Last year, some clients had failed to match on their own, and wanted to get it right on their second attempt, so they chose to hire me. That happens every year, but what was unusual was that several of them were considering applying to PGY-1 programs only (preliminary medicine, preliminary surgery and transitional year programs), without planning to apply to a categorical or advanced field.
After supporting medical students and graduates since 2001, including working almost exclusively with IMGs for the past ten years, I understand the desire to match somewhere, anywhere, just to get a toehold in a hospital and try to build a career out of that. But even in a desperate situation like this, I still don't recommend a preliminary training year by itself for most people, especially not preliminary surgery, which typically has the most openings during SOAP.
The reason is that it's sort of like a stepping stone that leads nowhere you want to go. Let's say that what you really think you'd be best at is family medicine, but you didn't match on your own last year. Typically, the people who need to complete a preliminary year do so because their final specialty requires it, like anesthesiology or radiology. That's who the program directors are looking to hire; in fact, when you apply to a preliminary field, ERAS asks you to designate the advanced specialty you eventually hope to train in.
If you were to do a preliminary year, what skills would you develop during that time that would help you as a family physician? It might be good preparation for some aspects of Step 3, and I suppose you'd get some new LORs out of it, but even those letters might be too surgery-focused and not say anything that most family medicine program directors want to hear.
Beyond that, you would still need to reapply through ERAS if you still wanted to complete FM residency training...but when and how would you do that? The life of a PGY-1 in surgery is supposedly pretty brutal, and would you have time to complete your FM application and then go on all of your interviews while on your feet in surgery 80 hours per week? If you take too much time off from preliminary training, you won't even be able to count on a strong recommendation from your program director, and will end up weaker than if you had never done the PGY-1 year at all.
Please contact me if I can provide any more information. I am happy to provide a free assessment of your application, and develop a plan for your future. I can help you develop your personal statement and CV, advise you about your strengths and weaknesses, and much more!