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Explaining yourself

Discussion in 'General Residency Issues' started by misery, May 16, 2007.

  1. misery

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    Ok guys I know I'm way to early to be worrying about this, finishing second year, I just want to know I haven't absolutely F'd myself. This semester while in the midst of studying for boards getting a new house, etc, etc I failed a class. Mind you I am an A to High B student. It is our clinical skills course and basically to pass it you have to pass all the components of the course. Our final exam was a series of simulated patients, and I had a bad morning. My grade going into the final was an 88, but I failed the final, which by the policy means I failed the course. Now I have to remediate that exam, but the highest I can get is a 70x and it's an 8 hour course. So not only will I have a crushing blow to my GPA and class rank, but also it will be indicated on my transcript that I had to remediate, even though with my failing final score which was a 65, my average is still a B:mad:

    So, how will I explain this in my apps for residencies. Am I destined to do a residence in PoDunkville now, all my dreams of competitive residencies down the drain. Any advice, encouragement, words of wisdom?

    THX
     
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  3. TxMed

    TxMed SpottieOttieDopalicious
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    terrible situation. i've heard about this happening and it must really suck. i have no advice or wisdom to offer.


    -tm
     
  4. Winged Scapula

    Winged Scapula Cougariffic!
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    You don't unless asked. I do not believe that the personal statement is a place to try and explain away any or all of your faults. Very few students get invited for a residency interview based on grades or class rank.

    If and when you interview someplace that asks about the remediation you must do all you can to take the blame: the class was NOT unfair, the scoring was NOT unfair, the professor or school was NOT out to get you. Rather you underestimated the amount of work needed to pass that exam and devoted more time to studying for Step 1 and other responsibilities. You know how important clinical skills are and as your clinical evaluations show, you have learned from your mistakes and have done well on all your clinical rotations since.

    Depends on your Step 1 score, clinical evaluations during 3rd and early 4th year, Step 2 score (if you take it early) and letters. Your class rank and gpa are important but generally fall a ways down the list in things residencies use to evaluate candidates. Obviously this may have an effect on your application but if its really only one red flag in your chart, then it probably won't be a big deal - even for competitive specialties outside of Podunkville.

    You should be allowed to insert a letter of explanation into your file if you wish, and ask that the school send it along with the rest of your application come residency time.

    Mostly importantly, you need to set up a meeting with your dean before summer of 4th year when he/she will be preparing Dean's letters. You'll need to see how they plan on "spinning this" as I expect they will mention it in their letter - you need to be able to plead your case so that the letter doesn't seem to damaging and this seems like just a blip of bad judgement in an otherwise stellar career. I would caution you against using the phrase "bad morning" when talking about the issue - we all have bad days: fights with our SO, dog is sick, just don't feel well, etc. But you CANNOT use that as an excuse to give your patients any less than your best, so fight the temptation to do that as it won't wash.

    Best of luck...
     
  5. misery

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    Now thats the kind of advice I was looking for. I'll see how things play out, and I didn't even think of putting a letter in my file, great idea. Thanks for the help. Anyone else have this happen?
     
  6. aProgDirector

    aProgDirector Pastafarians Unite!
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    I don't think that "putting a letter in your file" is going to do much. First of all, all residency applications are now electronic, and there isn't a place to put such a letter. Hence, residency programs won't see it. I guess it could be included with your Dean's letter, but that might just make it look more serious / concerning than it really is.

    I otherwise agree fully with Kimberli. Your MSPE letter writer (MSPE = Medical Student Performance Evaluation, new lingo for the Dean's letter since it's usually not written by the Dean) will need to address this in the letter, briefly and succinctly. They are good at doing this -- as you are not the first to fail a course. They should allow you to see the letter, but will not allow you to change it except for factual errors. Still, it is in their best interest to get you into the best residency they can, so they will usually spin this as best as possible. Until you see how this is worded, I really wouldn't do anything, except pass the course the second time. If you see the MSPE and are really unhappy with it, and they are unwilling to change it (unlikely), then you will probably be best able to address this in your personal statement.

    The major issue is going to be whether there is a pattern of this sort of thing. Most programs will simply overlook a failed year 1 or 2 course, as long as it is remediated and there are no further problems. Add an unsatsifactory Step 2 CS, or a marginal Year 3 grade, and then you have something to worry about.

    Obviously, the more competitive the field / program, the more of a problem this could be.

    Some people decide to discuss it briefly in their personal statement. I personally don't think this will matter much either way. As Kimberli mentions, you need to be ready to discuss this at interview, since it will come up.
     
  7. Winged Scapula

    Winged Scapula Cougariffic!
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    I agree - it is probably low yield, but I would always advocate that students and residents have some sort of written statement about negative events in their file.

    Everyone should be aware of what's in their file...when I was a junior resident I found one of my seniors had written a letter complaining about my management of a patient - without telling me about it or even asking why I had done what I had done. Now, if I hadn't asked to see my file, I would have never known it was in there but should that letter have ever been sent out, I felt better knowing that I had documented the situation as it occurred and answered all the questions about my management appropriately.

    While residency applications are electronic, programs can scan and upload other items or applicants can send things themselves. I agree, doing so unsolicited might make it seem like its a bigger deal than it is, but I still believe that having a "rebuttal" to any red flags in any employment file, while the event is fresh in your mind, is worthwhile. Even if only for the OP's peace of mind that she has had her say.
     
  8. elizabeth5863

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    Hello,

    I've had something similar happen to me, but it was with a different class. I had a passing grade going into my biochemistry final during my 1st year but failed the final by 2 points. I failed the course (even though I had an overall passing grade) and had to remediate by taking an essay exam. They changed the grading policy the following year because the biochem professor was (and still is) incredibly hard, and many students were not (and still are not) happy about the intensity and detail to which he is teaching the course. Sure, it was indicated on my transcript but it's only with a small symbol. I mistakenly lived through much of my med school years fearful about what would show up on my dean's letter. At the beginning of my 4th year, I found out my dean's letter did not indicate failure of biochemistry. Thinking they made a mistake, I asked a dean about it. She said that since I had an overall passing grade in the course and did not have to retake the biochemistry course (but just one exam), they didn't consider that remediation or a failure on the dean's letter (even though there was just a small symbol on the transcript indicating I retook an exam).

    I wouldn't be too worried at this point and let this one incident affect the rest of your med school career. You still have your 3rd year. Don't live in fear and make the mistake I did; med school can be really fun instead of not-so-fun when you worry about what will be on the Dean's letter.

    We have simulated pt exams at the end of each major clerkship at my med school. I know one classmate of mine who went on to match into orthopedics despite doing badly on simulated pt exams, (he did just fine on Step 2CS). (The simulated pts are subjective and are there to help you in preparing for Step 2CS. At my med school, I feel that they are harder at grading than the pts in the actual Step 2CS and the cases are harder). I'm not sure how things are at your med school, but at my med school, you get an overall grade for a course and, even if you do badly in one component, it might not show up in the dean's letter if you did well overall in the course.

    I would talk to your deans to ask them about what will go on your dean's letter. (Be aware that different deans will say different things; while one dean may leave a negative comment on the letter, another dean would let you strike it out).


    As for the personal statement, I wouldn't use it to explain negative things (esp. if you find out they aren't going to be on your dean's letter). Most residency programs (from what my advisors and deans told me) want to hear about how you chose medicine or why a particular field.

    Good luck! Sounds like you get really good grades and you're early in your med school career, so don't let this one thing worry you too much.
     
  9. radonc

    radonc Senior Member
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    * dont do anything to draw any negative attention to yourself
    * keep things positive


    ie dont write a letter
     
  10. flipflopsnsnow

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    I failed my very first course in medical school (yeah, giant blow to ego). This was unfortunately going to be on my permanent record and I was totally nervous about it through the rest of medical school.
    I met with my Dean early in my 4th year and asked her advice on how to "spin" it in a way that wouldn't make me look too bad. And she was able to do that in her letter - well I at least thought it sounded okay.
    On the interview trail, I was only asked about it one time (out of 11 interviews). Granted I wasnt applying to top notch places. And I ended up with my number one choice in the match.
    Try and make sure that YOU are okay with the failing grade and that you can recover from it well.
     
  11. sdnetrocks

    sdnetrocks Senior Member
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    Not to gloat, but...

    I failed a course during the first year as well (the one where we had to memorize all the limb anatomy - muscles of the forearm, etc.). I ended up remediating it.

    So of course I was expecting this fact to show up somewhere when it came time to apply to residency. Not only was there no mention of this, but in fact my dean's letter stated something to the effect of "This student did not fail any courses".

    Conclusion: Don't worry about this prematurely!
     
  12. misery

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    Thanks guys for the words of encouragement. They may not appear so, but they are. I'm going to let things play out. Like many of you have said, I have my rotations. I'm actually really good clinically, just not with imaginary patients, but I think its that attitude that got me here. Anyway, I really appreciate all your comments, they have put me at great ease.
     
  13. aProgDirector

    aProgDirector Pastafarians Unite!
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    Believe it or not, this has been studied. I might have worded the conclusion a bit differently, so as not to be quite so inflammatory.

    1: Acad Med. 1999 Sep;74(9):1033-5.

    The dishonest dean's letter: an analysis of 532 dean's letters from 99 U.S. medical schools.

    Edmond M, Roberson M, Hasan N.

    Department of Internal Medicine, Medical College of Virginia, Virginia
    Commonwealth University, Richmond 23298-0509, USA. [email protected]

    PURPOSE: To quantify the censure of potentially negative information in dean's letters.

    METHOD: Concordance between 532 dean's letters and the corresponding transcripts was determined for six variables (failing grade in a preclinical course, marginal preclinical course grade, failing grade for a clinical rotation, marginal clinical rotation grade, leave of absence, and requirement to repeat an entire year of medical school). RESULTS: The evaluated variables were not found in the dean's letters 27% to 50% of the time that they were present on the transcripts. In three of nine instances (33%), a failing grade in a clinical rotation was not included. Four students had been required to repeat an entire year, but this was noted in only two cases. In toto, 35 of 104 (34%) of the variables identified on the transcripts were not reported. In addition, deans were significantly less likely to report a student's USMLE 1 score if the score was at or below the 20th percentile (p = .03). CONCLUSION: Some deans suppress negative information in their letters and potentially obfuscate the residency selection process.
     
  14. radonc

    radonc Senior Member
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    word of the day: obfuscate
     
  15. misery

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    Thanks everyone for your words of wisdom. My re-examination went fine. I will heed your advice as things play out.
     

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