Clerkship Delays

[dr.pepper1992]

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I have to take extra time to study for a Step 1 retake, and because of that I’m now falling behind the standard clerkship schedule. My school has a policy that students “can’t be more than one clerkship behind” or they get pulled from rotations and have to restart with the next class. I'm so frustrated with myself for failing marginally and letting personal issues get in the way of my future.

I’ve explained to my school my situation and asked student affairs multiple times why this policy exists. They won’t give me any academic or logistical reason for it and just say there are "lots of reasons". I’ve already mapped out a workable schedule where I would miss two 8‑week clerkships now, then make them up during M4 using the built‑in flex time + non‑clinical elective time (which together equal 16 weeks). The curriculum has enough time to make up the missed rotations without delaying graduation. If I were to make up the missed rotations I would be done with core clerkships by end of July next year, which leaves time to study/take Step 2 and complete ERAS.

I’ve tried to explain this, but student affairs won’t engage with the actual scheduling plan or explain why it’s not allowed. They just say “policy is policy.”

Has anyone dealt with something like this?

How do you advocate for yourself when the school won’t give a rationale?

Is there a way to push for an exception?

 

[psychclerkshipdirector]

I am a psychiatry clerkship director with 25 years of clinical experience as a psychiatrist and a medical educator. First, I can see why you are frustrated. You mentioned that part of your frustration is with letting your personal issues get in the way of your future. I want to give you perspective from personal experience as well as from experience with medical students. In your career as a physician, life will happen: family emergencies, physical illness, mental health crises, etc. If personal issues are difficulties in life, this is a sign that they must be addressed. "Sucking it up" and going forward without dealing with these issues is not sustainable. They will only come up again and again and potentially prevent you from becoming the best physician that you can be for your patients. Your personal issues are not a failure-- they are a means of introspection to allow you to look at aspects of yourself that need growth. Whatever your issues are, I highly recommend seeking professional assistance with them, if you haven't done so already. As for the frustration of falling behind-- yes, it is frustrating to look at the prospect of no graduating with your class and starting residency when you wanted. But remember-- you are going to be a physician for the rest of your life. Medical education has instilled the belief that time in school equals competency. It does not, and this is the premise of competency based medical education. Individuals master tasks at different rates. The focus is to become a competent and compassionate physician for the benefit of your patients. If it takes you little longer to do that, that's OK. Ask yourself where you mental energy is best spent-- trying to get an exception to the school's policy, or focusing on your clinical rotations? As far as reasons why your school isn't giving you concrete answers for their policy, I really can't say without speaking with someone from student affairs, but perhaps your school has a policy regarding how many hours a student can miss in an academic year.

 

[GoSpursGo]

Moving to med students.

I agree with @psychclerkshipdirector . There likely are reasons the policy exists, and even if you don't understand them you aren't going to win that fight. Focus on what you can control, which is ensuring you pass your step 1 retake, and if you feel you need to then drop down the the class below you. Your number one priority needs to be avoiding failing out of med school

 

[Hollow Knight]

I had some personal stuff go on in medical school, details aren't important. I toughed it out and passed everything, but it was way more stressful than it needed to be. In retrospect I probably would have benefited from an extra year to exercise/go to therapy/etc and study for boards at the same time while purging the negative emotions.

All that to say, it sounds like this "policy" isn't the end of the world, and it seems like you can't change it anyway. Nothing wrong with talking to your school, but like the lovely psychiatrist said above, I'd focus on becoming the healthiest version of yourself possible.

I had some peers take an extra year like you're being made to do (for divorces, family with terminal illness, or whatever), and guess what, they will become attendings a year after me and get paid the same as I will. Ultimately it will all work out if you focus on taking care of yourself and studying properly. And asking for help.

 

[Starr_key]

A few reasons:

1. Time. They don't want to put in extra effort to accommodate you, they have 60-100+ students they need to schedule first. Much easier to put students who need extra time with the next class and do it all at once. You're also likely not the only one in this situation, so once again easier to group you guys in a bigger group than accommodate you all separately.

2. Space. The clinical spaces need to be able to accommodate you at that time. Also going hand in hand with time, they're not gonna email those spaces to work around your schedule. Space is limited.

3. Extra money. Extra year means extra year of tuition.

4. Discourage students from taking an exceptionally long time for retake. They want you to pass, but pass within a reasonable time frame. The pass rate for STEP1 the second time is exceptionally high, but they know students may get anxious and keep pushing off their test date if they have the option to.

Yes, you would be done with clerkships by end of July, but there's no predicting how long you will need for STEP2 dedicated. Starting with the next class gives you more time to prepare a stronger application and more time for STEP2 studying (which is more important than STEP1).

Much better to restart with the next class than rush everything, realize you need more time for STEP2 and then pull your ERAS app or not match.

 

[NotAProgDirector]

They are very unlikely to give you an exception. If they do, then the policy is over for everyone. If they try to enforce it in the future, someone can point to you and claim (successfully) that they are being discriminated against.

In addition to all the reasons above, they may have had too many students rush to take the exam to stay on schedule and fail it again, and decided that it's better to create a break like this so you can take the time you need to succeed.

This is not the end of the world. Failing S1 again and getting dismissed from medical school would be the end of your medical career. So take the time you need, pass the exam, and start again per your school's policy.

 

[Redpancreas]

They are very unlikely to give you an exception. If they do, then the policy is over for everyone. If they try to enforce it in the future, someone can point to you and claim (successfully) that they are being discriminated against.

In addition to all the reasons above, they may have had too many students rush to take the exam to stay on schedule and fail it again, and decided that it's better to create a break like this so you can take the time you need to succeed.

This is not the end of the world. Failing S1 again and getting dismissed from medical school would be the end of your medical career. So take the time you need, pass the exam, and start again per your school's policy.

That’s administration’s unspoken reason, but assuming OP failed Step 1 but otherwise has a good record, it doesn’t make sense for him to automatically repeat a year which will be seen as two dings for the rest of his medical career. It would certainly be much more advantageous to have an isolated Step 1 failure than a repeated year as well.

 

[Starr_key]

I am a psychiatry clerkship director with 25 years of clinical experience as a psychiatrist and a medical educator. First, I can see why you are frustrated. You mentioned that part of your frustration is with letting your personal issues get in the way of your future. I want to give you perspective from personal experience as well as from experience with medical students. In your career as a physician, life will happen: family emergencies, physical illness, mental health crises, etc. If personal issues are difficulties in life, this is a sign that they must be addressed. "Sucking it up" and going forward without dealing with these issues is not sustainable. They will only come up again and again and potentially prevent you from becoming the best physician that you can be for your patients. Your personal issues are not a failure-- they are a means of introspection to allow you to look at aspects of yourself that need growth. Whatever your issues are, I highly recommend seeking professional assistance with them, if you haven't done so already. As for the frustration of falling behind-- yes, it is frustrating to look at the prospect of no graduating with your class and starting residency when you wanted. But remember-- you are going to be a physician for the rest of your life. Medical education has instilled the belief that time in school equals competency. It does not, and this is the premise of competency based medical education. Individuals master tasks at different rates. The focus is to become a competent and compassionate physician for the benefit of your patients. If it takes you little longer to do that, that's OK. Ask yourself where you mental energy is best spent-- trying to get an exception to the school's policy, or focusing on your clinical rotations? As far as reasons why your school isn't giving you concrete answers for their policy, I really can't say without speaking with someone from student affairs, but perhaps your school has a policy regarding how many hours a student can miss in an academic year.

I like this answer a lot! 🙂

 

[dr.pepper1992]

Why did you miss >2 months? If you failed, you would continue your current block and take the next block to study. Did you have to take more time off to study initially or have difficulty with a clerkship? If the answer is yes, I would not waste time. Them allowing you a fast track option is a disservice to you when you have already struggled. Repeating a year at this point wouldn’t be much more of a sting on your application than a failed Step & clerkship delay/fail if that makes sense.

Now, if you’re saying any failed Step 1 results in a delayed year that sounds like some BS to me. First, that’s statistically 10% of the class which seems like an atypical consequence to place on such a large part of the student body. Also, your application will be viewed as repeating a year and failing Step 1 which is only mitigated by an explanation in the personal statement assuming someone reads it carefully and again at interview stage if you’re invited. I would carefully draft a statement taking ownership of the failure, showcasing your otherwise lack of academic issues, and how this would disproportionately affect your career. If administration says they can’t make an exception, that’s not your problem, that’s their curricular flaw. Be polite, but persistent, and escalate the situation with humility.

So I took extended time during dedicated meaning we had an extra 8 weeks to prepare for the exam along with the 6 weeks already given to us. The extra 8 weeks were during the first rotation, so if I had passed I would've joined back during the 2nd rotation and made up the missed time at the end of 3rd year. I only used two weeks of the extra time because I thought I was ready. Obviously that was not the case. I'm planning on taking the exam at the end of this month as I would've had an extra 2 month to study at that point and. Given that information, I was hoping to join back during the third rotation and makeup the first missed two at the end of 3rd year. However, the school is making me take the entire year off even if I pass (*knock on wood*) before the next rotation begins. We have 34 weeks of clinical elective time/flex time/away time during M4 year that could easily be used to makeup the last remaining two rotations. I'm not trying to do a competitive specialty or go to a prestigious program (not that I could in the first place). I had planned to get letters from doctors I have been working with and who I will work with during M3 rotations. My last rotations would be IM and FM which would help me a lot with Step 2 studying and I'd start studying earlier on and take an easy/chill elective while studying for Step 2. I know the school will probably not take my word for it, but I haven't had any red flags thus far. I just would hate to take a year off to do research even though the speciality I'm interested in doesn't require a ton of research.