Didn't Match, Now what

[AnesNavy]

So I have a few questions that I've been pondering these past few weeks. Yeah, I'm a bit late, but I thought I had a good plan but now I'm starting to doubt myself. Here's my situation. I'm a citizen and a U.S. grad. I applied for Anesthesiology and some Prelim and Transitional programs. I got 13 anes interviews, 2 prelim, and 1 transitional. Mind you, I applied to over 80 programs. Here's why:

Step 1: 203
Step 2 CK: 226
Step 2 CS: PASS

In addition to my low Step 1 score, my application was tainted with a failing NMBE Internal Medicine Board exam (passed on 2nd attempt), a failed OSCE (remediated and put in my Dean's letter), and an unprofessionalism (which was put in my Dean's letter).

Whew! Now, here's the thing....I think I was able to get those interviews because they had not viewed my Dean's letter yet. This time around, I'm not sure, maybe they will be able to see my Dean's letter before they offer me an interview. So basically, my interviews were spent discussing all the blemishes in my record. Needless to say, I didn't Match. I was lucky enough to Scramble into a Prelim Surgery position.

There's not much you can do to beef up your application in a few months, especially in my situation. My plan was to take Step 3 early and do my best as an intern and apply again inside and outside the Match for Anesthesiology. I don't want to put too much info on here, but I did a lot of anesthesia rotations (home and away), founded an interest group in anesthesia at my med school, and attended national conferences. I have been sitting in on cases since college and had an Anesthesiologist as my mentor. Basically, I only considered anesthesiology and nothing else. Now, I'm starting to feel like there's no hope for me and I should look elsewhere.

Any advice, whether good or bad is appreciated. Thanks in advance!

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[NotAProgDirector]

You are probably correct. You passed their initial filters -- USMLE scores, grades, etc. The problems -- a failed OSCE and the unprofessionalism incident -- only show up in the dean's letter. At that point, most programs will simply let you come and interview you, and then either not rank you or you end up near the bottom of the list. Since Dean's letters are release Nov 1st, any interview offers before that were without dean's letters.

So:

1. Next year, the same rules apply. Dean's letters are released on Nov 1st. Programs that interviewed you this year may or may not choose to do so again.

2. You may have some serious trouble getting time to interview during your prelim surgery year. Do you have vacation time during Nov-Jan? Many programs will not let you take time from your rotations (like you can in medical school).

3. The most important thing to add to your application is a letter from your PD saying that you are doing a great job. You'll want this letter by the end of Sept, so it will only include the first three months.

4. Step 3 is unlikely to help. If very high, then maybe. If low, then doom. When are you planning on taking Step 3? Your prelim surg program is unlikely to give you time to take it.

5. You need a plan B. Don't give up on anesthesia, but you need a backup plan.

The number of red flags in your application are a real problem. Any one of them can make it difficult to match. You have many.

 

[Winged Scapula]

A big question in my mind is: does the program where you're doing Prelim Surgery have an Anesthesia residency?

If so, this will be your best chance to shine and see if they will interview you and offer you a position next year. You will obviously need to do the rest of the things noted above by aPD, but I'd venture your best shot is at a place where they can see beyond the red flags on your application.

 

[AnesNavy]

Thanks for the replies.

To address these questions:
1. Only 3 weeks of vacation, separated by week of course. I requested dates that will be good to interview, but again it is a toss up if these dates will coincide with interviews, should i get them. Also, no vacation time allowed in January. Ouch!

2. No anes program, but my PD was kind enough to talk to the PD of a nearby University residency program, and I will be rotating there in October.

3. I will register for Step 3 today, and plan to take it in August.

4. I agree that a letter from my PD would be nice. I will try my best to get a good one, although I'm not sure how well he will know me in 2 months. (I would like to have ERAS in by Sept. 1st)

5. I have considered re-writing my PS to address my unprofessionalism. Not sure how much that would help though.

6. I'm still debating on my Plan B. Although, interviewing for another specialty seems almost impossible with my time restrictions for interviewing.

 

[EC3]

What do you have to lose by addressing your unprofessionalism in your PS?

If they screen you out, you likely wouldn't have matched there anyway. If they give you an interview, you know that they're willing to give you a shot despite past indiscretions. I don't see a meaningful disadvantage; getting many interviews does you no good if they change their outlook once your Dean's letter arrives. Additionally, it sounds like you don't have a very controllable schedule, and receiving fewer realistic interviews may actually be beneficial.

 

[AnesNavy]

EC3: Good point, thx.

 

[dragonfly99]

I think that you need to address the unprofessionalism in your personal statement. The failed OSCE and what I assume is a failed IM 3rd year clerkship shelf exam (you called it the medicine board exam but you can't have taken that unless you already did 3 years of IM residency...) don't help either, but you may not want to draw attention to those by mentioning them in your personal statement. The unprofessionalism is a big deal to program directors because nobody wants to deal with a "problem resident" in their program.

I also agree with the comment above from the attending that you need to get letter(s) from your intern year attendings, particularly ones that comment on your personal qualities. A PD letter would be good, probably critical, but it wouldn't hurt to get one from another attending as well.

I do not think that taking the Step 3 early is going to help you...unless you pull a 260 or something, which is very unlikely to happen when you are only 2 months into internship. I think your plan of when to take it is bad because you're going to be stressed out and not have time to study, plus the test tests patient management, which you won't have much experience with only <2 months into internship. I'd argue for putting it off, perhaps until even after your intern year is over. But it's your call and I suppose if you've been studying a lot for it already you might be O.K. ...I definitely doubt you'd fail but I don't see the point in risking a low score. Your USMLE scores were not the problem with you not matching...the step 1 is lowish but not too low to match somewhere.

You can try and look for off-cycle anesthesiology open positions, too...they do come up.

I commend you for having the guts to scramble your way into an intern year position, though. I think it was the best you could do in your particular situation, and I wish you well. Surgical prelim is going to be tough, but if you can survive it, not blow your top or get into any personal conflicts, and get pretty good evaluations I think you can go on fro this and do something, perhaps even anesthesia if you are lucky.

 

[DarthNeurology]

So I have a few questions that I've been pondering these past few weeks. Yeah, I'm a bit late, but I thought I had a good plan but now I'm starting to doubt myself. Here's my situation. I'm a citizen and a U.S. grad. I applied for Anesthesiology and some Prelim and Transitional programs. I got 13 anes interviews, 2 prelim, and 1 transitional. Mind you, I applied to over 80 programs. Here's why:

Step 1: 203
Step 2 CK: 226
Step 2 CS: PASS

Any advice, whether good or bad is appreciated. Thanks in advance!

I would focus on what you are doing now and changing what you can change, i.e. getting great comments in your prelim year. I think passing Step 3 decently would help you as this is another hurdle that you won't have to deal with anymore. I would write in your PS about your "unprofessionalism" and about how you (presumably) took a long look in the mirror and changed what was asked of you or what you perceived to be wrong and how you learned from it. I don't know what the "unprofessionalism" was, but if you passed your clerkships and perhaps got conflicting comments from attendings then if you believe that whatever it was was exaggerated or is false then you could talk to your medical school about perhaps editing it or putting it into a more truthful context. A lot of what is put into evaluations and dean's letter could seem different viewed from various view points and can make a mountain out of a mole hill. You could consult a lawyer and see if anything was said with malintent, you may not even need to file a lawsuit but could have your lawyer present your case to the school. I have known students who used an attorney to get malicious statements removed from their dean's letter, some schools will edit for dubious comments and others will let attendings put in anything no matter how bad, exaggerated or false it is, the optimum and fair approach is somewhere in the middle. If it does describe what happened then I would leave it alone and just explain how you improved in your PS. You will learn that part of professionalism as an attending is defending yourself, sometimes with legal action, against people i.e. fellow colleagues, hospitals and patients who say things that are exaggerated or false. Behind closed doors I have seen well respected attendings threaten people making inappropriate comments about them by saying that they and their "ten lawyers" will have something to say about this.

ALL physicians, be it residents or attendings, and medical students should not hesitate to use legal action (or even just the threat of legal action) to maintain their reputations in cases were there is maliciousness going down. No doubt about it, because medical students, residents and attendings ARE overall nice and talented people there are plenty of folks who love to tear them down. Remember that people who work in medical schools live in an isolated environment in a way and become detached from the evalations they give if they do a lot of them and make assumptions based more on personal feelings the longer they are in an academic environment, but a lawyer can help give perspective.

If you are persistent you will most likely eventually get an anesthesia residency position. You may have to do research for a couple years or even do another prelim, like medicine, but make sure you know how this would affect residency funding. I would plan to do one to two years or so of research WHILE shadowing an anesthesiologist if you don't match next year and then apply again knowing that you did your best. After that you could go into another field knowing you gave it your best shot, you don't want to think "what if" forever.

 

[AnesNavy]

Thanks to all for the advice. I do feel like the unprofessionalism was unfair. I never had a say so in the situation and didn't even know what a Dean's letter was at the time (occurred 2 months into med school). Had I been more proactive at the time, maybe things would have been different. Anyway, we'll see how things go this time around.

 

[Taurus]

If you had a strong application, that could have offset an unprofessionalism issue and you would have probably matched into anesthesia. However, with your weak board scores and clinical performance, the unprofessionalism was, as they say, a nail in the coffin. You should seriously consider FM or IM and go from there. There's no point in doing prelim surg and prelim med years without something concrete for your future.

 

[3dtp]

I think this is a good point to repeat what someone said in another thread.

I think all medical students and residents should keep a detailed diary of their own. In effect, an "educational transcript diary." This journal should be timely and memorialize events and incidents which may, good or bad, be used in promotion/retention/dismissal actions down the road. I kept a lab notebook, bound and page numbered, diary of my medical school, residency and fellowship training. It was an extremely important document.

When items like "unprofessional conduct" or others are raised, then an alternative contemporaneous record, independent of the school/programs may be key to keeping the program/school honest and professional itself.