores, grades, letters) and risk tolerance, but many DO applicants target:

• 20–40 programs if reasonably competitive.
• 40–60+ programs if weaker metrics, no home program, or prior unmatched attempts.

Use your evaluating residency programs rubric to categorize programs into reach, realistic, and safety, and make sure you’re not overloading on reach programs only.

3. Should I prioritize name recognition or prelim outcomes when choosing programs?

For a one‑year preliminary surgery year, outcomes and support matter more than name alone. A mid‑tier community program where:

• Prelims get strong operative experience,
• Faculty advocate for them,
• DO graduates have matched into solid categorical spots,

may be a better choice than a big‑name institution where prelims are overworked and under‑supported with poor follow‑through.

Ideally, you find programs that offer a balance of reputation and proven prelim success—your research should highlight those.

4. How can I tell if a program will truly support my transition after the prelim year?

Look for objective markers:

• Programs that track and share where prelims go after the year.
• Evidence of past prelims (especially DOs) matching into strong positions.
• Clear statements from PDs or residents about:
  • Help with letters,
  • Feedback and career counseling,
  • Internal opportunities to convert to categorical (when realistic).

During interviews or calls, ask directly:

• “Can you share some recent examples of where your non‑designated prelims have matched after completing your program?”

The specificity and confidence of their answer is one of the best indicators of how seriously they take their responsibility to prelim residents.

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A preliminary surgery residency can be a powerful stepping stone in your training journey as a DO graduate—but only if you approach it with a deliberate, informed plan. By using a systematic program research strategy, focusing on DO‑friendly cultures, understanding true prelim outcomes, and asking the right questions, you can choose a prelim year that not only challenges you—but also opens doors for the rest of your surgical career.