Depressed and Dismisseed

[8215]

I was attending a US medical school until I ended up experiencing a severe case of major depressive disorder that led me to take two years off between my third and fourth year in medical school. In my fourth year, I ended up relapsing and experiencing major depression again at which point my school decided to academically dismiss me because I was unable to sit for the USMLE Step 2 CK examination within the period of time that was set. I was not successful at appealing the school's decision to dismiss me.
I managed to get accepted into a Caribbean medical school because I would very much like to continue on and become a physician. I am interested in pursuing Internal Medicine and would like to know how I should go about explaining my situation to residency programs. Any advise would be greatly appreciated.

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[Robotman]

I don't imagine this ending well for you.

 

[sinombre]

Has anything changed? Do you have any reason to believe that you won't experience another episode of severe depression?

 

[8215]

Would it be easier for me to not disclose the depression to begin with and state that I was going through some tough times and had to take time off?

 

[8215]

And that the reason for the dismissal was because I was unable to meet the requirements of my medical school?

 

[sinombre]

You probably shouldn't do anything medicine-related unless you're fairly certain that your depression is under control and this won't happen again. What if the same thing happens again and you're another 200k in the hole? What if it happens during residency or beyond when you're actually responsible for patients?

 

[8215]

I saw several psychiatrists and finally saw one that put me on the right medications. My depression is very well controlled and I've been feeling much better. It just took some time to find the right meds to be on.

 

[sinombre]

I saw several psychiatrists and finally saw one that put me on the right medications. My depression is very well controlled and I've been feeling much better. It just took some time to find the right meds to be on.

Glad to hear that. Going Caribbean in your situation (or really in any situation) is a huge gamble, as I'm sure you know. The downside of spending the time and money going this route could financially ruin you. What would you do if 4 years from now you are another $200k-ish (plus interest) in debt and are unable to match? That is a very real possibility, and something you need to consider before you make a decision.

 

[8215]

I am going to a school that was willing to take all my credits. So I will only have $10k in additional debt. I have one more semester to complete.

 

[Robotman]

I am going to a school that was willing to take all my credits. So I will only have $10k in additional debt. I have one more semester to complete.

Oh in that case, hmm, is it a top 4 carib school, I can't imagine SGU or AUC taking the transfer because they have a strict no transfer policy, but seriously is it top 4 carib so I know what to tell you next?

 

[8215]

No it's not a top 4 school. It's one of the smaller ones. I wasn't sure if doing a year of research and taking Steps 2/3 before matching would help me out.

Also, I ended up having a lot of family trouble during that period of time which is why I took some time off. My father was reentering the picture and as a victim of domestic abuse, I wouldn't handle anything at that time because it brought out a lot of PTSD type of symptoms.

 

[Robotman]

No it's not a top 4 school. It's one of the smaller ones. I wasn't sure if doing a year of research and taking Steps 2/3 before matching would help me out.

Also, I ended up having a lot of family trouble during that period of time which is why I took some time off. My father was reentering the picture and as a victim of domestic abuse, I wouldn't handle anything at that time because it brought out a lot of PTSD type of symptoms.

You already have too much time lost and they will ask about it. Taking a year of research now would probably only harm you at this point. You're gonna have to practice on how to spin your story and talking about this smorgasbord of depression, domestic abuse and PTSD is not what you want to be spilling during an interview. Interview is how they determine if they want to work with you, and working with someone damaged with tons of baggage is not something anyone wants to work with.

 

[sinombre]

I think your biggest problem is going to be providing some kind of proof to PD's that this won't happen again. A year of research definitely won't accomplish that.

 

[8215]

Yeah it's actually much easier not to mention the problems. It actually makes me feel a whole lot better not even thinking about them. Thanks for your help!

 

[8215]

I think doing as well as I can in Step 2 CK might help?

 

[sinombre]

I think doing as well as I can in Step 2 CK might help?

Again, grades aren't really the issue here, the issue is proving that you're not going to have some kind of relapse and have to quit at some point during residency.

 

[8215]

Any way in which I can do this? Would it be helpful to mentioned that the medications I am taking are a lot stronger and more potent than what I was taking before? I started taking a medication that just made it onto the market and is supposed to help for treatment-refractory depression.

 

[sinombre]

I'm assuming rotations + LORs are the only way to potentially help your situation, as this is the only way you can really "prove" your reliability...

 

[8215]

I have some pretty strong clinical letters from my past med school. Hopefully those will help. I did really well during my third year before all these problems started. I also did well during fourth year on rotations before I ended up having to take time off.

 

[demayette]

@8215 Will you be able to continue were you left off or do you have to start over again?

Edit: You already answered my question... For only 10k, I think it's worth it....

 

[Robotman]

@8215 Will you be able to continue were you left off or do you have to start over again?

Edit: You already answered my question... For only 10k, I think it's worth it....

Ya for 10k its definitely worth a shot.

 

[jakeislove]

I'd avoid any place that wasn't among the big 4.

Additionally, be 100% sure your aggregate student loan debt will not exceed underwriting guidelines for whatever loan program the school has access to. "100%" sure means calling the student loan company yourself and asking.

 

[Smurfette]

With a US med school dismissal on your record and 2 year LOA before the dismissal, this will make things far more difficult than the average caribbean grad to get a residency in the US. You will have to disclose this in your apps. The vast majority of programs will not consider you with a dismissal, to be honest, so you need to be willing to go anywhere. Are you going to be able to complete all USMLE steps within 7 years? This is another issue due to licensure requirements. You also need current LORs.

Use your PS to explain what happened (you don't need to go into detail, but can say medical issues resulted in dismissal, and these issues are now controlled and no longer a problem) and be honest if you do get any interviews; if you seem to be hiding something or less-than-forthcoming, this will not help you.

 

[brosef]

You would have to be willing to go anywhere and face the possibility of doing a prelim year + reapply again. For 10k, I would do it. If I were a PD, I would be wary of you.

But I did have a friend busted for selling cocaine and still got a radiology spot. The dudes the a genius otherwise though. Guess anything is possible.

 

[jdh71]

I was attending a US medical school until I ended up experiencing a severe case of major depressive disorder that led me to take two years off between my third and fourth year in medical school. In my fourth year, I ended up relapsing and experiencing major depression again at which point my school decided to academically dismiss me because I was unable to sit for the USMLE Step 2 CK examination within the period of time that was set. I was not successful at appealing the school's decision to dismiss me.
I managed to get accepted into a Caribbean medical school because I would very much like to continue on and become a physician. I am interested in pursuing Internal Medicine and would like to know how I should go about explaining my situation to residency programs. Any advise would be greatly appreciated.

I'd try telling your story, basically the same way you told it here.

This is what happened. This what I did. This is what I'm doing now. And finally, here is why I don't think it will be a problem again.

Someone will probably take a chance.

 

[Doctor Bob]

My math may be a little off, but... if I calculated it right your odds are... well... bad.

So, it's 2014 now. Based on previous threads your dismissal issues occured in 2012, making the 2011-2012 year your 4th. So 2009-2011 would be the 2 year gap you had between 3rd and 4th year. That would then make 2008-2009 your third year. Assuming you're like most med students you took Step 1 in summer of 2008. So that's the start of your 7 year USMLE clock. Which means it ends summer of 2015. And based on your above posts you haven't even finished step 2.

I don't see you taking step 2, and finishing a semester of school, and taking step 3 in the next ~9 months.

 

[Psyche Estrelle]

This is more of a message for people thinking of taking a leave of absence due to mental illness. As someone who also suffers major depression, panic disorder, and PTSD, the only (not very warm) advice I can give is that, whether people tell this to your face or not, the medical field is extremely unforgiving of mental illness in physicians. Never mind that it's extremely common, not to mention counter-intuitive for a healing field to be callous. The truth is that no one wants to hear about it, and that is something you have to accept if you want to forge ahead.

First and foremost, you have to do what is right for yourself and for your safety of course. But second, if you aren't imminently going to commit suicide, I highly recommend that you keep fighting and do whatever you can to never take another leave of absence. See three different psychiatrists, get acupuncture, exercise like crazy, do whatever it takes. As it is, for nearly every JOB (let alone residency spot) I've applied for, every application always requested disclosure and full explanation any leave of absence I might have had, and I can assure you that if I ever put depression as my reason, my application would automatically be red flagged. In fact, I've always had to sign a contract affirming that I have no "physical or mental condition" that might impair me from coming to work every day. For every future application you have to do everything you can to make yourself look as superhuman as possible... just don't draw attention to the depression.

Residency was hell for me, but I knew that if I took an extended leave of absence, my career ran a very real risk of being in jeopardy. Every year until you graduate from residency, your entire life and career is the complete mercy of people who may or may not give a crap about you. For those thinking about "taking a break," I highly recommend continuing to fight and not taking a chance. If you think that your life may be in danger (to suicide) if you continue to move forward, I would recommend reconsidering your career choice, because I can assure you it isn't going to get easier even if you graduate from residency. You will still have to contend on a daily basis with rampant unethical practices, callous douchebags, demanding and thankless patients, PTSD triggers, and many other depressing things. Please think long and hard about that.

 

[jakeislove]

I wish more people were as honest as Psyche Estrelle on this topic.

 

[8215]

So do you think it is easier for me to explain things without the depression? In addition to the depression which resulted because of everything else, I was in an MBA program during a time which I had some serious family problems ( which I neglected to mention ), but they are what they are and I couldn't complete that year. I had also developed a severe case of mono that year. My medical school recommended that I take a 1 year LOA. After that I started fourth year which ended up find in the beginning, but I was unable to complete the fourth year requirements due to sickness which was due to chronic fatigue syndrome as a result of the mono that I had. All this caused me to be fairly depressed. I've never been unable to do things before. You'd be depressed as well if you can't move.

 

[tdram]

So do you think it is easier for me to explain things without the depression? In addition to the depression which resulted because of everything else, I was in an MBA program during a time which I had some serious family problems ( which I neglected to mention ), but they are what they are and I couldn't complete that year. I had also developed a severe case of mono that year. My medical school recommended that I take a 1 year LOA. After that I started fourth year which ended up find in the beginning, but I was unable to complete the fourth year requirements due to sickness which was due to chronic fatigue syndrome as a result of the mono that I had. All this caused me to be fairly depressed. I've never been unable to do things before. You'd be depressed as well if you can't move.

I hope this doesn't sound mean, but honestly with all these issues, maybe trying to continue in medical school isn't the best idea. Have you thought about anything else you can do?

 

[Psyche Estrelle]

So do you think it is easier for me to explain things without the depression? In addition to the depression which resulted because of everything else, I was in an MBA program during a time which I had some serious family problems ( which I neglected to mention ), but they are what they are and I couldn't complete that year. I had also developed a severe case of mono that year. My medical school recommended that I take a 1 year LOA. After that I started fourth year which ended up find in the beginning, but I was unable to complete the fourth year requirements due to sickness which was due to chronic fatigue syndrome as a result of the mono that I had. All this caused me to be fairly depressed. I've never been unable to do things before. You'd be depressed as well if you can't move.

Oh, I can assure you, I am no stranger to severe depression. I was briefly hospitalized for suicidal ideation after being raped by two male acquaintances near the beginning of my residency, so yeah, I have an idea what being depressed is like. I'm just trying to tell you that in my experience, admissions committees/program directors/employers don't want to hear excuses. They just don't. Comments like "You'd be depressed as well if you can't move" will not help you in any way. I have no doubt that the conditions you suffered were completely debilitating, but I promise you that they definitely won't care to hear about the mono, the chronic fatigue syndrome, nor the family problems. The explanations you give will have to put a heroic spin on the reasons why you took so much time off. It's not within the realm of impossibility but it will be an uphill battle you have to be prepared and ready for.

 

[8215]

Sorry to hear what you've been through. That's really hard.

I guess at the end of the day, it's just easier to say that I had to quit my MBA program, take some time off and then was dismissed because I couldn't fulfill requirements because I was unwell. I think at the end of the day, it was a hard experience to go through because no one wants anything to interfere with their medical career. It's a joy to be getting up each morning and taking care of patients.

 

[Psyche Estrelle]

Sorry to hear what you've been through. That's really hard.

I guess at the end of the day, it's just easier to say that I had to quit my MBA program, take some time off and then was dismissed because I couldn't fulfill requirements because I was unwell. I think at the end of the day, it was a hard experience to go through because no one wants anything to interfere with their medical career. It's a joy to be getting up each morning and taking care of patients.

Thank you for your consideration. I think genuine statements like your last sentence will get you farther than any comments that highlight your suffering. People unfairly expect doctors to be completely selfless.

 

[jakeislove]

Thank you for your consideration. I think genuine statements like your last sentence will get you farther than any comments that highlight your suffering. People unfairly expect doctors to be completely selfless.

Our culture places a high value on stoicism and is wary of residents with personal issues (depression, divorce, pregnancy*, illness, etc...) could create extra work.

I feel OP has to communicate what's been learned from the experience, how that knowledge can help patients and be a benefit to a particular program. They'd also have to pretty much convince someone of having better insight on when to get help and having the proper tools to deal with depression in a way that won't require a LOA during residency or other team members covering.

* Touchy subject (I know) but no one really wants to do more work during residency.

 

[DokterMom]

My instinct would have been that factual honesty would play better than evasiveness, but @Psyche Estrelle personal experience is a much more reliable indicator of how things really play out in the real world.

Just in case though (and @Psyche Estrelle - Would you weigh in on this please?) -- I'd think it might be wise to have a 60-second 'sound bite' prepared that basically states what the core problems were (leading with the physical, then family, and finally the mental issues resulting from the previous), how you handled them, that you did really well before experiencing the problems, how you have done well now for ___ years, and how you are now confident that those issues are successfully conquered and behind you, and that your commitment to medicine has never wavered.

Pull it out only if necessary, and if then, 'sandwich' that very brief statement in stoic prose about how legitimately demanding a medical career is and how you're up to the challenge. How their concerns are reasonable and that you appreciate the opportunity to address them head-on and lay their fears to rest. That you don't want to lay on a sob story, because everyone faces challenges, but you also don't want to be evasive in the face of legitimate concerns. So in a nutshell, the situation was ----- above ----- Then that you wanted them to be able to know that you have fully addressed and overcome the difficulties that you faced and they can now be confident that these issues are fully behind you.

 

[jdh71]

My instinct would have been that factual honesty would play better than evasiveness, but @Psyche Estrelle personal experience is a much more reliable indicator of how things really play out in the real world.

Just in case though (and @Psyche Estrelle - Would you weigh in on this please?) -- I'd think it might be wise to have a 60-second 'sound bite' prepared that basically states what the core problems were (leading with the physical, then family, and finally the mental issues resulting from the previous), how you handled them, that you did really well before experiencing the problems, how you have done well now for ___ years, and how you are now confident that those issues are successfully conquered and behind you, and that your commitment to medicine has never wavered.

Pull it out only if necessary, and if then, 'sandwich' that very brief statement in stoic prose about how legitimately demanding a medical career is and how you're up to the challenge. How their concerns are reasonable and that you appreciate the opportunity to address them head-on and lay their fears to rest. That you don't want to lay on a sob story, because everyone faces challenges, but you also don't want to be evasive in the face of legitimate concerns. So in a nutshell, the situation was ----- above ----- Then that you wanted them to be able to know that you have fully addressed and overcome the difficulties that you faced and they can now be confident that these issues are fully behind you.

Yup. NEVER get into the hoary war story details. The details will horrify almost anyone who is a PD, state board member, or credentialing committee member.

Just the basic facts. Why it won't happen again.

 

[Shjanzey]

You are not going to match. I just don't see it happening.

 

[Robotman]

You are not going to match. I just don't see it happening.

Status: Pre-medical

 

[Shjanzey]

Status: Pre-medical

I live for moments like this. I haven't updated my status, but thank you for judging and dismissing me. I also know that this person is not going to match. They are at the very end of a long long line. Behind all the US allopathic grads, behind all the DO grads who got competitive step scores, behind all the impressive IMG applicants, and yes even behind his peers from the same carribean med school that managed to do decent on Step 1. This person has to live with the stigma of getting dismissed from a US school. You can't just walk away from that.

Take your weak "pre-med" one liner and try again.

 

[Robotman]

regurgitation

You have not even come close to feeling the sweat of an attending falling on your back, the humiliation of public embarrassment, the long journeys to interview with lunches and dinners where you have to pretend to be normal. What you failed to regurgitate is that academic performance gets you the interview, the interview gets you the job. So to give an affirmative decision based on your premonitions is ridiculous and only what someone like you would say:

Status: Pre-medical

When you get to MS-3/4; then feel free to give your advice. But until then, please go out and give Pre-meds your MCAT advice.

 

[Shjanzey]

You have not even come close to feeling the sweat of an attending falling on your back, the humiliation of public embarrassment, the long journeys to interview with lunches and dinners where you have to pretend to be normal. What you failed to regurgitate is that academic performance gets you the interview, the interview gets you the job. So to give an affirmative decision based on your premonitions is ridiculous and only what someone like you would say:

Status: Pre-medical

When you get to MS-3/4; then feel free to give your advice. But until then, please go out and give Pre-meds your MCAT advice.

I have the wonderful experience of having a career behind me, of directing teams and working in the real world. I have had the great experience of teammates and managers taking credit for my work, while at the same time passing the blame to me whenever anything goes wrong. I wish an attending would come down on me. Public humiliation pales in comparison to an incompetent slackard getting reward for your hard work. If you consider these things difficult moments in life, then you have a lot yet to experience.

I have the luxury of being married to a very competitive IMG who has struggled to match residency. Watching her get passed up by AMG whose performance was not as good was frustrating. Finding ways to overcome this barrier was very instructive and taught me very valuable lessons on how to approach residency. What you mention above only works in an ideal world where everything is fair and the ideal of redemption is held by everyone in a position to grant you a residency. The harsh reality is that academic performance only opens the door. Your performance during the interview, your efforts to network, the time you have spent during your summer breaks improving your CV. Those are the things that will make you or break you, because it is not just you who is being evaluated. The program directors are taking your file and putting it up against 100s of other very ambitious, qualified applicants. The naivety of your post is amazing.

The only think you have in favor of your argument is this tiny pedastal where I have not reached some arbitrary Medical School level, as if this is some kind of RPG, where I am now qualified to have an understanding of how the world works. I have walked this road already, so I don't need your sage advice. Thank you oh wise whatever-year-you-are for looking down your nose at me.

 

[Robotman]

I have the wonderful experience of having a career behind me, of directing teams and working in the real world. I have had the great experience of teammates and managers taking credit for my work, while at the same time passing the blame to me whenever anything goes wrong. I wish an attending would come down on me. Public humiliation pales in comparison to an incompetent slackard getting reward for your hard work. If you consider these things difficult moments in life, then you have a lot yet to experience.

Happens on rotations, especially if the resident/attending is attracted to the slackard. You haven't experienced it yet in something such as medicine.

What you mention above only works in an ideal world where everything is fair and the ideal of redemption is held by everyone in a position to grant you a residency. The harsh reality is that academic performance only opens the door. Your performance during the interview, your efforts to network, the time you have spent during your summer breaks improving your CV. Those are the things that will make you or break you, because it is not just you who is being evaluated. The program directors are taking your file and putting it up against 100s of other very ambitious, qualified applicants. The naivety of your post is amazing.

This is what I've said/alluded to in my post, your reading comprehension is what amazes me.

The only think you have in favor of your argument is this tiny pedastal where I have not reached some arbitrary Medical School level, as if this is some kind of RPG, where I am now qualified to have an understanding of how the world works. I have walked this road already, so I don't need your sage advice. Thank you oh wise whatever-year-you-are for looking down your nose at me.

You're welcome.

 

[Shjanzey]

Happens on rotations, especially if the resident/attending is attracted to the slackard. You haven't experienced it yet in something such as medicine.

Whatever dude. Getting yelled at by superiors is common in any workplace.

This is what I've said/alluded to in my post, your reading comprehension is what amazes me.

Yet you chose to ignore the fact the OP was dismissed from US school. Grades + interview aren't going to overcome that. This person needs to network like crazy, and I would even suggest researching at the institute of interest so that they get first hand experience that OP isn't a screw-up.

You're welcome.

 

[Robotman]

Whatever dude. Getting yelled at by superiors is common in any workplace.



Yet you chose to ignore the fact the OP was dismissed from US school. Grades + interview aren't going to overcome that. This person needs to network like crazy, and I would even suggest researching at the institute of interest so that they get first hand experience that OP isn't a screw-up.

Why didn't you say this and only when I called you out? Why did you just want to troll? Like I said before, just regurgitating information.

Status: Pre-medical

 

[Shjanzey]

Why didn't you say this and only when I called you out? Why did you just want to troll? Like I said before, just regurgitating information.

Status: Pre-medical

I am post-test and have free time for once. Couldn't think of anything better to do than wind up a few of my peers

 

[Robotman]

I am post-test and have free time for once. Couldn't think of anything better to do than wind up a few of my peers

And the jokes on you, I'm an MS-2 at Top 4 caribbean. Thanks for showing your cards before I did.

 

[Psai]

I live for moments like this. I haven't updated my status, but thank you for judging and dismissing me. I also know that this person is not going to match. They are at the very end of a long long line. Behind all the US allopathic grads, behind all the DO grads who got competitive step scores, behind all the impressive IMG applicants, and yes even behind his peers from the same carribean med school that managed to do decent on Step 1. This person has to live with the stigma of getting dismissed from a US school. You can't just walk away from that.

Take your weak "pre-med" one liner and try again.

Lol at a med student who gets off by telling people off for calling him a premed when he didn't take two seconds to change his status. Imgs from the Caribbean are not impressive by default because if they were impressive they wouldn't be from the Caribbean

 

[Shjanzey]

And the jokes on you, I'm an MS-2 at Top 4 caribbean. Thanks for showing your cards before I did.

Sweet, no competition from you then.

Lol at a med student who gets off by telling people off for calling him a premed when he didn't take two seconds to change his status. Imgs from the Caribbean are not impressive by default because if they were impressive they wouldn't be from the Caribbean

I deliberately didn't change my status, because I love it when people only have "pre-med" to use as a criticism. It makes my day. I will keep it as pre-med into residency.

 

[SouthernSurgeon]

I deliberately didn't change my status, because I love it when people only have "pre-med" to use as a criticism. It makes my day. I will keep it as pre-med into residency.

That's pretty lame.

 

[Shjanzey]

That's pretty lame.

Why?