I will contact them ASAP--but Monday would be preferable to tomorrow because it gives me the weekend to think about what I'll say.
I would suggest:
Dear [insert name of psychiatry program coordinator],
I am very happy to have matched to your program. However, recently I became aware that I did not pass Step 2 CK and therefore must re-schedule to take this examination. I was wondering what effect, if any, this would have on my intern rotations.
Sincerely,
Folieatrois
You gotta get the ball rolling on this. It doesn't really matter *what* you say, the PD isn't going to care if you promise to study real hard either, they have a policy for what to do in this case, and it won't be tailored to your situation likely as this happens a lot. They will either tell you:
1. We can't hire you, sorry, we require our interns to have passed Step 2 CK, we wish you success in your new life.
2. You have to pass it in three months or we won't keep you on as a resident.
3. You have to pass it by the end of intern year.
4. Pass it when you like, i.e. in the next three years and tell us how it went! (Just kidding, some gallows humor).
They want to know and how you break it to them won't matter. But when you do will. The program coordinator, probably not the PD even, will be able to tell your their policy, probably by the end of tomorrow and you can relax easy if it is good info. If not, then you have the weekend to recharge and plan on re-applying OR perhaps registering ASAP to take it again. You are wasting time worrying more on the weekend which is what you are doing.
I don't think it makes sense to say that your PD will be worrying that you won't be learning psych during internship if studying for Step 2. . . The learning in internship is more hands on and active learning, and psychiatry takes a lot of time learning which patients are a danger to themselves and some of the more finer aspects of patient care, i.e. it is stuff you don't learn in a textbook. Most of the important stuff you will learn in internship for psychiatry is more medicine, there are a lot of medical disorders that may present psychiatrically so studying and doing well on Step 2 is very important for psychiatry in general and they want you to known medicine very well to be a good psychiatrist.
There was one patient I saw on psych who had the classic signs of Wilson's disease, Kayse
r-Fleischer rings, and had been misdiagnosed as having schizophrenia for years, very sad. If you don't have medicine down well your psychiatry PD will note this and this would hurt you in a psychiatry program, as he/she will want you to be very familiar with general medical conditions and neuropsychiatric conditions as well. Ironically, psychiatrists get only a small amount of medicine training, but it is very crucial to be a good psychiatrist to also be a good internist as well. Your fund of knowledge problem, if there is a problem, will hurt you more in pscyhiatry in a way as IM residents get three years to learn the stuff and you really need to know if from the get-go.
Remember that the stuff you will need to manage well in residency as a psychiatrist are often very medically related problems that could result in a lawsuit if not done properly, such as recognizing neurolpetic malignant syndrome, caring for patients who are detoxing or on various illicit drugs, etc . . . and you will need to function well on medicine rotations in internship such as MICU rotations. I have seen a psychiatry resident who was terminated due to failure to perform well on such a rotation in internship, NOT for not being able to "talk to" psych patients. Your most valuable assets to a program director in a psychiatry residency are having good inpatient psych skills AND excellent fund of knowledge in medicine, not your personality or how well you related to patients.