Big Decision

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I am a third year medical student and i got thru my first 2 years of medical school ok and then this year hit and i flunked surgery and hated it and now i am doing my first week of pediatrics and i hate the work--h and p's and admissions and progress notes and following patients and just keeping track of everything. Another thing i should mention is i failed surgery because of clinical skills and i was not in agreement with that but now i am beginning to think it might really be true that although i passed step 1 and have ok medical knowledge my clinical skills suck on top of me not enjoying the work. So I feel like i have 3 or 4 options: withdraw now, take a leave of absence and see how i feel in some months, or keep going and either graduate or flunk out; what do you think the best thing is for me to do? I dread having to do the work, i dont enjoy it, and i dread going in and i talked to an intern who feels that way; i can not see myself doing intern year let alone residency for 3 or more years. Another thing to consider is loans: 200,000 right now, and if i keep going and flunk and out later, it will just be more. And i don't might that much debt, i dont care a lot about money and feel like i would be happier poor with a less stressful job than financially ok in medical school. Any and all advice would be appreciated. Thanks.

Several thoughts:

The first thing to figure out is to make sure that there isn't some external problem here -- mostly, ensuring that you're not clinically depressed, not on drugs, and not distracted by some personal / external issue. It's hard to tell yourself if you're depressed, so you might want to consider being evaluated by your student health department to be sure.

You failed surgery. I'm assuming that when you say you failed it for clinical reasons, you mean that it wasn't just that you scored too low on a shelf exam. Although it's a complete guess, it's likely that you failed not because your clinical skills are poor, but simply that you didn't really try. Not putting effort in, or the appearance of trying to cut corners, is going to get you failed.

So, what next? I'm going to assume that you're not depressed. Well, you can certainly drop out. You say you hate doing H&P's, and hate following patients. There are some fields of medicine where you don't do those things -- most notably pathology and radiology. With a failure in surgery and a not stellar step 1 score, you can forget about radiology. So, before you drop out, I'd highly recommend doing a pathology rotation.

Pathology comes in several flavors:

Anatomic pathology -- doing autopies, and reading micro pathology slides (i.e. biopsy results). Note that most pathologists only do the slides once they finish training.

Clinical pathology -- this is lab based medicine, running a clinical lab. You're in charge of organizing all of the lab testing that a lab does.

Transfusion medicine -- this focuses on blood banking.


None have much patient contact (blood banking may require some patient contact, and you might need to read frozen sections while a patient is in the OR or having a biopsy done)

Most medical schools do not include a path rotation in their 3rd year clerks. But, if you're thinking of dropping out, they might let you do a 3rd year clerkship in path. If you liked it, then you'd need to find a way to "power through" the other clinical rotations and graduate, but perhaps with some sort of "end in sight" you'd be able to do so.

Dropping out is irreversible. And your student loans are not dischargable in bankruptcy (usually).

We'll see what others have to say.

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Several thoughts:

The first thing to figure out is to make sure that there isn't some external problem here -- mostly, ensuring that you're not clinically depressed, not on drugs, and not distracted by some personal / external issue. It's hard to tell yourself if you're depressed, so you might want to consider being evaluated by your student health department to be sure.

You failed surgery. I'm assuming that when you say you failed it for clinical reasons, you mean that it wasn't just that you scored too low on a shelf exam. Although it's a complete guess, it's likely that you failed not because your clinical skills are poor, but simply that you didn't really try. Not putting effort in, or the appearance of trying to cut corners, is going to get you failed.

So, what next? I'm going to assume that you're not depressed. Well, you can certainly drop out. You say you hate doing H&P's, and hate following patients. There are some fields of medicine where you don't do those things -- most notably pathology and radiology. With a failure in surgery and a not stellar step 1 score, you can forget about radiology. So, before you drop out, I'd highly recommend doing a pathology rotation.

Pathology comes in several flavors:

Anatomic pathology -- doing autopies, and reading micro pathology slides (i.e. biopsy results). Note that most pathologists only do the slides once they finish training.

Clinical pathology -- this is lab based medicine, running a clinical lab. You're in charge of organizing all of the lab testing that a lab does.

Transfusion medicine -- this focuses on blood banking.


None have much patient contact (blood banking may require some patient contact, and you might need to read frozen sections while a patient is in the OR or having a biopsy done)

Most medical schools do not include a path rotation in their 3rd year clerks. But, if you're thinking of dropping out, they might let you do a 3rd year clerkship in path. If you liked it, then you'd need to find a way to "power through" the other clinical rotations and graduate, but perhaps with some sort of "end in sight" you'd be able to do so.

Dropping out is irreversible. And your student loans are not dischargable in bankruptcy (usually).

We'll see what others have to say.
Suggest asking for a LOA to see if Medicine is truely the thing for you. It's better to get out now than accrue another two years worth of tuition.
It's NOT a crime or personal failing to determine that this career path isn't the one that truely best for you.
Talk this over with all of the people you trust, especially those who will not tell you the things you want to hear.
Just a thought...perhaps hospital administration, teaching, or research might be the path to take if you decide to stick it out, but still don't want to touch patients.
 
I have a few suggestions/thoughts on this.

First, if you haven't done this yet, sit down with an experienced faculty member and discuss this. This doesn't have to be a dean, and maybe shouldn't be, but find someone who you can discuss this with. I'm not sure a LOA is what is needed here, but your story and feelings need to be fully discussed 1:1 with someone at the faculty level.

Second, keep in mind that even beyond path, being an MS3 is not what being an attending is. Do you like patient care? Do you hate the rounds, etc but not the people? There are a lot of options.

Finally, if you can tolerate it, but just don't see a career in patient care, then you might try to finish school. Doing so opens a lot of options to your career that being a med student dropout doesn't. They aren't ideal, but something.

Also, you might just find the ideal field for you as you move along your rotations that isn't obvious at the moment (e.g. rads, path, anesthesiology, EM), etc. You'll need to put the effort into it though.

If you really don't like what you are doing, then of course you should stop sooner rather than later, but consider this carefully as once you quit, it's almost impossible to come back. A LOA would be best in that case.
 
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