I'm an M3 who keeps failing things. 1. Were there people like me who became good doctors? 2. Could anyone help guide me in figuring out why?

[sdnsn]

tl;dr:

I'm an M3 (US MD program) who's a very poor student.

1. I'm wondering if there are other people out there who were like me but who somehow made it through and became good doctors? I'd love to hear about others who were in a similar place as I am. I'm curious what the road ahead could look like - the good, the bad, and the meh (neutral).

2. Also, I can't figure out why I'm hitting so many walls. I know that I know myself the best, but I wonder if I could discuss my experience with people to figure out why this is happening. If anyone might be able to shed any insight into why I keep failing, or at least guide me on how I could answer this for myself, I would be very grateful. My dean said that the only way that students who were in my position succeeded was that they took a time-out, stopped, and came up with a deliberate and manageable plan. So that is what I am trying to do now.


--


Why do I keep struggling so badly in med school? Reasons I can think of:
- mild depression
- isolation (I did M3 rotations in another state where I have no support system. I have only 3 good med school friends, so I tend to keep to myself)
- not studying effectively (studying hard but not smart)
- I peaked when I took my MCAT, and it was all downhill after that??

These problems don't seem so bad. Are these really serious enough to result in so many failures?

I have been doing online text therapy over the past year, and I have begun working with an in-person therapist (video sessions only so far).

I've met with my dean after every failure - so we've met a lot. In our latest meeting today, she said that I shouldn't be hitting this many walls, so I know that this level of struggle isn't normal.


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I want to go against the culture of feeling shame about and hiding failures, and instead talk about them. So, here are my med school "failures":
- step 1 = 209
- Failed my end-of-M3 OSCE (will take an elective that is actually a remediation class)
- Failed the peds shelf twice, so I have to retake all of peds clerkship
- Must remediate 1 month of IM clerkship, which I got a conditional pass on due to poor evals. As a result of retaking peds and IM, I'm taking an extra year to finish school and apply to residency.
- Failed one block exam in M2 (started getting tutoring from M4s, which helped a lot)
- Barely passed weekly quizzes during M1-M2
- Haven't received family med shelf exam grade yet, but I feel like I failed it
- This is all without the "distraction" of doing research or extracurriculars, because I've done no research in med school, and very minimal volunteering. My non-school time is spent doing non-medicine-related hobbies.


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I want to do psychiatry and, in my very inexperienced opinion, I think I would be darn good at it, because I love connecting with and understanding people as a way to help them with their behavioral/mental/emotional health. I'm curious about people and their stories, and I've been told that the sort of genuine empathy and curiosity that makes a good psych can't be taught. Psych, which I discovered only in M3, is what's keeping me going in med school.

But I have to get through all the other stuff to get to psychiatry, including showing vast improvement in medicine through my remediation, sub-I's, step 2 CK, intern year, step 3, etc.

I remember when I took an aptitude test during the time I was applying to med school. I was told that it's not that I couldn't do medicine, but it would be like fitting a square peg into a round hole: medicine and I wouldn't be a good fit. I dismissed that opinion, and now, I think about those words every so often...I'm also an older student (turning 33 this year). I don't think these are why I keep failing, though...I think?

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[IMGASMD]

What was your MCAT? Break down please. How are you doing with exams in general? GPA?

 

[Oedipa Maas]

It’s a little unusual that you’ve been having difficulty in so many different areas - OSCE (basic clinical encounters that you regurgitate), exams (part memorization/recall, part critical thinking, part overcoming test anxiety), and then clinical evals (people skills? applying book knowledge to real life? team work?). That’s every aspect of student evaluation that you will need to work on and I can see why your dean thinks that taking some time to approach and tackle each aspect might be a good idea.

It looks like in previous posts you have found yourself not enjoying capital-M Medicine and have found yourself enjoying aspects of medicine that you do not need a medical degree to do. I’m not really sure how you will reconcile that moving forward and how that will shape your path. You will still need a strong knowledge base in medicine in Psychiatry. In previous posts you mention disliking rounding, discussing medical conditions with patients and following up on labs. In this post, you mention empathy and curiosity about others. You need to find a way to tie that empathy to your role in medicine. It’s great to have deep and meaningful conversations with patients, but you need to transfer that interest and care to the patient as someone needing medical care as well. I would also think about the fact that patients probably would not be having deep and meaningful conversations where they disclose their life stories to you if you were not a medical student/doctor. In other words, those rewarding conversations don’t happen without lab checks and rounding.

 

[curbsideconsult]

These problems don't seem so bad. Are these really serious enough to result in so many failures?

Studying ineffectively is huge. That could be your problem. Or it could be that all of those problems together resulted in a multiplier effect causing the failures. It sounds like you're already trying to address the mild depression and isolation. You need to also look at different ways to study and stick with the way(s) that work for you.

I want to do psychiatry and, in my very inexperienced opinion, I think I would be darn good at it, because I love connecting with and understanding people as a way to help them with their behavioral/mental/emotional health. I'm curious about people and their stories, and I've been told that the sort of genuine empathy and curiosity that makes a good psych can't be taught. Psych, which I discovered only in M3, is what's keeping me going in med school.

You will still need a strong knowledge base in medicine in Psychiatry.

In previous posts you mention disliking rounding, discussing medical conditions with patients and following up on labs.

I'm not sure you have a great understanding of the practice of psychiatry. As a psych attending, you probably won't get to spend a lot of time with patients in the way that you're describing. Some do, but most don't. What you're describing is the role of a counselor. As Oedipa said, you need a very strong understanding of medicine in order to do psychiatry well because it's mostly med management. Psych drugs are incredibly dangerous and if you don't understand or care to understand the medical side of things your patients will suffer unnecessarily.

Rounding sucks, I'll give you that. But discussing patients' medical conditions with them should have been a highlight of rotations. I loved when I had a good enough grasp of a patient's pathophysiology to be able to explain in broad brushstrokes what's happening with them and what the next plan of action was in their course of treatment. Labs were also interesting to follow up on because I, as a lowly medical student, could follow someone's electrolytes and talk with the residents about what I would do to correct them.

I remember when I took an aptitude test during the time I was applying to med school. I was told that it's not that I couldn't do medicine, but it would be like fitting a square peg into a round hole: medicine and I wouldn't be a good fit. I dismissed that opinion, and now, I think about those words every so often...I'm also an older student (turning 33 this year). I don't think these are why I keep failing, though...I think?

Can you elaborate what they said exactly? Why did they say you wouldn't be a good fit?

Maybe in this upcoming year, it would help if you could connect everything in medicine to mental health issues. For example, think about severe cirrhosis or hyponatremia leading to altered mental status; or how someone's Crohn's disease or rheumatoid arthritis can lead to depression because their disease is painful and difficult to treat, etc etc. Sometimes a shift in perspective can turn things around.

 

[Calcan]

I'm in a similar, but different situation. I'm also non-trad and immediately before med school taught a couple MCAT sections after doing well in pre-med courses for a couple of years (I had a different background originally).

I'm actually in a Canadian med school, but unfortunately didn't turn down an interview or offer to go to a French-speaking school (which makes up a small part of Canada) and would have meant going through a second application cycle. French environment has been a huge performance barrier, especially in medical oriented rotations & grades. Even though the school knew my background, I've been blamed during clerkship for bad French, even though I've worked very hard to improve, which has had all sorts of secondary repercussions like having difficulty writing complex notes, etc..

I did really well in electives & rotations like plastics, derm, obs-gyn (well).. but disastrous outcome in 'basic' rotation like pediatrics and family with language being criticized.

There's nothing in our curriculum that's Step 1 like - but with a lot of effort I wrote and passed it - originally, obvi, I didn't think I'd need it for anything except for maybe fellowship.

I'm thinking of writing & trying to do really well on Step 2 and maybe aiming for FM (or something else) somewhere warmer in the US - any ideas how realistic this is ? I went unmatched in Canada this year so have to reapply (and probably redo some rotations ).

 

[IMGASMD]

I'm in a similar, but different situation. I'm also non-trad and immediately before med school taught a couple MCAT sections after doing well in pre-med courses for a couple of years (I had a different background originally).

I'm actually in a Canadian med school, but unfortunately didn't turn down an interview or offer to go to a French-speaking school (which makes up a small part of Canada) and would have meant going through a second application cycle. French environment has been a huge performance barrier, especially in medical oriented rotations & grades. Even though the school knew my background, I've been blamed during clerkship for bad French, even though I've worked very hard to improve, which has had all sorts of secondary repercussions like having difficulty writing complex notes, etc..

I did really well in electives & rotations like plastics, derm, obs-gyn (well).. but disastrous outcome in 'basic' rotation like pediatrics and family with language being criticized.

There's nothing in our curriculum that's Step 1 like - but with a lot of effort I wrote and passed it - originally, obvi, I didn't think I'd need it for anything except for maybe fellowship.

I'm thinking of writing & trying to do really well on Step 2 and maybe aiming for FM (or something else) somewhere warmer in the US - any ideas how realistic this is ? I went unmatched in Canada this year so have to reapply (and probably redo some rotations ).

I would start a new thread and not hijack this one.......

 

[longhaul3]

Lots of people struggle with exams and fund of knowledge. You passed Step 1 so despite all your struggles, you can be pretty confident that you have what it takes to make it through from that perspective.

On the other hand, it's unusual that you're struggling in so many different domains that require different skills. Failing the summative OSCE is one example, but if you have severe knowledge gaps, that can explain it; if you don't know what to ask or what to do, it doesn't matter how good your doctoring skills are. To me, the biggest question mark is the clerkship evaluations that were so bad that you need to remediate. What were the issues brought up by the evaluators? In my experience it takes a lot, like professionalism or personality issues, for someone to get truly bad evaluations.

 

[operaman]

Wow OP, sorry you’re having such a rough time. Your dean is right - you have a very complex set of problems and you’re smart enough to know there won’t be a simple or easy solution. I also ask your forgiveness in advance for any unfair assumptions I make; I assure you I’m writing in good faith but with limited background information. So, in no particular order, some thoughts:

1) When I read any story with disparate performance - ie. solid uGPA, high MCAT --> failed exams, below average step 1, now with multiple clinical failures -- my gut reaction is to suspect substance abuse. If not substance abuse, then typically a mental health condition beyond mild depression as noted above. If the problems began during M3 I think we could attribute it to burnout, but you report issues for the duration of medical school so this seems less likely. Medical school is a pressure cooker (credit: Goro) and it tends to bring out issues that were previously well controlled. You made an old post a few years back about having similar issues in another high pressure environment which suggests this goes well beyond a disinterest in medicine. You mention a therapist but this goes well beyond that; you would be wise to avail yourself of all the mental health resources your school offers and see if you can put together a team of professionals that can help you. My sense is that your biggest bang-for-the-buck will come from addressing these underlying issues.

2) Piggybacking off #1, you are still in what I would call the relatively easy part of medical training. Not only do you still have Step 2CK, CS, and Step 3 to contend with, but residency itself is a pressure cooker that makes med school seem like a cakewalk. It's much more interesting and fulfilling, but you're adding a lot of pressure, fatigue, and clinical workload while still needing to study every day, pass high stakes exams, and handle high pressure situations. Without some major changes, you are at very high risk for not completing a residency - any residency. If you do end up graduating medical school, you will need to pick your program and field very carefully.

2.5) Your chances of landing a psych spot are low already and with a step failure (for which you are VERY high risk), it would be a non starter. That said, FM has a LOT of psych in it, much to the chagrin of many med school friends who are now FM attendings. Your best/only shot at psych will be your home program assuming you have a good relationship with that department. As noted in other comments, the things you like about psych are a small part of the job.

3) Your study skills have very little to do with this. Whatever you've done has gotten you this far so they can't be so terribly dysfunctional as to be the primary source of your current problems. You also don't have the time on the wards to make major adjustments in your approach. With the extra year you may be able to carve out additional study time for CK and CS and you will probably need it. Better now to make your current methods work by controlling time/scheduling rather than attempting to develop new study habits/skills.

4) You need some tutoring for the wards. This can be harder to find, but ask your dean if they could help you find someone that would take you under their wing and provide some one-on-one guidance. I think this too is a very small part of your overall issue, but to graduate med school and especially to have any chance of finishing a residency, you are going to need some serious help. I hope your school has already done this, but if not, ask for it. Most schools have a handful of attendings who are exceptional teachers and clinicians and can help a struggling student put the pieces together. You need serious help with the most basic of doctoring skills - taking a basic history, doing an exam, interpreting data, formulating a reasonable ddx, and making a basic plan. The OSCE failure suggests deficiencies in all of these and I worry the remediation class won't be sufficient. Remember you will still have to take and pass Step 2CS which is generally a lot harder than OSCEs because you have not only the clinical part, but you have to write a graded note afterwards as well.

4.5) Your plan needs to include some kind of re-do of the OSCE or a formal CS course. A Step failure will mean the end of your medical career given all your other struggles, so make sure you are fully prepared when you take it.

5) I am concerned about your level of insight into your issues. You clearly have a very analytical mind and are very thoughtful, but despite your openness I fear you don't fully grasp your current situation or the road before you. This also doesn't seem to be a new thing. Your pre-med posts talk about washing out of OCS yet then wanting to go into surgery to become a military doc or an astronaut. The disconnect between fantasy and reality in those posts is staggering and I fear some of that persists in your present predicament. This all goes back into #1 above.

6) Finally, you would do well to put some serious thought into your exit plan. Unless something major changes, the odds of you graduating, passing steps, matching, and completing any residency program are slim to none. It sounds like you don't like medicine that much so maybe this isn't a terrible thing. The only thing worse than pulling the rip cord now with all the debt is having it pulled for you after 2 more years of tuition and heartache. The hard truth is that medicine may not be the right career for you, and it sucks to figure that out after so many years of struggle, but getting out now does save you another $100k of expenses. If you think you can graduate, you should also look into non-clinical uses of the MD. Unfortunately these are limited for those without a residency - maybe you could survive at least a pre-lim year or something - but you need to have thought through all your options. You are not going to find the fulfilling, thrilling, adventurous career you hoped for, but you may be able to find something tolerable that allows you to do thrilling and adventurous things on your own time.

 

[softball2344]

OP, sorry to hear about these struggles. I agree with your dean that the only way forward is to make MAJOR changes. Moreover, if you aren't willing to do FM I would also think about the possibility that moving forward isn't best for you. Psych has gotten super competitive and I don't think it's a realistic option anymore. Good luck.

 

[sdnsn]

I'm sorry I didn't reply to these comments in April. I'm not sure how I missed reading all these replies. Maybe this thread is dead now, but I'll still reply.

What was your MCAT? Break down please. How are you doing with exams in general? GPA?

MCAT was 517. Breakdown:
My school was P/F during M1-M2, so no GPA. I got through M1-M2, but I think I just barely passed most of the quizzes. I failed one block exam (can't remember which one it was; I did well enough on the next block exam to average a pass between the two, so no remediation). I also didn't look at my block exam scores, or even my shelf exams or evals. I've been doing this kind of avoidance thing since high school. I think it stems from being afraid to see a poor score and then feeling badly about myself. But then I recently looked at my M3 evals and shelf exam scores, and I realize that...I felt nothing. It's not a big deal. It's better to know and then know how to adjust for the future.

I'm not sure you have a great understanding of the practice of psychiatry. As a psych attending, you probably won't get to spend a lot of time with patients in the way that you're describing. Some do, but most don't. What you're describing is the role of a counselor. As Oedipa said, you need a very strong understanding of medicine in order to do psychiatry well because it's mostly med management. Psych drugs are incredibly dangerous and if you don't understand or care to understand the medical side of things your patients will suffer unnecessarily.

Rounding sucks, I'll give you that. But discussing patients' medical conditions with them should have been a highlight of rotations. I loved when I had a good enough grasp of a patient's pathophysiology to be able to explain in broad brushstrokes what's happening with them and what the next plan of action was in their course of treatment. Labs were also interesting to follow up on because I, as a lowly medical student, could follow someone's electrolytes and talk with the residents about what I would do to correct them.

Yes, I feel like one of my strengths is that counseling skill. During my IM remediation in October, I started to identify with that feeling you described having when you could explain things to patients. I loved being responsible for making sure they understood what was going on and trying to find ways to help them understand. A lightbulb started to go off for me.

Can you elaborate what they said exactly? Why did they say you wouldn't be a good fit?

Besides the square peg/round hole thing and something like "there's nothing here that would indicate that you're especially suited to medicine," I can't recall what they said. But these are the "kinds of work suggested by your aptitude pattern": psychology, sociology; counseling; teaching; journalism; advertising, marketing, public relations.

Lots of people struggle with exams and fund of knowledge. You passed Step 1 so despite all your struggles, you can be pretty confident that you have what it takes to make it through from that perspective.

On the other hand, it's unusual that you're struggling in so many different domains that require different skills. Failing the summative OSCE is one example, but if you have severe knowledge gaps, that can explain it; if you don't know what to ask or what to do, it doesn't matter how good your doctoring skills are. To me, the biggest question mark is the clerkship evaluations that were so bad that you need to remediate. What were the issues brought up by the evaluators? In my experience it takes a lot, like professionalism or personality issues, for someone to get truly bad evaluations.

I thought about summarizing the comments, but including the original comments shows just how damning they were and how badly I did. Maybe I'll delete these later. Anyway, I really do believe I've improved since these were written. I still have to think about whether to give M3 another try (which is what I'm leaning toward). I'm also hearing that psych might not be in the cards for me, which kills me, but I think I feel that way because of the shock of it...so, just try to get the MD degree and then do something outside of medicine? Anyway, here are the comments:

IM comments. IM was my first rotation, April 2019, in a new city with no support system outside of the hospital (people wrote a lot...):
(deleted)

Constructive feedback:
(deleted)

I didn't need to remediate FM, but FM was my last rotation:
(deleted)

Peds, attempt 1 (Nov 2019):
(deleted)

Peds, attempt 2 July/Aug 2020):
(deleted)

EM, Aug/Sep 2019 (I struggled here but passed):
(deleted)

Medical school is a pressure cooker (credit: Goro) and it tends to bring out issues that were previously well controlled. You made an old post a few years back about having similar issues in another high pressure environment which suggests this goes well beyond a disinterest in medicine. You mention a therapist but this goes well beyond that; you would be wise to avail yourself of all the mental health resources your school offers and see if you can put together a team of professionals that can help you. My sense is that your biggest bang-for-the-buck will come from addressing these underlying issues.

5) I am concerned about your level of insight into your issues. You clearly have a very analytical mind and are very thoughtful, but despite your openness I fear you don't fully grasp your current situation or the road before you. This also doesn't seem to be a new thing. Your pre-med posts talk about washing out of OCS yet then wanting to go into surgery to become a military doc or an astronaut. The disconnect between fantasy and reality in those posts is staggering and I fear some of that persists in your present predicament. This all goes back into #1 above.

6) Finally, you would do well to put some serious thought into your exit plan. Unless something major changes, the odds of you graduating, passing steps, matching, and completing any residency program are slim to none. It sounds like you don't like medicine that much so maybe this isn't a terrible thing. The only thing worse than pulling the rip cord now with all the debt is having it pulled for you after 2 more years of tuition and heartache. The hard truth is that medicine may not be the right career for you, and it sucks to figure that out after so many years of struggle, but getting out now does save you another $100k of expenses. If you think you can graduate, you should also look into non-clinical uses of the MD. Unfortunately these are limited for those without a residency - maybe you could survive at least a pre-lim year or something - but you need to have thought through all your options. You are not going to find the fulfilling, thrilling, adventurous career you hoped for, but you may be able to find something tolerable that allows you to do thrilling and adventurous things on your own time.

OP, sorry to hear about these struggles. I agree with your dean that the only way forward is to make MAJOR changes. Moreover, if you aren't willing to do FM I would also think about the possibility that moving forward isn't best for you. Psych has gotten super competitive and I don't think it's a realistic option anymore. Good luck.

Quoting these four here to remember them