OMS4 being threatened with dismissal

[Proudfather94]

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Hello everyone, I am a 4th year medical student who passed boards on the first try, and passed pre clinical with no academic issues. I received a subpar third year education, due to my clinical sites not instructing me on how to write notes, or how to do presentations. When I started fourth year, since I did not get these required parts of my education I have been criticized for lacking them. Does anyone here have resources or advice to give? I am primarily struggling with inpatient presentations and note writing, particularly H&Ps and progress notes. Despite telling my school the issues I am having, I feel that I am being railroaded to dismissal without much support. I have been told by residents on multiple rotations that they believe I am struggling because I received a poor third year education. Since I excelled in preclinical, and most of third year, I feel that I am being punished because my school is not monitoring our rotation sites to make sure we are being adequately taught.

 

[thumbz]

Do you have an idea why your 4th year is so much more challenging? Usually DO schools with awful clinical rotations have them in 3rd and 4th year, so students just get passed along until they graduate.

Can you give us a little more info? Is this one rotation? Or several in a row? Is it medicine? Surgery?

 

[Proudfather94]

Do you have an idea why your 4th year is so much more challenging? Usually DO schools with awful clinical rotations have them in 3rd and 4th year, so students just get passed along until they graduate.

Can you give us a little more info? Is this one rotation? Or several in a row? Is it medicine? Surgery?

The main place we rotate at told me they don't let med students write notes but at the beginning of 4th year expected us to write them. The surrounding sites expect you to write notes 3rd year so they are more strict with their grading. I didn't pass an IM rotation beginning of 4th year and an icu one at a different organization. The site I'm at now is saying I'm doing a good job with them I think I started 4th year in the hole and had to learn how to do them well with help from my rotation sites. I surg rotation 3rd year but honestly the preceptor didn't like me and I didn't know how to communicate with her. I did my remediation when I was supposed to be on dedicated and he didn't have any concerns about me.

 

[Rapsidy]

Use AI to help you learn how to write notes. I use open evidence a lot to help with the assessments. Don’t use it as a way to think for you but to help you stream line your thoughts and differentials into a succinct and concise assessment that doctors can read quickly and understand your rationale.

If you are struggling with presentations then present to yourself in the mirror. You can easily have a sheet on the wall to remind you of the soap format of SOAP so you can reference it when you are starting to jump around. As someone with ADHD I struggled immensely with my soap presentations for a while because I wanted to jump around and go straight to plans when I started talking about a problem. It just takes practice even if you feel stupid talking to yourself in a mirror. You can also grab a medical school friend as well and practice presenting to them.

Also for notes, steal as many dot phrases and templates as you can from residents and attendings. Nobody has time to write out complete notes from scratch, most things are templated to the ground these days. If you don’t have those you are handicapping yourself.

Those are just some things I can think of at 5 am in the morning when I’m avoiding going to inpatient work on Christmas Eve but I hope it helps.

 

[NotAProgDirector]

Were you the only student at this site? Is this the first year they have had students? Because if other students are continuing and you're struggling, that suggests a different problem. Even if they didn't require that you write notes, you could have done so on your own for the practice.

 

[Proudfather94]

Were you the only student at this site? Is this the first year they have had students? Because if other students are continuing and you're struggling, that suggests a different problem. Even if they didn't require that you write notes, you could have done so on your own for the practice.

I was at a site that not many students rotate at. I'm not sure as to the extent others are struggling with these things, as people don't like to really talk about it. I understand trying to practice note writing on my own, but the problem that I was encountering was that sites want the notes in their specific template. All of my rotations where this was an issue prohibited the use of EMRs outside of the hospital (no haiku), and you would be told who your patient was in the morning. This made it physically impossible to prepare your presentation and notes without using the template. I did not know how to use epic the best 4th year, which is what lead to messed up notes and presentations for the most part as I was scrambling to find the information in the time provided and by the time I had to present I was a scrambled mess. I asked for help multiple times, however I was never really given the assistance I needed only a few pointers.

Alot of this issue would have been provided if all of the rotation sites were required to have us write notes during 3rd year. 3rd years messing up notes and presentations is alot more forgivable than 4th year students. I honestly do not see any other way that I could have been ready for these things to a 4th year level without my rotation sites 3rd year actually doing what they needed, which was on my school to enforce.

 

[RockClimberMed]

prohibited the use of EMRs outside of the hospital (no haiku), and you would be told who your patient was in the morning. This made it physically impossible to prepare your presentation and notes without using the template.

Couldnt you just get there earlier to give yourself more time? Are you saying you didnt have access to the Smartphrases or what? If anything usually templated notes make things easier

 

[Proudfather94]

Couldnt you just get there earlier to give yourself more time? Are you saying you didnt have access to the Smartphrases or what? If anything usually templated notes make things easier

I did get there early, but the problem is I would have to wait until the residents got there, so that I knew who patients were. I understand they make things easier, and they do now. When you're trying to find the relevant information in someone's chart using an EMR that you are not used to yet, finding the information that is auto populated vs the information that you need to look up and add is a very big challenge.

 

[NotAProgDirector]

I did get there early, but the problem is I would have to wait until the residents got there, so that I knew who patients were. I understand they make things easier, and they do now. When you're trying to find the relevant information in someone's chart using an EMR that you are not used to yet, finding the information that is auto populated vs the information that you need to look up and add is a very big challenge.

Something sounds very strange. Usually, you follow your patients from day to day. You get your patients assigned, and then you see them evry day. When you send someone home, then you get a new patient (sometimes the next day). It would be very strange to need to wait until the residents arrive to know whom your patients are -- unless this was a rotation in a day surgery program or something like that.

 

[hellosnd]

I'm an IM PGY3 about to be done... seen my fair share of great and awful MS3 and MS4s.

Just ask your resident if they have time to go over a note, presentation, H&P with you. If they are busy or if personalities don't mesh, find someone else. Feel like most of us want to help as long as you are teachable (actually listen to feedback and incorporate the feedback)

The medical students I tend to dislike the most are those who have an excuse (explanation) for everything I say, do not learn from their mistakes, and are overall ungrateful for my time. Nothing more frustrating than a medical student who always has an excuse or takes up 10-20 mins of my morning pre-rounding time, then proceeds to ignore all my feedback and present horribly.

I surg rotation 3rd year but honestly the preceptor didn't like me and I didn't know how to communicate with her.

This is kinda red-flaggy to me. Sure, preceptors have different personalities and might not actually like you, but you will have people like that wherever you go, and definitely in residency with various attending physicians and senior/chief residents. You need to learn to communicate/get along with all personalities types

Something sounds very strange. Usually, you follow your patients from day to day. You get your patients assigned, and then you see them evry day. When you send someone home, then you get a new patient (sometimes the next day). It would be very strange to need to wait until the residents arrive to know whom your patients are -- unless this was a rotation in a day surgery program or something like that.

I assume they mean dripped patients, where senior residnet need to assign patients to the team?

 

[DOVinciRobot]

I did get there early, but the problem is I would have to wait until the residents got there, so that I knew who patients were. I understand they make things easier, and they do now. When you're trying to find the relevant information in someone's chart using an EMR that you are not used to yet, finding the information that is auto populated vs the information that you need to look up and add is a very big challenge.

Harsh post incoming.

You aren’t telling us something. 1. 4th years don’t just get threatened with dismissal. 2. The above sounds very lazy and whether or not you are familiar with the EMR not one of them is so confusing you literally can’t find any relevant information on them. Waiting until the residents get there to try and figure out who the patients are is simply lazy. There are multiple ways to find out who the patients are, the easiest of which is to ask the residents the day prior before you leave which patients you need to round on in the morning. 3. You subtly slipped in that you failed Surgery. Failing a core rotation is a big deal. Makes me wonder what other academic troubles you’ve had that you aren’t telling us.

Many DO students across the country get shafted with bad 3rd year rotations. Time to take your education in your own hands and stop waiting for someone to hold your hand. That won’t change in residency.

 

[kirtar]

I don't find the argument that the templates are holding things back to be particularly compelling. Regardless of whether the template decides to be SOAP, APSO, or whatever format, it's mostly just re-arrangement of the same information. Overall it sounds like you're expecting to be drip fed everything and not taking initiative to do things like figure out (or ASK) where to find a piece of information in Epic.

 

[Ho0v-man]

You’ve failed 3 rotations. It’d be weird if your school wasn’t threatening you with dismissal. Glad to hear you’re doing better after a rocky start to 4th year.

If you didn’t know how to present, write progress notes, or an H&P at the start of 4th year, that’s bad. It might be your schools fault or it might be your lack of initiative resulted in no one bothering with you in 3rd year because they’re busy enough already. Maybe a mix. Whatever. Either way, you’re not meeting expectations. But is everyone from those sites failing multiple rotations? Doubt it.

In 6 months you won’t have anyone to blame but yourself. You’ll have attendings who don’t like you (or anyone), you’ll have difficult patients and complex lose-lose medical decisions to make. You likely won’t make it through if you make excuses every time you come up short, even if it’s a legitimate excuse. No one cares.

And in residency, you’re gonna come up short. Frequently. The point is to see that you aren’t hitting the mark and have the maturity and self awareness to realize what needs to change.

That’s why a big part of rotation grades in med school aren’t about knowing everything. It’s about being teachable.

 

[Proudfather94]

I see what you guys are saying and you are right that I should have been more proactive. I was trying to get better at looking at the EMR and presenting and thankfully my rotations outside of my schools core sites have been very helpful with giving me the ability to address my deficiencies. I am willing to see where I come up short and to try and fix it, but to be put in this position in the first place is where my issue stands. Almost all of my evaluations 3rd year say the exact opposite of what my first gensurg rotation said about me, I honestly believe the preceptor had personal issues with me.
I should have been more assertive when I asked for help. I tried to get experience with writing notes since the beginning of third year. I understand that I could have tried harder to learn these things on my own when I realized I was not being taught appropriately, but to be honest asking multiple times for help and not recieving it took a large toll on my motivation.

 

[NotAProgDirector]

At this point, what's done is done and your best plan is to figure out how to move forward.

The key issue is not getting dismissed. You're somewhat vague about whether your school has started dismissal process or not. If they have, you need to request a hearing / appeal or whatever your student handbook requires. This would then give you a chance to explain the situation and how you plan to address it. in general, blaming the school for not giving you a good education isn't a winning strategy, even if true. So you'll need to find a better way to describe your circumstances.

If that's successful (or you're not actually in the process of being dismissed), then you need to focus on not failing anything else, ever. You should assume you're on thin ice and failing one more thing, no matter how small or minor, will be fatal to your career. You need to get caught up with your skills. Whatever it takes.

I am assuming you are not in the match fo rthis year. At this point, you need to focus on not failing out, and plan to match next year. You'll need a plan that includes applying to non-competitive fields / places, as multiple clinical fails is going to be a huge barrier even if you stop failing things now.

If you need an LOA, then you should set that up ASAP to get yourself in the best possible position to succeed.

 

[Proudfather94]

At this point, what's done is done and your best plan is to figure out how to move forward.

The key issue is not getting dismissed. You're somewhat vague about whether your school has started dismissal process or not. If they have, you need to request a hearing / appeal or whatever your student handbook requires. This would then give you a chance to explain the situation and how you plan to address it. in general, blaming the school for not giving you a good education isn't a winning strategy, even if true. So you'll need to find a better way to describe your circumstances.

If that's successful (or you're not actually in the process of being dismissed), then you need to focus on not failing anything else, ever. You should assume you're on thin ice and failing one more thing, no matter how small or minor, will be fatal to your career. You need to get caught up with your skills. Whatever it takes.

I am assuming you are not in the match fo rthis year. At this point, you need to focus on not failing out, and plan to match next year. You'll need a plan that includes applying to non-competitive fields / places, as multiple clinical fails is going to be a huge barrier even if you stop failing things now.

If you need an LOA, then you should set that up ASAP to get yourself in the best possible position to succeed.

Thank you, I'm at a spot right now that I'm not sure what I should do. The rotation I'm on right now said my notes and presentation skills are pretty good so I feel I have time.
The process hasn't been started to dismiss yet thankfully it was written on paper as a possibility if I messaged up again

 

[NotAProgDirector]

That's a positive. So it sounds like you're on probation.

What you need to do is make sure that nothing else goes wrong. Because once you get a warning like this, if there are any more problems -- including something completely different or unrelated -- you're likely to be terminated.

You mentioned in your OP that you had problems with your surgery clerkship and "didn't know how to communicate with your preceptor". This can't happen again.

Are you applying in the match this year?

 

[Proudfather94]

That's a positive. So it sounds like you're on probation.

What you need to do is make sure that nothing else goes wrong. Because once you get a warning like this, if there are any more problems -- including something completely different or unrelated -- you're likely to be terminated.

You mentioned in your OP that you had problems with your surgery clerkship and "didn't know how to communicate with your preceptor". This can't happen again.

Are you applying in the match this year?

I did apply, but as I likely can't graduate this year it was a waste of time.

 

[NotAProgDirector]

I did apply, but as I likely can't graduate this year it was a waste of time.

Perhaps for the best. You really need to avoid any situation where a rotation dings you for missing time due to interviews. You want to put your full effort into your clinical performance. because, another fail/problem, and you'll be dismissed and that will be that.

This also takes any pressure off taking S2/L2 anytime soon (if you haven't done so already). You can focus on your clinical work, and plan to take it in the spring / summer.

What field(s) were you applying / considering?

 

[Proudfather94]

Perhaps for the best. You really need to avoid any situation where a rotation dings you for missing time due to interviews. You want to put your full effort into your clinical performance. because, another fail/problem, and you'll be dismissed and that will be that.

This also takes any pressure off taking S2/L2 anytime soon (if you haven't done so already). You can focus on your clinical work, and plan to take it in the spring / summer.

What field(s) were you applying / considering?

I was pretty dead set on Psych but I don't think that will probably be an option if I make it to that point. I'm honestly trying to do well and I am doing everything I can to keep doing my best and to keep going.

 

[NotAProgDirector]

Agree. In some ways, an extra year might help get some distance between this poor performance and your application, more time for psych rotations and experiences. But psych has become more competitive, and you'll need to apply to FM also. You can definitely try to tailor an FM practice to psych type issues once you finish a residency.

But for now, the goal is not failing out of medical school.