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Do you guys think I have a chance of matching into a decent psych program? Any advice? I don’t know if my school will show that I initially failed the psych NBME or if they will just show the Pass.
This part, none of us can know--you should just directly ask your dean.

The rest of your application seems like it will be quite good, with an above average step 1 score and lots of psych-related experiences. You may not match at a name-brand psych program, but I would expect you should be able to match as long as you apply to a decent range of programs.
 
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Dr G Oogle

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+1 talk to your dean. I might also try to parley your experience with depression into a personal statement especially if you do great the rest of the year because a) it explains your performance and honestly to be able to deal with illness and still pass in Med school is pretty great and b)while it’s not always possible I think it is powerful to have a doctor who has dealt with some of the issues that a patient is dealing with it, I think it provides a level of comfort and decreases the stigma that a patient may be dealing with

As an example I am interviewing people for uro residency who had a similar experience and did poorly on step 1, in the past this low of a score would even preclude an interview offer and yet this person is at the very top of the list because they demonstrate resiliency and dedication and otherwise have a great app.

I’ve also known several people personally (classmates) who went through similar experiences and honestly all were absolute rockstars on the other side of it and matched at great places and continue to excel

tldr; do well the rest of the year, write a great personal statement about your own experience with a disease you have personal experience with and I think you’ll be a phenomenal applicant
 
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Frank S

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+1 talk to your dean. I might also try to parley your experience with depression into a personal statement especially if you do great the rest of the year because a) it explains your performance and honestly to be able to deal with illness and still pass in Med school is pretty great and b)while it’s not always possible I think it is powerful to have a doctor who has dealt with some of the issues that a patient is dealing with it, I think it provides a level of comfort and decreases the stigma that a patient may be dealing with

As an example I am interviewing people for uro residency who had a similar experience and did poorly on step 1, in the past this low of a score would even preclude an interview offer and yet this person is at the very top of the list because they demonstrate resiliency and dedication and otherwise have a great app.

I’ve also known several people personally (classmates) who went through similar experiences and honestly all were absolute rockstars on the other side of it and matched at great places and continue to excel

tldr; do well the rest of the year, write a great personal statement about your own experience with a disease you have personal experience with and I think you’ll be a phenomenal applicant
Thank you so much! Yeah, I’ll incorporate my own health experiences into my personal statement. I was kind of worried of doing so, though, because I was afraid that residency programs wouldn’t want someone who’s struggling with depression and other health issues while working. I still go to therapy and am still undergoing treatment for a chronic health problem, and will probably do so for a long time, if not for the rest of my life. My therapist said this could be viewed as a strength, but I kept thinking that some residency programs would probably see it as baggage. Anyway, thank you so much for your detailed response 😊
 

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Thank you so much! Yeah, I’ll incorporate my own health experiences into my personal statement. I was kind of worried of doing so, though, because I was afraid that residency programs wouldn’t want someone who’s struggling with depression and other health issues while working. I still go to therapy and am still undergoing treatment for a chronic health problem, and will probably do so for a long time, if not for the rest of my life. My therapist said this could be viewed as a strength, but I kept thinking that some residency programs would probably see it as baggage. Anyway, thank you so much for your detailed response 😊
I hope people will see it as a strength because it is, places that don’t are probably not places that you would find to be supportive in general and less interested in resident well being
 
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Matthew9Thirtyfive

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Thank you so much! Yeah, I’ll incorporate my own health experiences into my personal statement. I was kind of worried of doing so, though, because I was afraid that residency programs wouldn’t want someone who’s struggling with depression and other health issues while working. I still go to therapy and am still undergoing treatment for a chronic health problem, and will probably do so for a long time, if not for the rest of my life. My therapist said this could be viewed as a strength, but I kept thinking that some residency programs would probably see it as baggage. Anyway, thank you so much for your detailed response 😊

I would hope psych programs would not share the same stigma for depression others might.
 

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I hope people will see it as a strength because it is, places that don’t are probably not places that you would find to be supportive in general and less interested in resident well being
Thank you again 🙏I really appreciate your words of advice.
 

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We can debate whether it's stigma or not, but all residency programs want residents who will complete the program without issue. You generally don't want to tell them why you might have issues doing so, but that doesn't mean there isn't a good way to write about this. This topic has been discussed numerous times in the Psychiatry Residency forum here over the years. For example:



 
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Frank S

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We can debate whether it's stigma or not, but all residency programs want residents who will complete the program without issue. You generally don't want to tell them why you might have issues doing so, but that doesn't mean there isn't a good way to write about this. This topic has been discussed numerous times in the Psychiatry Residency forum here over the years. For example:



These threads have been super informative. Thank you! It’s good to hear arguments on both sides.
 

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Hi guys,
Hope everyone’s staying healthy :)

I had a question regarding matching into a psychiatry program. Psych was my first core clerkship, and I initially failed the psych NBME. My school gives out grades of Pass, High Pass, and Honors. Because I failed, I got a conditional and had to repeat the exam. I retook the exam and got a grade in the 65th percentile. So they changed my grade from conditional to a Pass.
The reason I failed the psych NBME and was a lackluster student during psych was that I was dealing with personal health issues and had severe depression. I failed the NBME literally because I didn’t have the energy to sit through the entire exam and answer the last 20 questions. All of my other clinical grades have been High Passes and 1 Honors in Family Med. My Step 1 score is good - a 240, but I haven’t taken Step 2 yet. I’m also graduating a year late and will be doing psych-related research for 6 months or so. I am also planning on taking more psych electives and doing well on them (not sure if I can get Honors but will prob get High Passes at least).

Do you guys think I have a chance of matching into a decent psych program? Any advice? I don’t know if my school will show that I initially failed the psych NBME or if they will just show the Pass.

Thank you all so much!

I hope you don't mind my bluntness, but the part I bolded is what will hurt you more than anything else. Depression sucks and psych programs will not hold it against you unless they think you'll use it as an excuse to do poor work. Believe it or not, students do. Depression is something easy to use because there's no test to determine if it's true or not so when a student does poorly, that (along with ADHD) is a convenient excuse. That casts a shadow on those with legitimate depression.

If you get a jerk for an interviewer and you bring this up, their next question will be: wow, you were only depressed for this one rotation (since all your other rotations were high pass/honors)?

What you should do is stop all talk of depression. If asked why you didn't get a high pass or honors, you say "it was my first rotation, I was disorganized and trying to figure out the hospital, and I wasn't at my best, but I worked really hard and figured it out which is why I did so much better on my other rotations". That is still not ideal, but much better than saying you were depressed for 4 weeks and it's the reason for the grade.
 
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sloop

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The answer to whether you can match into a decent psych program probably depends on what you regard as decent. In many cases, it will not rule you out, but the best psych programs can be competitive.

I have done many interviews for my program the last few years and can say that many of the applicants have board scores in the 240s-250s. Most of these same applicants have honored their psych rotation, let alone had to remediate.

That said, it is very likely that you could still match into a strong university-based program, if that is what you desire. Your clerkship grade would probably only hurt you at the more competitive places.

Regarding stigma of mental health in psychiatry: we do tend to understand people with these kinds of struggles but it’s not like the fact that you were struggling with mental illness is going to negate the poor grade. I don’t actually think this is so much “stigma” as it is reality. People with histories of mental illnesses that have significantly impacted academic or clinical performance are liabilities for programs. It really sucks when one resident is out or just performing poorly and the other residents have to pick up the slack. Additionally, at rigorous programs, this can create significant staffing issues that are difficult to remedy. Programs are obviously going to want to avoid this, if possible. Hence, I wouldn’t immediately have the expectation that psych programs are going to be uniquely forgiving of this sort of thing.
 
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sloop

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Thank you! Yeah, I understand that residency programs won’t want to hold my hand if I get sick during residency. The thing is - my mental health problems stem from a physical condition that I have. I’m getting treatment for my physical condition, but the nature of my condition is that it has flares. I’m learning to deal with those flares without falling into a depression. Anyway, I don’t want to match into a super competitive program - I’d be happy to match into a good mid-tier program that actually cares about resident wellbeing and would understand if I had to take a day off here or there (not that I’m planning on being sick during residency, but I can’t rule it out) and where I wouldn’t have to hide my health problems.
I will clarify that I think wanting to avoid these situations is also different from being unsupportive when it happens.

My program has and would be supportive of a resident needing accommodations or time off due to mental illness. Still, trust me when I say it’s a giant headache when it happens and it is very frustrating for both attendings and residents.

Additionally, it’s not so much about caring about resident well-being. Better programs are often more rigorous in part because they give residents more responsibility and thus depend on them more for the operation of the hospital. As an example, some psych programs essentially have the capacity to continue operating even if all of the residents were suddenly unavailable. At these places, the attendings would just do admissions, staff the ED and consults and directly see clinic patients instead of supervising. This would usually suck for the attendings but they could do it. My impression is that most of the best residency programs are not structured this way for various reasons (they tend to pay attendings less, the faculty often have more significant time commitments to other activities/research and can’t be on the wards the whole day, they may not have permanent, dedicated, full-time attending staffing in the emergency department, etc.) In these circumstances, it is simply more onerous when a resident gets sick for weeks to months at a time than at a less resident-dependent program. It’s not that the program won’t be supportive, it’s just that doing so entails a lot more work.
 
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sloop

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I see. I guess what I’m trying to understand from your comment is what are you recommending that I do? I’m undergoing treatment and going to therapy for the depression. If I could wish my physical condition away, I would. The only thing that’s causing my depression is my physical condition that causes physical symptoms. I don’t have idiopathic depression that just comes from nowhere. What do I do then? Lie about my physical condition/hide it? Not apply to residency? I don’t mean to sound rude; I just genuinely want to know what you’re recommending I do, since I’m already doing the maximum I can to treat my physical condition that’s causing my mood symptoms.
I was mostly focusing on the first question you asked regarding your chances. I mostly wanted to prepare you for the fact that this is a negative on your application and will be more of a negative for some places than others. I was just explaining why the fact that it was due to a mental illness is not necessarily going to be as mitigating as you might expect from psychiatry.

In terms of what to do, there are a few different tactics. What I will say is that if you are going to bring up the illness aspect of your performance, you should be prepared to explain it in a way that leaves almost no doubt that this problem is in the past and is not going to impact your performance in residency. It’s impossible to say how interviewers are going to react to this explanation. I’m sure some will not find it to be much of an issue. Others are going to find it hard to overlook a history of poor performance related to mental illness as a harbinger of future problems. I think that this approach would be the most viable if you have a clear history of improvement and/or clinical excellence after you were treated. The disadvantage of this approach is that it involves admitting an illness affected your performance and it might be difficult to reassure an interviewer that a similar situation won’t occur in residency. The advantage is that, if you are successful in reassuring the interviewer, the poor grade reflects less on you personally and more on the “illness.”

The other approach, as has been mentioned, is to either not mention mental illness or at least not attribute your academic struggles to it. Practically this would entail “owning” the poor performance and acknowledging you made some mistake that you have since remedied. The downside of this is that it involves framing the issue in the context of a weakness you have as an applicant. The advantage is that most people understand that people can have momentary academic difficulties that they overcome and these are unlikely to resurface as future problems (in comparison to an illness, which might recur even with the best treatment).
 

Mass Effect

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I see. I guess what I’m trying to understand from your comment is what are you recommending that I do? I’m undergoing treatment and going to therapy for the depression. If I could wish my physical condition away, I would. The only thing that’s causing my depression is my physical condition that causes physical symptoms. I don’t have idiopathic depression that just comes from nowhere. What do I do then? Lie about my physical condition/hide it? Not apply to residency? I don’t mean to sound rude; I just genuinely want to know what you’re recommending I do, since I’m already doing the maximum I can to treat my physical condition that’s causing my mood symptoms.

Why do you need to bring up your own mental health at all? You took time off due to your physical condition. Done.
 

Mass Effect

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Maybe that’s a good strategy, but the thing is that my condition is chronic - it may never go away. Sometimes it gets better and I barely notice it, and at times I have flares and feel worse. But I’m learning to deal with it. The thing is, doctors don’t even have a definitive cure for my condition; there are treatments, but for many ppl they don’t work particularly well. I’m thankful not to have the severe kind (at least yet), but it’s definitely not easy going about it day to day struggling with it. Would residencies be more forgiving about a physical condition that has flares rather than a mood condition? I don’t even care about the prestige of the place I match; just as long as they can be accommodating if I ever need to take a day or two off here or there (which I’m going to try my best not to do obv) and will allow me to get enough sleep at night (my flares are often brought on by lack of sleep). Of course I’d want the place to also train me decently, so I’m actually useful to patients afterward. Idk, do you think such a place exists? 😔Thank you! I appreciate honesty.

Depression is also chronic in many people and a hell of a lot less predictable.

I think you're overthinking it. You took time off due to a medical condition. You underwent workup, got treatment, returned stronger than ever and it only cemented your desire to be a physician. You're doing well now.

Done.

You don't need to tell people it's chronic (no one is going to ask), you don't need to tell them that there are flares.

The desire to overshare is what tanks a lot of applications.

To answer your question -- chronic conditions are bad, whether it's physical or mental. In your case, the depression is tied to your physical condition, so if the condition worsens or flares, what keeps you from being depressed all over again? I don't see what telling them about the depression gets you since you're likely going to tell them about the chronic condition anyway.
 
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Frank S

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Depression is also chronic in many people and a hell of a lot less predictable.

I think you're overthinking it. You took time off due to a medical condition. You underwent workup, got treatment, returned stronger than ever and it only cemented your desire to be a physician. You're doing well now.

Done.

You don't need to tell people it's chronic (no one is going to ask), you don't need to tell them that there are flares.

The desire to overshare is what tanks a lot of applications.

To answer your question -- chronic conditions are bad, whether it's physical or mental. In your case, the depression is tied to your physical condition, so if the condition worsens or flares, what keeps you from being depressed all over again? I don't see what telling them about the depression gets you since you're likely going to tell them about the chronic condition anyway.
Ok, that’s good advice. Thank you! Just to clarify, I shouldn’t tell them what exact condition I have? Just say “medical condition”? Because if I tell them, they’ll know it’s chronic. The reason I wanted to be super honest and share everything was that in the situation that I do get worse and do end up missing some days of work (which of course I’ll try my best not to do), that they aren’t then surprised to find out that turns out my condition is chronic. Obv I’d try my best not to do this, and I’m aware how much of an inconvenience it’d be to my co-residents and everyone else, but I’d only do this if I’m feeling terrible myself.
 

Mass Effect

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Ok, that’s good advice. Thank you! Just to clarify, I shouldn’t tell them what exact condition I have? Just say “medical condition”? Because if I tell them, they’ll know it’s chronic. The reason I wanted to be super honest and share everything was that in the situation that I do get worse and do end up missing some days of work (which of course I’ll try my best not to do), that they aren’t then surprised to find out that turns out my condition is chronic. Obv I’d try my best not to do this, and I’m aware how much of an inconvenience it’d be to my co-residents and everyone else, but I’d only do this if I’m feeling terrible myself.

If they ask, tell them. But I promise you they likely are not going to ask.

No one can predict what's going to happen to any of us. If you miss work due to illness, then you miss work due to illness. It happens. Don't lie to them, but if they don't ask, you don't need to volunteer information either.

Just based on what you've said, I'm thinking you have an autoimmune illness. You know what triggers a flare in autoimmune disorders? Stress. You know what residency is? Stressful. Why would you want to give them a reason to hesitate in the rank meeting? Don't lie, but don't volunteer information that might hurt you either.
 
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Frank S

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If they ask, tell them. But I promise you they likely are not going to ask.

No one can predict what's going to happen to any of us. If you miss work due to illness, then you miss work due to illness. It happens. Don't lie to them, but if they don't ask, you don't need to volunteer information either.

Just based on what you've said, I'm thinking you have an autoimmune illness. You know what triggers a flare in autoimmune disorders? Stress. You know what residency is? Stressful. Why would you want to give them a reason to hesitate in the rank meeting? Don't lie, but don't volunteer information that might hurt you either.
Thank you 🙏. I think that’s what I’ll do. Appreciate your taking the time to give me useful advice!
 
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Candidate2017

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OP, programs that truly value resident wellness will only take applicants with a strong track record because everyone else's wellness depends on YOU showing up and getting the job done.

Residency is a zero sum game.
 

BacktotheBasics

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I don't know anything about matching Psychiatry, but I will make a couple of points. If you only see yourself happy doing Psychiatry you can probably get there eventually with enough persistence. In terms of your chances, ask over at the Psychiatry forum if there's a an aPD over there who takes questions.

1.) I feel like whatever you were (or maybe still are) dealing with was definitely debilitating. Psychiatry is by far the easiest NBME to honor/pass because the material is limited and knowing the disorders and their timelines allows you to exclude lots of answers (much of which is Step 1 stuff). You probably know this already given your interest in the field. I say it not to make you feel worse but to emphasize that whatever happened really hit you hard and its unfortunate that it did during a key time you needed to perform in medical school. Make sure whatever it is, that it's resolved/under control. Moving forward though, its reassuring that you have gotten honors/high passes in other rotations (part of which I assume require shelf exams). As you allude to, that's something to build off of.

2.) As you know you have 2 red flags (Psych repeat-figure out if that's a repeat or not, graduating late). The first thing priority is avoiding another setback. Not a medical one (that's my first point) but another knock on your record like a bad Step 2 score, more years off, etc. Try not to put any pressure on yourself to redeem your past shortcomings. Don't worry if your CK isn't 250+, etc. Just do your best and avoid the urge to overcompensate. It will only make things worse. Try to make that research year productive because that will make the year look more palatable but don't let one year become two, etc.

3.) The sad truth about admissions (anywhere not just in medicine) is that despite the fact that this has made you a stronger person and your resilience demonstrates your commitment to the field, they have 100s of applicants from people who were lucky enough not to run into the stuff you've run into. Life's not fair and the earlier you learn this, I think the more grief you avoid. You may have to suck things up and take a few steps back that you feel are "above you" to get where you want to go. That includes applying to FM/IM programs to at the very least keep things moving in the right direction (as the alternative would be a large gap in clinical training that becomes harder to justify).

Best of luck! I'm sure you'll achieve what you want!
 
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Frank S

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I don't know anything about matching Psychiatry, but I will make a couple of points. If you only see yourself happy doing Psychiatry you can probably get there eventually with enough persistence. In terms of your chances, ask over at the Psychiatry forum if there's a an aPD over there who takes questions.

1.) I feel like whatever you were (or maybe still are) dealing with was definitely debilitating. Psychiatry is by far the easiest NBME to honor/pass because the material is limited and knowing the disorders and their timelines allows you to exclude lots of answers (much of which is Step 1 stuff). You probably know this already given your interest in the field. I say it not to make you feel worse but to emphasize that whatever happened really hit you hard and its unfortunate that it did during a key time you needed to perform in medical school. Make sure whatever it is, that it's resolved/under control. Moving forward though, its reassuring that you have gotten honors/high passes in other rotations (part of which I assume require shelf exams). As you allude to, that's something to build off of.

2.) As you know you have 2 red flags (Psych repeat-figure out if that's a repeat or not, graduating late). The first thing priority is avoiding another setback. Not a medical one (that's my first point) but another knock on your record like a bad Step 2 score, more years off, etc. Try not to put any pressure on yourself to redeem your past shortcomings. Don't worry if your CK isn't 250+, etc. Just do your best and avoid the urge to overcompensate. It will only make things worse. Try to make that research year productive because that will make the year look more palatable.

3.) The sad truth about admissions (anywhere not just in medicine) is that despite the fact that this has made you a stronger person and your resilience demonstrates your commitment to the field, they have 100s of applicants from people who were lucky enough not to run into the stuff you've run into. Therefore its important to realize that life's not fair. The earlier you learn this in life the more grief you avoid. You may have to suck things up and take a few steps back that you feel are above you to get where you initially wanted to. That includes applying to FM/IM programs to at the very least keep things moving in the right direction (as the alternative would be more gap years that become harder to justify)

Best of luck! I'm sure you'll achieve what you want!
Thank you very much! I really appreciate useful comments. I’ll try not to overcompensate. I was already stressing myself out that now I have to get a Step2 with a grade of 250+, but you’re right - stress will just make it worse. Thanks:)
 
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BacktotheBasics

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Thank you very much! I really appreciate useful comments. I’ll try not to overcompensate. I was already stressing myself out that now I have to get a Step2 with a grade of 250+, but you’re right - stress will just make it worse. Thanks:)
Be kind to yourself :) It's the secret to resilience.
 
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