FM PGY-1 wanting Psych transfer - chances?

[LeaveNoTrace]

PGY-1 in FM, looking to see what my chances as a psych transfer are like and any potential resources or tips to improve interview skills.

Stats:

US grad. Mid-tier MD school - something like the University of Vermont or Rutgers.
Class rank: bottom quartile
Preclinicals: pass/fail; all pass
Clinicals: third year all Pass, no failures
Fourth year: Pass in Pediatrics Sub-I, honors Psych Sub-I, high pass Child Psych rotation, Honors C-L Psych elective
Took research year; published paper in March 2024
No criminal record, disciplinary actions, or professionalism flags

Programs applied to: 140 psych, 60 FM

Interviews attended: 17 psych, 8 FM

Matched to sixth (of eight) FM program.

Program director currently very supportive of my intention to transfer to psych.

I think that my interview skills might need a lot of work and am open to suggestions. I've been thinking about this quite a bit, myself, and I've come up with some ideas already:

- Learn improv; seek acting and voice lessons in order to project a better presence.

- Address impostor syndrome/belief that I do not belong in psychiatry or medicine

- Get interview coaching/schedule practice interviews

- Get a much better Zoom setup than my laptop and microphone. Over Zoom, eye contact is hard: if you look at the camera, you miss the facial expressions, and if you look at the facial expressions you wind up not making eye contact. I've heard about setups used by corporate executives that do lots of Zoom calls that greatly decrease or even eliminate that. Yes, it might be overkill - but anything helps.

- Prepare more thoroughly for each interview. Learn as much as I can about the program, the program director, what each program is looking for in a resident, etc.

- Discuss background, style choices with theater design and interior designer friends - a blank white wall or a couple of pictures might not be cutting it.

Any advice here? Would taking step 3 before applying be a good idea?

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[Sushirolls]

Getting step 3 done could be a minor benefit. "this resident can pass their exam and we don't have to worry about them later."

Others who are closer to the relative competition or in academia will have a better feedback. I think I've now crossed the line of being too far out and removed to give quality feedback.

 

[LeaveNoTrace]

Getting step 3 done could be a minor benefit. "this resident can pass their exam and we don't have to worry about them later."

Others who are closer to the relative competition or in academia will have a better feedback. I think I've now crossed the line of being too far out and removed to give quality feedback.

Thanks. Any advice on interview skill development?

 

[FlowRate]

Do practice interviews with people you think are willing to give you direct, constructive feedback.

Some of your other ideas speak to almost an idea of improving a persona/"acting" for an interview, which could come across wrong if that ends up being your mindset.

Do you think you went into interviews unprepared previously? (re: "prepare more thoroughly")

 

[Merovinge]

Did you mention your Step score? I presume you passed Step 1 first try?

As far as interview goes, I would find any psych attending and practice at least a few times. If you have to pay a few hundred bucks for their time it would be entirely worth it. You can practice with lay folks as well but psychiatrists will know better how to help. I would be much less worried about your Zoom background, and much more worried about your ability to genuinely discuss your interest in psychiatry. Psychiatrists have much better bull**** meters than other fields, where frankly they might look upon you favorably for bull****ting.

 

[Celexa]

I'm a little surprised people are being as gentle with you so far as they are in answering. Your application was good enough to land a LOT of interviews, as these things go in the current environment, and you didn't match. The chances of matching increase fairly consistently up to around 12 interviews, and over that, the curve flattens. To have interviewed at 17 psych programs AND multiple family programs and almost not matched at all... Before trying again, you need to perform well in your current residency AND do some serious soul-searching and talking to people who know you to figure out what could have gone wrong in your interviews.

It's atypical enough for me to wonder if your PD is supportive of you switching specialities bc they are worried about having to remediate something and would rather you move on.

Generally as a dept adviser, I worry most about my students getting interviews and relax substantially once they have. It's very important to realize how truly unusual it is to have that many interviews and still not match.

 

[Sushirolls]

@Celexa has a point.

I have another thought, but I'll make a new thread.

 

[LeaveNoTrace]

I'm a little surprised people are being as gentle with you so far as they are in answering. Your application was good enough to land a LOT of interviews, as these things go in the current environment, and you didn't match. The chances of matching increase fairly consistently up to around 12 interviews, and over that, the curve flattens. To have interviewed at 17 psych programs AND multiple family programs and almost not matched at all... Before trying again, you need to perform well in your current residency AND do some serious soul-searching and talking to people who know you to figure out what could have gone wrong in your interviews.

It's atypical enough for me to wonder if your PD is supportive of you switching specialties bc they are worried about having to remediate something and would rather you move on.

Generally as a dept adviser, I worry most about my students getting interviews and relax substantially once they have. It's very important to realize how truly unusual it is to have that many interviews and still not match.

For what it is worth, I'm an URM; as such, might this have gotten me interviews that I would otherwise not have gotten? If candidates aren't all on a level playing field at interview, might my interview performance have needed to be better than the guy with the 250 on step 2 and 2nd quartile class rank in order to have a shot at matching? Of course - if they are on a level playing field or close to it, then my interview skills probably weren't up to snuff. As for FM: it might be possible that they saw the psych rotations I did during medical school and were able to tell that I was using FM as a backup specialty...on the other hand, there are probably lots of people like that.

 

[Celexa]

For what it is worth, I'm an URM; as such, might this have gotten me interviews that I would otherwise not have gotten? If candidates aren't all on a level playing field at interview, might my interview performance have needed to be better than the guy with the 250 on step 2 and 2nd quartile class rank in order to have a shot at matching? Of course - if they are on a level playing field or close to it, then my interview skills probably weren't up to snuff. As for FM: it might be possible that they saw the psych rotations I did during medical school and were able to tell that I was using FM as a backup specialty...on the other hand, there are probably lots of people like that.

Programs vary in exactly how they handle things after interview--some weight factors of the written application, and some treat it 100% blank slate from the interview. Enough do the latter that you do need to really be concerned it was something about how you interviewed. And even in places where they still take into account other parts of the application, the interview is still very important.

It is certainly possible the FM programs ranked you lower if worried they were backups, but that still leaves you with 17 psych interviews and no psych match, and as you say there are a lot of people using FM as a backup for psych these days.

I would honestly reach out to someone at your medical school, a Dean or maybe one of your letter writers, or the departmental adviser if there is one, to do a postmortem. Or, after settling in in your current residency program and truly doing well, revisiting this question next cycle or off cycle.

 

[LeaveNoTrace]

It's atypical enough for me to wonder if your PD is supportive of you switching specialties because they are worried about having to remediate something and would rather you move on.

Perhaps; however, several people in my program have left for other specialties, either intern year or second year, and the program has been extremely supportive. All of my co-interns and senior residents have been unfailingly kind; everyone talks about how kind people are and a lot of tears were shed at the graduation ceremony...on the other hand, I have heard of program directors trying to pass on the potentially-salvageable scratch-and-dent residents. On the third hand, I've also heard about PDs not wanting to send other PDs lemons.

 

[Sushirolls]

Thinking out loud... maybe good idea, maybe bad idea...
Your current FM PD has expressed support.
They still ranked you, AND you matched there, and you are still showing/building/reflecting quality professional relationships with current PD and staff.

This may be your cheapest, quickest, easiest source to get feedback. "Yo PD! You remember my interview days... give me feedback."

You might get the honest feedback you'd hope for. Other places and rotations might not give full honest review out of concern of liability or just being too busy.

 

[LeaveNoTrace]

Thinking out loud... maybe good idea, maybe bad idea...
Your current FM PD has expressed support.
They still ranked you, AND you matched there, and you are still showing/building/reflecting quality professional relationships with current PD and staff.

This may be your cheapest, quickest, easiest source to get feedback. "Yo PD! You remember my interview days... give me feedback."

You might get the honest feedback you'd hope for. Other places and rotations might not give full honest review out of concern of liability or just being too busy.

That's honestly a pretty good idea - I'd asked if there was anything that would keep them from being able to support me in transferring to psychiatry; they said no and connected me to people that may have contacts that would be able to help me out. They might be working diligently to flush lemons out of their program; however, the program is generally very supportive and kind. Also, would PDs want to risk their reputations by sending their friends at other programs their problematic or subpar residents?

 

[Sushirolls]

PDs know PDs in their own field, a few.
And they a few of the PDs in other fields at their large center.
FM and Psych are huge. No way they know everybody.

True lemons, PDs don't support. They sink.

 

[LeaveNoTrace]

PDs know PDs in their own field, a few.
And they a few of the PDs in other fields at their large center.
FM and Psych are huge. No way they know everybody.

True lemons, PDs don't support. They sink.

Right. I have some more personal information that I might want to PM you about. Let's just say that I have been told that I have a flat affect, and I am reasonably aware about why I fell so far in my rank list...

This being said, it is very possible that I might be a subpar-but-not-garbage resident. Kind of janky, but not a true dumpster fire that either gets good or gets booted. If that is the case, it might make sense to 1) work at improving and 2) get while the getting is good, improving interview skills with a bunch of practice and shooting my shot now.

 

[Sushirolls]

If you are going to take the shot, it's best taken early. More time the harder it is. Others could chime in, but post residency and board certification might stand another upsurge in odds, but at that point many are like, "bag it."

Flat affect can be a negative. Improving that in just a few months is a difficult feat. And who you have coaching you can vary the milage.

Its also difficult in that trying to short cut with mimicry only goes so far. We had one staff doc who was lively, and great sense of humor, and would be able to say things that now in cancel culture would have been like detonating a nuclear bomb. But the way this doc could deliver things was just good/acceptable/excellent. If others tried mimicking that patient encounter style - they would tank hard. So in some ways, you can't fully change you - but try to optimize you.

There was an IMG in my residency I noticed was coming across flat, mostly cultural but partly individual traits. I did what I could to encourage on rotation and in social settings American nuances and more lively social interactions. He did match, can't recall if that first cycle, or second cycle though.

 

[LeaveNoTrace]

If you are going to take the shot, it's best taken early. More time the harder it is. Others could chime in, but post residency and board certification might stand another upsurge in odds, but at that point many are like, "bag it."

That is what I am honestly leaning towards; I don't want to do two residencies or most of two residencies unless that is truly what it takes for me to practice psychiatry.

Flat affect can be a negative. Improving that in just a few months is a difficult feat. And who you have coaching you can vary the mileage.

Very true; I have some ideas about how best to do that. Been reading research papers and books on things like acting. Being more expressive and more in touch with my own emotions and those of my interviewers seems like a good way to go. I've been working hard at this and at communication skills in general for the past few years, and feel that I now do OK at building rapport with patients. On the other hand, I was also quite nervous in my interviews and my lack of confidence/impostor syndrome probably showed as well. This is something I'm now actively working on.

Its also difficult in that trying to short cut with mimicry only goes so far. We had one staff doc who was lively, and great sense of humor, and would be able to say things that now in cancel culture would have been like detonating a nuclear bomb. But the way this doc could deliver things was just good/acceptable/excellent. If others tried mimicking that patient encounter style - they would tank hard. So in some ways, you can't fully change you - but try to optimize you.

Agreed. For what it is worth, I am an excellent public speaker and got good mostly through solo practice/imitation in middle school. Interviews and things like that are rather different, though. Interestingly enough, my affect is not flat when I'm delivering a speech.

There was an IMG in my residency I noticed was coming across flat, mostly cultural but partly individual traits. I did what I could to encourage on rotation and in social settings American nuances and more lively social interactions. He did match, can't recall if that first cycle, or second cycle though.

I wonder - did he, like me, have body language that might be described as stiff or jerky? When you're more than a little flexible and also a bit clumsy, things can look awkward. There are ways around this, too - mindfulness meditation might be helpful and so too might dance - but I honestly haven't put very much work into it. I suspect that this sort of thing is reasonably easy to get OK at once you have figured out the problem; figuring out what's not exactly optimal is the hard part!