Help! Clerkship grades, venting, and ENT...

[choo301]

Hi folks,

I just got my surgery clerkship grade and unfortunately, I found out that I did NOT honor. In fact, I've gotten high pass on every single one of my 3rd year clerkships (currently on OBGYN, fingers crossed), but not a single honors grade to put as a "gold star" on my transcript! (I swear I'm not a d-bag on my rotations, it's just that while I always seem to be "a pleasure to work with," I never seem to get the benefit of the doubt grade-wise...)

From what it seems like, the majority of ENT applicants are outstanding students with AOA, monster step 1 and/or 2 scores, world-class research, etc. Now, I like to think that I'm no slouch with a 247 on my step 1, but so far it seems like that's the only thing I can hang my hat on. Can anyone offer me some advice so that I could possibly match some day in this awesome/fantastic/superlative field? Many thanks in advance!

Some more info:
1) Research-wise, I only have a chart review to my name, with plans to do some more clinical research early in 4th year. (Side question: Do I need to take a year off for research?)
2) I plan on doing 1 ENT rotation at home institution, plus two aways.
3) I also plan on taking Step 2 CK very early, in the hopes that I will do well and perhaps offset my lack of clinical honors (thus far).

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[nordr]

Not honoring surgery is not the best but by no means will it put an end to your aspirations. In fact I didn't honor surgery or medicine and recently matched to my #1 choice. I think you just need to relax. Your step 1 is already above average for matching applicants so I don't see the point in taking step 2 early. Is the chart review ENT? Think it is very important to have ENT research. As far as taking a year off I would talk to someone at your home institution like the chairman or program director (that's what I did my 3rd year) bring your CV and ask what he thinks your chances are and what you can do to improve your competitiveness.

At this point the most important thing for you seems to be to rock your ENT rotations. Any idea why you are not getting honors? You should ask your surgery clerkship director why you did not honor and make sure you can make up for whatever is lacking in your ENT rotations.

 

[choo301]

Not honoring surgery is not the best but by no means will it put an end to your aspirations. In fact I didn't honor surgery or medicine and recently matched to my #1 choice. I think you just need to relax. Your step 1 is already above average for matching applicants so I don't see the point in taking step 2 early. Is the chart review ENT? Think it is very important to have ENT research. As far as taking a year off I would talk to someone at your home institution like the chairman or program director (that's what I did my 3rd year) bring your CV and ask what he thinks your chances are and what you can do to improve your competitiveness.

At this point the most important thing for you seems to be to rock your ENT rotations. Any idea why you are not getting honors? You should ask your surgery clerkship director why you did not honor and make sure you can make up for whatever is lacking in your ENT rotations.

Thanks, nordr. I apologize if I came off as a little spastic; I suppose these forums aren't particularly healthy for one's neuroses...

Anyways, the chart review WAS ENT-related. As for all of my non-honors grades, I think the common theme seems to be that I am on the shy/quiet side, which unfortunately seems to come across as lacking self-motivation. It's difficult to fix such a long-standing habit, but I guess I'll have to just keep trying even harder.

Also, I emailed my dean, who suggested the exact same thing you did: meet with the chair of the department here. So I'll have to see how that one goes.

All in all, thanks much for the advice, congratulations on matching, and best of luck to you!

(To anyone else out there reading this, the more advice the better! Much appreciated!...)

 

[gstrub]

FYI,
My step I score: more than 10 pts lower than yours
I got only one clinical H during 3rd year (neuro), rest HP, one P
Barely in the top half of class
Matched, 1st choice, big name program

It is not the end of the world. Make sure you try to make the other elements of your application (that you can control) shine (LORs, research) and apply broadly. Get honors in your ENT AI, make sure you get face time with the chair and the program director, and you should do fine if you're normal and likable.
Good luck,
G

 

[ZagDoc]

Milk that chart review for all its worth... turn it into a presentation and give it at grand rounds, submit it for a poster at one of the regional or national meetings, etc. You can turn a single "project" into 4 or 5 lines on your CV.

Finished projects are higher yield than in-progress ones, but in-progress is better than none. Would be good to pursue another project or two early in fourth year. Programs mainly want to see (1) scientific/clinical curiosity (2) you're comfortable doing research (3) you're competent with doing research. Residents that fit the 3 above tend to be more productive with publications during their residency, and this is turn reflects well on the program. That's the main "purpose" of having research on the application, essentially. If you can demonstrate that on your CV, you've jumped another hurdle.

Don't sweat clinical grades too much. I also didn't honor GenSurg, and matched my #2. Third year grades are a bit of a crapshoot... I just "passed" my Family Med rotations... was only asked about it on one of my interviews, and my explanation seemed to satiate their curiosity. Your sub-i and away grades will be much more important. I was also shy coming into med school. Remember, its less about being "loud" or "outspoken" and more about being confident in your clinical decisions and having sound reasoning behind those decisions. Be firm in your opinions, read a lot, prep your cases.

As above, face time with the chair and with the department is key. Schedule 1-to-1s with the important people in your department (chair, PG, notables) and come in with a few questions. You want to seem interested and engaged but not long-winded or needy. The chair can be a great advocate for you come application season. You want everyone to know who you are, but not know too much about you, if that makes any sense. You want to department to know who you are and that you're shooting for ENT prior to your sub-i, so you're not in and out in 4 weeks like a lot of rotators. Try to attend grand rounds in your free time to maintain a presence (and learn something!)

Good luck!

 

[choo301]

gstrub & ZagDoc: Thanks for the info, I really appreciate it!

As far as away rotations are concerned, has anyone had any experience at either UMaryland or Georgetown? Ideally I'd like to do residency in the Baltimore/DC area as my fiancee is likely headed there for law school...

 

[gstrub]

I rotated at Hopkins, so it's in that area. Absolutely awesome away rotation. Can't comment on UM or Georgetown...I didn't even get interviews there. JHU is the big dog so to speak in that area...I would consider an away there, no matter what your geographical baggage might be. You will see, work with, and learn from the best. Just my opinion...

 

[muncher]

ahha wow when i read this thread, it raised some hairs on my body, because i was in almost EXACTLY the same spot last year. the good news is i got a good # of interviews, including a few top tier programs and ended up matching at my #1. your plan of attack is excellent, so i just want to give you a couple of pointers that you'll hopefully find helpful.

you should schedule your aways at places where you want to end up. there are a couple of posts on this forum that discourage people from doing aways because 'it can only make them look bad.' FALSE. you already look mediocre on paper, hence, you can only do better by doing an away rotation. with that said, you absolutely want to destroy those aways... do everything you can do separate yourself from the pack. ie, take extra call, get in on research projects, be the first person in, last person out... if i had worked as hard on my 3rd year rotations as i did on my aways, i would have probably honored medicine and surgery and made aoa. anyways, if you do a good job, this'll land you an interview at a place you'll really want to be at, a leg-up on the other people who will be ranking said program, and hopefully a great letter from the PD there.

2ndly, if you consider yourself a shy, quiet person, i would strongly recommend doing soem hardcore interview practicing. like get a camcorder and record yourself... practice with people who aren't afraid to tell you how much you suck... it's tough but it's the only way to avoid looking like a fool when it really counts.

like one of the above posters said, milk that research for all its worth. all you've got going for you right now is a slightly above average step 1 score. your clinical grades are slightly below average so to get yourself a couple of extra interviews make sure you do everything you can to bolster your research.

step 2 -- i took it early just like you're planning and i regret it for a coupel of reasons. i did pretty much teh same as i did on step 1 and not a single person commented on it during interviews. what's worse is that I could have spent that month memorizing pasha or doing an extra away rotation or bolstering my research... you step 1 score is more than adequate and even if you got like a 280 on your step 2, which is far from guaranteed, it will probably not yield you too many more interviews.




keep in mind that only about 30% of the applicants that end up matching are AOA, so don't sweat it if you are not. with that said, there are many top tier programs out there that will deny you an interview if you are not AOA and/or honored surgery and medicine... that's why it's important to apply broadly if you're not the perfect applicant.

letters letters letters. can't stress how important these are. a strong letter can land you an interview and make you look like a star even before you step in the door. in my humble opinion, a 5 paragraph essay from a no name surgeon who knows you really well will be much more impressive than a form letter from a big wig. of course if you can get an awesome letter from a big name then that's even more awesome. but yea, get this done early, put a lot of thought into who to ask, and then cross your fingers and hope for the best.

last piece of practical advice: 8 hours of sleep every night! you want people to think: holy **** this guy is the first one here every day and last one to leave but he never looks tired!

anyways, good luck man! it's an exciting time!

oh, last bit of encouragement: with stats that are almost identical to yours, i landed interviews at umaryland and gtown!

 

[HEENTdude]

ahha wow when i read this thread, it raised some hairs on my body, because i was in almost EXACTLY the same spot last year. the good news is i got a good # of interviews, including a few top tier programs and ended up matching at my #1. your plan of attack is excellent, so i just want to give you a couple of pointers that you'll hopefully find helpful.

you should schedule your aways at places where you want to end up. there are a couple of posts on this forum that discourage people from doing aways because 'it can only make them look bad.' FALSE. you already look mediocre on paper, hence, you can only do better by doing an away rotation. with that said, you absolutely want to destroy those aways... do everything you can do separate yourself from the pack. ie, take extra call, get in on research projects, be the first person in, last person out... if i had worked as hard on my 3rd year rotations as i did on my aways, i would have probably honored medicine and surgery and made aoa. anyways, if you do a good job, this'll land you an interview at a place you'll really want to be at, a leg-up on the other people who will be ranking said program, and hopefully a great letter from the PD there.

2ndly, if you consider yourself a shy, quiet person, i would strongly recommend doing soem hardcore interview practicing. like get a camcorder and record yourself... practice with people who aren't afraid to tell you how much you suck... it's tough but it's the only way to avoid looking like a fool when it really counts.

like one of the above posters said, milk that research for all its worth. all you've got going for you right now is a slightly above average step 1 score. your clinical grades are slightly below average so to get yourself a couple of extra interviews make sure you do everything you can to bolster your research.

step 2 -- i took it early just like you're planning and i regret it for a coupel of reasons. i did pretty much teh same as i did on step 1 and not a single person commented on it during interviews. what's worse is that I could have spent that month memorizing pasha or doing an extra away rotation or bolstering my research... you step 1 score is more than adequate and even if you got like a 280 on your step 2, which is far from guaranteed, it will probably not yield you too many more interviews.




keep in mind that only about 30% of the applicants that end up matching are AOA, so don't sweat it if you are not. with that said, there are many top tier programs out there that will deny you an interview if you are not AOA and/or honored surgery and medicine... that's why it's important to apply broadly if you're not the perfect applicant.

letters letters letters. can't stress how important these are. a strong letter can land you an interview and make you look like a star even before you step in the door. in my humble opinion, a 5 paragraph essay from a no name surgeon who knows you really well will be much more impressive than a form letter from a big wig. of course if you can get an awesome letter from a big name then that's even more awesome. but yea, get this done early, put a lot of thought into who to ask, and then cross your fingers and hope for the best.

last piece of practical advice: 8 hours of sleep every night! you want people to think: holy **** this guy is the first one here every day and last one to leave but he never looks tired!

anyways, good luck man! it's an exciting time!

oh, last bit of encouragement: with stats that are almost identical to yours, i landed interviews at umaryland and gtown!

+1 on the sleep comment.

I lasted through my general surgery and 3rd year ENT rotations because I nearly always got plenty of sleep at home. It makes the 30-35 hour straight call NO SLEEP that I did several tiems MUCH MORE bearable. I was actually able to function at 3-4 am in the morning.

 

[Pir8DeacDoc]

If you can find a way to get that much sleep and be the first person in and the last to leave and read and work on assignments at night, please share with me so that I might use your strategy.

Sincerely
PGY-4

 

[muncher]

haha it really depends where you are. i was on one away rotation that did a lot of in house free flaps and you're right, there's absolutely no way to catch 8 hours of sleep every night. but on my other 2 rotations it could easily be done while reading and working hard.

 

[Pir8DeacDoc]

We do all of our own free flaps, which adds a lot of hours to training. I enjoy it, but there's no way in the world I get 8 hours sleep. Glad to know some of the ENT residents out there are

 

[muncher]

are you guys responsible for overnight flap checks as well?

 

[HEENTdude]

If you can find a way to get that much sleep and be the first person in and the last to leave and read and work on assignments at night, please share with me so that I might use your strategy.

Sincerely
PGY-4

I'm sure it's probably my own institution. The hours are a "tad" more chill than say Gen Surg. Don't get me wrong, I definitely realize that there are programs where the hours suck a lot more. I am definitely willing to pull my own weight when that time comes.

 

[msupaintballer]

Come on man, you got to have a little faith in yourself, how could you not with such amazing board scores and what not. Instead of applying into a residency wishing "Pick me Pick Me Pick me" you should be thinking, what a value you are bringing them by having you as their resident.

I did an ENT elective in a private office of some big name attendings. I worked hard, patients loved me, knew my stuff, if not would research it, got along with everyone in the office and OR, mindless to say I have bottom of barrel grades and scores, the docs would have loved to offer me a residency position.... its too bad i had a change of heart to OB/GYN two months previous. Either way, I got an incredible letter.

I know students who failed USMLE first time and still matched a TOP program in plastics. Be confident, humble, work harder than everyone and never take NO for an answer and you will be great.

 

[resxn]

I did an ENT elective in a private office. . .mindless to say I have bottom of barrel grades and scores, the docs would have loved to offer me a residency position....

 

[MCAT guy]

wait, needless to say?

 

[resxn]

wait, needless to say?

that's the least of the 4-5 warning bells in that post

 

[msupaintballer]

I don't understand. Other than less than stellar grades there are no warning signs at all. I have rotated with plenty of students who are Top 5%, 250+ USMLE, and if they didn't mention that no one would have known. Most were lazy since they knew they could fall bank on their grades. Now of course there are exceptions. Also clinical grades are so subjective, I know some attendings who everyone get honors and others who never give honors regardless.

However, rotating in a private practice of a doctor who is an attending at the hospital and conducts majority of the residency interviews offers unique experience than just rotating in the hospital. They get to know you a lot better, get far more exposure direct with them, you don't have to worry about being thrown under the bus or competing. And yes residents have a lot of pull and say but at the end of the day its the attendings who make the decisions.

I guess my approach is a little different since I dont have a 250+ USMLE to ride on, however my experiences have shown me so far that regardless of specialty, if the program/attendings likes you, knows your hard working, PASSIONATE, smart and RELIABLE, they will take you over a strong paper applicant almost any day.

 

[resxn]

The warning bells are: "Bottom of the barrel grades and scores" not "less than stellar" which is somewhat different. "Private practice" attending rather than one who "conducts majority of the residency interviews [sic]"--again, something quite different at least in implication. Change of heart to ob/gyn rather than what? ENT? And I didn't include the typos. Then this statement, "the docs would have loved to offer me a residency position"

I 100% agree with these 2 statements you made. First, "regardless of specialty, if the program/attendings likes you, knows your hard working, PASSIONATE, smart and RELIABLE, they will take you over a strong paper applicant almost any day." Second, "Be confident, humble, work harder than everyone and never take NO for an answer and you will be great."

Here's the reason I have a problem. I think it is somewhat extraordinary that a private practice ENT conducts a majority of the interviews at a residency. That's a bell in and of itself. Granted, I've only been affiliated with 5 residency programs in some fashion or another, but in all of them, private practice attendings who were invited to interview residents rarely had much ammo in selecting applicants even when their vote was counted at the end of the day. Furthermore, assuming that this private practice guy has sway in the resident selection process, it would be hard to suppose that one attending espousing the virtues of one student with crappy grades and crappy scores can convince an entire committee that he's the right one for them.

Not saying it can't happen, I'm just skeptical. And I'd bet a month's salary it's the exception more than a rule.

One thing I want people to know on this board is truth. I want people to have realistic expectations for good or for bad. I don't want people to think that their only chance to get in is 3 papers, 250+ boards, and all honors/AOA. But at the same time I don't want them to put all their eggs in the ENT basket when they get 210, no papers, 1 honor is psych, and are not AOA.

Just realism and truth is what the people on this board need and deserve. If your experience is unique, and I think it is, I have a duty to call it out.