Medical Student on the Spectrum

[Redpancreas]

Today I was sad to hear one of my favorite medical students who’s super authentic, hardworking, capable, and kind didn’t match his desired specialty. He’s is very much on the spectrum though and it’s immediately apparent to anyone who meets him.

His board scores, letters, etc. were all way higher than average (at least per his report- I obviously dunno for sure) and he wasn’t applying to anything super competitive. We talked today and honestly I can’t help wondering if it’s because he’s on the spectrum and people were rubbed the wrong way during interviews or maybe there were comments in his evals. As someone who may be on the spectrum myself and is probably somewhat socially awkward, I felt a degree of kinship with him and just wanted to tell him to keeping giving it his all, but I wondered if he had any insight into how he may be being perceived.

Honestly if I felt it would be constructive, I would have shared my honest thoughts because, I’ve learned that’s it’s much better to receive harsh/direct honest advice from someone well meaning than kind words from someone who doesn’t care. The thing though is to what extent can he change the way he comes off so other people don’t see him as a liability but an asset that he truly is. I feel like I’ve worked with him on multiple rotations to know he’s much harder working than most and also more capable, but I feel like some just blow him off because he’s got one hell of a monotone voice and awkward facial expressions/formalities/etc.

Any thoughts?

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[JuicedToTheSocks]

What he do to make u think he not on the spectrum?

Sometimes I wonder if I'm on the spectrum tbh. Lotta social norms are just dumb

 

[LunaOri]

If he did not disclose being on the spectrum in his application, and it was not mentioned in his letters, it might have come as a confusing surprise to interviewers. We interviewed one such candidate, and interviewers thought his odd affect, monotone voice, and lack of eye contact meant that he was not interested in the program.

 

[cincincyreds]

Today I was sad to hear one of my favorite medical students who’s super authentic, hardworking, capable, and kind didn’t match his desired specialty. He’s is very much on the spectrum though and it’s immediately apparent to anyone who meets him.

His board scores, letters, etc. were all way higher than average (at least per his report- I obviously dunno for sure) and he wasn’t applying to anything super competitive. We talked today and honestly I can’t help wondering if it’s because he’s on the spectrum and people were rubbed the wrong way during interviews or maybe there were comments in his evals. As someone who may be on the spectrum myself and is probably somewhat socially awkward, I felt a degree of kinship with him and just wanted to tell him to keeping giving it his all, but I wondered if he had any insight into how he may be being perceived.

Honestly if I felt it would be constructive, I would have shared my honest thoughts because, I’ve learned that’s it’s much better to receive harsh/direct honest advice from someone well meaning than kind words from someone who doesn’t care. The thing though is to what extent can he change the way he comes off so other people don’t see him as a liability but an asset that he truly is. I feel like I’ve worked with him on multiple rotations to know he’s much harder working than most and also more capable, but I feel like some just blow him off because he’s got one hell of a monotone voice and awkward facial expressions/formalities/etc.

Any thoughts?

Medicine is very clicky. We interview people and prefer to take people we like ultimately. We had someone in our residency program who had very high board scores. Someone knew him from the medical school he came from and told our director not to take him. Ultimately this person was lazy, dangerous, and put no effort into what they did and made it so we all had to work harder. We had to beg the director to fire him which ultimately happened since he never bothered to study for the board exams.

It absolutely matters how one conducts themselves in an interview. Yes high board scores are great but at the end of the day we have to work with these people so we need people who listen and do what they are told and don't act awkward. If someone is going to act strange in an interview game over. It's a tough world.

 

[LunaOri]

I disagree a little, cincincyreds—if I knew in advance that a candidate was not neurotypical, communication skills would still be important, but I would not be distracted by his/her affect or lack of eye contact.

 

[Karlington]

Today I was sad to hear one of my favorite medical students who’s super authentic, hardworking, capable, and kind didn’t match his desired specialty. He’s is very much on the spectrum though and it’s immediately apparent to anyone who meets him.

His board scores, letters, etc. were all way higher than average (at least per his report- I obviously dunno for sure) and he wasn’t applying to anything super competitive. We talked today and honestly I can’t help wondering if it’s because he’s on the spectrum and people were rubbed the wrong way during interviews or maybe there were comments in his evals. As someone who may be on the spectrum myself and is probably somewhat socially awkward, I felt a degree of kinship with him and just wanted to tell him to keeping giving it his all, but I wondered if he had any insight into how he may be being perceived.

Honestly if I felt it would be constructive, I would have shared my honest thoughts because, I’ve learned that’s it’s much better to receive harsh/direct honest advice from someone well meaning than kind words from someone who doesn’t care. The thing though is to what extent can he change the way he comes off so other people don’t see him as a liability but an asset that he truly is. I feel like I’ve worked with him on multiple rotations to know he’s much harder working than most and also more capable, but I feel like some just blow him off because he’s got one hell of a monotone voice and awkward facial expressions/formalities/etc.

Any thoughts?

I'm afraid this is an impossible question to answer, as it's highly individual and depends on him and the severity of his condition.

Regardless, it's very kind of you to care, and consider helping him. 🙂 If you think you're able to do it in a constructive manner, then by all means go ahead and do so. Best case scenario you are able to help him a bit. Worst case scenario you are not, but then he will hopefully at least learn a bit more about his limitations, and may be realistic for him to expect.

 

[lanzhou_lamian]

I’d let him know. It’s very possible he doesn’t realize how he comes off to people in interviews. Maybe he can fix it, maybe he can’t, but he can’t fix what he doesn’t know.

 

[mistafab]

It really depends.

Depends on your relationship with this person, their receptiveness to feedback, and how specific you can be (helpful).

Best advice for a friend like this is to encourage them to pursue specialties or jobs where they minimize swimming uphill as much as possible. Medicine is hard enough, you dont want every interaction to be a challenge ON TOP OF all else. Most residents find residency very hard, typically due to workload, steep learning curve, and increasing amounts of responsibilty. Imagine if every patient interaction was challenging for social reasons in addition to all the above.

Programs can be accomodating. Some specialties more than others. Some settings more than others (i,e, academic/ research oriented programs). Patients or other staff are not typically going to be accommodating. That’s the main barrier to success here.

 

[LeaveNoTrace]

If he did not disclose being on the spectrum in his application, and it was not mentioned in his letters, it might have come as a confusing surprise to interviewers. We interviewed one such candidate, and interviewers thought his odd affect, monotone voice, and lack of eye contact meant that he was not interested in the program.

I have heard that self-disclosure here was almost always a bad idea; the argument was that even if it was obvious, it was an indication of oversharing and lack of boundaries. Also, program directors might be biased against autistic candidates. Some of that is because of very real communication difficulties and some of it may be due to stereotypes...it is interesting to hear someone arguing for disclosure. Out of curiosity - what specialty are you in? Pathology (where autistic medical students are directed to) is very different from psychiatry, where self-disclosure would probably get your application rejected without a second thought.

 

[esob]

It definitely depends on the specialty. When I interview potential residents for psych, there is a certain degree of "flow" that matters more than board scores or other metrics because if you don't have that quality on interview day, I feel you are unlikely to ever "learn" it.

 

[operaman]

Yeah this is a very tough thing to overcome. I remember a guy from the interview trail when I was there who I think was in his 2nd or 3rd cycle that time and was clearly a bit off. I remember at all the socials he would walk up to people and do card tricks with the deck of playing cards he had with him. I saw him at some pretty solid program interviews so his stats just have been great, but I don’t think he ever matched ent.

I saw a handful of similarly atypical folks come through our program to interview when I was a resident and without exception they were DNR’d or put at the bottom of the list.

I’m not sure if such behavior is fixable, certainly within the short span of time available. There’s no motivation for programs to look past it, especially if they have plenty of better candidates. Best bet for such folks is to aim for specialties that are historically more likely to attract other atypical people. Without the ability to interview like a normal human, I think competitive fields are a no go unless there’s something truly stellar on the CV and maybe not even then.

 

[Candidate2017]

Listen, we're not looking for the applicant with the most rizz. Just someone with basic social skills to navigate the real world. Someone who won't tick off catty nurses. Someone who can explain to people their loved one is brain dead, needs hospice, or has schizophrenia etc. Someone who can work with difficult, entitled populations... and med students. No program director wants to deal with that smoke and the inevitable complaints.

If someone is smart enough to make it through med school but still hasn't figured out a workaround for social graces, they need to consider specialties with limited patient contact. Or engineering.

Also, if I had a dollar for every patient who said they were "on the spectrum"...

No you're not, you're socially awkward. I'm also of the opinion that doctors or soon to be doctors shouldn't throw around layperson Tiktok terms for an actual medical diagnosis. I may as well refer the next patient that complains of recent upper respiratory infection upon ROS, to ENT for "had a cold".

 

[LeaveNoTrace]

Today I was sad to hear one of my favorite medical students who’s super authentic, hardworking, capable, and kind didn’t match his desired specialty. He’s is very much on the spectrum though and it’s immediately apparent to anyone who meets him.

His board scores, letters, etc. were all way higher than average (at least per his report- I obviously dunno for sure) and he wasn’t applying to anything super competitive. We talked today and honestly I can’t help wondering if it’s because he’s on the spectrum and people were rubbed the wrong way during interviews or maybe there were comments in his evals. As someone who may be on the spectrum myself and is probably somewhat socially awkward, I felt a degree of kinship with him and just wanted to tell him to keeping giving it his all, but I wondered if he had any insight into how he may be being perceived.

Honestly if I felt it would be constructive, I would have shared my honest thoughts because, I’ve learned that’s it’s much better to receive harsh/direct honest advice from someone well meaning than kind words from someone who doesn’t care. The thing though is to what extent can he change the way he comes off so other people don’t see him as a liability but an asset that he truly is. I feel like I’ve worked with him on multiple rotations to know he’s much harder working than most and also more capable, but I feel like some just blow him off because he’s got one hell of a monotone voice and awkward facial expressions/formalities/etc.

Any thoughts?

On a monotone voice: there is in fact an autistic "accent". If he was able to figure out exactly what that was as well as his facial expressions and so forth, he could make quite a bit of progress. Much of the difficulty for him is probably in figuring out what exactly he is doing that is off-putting, rather than fixing the specific behaviors. I would also guess that if you simply read a transcript of his interview it would not sound different from any other interview transcript...

 

[operaman]

Listen, we're not looking for the applicant with the most rizz. Just someone with basic social skills to navigate the real world. Someone who won't tick off catty nurses. Someone who can explain to people their loved one is brain dead, needs hospice, or has schizophrenia etc. Someone who can work with difficult, entitled populations... and med students. No program director wants to deal with that smoke and the inevitable complaints.

If someone is smart enough to make it through med school but still hasn't figured out a workaround for social graces, they need to consider specialties with limited patient contact. Or engineering.

Also, if I had a dollar for every patient who said they were "on the spectrum"...

No you're not, you're socially awkward. I'm also of the opinion that doctors or soon to be doctors shouldn't throw around layperson Tiktok terms for an actual medical diagnosis. I may as well refer the next patient that complains of recent upper respiratory infection upon ROS, to ENT for "had a cold".

As an ENT, sadly this happens all too often!

 

[FluffyCat1212]

First of all, I think that it is really kind of you to want to help your friend match and take the time to seek out the best way to do it.

I would personally give the feedback, but the timing and tone of the feedback are critical. How is he doing with the news? If it seems like the wound is still fresh, I would give it a little more time. Constructive feedback (especially when unsolicited) can hurt more than help if he's still really upset. When he's in a better place emotionally, I would offer to do a mock interview with him (as a peer, not as an expert) because the more practice the better, right? Use the mock interview to gauge how he does in interviews, then gently give a specific and actionable version of that feedback if it seems applicable. Also, framing it as a "tip" rather than a criticism may make it easier to stomach if he's on the sensitive side.

idk, just my $0.02

 

[DO2015CA]

As an ENT, sadly this happens all too often!

Sometimes it’s the demanding patient that demands nothing less than a specialist. That’s the frustrating dumb thing lol.

 

[rhomantic]

what's his desired specialty? rejection can be redirection. his autistic traits may serve him well in some specialties but may be an added layer of adversity for others.

 

[Splenda88]

The vast majority of med students are on the spectrum. Some are just higher...

 

[TragicalDrFaust]

Reach out to offer support. “Hi, how is everything going? I know you were applying ___ but matched ___”.

Gauge his attitude about not matching his preferred specialty. Have you ever observed him respond to criticism or adversity before? If his attitude seems good and you know he takes criticism well, you could broach the topic by assessing how much insight into why he didn’t match. “If you’re up for talking about it, do you have any idea why you didn’t match ___”?

If he says yes, it’s pretty easy to bring up your thoughts. If he says he’s not up for it, you could say you observed something that may have made a difference, if he ever wants your opinion.

 

[Laradd]

The vast majority of med students are on the spectrum. Some are just higher...

This is so true lol. I would be lying if I didn't think i had a little bit of tism in me