MD Medical/Mental Health LOA & Step 1 - Need Advice

[NeedAdvice123]

Hey guys, I'm an M2 and need some advice regarding taking a medical LOA for mental health reasons and taking Step 1.

For some background info: I was diagnosed with Bipolar II disorder in undergrad, started treatment at the time, and have been relatively stable on the same medication for it for ~9 years now (I'm a non-trad student). I definitely still experience depressive and hypomanic episodes, but since I've been on-treatment the symptoms are relatively "minor"/muted-- I can definitely recognize when I'm going through them based on some tell-tale changes in my mood and habits, but other people would honestly not really notice a difference in my outward behavior unless they know me really well.

So in terms of what's going on right now: I've been mildly depressed for about two and half months and am scheduled to take Step 1 towards the end of May. Like I mentioned before, my episodes are relatively muted compared to what they would/could be without treatment, but I still struggle with some of the usual symptoms that affect me. The main symptom that's my issue in this context, though, is just a complete lack of motivation/focus. Despite totally understanding how important this test and my score is (especially given my goal specialty, which is competitive), I literally cannot get myself to study for any extended period of time and have honestly only done an embarrassingly small fraction of the studying that I should be doing. When I've felt like this in past episodes, I've generally been able to "power through" whatever tasks or obligations I have and do a passable enough job with what motivation I could muster--and I could technically still do so in this case--but I recognize that Step 1 would literally be the worst situation to try doing this with given its importance.

At this point, I'm trying to finally come to terms with the fact that I probably need to let my school admin know what's going on and ask for some help regarding taking time off and delaying Step 1. Logically, I know this would probably be the best thing for me to, but I'm honestly still struggling with working up the courage to do it, which is what I need advice with, I guess. Some of my reluctance probably comes down to fear regarding the optics of having to take a medical LOA and how it affects the rest of my education and future residency application, so I mainly have questions about what to expect and/or what I need to do because I really have no idea how a medical LOA would work. What options do I have in terms of length of LOA? Would schools force a full-year off in this context or would I be able to take off a semester and start again in the spring? What details are disclosed in residency applications regarding medical LOAs, and for ones specifically regarding mental health issues, how would/should students address it? And, honestly/realistically, how detrimental are medical LOAs for mental health reasons (whether disclosed or assumed) in residency applications? Also, just in case this is relevant info needed for any advice: I have no academic red flags and passed all my preclinical courses without remediation or repeats.

Obviously, I understand that the answers to some of my questions will probably be school-specific and my school will give me more info when I reach out, but I also don't want to be flying blind in terms of what to expect when I do finally meet with them, so any help/advice would be appreciated. Thanks in advance

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[Redpancreas]

Hey guys, I'm an M2 and need some advice regarding taking a medical LOA for mental health reasons and taking Step 1.

For some background info: I was diagnosed with Bipolar II disorder in undergrad, started treatment at the time, and have been relatively stable on the same medication for it for ~9 years now (I'm a non-trad student). I definitely still experience depressive and hypomanic episodes, but since I've been on-treatment the symptoms are relatively "minor"/muted-- I can definitely recognize when I'm going through them based on some tell-tale changes in my mood and habits, but other people would honestly not really notice a difference in my outward behavior unless they know me really well.

So in terms of what's going on right now: I've been mildly depressed for about two and half months and am scheduled to take Step 1 towards the end of May. Like I mentioned before, my episodes are relatively muted compared to what they would/could be without treatment, but I still struggle with some of the usual symptoms that affect me. The main symptom that's my issue in this context, though, is just a complete lack of motivation/focus. Despite totally understanding how important this test and my score is (especially given my goal specialty, which is competitive), I literally cannot get myself to study for any extended period of time and have honestly only done an embarrassingly small fraction of the studying that I should be doing. When I've felt like this in past episodes, I've generally been able to "power through" whatever tasks or obligations I have and do a passable enough job with what motivation I could muster--and I could technically still do so in this case--but I recognize that Step 1 would literally be the worst situation to try doing this with given its importance.

At this point, I'm trying to finally come to terms with the fact that I probably need to let my school admin know what's going on and ask for some help regarding taking time off and delaying Step 1. Logically, I know this would probably be the best thing for me to, but I'm honestly still struggling with working up the courage to do it, which is what I need advice with, I guess. Some of my reluctance probably comes down to fear regarding the optics of having to take a medical LOA and how it affects the rest of my education and future residency application, so I mainly have questions about what to expect and/or what I need to do because I really have no idea how a medical LOA would work. What options do I have in terms of length of LOA? Would schools force a full-year off in this context or would I be able to take off a semester and start again in the spring? What details are disclosed in residency applications regarding medical LOAs, and for ones specifically regarding mental health issues, how would/should students address it? And, honestly/realistically, how detrimental are medical LOAs for mental health reasons (whether disclosed or assumed) in residency applications? Also, just in case this is relevant info needed for any advice: I have no academic red flags and passed all my preclinical courses without remediation or repeats.

Obviously, I understand that the answers to some of my questions will probably be school-specific and my school will give me more info when I reach out, but I also don't want to be flying blind in terms of what to expect when I do finally meet with them, so any help/advice would be appreciated. Thanks in advance

I am glad to hear you've come to a realization that this is a problem as that itself is sometimes the hardest thing to admit. As you've said, LOAs vary by schools, but they are generally classified by type and length. There are medical, administrative, and academic leaves of absences.

I actually took a LOA prior to Step 1 (to have more time, essentially). It was 2 months in length and meant I had to do my first rotation last and it was classified as an "administrative LOA" on my transcript. I did well on the exam and moved on. I was asked about it on 2-3 out of 15-16 interviews particularly at the more competitive places. I gave a pretty plain answer and I suppose it was fine, but it was definitely noted.

When taking a LOA, first you need to explain (both to yourself and to admin) why you need it. I understand you've got a psychiatric diagnosis. For that, I suggest you first and foremost see your Psychiatrist (like you said you're doing) and figure out what may be going on from neuropsychiatric perspective. Talk with him/her and see if it would be helpful to get yourself plugged in with a therapist. Sometimes, just having that regular check-in each week to challenge some cyclic thoughts does wonders. If through this comprehensive approach you find that your problems are primarily psychiatric in nature, I suggest you just follow your psychiatrist/psychologists lead. I'm not saying listen to what they say blindly, but if this complete lack of motivation is truly due to your diagnosis, then they should be the ones helping determine length of your LOA. Don't worry about the longterm consequences. Those are all mute in comparison to your mental health which is why I am not going to get into the weeds about that.

Now, after discussing with your mental health team, you think this is more related to "burnout", then the solution's general self-care like daily exercise, setting a side a few hours a day to just chill, and checking in with others. It may also help to stretch the timeline of Step 1. Right now, it probably feels like an elephant on your chest with all your procrastination weighing on you so potentially extending the deadline gives you a clean slate allowing you the time to incorporate healthy habits mentioned above and get mind back on track. If you end up doing this, I recommend you take as few months off (no greater than 3) as possible as you may not even need to delay your residency application/graduation.