Looking for Advice - Unmatched after SOAP

[Hootah]

Hello everyone, first post here on the forum. Unfortunately I have found myself without a residency placement after SOAP. While I recognize I am certainly not the only person in this situation, I have found difficulty relating to the generalized "what to do if you don't match" guides out there and was hoping someone on here may have a suggestion or idea.

First I need to explain my situation, and I will try my best to make the background information both brief and relevant. Throughout my medical school career I have excelled in the clinic but have struggled disproportionally on exams. There was never a test in medical school that I was able to comfortably finish in time. Neuropsych testing indicated accommodations were warranted, and my medical school agreed after which I was able to pass each rotation's shelf exams. However, the USMLE then refused my request for accommodations citing that I had never received them in primary school. While I try not to dwell on the past, I need to mention here that both of my parents were rather... complex... and my childhood was complex as a result; my primary education was split between 6 different school systems. I had been able to adapt well on my own up through College, but the increased demands of medical education was too much for my current strategies to cope, and my vulnerabilities became deficiencies.

I am proud to say that since, without accommodations, I have been able to pass each of my Step exams! But, this has come at a rather high cost: in the process I failed Step 1 twice, and both Step 2 CK and Step 2 CS once. In my ongoing efforts to match into a residency program, I'm finding that my perseverance to pass is also the very thing most detrimental to my application. I have never been more frustrated in my life than I have been for the past few months.

I am happy to share more information if anyone would find it helpful, just wanted to avoid adding to an already-lengthy post. Thank you all!

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[GoSpursGo]

I'm going to try and put this as plainly is I can, while recognizing that I am sure this entire process has been incredibly difficult and disappointing: what you describe are reasonable explanations for failing the USMLEs, but not excuses. At the end of the day, all that matters is convincing a program director that you will be able not only to perform well clinically, but also pass your specialty board exams at the end of your residency. A program director looking at your exam history will rightfully be concerned that you are at high risk for failing your board exams. If your personal statement included any of the statements that you gave above, I would read that and think you feel that you've done your best and don't have a concrete plan for doing better in the future. If you can't get accommodations for your tests, then you need to develop some other testing strategy which you can describe specifically in your personal statement.

Without knowing your school (US MD vs DO vs carrib) what specialty you applied for and how broadly you cast a net, it's hard to advise any further. If you're an IMG, frankly I am not sure what you can do to pull yourself out of this hole, but a US grad might be able to reapply successfully. Clearly, applying to rural FM and IM programs is you're only move here.

 

[NotAProgDirector]

I'm going to guess it's unlikely the OP is at a carib school - exam performance like that gets you tossed.
Also not a DO school - no one in their right mind would take CS.
This sounds like a US MD school, giving you lots of chances to succeed. I agree with the above, your track record isn't one of problems followed by success, it's the same problem over and over again. And with the CS failure, that might worry programs that you won't be able to get clinical work done fast enough.

Knowing how many / which programs / which fields you applied to and how many interviews you got would be very helpful.

 

[Hootah]

Responding to GoSpursGo:

Happy to hear that what I've explained comes across as explanations and not excuses - had feedback from programs saying I was 'blaming the system' for my exam challenges. You certainly opened my eyes with the comment "I would read that and think you feel that you've done your best and don't have a concrete plan." I had been considering this only from the perspective of providing an explanation! I already developed a successful test-taking strategy, simply made the assumption explaining this would be unnecessary details. Will add that in asap.

Some more information: I'm a US MD grad and was applying into Neurology, but at this point would obviously be happy in psych / FM / IM. Didn't cast the widest net in terms of programs, applied to about 16 total focusing to the least competitive. Had 1 interview. I was hoping the support from my home Neurology program would pull through but unfortunately didn't - this was actually a big surprise, program director offered to mentor me earlier in the year while residents and multiple other attendings actively encouraged me to apply to their program.

I think you essentially hit the nail on the head with trying to 'convince' program directors that I've conquered my testing demons, tough to do with just words. Some people suggested taking Step 3 prior should I need to reapply; do you think this is a good option?

 

[Hootah]

Responding to NotAProgDirector:

More of the information you're looking for is in my response to GoSpursGo, and you are correct in your reasoning!

You are absolutely right that the CS failure has programs concerned about my time management and efficiency - had several questions on exactly that. This is where I feel like I start sounding like a crazy person... I have only ever had time management issues on exams, genuinely not elsewhere. When I give this explanation it seems unsatisfactory even to me, but it is supported by my evaluations. Do you have any ideas for a better way I can approach this topic?

 

[DokterMom]

You say you excel clinically. This could be your salvation if you can get some of the well-respected physicians you have worked with to go to bat for you and work their networks.

You don't say what the neuropsych testing revealed, but if you can explain it in one sentence along with what you are now doing that has allowed you to succeed, that could help. If you are confident you can pass Step 3 on the first attempt, it can only help. (Unless you're wrong and don't pass first time... That would really, really hurt.)

Psych has become very competitive, so probably not an option. And next time, cast a very wide net.

 

[GoSpursGo]

Responding to GoSpursGo:

Happy to hear that what I've explained comes across as explanations and not excuses - had feedback from programs saying I was 'blaming the system' for my exam challenges. You certainly opened my eyes with the comment "I would read that and think you feel that you've done your best and don't have a concrete plan." I had been considering this only from the perspective of providing an explanation! I already developed a successful test-taking strategy, simply made the assumption explaining this would be unnecessary details. Will add that in asap.

Some more information: I'm a US MD grad and was applying into Neurology, but at this point would obviously be happy in psych / FM / IM. Didn't cast the widest net in terms of programs, applied to about 16 total focusing to the least competitive. Had 1 interview. I was hoping the support from my home Neurology program would pull through but unfortunately didn't - this was actually a big surprise, program director offered to mentor me earlier in the year while residents and multiple other attendings actively encouraged me to apply to their program.

I think you essentially hit the nail on the head with trying to 'convince' program directors that I've conquered my testing demons, tough to do with just words. Some people suggested taking Step 3 prior should I need to reapply; do you think this is a good option?

Just to be clear—I’m not sure your lengthy explanation does you any favors without a plan for what will be different going forward. Whether you consider it an “excuse” is kind of beside the point.

If you applied to only 16 programs, I hope this was a wake up call. No matter what someone tells you to your face, your stats are your stats and you need to cast an incredibly wide net.

Step 3 would help if you pass, and would be absolutely crushing if you fail. Do not attempt unless you are consistently getting passing marks

 

[deleted480308]

Responding to GoSpursGo:

Happy to hear that what I've explained comes across as explanations and not excuses - had feedback from programs saying I was 'blaming the system' for my exam challenges. You certainly opened my eyes with the comment "I would read that and think you feel that you've done your best and don't have a concrete plan." I had been considering this only from the perspective of providing an explanation! I already developed a successful test-taking strategy, simply made the assumption explaining this would be unnecessary details. Will add that in asap.

Some more information: I'm a US MD grad and was applying into Neurology, but at this point would obviously be happy in psych / FM / IM. Didn't cast the widest net in terms of programs, applied to about 16 total focusing to the least competitive. Had 1 interview. I was hoping the support from my home Neurology program would pull through but unfortunately didn't - this was actually a big surprise, program director offered to mentor me earlier in the year while residents and multiple other attendings actively encouraged me to apply to their program.

I think you essentially hit the nail on the head with trying to 'convince' program directors that I've conquered my testing demons, tough to do with just words. Some people suggested taking Step 3 prior should I need to reapply; do you think this is a good option?

I would like tonsee you match so we’re gonna have that “slap your friend to save them from themself” talk

16 makes me seriously question your judgement in other areas. It’s just a ridiculous decision. You can still be a good doctor and a good human. Those have nothing to do with board exams so don’t get in your feeling about the next sentence. You’re a bottom tier candidate now. The reason is irrelevant, it’s just true. You never had the luxury of 16 apps and whoever told you that was a good idea is incompetent or they dislike you.

Also, “i’m finding my perseverance to pass is the biggest detriment to me application”? I have no idea what you are saying there. Are you bad at phrasing or do you really think having perseverance is a detriment. Perseverance is not a detriment. Failing 4 board exams is a detriment. Feel free to fill out neuro apps but they are probably donations. Focus on FM programs that many don’t want to be at, find some that specifically mention (must pass within x attempts) they take board failures. Call them and tell them how honored you would be to have a chance and how hard you will work for them.

you can still be a good person and a good doctor, but you have to navigate this better than you have been if you want to be a doctor at all. Keep your head up and adjust

 

[Hootah]

I would like tonsee you match so we’re gonna have that “slap your friend to save them from themself” talk

16 makes me seriously question your judgement in other areas. It’s just a ridiculous decision. You can still be a good doctor and a good human. Those have nothing to do with board exams so don’t get in your feeling about the next sentence. You’re a bottom tier candidate now. The reason is irrelevant, it’s just true. You never had the luxury of 16 apps and whoever told you that was a good idea is incompetent or they dislike you.

Also, “i’m finding my perseverance to pass is the biggest detriment to me application”? I have no idea what you are saying there. Are you bad at phrasing or do you really think having perseverance is a detriment. Perseverance is not a detriment. Failing 4 board exams is a detriment. Feel free to fill out neuro apps but they are probably donations. Focus on FM programs that many don’t want to be at, find some that specifically mention (must pass within x attempts) they take board failures. Call them and tell them how honored you would be to have a chance and how hard you will work for them.

you can still be a good person and a good doctor, but you have to navigate this better than you have been if you want to be a doctor at all. Keep your head up and adjust

sb247, slap away! Hahaha how else can I hope to improve?

Wasn't trying to say perseverance was a detriment, but i see how it could be read that way. Was more trying to express my frustration in realizing that programs seemed only to focus on the failures, and not the efforts taken to overcome them.

In all honesty, for 15 of those 16 programs I was pretty sure I wasn't going to get an interview. My deans were realistic with the numbers, but I just dint know how many people in my position they've advised before. I had my neurology rotation a month before ERAS opened, and it was during this time that the program director offered to mentor me and I was getting a lot of encouragement from the other attendings and residents. I was good in the clinic, and the people liked me; I'm embarrassed to say that I succumbed to temptation. I felt that given my exam scores I was going to need people known to a program to advocate for me. Without the time for away rotations I took a gamble on my home program, and lost.

 

[deleted480308]

sb247, slap away! Hahaha how else can I hope to improve?

Wasn't trying to say perseverance was a detriment, but i see how it could be read that way. Was more trying to express my frustration in realizing that programs seemed only to focus on the failures, and not the efforts taken to overcome them.

In all honesty, for 15 of those 16 programs I was pretty sure I wasn't going to get an interview. My deans were realistic with the numbers, but I just dint know how many people in my position they've advised before. I had my neurology rotation a month before ERAS opened, and it was during this time that the program director offered to mentor me and I was getting a lot of encouragement from the other attendings and residents. I was good in the clinic, and the people liked me; I'm embarrassed to say that I succumbed to temptation. I felt that given my exam scores I was going to need people known to a program to advocate for me. Without the time for away rotations I took a gamble on my home program, and lost.

Backup backup backup backup

for all residents reading this in the future, always have a bunch of backups.

I hope next year is better OP, you seem to have learned a tough lesson but this can still be salvageable. Good luck and keep trucking

 

[NotAProgDirector]

The good news is that you've made a mistake you can fix.

Neurology is one of the least competitive fields, so that's a plus. You need to apply to a much larger group of programs. You need to apply to geographically unpopular places, and community programs.

You have not yet demonstrated that your new plan for exams is effective. You could take S3, and if you pass the firt time that would be supportive. But if you fail, then you're in really big trouble. And I hate to advise people to take S3 without some clinical experience.

 

[gutonc]

sb247, slap away! Hahaha how else can I hope to improve?

Wasn't trying to say perseverance was a detriment, but i see how it could be read that way. Was more trying to express my frustration in realizing that programs seemed only to focus on the failures, and not the efforts taken to overcome them.

In all honesty, for 15 of those 16 programs I was pretty sure I wasn't going to get an interview. My deans were realistic with the numbers, but I just dint know how many people in my position they've advised before. I had my neurology rotation a month before ERAS opened, and it was during this time that the program director offered to mentor me and I was getting a lot of encouragement from the other attendings and residents. I was good in the clinic, and the people liked me; I'm embarrassed to say that I succumbed to temptation. I felt that given my exam scores I was going to need people known to a program to advocate for me. Without the time for away rotations I took a gamble on my home program, and lost.

Man...I had a solid AF application (PhD, AOA, pubs, decent Step scores without multiple attempts) for a slightly more competitive specialty and I applied to more than twice that many programs. I'm sorry your advising was sorry horrible.

I agree that taking Step 3 is probably the worst thing you could do at this point because, unless you've done a huge amount of work in your test taking strategy, that's actually going to be the nail in your coffin.

I disagree a bit with @sb247 in that Neuro and FM are similar in competitiveness and if Neuro is what you want to do and your app is tilted that way, you're better off headed in that direction. That said, some FM backup programs are not a bad idea.

Did you try to SOAP for a prelim year for this year? What are your plans for this year? If you don't have an internship option, I'd recommend some clinical research in neurology, preferably somewhere with less terrible advisors that you could use to get an updated LOR.

 

[ThoracicGuy]

Responding to GoSpursGo:

Happy to hear that what I've explained comes across as explanations and not excuses - had feedback from programs saying I was 'blaming the system' for my exam challenges. You certainly opened my eyes with the comment "I would read that and think you feel that you've done your best and don't have a concrete plan." I had been considering this only from the perspective of providing an explanation! I already developed a successful test-taking strategy, simply made the assumption explaining this would be unnecessary details. Will add that in asap.

Some more information: I'm a US MD grad and was applying into Neurology, but at this point would obviously be happy in psych / FM / IM. Didn't cast the widest net in terms of programs, applied to about 16 total focusing to the least competitive. Had 1 interview. I was hoping the support from my home Neurology program would pull through but unfortunately didn't - this was actually a big surprise, program director offered to mentor me earlier in the year while residents and multiple other attendings actively encouraged me to apply to their program.

I think you essentially hit the nail on the head with trying to 'convince' program directors that I've conquered my testing demons, tough to do with just words. Some people suggested taking Step 3 prior should I need to reapply; do you think this is a good option?

This was the worst mistake. With your step failures and other issues, you really needed a wide net out there. Reapplying, you need to look at over 100 applications, and probably more.

 

[Hootah]

Man...I had a solid AF application (PhD, AOA, pubs, decent Step scores without multiple attempts) for a slightly more competitive specialty and I applied to more than twice that many programs. I'm sorry your advising was sorry horrible.

I agree that taking Step 3 is probably the worst thing you could do at this point because, unless you've done a huge amount of work in your test taking strategy, that's actually going to be the nail in your coffin.

I disagree a bit with @sb247 in that Neuro and FM are similar in competitiveness and if Neuro is what you want to do and your app is tilted that way, you're better off headed in that direction. That said, some FM backup programs are not a bad idea.

Did you try to SOAP for a prelim year for this year? What are your plans for this year? If you don't have an internship option, I'd recommend some clinical research in neurology, preferably somewhere with less terrible advisors that you could use to get an updated LOR.

In all honesty I liked my advisors and they genuinely mean well, I just don't think they're used to dealing with this type of scenario.

At this point I'm viewing Step 3 as a last resort to be paired with a research/intern year should I not find a residency position. If I set aside dedicated time to study for it, I believe I can pass first try. That being said, I will accept any residency spot even off-cycle.

I did try to SOAP - applied to all unfilled categorical neurology and psychiatry positions, and to every prelim year position. No hits. Plan right now is to keep reaching out to programs through the end of the month - I've sent about 2500+ emails to different programs since the end of SOAP. A few hits but no interviews yet. Also applying to internship positions when I find them - i.e. recent one for sleep medicine asking for 'an unmatched medical graduate'

 

[ThoracicGuy]

In all honesty I liked my advisors and they genuinely mean well, I just don't think they're used to dealing with this type of scenario.

At this point I'm viewing Step 3 as a last resort to be paired with a research/intern year should I not find a residency position. If I set aside dedicated time to study for it, I believe I can pass first try. That being said, I will accept any residency spot even off-cycle.

I did try to SOAP - applied to all unfilled categorical neurology and psychiatry positions, and to every prelim year position. No hits. Plan right now is to keep reaching out to programs through the end of the month - I've sent about 2500+ emails to different programs since the end of SOAP. A few hits but no interviews yet. Also applying to internship positions when I find them - i.e. recent one for sleep medicine asking for 'an unmatched medical graduate'

Honestly, I'm not sure I would try passing it before another round of applying, particularly given your last round. As others have said, if you fail it, your application is much much harder to support.

 

[gutonc]

In all honesty I liked my advisors and they genuinely mean well, I just don't think they're used to dealing with this type of scenario.

I liked my advisors too. But they weren't used to dealing with the kind of applicant I was either. So I smiled and nodded during meetings, and sought advice elsewhere. But blaming your advisors at this point is kind of lamesauce and irrelevant.

At this point I'm viewing Step 3 as a last resort to be paired with a research/intern year should I not find a residency position. If I set aside dedicated time to study for it, I believe I can pass first try. That being said, I will accept any residency spot even off-cycle.

You don't need to pass Step 3 first try. You need a 250. Which is probably not going to happen. Please don't take Step 3 now, no matter what else happens.

I did try to SOAP - applied to all unfilled categorical neurology and psychiatry positions, and to every prelim year position. No hits. Plan right now is to keep reaching out to programs through the end of the month - I've sent about 2500+ emails to different programs since the end of SOAP. A few hits but no interviews yet. Also applying to internship positions when I find them - i.e. recent one for sleep medicine asking for 'an unmatched medical graduate'

Find something clinical or research, preferably in neurology or related (sleep counts) to do this year, and get an amazing LOR out of it. Then apply to every...single...neurology program next year.

 

[Splenda88]

At this stage, you need to salvage your medial career... Try to find a spot in anything (FM, Pathology, Prelim surgery etc...) so you can have at least 1 year of postgrad training, which will make you eligible to have a full or unrestricted medical license ~33 states.

 

[Mad Jack]

Responding to GoSpursGo:

Happy to hear that what I've explained comes across as explanations and not excuses - had feedback from programs saying I was 'blaming the system' for my exam challenges. You certainly opened my eyes with the comment "I would read that and think you feel that you've done your best and don't have a concrete plan." I had been considering this only from the perspective of providing an explanation! I already developed a successful test-taking strategy, simply made the assumption explaining this would be unnecessary details. Will add that in asap.

Some more information: I'm a US MD grad and was applying into Neurology, but at this point would obviously be happy in psych / FM / IM. Didn't cast the widest net in terms of programs, applied to about 16 total focusing to the least competitive. Had 1 interview. I was hoping the support from my home Neurology program would pull through but unfortunately didn't - this was actually a big surprise, program director offered to mentor me earlier in the year while residents and multiple other attendings actively encouraged me to apply to their program.

I think you essentially hit the nail on the head with trying to 'convince' program directors that I've conquered my testing demons, tough to do with just words. Some people suggested taking Step 3 prior should I need to reapply; do you think this is a good option?

Everything is quite a long shot at this point, but psych especially these days. It's much more competitive than it used to be, and you'll likely just be throwing your money away

 

[Splenda88]

Everything is quite a long shot at this point, but psych especially these days. It's much more competitive than it used to be, and you'll likely just be throwing your money away

It's very upsetting to see intelligent people (aka medical students) who have their career on the line don't know how to navigate the system... OP thinking psych is a back up to neurology make me think OP is in real trouble...