Gap year during/after med school

[Rogert]

I am in the unfortunate position of needing to consider taking a gap year. I am uncertain if the risks outweigh the benefits and would appreciate the insight of assorted internet strangers.

Relevant information:
4th year DO student interested in Psychiatry, preferably Child Psychiatry
Level 1: 253
Level 2: 276
Two PE failures. I am currently scheduled to take it a third time on Tuesday. I did a practice exam today with standardized patients and I don't believe it went well.
Letters of recommendations: I presently only have two letters and only one from a psychiatrist though not for lack of people saying they will write them.
86 programs applied to, 0 interviews. According to the residencies I've spoken to, this is because my application was never considered complete due to the above concerns.

Taking a gap year would allow me time to work with my school to ensure I'm capable of checking all the boxes I need to check and pass this test. It would also allow all of my letters to be in the system when I reapply. However, I would need to admit that I needed to delay graduating in order to pass a test 90%+ of people pass on the first attempt in addition to the already existing two failures. I am unsure if this would make me look worse than I already do to programs for next years match. I am also unsure what I would be doing with my time or how I would financially support myself over the year.

Going forward on Tuesday runs the risk of me failing for a third time leading to me being barred from graduation from my school. On the other hand, it would give me the opportunity of scrambling into a residency this year.

To me, the proper choice seems to be delaying a year as it is less likely to end my career on the spot however I don't know if the reward is actually worth the risk. As such, I would appreciate input regarding anything I might be missing in this decision. Thank you.

---

Members don't see this ad.

 

[adaptation1]

That's not an easy situation. Whatever you choose, I'm rooting for you. I know you are looking for practical advice and hope you get it.

 

[downwithDTB]

1) don't you need a 400 to pass the comlexes?
2) the risk of failing the third time is very serious. you need someone to give you very honest and critical feedback on your skills so that you know exactly what you need to address to pass and then spend a lot of time working to improve this.
3) given the debt and the potential income in medicine, if you like medicine at all you should really be doing everything you can to match. This year is a wash. You have clear deficiencies and should ask people at your school to give it to you straight in the toughest way possible. Take that to heart and spend a year correcting the deficiencies. Work at Target for money if you need to, but correct your deficiencies. Get a letter from someone saying what you have improved. Write a PS saying that you realized that you have difficulty with x and then you spend a year correcting it. Then apply to every program that has taken a do or a carribean grad and some FM and neuro or peds programs.

Take home message: figure out what you are doing wrong, take it to heart and get better at it. You can do that and if you take the challenge; however, you need to be more active this time around in soliciting honest feedback and getting letters on time. Get a psychiatist or good psychotherapist if you need to.

 

[finalpsychyear]

Speak with your dean sometimes there can be multiple deans on what to do. I don't know what PE means if that's something school dependent or standardized like step 2 CS. If failing it a 3rd time ends your chances for graduation thats a huge risk. You should be significantly improved from your past 2 failures to roll that dice. I guess you have to decide if you have improved significantly from the first 2 times to warrant a 3rd attempt in your current time frame.

However, if passing was arbitrarily 70 for this PE exam and your previous scores were like 55 and then 60 I personally would hold off if the consequence was dismissal from your school. If you got like a 69 o the second attempt and have improved further since then i would talk to your dean and or clinical attendings on your dilemma. I doubt they will encourage you to try attempt number 3 if they feel your still weak.

Regardless, please seek your school advisors and dean and clinical attendings who know your your skill strengths and weaknesses prior to making this decision but what i wrote above are a few factors you will want to consider but MOSTLY you should seek the deans, mentors, and clinical advisors who have been grading you as they will know best for your situation.

 

[splik]

If you take a year off, you need to make it useful. It cannot appear to be for the sole purpose of having to repeat this exam. It should add some value to your story and help your career trajectory. And not research - that's not going to help you. you could do an MPH or MBA or MEd or a medical education fellowship or get involved in advocacy or something that lights a fire in your belly.

Either way, I have to tell you that you have no hope in hell of matching into psychiatry directly. You should try to get into something else, I would suggest pediatrics. Then after a successful intern year or residency completion in say pediatrics, you could apply for psychiatry residency or child psychiatry fellowship (some of the child psychiatry fellowships that are not reputable and cannot fill will accept people who have not finished their psychiatry residency, and then you can go onto psychiatry residency backwards - after the fellowship). In addition, there are a few post peds portal programs which allow you to complete psychiatry and child psychiatry residency in 3 yrs following peds residency.

 

[Rogert]

1) don't you need a 400 to pass the comlexes?
2) the risk of failing the third time is very serious. you need someone to give you very honest and critical feedback on your skills so that you know exactly what you need to address to pass and then spend a lot of time working to improve this.
3) given the debt and the potential income in medicine, if you like medicine at all you should really be doing everything you can to match. This year is a wash. You have clear deficiencies and should ask people at your school to give it to you straight in the toughest way possible. Take that to heart and spend a year correcting the deficiencies. Work at Target for money if you need to, but correct your deficiencies. Get a letter from someone saying what you have improved. Write a PS saying that you realized that you have difficulty with x and then you spend a year correcting it. Then apply to every program that has taken a do or a carribean grad and some FM and neuro or peds programs.

Take home message: figure out what you are doing wrong, take it to heart and get better at it. You can do that and if you take the challenge; however, you need to be more active this time around in soliciting honest feedback and getting letters on time. Get a psychiatist or good psychotherapist if you need to.

I think passing is like 200? I passed which is all I cared about.

Speak with your dean sometimes there can be multiple deans on what to do. I don't know what PE means if that's something school dependent or standardized like step 2 CS. If failing it a 3rd time ends your chances for graduation thats a huge risk. You should be significantly improved from your past 2 failures to roll that dice. I guess you have to decide if you have improved significantly from the first 2 times to warrant a 3rd attempt in your current time frame.

However, if passing was arbitrarily 70 for this PE exam and your previous scores were like 55 and then 60 I personally would hold off if the consequence was dismissal from your school. If you got like a 69 o the second attempt and have improved further since then i would talk to your dean and or clinical attendings on your dilemma. I doubt they will encourage you to try attempt number 3 if they feel your still weak.

Regardless, please seek your school advisors and dean and clinical attendings who know your your skill strengths and weaknesses prior to making this decision but what i wrote above are a few factors you will want to consider but MOSTLY you should seek the deans, mentors, and clinical advisors who have been grading you as they will know best for your situation.

The PE is the DO equivalent of the Step 2 CS. As a result, I have no real feedback other than "you failed." I am working with a doctor who had previously helped grade the test and I would have access to my school's standardized patients.

If you take a year off, you need to make it useful. It cannot appear to be for the sole purpose of having to repeat this exam. It should add some value to your story and help your career trajectory. And not research - that's not going to help you. you could do an MPH or MBA or MEd or a medical education fellowship or get involved in advocacy or something that lights a fire in your belly.

Either way, I have to tell you that you have no hope in hell of matching into psychiatry directly. You should try to get into something else, I would suggest pediatrics. Then after a successful intern year or residency completion in say pediatrics, you could apply for psychiatry residency or child psychiatry fellowship (some of the child psychiatry fellowships that are not reputable and cannot fill will accept people who have not finished their psychiatry residency, and then you can go onto psychiatry residency backwards - after the fellowship). In addition, there are a few post peds portal programs which allow you to complete psychiatry and child psychiatry residency in 3 yrs following peds residency.

This would be my biggest reservation, though I am curious the reasoning. The few people I have talked to so far about this have all assumed that research is what would be expected. My plans were to either go back to being an orderly at the psych hospital I used to work at or find some some temp social work position but the focus would have been the test since as far as I know it's the largest barrier to me matching that I have control of. Would those degrees be beneficial? I've read elsewhere they aren't useful for reapplicants.

Saying I have no shot at psych is also curious to me. I just finished an audition rotation yesterday and a member of the selection committee talked to me and gave me the idea of taking a year off and reapplying next year. Do mind explaining your reasoning a bit?

 

[futuredo32]

Why are you failing the PE exam- the DO version of the allopathic CS exam? Does your school prep you for this at all? Is anxiety playing a role- if so see your doctor and try low dose propranolol or Xanax prior to make sure you don't have any negative effects and use it for the exam. Did you buy the first aid book for the PE exam? ( Take a trial dose over the weekend to make sure you don't have any adverse effects) . We are talking about the step 2 exam where you examine live patients and write a note and it's on camera?) I read the First Aid book for CS and it was helpful, it's a super fast read. Can you have someone at your school work with you? If you don't pass, you honestly may not match or get interviews because they are worried either a. there is a significant deficit in your ability to conduct a physical exam and communicate effectively with patients or b, that you may not pass in time to start residency. This exam is still pass/fail? I have massive test anxiety but I did quite well on this exam. Are they still showing you where your deficit is on the score report? Are you washing your hands with each patient, knocking on the door, keeping the patient covered and being respectful at all times ie the basics. On the patients who are basically asking for OMM (it was beyond obvious when I took it that's what they wanted). I explained OMM to the patient, one was on an area I didn't really know much about. I think I called it joint play, don't do HVLA on anyone. I would see if you can meet with someone at your school who knows about the exam and have them work with you as much as possible until the exam and get their opinion on whether you are ready to take it. I took a gap year after graduating to care for my Grandma but volunteered in a free clinic, if you don't match into anything, I would also shadow at a few programs for a week or two if they allow you to. Send your letter writers a reminder that you need your letters please. Malingering can be in your differential diagnosis. Don't put refer to another specialty in your treatment plan. Is English your native language? Are you empathetic with your patients? Have you had trouble with patients on your FP rotations?
If it were me, I would call your Dean and see if the person in charge of the practice PE exam can work with you as much as possible prior to Tuesday and read the First Aid book. If you can do this and the person doesn't think you are likely to pass, personally I would wait and take it later this year and at least pick up a traditional rotating year or transitional year and I would start applying for these positions ASAP as a plan B. It should not take you an entire year to prepare for the CS exam. Find your weakness(es) and work on those. I actually had to take the psych board exam three times, but I found the CS really easy. I know we all have our strengths and weaknesses. The CS was a long day but doable. I think the key for you will be working with someone at your school (faculty) for a patient or two and finding the problem about WHY you are failing. Unless there is a vast knowledge or personality issue it's likely an easy fix. The patient says they have pain or SOB, say "I'm sorry,that must be hard to deal with, I am going to try to find out the cause and see what we can do to help you feel better" When you are done with one patient, forget that patient and move on to the next patient. I totally blew one patient's diagnosis and still did fine, I can't reveal why because of the non disclosure cause but the patient dropped a huge piece of information which was key as I was leaving the room, which I asked about early on. When I took it, there were two that didn't count and you didn't know which two. If they are having SOB your differential can be pneumonia, asthma, CHF, PE, malingering. Plan labs, CXR, the basics.
Amazon product

 

[PikminOC]

I hope u pass the test. Can you do a prelim or transition year of residency?

 

[Rogert]

Why are you failing the PE exam- the DO version of the allopathic CS exam? Does your school prep you for this at all? Is anxiety playing a role- if so see your doctor and try low dose propranolol or Xanax prior to make sure you don't have any negative effects and use it for the exam. Did you buy the first aid book for the PE exam? ( Take a trial dose over the weekend to make sure you don't have any adverse effects) . We are talking about the step 2 exam where you examine live patients and write a note and it's on camera?) I read the First Aid book for CS and it was helpful, it's a super fast read. Can you have someone at your school work with you? If you don't pass, you honestly may not match or get interviews because they are worried either a. there is a significant deficit in your ability to conduct a physical exam and communicate effectively with patients or b, that you may not pass in time to start residency. This exam is still pass/fail? I have massive test anxiety but I did quite well on this exam. Are they still showing you where your deficit is on the score report? Are you washing your hands with each patient, knocking on the door, keeping the patient covered and being respectful at all times ie the basics. On the patients who are basically asking for OMM (it was beyond obvious when I took it that's what they wanted). I explained OMM to the patient, one was on an area I didn't really know much about. I think I called it joint play, don't do HVLA on anyone. I would see if you can meet with someone at your school who knows about the exam and have them work with you as much as possible until the exam and get their opinion on whether you are ready to take it. I took a gap year after graduating to care for my Grandma but volunteered in a free clinic, if you don't match into anything, I would also shadow at a few programs for a week or two if they allow you to. Send your letter writers a reminder that you need your letters please. Malingering can be in your differential diagnosis. Don't put refer to another specialty in your treatment plan. Is English your native language? Are you empathetic with your patients? Have you had trouble with patients on your FP rotations?
If it were me, I would call your Dean and see if the person in charge of the practice PE exam can work with you as much as possible prior to Tuesday and read the First Aid book. If you can do this and the person doesn't think you are likely to pass, personally I would wait and take it later this year and at least pick up a traditional rotating year or transitional year and I would start applying for these positions ASAP as a plan B. It should not take you an entire year to prepare for the CS exam. Find your weakness(es) and work on those. I actually had to take the psych board exam three times, but I found the CS really easy. I know we all have our strengths and weaknesses. The CS was a long day but doable. I think the key for you will be working with someone at your school (faculty) for a patient or two and finding the problem about WHY you are failing. Unless there is a vast knowledge or personality issue it's likely an easy fix. The patient says they have pain or SOB, say "I'm sorry,that must be hard to deal with, I am going to try to find out the cause and see what we can do to help you feel better" When you are done with one patient, forget that patient and move on to the next patient. I totally blew one patient's diagnosis and still did fine, I can't reveal why because of the non disclosure cause but the patient dropped a huge piece of information which was key as I was leaving the room, which I asked about early on. When I took it, there were two that didn't count and you didn't know which two. If they are having SOB your differential can be pneumonia, asthma, CHF, PE, malingering. Plan labs, CXR, the basics.
Amazon product

If I choose to go forward with the exam on Tuesday, a doctor who does/did help score the exam will be providing me with resources to prepare. I had previously been using a similar textbook to what you linked but geared towards the PE. It's the same textbook nearly all of my classmates used. I aced the humanistic portion of the exam on the first attempt but failed it the second despite not actively changing anything in that aspect. I've been doing audition rotations for the past few months and have received nothing but praise, particularly regarding patient interaction. I initially struggled with checking off enough boxes during data gathering but I fixed that the second time around. I don't believe I was an all-star during my FM rotation but I was trusted enough to be the lead on cases when things got to busy for my resident to do in a timely manner and one of my letters is from an FM doc. I'm still waiting to get an official summary of my practice yesterday, but I felt that I was globally subpar. To me that speaks to a confidence/anxiety issue as I've demonstrated competency in all of the areas individually. I may of course be missing something/overestimating myself.

I hope u pass the test. Can you do a prelim or transition year of residency?

I appreciate the support. I cannot qualify for any residency unless I pass this test. And until my letter writers complete their letters but I have little control over that.

 

[futuredo32]

Actually you can "remind" your letters to send in.

 

[MacDonaldTriad]

I think it is unlikely you will manage to SOAP into a psychiatry position this match. Last match there were something like 8 slots nationally and most of these were research tracks. If that is your plan, you will likely be taking a gap year planned or not. If you are willing to scramble into a TY year or FM or Peds, you have a good chance, but you have to graduate.

 

[downwithDTB]

The PE is the DO equivalent of the Step 2 CS. As a result, I have no real feedback other than "you failed." I am working with a doctor who had previously helped grade the test and I would have access to my school's standardized patients.

This would be my biggest reservation, though I am curious the reasoning. The few people I have talked to so far about this have all assumed that research is what would be expected. Would those degrees be beneficial? I've read elsewhere they aren't useful for reapplicants.

Saying I have no shot at psych is also curious to me. I just finished an audition rotation yesterday and a member of the selection committee talked to me and gave me the idea of taking a year off and reapplying next year. Do mind explaining your reasoning a bit?

Your application has two major red flags: 1) two LORs and 2) two PE fails; more importantly your application is moot if you fail PE once more.

Before going any further, you need good information as to why those things happened. Talk to the doc above; ask for lots of feedback from the standardize patients. Don't walk into PE saying I "think I did bad with the standardized patients." You must *know* how you did. If you did what you did in PE and they are saying "great job" they don't know what they are talking about. Ask a dean what you can do better. Make sure you insist on honest feedback, "I *must* have a real deficit because I failed PE twice and only got two LORs, can you please help me figure this out."

Regarding what to do next year: research helps people who are good and research and want to do research most. A prelim or trad internship would be great, BUT only if you don't have to risk rushing PE to do it, and I suspect that you would. When I see a red flag in an application, I want to know how the person learned and grew from it, not did they do some irrelevant CV booster. Did they see someone to treat the anxiety/other condition interfering with performance and pass PE? Did they realize they have poor interpersonal skills and do extra clinical work and take improv classes? The only way to figure out what to do next is to learn what you need to fix and work really hard at it.

Finally, I did not say that psych is out for you. I said, it's not worth risking taking PE when you don't think you've addressed the problem and that next year applying to DO friendly, less competitive specialties AND psych might not be a bad idea, just in case. If you address your weaknesses well, you very well may match into psych.

 

[samac]

For one those aren’t your level scores. That exam is scored with 400 as passing. Do you mean 453? That makes a difference. If so it’s on the lower end of things and that’ll hurt.
Not having all your letters definitely hurt. I don’t know how that happened either.
The PE is a stupid exam that’s super subjective. It doesn’t reflect a good clinician and I’m sorry this happened to you.
That aside it seems like you went into this whole process with an extreme lack of understanding and unpreparedness. I dont think that’s all on you, DO schools are notoriously not very helpful. At least mine isn’t. A couple options: take the test and throw it all into the SOAP this year into an FM/Peds position. Psych is unlikely.
option 2: Delay graduation with your school. While doing this do something productive. You can try psych again but I still think it would be a hard long road. If you’re willing to do another field I’d definitely apply to that too.

 

[TexasPhysician]

This is a tough call. Failing a third time apparently ends your career. Matching will already be difficult with 2 failures, but taking a gap year will add another red flag.

In what areas did you struggle with PE/CS? How close were you to passing.

 

[Rogert]

Your application has two major red flags: 1) two LORs and 2) two PE fails; more importantly your application is moot if you fail PE once more.

Before going any further, you need good information as to why those things happened. Talk to the doc above; ask for lots of feedback from the standardize patients. Don't walk into PE saying I "think I did bad with the standardized patients." You must *know* how you did. If you did what you did in PE and they are saying "great job" they don't know what they are talking about. Ask a dean what you can do better. Make sure you insist on honest feedback, "I *must* have a real deficit because I failed PE twice and only got two LORs, can you please help me figure this out."

Regarding what to do next year: research helps people who are good and research and want to do research most. A prelim or trad internship would be great, BUT only if you don't have to risk rushing PE to do it, and I suspect that you would. When I see a red flag in an application, I want to know how the person learned and grew from it, not did they do some irrelevant CV booster. Did they see someone to treat the anxiety/other condition interfering with performance and pass PE? Did they realize they have poor interpersonal skills and do extra clinical work and take improv classes? The only way to figure out what to do next is to learn what you need to fix and work really hard at it.

Finally, I did not say that psych is out for you. I said, it's not worth risking taking PE when you don't think you've addressed the problem and that next year applying to DO friendly, less competitive specialties AND psych might not be a bad idea, just in case. If you address your weaknesses well, you very well may match into psych.

Apologies, I was multiquoting and someone else had said I didn't have a shot. To be fair, I don't "only" have two LoRs. I just two in the system. I have periodically tried to contact the individuals so that I would have four (five as of yesterday) in the system. But, sincerely, thank you for your perspective. I will be working hard this next year to work on my deficits.

For one those aren’t your level scores. That exam is scored with 400 as passing. Do you mean 453? That makes a difference. If so it’s on the lower end of things and that’ll hurt.
Not having all your letters definitely hurt. I don’t know how that happened either.
The PE is a stupid exam that’s super subjective. It doesn’t reflect a good clinician and I’m sorry this happened to you.
That aside it seems like you went into this whole process with an extreme lack of understanding and unpreparedness. I dont think that’s all on you, DO schools are notoriously not very helpful. At least mine isn’t. A couple options: take the test and throw it all into the SOAP this year into an FM/Peds position. Psych is unlikely.
option 2: Delay graduation with your school. While doing this do something productive. You can try psych again but I still think it would be a hard long road. If you’re willing to do another field I’d definitely apply to that too.

It was definitely 453. That other poster was right, I'm just frazzled. For the letters, I haven't had a problem getting people to agree to write them, just getting them to actually write them and put them in the system. As of yesterday, I'm officially delaying graduation. Still not sure how I'll spending my time next year but the plan is to reapply next year to psych and peds.

This is a tough call. Failing a third time apparently ends your career. Matching will already be difficult with 2 failures, but taking a gap year will add another red flag.

In what areas did you struggle with PE/CS? How close were you to passing.

The first time I failed the data gathering part. The second time I studied up and passed that but failed the humanistic portion despite only actively changing things I had seen from my study materials. So I have passed each area individually just not all together. They don't tell you qualitatively what went wrong or how close you were though.

 

[TexasPhysician]

This is definitely a personal decision as the risks are quite high.

Personally, I would study all weekend and take it. If I couldn’t appeal/re-take, I’d spin off and get a MBA from as good of a program as I can. I’d then transition into healthcare related business by marketing my MD. I have friends that have done this on purpose, and they seem happy with it.

Pass and I’d also apply to all prelim spots in an attempt to land anywhere now. Prelim spots can set you up well for a PGY2 psych spot.

This is my personal opinion as I have no interest in delaying life with unknowns for another year with a lack of control. There isn’t a right or wrong here though. Either way, go into it knowing you have a bright future despite the outcome.

 

[downwithDTB]

If I couldn’t appeal/re-take, I’d spin off and get a MBA from as good of a program as I can. I’d then transition into healthcare related business by marketing my MD.

Your plan is reasonable; however, if one fails the same step (1, 2 or PE) three times, they are barred from graduating with their MD/DO or ever practicing as a physician. I don't know if businesses would look as favorably on someone who didn't graduate with their MD/DO as they would on an MBA, MD/DO. I assume that your friends who went this route actually graduated med school?

 

[TexasPhysician]

Your plan is reasonable; however, if one fails the same step (1, 2 or PE) three times, they are barred from graduating with their MD/DO or ever practicing as a physician. I don't know if businesses would look as favorably on someone who didn't graduate with their MD/DO as they would on an MBA, MD/DO. I assume that your friends who went this route actually graduated med school?

My friends did pass step and graduate. FSMB lists some states allowing licenses for physicians with up to 5 failures per step, so I don’t see why schools wouldn’t have some sort of appeals process and allow exceptions. Certainly worth a thorough discussion with your school.

 

[futuredo32]

Your plan is reasonable; however, if one fails the same step (1, 2 or PE) three times, they are barred from graduating with their MD/DO or ever practicing as a physician. I don't know if businesses would look as favorably on someone who didn't graduate with their MD/DO as they would on an MBA, MD/DO. I assume that your friends who went this route actually graduated med school?

Is this new? I know of someone who failed one of the step exams 5x and they are now a practicing physician .

 

[futuredo32]

Today is Tuesday, if you opted to take it, I hope you do well.

 

[downwithDTB]

Is this new? I know of someone who failed one of the step exams 5x and they are now a practicing physician .

Apparently there are states you can fail 5x? Who knew. I had always heard 3x, but maybe that's state and school dependant. In any case, OP said their school has a limit of three.

 

[Rogert]

Today is Tuesday, if you opted to take it, I hope you do well.

I appreciate the well wishes. I decided it was in my best interest to delay taking the test and graduate next year.

 

[futuredo32]

I appreciate the well wishes. I decided it was in my best interest to delay taking the test and graduate next year.

I live in Michigan and will be home some weekends but am working in God forsaken Bangor Maine for the next 12 months. IF you live in either state and want someone to practice with, just let me know. I had no idea about the three times for taking a board exam rule. This is just one more hurdle to jump and you have jumped many to get where you are. You can do this. Good luck and make the extra year count and also take some time to do fun stuff.

 

[futuredo32]

And honestly my application may as well have been red flag. I matched. So you aren't going somewhere "prestigious" I am sure after you pass your CS you will match somewhere

 

[meow1985]

Pssst: I agree with applying to another specialty when you do apply. I would also consider pre-match psych programs. Though this is just an n of one, I have a friend with lots of red flags who got offered a slot at one. They took 6 years to graduate med school (not due to failures but due to taking time off and dropping several classes due to personal issues), mediocre grades and scores, and went through the match once and didn't match. They then got offered a prematch spot and decided to take it. Prematch programs generally aren't very good, but at a certain point, residency is residency.