The article by Altus et al1 in the July 1992 issue of the Archives is one of two recent publications1,2 that convincingly raises the possibility of a negative association between the presence of preliminary residents and eventual career choices within the field of internal medicine. Altus et al1 have postulated a "prerequisite mentality" in these residents that may make them more of a liability than an asset in recruiting student interest in internal medicine. Their results are quite clear, yet we have had considerable experience with preliminary residents, and our impressions have been quite different. This has caused us to reflect on their article, their conclusions, and our own.
We have developed a special segment of our overall residency program specifically for preliminary residents. Rather than being used primarily as "fillers" for rotations as needed, they are given large segments of time (4 to 6 months) on