Letter of Concern in your File

[blackandtan]

I have a friend who has had some disciplinary problems in medical school. She has not been suspended, but will have a letter of concern in her file. Her infractions were all out of school infraction (i.e. she has great scores and marks in her clinicals including comments praising her professionalism).

Any attendings or PD's out there: How will this affect her residency options?

Step one score was 240, Multiple Honors, greater than 80th percentile on shelfs, coming from Ivy league school. Some good extracurricular/volunteer experience. Little research.

Interested in Internal Medicine residencies.

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[Taurus]

It won't hold her back, but it's a black mark nonetheless.

Only the top, top IM programs are off-limits to her now.

She should be fine.

 

[medicinesux]

please don't tell me this was because (s)he pissed off nurse Jackie?

There maybe a box on the ERAS application where you may need to address this "letter of concern". I am not sure but I can't really remember that far back. I mostly agree with taurus, but I think it depends on the reasons why this naughty letter was put in this person's file and how the PD views it. If I was a PD and it was for the above reason I would laugh my arse off and could care less.

 

[blackandtan]

No,

Its for things like parking warnings, misguided noise complaints, scheduling conflicts. Nothing regarding her clinical experiences at all.

 

[doctorFred]

No,

Its for things like parking warnings, misguided noise complaints, scheduling conflicts. Nothing regarding her clinical experiences at all.

Although any one of those things in a vacuum is meaningless, when enough of them accrue, it's a red flag (at least it was enough for someone to write a letter of concern.) Clinical experiences are really only half the picture - what you're talking about speaks to personality, and that's the other half. I wouldn't be so quick to dismiss their importance.

 

[blackandtan]

Oh, absolutely not, is anyone dismissing the importance, hence the thread to gauge the impact on her future. Any item on the list of complaints compiled seems trivial, but put them all together and you have a pattern of behavior that may be concerning depending on the light in which you look at them.

At this point, the damage is done, I was just hoping for some input from Attendings and PD's about how they might look at an otherwise above average application that has this letter of concern attached to it. I know its hard especially when you don't have it there to look at.

I guess a more specific question is this:

Would a letter of concern prevent you from interviewing an otherwise good candidate for your program?

 

[gutonc]

Oh, absolutely not, is anyone dismissing the importance, hence the thread to gauge the impact on her future. Any item on the list of complaints compiled seems trivial, but put them all together and you have a pattern of behavior that may be concerning depending on the light in which you look at them.

At this point, the damage is done, I was just hoping for some input from Attendings and PD's about how they might look at an otherwise above average application that has this letter of concern attached to it. I know its hard especially when you don't have it there to look at.

I guess a more specific question is this:

Would a letter of concern prevent you from interviewing an otherwise good candidate for your program?

When you say "in her file" do you mean that it existence and/or contents will be included in the MSPE or that it exists in some mythical "permanent record." If the former, it will likely be somewhat harmful. If the latter, unless it somehow gets noted in an LOR or something, I can't figure out how programs would find out about it. It's not like there's a spot in ERAS for that kind of thing.

aPD may have a better answer though.

 

[Ludicolo]

I would assume this will be mentioned in the MSPE.

With her stats, she will get interviews, since many of them will be offered before the Dean's letter is released. However, when interviewers review her file, she will be considered somewhat of a slight risk. She will certainly have to explain herself during the interview multiple times. How well she does could determine where she ends up.

 

[Speculatrix]

You are asking the wrong crowd and also making a number of assumptions. You first need to find out whether this will go on the MSPE (i.e. Dean's Letter). This is only something that she can find out from the person who is writing her Dean's letter. I would advise her to stay out of trouble for a bit, show that she can deal with her parking infractions, etc., and then approach the Dean who will be writing the MSPE, and find out whether it will be mentioned. Since it's mainly an academic document, dealing with academic progress and violations thereof, if I were the Dean, I would choose not to include this information for the MSPE.

IF THIS IS THE CASE, breathe a sigh of relief, and continue to apply as normal. Nevertheless, keep in mind that 240 is simply not enough for top IM these days, since that is the low end of the curve for the best programs.

 

[docB]

No,

Its for things like parking warnings, misguided noise complaints, scheduling conflicts. Nothing regarding her clinical experiences at all.

That point about "scheduling conflicts" would be the biggest issue for me. The biggest part of residency is showing up. Something that tells me a candidate might not be reliable would give me pause.

 

[NotAProgDirector]

Most of what I can say has been said already. If this is in her MSPE, it would be a pretty big concern. This type of behavior tends to continue. I have enough problems. I can help residents with average, or even below average, step scores to improve. I can't fix people who have personality deficits that create behavior problems like this.