Must repeat fourth year due to "below expectations" on clinical evals

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HI SDN, I need some guidance what to do based on a decision my school made telling me to repeat fourth year due to some "below expectations" I received on clinical evaluations. I received a recent "below expectations" on a family medicine sub internship; my preceptor commented how I "struggled to discuss assessments and plans with the resident team, have communication issues, and lacked confidence in presentations". I believe this is because this is only the second month I have ever done in ward-based rotations; I did not have any practise in third year discussing assessments and plans, or any experience with bedside presentations and became nervous the first time doing this in front of a healthcare team consisting of over ten people. I do not believe it is medical knowledge I am lacking: I have a USMLE Step1 of 228, Step2 220, COMLEX Level1 556, COMLEX Level2 535, passed all my NBOME shelves with honours in psychiatry, have no written exam or clinical rotation failures, average student academically in reputable DO school. However, I did have to remediate my COMLEX Level2PE (failed biomechanical domain due to running out of time for more than half the cases; will get score back Dec3). I have 3 strong LORs.
In third year rotations, I received "exceed expectations" on 3 rotations: pediatrics, gen surg and FM. "Below expectations" on 2 rotations: orthopaedic surgery, IM sub-specialty (with borderline meets expectations in PM&R).
In fourth year rotations, I received "below expectations" in EM and this past FM SubI. Meets expectations in IM SubI and exceeds expectations in current IM rotation.
The rotations at my current clinical site as well as most rotations through my school are preceptor-based (like shadowing) so I believe another year with these rotations will not directly help me "function as an intern" by improving my discussion of assessments&plans. I do not even have access to the EMRs. Plus, I am in significant financial challenges and do not know how I can afford another $50K tuition. I applied to FM residencies this year and have almost 10 interviews scheduled. I am scared being held back a year will significantly hinder my chances of matching next year.
I am allowed to appeal this decision my school made this week... I need some advice/suggestions/support/anything since my school is not able to provide me with any after asking repeatedly for help. How can I write a convincing appeals letter saying what I can do this year to be ready for intern year? What should I do personally do be ready to function autonomously as an intern? I do not have any more ward-based rotations planned for the rest of the year (it is very challenging to find any at my clinical rotation site). Should I just not appeal and accept my school's decision to repeat fourth year (after your review of my performance)?
Thank you so much for your time. I would greatly appreciate any feedback at all during this difficult time.

 

[AMEHigh]

Do you have a trusted mentor at the school?
Ideally someone who is FM since that is the specialty you are applying.
I would definitely talk with them about your appeals case and have them write you a letter and bring any other documentation.
But yes I would definitely talk with someone trusted who can guide you as the process is school dependent.

 

[2021Doctor]

Having to repeat 4th year will be a red flag on your record. I do not understand why your school wants to sabotage you.
You have 10 interviews scheduled and they are stabbing you in the back imo.
Since you basically just shadowed during the 3rd year, what do they expect?
Does you student handbook allow them to make you repeat a year despite not failing any rotations?
Imo this is the type of situation where you may need legal representation/advice.

 

[Rekt]

You need to absolutely appeal, probably with legal support. None of this makes any sense. You have no failures and somewhat decent board scores. You didn't technically fail any clerkships and likely have enough interviews to match already. The only thing I see is your school fishing for more money.

 

[scoopdaboop]

what school is this? newer school? sounds like BS to me. your appeal will likely get through because if the school was realistically looking out for your future, then there's no way they make you repeat.

 

[DokterMom]

I'm concerned. You've had several 'below expectations' clinical grades, so there does appear to be a legitimate problem. I'm not blaming you, since it sounds like your school has not provided the type and quantity of clinical experiences needed for you to acquire the necessary skills. But that said -- if you're performance is 'below expectations', that's a real problem.

As painful as it would be to repeat 4th year, it is far better than failing an internship. Failing 4th year is a red flag; failing out of an internship is likely to be permanent.

I do suggest rounding up some faculty support -- but also advocating for yourself. If the school does make you repeat the year, what are they willing to do differently to help you succeed? More shadowing certainly isn't it...

 

[ciestar]

I'm concerned. You've had several 'below expectations' clinical grades, so there does appear to be a legitimate problem. I'm not blaming you, since it sounds like your school has not provided the type and quantity of clinical experiences needed for you to acquire the necessary skills. But that said -- if you're performance is 'below expectations', that's a real problem.

As painful as it would be to repeat 4th year, it is far better than failing an internship. Failing 4th year is a red flag; failing out of an internship is likely to be permanent.

I do suggest rounding up some faculty support -- but also advocating for yourself. If the school does make you repeat the year, what are they willing to do differently to help you succeed? More shadowing certainly isn't it...

This was my concern as well. It isn’t as though this is an outlier below expectations grade. OP has several clerkships that resulted in a below expectations evaluation.

 

[Wjldenver]

Removed this post since I should have read OP’s post closer...

 

[jurassicpark]

I can understand preceptorships are extremely variable in how they are taught. Though as a rule, the one thing a third year should be able to do is put together a coherent presentation. Doesn't mean it needs to be right, but there should be a good logic and flow to it. Were you just trailing and watching your Attending or were you presenting to them?

As others have pointed out, definitely there were red flags already present when you received below average ratings on two rotations and one barely meets. Were these issues addressed by you or your school at any point? I think you need to sit with your school/counselors etc and go over with why you had received these grades and what can be done to overcome them. Definitely being held back as a fourth year is far far from ideal, but to possibly go into internship with possible serious deficiencies may be career ending.

 

[Splenda88]

Sue that stupid school... This is madness!

I am working with interns now and all them can present well. But when it comes to actually treating patient most of them can't, and we are already 4+ months into residency.

 

[Drrrrrr. Celty]

I can understand preceptorships are extremely variable in how they are taught. Though as a rule, the one thing a third year should be able to do is put together a coherent presentation. Doesn't mean it needs to be right, but there should be a good logic and flow to it. Were you just trailing and watching your Attending or were you presenting to them?

As others have pointed out, definitely there were red flags already present when you received below average ratings on two rotations and one barely meets. Were these issues addressed by you or your school at any point? I think you need to sit with your school/counselors etc and go over with why you had received these grades and what can be done to overcome them. Definitely being held back as a fourth year is far far from ideal, but to possibly go into internship with possible serious deficiencies may be career ending.

I think that presenting is a complicated and annoying topic. What is expected is almost always different between different faculty. And ofc there is always personal style. The way I was taught to do presentations in 3rd and 4th year is frowned upon at my program. At my program presentation is almost always problem focused and I almost always blend subjective and objective histories to correlate with my point otherwise i'll be talking for >10 minutes.

As a whole I don't think annoying should be held back for doing poorly on presenting because they'll just relearn however they do it at their program. This not to mention that in a lot of fields traditional presentations aren't really done.

 

[Drrrrrr. Celty]

Sue that stupid school... This is madness!

I am working with interns now and all them can present well. But when it comes to actually treating patient most of them can't, and we are already 4+ months into residency.

I can treat.... but my senior did it already cuz they don't want to be here till 8pm XD.

#residency

 

[Epilepsy365]

This is ridiculous.

Appeal the process and rake the school through the coal.

You will not fail intern year if you give it 100%.

People make a big deal out of presentation. There is no single right way for presentation as long as it is semi coherent and logical. The money made is in the A/P but that is something that you develop as an intern after taking care of 6-10pts daily during intern year.

 

[PathDoctor]

Ask 10 different attendings how to do an oral presentation and you will get 10 different answers.

 

[MedicineZ0Z]

You should absolutely be allowed to graduate. Knowledge is all that matters, if you have it - you can rapidly apply it and diagnose and treat.
Presentations vary drastically from setting to setting and then even more so from attending to attending. It's a drastically overrated thing as a whole. What matters is having the right A&P.

With that said, I would be concerned about having weak clinical acumen cause you didn't do much during your rotations.

 

[NotAProgDirector]

In a prior thread, you mentioned that you had 4 third year preceptors raise concerns about your ability to perform as a physician. Now you're having the same problem in your 4th year. "Below expectations" evaluations are usually very rare. It's certainly possible that the structure of your 3rd year hasn't prepped you well for 4th year, but other students at your school have (apparently) done fine with similar training. I think you have a major performance problem you need to deal with. I highly doubt that trying to appeal or fight this will end well for you. Just from what you've written here your school seems to have very adequate evidence of poor performance. Board scores measure medical knowledge, but "patient care" is applying that knowledge to the care of patients and you seem to be having great difficulty. I agree that repeating your 4th year will be a huge red flag and will likely create lots of problems, but I doubt you actually have any choice in the matter. I do wish you the best, you have lots of hard work ahead of you and fixing this won't be easy.

 

[mathnerd88]

I think people are overlooking the fact that the OP did fail the Comlex Level 2 PE on the biomechanical domain. Knowing how to answer board questions is very different than actual clinical practice.

That being said, OP, I wish you the best of luck. I know it's very difficult to be in your position, but keep your head high.

 

[Epilepsy365]

I think people are overlooking the fact that the OP did fail the Comlex Level 2 PE on the biomechanical domain. Knowing how to answer board questions is very different than actual clinical practice.

Really, dude? The COMLEX Level 2 PE has nothing to do with actual clinical acumen. Please stop.

 

[mathnerd88]

Really, dude? The COMLEX Level 2 PE has nothing to do with actual clinical acumen. Please stop.

Then what does it have to do with then? You still have to form an appropriate assessment and plan after seeing a standardized patient and what you believe is the potential diagnosis. Don't know what has gotten you all hot and bothered about it.

 

[Gastrapathy]

OP, it’s early in the year. Ask to be helped to remediate your deficiencies this year as your “appeal”

 

[Goro]

OP, I suspect that if the choice is repeating the year, or never becoming a doctor, you'll choose the former path.

This is an interesting situation. You have several red flags. Surely despite the poor clinician education the numbers of students who have to repeat OMSIV are low? Or high?

I remind SDNers that there are always two sides to every story, as pointed out by the sage aPD.

OP, you need to look at your student handbook and see what the school's policies are. Avoid armchair lawyers who so glibly throw out "lawyer up" advice. As mentioned previously, seek out trusted Faculty who can serve as advocates, and then appeal. As per the wise Gastrapathy's advice, have an action for remediation ready to go. Show that you're proactive.

 

[Drrrrrr. Celty]

Then what does it have to do with then? You still have to form an appropriate assessment and plan after seeing a standardized patient and what you believe is the potential diagnosis. Don't know what has gotten you all hot and bothered about it.

It's a test that examines whether or not you have sufficient medical knowledge, but also how to use it in a very specific way that will not be recreated ever again.

 

[PathDoctor]

Then what does it have to do with then? You still have to form an appropriate assessment and plan after seeing a standardized patient and what you believe is the potential diagnosis. Don't know what has gotten you all hot and bothered about it.

Imo you are a bit off base here. Why does the NBOME never release pass rate by race and ethnicity? Could it be because the PE exam is graded by predominantly white standardized patients who are biased (either consciously or unconsciously) against minority candidates?

NBOME 101 W Elm St, Conshohocken, PA 19428
As of the 2010 census, the borough was 88.7% White, 6.5% Black or African American, 0.1% Native American, 1.8% Asian, and 1.7% were two or more races. 3.5% of the population were of Hispanic or Latino ancestry .

Conshohocken, Pennsylvania - Wikipedia

en.wikipedia.org

NBOME 8765 W Higgins Rd, Chicago, IL 60631
Zip 60631
White 26,510 92.6%
Black Or African American 130 0.5%
American Indian Or Alaskan Native 37 0.1%
Asian 852 3.0%
Native Hawaiian & Other Pacific Islander 5 0.0%
Other Race 612 2.1%
Two Or More Races 495 1.7

ZIP Code 60631 Map, Demographics, More for Chicago, IL

Interactive and printable 60631 ZIP code maps, population demographics, Chicago IL real estate costs, rental prices, and home values.

www.unitedstateszipcodes.org

 

[BorntobeDO?]

I would seek legal counsel. And quickly. This situation is getting out of hand. Then I would repeat rotations with friendly physicians. Emphasize with them that you cannot have below expectations on your eval or you will fail. Thats what I do to get thru school.

That said, something is off here. I don't know what it is but you have too many below expectations. You need to be very careful how you rank residencies. Somewhere with strong teaching that doesnt throw you to the wolves is a must.

 

[Chibucks15]

Imo you are a bit off base here. Why does the NBOME never release pass rate by race and ethnicity? Could it be because the PE exam is graded by predominantly white standardized patients who are biased (either consciously or unconsciously) against minority candidates?

NBOME 101 W Elm St, Conshohocken, PA 19428
As of the 2010 census, the borough was 88.7% White, 6.5% Black or African American, 0.1% Native American, 1.8% Asian, and 1.7% were two or more races. 3.5% of the population were of Hispanic or Latino ancestry .

Conshohocken, Pennsylvania - Wikipedia

en.wikipedia.org

NBOME 8765 W Higgins Rd, Chicago, IL 60631
Zip 60631
White 26,510 92.6%
Black Or African American 130 0.5%
American Indian Or Alaskan Native 37 0.1%
Asian 852 3.0%
Native Hawaiian & Other Pacific Islander 5 0.0%
Other Race 612 2.1%
Two Or More Races 495 1.7

ZIP Code 60631 Map, Demographics, More for Chicago, IL

Interactive and printable 60631 ZIP code maps, population demographics, Chicago IL real estate costs, rental prices, and home values.

www.unitedstateszipcodes.org

Man everyone plays the race card nowadays...you have zero actual proof anyone is actually “biased”. Demographic data doesn’t count

 

[Mass Effect]

The only thing worse than repeating 4th year is being terminated in internship/residency for "below expectations." That's career-ending.

That said, if everything you say is true, you should name your school because the fact that you had no ward-based rotations and only shadowed for MS 3 year is educational malpractice. It's schools like yours that give all DOs and DO schools a bad name. It's the reason DO stigma still exists.

 

[Mass Effect]

I think that presenting is a complicated and annoying topic. What is expected is almost always different between different faculty. And ofc there is always personal style. The way I was taught to do presentations in 3rd and 4th year is frowned upon at my program. At my program presentation is almost always problem focused and I almost always blend subjective and objective histories to correlate with my point otherwise i'll be talking for >10 minutes.

As a whole I don't think annoying should be held back for doing poorly on presenting because they'll just relearn however they do it at their program. This not to mention that in a lot of fields traditional presentations aren't really done.

Except that the OP also received "below expectation" evals in MS 3 year, when he/she wasn't presenting, so clearly presentation isn't the only problem here, even if that's the problem with this particular ward-based rotation.

 

[Mass Effect]

You will not fail intern year if you give it 100%.

Please don't put false information out there. There are many residents and interns who put in 100% and still get terminated every year. Medicine isn't about participation trophies.

 

[Mass Effect]

Really, dude? The COMLEX Level 2 PE has nothing to do with actual clinical acumen. Please stop.

In combination with the OP's multiple below expectation clinical evals, it is absolutely relevant. All of this is a cumulative mountain of evidence that the OP is lacking in clinical acumen. I don't believe for a second this is all about presentation. If that was the case, the OP wouldn't have received "below expectations" in rotations in which he/she was just shadowing. There is something very wrong with this picture. Repeating MS 4 year may severely restrict your options, but graduating and starting internship with deficiencies like this can end your career entirely.

The OP stated: "I did not have any practise in third year discussing assessments and plans, or any experience with bedside presentations and became nervous the first time doing this in front of a healthcare team"

So if the problem is this is the first time he/she is doing this, what was the cause of the below expectation evals from MS 3 year?

 

[Espressso]

This is interesting for sure.

I am confused how can the school try and hold you back if s/he have yet to actually fail a rotation AND the OP has 10 interviews? I mean, clearly there are some clinical deficiencies (re failed PE along with the below expectations evals). But as a commenter has said earlier, it seems a bit sabotaging on the part of the school. Assuming OP passes PE redo, with 10 interviews, the match rate is quite high for OP. Unless the school has significant reason to believe that the OP won't actually match.

If the school were to not take any action, let the student continue as is, they match and graduate, then fail out of internship. School is off the hook and it's not their problem, right? I just don't understand why the school is this invested in a student who has yet to formally fail a rotation.

 

[Espressso]

OP should definitely name the school though. The description of the shadowing is bad.

 

[Neopolymath]

Name and shame

 

[deleted610572]

You should seek how and do away rotations for the remainder of the year. It will be costly yes but you will gain the experience. Just need them to be places with residents. This should catch you up to speed

 

[deleted610572]

I would seek legal counsel. And quickly. This situation is getting out of hand. Then I would repeat rotations with friendly physicians. Emphasize with them that you cannot have below expectations on your eval or you will fail. Thats what I do to get thru school.

That said, something is off here. I don't know what it is but you have too many below expectations. You need to be very careful how you rank residencies. Somewhere with strong teaching that doesnt throw you to the wolves is a must.

I can see both side and disagree finding physicians that will continue to let OP fly under the radar. There is too many poor grading to say there isn’t something wrong.

 

[DokterMom]

This is interesting for sure.

I am confused how can the school try and hold you back if s/he have yet to actually fail a rotation AND the OP has 10 interviews? I mean, clearly there are some clinical deficiencies (re failed PE along with the below expectations evals). But as a commenter has said earlier, it seems a bit sabotaging on the part of the school. Assuming OP passes PE redo, with 10 interviews, the match rate is quite high for OP. Unless the school has significant reason to believe that the OP won't actually match.

If the school were to not take any action, let the student continue as is, they match and graduate, then fail out of internship. School is off the hook and it's not their problem, right? I just don't understand why the school is this invested in a student who has yet to formally fail a rotation.

You're thinking like a student @espresso. The school is thinking like a school. They don't want to launch the OP out into the medical world with their "brand" attached until she is performing adequately. Her clinical skills deficiencies are analogous to "professionalism" issues -- hard to define precisely, but important nonetheless.

And the 10 interviews? Those are based on paper qualifications, which the OP has. Securing 10 interviews has absolutely no bearing on whether or not she is ready to succeed in clinical practice.

 

[Drrrrrr. Celty]

Except that the OP also received "below expectation" evals in MS 3 year, when he/she wasn't presenting, so clearly presentation isn't the only problem here, even if that's the problem with this particular ward-based rotation.

This I did not know. In this case there seems to be some trend of stuff. Which they should clearly work on.

 

[Epilepsy365]

HI SDN, I need some guidance what to do based on a decision my school made telling me to repeat fourth year due to some "below expectations" I received on clinical evaluations. I received a recent "below expectations" on a family medicine sub internship; my preceptor commented how I "struggled to discuss assessments and plans with the resident team, have communication issues, and lacked confidence in presentations". I believe this is because this is only the second month I have ever done in ward-based rotations; I did not have any practise in third year discussing assessments and plans, or any experience with bedside presentations and became nervous the first time doing this in front of a healthcare team consisting of over ten people. I do not believe it is medical knowledge I am lacking: I have a USMLE Step1 of 228, Step2 220, COMLEX Level1 556, COMLEX Level2 535, passed all my NBOME shelves with honours in psychiatry, have no written exam or clinical rotation failures, average student academically in reputable DO school. However, I did have to remediate my COMLEX Level2PE (failed biomechanical domain due to running out of time for more than half the cases; will get score back Dec3). I have 3 strong LORs.
In third year rotations, I received "exceed expectations" on 3 rotations: pediatrics, gen surg and FM. "Below expectations" on 2 rotations: orthopaedic surgery, IM sub-specialty (with borderline meets expectations in PM&R).
In fourth year rotations, I received "below expectations" in EM and this past FM SubI. Meets expectations in IM SubI and exceeds expectations in current IM rotation.
The rotations at my current clinical site as well as most rotations through my school are preceptor-based (like shadowing) so I believe another year with these rotations will not directly help me "function as an intern" by improving my discussion of assessments&plans. I do not even have access to the EMRs. Plus, I am in significant financial challenges and do not know how I can afford another $50K tuition. I applied to FM residencies this year and have almost 10 interviews scheduled. I am scared being held back a year will significantly hinder my chances of matching next year.
I am allowed to appeal this decision my school made this week... I need some advice/suggestions/support/anything since my school is not able to provide me with any after asking repeatedly for help. How can I write a convincing appeals letter saying what I can do this year to be ready for intern year? What should I do personally do be ready to function autonomously as an intern? I do not have any more ward-based rotations planned for the rest of the year (it is very challenging to find any at my clinical rotation site). Should I just not appeal and accept my school's decision to repeat fourth year (after your review of my performance)?
Thank you so much for your time. I would greatly appreciate any feedback at all during this difficult time.

After careful consideration, I won’t make any judgment but I will say this. If you receive multiple below expectations on multiple preceptor based rotations that don’t require presentations, there are two possible things:

1) You can’t talk to patients effectively
2) Your interaction with your doc or staff is consistently wrong

You don’t need to reply to me but I want you to look deeply in the mirror and think about them bc these two issues are major red flags that I have seen or heard of stories for termination in residency. You need to think about these two deficits especially if my proposed circumstance is true.

If your main problem is operating at a fast pace environment with A/P, I would urge you to research your FM residencies wisely and rank those that are known to be family and resident learning friendly high on your list.

 

[fldoctorgirl]

I can see why at this point, your school is considering making you repeat the year. Like @DokterMom said, it seems crazy from a student's perspective because you haven't technically failed any clerkships, but it makes sense from a school's perspective. I think the biggest red flag with your school is that they didn't reach out to you earlier, after 1 or 2 'below expectations' evals, to try and help you out. I obviously don't know all the details, but you didn't mention anyone offering any resources to you to try and help. I know at my school, if someone fails the PE, they go through really deep introspection and work with a faculty member to try and fix the deficiencies. Something similar should've been offered to you after your evals came back, and if it wasn't, you should definitely name and shame your school. I don't think blaming all of this on your inability to present really makes sense, though, as I doubt that many preceptors would give you below average evals just based on that alone.

 

[Goro]

Imo you are a bit off base here. Why does the NBOME never release pass rate by race and ethnicity? Could it be because the PE exam is graded by predominantly white standardized patients who are biased (either consciously or unconsciously) against minority candidates?

NBOME 101 W Elm St, Conshohocken, PA 19428
As of the 2010 census, the borough was 88.7% White, 6.5% Black or African American, 0.1% Native American, 1.8% Asian, and 1.7% were two or more races. 3.5% of the population were of Hispanic or Latino ancestry .

Conshohocken, Pennsylvania - Wikipedia

en.wikipedia.org

NBOME 8765 W Higgins Rd, Chicago, IL 60631
Zip 60631
White 26,510 92.6%
Black Or African American 130 0.5%
American Indian Or Alaskan Native 37 0.1%
Asian 852 3.0%
Native Hawaiian & Other Pacific Islander 5 0.0%
Other Race 612 2.1%
Two Or More Races 495 1.7

ZIP Code 60631 Map, Demographics, More for Chicago, IL

Interactive and printable 60631 ZIP code maps, population demographics, Chicago IL real estate costs, rental prices, and home values.

www.unitedstateszipcodes.org

Thread hijacking is a TOS violation.

 

[mathnerd88]

It's a test that examines whether or not you have sufficient medical knowledge, but also how to use it in a very specific way that will not be recreated ever again.

Ehh, think what you will, but IMO still an appropriate exam. At least they’re only testing you on one specific chief complaint, not a million like most patients have. If students can’t even handle one chief complaint, how will they handle multiple?

The point of the PE is to make sure you know how to take an appropriate history while being professional and humanistic, even though in real life you only probably ask about 50% of the actual questions, which IMHO, makes you miss diagnosis’s a lot. You also have to formulate an assessment and plan after taking the history. I don’t see how it’s a problem. The Step 2 CS does the same thing, and the pass rates are similar to that of the PE. Either way, it’s an exam everyone still has to pass to graduate.

 

[Sardonix]

Ask 10 different attendings how to do an oral presentation and you will get 10 different answers.

And they will ALL say you have to do it THEIR way because that's OBVIOUSLY the ONLY way...

 

[Drrrrrr. Celty]

Ehh, think what you will, but IMO still an appropriate exam. At least they’re only testing you on one specific chief complaint, not a million like most patients have. If students can’t even handle one chief complaint, how will they handle multiple?

The point of the PE is to make sure you know how to take an appropriate history while being professional and humanistic, even though in real life you only probably ask about 50% of the actual questions, which IMHO, makes you miss diagnosis’s a lot. You also have to formulate an assessment and plan after taking the history. I don’t see how it’s a problem. The Step 2 CS does the same thing, and the pass rates are similar to that of the PE. Either way, it’s an exam everyone still has to pass to graduate.

I don't disagree that we need a filter like this. It just needs to be improved upon somewhat.

 

[deleted610572]

Ehh, think what you will, but IMO still an appropriate exam. At least they’re only testing you on one specific chief complaint, not a million like most patients have. If students can’t even handle one chief complaint, how will they handle multiple?

The point of the PE is to make sure you know how to take an appropriate history while being professional and humanistic, even though in real life you only probably ask about 50% of the actual questions, which IMHO, makes you miss diagnosis’s a lot. You also have to formulate an assessment and plan after taking the history. I don’t see how it’s a problem. The Step 2 CS does the same thing, and the pass rates are similar to that of the PE. Either way, it’s an exam everyone still has to pass to graduate.

im curious. Have you done the PE yet? What you are saying is the goal but the truth is that’s not the reality. It’s a complete ambiguous exam where they fail people who, evidence by school OSCE videos, shouldn’t have failed and those who can’t carry a conversation in a bucket pass. The exam is hugely flawed.

 

[MusicDOc124]

Having a failed PE and multiple "below expectations" rotations in BOTH 3rd year and 4th year in multiple fields is concerning.

With that said, it's not a reason your school should cause you to repeat if you're not failing.

Definitely appeal and seek legal counsel as the cost of that will significantly outweigh the cost of another year of school.

Now again, with that said - you need to take responsibility yourself too. While the school has some blame, you must also keep in mind that you are simultaneously responsible for your own education and training. You need to keep yourself accountable. I dont see that here - I see blame being pointed, and only pointed.

You don't want this type of issue to arise while a physician - resident or beyond. Figure out the issue - ask for feed back from those who wrote the comments. Ask for help if needed.


TLDR: You still have some accountability here, but you absolutely should appeal this with legal counsel, especially with having interviews lined up, and enough to likely match.

Good luck with this process!

 

[blah12346497]

I am so sorry you are going through this OP. I hope everything works out in the end. I truly think the transition from board scores like yours to excellent patient presentations is minimal at most. Just sit down with someone who's good at it and have them run through it with you. Look up dosing before you present. Pick a good resource for common workups and you should be fine.

Off topic. Anyone else have issues memorizing patient presentations? I always have to refer to my notes and it sucks lol. Maybe I have crap memory idk. Any tips would be great!

 

[BorntobeDO?]

Man everyone plays the race card nowadays...you have zero actual proof anyone is actually “biased”. Demographic data doesn’t count

Because all the patient actors obviously only live in the zip code the testing centers are in... Seriously I agree that was a ridiculous post that you quoted

 

[BorntobeDO?]

After careful consideration, I won’t make any judgment but I will say this. If you receive multiple below expectations on multiple preceptor based rotations that don’t require presentations, there are two possible things:

1) You can’t talk to patients effectively
2) Your interaction with your doc or staff is consistently wrong

You don’t need to reply to me but I want you to look deeply in the mirror and think about them bc these two issues are major red flags that I have seen or heard of stories for termination in residency. You need to think about these two deficits especially if my proposed circumstance is true.

If your main problem is operating at a fast pace environment with A/P, I would urge you to research your FM residencies wisely and rank those that are known to be family and resident learning friendly high on your list.

Noting that I agree competely with this post. Something is definitely not right with OP if these issues keep coming up, and they need to be very careful in selection of residency. If OP is having trouble interacting in a team, then s/he needs to imitate those who are doing well, and ask them for feedback. I still think OP needs to do as I said earlier to get by, cause this late in the game s/he is in a bad spot if they have to repeat a year, but something is obviously not right, and needs to be fixed.

 

[BorntobeDO?]

HELP: Suspended from clinical rotations pending psych eval

Hi SDN community, I am a fourth year medical student at an osteopathic medical school in USA who is in need of some urgent help. Yesterday, I got temporarily suspended from clinical rotations pending a psychology/psychiatric assessment. BG story: I am an average student in school (no failures...

forums.studentdoctor.net

This is not making the picture better OP. I think your goose may be cooked.

Hi SDN community, I am a fourth year medical student at an osteopathic medical school in USA who is in need of some urgent help.
Yesterday, I got temporarily suspended from clinical rotations pending a psychology/psychiatric assessment. BG story: I am an average student in school (no failures, passed all my shelf exams, Step1 230, COMLEX1 560, pending Step2/Level2CE/Level2PE exam scores). However, I have had 4 preceptors in my third year of medical school indicating they were "concerned about me being a physician" in my clinical evaluations. I reflected that this may be due to me being nervous with them since they were men with a bright yet overconfident (even cocky personality). I had some minor childhood trauma with my dad who also had this personality and was verbally abused by him as a teenager, which makes me underperform in this setting. I told my school this at a "Student Progress Committee" meeting with ~12 faculty members but could not stop crying all of the sudden in the middle of talking about my dad. This may have made them afraid I was emotionally unstable/crazy and a danger to patients. I have no past psychiatric or medical history and am content in my life/not suicidal. I believe this psych assessment is so unnecessary but I can see how it is necessary from my school's perspective.
I have my most important audition rotation coming up next Monday, which I may not be able to go to anymore and am devastated.
What I need help is: What is the fastest and cheapest way I can get my psychology/psychiatric assessment done- who can I contact?
Also, what is the best way I can handle my situation so I can graduate medical school on time? I cannot afford to take another year due to financial challenges.
Thank you so much for your time. Any advice at all would be very helpful.

 

[bogle8]

im curious. Have you done the PE yet? What you are saying is the goal but the truth is that’s not the reality. It’s a complete ambiguous exam where they fail people who, evidence by school OSCE videos, shouldn’t have failed and those who can’t carry a conversation in a bucket pass. The exam is hugely flawed.

Exactly this. I had to retake the PE and I can tell you that I basically changed nothing to pass the second time. Also there was no evidence based on my prior performance that I was at risk to fail it.

 

[ciestar]

Because all the patient actors obviously only live in the zip code the testing centers are in... Seriously I agree that was a ridiculous post that you quoted

I saw that and thought the same. Conshy is very suburban, but so very close to Philly and Chicago is obviously.. Chicago