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Discussion in 'General Residency Issues' started by ocean4, Feb 4, 2007.
I guess alot of that depends on the nature of your personal duress. If you failed because you didn't like dealing with semi-vegetative geriatric patients with medication lists as long as a major metropolitin phone book, or if you failed because, to you, the notion of discussing the differential diagnosis ad nauseum of a sneeze in an otherwise healthy 35 year adult male made you want to pull your every hair out one by one, then IM is not for you, not at any hospital.
If you failed because of some personal issue that you have taken appropriate steps to resolve, and if you can demonstrate some competence in IM and can articulate some reasons why you would make a good IM physician, then you shouldn't have a problem.
I personally don't know any internists who failed that particular clerkship as a student, but common sense tells me that I'm sure there are a few out there. The key issue is why you failed the rotation and what you have done to correct that. And, obviously, demonstrating competency when you remediate the clerkship.
There are some Program Directors who post on these forums as well, and they may be able to give you some better insight. But you seem to want some reassurance that everything is going to be OK for you, when in reality nobody can give you that kind of assurance on an anonymous message board and with so little insight into your particular situation.
I only personally know two people who failed their IM clerkship. One was planning to go into Path anyway and didn't really care about it (although he was pissed that he had to repeat it). The other one was planning to do IM. She failed b/c of her shelf score and only had to repeat the shelf, not the whole clerkship, and did just fine on her Sub-I. For whatever reason (we never really discussed it) she ended up deciding on (and matching in her #2 choice) Psychiatry.
So to answer your question, I don't personally know anyone who failed their IM clerkship and then matched in IM. I would say that if you have to repeat your clerkship, you really need to nail it and you need to do even better on your Sub-I. Then you should do a few IM away electives and kick butt in them in order to further buff your CV and get good LORs.
Once you get interviews (and assuming you don't have a sub-200 Step 1 score and you don't only apply to Hopkins, UCSF, Stanford and BWH you will get interviews) you need to have a damn good explanation for interviewers and PDs for why you initially failed your clerkship.
Does the program director at your school advise medical students in any way? That person may be able to offer you more insight as to what you need to do to match in IM. If there were some personal problems that interfered with your performance in the clerkship, the PD at your home institution may take that into consideration when ranking you for your home program should you decide to go into IM. Believe it or not, there are some people who are very understanding about such things.
I also agree with the advice that you will need to really perform well when you remediate your clerkship. You are really going to have to strive to go that extra mile and show the people at your school what you can do clinically. I would also advise you to take your Medicine Sub-I early next year and do well. Get good letters of recommendation---they do go a long way. Do well in any IM elective that you take.
Also, talk to the Deans at your school. Ask them if anyone ever failed a particular clerkship and then subsequently matched into that specialty. Good luck!
Two things I would recommend: 1. Repeat rotation at same location and make sure you do well. 2. Explain why you failed in your personal statement when you apply.
When someone sees your application they will see the failure and wonder what happened. They will not know if you were on drugs or if your father had a triple bypass two weeks into rotation or what. It needs to be addressed somewhere in the application so that the PD's have some idea as to what happened when reviewing your application.
Basically, if you failed one rotation and it is clearly an outlier, it can be overcome. However, if you have a bunch of C's and D's then an F, it is not so easy. One last thing I would do is do an away rotation at a place you would like to (and have a reasonable chance to) match. I doubt you will get an IM spot at Hopkins or Duke with an F, however there are MANY great places to train that you can look into.
Come to think of it, I remember the surgery coordinator at my home program telling us about a girl who received a "Conditional" in Surgery. She had actually Honored the clinical portion of her clerkship, but failed the Shelf exam, which meant that she automatically received a Conditional grade for the course. She remediated that exam, kicked butt on her Surgery Sub-I, and subsequently matched at one of the top surgical programs in the country! There is definitely hope for you!
Another piece of advice----apply to A LOT of programs---and apply to a wide range of programs based on their competitiveness. I know that it is expensive, but the more interviews you have, the more likely you are to match. If you get more interviews than you can handle, you can always cancel a few of them. Also, go for the gold. Apply to a couple of "reach programs" if you can afford to do so. The worse that they can do is send you a rejection letter, but you never what will happen until you try.
I would also try to get my application in early. A lot of programs start sending out invites as soon as the applications roll in. If you wait until it is too late, all of the interview slots may fill up. By applying early, you can also see how many interviews you are getting early in the game. If you aren't getting very many, you can always add more programs to your list.
There is no place to post such a question, you just have to hope they see your query and respond. You could try PMing AProgDirector although I'm generally not in favor of recommending SDN users email each other with personal requests (without the permission of the emailee).
I am sure you will get a residency somewhere...
But let me tell you that your application will be automatically flagged...and you will probably get 50% less interviews than you would have otherwise.
I agree with all of the above sentiments. A failure in a clerkship is a serious issue. At most schools, less than 2-3% of students fail their clerkships, so this clearly is a "red flag". As other have mentioned, sometimes the failure is due to a shelf exam score -- in that case, repeating the exam and getting a good score, and taking Step 2 early (and doing well) will go a long way towards reassuring programs about your skills.
If you failed due to clinical evaluations, that's more serious. I certainly understand your above statements about personal / family matters that impacted your performance. You are certainly entitled to your privacy. However, Program Directors are going to want to be sure of two things: 1) that the issue that caused your problem is completely resolved, and 2) you are not likely to "fall apart" again when a stressful family situation occurs during your residency.
The best way that you can do this is to be 100% honest, and put thye whole story in your application. I agree with the above poster that your PS tends to be the best place to put this. I have seen some applicants explain problems like this mixed into their PS, and some write a split PS -- first an explanation of their problem, then a line, then their "real" PS. Doesn't matter either way.
Some programs will throw your application in the trash without further review, and there is nothing you can do about that but apply broadly. That being said, many good programs will likely still interview you if you are honest and up front. If you hide behind "personal, family problem" programs will assume the worst.
Since grades in required clerkships like IM are the most important academic criteria used by programs to select residents, failing a clerkship will certainly raise a red flag, as aProgDirector mentioned.
When a program looks at your application, your transcript will show the failed grade. Most schools will also include the failed grade along with narratives from your evaluators in the Dean's letter (MSPE). So, although programs will not receive the evaluation form completed by your evaluator, his or her comments on the form may find their way, sometimes verbatim, into the Dean's letter. Of course, the Dean's letter is a standard part of the residency application.
Failing a clerkship does not mean that all is lost. In fact, having advised students who have failed clerkships in the past, I can tell you that you can match into a good program. However, it does make your job much more difficult and you have to have a specific strategy for success. I would recommend that you meet with your advisor(s) as soon as possible because developing this strategy now will be the key.
I was a paragon of slackerhood and never came close to failing a rotation as MS. In fact, I even used to slip out on OB and sleep like 15 hours/day...
Always pathetic when somebody excuses their professional failings on a personal matter.
There is no room or call for insulting users who are asking for advice in a reasonable manner. I trust that I can ask that everyone behave professional and that request will be honored.
You should be fine, failing rotations is not unheard of to PDs. Don't fail anymore rotations please. A lot of people become quite accomplished when coming from behind
By the time you apply, you will have probably figured out what went wrong, what you learned from it, and how to handle a difficult situation in the future.
I know a physician who said he failed a pre-clinical course at an international med school- he is now very successful and laughed when explaining it.
That doesn't happen to everyone, it depends on how you handle it.
what did I say that was rude?
Sorry, but if you can't do the job, then you can't do the job. In the real world you cant say, "I'm sorry for not delivering the pizzas properly. I was dealing with a personal issue."
Why do doctors think they can get away with things that people in the blue collar world can't?
Will the mods send this guy a warning too?
'Cause they're not blue collar workers who can be replaced by holding a job fair at the local high school?
All doctors have better than a decade of intense, challenging, competitive, postsecondary education and training. There's a great deal of unfilled and latent demand for our services. As long as you haven't proven yourself to be unsafe or a liability, second chances will be given, slack will be cut, and professional failings forgiven.
Blue collar workers who are upset by this "double standard" should feel free to take the needed steps to acquire a shirt of another hue.
There is something fishy about this thread... Anyhoo - do an away IM rotation with a program where you want to match. Do well and get to know the faculty and residents. If they like you, they get along with you (assuming you are not threatening their family members), and your clinical performance is excellent, that will help you both with that program and with a letter of recommendation from that program when you apply...
I only know of one instance, but in this case, the person failed his IM clerkship once, and then got an average score the second time. He's now the IM clerkship coordinator at a small hospital.
Check with your student affairs person after you retake the course (I am assuming you are already hooked in with him or her). It may not be right, but I have heard of schools downplaying a failed course in the transcript and/or dean's letter.
P.S. Sorry about your parents, but it was kind of f*cked up for you to wish the same misfortune on someone else
Interesting point brought up by Hard24Get. Not too long ago, there was an article published in Academic Medicine titled "The Dishonest Dean's letter." Basically, what the authors did was to compare the Dean's letter to the transcript looking for any discrepancies. They found that discrepancies were common in the Dean's letter. In some cases, Deans withheld important information in their letters such as failing a clerkship.
Dean's letters are dishonest!!
All I have done was be kind and hardworking in my rotations, thankful to the Dean and his staff, and they write some crap letter with inaccuracies.
Moreover, they Dean's letter they gave me was NOT the crap Dean's letter they sent to ERAS. They were obviously irritated about my switching fields.
Dean's offices are just a 'little bit' corrupted unfortunately. As though they are unhappy with their own lives and so have to make others difficult.