I screwed up in my away rotation, residency chance ?

[stronghold]

I have just finished my 3rd week in my away rotation and I screwed up. I asked one of the attending physicians whom I worked with and he told me I need to read more and increase my medical knowledge, I have enthusiasm but I need to read more. I was really devastated when I heard that . I still have one week but in different service in GS with different attending and different team (although the residents are in close contact with the previous team's residents everyday). It is really hard for me to accept that since I payed thousands for travel from my country, housing...etc. I did not ask about letter of recommendation from any of the attendings in those 3 weeks since I don't feel anyone will write me a strong letter.
What to do? Try to study more and appear different in the 4th week with the new attending in the different service? or I am already done?!
Your advice please

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[ACSurgeon]

I have just finished my 3rd week in my away rotation and I screwed up. I asked one of the attending physicians whom I worked with and he told me I need to read more and increase my medical knowledge, I have enthusiasm but I need to read more. I was really devastated when I heard that . I still have one week but in different service in GS with different attending and different team (although the residents are in close contact with the previous team's residents everyday). It is really hard for me to accept that since I payed thousands for travel from my country, housing...etc. I did not ask about letter of recommendation from any of the attendings in those 3 weeks since I don't feel anyone will write me a strong letter.
What to do? Try to study more and appear different in the 4th week with the new attending in the different service? or I am already done?!
Your advice please

"read more to increase medical knowledge" is advice that applies to every student and resident. Unless you were totally unprepared numerous times, chances are the attending is giving you this feedback because he/she doesn't know what else you can improve (ie it's a good thing). Now, if you asked him for a letter, and his response was "no, because you need to read more," then that would be bad.

 

[Buzz Me]

I have just finished my 3rd week in my away rotation and I screwed up. I asked one of the attending physicians whom I worked with and he told me I need to read more and increase my medical knowledge, I have enthusiasm but I need to read more. I was really devastated when I heard that . I still have one week but in different service in GS with different attending and different team (although the residents are in close contact with the previous team's residents everyday). It is really hard for me to accept that since I payed thousands for travel from my country, housing...etc. I did not ask about letter of recommendation from any of the attendings in those 3 weeks since I don't feel anyone will write me a strong letter.
What to do? Try to study more and appear different in the 4th week with the new attending in the different service? or I am already done?!
Your advice please

I'm a little confused...you're still doing your away rotation right now, and won't be done until the end of the month? You realize that it's too late to get a letter of recommendation, and that the programs will finalize their rank lists on February 22nd, right?

 

[europeman]

You are taking what he said way too harshly! Ask him for a letter. Enthusiasm and eagerness amd motivation are the most important qualities!

 

[stronghold]

"read more to increase medical knowledge" is advice that applies to every student and resident. Unless you were totally unprepared numerous times, chances are the attending is giving you this feedback because he/she doesn't know what else you can improve (ie it's a good thing). Now, if you asked him for a letter, and his response was "no, because you need to read more," then that would be bad.

Lazymed, Thank you very much. What he said exactly that I have the enthusiasm and the power but my medical knowledge is not in the competitive range and I have to read more since they accept highly competitive applicant, he also advised me to ask people who matched in US what they did to get spot. He also advised me that to have a look on less competitive programs. When I asked him the last time that if I increased my medical knowledge since I still have additional year in my education beside high usmle scores, what other things to do? he said that the only deficient thing is competitive medical knowledge! after that he started to elaborate that may be because I am from different medical system....etc. This is the whole story my friend, is this normal?! go and ask for letter? What to tell him exactly?

I'm a little confused...you're still doing your away rotation right now, and won't be done until the end of the month? You realize that it's too late to get a letter of recommendation, and that the programs will finalize their rank lists on February 22nd, right?

Buzz Me, our dear moderator, I am just doing away rotation but I still have a year in my medical education, so I am not applying for that match. Hopefully, I will get your input. I made things more clear in my reply just above (to lazymed)

You are taking what he said way too harshly! Ask him for a letter. Enthusiasm and eagerness amd motivation are the most important qualities!

Europeman, Thanks a lot, so what to tell him exactly? I fear that he will write average/poor medical knowledge in the letter and this will be a disaster!

Any other inputs would be appreciated

 

[stronghold]

And what about the next 4th week with the new team and new attending?
Sorry if I asked many question. But I am really confused and devastated, I owe to you SDN community.

 

[ACSurgeon]

And what about the next 4th week with the new team and new attending?
Sorry if I asked many question. But I am really confused and devastated, I owe to you SDN community.

For the most part, if an attending agrees to write you a letter, they won't say anything that'll hurt your chances. This is why you have to ask this attending now, so that if he says no, you can find someone else who will. Also, the fact that you are a FMG will make matching into gen surg very hard, so even if your attending thought you had all the medical knowledge in the world, you'd still have to apply broadly and feel lucky to match anywhere.

 

[angleoflouise]

For the most part, if an attending agrees to write you a letter, they won't say anything that'll hurt your chances. This is why you have to ask this attending now, so that if he says no, you can find someone else who will. Also, the fact that you are a FMG will make matching into gen surg very hard, so even if your attending thought you had all the medical knowledge in the world, you'd still have to apply broadly and feel lucky to match anywhere.

Ask someone else in the program to write the lor, this doc will write in the lor that your knowledge is "good" or "average" which translates to " I don't know how this guy passed his boards" to program directors which is suicide to your plans of becoming a surgeon. Save your dignity and energy and just finish this away rotation the best you can. Think of this as a lesson learned and move on. I wouldn't apply to this institution if I were you bc this guy basically told you u have no chance there.

 

[angleoflouise]

What is your step 1 score? Have u taken 2ck yet? If not, then that's probably why your clinical knowledge is not there yet. There are 236 other programs that u can apply to so don't take this to heart, this place just may not be the place for you.

 

[igap]

I have just finished my 3rd week in my away rotation and I screwed up. I asked one of the attending physicians whom I worked with and he told me I need to read more and increase my medical knowledge, I have enthusiasm but I need to read more. I was really devastated when I heard that . I still have one week but in different service in GS with different attending and different team (although the residents are in close contact with the previous team's residents everyday). It is really hard for me to accept that since I payed thousands for travel from my country, housing...etc. I did not ask about letter of recommendation from any of the attendings in those 3 weeks since I don't feel anyone will write me a strong letter.
What to do? Try to study more and appear different in the 4th week with the new attending in the different service? or I am already done?!
Your advice please

This is why away rotations are considered a risk. Sure, if you are a rock star, then one can secure excellent letters of recommendation which will help you land a residency.

After working with a lot of rotating students over the years, I have come to the conclusion that for the most part, students hurt themselves more than help themselves on these "away" rotations.

It seems that the students are in a tough bind to begin with as they are in a new and foreign environment, in which they are under enormous pressure to perform perfectly every day, 24/7. It is so easy to have an off-day and burn yourself. I have seen it happen so very many times. I can count the number of students on one hand who have significantly helped themselves on an away rotation, and none of them were FMGs.

If the attending gave you the feedback you describe it is likely that he/she was conveying that you are behind the 8 ball compared to the typical applicant, and that you are not going to match at that program. One of the posters above stated that attendings will not agree to write a letter and then write a bad letter. This is absolutely false.

I have read many residency letters of recommendation, and have read some that were comically damning. Some were just plain old mean-spirited. You need to make sure that whomever is writing letters for you is going to write you a wonderfully strong letter. How do you know if an attending will do this? Follow your instinct, and learn to read the writing on the wall. It does not sound like you are going to get a good letter from this experience.

My advice is to not get discouraged. Every day is chance to improve yourself, and to learn more. Keep working at your goal, and if I read your posts correctly you have one more year before you are planning to apply. There are tons of general surgery programs, and some are very friendly toward FMGs. Do your research, and if you can afford another away rotation and set on doing one, do it at a program where other FMGs have succeeded before you.

 

[DoctwoB]

This is why away rotations are considered a risk. Sure, if you are a rock star, then one can secure excellent letters of recommendation which will help you land a residency.

After working with a lot of rotating students over the years, I have come to the conclusion that for the most part, students hurt themselves more than help themselves on these "away" rotations.

Do you feel this is true as well for the fields where away's are basically a requirement like neuro and ortho?

 

[Buzz Me]

After working with a lot of rotating students over the years, I have come to the conclusion that for the most part, students hurt themselves more than help themselves on these "away" rotations.

It seems that the students are in a tough bind to begin with as they are in a new and foreign environment, in which they are under enormous pressure to perform perfectly every day, 24/7. It is so easy to have an off-day and burn yourself. I have seen it happen so very many times. I can count the number of students on one hand who have significantly helped themselves on an away rotation, and none of them were FMGs.

Hmmm...interesting viewpoint. Now that I think about it, of all the students doing away rotations that I've worked with over the years (must be around 50-60 by now), I have to agree. I've only actively recommended a small handful - maybe 4-5 - to the program director here. The others either didn't really impress me too much, and blended in with the other applicants...or were bad enough that we all knew we wouldn't be ranking them.

 

[stronghold]

Thanks for everybody who replied and tried to help. I have met that attending today in the office for the letter issue and he told me if he writes a letter he will be honest and write everything. The exact words as he said:" I will write a letter and in addition to that you are friendly, team player, enthusiastic...etc, I will write that you medical knowledge level is below competitive level and equals first or second year medical students and you need additional years of experience." I think it is better no go ahead and ask him to start the letter? Or what do you think guys? The problem is that I was answering more true answers than his students were but I can not change his mind! Even he asked me about the new attending whom I will work for the fourth week!!
Keeping in mind this is my only surgical rotations in US, what to do? Iam not sure if I can come again to US in summer for research or other rotation, but if I have both choices, which is better; another rotation with my increased medical knowledge or research?
Thank you all

 

[PSurg530]

Do not get a letter from this person. They flat out told you they would write a letter with negative things in it. Doesn't matter how many good things are in there, this will be hard for PDs to overlook. I think your best bet is to study like crazy for this last week, and see if you can maybe get a better letter from the new attending.

If you have the money/time to travel again, I think another rotation would be better than research, especially if you still need to get a LOR.

Good luck!

 

[Dirt]

I will write that you medical knowledge level is below competitive level and equals first or second year medical students and you need additional years of experience.

That letter would get you rejected from any program you applied to regardless of anything else in your app.

 

[Buzz Me]

The exact words as he said:" I will write a letter and in addition to that you are friendly, team player, enthusiastic...etc, I will write that you medical knowledge level is below competitive level and equals first or second year medical students and you need additional years of experience." I think it is better no go ahead and ask him to start the letter? Or what do you think guys?

Ouch.

DO NOT get a letter from him.

 

[Winged Scapula]

A letter with THAT statement is liable to ruin your chances.

Bear in mind that LORs are almost overwhelmingly positive so that any negative or implied negative statement will be taken very seriously. The fact that he is comparing you to a much more junior student and states that he will put that in writing is very telling. We have no way of knowing whether his impression of your knowledge base is true but such a statement in a LOR is very damning.

What do we think? Do NOT, under any circumstances, submit a letter from this faculty member. You are better off having NO US letters than this one (although we haven't addressed the obvious question that will be raised if why you don't have a letter from your USCE).

 

[stronghold]

Thank you all for your advice, SDN members. I have started my new 4th weeks with the new attending who is considered more famous than the previous one I told you about. I tried to read before every operation and I think he likes me till now. So how to do you think to ask him for a letter? When and Where? he is too busy and the only time I see him is in OR,and he finishes before since he leaves the wound closure for the resident.
I really appreciate your efforts in helping me and I really believe this topic works for all students who have the same problem in away rotations; since it is a new and different environment.

 

[Buzz Me]

Wow...you're going to try and get a letter from him after working with him for only a week? And you have minimal exposure to him in the OR?

Don't you get to go on rounds with him? Or go to his clinic?

 

[stronghold]

Thank you Buzz me and SouthernIM, I want to clear some points; I did not work with the first attending that closely since we were 3 students in the service and there were 3 attendings including that one, we were switching every case so may be my contact with each of the 3 was less than a week in total, since they have different operating days and all of us as students were switching on cases of the day. In other words, I did not have the chance to work even a full day with any of them because we 3. Maybe this is the cause why he said that bad thing on me. I still have a chance of working most of next week too(5th week) with the new attending, is that better?

 

[LucidSplash]

Thank you Buzz me and SouthernIM, I want to clear some points; I did not work with the first attending that closely since we were 3 students in the service and there were 3 attendings including that one, we were switching every case so may be my contact with each of the 3 was less than a week in total, since they have different operating days and all of us as students were switching on cases of the day. In other words, I did not have the chance to work even a full day with any of them because we 3. Maybe this is the cause why he said that bad thing on me. I still have a chance of working most of next week too(5th week) with the new attending, is that better?

No. Everything Buzz and Southern said still stands. The scenario you detail above is fairly common and there are no extenuating circumstances here IMHO. It bears repeating that attendings DO speak with one another regarding students. I think you are best off using this as a learning experience and following Southern's advice.

 

[Buzz Me]

Agreed. Two weeks of off-and-on contact with this new attending (especially on a busy service) won't be enough time for you to obtain a strong, solid LOR. Add to that the fact that you had a substandard eval from the previous attending (who will likely talk to the other attendings on the service) and I wouldn't risk it.

 

[stronghold]

Hi again, but this time with good news. I was determined to work hard with the new attending. I tried to read before every operation, even went and observed the cases of the another student(after his permission). On my last day with him; he provided me with excellent feedback and I believe he liked me although I worked less than two weeks with him.
In addition to that he is more famous than the previous one (no offense).
The miracle happened , he accepted to right me letter of recommendation and mail it to me (I am international student and not applying next match).
The letter arrived, although it is just 2 paragraphs; 3-4 lines each one) I liked it and still better than nothing or bad letter from the first attending. One of the major things I learnt, It is all dependent on your team! I did everything with first team but my gut feeling the intern did not like me and sent bad picture to the chief and attending, even sometimes he was not good in speaking with me. On the other hand, the second team was great! . The ironic thing that the first team told me that the next team is malignant and I will have much yelling from attending! The only thing I am sorry for that I was not with second team from the beginning!
I want to thank everybody who participated in that topic and I believe it would be a useful topic for other students.
Regards

 

[angleoflouise]

Make sure that the LOR doesn't have key words that Program Directors look for like: solid, good, average. These words translate to stay away, not impressed, I've seen way better.

A good LOR will have words like: outstanding, excellent, best, superior.