Just found out I have to repeat M3 and graduate 2 years late, wondering if there are others else with similar struggles/experiences

[sdnsn]

Hi all,

I found out yesterday that I have to repeat my entire clerkship year (I also passed my peds remediation and a clinical skills exam remediation, and took but didn't pass an IM remediation). I started out as class of 2021, and now I'm on track to graduate in 2023. The max amount of time to finish school is 6 years. I wanted to start my second attempt at M3 in January, but I have to join and start with the class of 2023 in April, so I've been placed on a leave of absence until then. Happy to provide more details if people want to know.

I'm feeling pretty bummed about this and just want to feel like I'm not the only one who's been struggling this much throughout school. I'm wondering if there are any success stories about people in a similar situation. Hearing that might help me feel like there's hope for me and that it's possible for even someone like me to make it through.

Thanks.

-

Edit:

I really appreciate all the support. I want to give more background information to give a better understanding of my situation. Thanks for all the really thoughtful responses.

- I've been meeting with a therapist through school since June, and it seems that my issue is confidence, which relates to openness to vulnerability (perfectionism, shame, shame resilience - stuff Brené Brown talks about in Daring Greatly, which I'm reading right now). Being scared to be vulnerable (many years of being trained in perfectionism tendencies - I'm 33 now, started to think about medicine at age 26) has affected my presentations and notes (being afraid to be wrong, so I don't say my ideas or I use other notes' ideas, so people don't know that I DO have medical knowledge).

- I failed peds the first time around because I couldn't pass the shelf exam (didn't pass in two attempts, scored 2nd and 4th %iles). The second time, I got a high pass and scored 44th %ile on the shelf. The issue with peds was the shelf; what I changed was my study methods (UW and Anki cards everyday). I was reluctant to use Anki because the volume of cards seemed overwhelming, but once I tried it out (my therapist helped me see that I should at least try it out), I wished I had been using Anki since day 1 of med school.

- My OSCE exam failure seems to stem from not using an H&P template. In the OSCE remediation and IM remediation, I practiced using a template.

- I got 24X on step 2 CK (vs 20X on step 1). I was scoring similarly on practice UW blocks and exams leading up to test day, so I feel like this is an accurate representation, not a lucky fluke, of my knowledge foundation (which I struggled to demonstrate during M3 and got eval comments saying so). I attribute the change to doing UW and Anki cards everyday (repetition over time really works for me).

-

I wish that I didn't have to remediate the whole year. I wish that I could just, like, redo IM twice or something for a total of 4 months. But, I feel like I'd be fighting against Policies and Precedents (behemoth entities with capital Ps), even though I was part of the first class under a new curriculum, so repeating the whole year is just what I have to accept and do. And the committee folks have more experience than I do, so maybe they have seen over the years how helpful it is for students to retake M3, even if they didn't struggle with every part of it. Maybe during the long year, it will give me time to reflect, synthesize, build, grow...I might not have THAAAAT much time to reflect (it'll be a busy year), but as I'm going about my days, the fact that I did all of this once already will mean that I'll have moments of "hey, I've done or seen this before, I know what to do here," and the neural connections will click into place. In the long run, this will be really beneficial to me (the less beneficial part seems to relate to the extra tuition and apartment/living expenses I have to pay, but...sigh...it's fine...heh...Oh, and I have to break the news to my parents, and I know eventually they'll understand and support me, but it's a sucky feeling when I disappoint them).

---

Members don't see this ad.

 

[sunshinefl]

Hi all,

I found out yesterday that I have to repeat my entire clerkship year (I also passed my peds remediation and a clinical skills exam remediation, and took but didn't pass an IM remediation). I started out as class of 2021, and now I'm on track to graduate in 2023. The max amount of time to finish school is 6 years. I wanted to start my second attempt at M3 in January, but I have to join and start with the class of 2023 in April, so I've been placed on a leave of absence until then. Happy to provide more details if people want to know.

I'm feeling pretty bummed about this and just want to feel like I'm not the only one who's been struggling this much throughout school. I'm wondering if there are any success stories about people in a similar situation. Hearing that might help me feel like there's hope for me and that it's possible for even someone like me to make it through.

Thanks.

I do hope it works out for you and that someone with that experience comes to give you that boost.

 

[OrthoTraumaMD]

I hope you take advantage of the school’s learning resources and figure out what happened so you can do better next time. Failure is a part of life for everyone, but you have the final say in what happens next, so stay positive but also try to change the things you can to maximize your chance of success.

 

[Redpancreas]

Hi all,

I found out yesterday that I have to repeat my entire clerkship year (I also passed my peds remediation and a clinical skills exam remediation, and took but didn't pass an IM remediation). I started out as class of 2021, and now I'm on track to graduate in 2023. The max amount of time to finish school is 6 years. I wanted to start my second attempt at M3 in January, but I have to join and start with the class of 2023 in April, so I've been placed on a leave of absence until then. Happy to provide more details if people want to know.

I'm feeling pretty bummed about this and just want to feel like I'm not the only one who's been struggling this much throughout school. I'm wondering if there are any success stories about people in a similar situation. Hearing that might help me feel like there's hope for me and that it's possible for even someone like me to make it through.

Thanks.

This is not uncommon. Something about your methods were ineffective. It will take some time to reflect and figure out the extent of things. Here's what I suggest.

1.) Take a step back. Resilience is achieved in many ways. In the medical field where our lives are not on the line daily and millions of dollars don't hang in the balance for putting a ball in a hoop I think the best way to promote it is being kind to yourself. A lot of people are tempted to double down after this sort of event. In my experience that makes things worse. Be kind to yourself and take as long as you need to decompress whether that be until February or all the way until April. I would not put a date on it and just play it based of how you feel each week.

2.) I know how disappointing is feels to be delayed relative to your own peers. Medicine is an incredibly long road and we're all trying to get from undergrad -> med school -> residency -> specialty training -> attending as fast as we can with as few gaps as possible to still have some semblance of a life. Some people get through untouched which is great, but at the end of the day a majority of people have some form of struggle/setback in the whether it's early on in medical school like you or in residency/fellowship in the form of remediation/dismissal or as an attending in the form of a lawsuit that can someone back quite a bit. Then there's interpersonal conflicts like divorces, health issues etc. that hit you when your back is turned. It's better to have this sort of event happen now instead of continuing to skate by until finally something drastic happens.

3.) Utilize your school's resources to the fullest. A lot of people see this as generic, unhelpful advice but there's a couple reasons why this is so important. Your medical school is partly funded to support people in your situation. At your disposal are cognitive services, mental health support, and specific content experts whose services would not be free or at least not as expensive if you were not enrolled in XYZ medical school. I know everyone jumps to mental health since everyone admitted is usually academically proven so I would at least start by talking to your medical school counselor to figure out what the issues were. They will refer you to various services like counseling through a clinical psychologist or perhaps a psychiatrist if needed. Make sure you follow up and do exactly what they tell you. You may identify a weakness you did not know and how to manage it which will be very useful moving forward.

4.) If you feel ready to do some preparation after you're back on track I recommend reaching out to your IM clerkship director since that was the problematic rotation. Figure out how you failed and how to prevent that. If it was a NBME issue, buy/reset UWorld and create a study plan to get through all of OnlineMedEd. Don't distract yourself with other resources. The good news is if you're doing this you are preparing simultaneously for Step 2 CK. Cramming for 2 weeks doesn't work on these exams like it may have on content exams in medical school. You need to see this material over and over again for it to sink in and it takes time to get used to the clinical vignettes. If the issues were related to practical skills, then ask your clerkship director if you can get some help with physical exam skills or someone to coach you on your clinical reasoning. Engage with them very regularly.

5.) Redemption Factors: This is the least important bullet of this thread but there are XYZ things you can theoretically do to reassure residency programs. If the issue was NBME exams, passing them the second time around and doing reasonably well on Step 2 CK will do it. Fight to urge to chase 250+ on CK to compensate for what's happened. It may happen, it may not. If you historically struggle with exams it's a tall-order. Even an average score on CK will reassure programs that your medical knowledge (ie ability to pass the boards) is not a concern. If the issues were more clinically related, simply remediating successfully time around is the goal. The focus should be on learning the fundamentals, if honoring comes as a by-product, great...but it's not the focus.

Best of luck! I know it's cliché but getting through this to me at least demonstrates that you have ability to overcome something that many others don't or choose not to confront. Being realistic, it may not be seen that way in residency recruitment but it's a personal victory you will carry with you moving forward in life and I can promise you that opportunities to apply what you've learnt will present themselves down the road.

 

[operaman]

I can think of a handful of friends who had similar experiences. I don’t know all their details because they weren’t very public with it, but across the board they’re all practicing attendings today. I think it’s a testament to their own hard work and resilience as well as how much schools want their students to succeed.

As others have noted, the key is figuring out where you went wrong and fixing it for next time. Medicine is definitely a pressure cooker that will punish any bad habit or poor coping skill and can be absolutely merciless on any uncontrolled mental health issue. People smart enough to get in to Med school were probably smart enough to compensate before, but eventually medicine pushes most to a point where they have to confront it. If that’s any part of your story, I hope you’ve taken steps to address the underlying issues.

 

[Med Ed]

Hi all,

I found out yesterday that I have to repeat my entire clerkship year (I also passed my peds remediation and a clinical skills exam remediation, and took but didn't pass an IM remediation). I started out as class of 2021, and now I'm on track to graduate in 2023. The max amount of time to finish school is 6 years. I wanted to start my second attempt at M3 in January, but I have to join and start with the class of 2023 in April, so I've been placed on a leave of absence until then. Happy to provide more details if people want to know.

I'm feeling pretty bummed about this and just want to feel like I'm not the only one who's been struggling this much throughout school. I'm wondering if there are any success stories about people in a similar situation. Hearing that might help me feel like there's hope for me and that it's possible for even someone like me to make it through.

Thanks.

I read your previous thread from April, and it's quite clear that medicine is not your calling. Repeating M3 is highly unusual, in large part because the bar for scraping through is set pretty low. You've been failing everything because you have no real interest in the subject.

With regard to your chances at securing a psych residency, I think they are infinitesimal at this stage. Some years ago you may have found a slot in a program looking for a warm body, but the field has gotten significantly more competitive. Someone on the 6-year plan with an M3 repeat is not going to get significant traction.

If you want to stay in school and finish with the MD, I think you have to let go of the idea of ever practicing medicine and start searching for a non-clinical career path that motivates you. The creator of Non-Clinical Physician Jobs, for example, got a MBA and MPH and is now an executive. The career world outside medicine is far less predictable than clinical work, but it's at least as interesting.

 

[Redpancreas]

OP I have reviewed the edits you have made as well as the previous post in April and here are my thoughts. All these comments are my opinions in case I forgot to preface each opinion in this post. There are members with notably more experience than me with contradicting opinions and I respect them but wanted to give my own.

Your MCAT was good. Step 1 was not. Step 2 was good. Shelf exams were not. This to me reveals there is inconsistent performance. I think this is an issue of execution spurred by your habits and approaches or potentially mental health. I don't really think that performing poorly in multiple areas can only mean "medicine is not for you" as if these assessments somehow tell you whether or not you're subconsciously uninterested in a field. I do not think medicine is NOT for you, albeit Medicine (Internal Medicine) may not be your forte or your field of interest.

The next thing which caught my attention is a quote from April from someone who commented that said "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." I think this may have something to do with your lack of execution and I think its a cognitive habit that needs to be reshaped.

Third, if you plan to continue with medicine you need to realize that you may not be competitive for Psychiatry and are looking at Family Medicine or Internal Medicine as fields. I'm not saying 100% impossible, but it would take a lot of things going right. Also, if your issue is actually the product of a mood disorder, that is not a further reason to do psych, but a reason to stay away from it. It sounds like from your posts you don't like FM/IM. I think it's important to not stop there and say IM/FM are not for you but to ask, why not? No one inherently likes rounding if it means monotonously following your attending, standing at each patient's bedside for 20 minutes, and retaining little. Hell, I didn't like it until I learnt a lot more and then I fell in love with it. Could it be that you are not engaging with the material during rounds and understanding why every little thing that you're probably ignoring is being done? Based on the fact that you're failing your OSCEs I think its very likely you're not engaging with clinical medicine. Medicine becomes very enjoyable when you're aware of the significance of all the details and your knowledge of treatments are akin to cards you can play in a strategy game. If you're sitting in a room watching a card game with obscure symbols where people are speaking Chinese you'll think it's boring because you're not engaged.

---

I think Operaman on another thread makes a good point that the only thing worse than figuring out medicine is not for you right now, is figuring it out with two more years gone into it with an increased debt level. Only you can decide whether you want to continue clinical medicine or not. I personally see a path forward but acknowledge its an uphill battle and I don't want to push you in that direction when a lot of money and time are at stake. Others have given you some plausible alternatives. Now that you have some time off don't be afraid to look into them. I know it may hurt because you might not want to entertain the option of doing something else, but you have to. Take this level of openness you have and share them with support team and get everyone's perspective and use it to make a plan moving forward. One additional thing I can offer if you, in addition to what I typed above, is if you choose to pursue graduating medical school whether the goal is to pursue clinical medicine (FM/Psych) or some other career , I can help coach you and can field your questions at least daily through SDN Messaging. I can help with issues/questions you are having with medical decision making or content areas specifically within the area Internal Medicine. I have been above average on the ITE for PGY-1 to 3 IM residents. I love the field and can maybe spread a bit of my enthusiasm for it with you. PM me whenever you want to start and as often as you want, don't worry about being irregular about it. Completely free, not expecting anything in return.

 

[Goro]

Hi all,

I found out yesterday that I have to repeat my entire clerkship year (I also passed my peds remediation and a clinical skills exam remediation, and took but didn't pass an IM remediation). I started out as class of 2021, and now I'm on track to graduate in 2023. The max amount of time to finish school is 6 years. I wanted to start my second attempt at M3 in January, but I have to join and start with the class of 2023 in April, so I've been placed on a leave of absence until then. Happy to provide more details if people want to know.

I'm feeling pretty bummed about this and just want to feel like I'm not the only one who's been struggling this much throughout school. I'm wondering if there are any success stories about people in a similar situation. Hearing that might help me feel like there's hope for me and that it's possible for even someone like me to make it through.

Thanks.

-

Edit:

I really appreciate all the support. I want to give more background information to give a better understanding of my situation. Thanks for all the really thoughtful responses.

- I've been meeting with a therapist through school since June, and it seems that my issue is confidence, which relates to openness to vulnerability (perfectionism, shame, shame resilience - stuff Brené Brown talks about in Daring Greatly, which I'm reading right now). Being scared to be vulnerable (many years of being trained in perfectionism tendencies - I'm 33 now, started to think about medicine at age 26) has affected my presentations and notes (being afraid to be wrong, so I don't say my ideas or I use other notes' ideas, so people don't know that I DO have medical knowledge).

- I failed peds the first time around because I couldn't pass the shelf exam (didn't pass in two attempts, scored 2nd and 4th %iles). The second time, I got a high pass and scored 44th %ile on the shelf. The issue with peds was the shelf; what I changed was my study methods (UW and Anki cards everyday). I was reluctant to use Anki because the volume of cards seemed overwhelming, but once I tried it out (my therapist helped me see that I should at least try it out), I wished I had been using Anki since day 1 of med school.

- My OSCE exam failure seems to stem from not using an H&P template. In the OSCE remediation and IM remediation, I practiced using a template.

- I got 247 on step 2 CK (vs 209 on step 1). I was scoring similarly on practice UW blocks and exams leading up to test day, so I feel like this is an accurate representation, not a lucky fluke, of my knowledge foundation (which I struggled to demonstrate during M3 and got eval comments saying so). I attribute the change to doing UW and Anki cards everyday (repetition over time really works for me).

-

I wish that I didn't have to remediate the whole year. I wish that I could just, like, redo IM twice or something for a total of 4 months. But, I feel like I'd be fighting against Policies and Precedents (behemoth entities with capital Ps), even though I was part of the first class under a new curriculum, so repeating the whole year is just what I have to accept and do. And the committee folks have more experience than I do, so maybe they have seen over the years how helpful it is for students to retake M3, even if they didn't struggle with every part of it. Maybe during the long year, it will give me time to reflect, synthesize, build, grow...I might not have THAAAAT much time to reflect (it'll be a busy year), but as I'm going about my days, the fact that I did all of this once already will mean that I'll have moments of "hey, I've done or seen this before, I know what to do here," and the neural connections will click into place. In the long run, this will be really beneficial to me (the less beneficial part seems to relate to the extra tuition and apartment/living expenses I have to pay, but...sigh...it's fine...heh...Oh, and I have to break the news to my parents, and I know eventually they'll understand and support me, but it's a sucky feeling when I disappoint them).

Very sorry to hear about this, but after reading through your post history, I think that at a minimum you should ask for LOA, if possible, get your mental health in order, and then try to come back stronger. Otherwise, it's time for Plan B.

 

[LunaOri]

A classmate of mine had a similar experience. Lack of confidence led to failing and barely passing rotations. Repeating the whole year allowed for a fresh start (rather than doing a patchy remediation). Did much better the second time in M3. Ended up in a very good IM residency.

 

[Banco]

It really sucks they are making you redo the entire year.

Just to give you positive vibes, it is totally possible to make a strong comeback. A friend of mine had to remediate first year - he was really disappointed and crushed at the time. He ended up matching one of his top choices in integrated vascular surgery for residency.

 

[sdnsn]

I read your previous thread from April, and it's quite clear that medicine is not your calling. Repeating M3 is highly unusual, in large part because the bar for scraping through is set pretty low. You've been failing everything because you have no real interest in the subject.

With regard to your chances at securing a psych residency, I think they are infinitesimal at this stage. Some years ago you may have found a slot in a program looking for a warm body, but the field has gotten significantly more competitive. Someone on the 6-year plan with an M3 repeat is not going to get significant traction.

If you want to stay in school and finish with the MD, I think you have to let go of the idea of ever practicing medicine and start searching for a non-clinical career path that motivates you. The creator of Non-Clinical Physician Jobs, for example, got a MBA and MPH and is now an executive. The career world outside medicine is far less predictable than clinical work, but it's at least as interesting.

It startled me to read “it’s quite clear that medicine is not your calling.” Not because it’s a new idea to me (I’ve heard it before), and well, I’m not sure that I would call it my “calling” either. I think it startled me because I’ve been trying to suppress that and be in denial about it? I also had started to enjoy IM during my remediation, so I thought maybe I was turning over a new leaf. Maybe I also thought that I could still do medicine even if it weren’t my “calling” (but I know medicine's not that kind of profession). I wish I knew what my calling was. I can think of things I’m good at, but man, that school debt...those things I'm good at don't pay that much. The debt part scares me, but over time, I would pay it off - I mean, I have no choice.

This is also the first time I’m hearing that I have almost no chance at psych. I know that was said in my April post, and for some reason, it feels like I missed reading all those valuable comments, including operaman's comment (#8). I’m not sure how that happened. Anyway, I know that about me and psych now; I'm starting to process it.

“If you want to stay in school and finish with the MD, I think you have to let go of the idea of ever practicing medicine and start searching for a non-clinical career path that motivates you.” - I heard this before but didn’t give it much thought (I said, “what do they know, I still haven’t even finished M3 yet”). But this comment keeps coming up. With my low chance of doing psych, it’s time to start taking it seriously. I still want to keep a positive mindset about “maybe I’m still suited for medicine/psych.” But I don’t want to delude myself either, so I’m going to take your comment seriously and consider all scenarios (not choose denial anymore).

The next thing which caught my attention is a quote from April from someone who commented that said "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." I think this may have something to do with your lack of execution and I think its a cognitive habit that needs to be reshaped.

I just don't know what is fantasy vs reality then. Rhetorical question, not asking anyone to answer it. I just wanted to bold/remember to address that last sentence on my own and with my therapist.

Third, if you plan to continue with medicine you need to realize that you may not be competitive for Psychiatry and are looking at Family Medicine or Internal Medicine as fields. I'm not saying 100% impossible, but it would take a lot of things going right. Also, if your issue is actually the product of a mood disorder, that is not a further reason to do psych, but a reason to stay away from it. It sounds like from your posts you don't like FM/IM. I think it's important to not stop there and say IM/FM are not for you but to ask, why not? No one inherently likes rounding if it means monotonously following your attending, standing at each patient's bedside for 20 minutes, and retaining little. Hell, I didn't like it until I learnt a lot more and then I fell in love with it. Could it be that you are not engaging with the material during rounds and understanding why every little thing that you're probably ignoring is being done? Based on the fact that you're failing your OSCEs I think its very likely you're not engaging with clinical medicine. Medicine becomes very enjoyable when you're aware of the significance of all the details and your knowledge of treatments turn into cards you can play in a strategy game. If you're sitting in a room watching a card game with obscure symbols where people are speaking Chinese because you're not engage.

I added a second edit to my post, but basically, I started to enjoy IM during my remediation because I engaged with it more. I think that was a real shift in my thinking, and if/when I retake IM (leaning toward retaking), I hope that mentality/attitude shift will continue...

I think Operaman on another thread makes a good point that the only thing worse than figuring out medicine is not for you right now, is figuring it out with two more years gone into it with an increased debt level. Only you can decide whether you want to continue clinical medicine or not. I personally see a path forward but acknowledge its an uphill battle and I don't want to push you in that direction when a lot of money and time are at stake. Others have given you some plausible alternatives. Now that you have some time off don't be afraid to look into them. I know it may hurt because you might not want to entertain the option of doing something else, but you have to. Take this level of openness you have and share them with support team and get everyone's perspective and use it to make a plan moving forward. One additional thing I can offer if you, in addition to what I typed above, is if you choose to pursue graduating medical school whether the goal is to pursue clinical medicine (FM/Psych) or some other career , I can help coach you and can field your questions at least daily through SDN Messaging. I can help with issues/questions you are having with medical decision making or content areas specifically within the area Internal Medicine. I have been above average on the ITE for PGY-1 to 3 IM residents and am currently scoring above average on ABIM (IM board exam) UWorld which isn't amazing, but serviceable for your needs. I love the field and can maybe spread a bit of my enthusiasm for it with you. PM me whenever you want to start and as often as you want, don't worry about being irregular about it. Completely free, not expecting anything in return.

I feel like I have to give M3 another shot, but also, that extra debt is not chump change. I have to think about this. Thank you for the guidance about looking into plausible alternatives. Yes, it does hurt to think about alternatives, but I've now heard that advice from you, many others who replied to me or people who liked those replies, attendings/student dean/residents...I have to consider all possibilities. And thank you so much for the incredibly kind offer of support, I'm super grateful. I will keep it in mind.

A classmate of mine had a similar experience. Lack of confidence led to failing and barely passing rotations. Repeating the whole year allowed for a fresh start (rather than doing a patchy remediation). Did much better the second time in M3. Ended up in a very good IM residency.

It really sucks they are making you redo the entire year.

Just to give you positive vibes, it is totally possible to make a strong comeback. A friend of mine had to remediate first year - he was really disappointed and crushed at the time. He ended up matching one of his top choices in integrated vascular surgery for residency.

It's good to hear that people have gone through similar things, thank you for sharing

 

[operaman]

I didn’t recall your April post when I replied to this one but I’m looking back at it I think everything still stands. I saw your evals and am purposely not quoting them just in case you wish to delete later, but after reading them I have to agree that repeating the whole year is absolutely the right move if you intend to remain in medical school.

My read of them is that they all essentially say the same thing, even the nicer ones. You should hug those IM docs who took the time to be so candid and thoughtful in their comments. Those same issues seemed to plague you on the other rotations even if the comments weren’t as harsh; usually this says the attending didn’t feel like diving in to the problems on the eval rather than the absence of a problem. It sounds like you’ve struggled with the most basic parts of doctoring and putting the pieces together. Different people comment on different aspects of this, but the underlying issue is the same.

You would be wise to use the time before restarting to bolster both your knowledge base as well as your mental health. I noticed how many comments also mention this, though more euphemistically with things like concern for your “wellness.”

I do think you’ve got a shot at passing the year if you really work hard. Your CK performance was good and maybe you have found some ways to improve your knowledge base, so if you’re able to incorporate this to clinical thinking you may have a shot. Obviously CS still looms so make sure you allow ample prep time when that arrives.

While residency if you do one is a ways off, do bear in mind that all the performance issues noted in your comments are precisely the kind of things that get people fired from their programs. You not only need to pass the next two years, but do so with enough retained knowledge and skill that you can be a functional resident. The residency forum is filled with dismissal stories from residents who never addressed similar issues.

On the residency front, keep in mind that your home program remains your best shot at landing a position. Your prior comments suggest your app would be DOA at the moment, but with 2 years of stellar performance you might win some people over willing to give you a shot when the time comes.

 

[sdnsn]

I appreciate everything you've written.

You would be wise to use the time before restarting to bolster both your knowledge base as well as your mental health. I noticed how many comments also mention this, though more euphemistically with things like concern for your “wellness.”

My initial thought was "I don't think I have mental health concerns," because I don't fit DSM5 criteria for XYZ disorder. But I think "mental health" doesn't encompass just clinical disorders; it includes practicing kindness to one's self in various ways. During IM in April 2019, it included food, exercise, social support, and academic/clinical performance support (these things preceded April 2019 and likely are lifelong issues). I started to work on those things in April 2020 (after M3/when the pandemic shut things down - I've been improving in those areas and am continuing to work on them), and another big issue I'm working on now is openness to vulnerability (in all aspects of life and particularly in the clinical setting) and other things Dr. Brown mentions in Daring Greatly. None of these would appear in the DSM5, but it's all mental health.

Anyway, my point is that I think I now understand that these all count as part of the "mental health" that people are referring to.

While residency if you do one is a ways off, do bear in mind that all the performance issues noted in your comments are precisely the kind of things that get people fired from their programs. You not only need to pass the next two years, but do so with enough retained knowledge and skill that you can be a functional resident. The residency forum is filled with dismissal stories from residents who never addressed similar issues.

I see. I didn't know that (hadn't experienced hearing about this yet). I'm glad then that they're catching this in me now while I have the time and opportunity to work on them.

On the residency front, keep in mind that your home program remains your best shot at landing a position. Your prior comments suggest your app would be DOA at the moment, but with 2 years of stellar performance you might win some people over willing to give you a shot when the time comes.

I'm grateful to have people tell me the true picture/state of things, which hasn't come up in conversations with people at my school yet. Better to know this sooner rather than later so that I can be prepared to give that stellar performance. I can't control whether I match, or maybe I'll choose not to continue on with residency, but for now, I'm in school to learn, so that's my plan.

 

[ArdorAyurveda]

Have you also considered Pathology in addition to potentially community FM/IM?

 

[Redpancreas]

I can give you 4 examples where I agree with Operaman about some incoherent thinking and expectations v. reality not aligning. First is that you're disappointed you have to repeat the year when in reality it is the only way to potentially remedy the depth of this situation. Second is not realizing after that IM rotation the extent of the issue and not correcting it. Third is that it seems that the notion that obtaining a Psych residency will be difficult seems to be news to you (***devil's advocate at the end). Lastly is that your notions of what Psychiatry are completely off. It is not a field where you spend endless hours talking compassionately with patients.

I neglected reading your evaluations from the previous thread. After reading them I have a much better idea of what happened. The issue is your framework/reasoning is completely scattered/messed up. It is a major issue that will cause deficits across all rotations and make you seem much less competent than you are. It is NOT a death sentence. It requires daily, deliberate, relentless coaching from someone who KNOWS MEDICINE. That is the biggest thing you need. I guarantee you that if you get that, the anxiety will improve as you start making more sense to others, you will stop burning yourself out by working hard in low impact areas enabling you to be more energetic/engaged, and this will give you the motivation to follow through. Again, I usually hit up SDN daily and I am willing to work through some clinical reasoning exercises daily with you and try to rectify areas I see are messed up. This will not be enough and you need someone to watch histories/physicals you do on real patients who can hear your assessment and give you immediate feedback on all aspects.

That Medicine attending you first rotated with seemed to have a lot of detailed feedback and I'm sure it was on point. I don't think that it did you any favors though in terms of promotion nor do I think the comments are unique to you. Reading through it, I can tell you students/residents at most medical schools, across many across fields in residency have similar issues in their approaches. Sometimes it gets exposed. Many cover up for it in one way or the other (ex. ability to get work done or appease their staff). Many times though it goes unchecked and learners are just funneled through the system. To act that this something so uncommon/egregious is disingenuous. What likely is happened is you stood out from the bunch in a few negative ways and people starting looking for issues. When you look for issues in medicine (whether it's in a patient, physician, or system) you're going to find a bunch, but that's not going to tell you how or whether you need to fix them.

Overall, OP, after reading this I think that you need what I mentioned in the second paragraph. I also think you have the potential to succeed in medical school. Having gotten this far and with no alternative options that you seem to want to accept, I suggest you really try to fix what I detailed in my second paragraph. I outlined a more specific approach in my first response.


***I did not see it mentioned but with a 517 MCAT and this level of scrutiny at the medical student level, I suspect that you go to a decent medical school which may factor into your Psychiatry aspiration if it is even strong in the first place given that your impression of the field is a bit off. I'm not saying Psychiatry is suddenly attainable, but it may be more possible than some are saying. Regardless, the first decision you need to make is whether you want to give this 6-year plan a shot or whether you want to pursue other career paths. Only you can make that decision

 

[Blueprint Med School]

I'm sorry you're going through all this and I'm glad you're taking the right steps like seeing a therapist for long term success. The best thing to do is frame all the positives that will come from this: you're going to be set up to be a clinical rockstar, basically a fourth year in your core rotations. Hopefully this makes you basically an intern for your audition rotations which could let your work answer any questions the leave may raise.

You got this!

David D, MD - USMLE and MCAT Tutor
Med School Tutors

 

[cadingcading]

Dude if you want to do medicine do it. Don’t listen to those telling you to quit. You have gone so far. If you want to do it do it. And while your step one wasn’t the greatest you passed and did very well on step 2. Redo 3rd year to the best of your ability. Kill your shelf’s. Do well on auditions. You can do this

 

[sdnsn]

Have you also considered Pathology in addition to potentially community FM/IM?

I had...At that time, I didn't think it was for me (my exposure includes running into path if they came by a procedure to look at a sample, shadowing a path and a path PA, taking a path M4 elective). I still have my doubts, but I am open to learning more about it. The reasons for not thinking it was for me included "they're so smart," "I'm not smart enough," "it's too much knowledge to be the doctor's doctor." I feel embarrassed to say these things because I feel like someone is going to say that I'm absolutely not cut out for medicine based on my reasons. I just hope that people can understand that I feel like I've been changing a lot as a person this year, and I feel confused about things right now, and I'm processing a lot at the moment. So I wouldn't engrave my thoughts re path on anything permanent just yet.

First is that you're disappointed you have to repeat the year when in reality it is the only way to potentially remedy the depth of this situation.

I realize this now. I think my disappointment was a reaction to hearing the news on Tuesday, but after processing it more, I agree with and am thankful for the decision, and am even feeling a little excited for this second chance after I take a few months to figure out what all my issues are and how to address them, regroup, plan, etc.

Lastly is that your notions of what Psychiatry are completely off. It is not a field where you spend endless hours talking compassionately with patients.

I hear this. I really need to address this issue because I don't want to be in another fantasy vs reality situation a few years from now, posting on SDN about it...(of course I'm super grateful to be able to talk with people here, but you know, I was warned!).

I neglected reading your evaluations from the previous thread. After reading them I have a much better idea of what happened. The issue is your framework/reasoning is completely scattered/messed up. It is a major issue that will cause deficits across all rotations and make you seem much less competent than you are. It is NOT a death sentence. It requires daily, deliberate, relentless coaching from someone who KNOWS MEDICINE. That is the biggest thing you need. I guarantee you that if you get that, the anxiety will improve as you start making more sense to others, you will stop burning yourself out by working hard in low impact areas enabling you to be more energetic/engaged, and this will give you the motivation to follow through. Again, I usually hit up SDN daily and I am willing to work through some clinical reasoning exercises daily with you and try to rectify areas I see are messed up. This will not be enough and you need someone to watch histories/physicals you do on real patients who can hear your assessment and give you immediate feedback on all aspects.

Quoting this to remember the last sentence (and thanks again for the offer to be another source of support. I started doing the bolded part in week 2 of IM remediation with a couple of my good-at-medicine friends, and it lessened the anxiety. So I'm a believer). The last sentence is something I thought about, but it might be hard to implement in real life since residents are so busy. So I'll have to figure out ways to approximate it: be observed once a week by the chief resident, practice with those smart friends or a tutor, practice with the clinical skills attending...I'll figure something out.

I'm sorry you're going through all this and I'm glad you're taking the right steps like seeing a therapist for long term success. The best thing to do is frame all the positives that will come from this: you're going to be set up to be a clinical rockstar, basically a fourth year in your core rotations. Hopefully this makes you basically an intern for your audition rotations which could let your work answer any questions the leave may raise.

You got this!

David D, MD - USMLE and MCAT Tutor
Med School Tutors

Dude if you want to do medicine do it. Don’t listen to those telling you to quit. You have gone so far. If you want to do it do it. And while your step one wasn’t the greatest you passed and did very well on step 2. Redo 3rd year to the best of your ability. Kill your shelf’s. Do well on auditions. You can do this

Thanks, that's the hope and plan!

 

[BidingMyTime]

You mentioned having to do rotations in strange cities without support, are you attending a Caribbean school? American medical schools are generally extremely good (although not perfect) about only accepting students who have the ability to graduate. If you are in an American school, it's likely you do have the skills to succeed in medicine, even if you currently aren't doing so.

I'm a pharmacist, and I went to school back when it was difficult to get into pharmacy school (things are different now.) At the time I went, the program was a 5 year program, there were a few people at my school who were "7 year students", they had repeated 2 years. This was rare, because most people dropped out at that point. The 2 "7 year students" that I knew, like you, were struggling in several different areas, but they eventually pulled in together and graduated. 1 of them had a serious, undiagnosed mental condition (undiagnosed until the difficulties in pharmacy school.) Pharmacy and medical school are different, but the similarity is, any struggle in life, assuming you have the basic skills (and you do if you have been accepted to an American medical school,) you can overcome if you truly want to.

The question that you have to answer for yourself, do you truly want to? Do you want to be a doctor if you can't be a psychiatrist? Can you picture yourself being any other kind of doctor, or a family practice doctor...which is usually the default? If you really want to graduate medical school, you need to be able to picture yourself as being the default (which doesn't mean you have to give up your dreams of being a psychiatrist, just that you need to be satisfied with your career as a doctor if you can't be a psychiatrist.) You need to picture yourself as a family practice doctor, focus on what career satisfaction you would have from that, focus on how you would want to help the patients you would see in your practice and what skills you need to learn to help those patients. Honestly, many patients go through their family doctors or internists, before being referred to a psychiatrist. You could be a tremendous help to these patients, even without being a psychiatrist.

Assuming you have the basic skills to succeed, then at this point you need to mentally commit to being a doctor. You need to have a positive (realistic) goal in your mind that you can continually focused on when you are feeling tired and stressed. You need to put on hold any distracting hobbies or recreation, for the few short years needed to get to your goal. (Which isn't saying you shouldn't have any recreation, just realistically, it is going to be very minimal, compared to what you had in undergrad, and what you will have once you are through residency.)

 

[Oedipa Maas]

I had...At that time, I didn't think it was for me (my exposure includes running into path if they came by a procedure to look at a sample, shadowing a path and a path PA, taking a path M4 elective). I still have my doubts, but I am open to learning more about it. The reasons for not thinking it was for me included "they're so smart," "I'm not smart enough," "it's too much knowledge to be the doctor's doctor." I feel embarrassed to say these things because I feel like someone is going to say that I'm absolutely not cut out for medicine based on my reasons. I just hope that people can understand that I feel like I've been changing a lot as a person this year, and I feel confused about things right now, and I'm processing a lot at the moment. So I wouldn't engrave my thoughts re path on anything permanent just yet.


I realize this now. I think my disappointment was a reaction to hearing the news on Tuesday, but after processing it more, I agree with and am thankful for the decision, and am even feeling a little excited for this second chance after I take a few months to figure out what all my issues are and how to address them, regroup, plan, etc.


I hear this. I really need to address this issue because I don't want to be in another fantasy vs reality situation a few years from now, posting on SDN about it...(of course I'm super grateful to be able to talk with people here, but you know, I was warned!).


Quoting this to remember the last sentence (and thanks again for the offer to be another source of support. I started doing the bolded part in week 2 of IM remediation with a couple of my good-at-medicine friends, and it lessened the anxiety. So I'm a believer). The last sentence is something I thought about, but it might be hard to implement in real life since residents are so busy. So I'll have to figure out ways to approximate it: be observed once a week by the chief resident, practice with those smart friends or a tutor, practice with the clinical skills attending...I'll figure something out.



Thanks, that's the hope and plan!

Current intern here. We are busy but if a student approached me day one and showed me the evals you shared here, I would make it a priority to make sure I was observing you daily and having you practice your presentations to me before rounds. Not because my history taking and exam skills are top notch or my presentations are flawless, but because if confidence is the issue, doing things as much as possible with observation will help. I strongly suggest you set up an “expectations” meeting day one with the team and I would honestly share your previous feedback. I think once a week is probably not enough since rotations aren’t all that long if you look at it in a once a week context. Maybe you will work with someone different on the team every day on this and that would be good too to get those perspectives.

 

[Redpancreas]

Current intern here. We are busy but if a student approached me day one and showed me the evals you shared here, I would make it a priority to make sure I was observing you daily and having you practice your presentations to me before rounds. Not because my history taking and exam skills are top notch or my presentations are flawless, but because if confidence is the issue, doing things as much as possible with observation will help. I strongly suggest you set up an “expectations” meeting day one with the team and I would honestly share your previous feedback. I think once a week is probably not enough since rotations aren’t all that long if you look at it in a once a week context. Maybe you will work with someone different on the team every day on this and that would be good too to get those perspectives.

Same. I would also not have gone nuclear on the evaluation aspect like that IM attending did. If I wanted to type an essay or help you, I would have given it to the student and kept the evaluation objective instead of trying to editorialize and create red flags that may not have existed.

OP I think sharing the evaluation with the resident is a good thought. Wait until you meet him or her and get a gauge for how supportive they are first and how much time they will have for you because if you show someone who's neither supportive and doesn't have time, it will only work against you. If the resident's supportive, approach him with the evaluations. Bring it up once. Don't keep reminding him/her about it and make sure you're attentive this time around because people hate clueless people who aren't aware of what's going on. There is a difference between someone who quietly shares their vulnerability and asks for help when needed as opposed to someone who trumpets their needs and reminds the team of their struggles on a daily basis. You want to be the former. I also discourage you from sharing this with other medical students or attendings unless absolutely necessary. First is it will bias attendings and put a target on your back and invite them to make "constructive criticism" a focus on an evaluation. Medical students will also try to use this to their advantage. People try to be good, but competitive environments bring out the worst in people and before you know it your colleagues will start blaming stuff on you knowing that people will believe it given your history.

Also, I think we're nearing the end of what SDN can do for you in with this particular struggle so I'm going to check out. Like some more recent posters have said, I echo the sentiment that you should just go for it and don't let anyone tell you what you can't do because you have the knowledge. You need to work very hard on training yourself to have an organized thought process and ensure you're always looking for 1) what can kill the patient 2) what is most common etc. This needs to be done daily when you get back up on your two feet, not once for an hour with a chief resident. In your case, there is no such thing as too much practice. Consider using SPIT like that ED attending suggested. Regardless, pick some organization process and stick with it. Don't change it up too many times or else you're doing yourself a disservice.

I think at some point you have to stop collecting advice that's trying to change you and just do what you need to do. Best of luck! I am very confident you have what it takes but potential is meaningless unless you use it.

 

[softball2344]

Hey OP sorry to hear about your struggles. I agree that discussing with you fam, friends, deans, and counselor is best. I feel like some of the info you provided here and in your previous posts is very identifiable, I would perhaps delete! Wishing you the best!

 

[sdnsn]

The question that you have to answer for yourself, do you truly want to? Do you want to be a doctor if you can't be a psychiatrist? Can you picture yourself being any other kind of doctor, or a family practice doctor...which is usually the default? If you really want to graduate medical school, you need to be able to picture yourself as being the default (which doesn't mean you have to give up your dreams of being a psychiatrist, just that you need to be satisfied with your career as a doctor if you can't be a psychiatrist.) You need to picture yourself as a family practice doctor, focus on what career satisfaction you would have from that, focus on how you would want to help the patients you would see in your practice and what skills you need to learn to help those patients. Honestly, many patients go through their family doctors or internists, before being referred to a psychiatrist. You could be a tremendous help to these patients, even without being a psychiatrist.

Assuming you have the basic skills to succeed, then at this point you need to mentally commit to being a doctor. You need to have a positive (realistic) goal in your mind that you can continually focused on when you are feeling tired and stressed. You need to put on hold any distracting hobbies or recreation, for the few short years needed to get to your goal. (Which isn't saying you shouldn't have any recreation, just realistically, it is going to be very minimal, compared to what you had in undergrad, and what you will have once you are through residency.)

I think that I could see myself in FM. It's an idea that I need more time to get used to, but I would love to serve that role in people's lives (and be able to answer all their questions and allay their concerns about all their medical problems) and to form relationships with numerous patients whom I really care about. I appreciate this perspective you've offered and the advice about really mentally committing to be a doctor. It's something I've been hearing more often in recent months (as I've been going through all these struggles), and when I lived the IM life during the remediation and lived/breathed/slept medicine during the remediation and CK study, I could start to see the rewards of that dedication. And it's a US school, it just has options to rotate in other places.

Current intern here. We are busy but if a student approached me day one and showed me the evals you shared here, I would make it a priority to make sure I was observing you daily and having you practice your presentations to me before rounds. Not because my history taking and exam skills are top notch or my presentations are flawless, but because if confidence is the issue, doing things as much as possible with observation will help. I strongly suggest you set up an “expectations” meeting day one with the team and I would honestly share your previous feedback. I think once a week is probably not enough since rotations aren’t all that long if you look at it in a once a week context. Maybe you will work with someone different on the team every day on this and that would be good too to get those perspectives.

OP I think sharing the evaluation with the resident is a good thought. Wait until you meet him or her and get a gauge for how supportive they are first and how much time they will have for you because if you show someone who's neither supportive and doesn't have time, it will only work against you. If the resident's supportive, approach him with the evaluations. Bring it up once. Don't keep reminding him/her about it and make sure you're attentive this time around because people hate clueless people who aren't aware of what's going on. There is a difference between someone who quietly shares their vulnerability and asks for help when needed as opposed to someone who trumpets their needs and reminds the team of their struggles on a daily basis. You want to be the former. I also discourage you from sharing this with other medical students or attendings unless absolutely necessary. First is it will bias attendings and put a target on your back and invite them to make "constructive criticism" a focus on an evaluation. Medical students will also try to use this to their advantage. People try to be good, but competitive environments bring out the worst in people and before you know it your colleagues will start blaming stuff on you knowing that people will believe it given your history.

Thanks, I was wondering about whether to share and with whom. I like the approach of sharing my evals with the intent of asking for daily, active, constructive feedback to improve my performance (not to remind them of how lost I am).

Will delete identifiable info now. Thank you everyone for your thoughtful advice and support. I'm very grateful for this community.

 

[ekmf27050]

This is not uncommon. Something about your methods were ineffective. It will take some time to reflect and figure out the extent of things. Here's what I suggest.

1.) Take a step back. Resilience is achieved in many ways. In the medical field where our lives are not on the line daily and millions of dollars don't hang in the balance for putting a ball in a hoop I think the best way to promote it is being kind to yourself. A lot of people are tempted to double down after this sort of event. In my experience that makes things worse. Be kind to yourself and take as long as you need to decompress whether that be until February or all the way until April. I would not put a date on it and just play it based of how you feel each week.

2.) I know how disappointing is feels to be delayed relative to your own peers. Medicine is an incredibly long road and we're all trying to get from undergrad -> med school -> residency -> specialty training -> attending as fast as we can with as few gaps as possible to still have some semblance of a life. Some people get through untouched which is great, but at the end of the day a majority of people have some form of struggle/setback in the whether it's early on in medical school like you or in residency/fellowship in the form of remediation/dismissal or as an attending in the form of a lawsuit that can someone back quite a bit. Then there's interpersonal conflicts like divorces, health issues etc. that hit you when your back is turned. It's better to have this sort of event happen now instead of continuing to skate by until finally something drastic happens.

3.) Utilize your school's resources to the fullest. A lot of people see this as generic, unhelpful advice but there's a couple reasons why this is so important. Your medical school is partly funded to support people in your situation. At your disposal are cognitive services, mental health support, and specific content experts whose services would not be free or at least not as expensive if you were not enrolled in XYZ medical school. I know everyone jumps to mental health since everyone admitted is usually academically proven so I would at least start by talking to your medical school counselor to figure out what the issues were. They will refer you to various services like counseling through a clinical psychologist or perhaps a psychiatrist if needed. Make sure you follow up and do exactly what they tell you. You may identify a weakness you did not know and how to manage it which will be very useful moving forward.

4.) If you feel ready to do some preparation after you're back on track I recommend reaching out to your IM clerkship director since that was the problematic rotation. Figure out how you failed and how to prevent that. If it was a NBME issue, buy/reset UWorld and create a study plan to get through all of OnlineMedEd. Don't distract yourself with other resources. The good news is if you're doing this you are preparing simultaneously for Step 2 CK. Cramming for 2 weeks doesn't work on these exams like it may have on content exams in medical school. You need to see this material over and over again for it to sink in and it takes time to get used to the clinical vignettes. If the issues were related to practical skills, then ask your clerkship director if you can get some help with physical exam skills or someone to coach you on your clinical reasoning. Engage with them very regularly.

5.) Redemption Factors: This is the least important bullet of this thread but there are XYZ things you can theoretically do to reassure residency programs. If the issue was NBME exams, passing them the second time around and doing reasonably well on Step 2 CK will do it. Fight to urge to chase 250+ on CK to compensate for what's happened. It may happen, it may not. If you historically struggle with exams it's a tall-order. Even an average score on CK will reassure programs that your medical knowledge (ie ability to pass the boards) is not a concern. If the issues were more clinically related, simply remediating successfully time around is the goal. The focus should be on learning the fundamentals, if honoring comes as a by-product, great...but it's not the focus.

Best of luck! I know it's cliché but getting through this to me at least demonstrates that you have ability to overcome something that many others don't or choose not to confront. Being realistic, it may not be seen that way in residency recruitment but it's a personal victory you will carry with you moving forward in life and I can promise you that opportunities to apply what you've learnt will present themselves down the road.

Yo I'm just here to give you props on your amazingly compassionate, actionable, detailed advice. I remember you from another thread about someone remediating M1 year, and I was similarly blown away by how good your advice was. You're an MVP bro.