Failed shelf in specialty choice? Please help!

[Mazeroski60]

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I am a 3rd year and have so far finished my surgery & psych clerkships. I did well in surgery & received a high pass, despite not being interested in surgery at all. And when I got to psych I loved it, but just found out this week that I failed my shelf exam!! I got 8th percentile & I needed 10th percentile to pass. The frustrating part is I got honors on one attending evaluation, and high pass on the other, and regardless of how well i do when I retake the NBME exam (which is in a couple weeks), the best I can do is pass for the clerkship. This in addition to having a note in my Dean's letter about having to remediate the shelf.

My question is, am I still viable as far as psych residencies are concerned? I know psych is one of the least competitive fields for matching, but having failed the initial shelf in that area makes me think my chances are much slimmer. Additionally I had spoken with one of my attendings (the one who gave me honors) about careers in consultation/liaison & was considering med/psych programs, and then doing a C/L fellowship afterwards. I am assuming med/psych is more competitive, but i have no idea? The single most frustrating part is that I missed passing by one single question, which would have put me above the 10th percentile.

So I guess my question is do i have any shot for either psych or med/psych residency programs? And even if so, would I be severely limited as far as quality/location of programs? Thanks, i could really use some guidance!!

 

[njbmd]

You need to figure out what failing the shelf means in terms of your grade for the rotation. At my school, the shelf exam counted 45% of the grade; the in-house exam 25% and evals were the rest. This means that you could fail the shelf, do well on the inhouse and with good evals pass the rotation (not honor but still pass). Figure out what this means.

I would say that you might have to retake the shelf or you may have to redo the rotation. In any event, you need to ask your clerkship director what options are out there for you especially since you are interested in psych. Just because you failed the shelf exam, doesn't mean that you wouldn't make a great psychiatrist. You could have gotten out of sync with the bubbling and that caused your failure (clerical problem and not knowledge problem).

I wouldn't say this this knocks you out of psych or even Med-Psych if you have done well otherwise. My guess is that it was a clerical problem and you might be able to request a hand scoring of the exam which would show what happened. Good luck and speak to the clerkship director ASAP.

 

[Mazeroski60]

Yea, they are letting me retake the NBME exam on November 17. And I will not fail the clerkship per say, but I will receive a "conditional" grade in which there is a note in my Dean's Letter stating that I needed to remediate the NBME exam in order to pass the clerkship. It actually states my percentile when I failed, and then states my percentile when I (hopefully) pass on the retake. In fact our dean's letters include notes on all of our NBME shelf exams. Regardless, I will be able to only receive a maximum of a pass in the clerkship - so on my transcript, assuming all goes as planned, it will have a pass with an asterisk, and then at the bottom saying "upon successful remediation".

So basically I don't have to redo the rotation, but I have to successfully pass the NBME exam to pass the rotation. But describing the consequences above, you still think it is feasible to go for psych or med/psych residencies? I have meetings scheduled with the clerkship director & also one of my attendings next week, so hopefully I'll know more then, but for now I'm still kind of in panic mode.

Also I didn't even think of the possibility of a clerical error. I will see if there are any options as far as requesting a rescore. Thank you so much for your help, I really appreciate it 🙂

 

[dragonfly99]

Psych has so many IMG's...and you say your evals were good for psych.
I WOULD DEFINITELY have them check to make sure that there wasn't some grading mistake on your exam.
Also, study hard for the retake. Ask students who did well what books they studied with.
As long as you pass the USMLE on the first try, I would think you would not have any problem matching into psych. Med/psych - there are only a few programs and would think they are similar in competitiveness to psych or medicine by itself.

Psych is NOT a competitive residency to get. Just do a sub-I next year and make sure you still like it. As long as you do decent in the rest of third year, you should be able to explain away this test score when you interview or in your personal statement - just admit that you screwed up. It's just a blip on the screen and it won't matter that much in the end. It would keep you out of some programs (i.e. Harvard and very high places).

 

[QofQuimica]

Sorry that this happened to you. 🙁 I don't think you have to give up all hope over one test though. I would do three things if I were in your shoes:

1) Study my a** off for the next two weeks to ace the psych shelf on the retake. That will help give support to the idea that maybe you did misbubble or something, and plus you know that the new score will be reported along with the old one in your dean's letter.

2) Do at least one advanced rotation or a sub-I (maybe both) in psych, and make sure you earn honors in those.

3) I assume you haven't taken medicine yet. Bust your butt to get an honors in medicine too, including acing the medicine shelf.

Best of luck. 🙂

 

[Tired]

As long as you pass you will not have trouble finding a psych residency.

 

[PenguinHead]

^^ true

I know of people failing step 1 twice and still matching easily in psych. failing the psych shelf isn't going to be the end of you. good luck on the retake.

 

[NeuroTox]

A friend of mine who is a year ahead of me is interviewing and had a similar situation... he has plenty of interviews and is doing just fine. Just study hard and pass it this next time around 🙂

 

[Mazeroski60]

Thank you all so much for your helpful & encouraging responses. I took the advice I got here, and from many friends, residents, & attendings very seriously. I retook the psych shelf at the end of November. I studied as hard as I possibly could, whilst staying afloat on my inpatient medicine rotation i.e. couldn't commit as much time to focusing on psych as i would have, oh say during the psych rotation. The day I took it, I did not feel at all confident coming out of the exam.

So yesterday I got an email and I failed again! 🙁 The reported score I got from NBME was a 62 (the EXACT same score I got the first time!) I am currently still on my medicine rotation, and am enjoying it (as I expected I would), but am still heavily considering psych and/or med/psych residency programs.

My question is, now that this has happened, and I have essentially failed the rotation, is getting into psych even a possibility? I am completely assuming that med/psych would be out of the question. My school's policy is essentially that I go before the "academic progress committee" where I will undoubtedly be told I have to re-take the entire rotation (which is only 4 weeks, so its not catastrophic schedule-wise) but still.

Could use any advice! Please & thank you!

 

[LadyWolverine]

My school's policy is essentially that I go before the "academic progress committee" where I will undoubtedly be told I have to re-take the entire rotation (which is only 4 weeks, so its not catastrophic schedule-wise) but still.

I'm sorry to hear that you failed again. I know how draining your inpatient medicine rotation can be, and I can't imagine having to study for a very difficult shelf exam in another specialty while trying to stay afloat on IM. You probably didn't have enough time to study, and in retrospect it was probably a poor choice on the part of your school admin to have you take the shelf after 4 weeks of inpt med.

Look, I know you're probably pretty bummed, but maybe it's a good idea to repeat this rotation? Now you can focus on psych again, 100%, prep hardcore for your shelf (instead of trying to study while concurrently completing a totally different clerkship), and spend time on a rotation that you really enjoy. More exposure may solidify your desire to pursue a residency in psych, and maybe you can talk to your residents and attendings about what realistic choices you will have in the near future. If you received excellent marks for your performance during the rotation, maybe you'll really stand out again this time around. This is your chance to really express interest and establish a relationship with your home program.

 

[njbmd]

Thank you all so much for your helpful & encouraging responses. I took the advice I got here, and from many friends, residents, & attendings very seriously. I retook the psych shelf at the end of November. I studied as hard as I possibly could, whilst staying afloat on my inpatient medicine rotation i.e. couldn't commit as much time to focusing on psych as i would have, oh say during the psych rotation. The day I took it, I did not feel at all confident coming out of the exam.

So yesterday I got an email and I failed again! 🙁 The reported score I got from NBME was a 62 (the EXACT same score I got the first time!) I am currently still on my medicine rotation, and am enjoying it (as I expected I would), but am still heavily considering psych and/or med/psych residency programs.

My question is, now that this has happened, and I have essentially failed the rotation, is getting into psych even a possibility? I am completely assuming that med/psych would be out of the question. My school's policy is essentially that I go before the "academic progress committee" where I will undoubtedly be told I have to re-take the entire rotation (which is only 4 weeks, so its not catastrophic schedule-wise) but still.

Could use any advice! Please & thank you!

Again, as others have said, psych is not a particularly difficult specialty to enter meaning that there are usually more slots than applicants. This could definitely work in your favor. You might not have your "pick" of the higher caliber residency programs but with strong performances otherwise, you may be OK in the long run.

What is most problematic is why you have failed this shelf exam twice. You definitely need to figure this out as you don't want a third failure. Are you putting too much pressure on yourself because you are potentially interested in this field? In any event, go before your committee and see what they have to say. I can't imagine that if you retake the rotation and pass the shelf that there would be any dire consequences.

Consult the clerkship director and ask what references the most successful students are using and pick them up. Try to get the most from your retake of the rotation as for sure, you will be well-grounded in the subject matter. Most importantly, get this behind you as soon as you can so that you can move on and apply for residency. Finally, make sure that your performance in the retake of the clerkship is of the highest caliber. Go above and beyond with everything that you can and take no prisoners.

What is possible and not possible will depend on many things including your board scores (Step II) and your overall performance elsewhere.Don't rule out (or rule in) anything until you have put this behind you. You have some added pressure but you can certainly get beyond this if you set your mind to do so.

 

[peppy]

Sorry to hear about your difficulties. If it's any consolation, the Psych shelf exam is considered by a lot of people to be difficult. I've heard about a lot of people failing it unfortunately.
At residency interviews, you might be able to turn this experience to your benefit by saying that the extra effort you had to make to learn the material for the shelf exam helped solidify your interest in the field and reinforced your determination to succeed.
Many psych residencies seem to place more emphasis on your personality, how you get along with others, and your own mental stability than the numbers...so getting good LORs and shining in your interviews will go a long way to make up for this.
All the best to you!