Give me some ideas of what to apply into (bad student)

[psych2028]

Ok gang. I have been a pretty below avg student with several bumps in the road. The main ones being a failed step 1 (passed on 2nd attempt) and a failed IM shelf (passed on retake). Both fails have pretty extenuating circumstances but nobody really cares. Besides that, no failed classes, and I have gotten a mix of pass and HP on all core rotations with good written evals. All shelf exams have been around 40-50th percentile (with exception of IM but my retake was right back to normal 50th percentile). I've been on a few underwhelming research projects, have a fair amount of involvement in ECs/student groups, and have extensive work experience before med school as I am a non-trad with a good narrative leading up to the pursuit of medicine.

Anyways, I have been figuring I'd go into psych since day 1 due to pre-med school interests and multiple years of pertinent meaningful work experience....w/ subsequent research and ECs in med school. However, I am questioning that path not only because it is getting really competitive compared to previous years, but also because I have enjoyed other rotations and didn't love my psych rotation much. I figure I would like it more in the future if I stick with it, but that feels risky.

I loved being in the hospital doing more traditional medicine stuff like analyzing labs/imaging, helping out with minor procedures, learning ultrasound, ventilators, lines, all that. I really like performing the physical exam, especially neuro exam which I embraced and got pretty decent at for a 3rd year. Also, my favorite rotation was actually peds. I am a parent of two young kids and truly loved working with the kiddos. I am seriously intrigued by some peds specialties such as EM/PICU/NICU. I also really loved neurology including the prospect of child neuro, but I am thinking I screwed myself out of any chance of neuro due to limited research, my academic dumpster fires mentioned earlier. The fact that I didn't do well on IM shelf really felt like the nail in the coffin for neuro.

Anyways, what do you think I should focus on? I am trying to optimize my situation to get the best field I could match into. Psych, (heading toward child adolescent), neuro, child neuro, peds, hell I'd take family med if necessary for a little bit of all of the above I guess. It is not too late for me to adjust my fourth year schedule in terms of sub-i's, electives, aways, etc. if I want to head in one direction. Currently I am scheduled for psych rotations. What do now.

US MD/MPH class of 2025, upper-ish tier southern school

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[babybrains]

I don't think a failed shelf (particularly in IM, not neuro) necessarily precludes you from matching in neurology, be it child neurology or adult. Both adult neurology and child neurology are relatively noncompetitive; iirc in child neurology we may still on the whole have more spots than applicants, and even if not, I'm pretty sure the MD match rate is in the high 90s%. I could see it potentially hurting you a little in matching an IM prelim year for adult neurology, but I don't know too much about that.

But it's really a question of what you're interested in, especially since the specialties are different lengths - peds/fam med (3 years), neuro (4 years), child neuro (5 years). If your ultimate interest is psych, then you should find psych mentors and have an honest conversation with them about your competitiveness and what you can do to improve it if needed.

 

[Mr.Smile12]

What advice have you received from your student dean, who will write your MSPE?

 

[mrbreakfast]

I could see it potentially hurting you a little in matching an IM prelim year for adult neurology, but I don't know too much about that.

Advanced programs in adult neuro are, as a whole, generally more competitive than categorical positions, and are probably out of the question for OP.

The biggest issue is the failed step 1, which will limit your options in adult neuro. But if you decide that's what you want to do, and can rebound for the remainder of med school (including step 2), you'd probably be able to match somewhere. You don't necessarily need research, though you are correct in noting the IM shelf, after the neuro shelf, is probably the worst shelf to fail for neuro, unfortunately. If you wanted to do adult neuro, you may be looking at a dual application, though again I think an academic rebound will get you in somewhere.

Peds neuro is a whole different beast and you likely need to do a dedicated peds neuro rotation (which may be an away) at this point if you are seriously considering it.

You can likely match somewhere for pediatrics or FM, which are even less competitive. One of my friends had to remediate M1, failed/repeated M2, then failed step 1 (so had to repeat M2 year twice) and still matched in FM and is currently a private practice FM attending right now. You are far from out of options.

 

[babybrains]

Advanced programs in adult neuro are, as a whole, generally more competitive than categorical positions, and are probably out of the question for OP.

Good to know! Back when I was considering between adult and child neuro, I think the number of categorical positions was smaller, because applying to prelims/advanced programs in addition to categorical programs was essentially required. Sounds like OP should focus on categorical programs if they wind up set on that path.

 

[Goro]

Ok gang. I have been a pretty below avg student with several bumps in the road. The main ones being a failed step 1 (passed on 2nd attempt) and a failed IM shelf (passed on retake). Both fails have pretty extenuating circumstances but nobody really cares. Besides that, no failed classes, and I have gotten a mix of pass and HP on all core rotations with good written evals. All shelf exams have been around 40-50th percentile (with exception of IM but my retake was right back to normal 50th percentile). I've been on a few underwhelming research projects, have a fair amount of involvement in ECs/student groups, and have extensive work experience before med school as I am a non-trad with a good narrative leading up to the pursuit of medicine.

Anyways, I have been figuring I'd go into psych since day 1 due to pre-med school interests and multiple years of pertinent meaningful work experience....w/ subsequent research and ECs in med school. However, I am questioning that path not only because it is getting really competitive compared to previous years, but also because I have enjoyed other rotations and didn't love my psych rotation much. I figure I would like it more in the future if I stick with it, but that feels risky.

I loved being in the hospital doing more traditional medicine stuff like analyzing labs/imaging, helping out with minor procedures, learning ultrasound, ventilators, lines, all that. I really like performing the physical exam, especially neuro exam which I embraced and got pretty decent at for a 3rd year. Also, my favorite rotation was actually peds. I am a parent of two young kids and truly loved working with the kiddos. I am seriously intrigued by some peds specialties such as EM/PICU/NICU. I also really loved neurology including the prospect of child neuro, but I am thinking I screwed myself out of any chance of neuro due to limited research, my academic dumpster fires mentioned earlier. The fact that I didn't do well on IM shelf really felt like the nail in the coffin for neuro.

Anyways, what do you think I should focus on? I am trying to optimize my situation to get the best field I could match into. Psych, (heading toward child adolescent), neuro, child neuro, peds, hell I'd take family med if necessary for a little bit of all of the above I guess. It is not too late for me to adjust my fourth year schedule in terms of sub-i's, electives, aways, etc. if I want to head in one direction. Currently I am scheduled for psych rotations. What do now.

US MD/MPH class of 2025, upper-ish tier southern school

Family Med and Peds slots are going empty, even at good places this year.

 

[GoSpursGo]

Agree, FM and peds are easily attainable. My general gestalt has been that neuro is not terribly competitive, but you may be reaching the number of red flags where it may be problematic for neuro. Psych is going to be tough. I would otherwise suggest IM, if that wasn’t the shelf you had failed.

If you like peds, then I would strongly consider that route. You will definitely match and can likely match a solid program. Additionally, FM doesn't sound right for you if you want to be hospital based, other hospital-based specialties will be more competitive (not necessarily unattainable, just riskier with your red flags), and in many ways you can hit a "reset" with peds where most of the subspecialties are also uncompetitive. If you can do well at a good residency you should have a decent chance to attend a solid fellowship. There are problems with peds training, which you can readily read about in the peds forum, but it’s still a very rewarding field that I would absolutely do all over again 🙂

 

[psych2028]

Thank you to everyone for your helpful and informative feedback. I think deep down my heart wants to pursue the neuro route and it sounds like it is at least worth a shot. And if it doesn't work out, I am at peace with the reality of scrambling into peds or FM. I have went through the grieving process of failing a board and adjusting my expectations, and so at this point I want to shoot for a dream but will find a way to be happy with whatever I can get.

 

[mrbreakfast]

Neuro certainly isn't out of the question and it's not like a red flag will keep you from matching 100%. Just keep in mind it may be an uphill battle and you can climb that hill with strong performance, good letters, good neuro grades, etc.

My n =1 recommendation for neuro-inclined med students worried about their medicine performance is to consider doing a medicine sub-I (as well as a neuro sub-I, if that is an option) to demonstrate your growth, and while my usual recommendation is as many neuro letters as possible, an extra letter from IM would probably not hurt your situation. Even a small research involvement will open some doors, as well will a good background story (which is sounds like you already have). Good luck.