derm vs medicine

[novelty]

hi, i am a second year resident in internal medicine in a top 20 academic program. due to difficulties with performance (prioritizing patient care goals on the wards, and being efficient) i am being asked to resign or be terminated, after a period of remediation. i am an amg from a top 40 medical school, have step 1 score in 220s and step 2 score in 260s, 3rd quartile of med school class, and have pgy-2 in training exam > 80th percentile for pgy-2 (above average in my residency class). i do not have anxiety or depression, but was diagnosed with adhd during my remediation period (which i would have had since i was a child). i think my problem arose from a sensitivity to sleep deprivation which is common to people with adhd (can't focus whereas on 8 hrs of sleep per day i can focus much better). sleep deprivation seems to be the norm among medicine residents, but i really just cannot process information very well on 5-6 hours of sleep per night. i did however adequately complete intern year in internal medicine. i have always been interested in derm, did research as a med student with resultant book chapters and abstracts, but no peer-reviewed original research. i failed to match out of medical school, which led me to try pgy2 medicine in the first place. while my pd states that i am professional, that i am a "good person," that people liked working with me, that i can be a good doctor, that i have the smarts to be successful in internal medicine, and encouraged me to stay in the field (albeit at a different program!), i am interested in derm, and even when i pursued the medicine residency i had derm in mind afterwards. there is a small sample article done on matching outcomes for people who did not match into derm the first go-around, which showed that doing research rather than a different residency is more effective at getting you into derm (i should have heeded the article more during intern year), and especially given the knowledge of my neurobiology and sensitivity to sleep deprivation, i am planning to do research instead of continuing to pursue internal medicine residency. i just want to know if having to explain all of this to any clinical research fellowships would have a negative impact on me getting any positions, and also of ultimately matching into dermatology. i am currently looking for research opportunities in derm and am also preparing to take step 3. thanks for any help/advice. feel free to pm me as well.

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[asmallchild]

hi, i am a second year resident in internal medicine in a top 20 academic program. due to difficulties with performance (prioritizing patient care goals on the wards, and being efficient) i am being asked to resign or be terminated, after a period of remediation. i am an amg from a top 40 medical school, have step 1 score in 220s and step 2 score in 260s, 3rd quartile of med school class, and have pgy-2 in training exam > 80th percentile for pgy-2 (above average in my residency class). i do not have anxiety or depression, but was diagnosed with adhd during my remediation period (which i would have had since i was a child). i think my problem arose from a sensitivity to sleep deprivation which is common to people with adhd (can't focus whereas on 8 hrs of sleep per day i can focus much better). sleep deprivation seems to be the norm among medicine residents, but i really just cannot process information very well on 5-6 hours of sleep per night. i did however adequately complete intern year in internal medicine. i have always been interested in derm, did research as a med student with resultant book chapters and abstracts, but no peer-reviewed original research. i failed to match out of medical school, which led me to try pgy2 medicine in the first place. while my pd states that i am professional, that i am a "good person," that people liked working with me, that i can be a good doctor, that i have the smarts to be successful in internal medicine, and encouraged me to stay in the field (albeit at a different program!), i am interested in derm, and even when i pursued the medicine residency i had derm in mind afterwards. there is a small sample article done on matching outcomes for people who did not match into derm the first go-around, which showed that doing research rather than a different residency is more effective at getting you into derm (i should have heeded the article more during intern year), and especially given the knowledge of my neurobiology and sensitivity to sleep deprivation, i am planning to do research instead of continuing to pursue internal medicine residency. i just want to know if having to explain all of this to any clinical research fellowships would have a negative impact on me getting any positions, and also of ultimately matching into dermatology. i am currently looking for research opportunities in derm and am also preparing to take step 3. thanks for any help/advice. feel free to pm me as well.

I don't think you'll need to explain this to any of the research fellowships

I think you are making the correct choice in pursuing a research fellowship (and hopefully at a program that had a derm residency)

You will definitely have to explain your termination during derm interviews and it will unfortunately hurt your chances of matching (reapplicants are at a disadvantage already and one with a history of poor clinical performance is a huge red flag)

That being said, if derm is your dream and you are planning to go into research anyway, might as well give it a shot

 

[sore eye asses]

How about path?

 

[novelty]

I don't think you'll need to explain this to any of the research fellowships

I think you are making the correct choice in pursuing a research fellowship (and hopefully at a program that had a derm residency)

You will definitely have to explain your termination during derm interviews and it will unfortunately hurt your chances of matching (reapplicants are at a disadvantage already and one with a history of poor clinical performance is a huge red flag)

That being said, if derm is your dream and you are planning to go into research anyway, might as well give it a shot

I know that during the research experience I will have opportunities for clinical work with the residents in derm. What can I do in addition to this to offset any perception of my deficiencies in clinical performance, which should be expected to improve with time? thanks.

 

[DermViser]

I don't think you'll need to explain this to any of the research fellowships

I think you are making the correct choice in pursuing a research fellowship (and hopefully at a program that had a derm residency)

You will definitely have to explain your termination during derm interviews and it will unfortunately hurt your chances of matching (reapplicants are at a disadvantage already and one with a history of poor clinical performance is a huge red flag)

That being said, if derm is your dream and you are planning to go into research anyway, might as well give it a shot

I think this is a huge red flag that might be too big to overcome. I would recommend Path to Dermpath (or another fellowship).

 

[DermViser]

I know that during the research experience I will have opportunities for clinical work with the residents in derm. What can I do in addition to this to offset any perception of my deficiencies in clinical performance, which should be expected to improve with time? thanks.

It very much depends on what you're doing during your research fellowship. Each one is different.

 

[doc MD]

hi, i am a second year resident in internal medicine in a top 20 academic program. due to difficulties with performance (prioritizing patient care goals on the wards, and being efficient) i am being asked to resign or be terminated, after a period of remediation. i am an amg from a top 40 medical school, have step 1 score in 220s and step 2 score in 260s, 3rd quartile of med school class, and have pgy-2 in training exam > 80th percentile for pgy-2 (above average in my residency class). i do not have anxiety or depression, but was diagnosed with adhd during my remediation period (which i would have had since i was a child). i think my problem arose from a sensitivity to sleep deprivation which is common to people with adhd (can't focus whereas on 8 hrs of sleep per day i can focus much better). sleep deprivation seems to be the norm among medicine residents, but i really just cannot process information very well on 5-6 hours of sleep per night. i did however adequately complete intern year in internal medicine. i have always been interested in derm, did research as a med student with resultant book chapters and abstracts, but no peer-reviewed original research. i failed to match out of medical school, which led me to try pgy2 medicine in the first place. while my pd states that i am professional, that i am a "good person," that people liked working with me, that i can be a good doctor, that i have the smarts to be successful in internal medicine, and encouraged me to stay in the field (albeit at a different program!), i am interested in derm, and even when i pursued the medicine residency i had derm in mind afterwards. there is a small sample article done on matching outcomes for people who did not match into derm the first go-around, which showed that doing research rather than a different residency is more effective at getting you into derm (i should have heeded the article more during intern year), and especially given the knowledge of my neurobiology and sensitivity to sleep deprivation, i am planning to do research instead of continuing to pursue internal medicine residency. i just want to know if having to explain all of this to any clinical research fellowships would have a negative impact on me getting any positions, and also of ultimately matching into dermatology. i am currently looking for research opportunities in derm and am also preparing to take step 3. thanks for any help/advice. feel free to pm me as well.

all i got out of this is: step1 220, low rank in med school, about to get kicked out of IM, and I love derm lifestyle 'i want to switch' syndrome. these aren't good odds even with a derm fellowship or 2.

 

[asmallchild]

I know that during the research experience I will have opportunities for clinical work with the residents in derm. What can I do in addition to this to offset any perception of my deficiencies in clinical performance, which should be expected to improve with time? thanks.

As others have mentioned, there is not much you can do to offset this perception. Why would a program director take the risk on someone who has already been terminated when every year there is a crop of fresh new top of the class medical student graduates to select from?

That being said, even though it will be an uphill climb, I try never to discourage someone who wants to pursue dermatology.

Unless I am reading your original post incorrectly, arent you planning on pursuing research instead of a clinical career in medicine anyway? Your best shot would be to complete a research fellowship at a best with a derm program, try to impress as many people as possible, and reapply.

If you are interested in clinical medicine, and if there is any chance of completing your internal medicine residency, it would look a lot better to have completed the residency (and then complete a research fellowship)

And as another poster mentioned, I would NOT mention sleep deprivation as the reason for your switch from iM to derm.