failed internal medicine clerkship

[bele11]

hello all,

long story short, relatively benign and sometimes great 3rd year. Clinical honors in neurology, surgery, OB/GYN, psych. good to great evals.
Grades:
OB/GYN = A/B
peds = B
neuro = A/B
Psych = B
Surgery = A/B
Primary Care = B
Medicine = F

last rotation = medicine. hot and cold evals + failed department exam = fail.

i wanted to do ER,

am i completely screwed?

any thoughts would be appreciated,

thank you guys,

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[Blade28]

What's your school's policy on failed rotations? Make-up exam, repeat rotation, extra credit?

 

[bele11]

hi there,

thanks for asking.

i actually made a very strong appeal, with the dean of students backing me. i was denied; the F stays. they will not give me a formula for why I failed, they just keep telling me over and over that looking at all aspects of the clerkship, i did not pass and will need to take the course over again.

i am trying hard to find the lesson in this....i am buddhist, and am using this experience to practice feeling compassion for my aggressors. Often times the people that hurt us are in more pain than we are.

i am also hoping that i am not totally screwed for residency.

thanks much for your thoughts

jr

 

[Blade28]

hi there,

thanks for asking.

i actually made a very strong appeal, with the dean of students backing me. i was denied; the F stays. they will not give me a formula for why I failed, they just keep telling me over and over that looking at all aspects of the clerkship, i did not pass and will need to take the course over again.

i am trying hard to find the lesson in this....i am buddhist, and am using this experience to practice feeling compassion for my aggressors. Often times the people that hurt us are in more pain than we are.

Well I wouldn't assume they feel aggression - if you failed the final exam and had some poor evals, that'll do it.

I'm assuming you have to repeat at least the exam, if not the rotation - you'll want to make sure you can do this without needing to delay graduation. When I was in med school we had a couple people fail their Internal Medicine rotation, which was the longest one (11 weeks) - they typically shortened their vacation time during their MS-IV year, I think.

 

[chocomorsel]

PM me. I can tell you my story. Sorry to hear about yours. Keep your head up. It does kinda hamper your application a bit, but I don't think you are completely screwed either. Especially since you did so well in your other clerkships. Just apply broadly. Repeat whatever they make you repeat. You'll probably just lose out on vacation months, and hopefully your graduation will not be delayed.

 

[bele11]

hi there choco and blade,

choco, i would love to PM you, but i don't know what that is....how do you do it?

thank you also for being encouraging. i am going to try and honor IM the second time and get a letter, hoping that will strengthen my case.

blade, as far as aggression, the situation on the ward was that i had some very, very cruel residents who said some very mean and completely untrue things about me. It was on the basis of that that my rotation director failed me. If I had only failed the exam, i would have been able to take theat over and resolved the matter. During my appeal, he took the residents' word over mine, even though i had at least one other student witness the event.

hope to hear from you soon,
sincerely,
bele

 

[Ypo.]

That's really strange that you failed your last rotation after doing so well all year.


How's your step 1 score? Basically it's a whole package. You're going to need to have some explanation about why you did poorly in your last rotation. It's fortunate that you did so well the remainder of the year-that reflects well on you.

 

[PeepshowJohnny]

Well, most EM doctors fight with IM doctors anyway so it'll probably be fine. Failing the departent exam kinda sucks, and is an area you definitely need to focus on, but I think when you apply for residency you can definitely be a convincing case for "malignant personalities/program ruined me" when applying.

 

[Top Gun]

blade, as far as aggression, the situation on the ward was that i had some very, very cruel residents who said some very mean and completely untrue things about me. It was on the basis of that that my rotation director failed me. If I had only failed the exam, i would have been able to take theat over and resolved the matter. During my appeal, he took the residents' word over mine, even though i had at least one other student witness the event.

If you do have to repeat your medicine rotation, do you think your school will allow you to do it at a different site? That way, you might have a chance to work with a team that will evaluate you fairly. Of course, there's also the chance you'll get a team that's even worse, but we have to hope for the best, don't we?

 

[Tired]

Well, most EM doctors fight with IM doctors anyway so it'll probably be fine.

Yeah, not so much.

Why would you tell someone who failed an IM rotation (arguably the most important rotation of 3rd year), not based only on failing an exam (bad enough) but on evaluations as well (pretty damning)? And no, you can't write off a failing grade as a "malignant program" and get a free pass.

Just like failing Intro Bio as a premed, failing IM is a pretty heavy blow to come back from. Not that it can't be done, but EM is increasingly competitive, and it's going to be difficult to recover from. Solid board scores, a successful repeat, and doing well in a 4th year IM elective will help.

Again, it amazes me anyone would suggest this is no big deal.

 

[lord_jeebus]

Well, most EM doctors fight with IM doctors anyway so it'll probably be fine. Failing the departent exam kinda sucks, and is an area you definitely need to focus on, but I think when you apply for residency you can definitely be a convincing case for "malignant personalities/program ruined me" when applying.

I think it is a very bad idea to blame your attendings or program for a poor grade, even if it really is their fault.

Would you rather hire someone who blames others for poor performance, or takes responsibility? Obviously it would be necessary to show improvement following the failure.

 

[domer621]

Again, it amazes me anyone would suggest this is no big deal.

I agree. Medicine is the most important clerkship for applying to EM.
I still don't get how every attending and resident could hate you enough to fail you, especially since you did well in all your other rotations. The whole story seems fishy.

 

[Ypo.]

I still don't get how every attending and resident could hate you enough to fail you, especially since you did well in all your other rotations. The whole story seems fishy.

There are programs where everyone is just unhappy and nasty. I'm sure even if you haven't been in one you've heard stories. I've been fortunate to not be involved in such a program, but I know they exist.

What I'm trying to say is that I don't doubt the OP's story could be true. It seems more likely that if he/she had a bad attitude that it would have shown up on one of the evaluations from a previous rotation rather than just the one.

 

[chagall]

There are programs where everyone is just unhappy and nasty. I'm sure even if you haven't been in one you've heard stories. I've been fortunate to not be involved in such a program, but I know they exist.

What I'm trying to say is that I don't doubt the OP's story could be true. It seems more likely that if he/she had a bad attitude that it would have shown up on one of the evaluations from a previous rotation rather than just the one.

I can see your point, but it does seem strange to me that the OP not only got bad evals but also *failed* the shelf...that's pretty hard to do, no? I would think if you know you're working with difficult residents/attendings, you would do everything in your power to make sure you at least *passed* the shelf.

 

[Tired]

What I'm trying to say is that I don't doubt the OP's story could be true. It seems more likely that if he/she had a bad attitude that it would have shown up on one of the evaluations from a previous rotation rather than just the one.

I don't doubt the story, I just doubt the "it's not my fault" excuse that comes with it.

The central flaw in reasoning that accompanies the "malignant attendings/residents" excuse is that most people don't fail these rotations. So if most people pass and one person fails, how exactly did they pick the one person to fail, if not merit? Did they not like your tie? Did they draw your name out of a hat?

It's just likely that, whether or not you want to admit it, you did something to earn the bad evals.

I'm not trying to be a jerk, I'm saying that as a guy who's been there, tried to blame everyone else, and finally came to terms with my own shortcomings.

 

[bele11]

hello all, this is the OP...

i forgot to mention....our school just switched to the IM shelf exam. we were the last class to take the department exam. so, we were asked to take the shelf exam as a pilot student - not to be counted as part of our grade.

shelf exam = PASS
department exam = fail.

i have posted my 3rd year evals below.....

OB/GYN: AB
Bele demonstrated strong technical and clinical skills during her Ob/Gyn rotation. She seems to easily develop rapport with patients, families and staff. Bele showed great interest in Gyn Oncology, particularly in talking with patients in which she showed a great deal of compassion. She was a reliable and hardworking member of the team. Very enthusiastic. Pleasant and demonstrated excellent patient rapport. Demonstrated a commitment to healthcare that is not seen often anymore.

Pediatrics: B
Bele showed very good enthusiasm and was interested in improving her skills. She solicited and incorporated feedback well. She took feedback well. I have worked with Bele on 3 consecutive Thursdays in our general pediatric clinic. She has done a good job gathering information and seeing patients independently. Presents patients in an organized manner. Excellent attitude always looking for ways to improve. Shined on the last day -- seemed like she has been a keen observer. Much more confident in her presentation of patients, stating accurate impressions and independently stating treatment plans. She was very responsive to feedback regarding her case presentations and it was very apparent that she cared about making the most of her learning experiences during this rotation. Resident comments are as follows: Bele showed enthusiasm for pediatrics. Often she seemed eager to improve her skills and understanding of daily work. Improvement was evident at the end of three weeks. Your enthusiasm to learn and desire for individual feedback were very refreshing.

Neuroscience: Clinical A
Bele did a superb job on her Pediatric Neurology rotation. She's brought (bright), inquisitive, conscientious, and has very good clinical insight. She has a nice way with children and is a real team player. She gave the (team) a morale boost whenever it was needed. Bele thinks broadly about clinical problems and always considers the psychosocial dimension. I am confident that she will become a superb physician. Bele is an outstanding student, hardworking, smart, enthusiastic and warm.

Psychiatry: B (Clinical A)
Bele involved herself in all clinical activities on the unit from the first day, took risks to quickly overcome unfamiliarity and establish a good collaborative relationship with staff. Her interpersonal and communication skills are very good, and she demonstrated very good clinical judgment and skill with her patients. She was often able to function with independence, and so made a real contribution to the care of her patients.

Surgery: AB (Clinical Honors given)
General Surgery: Hard working driven student that cares deeply about patients. Good use of literature. Good notes. Needs to continue to read in depth and learn to apply knowledge. Otolaryngology: Bele was always enthusiastic about learning and willing to help out and asking for ways to improve her clinical skills. She will be a great physician!!!

Primary Care: B
Bele was very motivated to increase her medical knowledge. She related very well with the patients and medical staff. Bele has a strong commitment to patients' needs and is open to new learning opportunities.

IM: F
By the end of the rotation, Bele met expectations. She needs to learn to follow departmental hierarchy better. Bele, although initially hesistant, showed clear problem solving and demostrated excellent written work. Dr. _______: Bele was hardworking, enthusiastic, and knowledgeable regarding her patients. Resident comment: Bele was unavailable and did not work well with the team. Her written notes were often late by 2-3 days.


my question to all who care to offer advice: How do I explain this discrepancy to residency programs in a way that does not blame anybody, and in a way that I can take responsibility for it, even though these things that the resident said about me never happened?

thank you all,
sincerely,
bele

 

[Cras47]

hello all, this is the OP...

i forgot to mention....our school just switched to the IM shelf exam. we were the last class to take the department exam. so, we were asked to take the shelf exam as a pilot student - not to be counted as part of our grade.

shelf exam = PASS
department exam = fail.

i have posted my 3rd year evals below.....

OB/GYN: AB
Bele demonstrated strong technical and clinical skills during her Ob/Gyn rotation. She seems to easily develop rapport with patients, families and staff. Bele showed great interest in Gyn Oncology, particularly in talking with patients in which she showed a great deal of compassion. She was a reliable and hardworking member of the team. Very enthusiastic. Pleasant and demonstrated excellent patient rapport. Demonstrated a commitment to healthcare that is not seen often anymore.

Pediatrics: B
Bele showed very good enthusiasm and was interested in improving her skills. She solicited and incorporated feedback well. She took feedback well. I have worked with Bele on 3 consecutive Thursdays in our general pediatric clinic. She has done a good job gathering information and seeing patients independently. Presents patients in an organized manner. Excellent attitude always looking for ways to improve. Shined on the last day -- seemed like she has been a keen observer. Much more confident in her presentation of patients, stating accurate impressions and independently stating treatment plans. She was very responsive to feedback regarding her case presentations and it was very apparent that she cared about making the most of her learning experiences during this rotation. Resident comments are as follows: Bele showed enthusiasm for pediatrics. Often she seemed eager to improve her skills and understanding of daily work. Improvement was evident at the end of three weeks. Your enthusiasm to learn and desire for individual feedback were very refreshing.

Neuroscience: Clinical A
Bele did a superb job on her Pediatric Neurology rotation. She's brought (bright), inquisitive, conscientious, and has very good clinical insight. She has a nice way with children and is a real team player. She gave the (team) a morale boost whenever it was needed. Bele thinks broadly about clinical problems and always considers the psychosocial dimension. I am confident that she will become a superb physician. Bele is an outstanding student, hardworking, smart, enthusiastic and warm.

Psychiatry: B (Clinical A)
Bele involved herself in all clinical activities on the unit from the first day, took risks to quickly overcome unfamiliarity and establish a good collaborative relationship with staff. Her interpersonal and communication skills are very good, and she demonstrated very good clinical judgment and skill with her patients. She was often able to function with independence, and so made a real contribution to the care of her patients.

Surgery: AB (Clinical Honors given)
General Surgery: Hard working driven student that cares deeply about patients. Good use of literature. Good notes. Needs to continue to read in depth and learn to apply knowledge. Otolaryngology: Bele was always enthusiastic about learning and willing to help out and asking for ways to improve her clinical skills. She will be a great physician!!!

Primary Care: B
Bele was very motivated to increase her medical knowledge. She related very well with the patients and medical staff. Bele has a strong commitment to patients' needs and is open to new learning opportunities.

IM: F
By the end of the rotation, Bele met expectations. She needs to learn to follow departmental hierarchy better. Bele, although initially hesistant, showed clear problem solving and demostrated excellent written work. Dr. _______: Bele was hardworking, enthusiastic, and knowledgeable regarding her patients. Resident comment: Bele was unavailable and did not work well with the team. Her written notes were often late by 2-3 days.


my question to all who care to offer advice: How do I explain this discrepancy to residency programs in a way that does not blame anybody, and in a way that I can take responsibility for it, even though these things that the resident said about me never happened?

thank you all,
sincerely,
bele

Good job passing the IM shelf, . . . I really don't know what to say, all of this will come out in your Dean's letter. I think it will be hard to get an EM residency now, sorry, but a fail in IM makes this hard. Competitve EM and IM programs want an Honors or A in internal medicine. Do alot of EM electives and blow away Step 2. It is really hard to overcome an evaluation like this, but you can, just make sure it don't happen again. Maybe you could go into something less competitve like pediatric neurology which you did well in. . . I think your medicine rotation will be seen as an outlier, i.e. make sure it doesn't happen again, and don't get depressed about this.

 

[chintu]

I am really sorry this happened bele. Looks like you are a very good student with solid clinical evals and grades. It definitely sounds like you did not get along well with your residents an attending for whatever reason. It is hard to believe that medicine residents (generally known to be very friendly people to work with) will write something like this for a student unless they really had some issues. Can you recall any isolated incidents involving some arguments or issues with the residents that may be commenting on. Perhaps the fact that IM was your last rotation and you may have developed a careless attitude (and i m not suggesting that you did) towards it (burnout) knowing you had earned good evals throughout? In any case you should talk to your dean who will be responsible for writing the dean's letter if you haven't already. Often times if you make a good case about how you had done okay so far until the IM clerkship they have the power to edit our certain comments. I know this as I am in the process of appying right now and my dean definitely went over my evals with me to check and see if there were any isolated negative comments. Of course persistently negative remarks would stay and he wouldn't do anything about it but I do remember him mentioning that he can edit out certain negatives if needed to do so. Also, if you are really interested in EM I highly recommend setting up an away elective in EM at the place you are interested in (and know you have a decent shot of getting in). Work hard there and show them you can be a good student and more importantly a good team player. I can't emphasize how important this will play into your applications. I am saying this from experience. I am currently doing an away in IM (my intended specialty) at my top choice. Not only did they see my work ethic and medical knowledge but also my overall personality, ability to interact well with others, friendly outgoing nature, etc. I was invited to residents' gathering where I met the senior residents and chiefs and I went and met the program director in person expressing my intentions. Just two days after submitting my ERAS I was invited to interview there..basically at that point they had only received my ERAS app and USMLE step I score; they had not received my medschool transcript, step II, or LOR's from anyone. Point being, sure an F in IM may hurt you a bit in your overall apps but if you do as I say your chance of matching into EM will improve a lot and its very possible to get in i believe.

 

[bele11]

hello all,

i posted this in clinical rotations as well....please have a look...i'd love some advice on how to handle this situation.

hello all,

long story short, relatively benign and sometimes great 3rd year. Clinical honors in neurology, surgery, OB/GYN, psych. good to great evals.
Grades:
OB/GYN = A/B
peds = B
neuro = A/B
Psych = B
Surgery = A/B
Primary Care = B
Medicine = F

last rotation = medicine. hot and cold evals + failed department exam = fail.


i actually made a very strong appeal, with the dean of students backing me. i was denied; the F stays. they will not give me a formula for why I failed, they just keep telling me over and over that looking at all aspects of the clerkship, i did not pass and will need to take the course over again.

i am trying hard to find the lesson in this....i am buddhist, and am using this experience to practice feeling compassion for my aggressors. Often times the people that hurt us are in more pain than we are. as far as aggression, the situation on the ward was that i had some very, very cruel residents who said some very mean and completely untrue things about me. It was on the basis of that that my rotation director failed me. If I had only failed the exam, i would have been able to take theat over and resolved the matter. During my appeal, he took the residents' word over mine, even though i had at least one other student witness the event.

i am also hoping that i am not totally screwed for residency.

a little more info:

i forgot to mention....our school just switched to the IM shelf exam. we were the last class to take the department exam. so, we were asked to take the shelf exam as a pilot student - not to be counted as part of our grade.

shelf exam = PASS
department exam = fail.

i have posted my 3rd year evals below.....

OB/GYN: AB
Bele demonstrated strong technical and clinical skills during her Ob/Gyn rotation. She seems to easily develop rapport with patients, families and staff. Bele showed great interest in Gyn Oncology, particularly in talking with patients in which she showed a great deal of compassion. She was a reliable and hardworking member of the team. Very enthusiastic. Pleasant and demonstrated excellent patient rapport. Demonstrated a commitment to healthcare that is not seen often anymore.

Pediatrics: B
Bele showed very good enthusiasm and was interested in improving her skills. She solicited and incorporated feedback well. She took feedback well. I have worked with Bele on 3 consecutive Thursdays in our general pediatric clinic. She has done a good job gathering information and seeing patients independently. Presents patients in an organized manner. Excellent attitude always looking for ways to improve. Shined on the last day -- seemed like she has been a keen observer. Much more confident in her presentation of patients, stating accurate impressions and independently stating treatment plans. She was very responsive to feedback regarding her case presentations and it was very apparent that she cared about making the most of her learning experiences during this rotation. Resident comments are as follows: Bele showed enthusiasm for pediatrics. Often she seemed eager to improve her skills and understanding of daily work. Improvement was evident at the end of three weeks. Your enthusiasm to learn and desire for individual feedback were very refreshing.

Neuroscience: Clinical A
Bele did a superb job on her Pediatric Neurology rotation. She's brought (bright), inquisitive, conscientious, and has very good clinical insight. She has a nice way with children and is a real team player. She gave the (team) a morale boost whenever it was needed. Bele thinks broadly about clinical problems and always considers the psychosocial dimension. I am confident that she will become a superb physician. Bele is an outstanding student, hardworking, smart, enthusiastic and warm.

Psychiatry: B (Clinical A)
Bele involved herself in all clinical activities on the unit from the first day, took risks to quickly overcome unfamiliarity and establish a good collaborative relationship with staff. Her interpersonal and communication skills are very good, and she demonstrated very good clinical judgment and skill with her patients. She was often able to function with independence, and so made a real contribution to the care of her patients.

Surgery: AB (Clinical Honors given)
General Surgery: Hard working driven student that cares deeply about patients. Good use of literature. Good notes. Needs to continue to read in depth and learn to apply knowledge. Otolaryngology: Bele was always enthusiastic about learning and willing to help out and asking for ways to improve her clinical skills. She will be a great physician!!!

Primary Care: B
Bele was very motivated to increase her medical knowledge. She related very well with the patients and medical staff. Bele has a strong commitment to patients' needs and is open to new learning opportunities.

IM: F
By the end of the rotation, Bele met expectations. She needs to learn to follow departmental hierarchy better. Bele, although initially hesistant, showed clear problem solving and demostrated excellent written work. Dr. _______: Bele was hardworking, enthusiastic, and knowledgeable regarding her patients. Resident comment: Bele was unavailable and did not work well with the team. Her written notes were often late by 2-3 days.


my question to all who care to offer advice: How do I explain this discrepancy to residency programs in a way that does not blame anybody, and in a way that I can take responsibility for it, even though these things that the resident said about me never happened?

thank you all,
sincerely,
bele

 

[EM_Rebuilder]

I would relax. The most important thing at this point is to get IM re-took and passed. They get a couple EM rotations under your belt with good SLORs from them.

You also did not mention you Step I score. Hopefully it is decent as this can shed some light off that one bad mark.

I think one bad mark (i.e. a failed class) will not be so bad if you can keep other things more in line.

As far as explaining, I would keep it cool and simple. Say you really do not know what happened, you always did well, you did not change what you had done on previous rotations which you excelled in, you passed the shelf exam, and got the failing grade.... you sucked it up, went back, and (hopefully) passed with flying colors. Avoid blaming someone or saying it was the departments fault... EM is big about playing well with others so you want to not point out that perhaps that was the difficulty. I also would not point out about the trying to argue the grade and losing out at that; unless they ask if you did.

If you EM rotations, SLORs, and Step scores are good... I think this will not be a huge issue... you may not end up at the places where everyone else wants to go, but I bet you can still match in EM.

Good Luck...

 

[chagall]

hello all, this is the OP...

i forgot to mention....our school just switched to the IM shelf exam. we were the last class to take the department exam. so, we were asked to take the shelf exam as a pilot student - not to be counted as part of our grade.

shelf exam = PASS
department exam = fail.

i have posted my 3rd year evals below.....

I agree with the others...your other evals look really good (better than mine in most cases!). I don't know if it is this way at your school, but at mine, they will only include negative comments in your dean's letter if there is a pattern of similar comments, which it doesn't look like there is for you. I still don't know how to explain your IM eval and test grade, but if you can figure out exactly what happened and make it clear that this was an outlier, maybe that will get you a better shot.

 

[PeepshowJohnny]

Yeah, not so much.

Why would you tell someone who failed an IM rotation (arguably the most important rotation of 3rd year), not based only on failing an exam (bad enough) but on evaluations as well (pretty damning)? And no, you can't write off a failing grade as a "malignant program" and get a free pass.

Just like failing Intro Bio as a premed, failing IM is a pretty heavy blow to come back from. Not that it can't be done, but EM is increasingly competitive, and it's going to be difficult to recover from. Solid board scores, a successful repeat, and doing well in a 4th year IM elective will help.

Again, it amazes me anyone would suggest this is no big deal.

The EM fighting IM was intended to be a facetious joke.

Personally, I agree with you on the following things. If you're going to fail any section, I'd say IM is the worst to to fail. And I agree, getting poor clinical and academic reviews is harsh.

But I think there may be some factors here that have to be considered that may make this case special. First, this is a departmental exam and not a shelf exam (which she passed). If this exam was poorly writen, full of zebra type questions, I don't think that reflects well on somebody's ability to demonstrate competency in core medicine.

Plus, her evaluations in IM seem fishy. "Departmental Heirarchy?" Suggestions of tardiness when this is never mentioned in any other rotations? All of these sandwhiching a complimentary comment? Doesn't add up, especially in light of other high pass/pass evaluations.

Now, I may not have made a big deal about it as I should have, but I don't think this is a death knell for her hope in Emergency medicine. I don't subscribe to the typical SDN "You've made a mistake, you're doomed forever" attitude.

Does she have work to do? Absolutely. I suggest A) repeats clerkship and pass B) Rock her Sub-I next year (may want to do it at another site vs. with people you had bad experience with) in medicine to make up for problem third year and C) Good score on Step II to allso prove she understands the basis of medicine D) and gets some EM experience, gets a LOR out of it/gets the support of an attending/director. E) Apply broadly. Personally, I think this blip may raise eyebrows, but won't keep her from getting interviews.

 

[Celestron2000]

I feel your pain with malignant residents. I had one in IM who delighted in tormenting me and ended up with a C after an otherwise solid rotation (good comments from my other 2 teams.)

 

[AmoryBlaine]

I feel your pain! I know so many people (inc myself) that have one "outlier" as a rotation grade.

Anyway, my advice comes as an M4 so maybe not worth as much as a PD but here is my thought. Bright, personable people who are committed to EM do not fail unless they don't get good advice.

You have a red flag on your application, period. So apply to 60 programs and make quite a few of those programs outside the Indiana/Denver/Hennepin/Cinci "tier." I have long held the impression that we as med students greatly overestimate the competitiveness of EM.

I also greatly agree with the statement about just sucking it up and taking full responsibility. I think you are in a good position with such shining evals to where the rest of your record speaks for itself.

 

[bartleby]

I think that it goes without saying that taking personal responsibility and not playing the "blame game" is key. I think that you should take the initiative to address this in interviews and explain that your failing grade was due to the IM exam rather than any clinical misadventure or problem with your evaluations themselves. This is an important point, as failing because of the exam might be considered a pardonable sin by most many programs given your overall good grades as opposed to failing due to say, not showing up during your clerkship or doing something bad involving patient care.

Good luck!

 

[ditch doctor]

I think that you should take the initiative to address this in interviews and explain that your failing grade was due to the IM exam rather than any clinical misadventure or problem with your evaluations themselves.

If this is a departmental exam that was used over and over, and not too many people fail, I would be hesitant to say it is the "exam's" fault. If most everyone else is passing, it's *your* fault for not preparing, either adequately or appropriately. I would look introspectively on why you failed the exam, and address that. And what steps you're taking to improve. If I was interviewing, It'd look too much like shirking responsibility if you blame the exam. That's just my 2c worth.

And FWIW this is coming from someone that had to explain a bad grade and still got EM at my first choice, so all hope is not lost.

 

[keeping-it-real]

The most important things are the follwing: 1) Take ownership of your mistake 2) Express that you've learned from this mistake 3) Explain how you will avoid this mistake in the future

Regardless of what reality may be (believe me, in a perfect world you'd be able to speak your mind and not be penalized), you need to take ownership of this misdoing and turn it into a positive. On interviews, talk about how this experience has affected you and how you have grown from this.

What may hurt you a bit is that part of the reason you failed is because you failed the exam. I would avoid putting blame on the exam, though and express that you let yourself down by not making the necessary effort to study.

The bottom line is this. This WILL hurt your application a bit. This WILL NOT keep you from matching into ER.

 

[Cras47]

Upon reading Belle's medicine evaluation again, the attending seemed to note that she was hardworking, but the resident clearly did not like her. For some to write that bad an eval I feel that there has to be a subjective component i.e. the resident did not get along well with the student. What is bad about these evaluations is that the evaluator can say anything they want without "proof." I think that the better clinical rotations have a check-list so you are evaluated each shift in the ER for example. If your written notes were late by a couple of days, it seems that the resident yelled at you alot about this or were they unfairly bringing this up without warning? It is more than a little silly that residents who are sometimes only a little more than two years ahead of students suddenly act like they know everything and write bad evals that can hurt a student for decades. . . especially medicine residents who are generally on average no smarter/hard working than the average medical student.

Honestly, from reading the eval and reading between the lines, it seems like a resident was nasty with Belle, and the resident expected Belle to cower and fear the power of the resident, and she didn't and probably said, gave a nasty look to the resident, and couldn't stand being around this a** of a resident, who the, surprise, surprise, decides to give Bell a bad eval for "late notes" wink wink, . . . makes the medicine service look worse than the student. Medicine isn't like the military where anyone "above" you on the hiearchy can say and so anything to you that they want, but some residents and attendings want it to be this way.

 

[NinerNiner999]

I think the most important thing is to address this with your dean (who will be writing your dean's letter) and clarfy with him/her that this is clearly an outlier. Get to know your dean now, before your deans' letters are due. Let him/her know about your goal to be an EP. Most importantly, HONOR your EM rotation(s) at well-known programs. Have them send their evaluations directly to your dean. This will influence the "code" he/she uses when your dean's letter is written. This will not kill you, but may help to support your application if done well...

 

[DelawareEMIM]

I agree that medicine is an important rotation but you cannot do anything more important than kicking ass and taking names at an EM program you would like to train at. I have met plenty of fellow residents who are great on paper but cannot interact with a patient to save either of their lives. Conversely, I have worked with residents with less than stellar marks and are great docs.

As a secondary item, do an inpatient medicine sub-I and blow it out of the water. Two totally opposing grades in the same speciality will likely speak to the oddity that was your third year medicine rotation. Good luck.

 

[bele11]

hello all, this is the OP, Bele,

first, I would like to express my sincere gratitude for all who posted here. you guys don't even know me, and yet you took the time to post thoughtful comments that both support and guide me. from the bottom of my heart, thank you. i hope that this comes back to you a thousandfold.

i will most definitely try and blow my ER rotation, step 2 and my medicine sub I out of the water. certainly seems like the thing to do.

i do have one question though - regarding the exam. i know a few of you thought i should say i did not study hard enough for the exam. however, i did, in fact, study for the exam. it came out in the fact that i passed the shelf exam.

so my question is....should i lie and say i didn't study?

thank you,
you are all so great,

bele

 

[keeping-it-real]

i do have one question though - regarding the exam. i know a few of you thought i should say i did not study hard enough for the exam. however, i did, in fact, study for the exam. it came out in the fact that i passed the shelf exam.

so my question is....should i lie and say i didn't study?

thank you,
you are all so great,

bele

Say that you were surprised you did not pass the exam seeing as you thought you had put in adequate study time. Acknowledge that maybe you did not study the most appropriate material or that you did not put in as much time as you probably could have. Offer solutions as to how this will not happen in the future.

Also, what percentile did you get on your shelf? I know at my school you only have to get above 5th percentile to "pass". If you have scored a very low percentile, I wouldn't necessarily try to highlight this as evidence of your knowledge. Just my $.02.

 

[ditch doctor]

hello all, this is the OP, Bele,

first, I would like to express my sincere gratitude for all who posted here. you guys don't even know me, and yet you took the time to post thoughtful comments that both support and guide me. from the bottom of my heart, thank you. i hope that this comes back to you a thousandfold.

i will most definitely try and blow my ER rotation, step 2 and my medicine sub I out of the water. certainly seems like the thing to do.

i do have one question though - regarding the exam. i know a few of you thought i should say i did not study hard enough for the exam. however, i did, in fact, study for the exam. it came out in the fact that i passed the shelf exam.

so my question is....should i lie and say i didn't study?

thank you,
you are all so great,

bele

Re-read my post I said you either didn't prepare adequately or appropriately. It looks like you spent a fair amount of studying, you just didn't prepare for the exam the way you should have. It's kinda like the difference between quantity and quality. From what you are saying you did the quantity part, just not the quality part. You don't have to lie at all. I'm really not trying to be a hard-ass, I went through the same kind of deal, studying *A LOT* but getting crappy grades. But clearly you studied in a different, insufficient or ineffective way than someone that passed the exam, and if most of your fellow students are finding a way to pass, then the onus of the responsibility is on you to pass. Even if it's a crappy exam. It's not fair, but then again, as my dad used to tell me whenever I would bitch something isn't fair, "Boy, 'fair' is a place to ride rides."

Either way, if you beat the mean on Step II, get a good SLOR, interview well at >10 programs and you should be fine. All of my EM rotations were pass/fail only, so I can't comment about getting honors in EM.

 

[Arsenic]

the 2 versions of this thread have now been merged together so that everything is in one place, all posts that were in the EM forum version are now in this one.

 

[Cras47]

hello all, this is the OP, Bele,

first, I would like to express my sincere gratitude for all who posted here. you guys don't even know me, and yet you took the time to post thoughtful comments that both support and guide me. from the bottom of my heart, thank you. i hope that this comes back to you a thousandfold.

i will most definitely try and blow my ER rotation, step 2 and my medicine sub I out of the water. certainly seems like the thing to do.

i do have one question though - regarding the exam. i know a few of you thought i should say i did not study hard enough for the exam. however, i did, in fact, study for the exam. it came out in the fact that i passed the shelf exam.

so my question is....should i lie and say i didn't study?

thank you,
you are all so great,

bele

bele, you shouldn't lie at all about studying for the exam, just say you studied hard, did well on the national shelf, but basically there was alot of stuff you didn't expect on the departmental exam, i.e. basically these people on medicine are from another planet give weirdo evals and give weirdo exams and YOU'RE the normal one, not them . . . don't say this outright, but in a situation like this, the PD or outsider has to find out who the weirdo is.