Need help - Time sensitive issue here

[Sixfour]

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Long, long time lurker here (~7-8 years)... I've been helped a ton by reading the questions of others, and now I have an issue of my own.

I'm a 4th year student interested in EM. Just finished an ER rotation at my home insitution, and did well clinically and on the end-of-rotation exam. However, I have just (2 days ago) found out that a particular nurse took issue with me, complained to the resident I was working with, and my resident in turn reported back to the PD and clerkship director. There were 4-5 different nurses with whom I bantered (and it seemed they all enjoyed the back and forth) but one of them apparently took something I said (to jokingly give her a hard time) seriously. To be succinct, the clerkship director met with me and told me that because of "this incident", she will now only give me a pass (I would have honored otherwise apparently), and I just met with the PD and he says he will do his best to minimize the effect this has on my LOR, but that he will have to mention it. He did say that he still expects me to match but that things will be harder now. I have done what I can do about this situation... The bottom line is the program is going to stand by the nurse (which isn't unexpected - they know her well and have worked with her for years), and I am going to just have to deal with this as it is.

As a student, I'm just about average (maybe a little below) for ER. Step I 222, step II 236, mostly passes in years 2 and 3 with some high passes thrown in.

I write now to ask you all if you know where I can look to find out about new residencies coming 'online' this year. My PD recommended I apply to them, as they may be less picky. I want to do ER, have always wanted to do ER, and can't imagine doing anything else. I will train anywhere will take me, so the reputation of the program doesn't matter to me, with the exception I wouldn't want to be at a program known to be malignant.

I'm sure most everyone reading this knows this already, but be careful who you joke with, and be careful at all times with the image you project. What happened here with me is that I gave a nurse a hard time with how she was doing her job, completely tongue in cheek, wink wink style, and thought FOR SURE she knew I was just kidding with her... Not so, and now I am paying dearly for it. Be careful!

Thanks for your help 🙂

 

[HIJay]

acgme website has list of all the new programs

 

[EC3]

I think you should be able to match and wouldn't sweat it too much. Apply broadly and interview at as many programs as you can (aim for around 10 or so). Notwithstanding those who think ER is the next derm, ER as a specialty is solidly middle-tier in terms of competitiveness. Your numbers are solid, as are your grades. You may not be able to pull California or other highly sought after locations or programs, but this isn't the end of the world. Stay confident, interview well, and look forward to starting residency.

 

[It'sElectric]

A couple threads have been started recently in the EM forum, but off the top of my head - Southern Illinois University, U of Arizona/UPHK, University of Kansas...I probably forgot one.

 

[HIJay]

UMDNJ robert wood johnson

 

[Tiger26]

+Ft Worth I think

 

[It'sElectric]

+Ft Worth I think

I think it was decided their first class won't be until 2011...

 

[Sixfour]

Thanks for the responses - I'll check these out.

 

[EM2BE]

Do you need to use this LOR? There is always the option of not using it if you have others.

 

[dmitrinyr]

First of all, I want to say that this is why when you are a medical student at an away rotation who will be applying into that specialty, you have really walk on egg-shells and always watch what you say and how you act. It's basically a 1 month long interview where every shift you have to be on your best behavior as everything you do is being watched and will be noticed. This is why you cannot every be seen complaining, whining, lying, backstabbing or being in anyway offensive or improper. Everyone in that department, especially the PD, residents and attendings, is looking at you and is trying to see if you are someone who they can work with. So, if you normally make jokes and or comments that might be taken literally or might offend someone then try to limit those comments during these rotations. Same goes for interview day. It's hard I know... I'm the kind of person who makes the occasional witty comment and makes jokes but still when you are in that environment always think long and hard before making any joke or any comment in front of others as you never know how they will take it. Yes it might have been a situation where the nurse just took a joke in a way it wasn't intended to sound. It doesn't matter. Unfortunately, perception is reality. Therefore, if the nurse was offended by something you said, then you are branded by the resident, the PD and the entire department as possibly "offensive", capable of "offensive comments" or "error in judgement". And because perception is reality and because those in that ED will trust an employee over someone they've just met, they are left no choice but to put that on your LOR and not to honor you. Either way, if this is put on your LOR you are looked upon as not being a good team player and possibly someone that others might not want to work with, both of which are definitely not good to have. An option that you have, as others have mentioned, is not to use this LOR. If you don't use this LOR, then on interviews (and you will get them given that your numbers make you a solid applicant) you are guaranteed to be asked (a) why you only got a pass and not honors on this EM rotation and (b)why is there no LOR from this rotation (which seems odd).
Second, I don't know you (the OP) personally, and you may be a fine person who got misunderstood and it sucks for such a minor thing to ruin or potentially damage your chances of matching into a specialty that you want to get into. Still, I think if you apply broadly and apply to the new programs (who might be less picky), you will most likely match somewhere. Just be ready to answer questions about this situation on your interviews. Good luck.

 

[The Buff]

I think you should be able to match and wouldn't sweat it too much. Apply broadly and interview at as many programs as you can (aim for around 10 or so). Notwithstanding those who think ER is the next derm, ER as a specialty is solidly middle-tier in terms of competitiveness. Your numbers are solid, as are your grades. You may not be able to pull California or other highly sought after locations or programs, but this isn't the end of the world. Stay confident, interview well, and look forward to starting residency.

I hate to be a downer, but in my experience ER programs are extremely touchy about people being good "team players". They care less about scores and grades and care a lot about LOR's and what kind of person you are. I think your idea of applying to new programs and less competitive programs is a good idea. I know at least two people who had fantastic scores and good grades from a good school who had a difficult time matching because of sub-standard LOR's. Your situation sucks and I feel for you--just try to strategize around this problem and hope for the best.

 

[docB]

Wow. That sucks. Here's what I would do with this:

I think you have to use the LOR from the PD at your home institution. Hopefully your PD there will in fact make it a minor footnote.

You seem to have "broadened" your perspective for what program you would accept. That's probably good. I suggest applying to a wide spectrum of programs both geographically and in term of perceived quality.

I would try to get enough money and time together to interview at every place I got an offer. Cast a wide net.

I would try to meet with your PD again and tell him (again) how worried you are about all this. I would ask him (and I'm phrasing this diplomatically) if there are any programs that he thinks would suit you based on your strengths. I would ask him if he has any contacts at those programs and if he could call and put in a good word for you. I would also ask any other faculty if they have any contacts and would be willing to call for you as well.

Good luck.

 

[Apollyon]

To be succinct, the clerkship director met with me and told me that because of "this incident", she will now only give me a pass (I would have honored otherwise apparently), and I just met with the PD and he says he will do his best to minimize the effect this has on my LOR, but that he will have to mention it.

As it is "apparent", is it possible you would have only gotten a high pass? Alternatively, this may indeed be a bigger deal than you let on. To convert: either you were going to get an "A", but now a "C" - could it have been a "B", that is now a "C"? Or, alternately, you would have gotten an "A", but are now getting a "C", and what you said/did - a small thing to you, but is enough to crump your grade and get specifically mentioned in your letter - might be more serious than you say?

 

[Sixfour]

Thanks for the advice... I did meet with my PD again, and he told me he will still write me a letter in which he recommends me as an applicant. He said he will minimize this incident in the letter, as he believes I did not intend any harm by giving the nurse a hard time.

Apollyon: It is possible I would get a high pass instead of honors. My resident told me he was going to recommend me for honors (prior to this incident, which occurred near the end of the month), and I know I honored the end of rotation exam. However, there are other factors in play, so the "honors" wasn't a guarantee. I obviously have no way of knowing exactly what my letter will say, and how it will be received by various programs. But my feeling after talking to my PD is that the grade will hurt me and need explaining, but my letter likely will not make me out to be a gamble for residencies, insofar as my character and personality (team-player, etc.) is concerned.

My other LOR's (including an away ER month) should all be very positive, especially regarding my ability to get along with others. Ironically, that is what I consider my strength going into interview season... My pre-clinical grades, 3rd year grades, and step I are all below average. I messed up in this situation, but usually I feel like I know who likes to banter, and who doesn't. Obviously in this situation caution should have been my guiding principle, *not* making friends through witty comebacks and banter.

Thanks again for the help everyone.

 

[RandomAttending]

I am new to post but have been a long time lurker and an EM attending at a New England program.

My 2 cents:

It is important that you really try to analyze what happened here. Look beyond how this will affect your current situation. If you have a tough time working on a team and with staff, this is going to get you in trouble for a long, long time.

A "recommend" on a SLOR is not necessarily so brilliant. You must have really done something that made people upset -- try to really figure out what this might be.

You should also ask the PD what you could do improve this situation -- is a formal apology in order? This shows you care beyond the grade you will get. A mention of this on letter could hurt you. Show a little remorse. Not getting a letter from your home school wouldn't look too great.

 

[Venko]

I entirely agree with RandomAttending take time for introspection. We all make mistakes, but the worst thing to follow them with is blame. I have made an inappropriate or unintentionally hurtful comment; we all have. We must try and understand what we can do better.

This is a tremendous opportunity to show your true character. Try and make the situation in your rotation better so that they remember that when things weren't easy, you did something remarkable.

Prove your quality!

- Thymeless

 

[Peds2ER]

Here's a link to the list of new programs on the ACGME website.

University of Arizona/UPHK Graduate Medical Education Consortium Program

John Peter Smith Hospital (Tarrant County Hospital District) Program

Southern Illinois University School of Medicine Program

UMDNJ-Robert Wood Johnson Medical School Program

University of Kansas School of Medicine Program

I agree with what's been said above. You're probably better off putting your sense of humour in check while rotating. You never know what some might consider offensive. That said, it sounds like you have a pretty decent outlook on the incident and are accepting full responsibility for it. If asked about it in interviews, I think it's a good idea to accept responsibility and emphasize what you have learned from the experience rather than casting blame on others. Sorry it had to hurt your grades so much. Good luck on the interview trail!

 

[ihearttriscuits]

dear fellow lurker,
i think its sad that this has been blown up to such a big deal.
you go to college get good grades for 4 years, survive medical school for another 4 and one comment to one nurse and your PD is going to write it in your eval? weak.
Sure you should watch what you say to some degree (im the last one to monitor what comes out of my mouth), but you have to be yourself and trying to interact with nurses is just part of the process. Not every nurse/tech/md will get along with you in the future, but I think it is really unfortunate that because one person took things the wrong way you are branded. Just hearing the story makes me bitter. I know "you are on a month long interview" but come on you have to have some fun. as long as your comment wasnt something from superbad i wouldnt worry about it.
So long story short; you will probably match, your stuff sounds great
sorry its getting blown up
in 1 year i bet you will put this behind you and be able to laugh at how this hit the fan
good luck and just be prepared to have some reply when this comes up in interviews and they try to push your buttons