Need Peds Residency advice on competitiveness

[shaw81]

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Hello,

I am a MS4 interested in Peds and am unsure of my competitiveness and would like some feedback on where I have a shot and perhaps some strategy.

I am a DO-PhD student from Michigan State with a considerable amount of research (I identified a new asthma susceptibility gene in my PhD work) with several publications in strong journals and oral and poster presentations at international meetings. I have strong service background with a several years of involvement at the national level with a physician scientist student organization (executive council, board of directors). I have considerable amount of volunteer experience at a free clinic (but no international). I've won several research and other awards (and am Sigma Sigma Phi--equiv to AOA). I think I have strong letters so far--my PhD mentor, the peds program director at the local children's hospital, the peds chair at my college (cowritten with a faculty member who was on my dissertation committee), and a local pediatrician. My clerkship evaluations are very strong across the board with lots of great comments. I don't have a honors option in my college. My USMLE1 is 218 (my COMLEX is comparable).

Due to my research background I'm interested in going to a peds program at a larger allopathic academic medical center and eventually pursuing a pulm or allergy fellowship. My top choices would be Denver, Cincinnati, Cleveland, or CHOP. I was not planning on applying to osteopathic peds residencies.

Now here's where it gets complicated. I just found out a week ago that I failed the COMLEX PE (equivalent to the USMLE CS). They are scant on the details. I'm pretty devastated by this. I'm pretty sure it was due to my osteopathic manipulation (OMM) skills being a bit rusty (after 3 years in the lab). I'm at a hospital where no one uses OMM and even though I prepared for the exam, I guess it wasn't enough. I know some might think this fits the trend.. a PhD who has no clinical skills, but most people who have worked with me would disagree-- and my evaluations reflect that. I hadn't released my COMLEX score to ERAS prior to the fail, so now my application will have this red flag.

So my question is how damaging was this fail? Did I just sink my shot at all competitive residencies? How do program directors look at the clinical skills exam? Has anyone at a place like Denver or CHOP ever failed the clinical skills exam? What are my best options for fire-control on this? Like I said, I think it was the OMM portion (which would be irrelevant at an allopathic residency anyway). I already knew that as a DO I was a long shot at some of these places. I thought the PhD/research background would help overcome that.

So my strategy (and please help me here). I'm retaking the PE a week from now. I feel I need to get a pass on this before I can release my ERAS application. I could release my application without my COMLEX scores (and just USMLE) but it would beg the question of what I was hiding. I was to take the USMLE 2 CK (and COMLEX2) this week, but after getting this fail, it took the wind out of my sails, so I rescheduled them for late September/early October. I'm doing a NICU rotation next month in Cincinnati and Peds Pulm at Rainbow in Cleveland.

Any advice?

Thanks. Shaw81

 

[shaw81]

Wow, no comments. Ok, I guess I'm on my own.

 

[oldbearprofessor]

Wow, no comments. Ok, I guess I'm on my own.

People on this forum tend to try to limit their advice giving to what they know about. There aren't a lot of DO/PhD's who failed the COMLEX PE probably around, especially within a day or so of the original posts.

So, here's the view from an MD who doesn't make these decisions.

I think your chance of matching at the top 10 USNWR Allo schools is slim, but not none. The research is the key, but even these programs are hiring residents not researchers. Having said that, there are tons of great programs that are not in the top 10 that will be fine for all your career needs.

Very very little research is done during residency. So, go to wherever you get in, do well and then go back to research as a fellow. At the fellowship application point, there will be less interest in your COMLEX PE score if any.

My advice should not be considered knowledgeable however.

 

[shaw81]

Thanks. I appreciate the feedback.

 

[michigangirl]

OBP (as always) is spot on. Most of us can't comment on your specific situation because we just dont have the experience with your situation-- which is extremely unique. Your research accomplishments are OUTSTANDING. Where that will truly make a difference is when you apply for fellowship, because, as was stated, in residency the focus is mostly clinical, with very little research time. Your chances of matching at a "top" allo program is low-- BUT, if you apply broadly and get into a peds residency that will train you well, get good letters, etc., your research experiences and strong residency performance will make you a shoe in at the "top" programs for fellowship in most fields. So don't despair! Good luck.

 

[Cuthbert]

Wow, no comments. Ok, I guess I'm on my own.

Cool it kiddo; we aren't all on here every day. 🙂

As a DO you need to be crytal clean on your grades/scores to get into a top residency. With that said, you have done very well other than your PE fail. The best you can do at this point is apply and wait and see.

Be prepared to discuss your fail and what you have done to correct it. Try to be as honest as possible. Push the COMLEX people to find out exactly why you failed. That way, if it truly was your OMM skills, who the hell cares. I doubt any allo program will care if that was the reason. Personally, I know my program would not (but I wasn't at any of the top programs you mention). If it was your people skills (as evidenced by your curt comment approximately 24 hours after you posted this thread), you may want to work on that.

Also, be sure to apply to some "lower tier" programs. You can get equally good education at other programs that do not fall under the so-called "best of the best" category. You will have equally good opportunities for fellowship placement from these programs, especially if you continue to work as hard as you have in the past and present.

Best of luck to you. I wish you well.

 

[shaw81]

Sorry for chomping at the bit-- it was actually over 24hrs before I replied to my own message, but I'll admit to being a bit overzealous 🙂 This is extremely anxiety provoking. I understand I'm a bit of a unique case. Actually, my patients (or patients' families) usually love me. I've been told I'm the best "intern" or medical student they've ever had a few times. I go the extra mile and probably spend too much time with the patients going over patient education (BTW, the Netter handouts on MDconsult are great!), bringing laboring patients ice chips, extra blankets, etc.

The NBOME is not very forthcoming. In fact, if you pass the exam they just send you a letter with a Pass written on it. Fail and they provide some more feedback (not much more)-- I passed the humanistic domain. The other part is biomedical/biomechanical domain. They break this section down into 4 subparts (see http://www.nbome.org/comlex-pe.asp?m=can ). I was given two "needs improvement" (one of three qualitative labels they give out based on a quantitative score, which they do NOT give you) on OMM and written communication. You can pass with a needs improvement on everything as long as your final score is past the threshold needed. So, I don't know if I failed by a point, or two points or how "badly" I needed improvement. I'm chalking it up to OMM because that's what I felt the least comfortable with at the end of the day. I had more than the average number of required OMM cases/patients requesting manipulation, so that didn't help me. I never was very good at OMM when I learned it to start with. I think it's a good treatment modality and have seen some amazing things with it. I'd recommend and refer patients to have it done by someone else-- I'm just not the one to do it.

I actually spent the last month on a subI in inpatient peds at MSU/Helen Devos Hospital in Grand Rapids, one of the smaller/lesser known programs (you wont find much mention it on this board... I've looked). This is was a fantastic experience and I think it's an up and coming program. Brand new hospital, great residency director (I impressed her enough that she volunteered to write me a letter), and they actually see both a lot of zebras and bread and butter. So, I'm definitely planning on applying to this and other smaller programs. The point about having little to no time to do research is true and well taken but...

With the particular field that I studied, genetics, the field is moving very fast. I will lose a lot of ground if I completely ignore or try to shelve my work for 3 years. My interest in programs catering to physician scientists (CHOP, Boston, CCHMC) is because they do so as part of their mission and provide tools for continuing development as a physician scientist (like mentorship). They also provide time (ok... some time) and resources (a lab, funding) to do the research, and usually funnel you into fellowships. There's also a cultural difference I've noticed. For my clerkships I'm at a smaller DO hospital where residents and students care less about research. I don't feel I always fit in and not just because I was in med school when they were in high school. They are happy to read about research in journal clubs, but I've been told by several residents that they don't see why they are required to do a research project as part of their residency (actually one resident who told me this wanted to go into Heme/Onc... so good luck). I've actually been asked by a several residents and other students why the heck I would bother to do a PhD-- like it's not important, and trying to explain my work mostly falls on deaf ears because they just don't care and it wont be on boards. My desire to go to a larger program might be a bit reactionary to how I feel being at a smaller community hospital now.

I feel I'm a bit in a catch-22-- good research, good service and leadership experience... things that the physician scientists minded programs seek out as part of their mission, but my USMLE1 is only decent/ok and borderline not good enough for some of these places (and I'm a DO and now have a big red flag from the COMLEX PE). On the other hand, many smaller programs are going to look at me and wonder why I'm applying to their program and may be concerned about how well I'll fit into their programs. Smaller programs usually are most concerned about wanting capable house officers (which I'm confident I'll be) and training clinicians and don't have as part of their mission to train physician scientists. (I'm paraphrasing this last point from years of listening to career development talks by physician scientists).

I'm rotating at Rainbow and Cincinnati, so maybe that will help score an interview. I feel if I get an interview, I can explain myself and I likely still have a shot.

So my final questions: do I submit my application on 9/1 with or without my COMLEX scores? or should I wait for my COMLEX PE retake scores (early October)? Am I hurting my chances substantially by waiting a month to submit my application? How many times will a program look at my application if I keep updating my scores as they come in? (is it one look and done?).

Thanks,
shaw81

 

[twilightdoc]

...So my final questions: do I submit my application on 9/1 with or without my COMLEX scores? or should I wait for my COMLEX PE retake scores (early October)? Am I hurting my chances substantially by waiting a month to submit my application? How many times will a program look at my application if I keep updating my scores as they come in? (is it one look and done?).

If it is possible to submit early without any scores and add your scores later, I would do that. I think that having a failing grade on any national standardized exam could trigger an automatic rejection from some programs, particularly the ones that are more competitive. Remember that most of the "top" programs get hundreds of applicants, far more than they can interview, so there needs to be an early screening mechanism, even though it is arbitrary and might result in missing out on excellent applicants who might have a single "blip" in their application or academic record.
Once you have passed that portion of your exam and submit your exam scores, you might be able to get an interview and a more careful review of your application.