Fiancé in residency program failed Step 3 exam for the third time. Seeking guidance on next step

[stresstest06]

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I posted here a few weeks ago about my fiancée, who is a PGY-2 resident in a TX FM program, failing Step 3 on her third attempt, and the people here were incredibly helpful. I’m hoping to get some guidance again now that she has received some feedback from her program. She’s been extremely shaken up by this whole experience and can’t seem to think clearly right now. As an engineer with no healthcare-related network or familiarity with how these situations are typically handled, I’m turning to the good folks on this forum for advice and perspective.

From what she shared with me, her PD seems to be supportive and the PD suggested that my fiancée considers resigning and transferring to a different program, and even mentioned that she would personally write her a strong LOR if she chooses to go that route. The alternative is that, given her overall clinical performance and standing within the program, they may consider allowing her to repeat PGY-2. However, that decision would require approval from the Clinical Competency Committee and university leadership. PD also mentioned that the chances of that happening may be slim.

So now we’re trying to understand the long-term implications if she resigns. Does resigning significantly hurt her chances of being accepted into another residency program in the future? Instead of resigning, should she ask the program to fire her? Would she be better off stepping away for a few months, focusing entirely on passing Step 3 on her final attempt, and then applying for PGY-2 openings afterward?

If she does take time off, realistically she probably wouldn’t retake Step 3 until the September/October timeframe. Do programs typically recruit for PGY-2 positions around that time, or are most positions already filled by then and she'll have to wait til Summer 2027? Is there a website or process for PGY-2 applicants?

Link to the original post: Fiancé in residency program failed Step 3 exam for the third time. Is her medical career over?

 

[smq123]

I posted here a few weeks ago about my fiancée, who is a PGY-2 resident in a TX FM program, failing Step 3 on her third attempt, and the people here were incredibly helpful. I’m hoping to get some guidance again now that she has received some feedback from her program. She’s been extremely shaken up by this whole experience and can’t seem to think clearly right now. As an engineer with no healthcare-related network or familiarity with how these situations are typically handled, I’m turning to the good folks on this forum for advice and perspective.

From what she shared with me, her PD seems to be supportive and the PD suggested that my fiancée considers resigning and transferring to a different program, and even mentioned that she would personally write her a strong LOR if she chooses to go that route. The alternative is that, given her overall clinical performance and standing within the program, they may consider allowing her to repeat PGY-2. However, that decision would require approval from the Clinical Competency Committee and university leadership. PD also mentioned that the chances of that happening may be slim.

So now we’re trying to understand the long-term implications if she resigns. Does resigning significantly hurt her chances of being accepted into another residency program in the future? Instead of resigning, should she ask the program to fire her? Would she be better off stepping away for a few months, focusing entirely on passing Step 3 on her final attempt, and then applying for PGY-2 openings afterward?

If she does take time off, realistically she probably wouldn’t retake Step 3 until the September/October timeframe. Do programs typically recruit for PGY-2 positions around that time, or are most positions already filled by then and she'll have to wait til Summer 2027? Is there a website or process for PGY-2 applicants?

Link to the original post: Fiancé in residency program failed Step 3 exam for the third time. Is her medical career over?

I hope for her sake that they allow her to repeat PGY-2. That is probably the easiest route for her.

To answer your last question, no, most programs don't typically recruit for PGY-2s in September. The new residency/academic year starts July 1, so they will be getting into their groove by then. There is a chance that she will find an open spot because someone will realize in August, "oh, I should do something else" and then quits right away, but I wouldn't bank on that. She'd have to retake Step 3 in September/October, and start looking for open PGY-2 slots around then. She may not find any, however, until later in the year - late winter/early spring; that is typically when people who are switching residency programs or switching specialties will have an idea of if they can make the jump, opening up a slot for your fiancee. The benefit of that plan is that, assuming that she passes Step 3, programs will feel less anxious about taking her on. The worst case for a program director would be to agree to take her, only for her to fail Step 3 again, which would put the new program in a real bind - I suspect that most programs would just decline to accept her as a PGY-2 unless she can prove that she's passed Step 3.

In her particular case, I suspect that the distinction between "being asked to resign" and "fired" is largely semantics.

 

[stresstest06]

I hope for her sake that they allow her to repeat PGY-2. That is probably the easiest route for her.

I’m hoping for that as well, but my biggest concern is how staying in the program might impact her ability to prepare for the exam, especially since this 4th attempt is essentially make-or-break for her. Part of me keeps wondering whether it might be better for her mental health and overall preparation to take some time off and fully focus on studying for this final attempt.

late winter/early spring; that is typically when people who are switching residency programs or switching specialties will have an idea of if they can make the jump, opening up a slot for your fiancee. The benefit of that plan is that, assuming that she passes Step 3, programs will feel less anxious about taking her on. The worst case for a program director would be to agree to take her, only for her to fail Step 3 again, which would put the new program in a real bind - I suspect that most programs would just decline to accept her as a PGY-2 unless she can prove that she's passed Step 3.

So she'll likely start looking for PGY-2 openings around December, and if she ultimately decides to leave her current program, it sounds like she’d be in a much stronger position if she passes Step 3 before applying elsewhere. Assuming she clears that final Step 3 hurdle, how difficult do you think it would realistically be for her to secure another residency position? Also, if she decides to transfer and she needs repeat PGY-2, does she need to clear Step 3 prior to applying to other programs?

In her particular case, I suspect that the distinction between "being asked to resign" and "fired" is largely semantics.

Would either option negatively impact her ability to secure another residency position and continue her training in the future? I keep coming across discussions on Reddit and other forums mentioning ACGME-related concerns, but I’m not fully understanding how those issues factor into situations like this.

Finally, how do residents typically find PGY-2 openings? I’ve seen Residency Swap mentioned on my previous post, but are there other common avenues/ websites or resources people use as well?

 

[smq123]

Assuming she clears that final Step 3 hurdle, how difficult do you think it would realistically be for her to secure another residency position? Also, if she decides to transfer and she needs repeat PGY-2, does she need to clear Step 3 prior to applying to other programs?

Would either option negatively impact her ability to secure another residency position and continue her training in the future? I keep coming across discussions on Reddit and other forums mentioning ACGME-related concerns, but I’m not fully understanding how those issues factor into situations like this.

Finally, how do residents typically find PGY-2 openings? I’ve seen Residency Swap mentioned on my previous post, but are there other common avenues/ websites or resources people use as well?

Given your fiancee's situation, I think that if she wants to apply for another residency position, she absolutely needs to do it with a passing Step 3 score in hand. I find it hard to believe that a program director would be willing to go through the hassle of getting your fiancee a position in their program, when there is a very real risk that she will ultimately not pass Step 3 on her next try either. So for her to get another position, I think she absolutely needs to pass Step 3 first.

As for how realistic it is to secure another residency position - it's hard to say. It helps that family med is not competitive and that there are lots of slots across the country. If she is not picky about geographic location, that's even better. If she's tied to Texas or one particular region, that makes it harder.

With regards to firing vs resignation, I think that it does not matter when it comes to applying for another residency position. It may matter for licensing and credentialing down the road - resignation is probably better. But in the immediate situation, I don't think it makes much difference.

Residents usually find PGY-2 openings through word of mouth or cold-calling. Just sending out emails to any and all programs that they can find. Residency Swap usually requires a fee and a lot of people don't think it's useful any longer. If your fiancee's program director is willing to help, they may be able to find programs with open PGY-2 slots - I believe many specialties have a listserv that the program directors are on.

 

[stresstest06]

Residents usually find PGY-2 openings through word of mouth or cold-calling. Just sending out emails to any and all programs that they can find

Appreciate you taking the time to reply. How do we usually find the programs? Is it usually through ACGME website? Sorry my fiancé most likely knows, but I'm trying not to discuss this situation with her much.

 

[NotAProgDirector]

Although there is no rule/law/requirement that she pass S3 to get a new PGY-2 spot, in her case it's practically required. Her program letter is likely to say "was a fantastic resident, we would have kept her except for her inability to meet our S3 requirement". Without it, few programs will consider her.

I agree with you that she's probably better off just focusing on S3 and not trying to be a resident at the same time. I say this with some reluctance, as some people become depressed when they are removed from training, and if she spirals her exam performance will likely not improve. But in this case a timeline of July/Aug to prep for an exam in Sept?Oct makes sense.

Agree with others about the timeline. Programs will end up with open PGY-2 spots because other residents fail to progress (like her) or try to switch specialties, or transfer programs due to personal issues which is much less common. Or, programs increase their complement and have new spots available. Open spots tend to start cropping up in January to March. There is no perfect way to find them - the best way is to have her current PD reach out to programs to see if anyone has an open spot. Cold contacting programs - plan for a very high rate of rejections or no response at all. Watch the ACGME site for new programs, or programs that are increasing in size.

Regarding resigning vs just letting her current contract expire (she wouldn't really get "fired") there is no practical difference. "Resign" at the end of her current contract is her best option.

 

[stresstest06]

Although there is no rule/law/requirement that she pass S3 to get a new PGY-2 spot, in her case it's practically required. Her program letter is likely to say "was a fantastic resident, we would have kept her except for her inability to meet our S3 requirement". Without it, few programs will consider her.

I agree with you that she's probably better off just focusing on S3 and not trying to be a resident at the same time. I say this with some reluctance, as some people become depressed when they are removed from training, and if she spirals her exam performance will likely not improve. But in this case a timeline of July/Aug to prep for an exam in Sept?Oct makes sense.

Agree with others about the timeline. Programs will end up with open PGY-2 spots because other residents fail to progress (like her) or try to switch specialties, or transfer programs due to personal issues which is much less common. Or, programs increase their complement and have new spots available. Open spots tend to start cropping up in January to March. There is no perfect way to find them - the best way is to have her current PD reach out to programs to see if anyone has an open spot. Cold contacting programs - plan for a very high rate of rejections or no response at all. Watch the ACGME site for new programs, or programs that are increasing in size.

Regarding resigning vs just letting her current contract expire (she wouldn't really get "fired") there is no practical difference. "Resign" at the end of her current contract is her best option.

Appreciate your input and the additional feedback.