Was required to sign a "Memorandum of Understanding (MOU)" and put on probation after retaking several COMATs, failing COMLEX Level 2, and not passing an elective rotation. While about to attempt Level 2 for the third time (previous scores 395 and 370) recently, my school's Student Promotion Committee (SPC) met me as I unfortunately did not email a specific faculty member every 2 weeks, which is required by the MOU. As the document mentions that students failing to satisfy any of its stipulations is subject to voluntary withdrawal with no right to appeal, the SPC and Dean both agree that I should quit the DO program immediately.
Can't sugar coat this OP, at my school, 2x COMLEX failures would lead to dismissal. A 395 score is still failing. You not only failed to show content mastery, you didn't even show baseline competence.
In my 20+ years of being of being a faculty member, this is the first time I've heard of someone failing an elective.
Later I had appointments with some SPC members and the Dean individually to provide further explanations (e.g. that I remain regular communications with other faculty members, whom the person I should email recommended me to contact; that I was busy attending an in-person board prep program; mental problems, family issues, etc.), yet their decision remains unchanged.
Let me get this straight. You were supposed to be in regular email contact with a faculty member, and you blew that off? Or did you somehow forget?
And why were you expecting the school to contact you about the app'ts? This is a professionalism issue in and of itself, much less about not fulfilling the requirements of the MOU, which you violated.
The school offers a Master of Science in Medical Health Sciences program that starts in September and takes around 200 hours. Currently I am planning to secure a master degree first, and then hopefully transfer to another medical school. Any advice (e.g. schools where I could have some hope) would be sincerely appreciated.
What's the point of getting the MS degree? Is this an SMP? Or an honest-to-God research/thesis-driven MS? If the former, what's the point? You've already shown that you can handle the pro-clinicals, which is what SMPs are for. If the latter, it's a good springboard into a research career. Good techs or lab mgrs are hard to come by.
I can't see any US medical school accepting you as a transfer student with so many red flags. This is on top of the fact that transfers are rare. Very rare
Some sidenotes: 1. Per that MOU I should have already violated the stipulation about emailing in early January, though it seems that both SPC and Dean had neglected it until this month, despite having had several Zoom meetings with me in between.
But you did violate the MOU on this, correct? So what if the Deans didn't mention it. You already broke the terms of the MOU!
2. I fortunately did not fail any pre-clinical course with a GPA around 3.6 and obtained passing scores for Step 1 and 2 first time. The school still allowed me to take Level 2 and the score will be available in two weeks.
I suspect that a pass on the third try may not save you
3. So far I have not signed the withdrawal paperwork and I wonder if remaining my enrollment status as long as possible would be beneficial for transfer, though I have to do so in around a month according the SPC member I met.
You're looking at a dismissal now with this. I can see that you're in denial...you're in a rough place. But you have to move on with your life now. There's no transfer coming
4. That SPC member also clarified the anything related to the MOU would not show up on my transcript, whose unofficial version for some reason did not reveal that I failed rotation and was on probation. However, I am uncertain if the Dean would do a letter of good academic standing or mention anything related to probation or MOU incompliance in her writing.
I wouldn't put all my hopes on the bolded. And even if the Dean wrote that you "left in good standing" (which I can't see happening, because that would be out and out lying), I can guarantee you that any other med school in the US considering you would be calling your school to find out what really happened.
You mentioned mental health and family issues. Did these occur before all your troubles started? If so, why did you not take a LOA?
I respect your judgment if you believe I am sugar coating. I unpack the scores just in case anybody needs more information, otherwise I probably would not disclose the other 370. In a hindsight, I think scoring much lower than the first attempt after months of board study could support their decision to have me withdraw.
At the bottom of this message I present the corresponding preceptor's evaluation and my original appeal about the failed elective.
The MOU required me to contact a specific faculty member every two weeks. I forgot that stipulation and did not email her that often.
Probably I somehow miscommunicated again and I apolgize for that. I was trying to say between signning the MOU and receiving the decision I the SPC met me several times via Zoom and there is no mention of the "every two weeks" stipulation during any of the meetings, for which I never forget and were always punctual.
I am not sure how to categorize the master program, as my reply to NotAProgDirector says, the program is like a post-baccalaureate plus around 200 hours of research, for which students do need to do a paper and presentation. I am interested in the degree because if I end up returning to China and choose to continue my medical career there, a medicine-related master degree is definitely much better than a B.S. bioglogy one.
According to the SPC member I met if I did not do the paper in a month or two the school would automatically label me as "voluntarily withdrawn." I was delaying the withdrawal paperwork because enrolled students seem to have higher chance of transferring. If there is indeed zero likelihood of begging for mercy with a passing score or transfer, then it would not hurt too much to acknowledge that status.
As for carib schools, I am curious about how they would kick me out, by intentionally making me fail a rotation or something else?
To my perception the mental and family problems already exist before signing the MOU but significantly worsened afterwards. It could also at least partially be a mental thing why I forgot the "2 weeks" stipulation. Every time I read the MOU I feel ashamed and stigmatized. So later I chose to put it aside, thinking that as long as I end up passing level 2 things will get back on track. The false assumption was strengthened as SPC never contacted me for anything other than COMLEX, and one SPC member once said "If SPC do not reach you, you are doing fine. SPC only meet students when they did something wrong." Again I am not using those as excuses, but to reflect on how come I did not remember to do something that would has a decisive impact on my DO career. I did not do LOA because the MOU already placed me on probation, and according to a faculty member I cannot schedule any standardized test while on LOA. Plus the probation was like a LOA because I arranged my own schedule, as long as I do not spend more than 6 years in total as an enrolled student.
Copy of the evaluation of the preceptor who failed me.
I have precepted numerous trainees in various stages of their education. I am clinical faculty to physician assistants during their clinical years, precept medical students, residents at (program name) program as well as program name's HIV fellowship. (My name) did have some improvement during our month together, though I do have concerns he is below the level of what I would expect from a clinical 4th year medical student. I base this also on his fund of knowledge in comparison to the 2nd year PA students I precept and encourage (My name) to read more. I shared resources with him including MKSAP, UptoDate, USPSTF guidelines, American Thoracic Society handouts to support him and his learning. It is unfortunate he could not differentiate or recall H1 vs H2 blockers, and suggested cetirizine as a treatment for dyspepsia. I would also expect a fourth year medical student to have more of a plan for a routine check up beyond blood work. He was unable to articulate vaccines or age appropriate cancer screening such as cervical cancer screen etc which should been learned in your 3rd year. His presentation needs to be more succinct, and he needs to evolve from being a data gatherer to formulate a differential diagnosis and formulate an assessment and plan if he is to be a rising 4th year and soon to be intern.
Early in the rotation it was apparent that (My name) was fatigued or disengaged as it could be seen by his shifting about during the patient encounter. Additionally he fell asleep during one encounter where the patient was in fact a physician himself and we both stopped talking to stare at (My name) as he had his eyes closed with head propped on his hand leaning against the exam room sink. It was not only uncomfortable for (My name), but myself as well as he represents my alma mater. (My name) presented disheveled and sloppy to the rotation, with his white coat being several sizes too large and his hair consistently disheveled. I do give him praise as he shared he had lost 30 pounds which is not an easy feat, and credit for spending the weekend finding a white coat that fit him. He also did cut his hair during the rotation. I shared the importance to present professionally, not only for the fact that patients entrust their care to us, but also as you are under the scrutiny of attendings and future colleagues. I did allow him to optionally come to clinic in scrubs, or preferably alternating outfits--I do know finances can be difficult as a student. Unfortunately (My name) wore the same outfit of blue/white striped tie, pinstriped button up shirt and black pants during the entire 1 month rotation. Although patients would not know this to be the same outfit, it would certainly be noticed by residents and attendings on an audition rotation and would present poorly. (My name) also has the habit of cracking his knuckles very frequently against his own hands or on his face, even during patient encounters which is off putting. I commented upon this and he is actively trying to limit this distracting behavior.
In general, (My name)'s documentation is adequate and he did make improvements. Early in the rotation we had a patient with prior medical history of hypertension, hyperlipidemia, whose chief complaint was carpal tunnel. This was the predominant focus of our visit, though in review of (My name)'s documentation he only documented hypertension and hyperlipidemia as topics addressed. This was because I had dragged over these two diagnoses on our EMR but had yet to code for carpal tunnel. Although I had not yet had time to complete charting and code all diagnoses, I would expect an MS4 to be able to address in their note all topics discussed in the patient encounter--especially if carpal tunnel was the main crux of the visit. The situation where I do not have time to code all diagnoses in the EMR until the end of the day is common and other students have not omitted diagnoses in their note. I did bring this to (My name)'s attention and he did make improvements as accurate documentation in the clinical note is important not only for continued patient care but in the interest of the medical center for billing as well.
I do want (My name) to succeed. It is incredibly brave to see immigrants embarking to a foreign country where English is a second language. It is a story of my parents as well, and I want to see him do well. I hope these comments are not seen as overly harsh, but solely for the purpose of providing clear areas of improvement so that we may have more bilingual and culturally competent clinicians in our community.
Copy of my original email appealing the rotation failure.
I recently noted that Dr. L failed the internal medicine elective I did with him. Strongly disagreeing with the failing decision for reasons below, I have talked to Miss D during the virtual CED office hours this Tuesday regarding the matter (by the way, the Zoom links for office hours did not work for me yesterday and today). According to Miss D, a report would be submitted to the Dean and updates regarding the investigation would be available Wednesday. Yet I have not received any related emails. Thus, I am wondering if any CED faculty could please let me know whether any progress regarding the issue has been achieved at this point. Thanks very much and wish the CED team wonderful holidays. As a side note, I have not contacted Dr. L since noticing the failure and according to SPC I should not "chase after preceptors" negative comments on CPE. However, if by any chance Dr. L is willing to interact with me again to discuss his evaluations, I am more than happy to in any means he prefers, with or without the involvement of any (school name) faculty. Please also feel free to let Dr. L view whatever I put down here if he is interested.
Reasons why I think I should not have failed the elective:
1. Though Dr. L frequently shared with me his opinions about my performance regularly, he did not start working the CPE by the end of the last day of my elective with him. However, in the evaluation, he selected "Yes" for the question asking if he has reviewed the evaluation with me. Considering that Dr. L seemed very busy with both work and family during that last week. I am afraid that he might not have the energy to accurately, objectively, and comprehensively recall my strengths and weaknesses when deciding to fail me.
Also, I could clearly recollect that the cetirizine Dr. L referred to was not about dyspepsia but GERD. We were going over antihistamines for reflux management and then naming first vs second generation antihistamines. I could hear or remember it wrong but Dr. L might have said that cetirizine belongs to the first generation.
As for the age appropriate vaccine and screening, the context is that we were discussing the management plan for a middle-aged female presenting for an annual physical exam. I was saying “what about basic labs like CBC?” Dr. L then took over the conversation, listing the vaccines and screening exams in his mind. Had I been given more time to fully elaborate my thoughts or been asked more specific pertinent questions, I would have provided a more satisfying answer.
2. For more than one time Dr. L had asked me to self-evaluate, agreeing with me and reassuring me that I did fine overall when I made statements like "at least I think I have not failed this rotation."
3. Despite my relative weakness in medical knowledge, I still managed to pass all previous rotations, USMLE Step 1, COMLEX Level 1, and all COMATs. Even Dr. L himself mentioned he was impressed by my understanding of SSRIs, skin and eye pathologies, and HIV medical management. Another physician that Dr. L recommended me seeing on my last day of the elective verbally praised my recollection of the vaccine schedules for AIDs patients as well.
4. Throughout the 4 weeks Dr. L's feedback was more positive versus negative to my perception and never did he raise the forewarning that I should fail the elective for not perfectly satisfying his expectations.
5. I have made my best attempts to address the problems Dr. L pointed out in CPE, including but not limited to purchasing multiple white coats, cutting hair super short, and refraining from nodding my head and touching knuckles, which Dr. L himself appreciated verbally and literally in his evaluation.
6. Dr. L expressed in CPE and verbally that he wanted me to succeed and positively represents (school name) alumni and Asian immigrants. I truly value his comments but I am afraid that his determination to fail me may impact me more seriously than he might have anticipated. SPC has already reached out to me about dismissal after recognizing the failure and changed my rotation schedule. I am confronting the risk of not being able to graduate and moving forward to residency in time, and failing an elective of the specialty I am applying to could be a red flag for program directors. Additionally, I cannot help but spare time from preparing for board exams to work on this matter given concerns about its effects. Personally speaking, I think this failure has harmed me much more than it could benefit me in any ways I can imagine, and honestly now I feel the need to think carefully before choosing to do work with a (school name) alumni preceptor, worrying that I might end up unexpectedly failing the corresponding rotation.
