Doing additional clinical rotations after graduating and not matching

[funklab]

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So this is my second time around, I didn't match last year (my first MS4 year) because I failed step 2 ck and have a really really bad step 1 score. I applied to psych last year and 120 psych and FM programs this year, but the odds say I have only a 50/50 chance of matching the second time around. I delayed graduating so that I would be a "graduating senior"... again... but in December I will get that fancy/useless MD to add to the end of my name.

Since there is a pretty healthy chance that I won't match again this year, I'm trying to plan what I will do. There's an extremely low chance that I would match a third time around, especially having not been in the hospital for 18 months. So I was thinking that if March comes around again and I'm unsuccessful in SOAP again, the only option to continue to pursue a career in medicine would be to convince a program that I would make a reasonably competent physician by doing an acting internship (subinternship if you like) type of rotation with several different programs.

But is that even a thing after you graduate??? I feel like there would be some insurance issues and questions about letting a "physician" act as in a medical student capacity, especially one no longer affiliated with a medical school.

So if anybody knows if this is a thing or not, I'd appreciate some input.

 

[chipwhitley]

I don't think you can do medical student rotations anymore after you've graduated. You can probably do observerships or something like IMGs from other countries do.

 

[funklab]

Thanks chipwhitley, I hadn't heard of an observership before. Looking on the AMA's website, it states that an Observership "is meant to familiarize and acculturate an IMG to the practice of medicine in an American clinical setting, and provide an introduction to American medicine"

Which doesn't quite sound like it would be appropriate for my situation. Though I'm sure the work would be quite similar, the type of programs set up for observerships probable wouldn't be an equivalent experience to doing an AI. But I guess I really don't know much about observerships.

 

[chipwhitley]

Yeah, I'm just saying I don't think you could do an AI if you're not in medical school anymore. Those usually only take medical students. I've heard in Missouri or Arkansas you will soon be able to get an Assistant Physician license. Maybe you can get some clinical experience that way?

 

[ACSurgeon]

Thanks chipwhitley, I hadn't heard of an observership before. Looking on the AMA's website, it states that an Observership "is meant to familiarize and acculturate an IMG to the practice of medicine in an American clinical setting, and provide an introduction to American medicine"

Which doesn't quite sound like it would be appropriate for my situation. Though I'm sure the work would be quite similar, the type of programs set up for observerships probable wouldn't be an equivalent experience to doing an AI. But I guess I really don't know much about observerships.

You should apply to a few prelim medicine and surgery programs. It'll keep you in the clinical setting while earning enough money to live.

 

[funklab]

You should apply to a few prelim medicine and surgery programs. It'll keep you in the clinical setting while earning enough money to live.

Forget "earning enough money to live". All I need is that medical license. I'd be perfectly happy finishing my intern year, getting my license and working urgent care for $60 an hour for the rest of my life. Much better than reinventing my career after five years of medical school. I tried to soap into a bunch of open prelim/transitional year spots last year, but it didn't happen. As I gather those are rather competitive (at least the medicine ones) since Rads/Derm/PMR/Ophtho and whoever else are vying for them.

Judging from my experience with SOAP last year, I'm sure I look even worse at first glance than on closer inspection of my application. Pretty sure most programs I applied to in SOAP just glanced at the board scores and moved on, which is completely understandable in that time crunch situation when you're trying to fill your program.

 

[Donald Juan]

I'm not sure how much an observership would help. You might have little opportunity to show off how awesome you are as these are really for shadowing, not auditioning, and these individuals usually don't have any hands on. Can your school help let you know if there are any opportunities you could have to do AI's after graduation? Also, I agree with doing the prelim year, but if you had an opportunity to get your face at any programs that might be less competitive before then it would also help.

 

[Merely]

I'm genuinely curious and do not mean to offend you in any way but did something happen in medical school that caused you to do poorly and you just were not able to keep up with the overwhelming amount of material? Or were you just pretty laid back and not studying as hard as you could have been during school? As a US graduate I feel like you should match if IMGs are matching but I'm obviously very ignorant lol

 

[chipwhitley]

I'm genuinely curious and do not mean to offend you in any way but did something happen in medical school that caused you to do poorly and you just were not able to keep up with the overwhelming amount of material? Or were you just pretty laid back and not studying as hard as you could have been during school? As a US graduate I feel like you should match if IMGs are matching but I'm obviously very ignorant lol

It's not as simple as any US grad gets in anymore. US grads who have bad scores and failures are going to lose out to IMGs with high scores.

 

[funklab]

I'm not sure how much an observership would help. You might have little opportunity to show off how awesome you are as these are really for shadowing, not auditioning, and these individuals usually don't have any hands on. Can your school help let you know if there are any opportunities you could have to do AI's after graduation? Also, I agree with doing the prelim year, but if you had an opportunity to get your face at any programs that might be less competitive before then it would also help.

I'm not sure how much my school will be able to help me, though I haven't talked to them yet. I certainly wouldn't want to do any AIs at my school (their psych and FM programs are way too competitive for me to get into). I guess I should ask their advice while I'm still a student, but once I graduate I'm pretty sure they're gonna wash their hands of me (understandably so, I messed up their board pass rates and their match rates).

Perhaps I overestimated the competitiveness of prelim years? I didn't out and out apply to any this year. I assumed that I would be much less competitive than the average derm/rad/ophtho applicant and it would be hard to explain in an interview why I really wanted to go into "prelim year" while not applying to any specialties that require it.

I'm genuinely curious and do not mean to offend you in any way but did something happen in medical school that caused you to do poorly and you just were not able to keep up with the overwhelming amount of material? Or were you just pretty laid back and not studying as hard as you could have been during school? As a US graduate I feel like you should match if IMGs are matching but I'm obviously very ignorant lol

Nah, no trouble in med school. I bombed step 1 unexpectedly, scoring about 30 points below what I'd been getting on practice exams... I think that probably shook my confidence with step 2, though both scores were within the margin of error of the passing score, so I guess I'm consistent?

Other than that I had a pretty decent application. MS1 and 2 are pass fail at my school and I passed everything. I generally scored in the middle 40-60% of pretty much every shelf exam and got mostly high pass/ honors. I've now done 4 acting internships at 4 different hospitals and got good feedback on all with two honors and one high pass (grade hasn't come in on the last one yet).

Basically the reason I started this thread is that I think I'm a reasonably competent student/clinician and that comes across much better in an AI than it does in an application that has my scores at the top in bold black letters. I've got a few interview invites, but at the end of the day with my board scores it's a gamble for any program since past performance would seem to suggest I might fail step 3.

 

[Merely]

You randomly scored 30 points below your average on step 1? Damn..that's scary sorry to hear that man that's a VERY tough situation to be in

 

[ACSurgeon]

I'm not sure how much my school will be able to help me, though I haven't talked to them yet. I certainly wouldn't want to do any AIs at my school (their psych and FM programs are way too competitive for me to get into). I guess I should ask their advice while I'm still a student, but once I graduate I'm pretty sure they're gonna wash their hands of me (understandably so, I messed up their board pass rates and their match rates).

Perhaps I overestimated the competitiveness of prelim years? I didn't out and out apply to any this year. I assumed that I would be much less competitive than the average derm/rad/ophtho applicant and it would be hard to explain in an interview why I really wanted to go into "prelim year" while not applying to any specialties that require it.



Nah, no trouble in med school. I bombed step 1 unexpectedly, scoring about 30 points below what I'd been getting on practice exams... I think that probably shook my confidence with step 2, though both scores were within the margin of error of the passing score, so I guess I'm consistent?

Other than that I had a pretty decent application. MS1 and 2 are pass fail at my school and I passed everything. I generally scored in the middle 40-60% of pretty much every shelf exam and got mostly high pass/ honors. I've now done 4 acting internships at 4 different hospitals and got good feedback on all with two honors and one high pass (grade hasn't come in on the last one yet).

Basically the reason I started this thread is that I think I'm a reasonably competent student/clinician and that comes across much better in an AI than it does in an application that has my scores at the top in bold black letters. I've got a few interview invites, but at the end of the day with my board scores it's a gamble for any program since past performance would seem to suggest I might fail step 3.

You should apply to prelim surgery and medicine. It should be easier to match a prelim spot through the main match than through the SOAP.

If you have stronger clinical grades and letters of Rec, I don't think passing step 3 would be a concern for a prelim spot.

 

[AMEHigh]

I'm not sure how much my school will be able to help me, though I haven't talked to them yet. I certainly wouldn't want to do any AIs at my school (their psych and FM programs are way too competitive for me to get into). I guess I should ask their advice while I'm still a student, but once I graduate I'm pretty sure they're gonna wash their hands of me (understandably so, I messed up their board pass rates and their match rates).

Perhaps I overestimated the competitiveness of prelim years? I didn't out and out apply to any this year. I assumed that I would be much less competitive than the average derm/rad/ophtho applicant and it would be hard to explain in an interview why I really wanted to go into "prelim year" while not applying to any specialties that require it.



Nah, no trouble in med school. I bombed step 1 unexpectedly, scoring about 30 points below what I'd been getting on practice exams... I think that probably shook my confidence with step 2, though both scores were within the margin of error of the passing score, so I guess I'm consistent?

Other than that I had a pretty decent application. MS1 and 2 are pass fail at my school and I passed everything. I generally scored in the middle 40-60% of pretty much every shelf exam and got mostly high pass/ honors. I've now done 4 acting internships at 4 different hospitals and got good feedback on all with two honors and one high pass (grade hasn't come in on the last one yet).

Basically the reason I started this thread is that I think I'm a reasonably competent student/clinician and that comes across much better in an AI than it does in an application that has my scores at the top in bold black letters. I've got a few interview invites, but at the end of the day with my board scores it's a gamble for any program since past performance would seem to suggest I might fail step 3.

You should absolutely apply to prelim years. The SOAP is a whole different monster. Obviously it's getting kind of late in the game, but I would do it.

Also, definitely talk to your school. My school is good about helping out alumni.

 

[ordersol7]

Wow man. All I wanna say is Im in solidarity with you. i am actually in a similar position postponing graduation and reapplying. I made a thread but the short version is I had low but passing boards on both steps and only passing clinical grades due to low shelf scores although the majority of my eval grades are HP and H. I did additional sub-is at more hospitals and honored them like you did. switched specialties to IM from EM.
Honestly i think the only difference between us is that I never failed even though my application on the whole is probably worse than yours. Have you talked to your attendings at your prior AIs about your situation? It might be a bit late but I was up front with an attending at a previous sub i who was also one of the pds and he gave me a lot of good advice about how to address it in my ps and on interviews. Best of luck to you man.

 

[funklab]

I think the window to get an interview for any prelim spots has probably already passed this year. Do prelim programs really not care what you want to do with your life though? I guess the reason I didn't apply to any is because it (in theory could have) taken up a date where I could interview for a program in a specialty I actually wanted to go into and I couldn't think of what would possibly make me an attractive prelim applicant... I've known at least two PM&R residents who matched to PM&R, but with no prelim year.

Judging by my experience in SOAP there are just as any if not more FM spots than prelim spots available (well medicine anyway). My ERAS bill was already $3,000, I guess I was too cheap and should have applied to some prelims as well.

 

[ordersol7]

Prelim med positions are competitive because the derm/rads/neuro/anesthesia folk etc vastly prefer them to prelim surg and frankly who could blame them? My advisors were pretty out of the loop about the competitiveness of those spots too. (And about the match in general, based on the really high percentage of people who went unmatched from my class).
I would put some apps out to prelim surgery too. It's not ideal, but it would let you keep up your clinical skills and perhaps generate new LORs to apply again if you needed to. Also don't give up hope on getting more invites. Last year I attempted to apply to IM after getting barely any EM interviews late in November. Even with my flags of low boards, applying late, and not having IM-specific letters I still got some invites into December and even one in January. People cancel and that leaves room for folks like us. Best of luck to you.

 

[PL198]

Prelim med positions are competitive because the derm/rads/neuro/anesthesia folk etc vastly prefer them to prelim surg and frankly who could blame them? My advisors were pretty out of the loop about the competitiveness of those spots too. (And about the match in general, based on the really high percentage of people who went unmatched from my class).
I would put some apps out to prelim surgery too. It's not ideal, but it would let you keep up your clinical skills and perhaps generate new LORs to apply again if you needed to. Also don't give up hope on getting more invites. Last year I attempted to apply to IM after getting barely any EM interviews late in November. Even with my flags of low boards, applying late, and not having IM-specific letters I still got some invites into December and even one in January. People cancel and that leaves room for folks like us. Best of luck to you.

wut? most of those people are gonna shoot for TYs

 

[ordersol7]

Ya but prelim meds are a close 2nd. There were plenty of people from my class that matched into their advanced specialty just fine but had to SOAP for a prelim spot because they only tried for TYs or prelim med years. Though like anything I don't know their situation. Like how competitive were they, did they apply broadly enough etc.

 

[DrBowtie]

I think the window to get an interview for any prelim spots has probably already passed this year. Do prelim programs really not care what you want to do with your life though? I guess the reason I didn't apply to any is because it (in theory could have) taken up a date where I could interview for a program in a specialty I actually wanted to go into and I couldn't think of what would possibly make me an attractive prelim applicant... I've known at least two PM&R residents who matched to PM&R, but with no prelim year.

Judging by my experience in SOAP there are just as any if not more FM spots than prelim spots available (well medicine anyway). My ERAS bill was already $3,000, I guess I was too cheap and should have applied to some prelims as well.

Talk to your home IM and GS PDs about doing a prelim if you don't match. Our GS would take any home student who needed a backup spot for a prelim. Your home programs are going to be your best resource.

You likely can't do an AI after graduation for insurance purposes. Any chance to extend grad date to May/June and do more rotations?

 

[Psai]

wut? most of those people are gonna shoot for TYs

Transitional years are pretty hard to get

 

[ordersol7]

I would 2nd going to your home schools/programs for advice even if it hurts. You may find they are more receptive than you expect. Remember that regardless of what their opinion of you may be it reflects VERY poorly on them to have people remain unmatched as a US MD school, especially someone who's made it through med school without hiccups up til your step 2.