Need some advice. I screwed up my future pretty bad

buffpenguin · Mar 20, 2016

Hey everyone,

I'm a 4th year at a US medical school. I wanted to do emergency medicine or pediatrics for my career. I honestly truly loved both and I know I will end up doing em-peds in the future. I need some advice on where to go.

1st/2nd= honored all first year classes (top 5% of class) then got lazy second year and just passed all classes.

3rd year/4th year: Started off my year by failing my internal medicine shelf due to not studying and thinking my 240 step 1 would carry me through. I then completed the year passing all my classes. I couldn't decide between committing to Pediatrics or EM because 3rd year would finish in July and August I would have to study for Step 2 and re-mediate internal medicine shelf exam. Stressed out and feeling no confidence in myself I couldn't study hard and my practice step 2 scores were coming out 210-220. I decided to postpone my test which further complicated many things. I then had 2 months to rush and grab two SLOE letters to apply. My first slow was good i was middle 1/3. The second was bad and I was low 1/3. I scored very low on the exam given by the NBME shelf ER school. I cant blame anyone but myself because ever since I failed internal medicine, I had a lack of confidence and felt not worthy of being a doctor. I always got stuck between two choices and would try to justify both until I would settle with a guess or a gut feeling. During my 2 away rotations I tried to step up and study for STEP 2 while trying to get good rotation evaluation but I failed to do so. I took step 2 and got a 226. My self fulfilling prophecy had come true.

In my third year I failed to comply with school policy. We have a strict policy and at any time any faculty member can report you for an early concern notice. Accumulation of 3 notices result in a message in your deans letter about your professionalism and how you remediated it. It doesn't specifically say what you do to keep that information confidential. I accumulated 3 in my 3rd year. My first was due to an online exercise that required you to watch an online video and then do an oral presentation. I rushed through the video and the faculty member reported me for being one of 10 students who fwd the video and finished it in record time (although my presentation was 100). My second notice came for being late on my registration forms for a clerkship. Many of our prior clerkship never said anything about paperwork so i was accustomed to it. This time though seemed like the faculty member was upset about it and reported me. The third was during my surgery clerkship when I didn't show up to my autopsy on time and was late.

Match Day till now: I got 9 interviews after applying to 100 EM programs. Every school asked me about professionalism and every school assumed i had psychiatric issues, DUI, drug problems, disruptive behavior. After explaining my situation they said it was harsh. I ended up not matching, and subsequently not soaping even though I applied to 31 Family medicine programs. Why i applied to 31 family medicine? I wanted to end the stress and burden on my family. I wanted to be part of the celebration and be with my friends at MATCH ceremony. I figured instead of doing my dream, I can still help people and I know I would enjoy it. I also just wanted to find a place for me and my wife and give her stability. No schools sent me offers, they didn't even call. One school did call and said professionalism was an issue and it worries schools.

Present day: I am trying to apply to some of the Prelim programs unfilled. I realized that family medicine was dumb because I shouldn't ever have done that. I now realize that its Peds or EM and nothing else. I know this is a setback and if I am unmatched I need to find a plan to prove myself to schools, and also prove to myself a couple of things.

Anyone have any advice or experience with an issue like this? What do you think caused me to burn out and not care my second year after being in the top 5% in my first year? What made me lose faith in myself and have no confidence in my medical acumen? Why did I struggle so hard making the jump from Step 1 to Step 2?

Tl😀R Started strong, messed up, failed IM NBME, Got unprofessionalism written on my deans letter, No match, No SOAP, everyone wants to avoid me due to my dean's letter, what should I do to move forward.

aladinforever · Mar 20, 2016

I feel like maybe you should post on the MD thread and not the preMD thread. You'll get a lot better advice there cause us pre-meds only have solid knowledge on getting into med school for the most part. We kinda don't know how things work that far down the line.

buffpenguin · Mar 20, 2016

Hey everyone,

I'm a 4th year at a US medical school. I wanted to do emergency medicine or pediatrics for my career. I honestly truly loved both and I know I will end up doing em-peds in the future. I need some advice on where to go.

1st/2nd= honored all first year classes (top 5% of class) then got lazy second year and just passed all classes.

3rd year/4th year: Started off my year by failing my internal medicine shelf due to not studying and thinking my 240 step 1 would carry me through. I then completed the year passing all my classes. I couldn't decide between committing to Pediatrics or EM because 3rd year would finish in July and August I would have to study for Step 2 and re-mediate internal medicine shelf exam. Stressed out and feeling no confidence in myself I couldn't study hard and my practice step 2 scores were coming out 210-220. I decided to postpone my test which further complicated many things. I then had 2 months to rush and grab two SLOE letters to apply. My first slow was good i was middle 1/3. The second was bad and I was low 1/3. I scored very low on the exam given by the NBME shelf ER school. I cant blame anyone but myself because ever since I failed internal medicine, I had a lack of confidence and felt not worthy of being a doctor. I always got stuck between two choices and would try to justify both until I would settle with a guess or a gut feeling. During my 2 away rotations I tried to step up and study for STEP 2 while trying to get good rotation evaluation but I failed to do so. I took step 2 and got a 226. My self fulfilling prophecy had come true.

In my third year I failed to comply with school policy. We have a strict policy and at any time any faculty member can report you for an early concern notice. Accumulation of 3 notices result in a message in your deans letter about your professionalism and how you remediated it. It doesn't specifically say what you do to keep that information confidential. I accumulated 3 in my 3rd year. My first was due to an online exercise that required you to watch an online video and then do an oral presentation. I rushed through the video and the faculty member reported me for being one of 10 students who fwd the video and finished it in record time (although my presentation was 100). My second notice came for being late on my registration forms for a clerkship. Many of our prior clerkship never said anything about paperwork so i was accustomed to it. This time though seemed like the faculty member was upset about it and reported me. The third was during my surgery clerkship when I didn't show up to my autopsy on time and was late.

Match Day till now: I got 9 interviews after applying to 100 EM programs. Every school asked me about professionalism and every school assumed i had psychiatric issues, DUI, drug problems, disruptive behavior. After explaining my situation they said it was harsh. I ended up not matching, and subsequently not soaping even though I applied to 31 Family medicine programs. Why i applied to 31 family medicine? I wanted to end the stress and burden on my family. I wanted to be part of the celebration and be with my friends at MATCH ceremony. I figured instead of doing my dream, I can still help people and I know I would enjoy it. I also just wanted to find a place for me and my wife and give her stability. No schools sent me offers, they didn't even call. One school did call and said professionalism was an issue and it worries schools.

Present day: I am trying to apply to some of the Prelim programs unfilled. I realized that family medicine was dumb because I shouldn't ever have done that. I now realize that its Peds or EM and nothing else. I know this is a setback and if I am unmatched I need to find a plan to prove myself to schools, and also prove to myself a couple of things.

Anyone have any advice or experience with an issue like this? What do you think caused me to burn out and not care my second year after being in the top 5% in my first year? What made me lose faith in myself and have no confidence in my medical acumen? Why did I struggle so hard making the jump from Step 1 to Step 2?

Tl😀R Started strong, messed up, failed IM NBME, Got unprofessionalism written on my deans letter, No match, No SOAP, everyone wants to avoid me due to my dean's letter, what should I do to move forward.

criticalelement · Mar 20, 2016

someone will take you as long as you graduated

hello lady! · Mar 20, 2016

buffpenguin said:
Hey everyone,

I'm a 4th year at a US medical school. I wanted to do emergency medicine or pediatrics for my career. I honestly truly loved both and I know I will end up doing em-peds in the future. I need some advice on where to go.

1st/2nd= honored all first year classes (top 5% of class) then got lazy second year and just passed all classes.

3rd year/4th year: Started off my year by failing my internal medicine shelf due to not studying and thinking my 240 step 1 would carry me through. I then completed the year passing all my classes. I couldn't decide between committing to Pediatrics or EM because 3rd year would finish in July and August I would have to study for Step 2 and re-mediate internal medicine shelf exam. Stressed out and feeling no confidence in myself I couldn't study hard and my practice step 2 scores were coming out 210-220. I decided to postpone my test which further complicated many things. I then had 2 months to rush and grab two SLOE letters to apply. My first slow was good i was middle 1/3. The second was bad and I was low 1/3. I scored very low on the exam given by the NBME shelf ER school. I cant blame anyone but myself because ever since I failed internal medicine, I had a lack of confidence and felt not worthy of being a doctor. I always got stuck between two choices and would try to justify both until I would settle with a guess or a gut feeling. During my 2 away rotations I tried to step up and study for STEP 2 while trying to get good rotation evaluation but I failed to do so. I took step 2 and got a 226. My self fulfilling prophecy had come true.

In my third year I failed to comply with school policy. We have a strict policy and at any time any faculty member can report you for an early concern notice. Accumulation of 3 notices result in a message in your deans letter about your professionalism and how you remediated it. It doesn't specifically say what you do to keep that information confidential. I accumulated 3 in my 3rd year. My first was due to an online exercise that required you to watch an online video and then do an oral presentation. I rushed through the video and the faculty member reported me for being one of 10 students who fwd the video and finished it in record time (although my presentation was 100). My second notice came for being late on my registration forms for a clerkship. Many of our prior clerkship never said anything about paperwork so i was accustomed to it. This time though seemed like the faculty member was upset about it and reported me. The third was during my surgery clerkship when I didn't show up to my autopsy on time and was late.

Match Day till now: I got 9 interviews after applying to 100 EM programs. Every school asked me about professionalism and every school assumed i had psychiatric issues, DUI, drug problems, disruptive behavior. After explaining my situation they said it was harsh. I ended up not matching, and subsequently not soaping even though I applied to 31 Family medicine programs. Why i applied to 31 family medicine? I wanted to end the stress and burden on my family. I wanted to be part of the celebration and be with my friends at MATCH ceremony. I figured instead of doing my dream, I can still help people and I know I would enjoy it. I also just wanted to find a place for me and my wife and give her stability. No schools sent me offers, they didn't even call. One school did call and said professionalism was an issue and it worries schools.

Present day: I am trying to apply to some of the Prelim programs unfilled. I realized that family medicine was dumb because I shouldn't ever have done that. I now realize that its Peds or EM and nothing else. I know this is a setback and if I am unmatched I need to find a plan to prove myself to schools, and also prove to myself a couple of things.

Anyone have any advice or experience with an issue like this? What do you think caused me to burn out and not care my second year after being in the top 5% in my first year? What made me lose faith in myself and have no confidence in my medical acumen? Why did I struggle so hard making the jump from Step 1 to Step 2?

Tl😀R Started strong, messed up, failed IM NBME, Got unprofessionalism written on my deans letter, No match, No SOAP, everyone wants to avoid me due to my dean's letter, what should I do to move forward.

Yikes.

How are your letters of recommendations? Do they address your unprofessionalism and the poor comments on your deans letter? Would your letter writers be willing to call places for you?

Short of that you may want to get into a department somehow (research year, etc) and prove that you're hardworking and not an entitled brat.

Good luck.

P0ke · Mar 20, 2016

ThoracicGuy · Mar 20, 2016

buffpenguin said:
Hey everyone,

I'm a 4th year at a US medical school. I wanted to do emergency medicine or pediatrics for my career. I honestly truly loved both and I know I will end up doing em-peds in the future. I need some advice on where to go.

1st/2nd= honored all first year classes (top 5% of class) then got lazy second year and just passed all classes.

3rd year/4th year: Started off my year by failing my internal medicine shelf due to not studying and thinking my 240 step 1 would carry me through. I then completed the year passing all my classes. I couldn't decide between committing to Pediatrics or EM because 3rd year would finish in July and August I would have to study for Step 2 and re-mediate internal medicine shelf exam. Stressed out and feeling no confidence in myself I couldn't study hard and my practice step 2 scores were coming out 210-220. I decided to postpone my test which further complicated many things. I then had 2 months to rush and grab two SLOE letters to apply. My first slow was good i was middle 1/3. The second was bad and I was low 1/3. I scored very low on the exam given by the NBME shelf ER school. I cant blame anyone but myself because ever since I failed internal medicine, I had a lack of confidence and felt not worthy of being a doctor. I always got stuck between two choices and would try to justify both until I would settle with a guess or a gut feeling. During my 2 away rotations I tried to step up and study for STEP 2 while trying to get good rotation evaluation but I failed to do so. I took step 2 and got a 226. My self fulfilling prophecy had come true.

In my third year I failed to comply with school policy. We have a strict policy and at any time any faculty member can report you for an early concern notice. Accumulation of 3 notices result in a message in your deans letter about your professionalism and how you remediated it. It doesn't specifically say what you do to keep that information confidential. I accumulated 3 in my 3rd year. My first was due to an online exercise that required you to watch an online video and then do an oral presentation. I rushed through the video and the faculty member reported me for being one of 10 students who fwd the video and finished it in record time (although my presentation was 100). My second notice came for being late on my registration forms for a clerkship. Many of our prior clerkship never said anything about paperwork so i was accustomed to it. This time though seemed like the faculty member was upset about it and reported me. The third was during my surgery clerkship when I didn't show up to my autopsy on time and was late.

Match Day till now: I got 9 interviews after applying to 100 EM programs. Every school asked me about professionalism and every school assumed i had psychiatric issues, DUI, drug problems, disruptive behavior. After explaining my situation they said it was harsh. I ended up not matching, and subsequently not soaping even though I applied to 31 Family medicine programs. Why i applied to 31 family medicine? I wanted to end the stress and burden on my family. I wanted to be part of the celebration and be with my friends at MATCH ceremony. I figured instead of doing my dream, I can still help people and I know I would enjoy it. I also just wanted to find a place for me and my wife and give her stability. No schools sent me offers, they didn't even call. One school did call and said professionalism was an issue and it worries schools.

Present day: I am trying to apply to some of the Prelim programs unfilled. I realized that family medicine was dumb because I shouldn't ever have done that. I now realize that its Peds or EM and nothing else. I know this is a setback and if I am unmatched I need to find a plan to prove myself to schools, and also prove to myself a couple of things.

Anyone have any advice or experience with an issue like this? What do you think caused me to burn out and not care my second year after being in the top 5% in my first year? What made me lose faith in myself and have no confidence in my medical acumen? Why did I struggle so hard making the jump from Step 1 to Step 2?

Tl😀R Started strong, messed up, failed IM NBME, Got unprofessionalism written on my deans letter, No match, No SOAP, everyone wants to avoid me due to my dean's letter, what should I do to move forward.

If your school will allow you to delay graduation, that would be best for you...

operaman · Mar 20, 2016

1) highly incongruent performance is a hallmark of substance abuse, mental illness, etc. It's rarely wrong. Applies to premeds with a 3.0/40 as it does to ms4s with top 5% and a 240 alongside a shelf failure. I know this is highly personal, but even if you feel like you don't have such problems, please see someone just to be sure. Now is the time for unfettered introspection.

2) you need a seismic shift in attitude. If even 10% of the attitude in your post was present in your PS or in interviews, then I totally understand why you didn't match. Sorry if this is harsh, but I'm assuming that by posting here you are seeking honest feedback. You've got to own your professionalism issues and how you address it going forward can't have even the slightest soupcon of excuses. The reality is that professionally minded students, after getting ONE such notice, would walk the straight and narrow path terrified of getting a second. If one of them got TWO - whoa! They'd be neurotically perfect from that day forward -- forget being late for an autopsy, they'd probably camp outside the door just to make sure they were on time! Yours have the added issue of being part of a larger pattern.

3) Along with the shift in attitude, you need a corresponding shift in narrative going forward. I don't know what the right one is for you, but it can't be the one above. Listen to this hypothetical rewrite of your story and notice the difference:

"Medical school is what ultimately forced me to grow up. I came in to medical school with the mindset and habits of a bright, entitled, and immature undergraduate student. First year went well and I honored everything and was in the top 5% of my class, but my habits and attitude began to be my undoing under the increased workload of second year with the looming specter of Step 1. I managed to pass my classes and put everything into my step study, ultimately scoring a 240, but thanks to my cram-and-purge approach, didn't have the underlying knowledge base necessary for success going forward. Everything finally came to a head in 3rd year - a time that rewards diligent, professional, and organized students who can manage their studies amidst the newfound clinical workload. I was none of those things and my wake-up call was failing my IM shelf exam. I sought advice from our academic advisers and began a seismic shift in my attitude and my habits. Like all things seismic, the change took time. I passed my remaining shelf exams and remediated my IM shelf, but my lingering immaturity did not go unnoticed by faculty and I accumulated 3 notices of concern which were noted in my MSPE. If I'm completely honest with myself, I'm lucky there weren't more, especially from early in the year when my growing pains were at their worst. I grew a lot during that year and by fourth year I had begun to find my stride and was becoming the professional I wanted to be. I look back at how I was in the beginning and even up through just last year and can't believe how immature and entitled I was, but I also see just how far I've come. "

4) You need advocates. In addition to your own attitude shift, you need some faculty who will vouch for your professionalism and integrity as it stands now. How is your relationship with your home peds department? I think a research year there or in some peds department would be something to consider. Bust your tail, be productive, and get some great letters and phone calls on your behalf. I would reach out to any faculty you clicked with on that rotation and start seeking advice, though be sure your narrative is adjusted first as mentioned above.

5) You will probably want to take Step 3 earlier than later. Programs are risk averse and this is one more thing you can check off the list. Obviously you need to pass it and you really need to do well on it. A great score would be a nice feather showing your academic redemption.

6) EM seems highly unlikely. Too competitive. Your route to Peds EM would be through a Peds residency. You should also apply to FM again through the regular match as a backup. Here again, your home programs are your best bet unless you made such a poor impression on your rotations that you've closed that door. In any case, I would start meeting with people and display your changed attitude and see how they respond.

Terror Billy · Mar 20, 2016

P0ke said:
Sounds like you may have gotten overconfident/cocky after doing so well first year, and that you felt you could rest on your laurels and slack off. Everything in med school is independent of each other and a separate battle. I'll make sure not to make the same mistakes as you.

Don't be such a dick, if this is how you normally are I'm sure you'll have quite the clinical skills

P0ke · Mar 20, 2016

piii · Mar 20, 2016

PhiGamDoc said:
Don't be such a dick, if this is how you normally are I'm sure you'll have quite the clinical skills

You can analyze his clinical skills based on one jerk comment? Amazing!

buffpenguin · Mar 20, 2016

operaman said:
1) highly incongruent performance is a hallmark of substance abuse, mental illness, etc. It's rarely wrong. Applies to premeds with a 3.0/40 as it does to ms4s with top 5% and a 240 alongside a shelf failure. I know this is highly personal, but even if you feel like you don't have such problems, please see someone just to be sure. Now is the time for unfettered introspection.

2) you need a seismic shift in attitude. If even 10% of the attitude in your post was present in your PS or in interviews, then I totally understand why you didn't match. Sorry if this is harsh, but I'm assuming that by posting here you are seeking honest feedback. You've got to own your professionalism issues and how you address it going forward can't have even the slightest soupcon of excuses. The reality is that professionally minded students, after getting ONE such notice, would walk the straight and narrow path terrified of getting a second. If one of them got TWO - whoa! They'd be neurotically perfect from that day forward -- forget being late for an autopsy, they'd probably camp outside the door just to make sure they were on time! Yours have the added issue of being part of a larger pattern.

3) Along with the shift in attitude, you need a corresponding shift in narrative going forward. I don't know what the right one is for you, but it can't be the one above. Listen to this hypothetical rewrite of your story and notice the difference:

"Medical school is what ultimately forced me to grow up. I came in to medical school with the mindset and habits of a bright, entitled, and immature undergraduate student. First year went well and I honored everything and was in the top 5% of my class, but my habits and attitude began to be my undoing under the increased workload of second year with the looming specter of Step 1. I managed to pass my classes and put everything into my step study, ultimately scoring a 240, but thanks to my cram-and-purge approach, didn't have the underlying knowledge base necessary for success going forward. Everything finally came to a head in 3rd year - a time that rewards diligent, professional, and organized students who can manage their studies amidst the newfound clinical workload. I was none of those things and my wake-up call was failing my IM shelf exam. I sought advice from our academic advisers and began a seismic shift in my attitude and my habits. Like all things seismic, the change took time. I passed my remaining shelf exams and remediated my IM shelf, but my lingering immaturity did not go unnoticed by faculty and I accumulated 3 notices of concern which were noted in my MSPE. If I'm completely honest with myself, I'm lucky there weren't more, especially from early in the year when my growing pains were at their worst. I grew a lot during that year and by fourth year I had begun to find my stride and was becoming the professional I wanted to be. I look back at how I was in the beginning and even up through just last year and can't believe how immature and entitled I was, but I also see just how far I've come. "

4) You need advocates. In addition to your own attitude shift, you need some faculty who will vouch for your professionalism and integrity as it stands now. How is your relationship with your home peds department? I think a research year there or in some peds department would be something to consider. Bust your tail, be productive, and get some great letters and phone calls on your behalf. I would reach out to any faculty you clicked with on that rotation and start seeking advice, though be sure your narrative is adjusted first as mentioned above.

5) You will probably want to take Step 3 earlier than later. Programs are risk averse and this is one more thing you can check off the list. Obviously you need to pass it and you really need to do well on it. A great score would be a nice feather showing your academic redemption.

6) EM seems highly unlikely. Too competitive. Your route to Peds EM would be through a Peds residency. You should also apply to FM again through the regular match as a backup. Here again, your home programs are your best bet unless you made such a poor impression on your rotations that you've closed that door. In any case, I would start meeting with people and display your changed attitude and see how they respond.

Thank you so much for your comments. You have no idea how helpful it was. I didnt say everything that I felt, but you basically guess exactly how things were in my head. I have never drank alcohol or done drugs though. But everything else was spot on!

candbgirl · Mar 20, 2016

OP maybe ask a mod to move this to the Residents forum. They seem to have witnessed/been involved with / every possible situation concerning residency and SOAP etc.

Sent from my iPad using SDN mobile app

atomi · Mar 20, 2016

buffpenguin said:
My first was due to an online exercise that required you to watch an online video and then do an oral presentation. I rushed through the video and the faculty member reported me for being one of 10 students who fwd the video and finished it in record time (although my presentation was 100).

Wait, WHAT? This actually happened? HFS.

If what you write is true, you got royally hosed by your school. I can't believe they allowed that stuff if the MSPE, to the point that every single place you applied saw it. Most of the MSPE is glanced over. If I were you, I would probably be writing the name of that school in my post because they deserve it. I mean, I put up with some of the bs policies and insulting way of being treated like a 4th grader by my school as well, but at the end of the day they were there to help us match.

alpinism · Mar 20, 2016

Hmm did you have 3 LORs when you applied in mid September?

When did your SLOEs get sent to programs?

EM is still possible but Peds would be more realistic due to it being less competitive.

I'd extend for a 5th year if possible and try to do some Peds or Peds EM research. Do some away rotations, work your ass off, and get great grades. Then get new LORs and have the letter writers address the professionalism concerns (be upfront with them). Briefly address the professionalism concerns in your personal statement as well and take responsibility for your actions (if you haven't done so already). Then apply on day one to as many programs as possible (including programs in less desirable locations).

Good Luck!

gyngyn · Mar 20, 2016

atomi said:
Wait, WHAT? This actually happened? HFS.

If what you write is true, you got royally hosed by your school. I can't believe they allowed that stuff if the MSPE, to the point that every single place you applied saw it. Most of the MSPE is glanced over. If I were you, I would probably be writing the name of that school in my post because they deserve it. I mean, I put up with some of the bs policies and insulting way of being treated like a 4th grader by my school as well, but at the end of the day they were there to help us match.

It was the pattern of behavior that made it into the MSPE, not the individual acts.
In order for the MSPE to mean anything, it has to contain pertinent information. No school wants to harm a student's chances for a match, but if PD's can't trust them to indicate when a pattern has been identified, none of their MSPE's will be trusted and all their students are harmed.

nwciowa · Mar 20, 2016

It seems like there is an almost pathological tendency to be late on things in some people. I have a classmate in one of my labs (who is in the MILITARY HPSP, no less) that is ALWAYS late to lab. I mean ALWAYS. This may seem harsh, but it seems like 2/3 of the disciplinary measures in your 3rd year were for being late to something. Start being early, to everything. Get assignments done early. Study early. 5 minutes early is on time. 15 minutes early is perfect, gives you time to adjust. You have to start thinking about patients and what your responsibilities will be, especially as someone who wants to match EM - 5 minutes late as an EM physician is plenty of time to decide life and death.

Seems pretty harsh, but I had to learn this lesson early on in my life. It never leaves you once you commit to it! Best of luck! You will be just fine.

Terror Billy · Mar 20, 2016

P0ke said:
I wasn't being a dick. He said he did well first year and then slacked off because he got lazy. Thanks for telling me the intentions of my own words though.

The I'll be sure not to make the same mistakes as you comment was highly unnecessary. No need to announce to the world your keen observational learning, he clearly understood he made a mistake...

P0ke · Mar 20, 2016

I'm done here.

atomi · Mar 20, 2016

gyngyn said:
It was the pattern of behavior that made it into the MSPE, not the individual acts.
In order for the MSPE to mean anything, it has to contain pertinent information. No school wants to harm a student's chances for a match, but if PD's can't trust them to indicate when a pattern has been identified, none of their MSPE's will be trusted and all their students are harmed.

Ok, lets look at the "pattern of behavior" from what he posted:

1. He fast-forwarded through an instructional video. Yet he still had learned the content well enough to give a perfect presentation.
2. He was unaware of some required paperwork that was due
3. He arrived late to a clerkship once

These three incredibly minor things bought him the scarlett letter of "unprofessional" on his MSPE and he didn't match. Unless he is flat out lying and not telling us about that time he sexually harassed a classmate or something, you've got to be kidding me. His school took his money and completely screwed him over.

P0ke · Mar 20, 2016

http://forums.studentdoctor.net/thr...p-my-future-pretty-bad.1189553/#post-17550087
this is a duplicate post

Goro · Mar 20, 2016

Very sorry to hear of your woes.

I'm not a mental health professional, but I'm getting a strong whiff of depression in your account.

What concerns me is whatever the cause of your behavior, you apparently didn't get help for it.

My question for you now is: do you really want to be a doctor? Because it seems like you're doing everything to sabotage your career except punch your Dean.

buffpenguin said:
Hey everyone,

I'm a 4th year at a US medical school. I wanted to do emergency medicine or pediatrics for my career. I honestly truly loved both and I know I will end up doing em-peds in the future. I need some advice on where to go.

1st/2nd= honored all first year classes (top 5% of class) then got lazy second year and just passed all classes.

3rd year/4th year: Started off my year by failing my internal medicine shelf due to not studying and thinking my 240 step 1 would carry me through. I then completed the year passing all my classes. I couldn't decide between committing to Pediatrics or EM because 3rd year would finish in July and August I would have to study for Step 2 and re-mediate internal medicine shelf exam. Stressed out and feeling no confidence in myself I couldn't study hard and my practice step 2 scores were coming out 210-220. I decided to postpone my test which further complicated many things. I then had 2 months to rush and grab two SLOE letters to apply. My first slow was good i was middle 1/3. The second was bad and I was low 1/3. I scored very low on the exam given by the NBME shelf ER school. I cant blame anyone but myself because ever since I failed internal medicine, I had a lack of confidence and felt not worthy of being a doctor. I always got stuck between two choices and would try to justify both until I would settle with a guess or a gut feeling. During my 2 away rotations I tried to step up and study for STEP 2 while trying to get good rotation evaluation but I failed to do so. I took step 2 and got a 226. My self fulfilling prophecy had come true.

In my third year I failed to comply with school policy. We have a strict policy and at any time any faculty member can report you for an early concern notice. Accumulation of 3 notices result in a message in your deans letter about your professionalism and how you remediated it. It doesn't specifically say what you do to keep that information confidential. I accumulated 3 in my 3rd year. My first was due to an online exercise that required you to watch an online video and then do an oral presentation. I rushed through the video and the faculty member reported me for being one of 10 students who fwd the video and finished it in record time (although my presentation was 100). My second notice came for being late on my registration forms for a clerkship. Many of our prior clerkship never said anything about paperwork so i was accustomed to it. This time though seemed like the faculty member was upset about it and reported me. The third was during my surgery clerkship when I didn't show up to my autopsy on time and was late.

Match Day till now: I got 9 interviews after applying to 100 EM programs. Every school asked me about professionalism and every school assumed i had psychiatric issues, DUI, drug problems, disruptive behavior. After explaining my situation they said it was harsh. I ended up not matching, and subsequently not soaping even though I applied to 31 Family medicine programs. Why i applied to 31 family medicine? I wanted to end the stress and burden on my family. I wanted to be part of the celebration and be with my friends at MATCH ceremony. I figured instead of doing my dream, I can still help people and I know I would enjoy it. I also just wanted to find a place for me and my wife and give her stability. No schools sent me offers, they didn't even call. One school did call and said professionalism was an issue and it worries schools.

Present day: I am trying to apply to some of the Prelim programs unfilled. I realized that family medicine was dumb because I shouldn't ever have done that. I now realize that its Peds or EM and nothing else. I know this is a setback and if I am unmatched I need to find a plan to prove myself to schools, and also prove to myself a couple of things.

Anyone have any advice or experience with an issue like this? What do you think caused me to burn out and not care my second year after being in the top 5% in my first year? What made me lose faith in myself and have no confidence in my medical acumen? Why did I struggle so hard making the jump from Step 1 to Step 2?

Tl😀R Started strong, messed up, failed IM NBME, Got unprofessionalism written on my deans letter, No match, No SOAP, everyone wants to avoid me due to my dean's letter, what should I do to move forward.

Goro · Mar 20, 2016

Actually, it was:

Started off my year by failing my internal medicine shelf due to not studying and thinking my 240 step 1 would carry me through.

I decided to postpone my test which further complicated many things. I then had 2 months to rush and grab two SLOE letters to apply.

My first slow was good i was middle 1/3. The second was bad and I was low 1/3.

I took step 2 and got a 226.

In my third year I failed to comply with school policy.

I rushed through the video and the faculty member reported me for being one of 10 students who fwd the video and finished it in record time (although my presentation was 100).

My second notice came for being late on my registration forms for a clerkship.

The third was during my surgery clerkship when I didn't show up to my autopsy on time and was late.

Did anyone notice for two bolded items, note the lack of ownership for the infractions in the OP?.

"Pattern of behavior" indeed. Pay attention to the wise gyngyn.

atomi said:
Ok, lets look at the "pattern of behavior" from what he posted:

1. He fast-forwarded through an instructional video. Yet he still had learned the content well enough to give a perfect presentation.
2. He was unaware of some required paperwork that was due
3. He arrived late to a clerkship once

These three incredibly minor things bought him the scarlett letter of "unprofessional" on his MSPE and he didn't match. Unless he is flat out lying and not telling us about that time he sexually harassed a classmate or something, you've got to be kidding me. His school took his money and completely screwed him over.

atomi · Mar 20, 2016

Goro said:
Actually, it was:

Started off my year by failing my internal medicine shelf due to not studying and thinking my 240 step 1 would carry me through.

I decided to postpone my test which further complicated many things. I then had 2 months to rush and grab two SLOE letters to apply.

My first slow was good i was middle 1/3. The second was bad and I was low 1/3.

I took step 2 and got a 226.

In my third year I failed to comply with school policy.

I rushed through the video and the faculty member reported me for being one of 10 students who fwd the video and finished it in record time (although my presentation was 100).

My second notice came for being late on my registration forms for a clerkship.

The third was during my surgery clerkship when I didn't show up to my autopsy on time and was late.

Did anyone notice for two bolded items, note the lack of ownership for the infractions in the OP?.

"Pattern of behavior" indeed. Pay attention to the wise gyngyn.

He clearly said that it was those three things that got him branded on his MSPE with professionalism concerns.
He did well on step 1 and ok on step 2. Passed both first times. His LORs could have been better. I would bet the bad LOR probably did more damage since bad LORs in a residency application are pretty uncommon. But those things didn't play into his unprofessionalism mark, which was probably the nail in the coffin.

My point was that it was absolutely ridiculous for his school to say "we are graduating this student, but simultaneously we think he may be unprofessional in the future" all because he didn't get the memo on some required paperwork, showed up late once, and fast forwarded through a video. Most students have done at least one of those things, if not all of them. If he was habitually late, never turned in any paperwork, and skipped all required video lectures, then yes, that's a pattern of behavior. But that's not what he said.

candbgirl · Mar 20, 2016

P0ke said:
http://forums.studentdoctor.net/thr...p-my-future-pretty-bad.1189553/#post-17550087
this is a duplicate post

And the responses from med students are SOOO different from premeds. Very enlightening and maybe everyone here should red med students take on this situation.

Sent from my iPhone using SDN mobile app

Med Ed · Mar 20, 2016

atomi said:
Ok, lets look at the "pattern of behavior" from what he posted:

1. He fast-forwarded through an instructional video. Yet he still had learned the content well enough to give a perfect presentation.
2. He was unaware of some required paperwork that was due
3. He arrived late to a clerkship once

These three incredibly minor things bought him the scarlett letter of "unprofessional" on his MSPE and he didn't match. Unless he is flat out lying and not telling us about that time he sexually harassed a classmate or something, you've got to be kidding me. His school took his money and completely screwed him over.

OP is presenting a one-sided, and I am betting highly sanitized, version of events. The documented incidents brought forth in professionalism cases invariably represent the tip of the iceberg. You may notice that the three reports all share something in common: the are all objective and independently verifiable.

You may also notice that the OP is still trying to openly discharge accountability for two of them. "But nine other students also fast-forwarded the video!" "But most of the other clerkships didn't have registration paperwork!"

Odds are the OP is very book smart, but sorely lacking in maturity and judgement. The school does not benefit one iota from having the OP go unmatched. Believe it or not, they don't like kneecapping students over trivialities.

Goro · Mar 20, 2016

In this case, I suspect that the OP did not violate enough school policies where s/he could have actually failed a year or worse, get dismissed. Thus, the school has no recourse but to award the diploma, but took appropriate actions to warn future employers via the MSPE.

Keep in mind that most schools do everything in their power to both graduate students and make sure that they get residency. I remember a time when we faculty were encouraged to submit comments to our students' dean letters. I wrote some candid and negative comments about one student who I really despised.

Our Clinical dean told me 'no way"....even though my comments were 100% accurate.

So, I suspect that there's more to the story than the OP is letting on, as is usual in cases like these. Being a parent, I know that there are always two sides to every story. EDIT: The sage Med Ed beat me to it!!

atomi said:
He clearly said that it was those three things that got him branded on his MSPE with professionalism concerns.
He did well on step 1 and ok on step 2. Passed both first times. His LORs could have been better. I would bet the bad LOR probably did more damage since bad LORs in a residency application are pretty uncommon. But those things didn't play into his unprofessionalism mark, which was probably the nail in the coffin.

My point was that it was absolutely ridiculous for his school to say "we are graduating this student, but simultaneously we think he may be unprofessional in the future" all because he didn't get the memo on some required paperwork, showed up late once, and fast forwarded through a video. Most students have done at least one of those things, if not all of them. If he was habitually late, never turned in any paperwork, and skipped all required video lectures, then yes, that's a pattern of behavior. But that's not what he said.

Ismet · Mar 20, 2016

Merging cross-posted threads into Allopathic forum.

operaman · Mar 20, 2016

Med Ed said:
OP is presenting a one-sided, and I am betting highly sanitized, version of events. The documented incidents brought forth in professionalism cases invariably represent the tip of the iceberg. You may notice that the three reports all share something in common: the are all objective and independently verifiable.

You may also notice that the OP is still trying to openly discharge accountability for two of them. "But nine other students also fast-forwarded the video!" "But most of the other clerkships didn't have registration paperwork!"

Odds are the OP is very book smart, but sorely lacking in maturity and judgement. The school does not benefit one iota from having the OP go unmatched. Believe it or not, they don't like kneecapping students over trivialities.

Ding ding ding! We have a winner!

If anyone believes these three things were the only times the OP displayed such behavior, well, I have a bridge and some beachfront property I'd love to sell you.

These are just the times it was caught and there was proof. Also note how everyone in this thread has noted the attitude of excuses and absence of any sense of taking responsibility.

I think people are also underestimating just how serious such infractions are. You want to see someone pissed off, find an EM resident at the end of a long shift when the next shift resident is late! Ask a program director what they think of residents who don't get required paperwork and whatnot done on time.

As for the school screwing him, there's both an ethical responsibility to be truthful in the mspe and a legal liability if they are not. If a students pattern of unprofessional behavior is not disclosed (or worse, lied about completely) and they go on to behave that way and ultimately cause harm to a patient as a result, you can be sure the hospital's attorneys (and their insurance company's attorneys) would come after the medical school and the dean who wrote the letter.

atomi · Mar 20, 2016

Med Ed said:
You may also notice that the OP is still trying to openly discharge accountability for two of them. "But nine other students also fast-forwarded the video!" "But most of the other clerkships didn't have registration paperwork!"

He fast forwarded through an online lecture. He clearly learned the content based on the fact that he presented it well. Virtually everyone has fast forwarded through something they were familiar with at some point in their training. This is so minor it's laughable. The punishment does not fit the crime. How am I the only person seeing this? I agree that we only have his side of the story, but just looking at those three events and ignoring everything else, they aren't enough to land him a red mark on his MSPE IMO. His school set him up for failure by doing this. This would not have happened at other schools.

atomi · Mar 20, 2016

operaman said:
I think people are also underestimating just how serious such infractions are. You want to see someone pissed off, find an EM resident at the end of a long shift when the next shift resident is late! Ask a program director what they think of residents who don't get required paperwork and whatnot done on time.

HFS. He was late one time. He overlooked some required bs paperwork. Get some perspective.
The law says we can throw you in jail for one year for speeding. Does that mean it's fair? Does that mean you're a danger to society and we have to keep you off the streets?

atomi · Mar 20, 2016

Goro said:
So, I suspect that there's more to the story than the OP is letting on, as is usual in cases like these. Being a parent, I know that there are always two sides to every story. EDIT: The sage Med Ed beat me to it!!

I agree there is probably more to the story that the OP is not disclosing. I would not be surprised if he is neglecting to tell us about some other more egregious policy violations. What is shocking me about this thread is that people are defending the red mark on the MSPE based on the 3 minor things he posted alone.

Nearly all of us will oversleep and be late at some point. It happens, and it's part of being human. When it happens once a week that's a different story, but from what he's posted, that's not what we're talking about. I overslept once as a med student and showed up late to my obgyn rotation. I apologized and nobody cared. Does that mean I don't deserve to be a resident now?

operaman · Mar 20, 2016

atomi said:
HFS. He was late one time. He overlooked some required bs paperwork. Get some perspective.
The law says we can throw you in jail for one year for speeding. Does that mean it's fair? Does that mean you're a danger to society and we have to keep you off the streets?

He was not late one time. He was late many times. When he wasn't late, he was skating in at the last second and physically present but not really prepared. Other people just ignored it and went on with their day, but the person doing the autopsy was probably sitting there waiting for him so he/she could start and was pissed off enough to fill out the paperwork.

BS paperwork? Let me ask you this: what do you think gets more physicians fired/sued/reprimanded/etc: being sh---y doctors, or failing to keep up with required paperwork? And just like I said above, this was not a one time offense. He did this for many other clerkships before but none of their admins cared bothered to fill out the form and submit it. The OP basically says this outright in his post.

Consigliere · Mar 20, 2016

Family practice is your only hope.

buffpenguin · Mar 20, 2016

I think you guys are completely right. I think over the past six months I have been torn between blaming myself and saying "these were such small incidents". Its so simple to get used to the notion that you can get away with things in life. That certain things aren't a priority. I have done that many times in my life. I think there were many really good points here. All the bashing aside, when I wrote this originally I wanted to say it raw in an unedited form. the angry side of me. The side that wishes I got away with it. The immature side that thinks it's not a big deal. I never did anything to harm a patient, and I would never take learning and treating patients as a joke. What got me the most was residency programs not giving me a chance to explain myself and assuming that it involved drugs, alcohol, personality disorders. I believe that there are many people in this post that shared that idea.

On the other hand there are some really wise users who criticized me and told me the truth. The part of me that knows that this is all one giant test. That it's gods plan to make me a better person. That I have more maturing to do before I become a doctor. That I need to realize that I have these deficits and need to work on fixing myself. The answer is right in front me. And I have known it all along. You can't be a doctor by getting by, being lazy, and getting lucky. It's hard work and dedication, it's an honor to do this profession. It's my dream and it's a huge responsibility. I think I really needed this criticism because I was beginning to feel like it was the schools fault. I know that if I let this bring me down then I will have proven everyone right about me. But I know I have much more to offer, and maybe by saying it here I will motivate myself more and help others before they come to the same realization. To be a successful person you have to be successful in every aspect of your life. You can't skate by in parts and work hard in others. As a husband, future father, Doctor, and a son. Being successful is a way of life.

Thank you guys

kenjixshadow · Mar 20, 2016

buffpenguin said:
I think you guys are completely right. I think over the past six months I have been torn between blaming myself and saying "these were such small incidents". Its so simple to get used to the notion that you can get away with things in life. That certain things aren't a priority. I have done that many times in my life. I think there were many really good points here. All the bashing aside, when I wrote this originally I wanted to say it raw in an unedited form. the angry side of me. The side that wishes I got away with it. The immature side that thinks it's not a big deal. I never did anything to harm a patient, and I would never take learning and treating patients as a joke. What got me the most was residency programs not giving me a chance to explain myself and assuming that it involved drugs, alcohol, personality disorders. I believe that there are many people in this post that shared that idea.

On the other hand there are some really wise users who criticized me and told me the truth. The part of me that knows that this is all one giant test. That it's gods plan to make me a better person. That I have more maturing to do before I become a doctor. That I need to realize that I have these deficits and need to work on fixing myself. The answer is right in front me. And I have known it all along. You can't be a doctor by getting by, being lazy, and getting lucky. It's hard work and dedication, it's an honor to do this profession. It's my dream and it's a huge responsibility. I think I really needed this criticism because I was beginning to feel like it was the schools fault. I know that if I let this bring me down then I will have proven everyone right about me. But I know I have much more to offer, and maybe by saying it here I will motivate myself more and help others before they come to the same realization. To be a successful person you have to be successful in every aspect of your life. You can't skate by in parts and work hard in others. As a husband, future father, Doctor, and a son. Being successful is a way of life.

Thank you guys

Are you going to attempt EM for the second time? I think that you still have a chance since you got 9 interviews. Write a redemption PS. Apply to new and undesirable location programs, no coast. Granted, you'll need to get honor in all of your SLOEs and show to PDs that you have learned from your mistakes. With that being said, apply FM as backup since you can't afford to SOAP or go unmatch again in next cycle.

673441 · Mar 20, 2016

buffpenguin said:
I think you guys are completely right. I think over the past six months I have been torn between blaming myself and saying "these were such small incidents". Its so simple to get used to the notion that you can get away with things in life. That certain things aren't a priority. I have done that many times in my life. I think there were many really good points here. All the bashing aside, when I wrote this originally I wanted to say it raw in an unedited form. the angry side of me. The side that wishes I got away with it. The immature side that thinks it's not a big deal. I never did anything to harm a patient, and I would never take learning and treating patients as a joke. What got me the most was residency programs not giving me a chance to explain myself and assuming that it involved drugs, alcohol, personality disorders. I believe that there are many people in this post that shared that idea.

On the other hand there are some really wise users who criticized me and told me the truth. The part of me that knows that this is all one giant test. That it's gods plan to make me a better person. That I have more maturing to do before I become a doctor. That I need to realize that I have these deficits and need to work on fixing myself. The answer is right in front me. And I have known it all along. You can't be a doctor by getting by, being lazy, and getting lucky. It's hard work and dedication, it's an honor to do this profession. It's my dream and it's a huge responsibility. I think I really needed this criticism because I was beginning to feel like it was the schools fault. I know that if I let this bring me down then I will have proven everyone right about me. But I know I have much more to offer, and maybe by saying it here I will motivate myself more and help others before they come to the same realization. To be a successful person you have to be successful in every aspect of your life. You can't skate by in parts and work hard in others. As a husband, future father, Doctor, and a son. Being successful is a way of life.

Thank you guys

Good luck man, I truly hope you match.

atomi · Mar 20, 2016

operaman said:
He was not late one time. He was late many times. When he wasn't late, he was skating in at the last second and physically present but not really prepared. Other people just ignored it and went on with their day, but the person doing the autopsy was probably sitting there waiting for him so he/she could start and was pissed off enough to fill out the paperwork.

BS paperwork? Let me ask you this: what do you think gets more physicians fired/sued/reprimanded/etc: being sh---y doctors, or failing to keep up with required paperwork? And just like I said above, this was not a one time offense. He did this for many other clerkships before but none of their admins cared bothered to fill out the form and submit it. The OP basically says this outright in his post.

No, he doesn't say that at all. You are just assuming all these things. You might be right, but you can't tell me I'm wrong because you KNOW all these unstated events to be truth. He said he was late that one time. He may have been late more, but that's all he said. Your analogy about the paperwork is asinine. He wasn't aware some form needed to be turned in. This happens. My opinion is that the school screwed him over. OP, I'm sorry this happened to you -- you clearly could have done better, but as you said, professionalism concerns on MSPEs are usually for egregious violations, and its not surprising that the programs thought that you had done something far worse than showing up late once and forgetting some paperwork. Regardless, it's too late now and it doesn't matter. You need to keep an eye out for PGY-1 openings that come up over the next year while planning a strategy for reentering the match next year. Good luck.

operaman · Mar 20, 2016

atomi said:
No, he doesn't say that at all. You are just assuming all these things. You might be right, but you can't tell me I'm wrong because you KNOW all these unstated events to be truth. He said he was late that one time. He may have been late more, but that's all he said. Your analogy about the paperwork is asinine. He wasn't aware some form needed to be turned in. This happens. My opinion is that the school screwed him over. OP, I'm sorry this happened to you -- you clearly could have done better, but as you said, professionalism concerns on MSPEs are usually for egregious violations, and its not surprising that the programs thought that you had done something far worse than showing up late once and forgetting some paperwork. Regardless, it's too late now and it doesn't matter. You need to keep an eye out for PGY-1 openings that come up over the next year while planning a strategy for reentering the match next year. Good luck.

Yes he does say that, but I'm too tired to be teaching reading comprehension and will leave it to others to read and see for themselves if they see fit. And yes I do know those other events to be the true as OP later alluded to.

You're more than welcome to believe whatever you want to believe, but in the immortal words of Dr. House, "I'd agree with you, but then we'd both be wrong."

Med Ed · Mar 20, 2016

atomi said:
He fast forwarded through an online lecture. He clearly learned the content based on the fact that he presented it well. Virtually everyone has fast forwarded through something they were familiar with at some point in their training. This is so minor it's laughable. The punishment does not fit the crime. How am I the only person seeing this? I agree that we only have his side of the story, but just looking at those three events and ignoring everything else, they aren't enough to land him a red mark on his MSPE IMO. His school set him up for failure by doing this. This would not have happened at other schools.

Again, odds are these three infractions were the tip of a much larger iceberg. I have been on the institutional side of these things, and we let so much stuff slide it's not even funny.

Med Ed · Mar 20, 2016

buffpenguin said:
I think you guys are completely right. I think over the past six months I have been torn between blaming myself and saying "these were such small incidents". Its so simple to get used to the notion that you can get away with things in life. That certain things aren't a priority. I have done that many times in my life. I think there were many really good points here. All the bashing aside, when I wrote this originally I wanted to say it raw in an unedited form. the angry side of me. The side that wishes I got away with it. The immature side that thinks it's not a big deal. I never did anything to harm a patient, and I would never take learning and treating patients as a joke. What got me the most was residency programs not giving me a chance to explain myself and assuming that it involved drugs, alcohol, personality disorders. I believe that there are many people in this post that shared that idea.

On the other hand there are some really wise users who criticized me and told me the truth. The part of me that knows that this is all one giant test. That it's gods plan to make me a better person. That I have more maturing to do before I become a doctor. That I need to realize that I have these deficits and need to work on fixing myself. The answer is right in front me. And I have known it all along. You can't be a doctor by getting by, being lazy, and getting lucky. It's hard work and dedication, it's an honor to do this profession. It's my dream and it's a huge responsibility. I think I really needed this criticism because I was beginning to feel like it was the schools fault. I know that if I let this bring me down then I will have proven everyone right about me. But I know I have much more to offer, and maybe by saying it here I will motivate myself more and help others before they come to the same realization. To be a successful person you have to be successful in every aspect of your life. You can't skate by in parts and work hard in others. As a husband, future father, Doctor, and a son. Being successful is a way of life.

Thank you guys

One question, did you ever have a heart-to-heart with your dean of student affairs before your MSPE was written?

buffpenguin · Mar 20, 2016

Med Ed said:
One question, did you ever have a heart-to-heart with your dean of student affairs before your MSPE was written?

So after three infractions it's stated that it will go on mspe evaluation. The school sent out an email with our mspe and it was no where in there. Later that day it was uploaded and said to be final according to the email. So I was happy that it didn't go on my mspe. Somehow two weeks later it was reuploaded and by the time I even figured it out it was a week after that. The dean told me at that time and after speaking with him about how it wasn't there and they said it was final but somehow changed it. I also think that if I knew he was gonna change it I would have applied to another specialty that would be less competitive. Either way I felt them changing without notifying after stating the final copy was uploaded to be wrong. And I'm wondering if here are grounds to fight them over that. Even though I know it should have been written according to school policy.

atomi · Mar 20, 2016

operaman said:
Yes he does say that, but I'm too tired to be teaching reading comprehension and will leave it to others to read and see for themselves if they see fit. And yes I do know those other events to be the true as OP later alluded to.

That's an interesting way of saying "I'm wrong, he didn't say that they weren't one time offenses in his original post."

buffpenguin said:
Somehow two weeks later it was reuploaded and by the time I even figured it out it was a week after that. The dean told me at that time and after speaking with him about how it wasn't there and they said it was final but somehow changed it. I also think that if I knew he was gonna change it I would have applied to another specialty that would be less competitive. Either way I felt them changing without notifying after stating the final copy was uploaded to be wrong. And I'm wondering if here are grounds to fight them over that. Even though I know it should have been written according to school policy.

Even if they thought it was reasonable to include it in the letter, they should have at least let you know what you were up against so you could address it at interviews. They set you up for failure. I would be pretty angry, but there's no way you can legally fight it. Your best bet is to be humble and kind and appeal to their senses of reason and empathy to have it removed next year.

Med Ed said:
Again, odds are these three infractions were the tip of a much larger iceberg. I have been on the institutional side of these things, and we let so much stuff slide it's not even funny.

I agree. That's why I was shocked that people were defending this is as reasonable in and of itself. People get away with far, far worse.

Med Ed · Mar 20, 2016

buffpenguin said:
So after three infractions it's stated that it will go on mspe evaluation. The school sent out an email with our mspe and it was no where in there. Later that day it was uploaded and said to be final according to the email. So I was happy that it didn't go on my mspe. Somehow two weeks later it was reuploaded and by the time I even figured it out it was a week after that. The dean told me at that time and after speaking with him about how it wasn't there and they said it was final but somehow changed it. I also think that if I knew he was gonna change it I would have applied to another specialty that would be less competitive. Either way I felt them changing without notifying after stating the final copy was uploaded to be wrong. And I'm wondering if here are grounds to fight them over that. Even though I know it should have been written according to school policy.

You may have grounds if the school violated its own procedures by not giving you the opportunity to review the MSPE that was actually sent out. While I have not personally seen it, I have heard tales of students suing over the content of their MSPE's.

Merely · Mar 20, 2016

operaman said:
1) highly incongruent performance is a hallmark of substance abuse, mental illness, etc. It's rarely wrong. Applies to premeds with a 3.0/40 as it does to ms4s with top 5% and a 240 alongside a shelf failure. I know this is highly personal, but even if you feel like you don't have such problems, please see someone just to be sure. Now is the time for unfettered introspection.

2) you need a seismic shift in attitude. If even 10% of the attitude in your post was present in your PS or in interviews, then I totally understand why you didn't match. Sorry if this is harsh, but I'm assuming that by posting here you are seeking honest feedback. You've got to own your professionalism issues and how you address it going forward can't have even the slightest soupcon of excuses. The reality is that professionally minded students, after getting ONE such notice, would walk the straight and narrow path terrified of getting a second. If one of them got TWO - whoa! They'd be neurotically perfect from that day forward -- forget being late for an autopsy, they'd probably camp outside the door just to make sure they were on time! Yours have the added issue of being part of a larger pattern.

3) Along with the shift in attitude, you need a corresponding shift in narrative going forward. I don't know what the right one is for you, but it can't be the one above. Listen to this hypothetical rewrite of your story and notice the difference:

"Medical school is what ultimately forced me to grow up. I came in to medical school with the mindset and habits of a bright, entitled, and immature undergraduate student. First year went well and I honored everything and was in the top 5% of my class, but my habits and attitude began to be my undoing under the increased workload of second year with the looming specter of Step 1. I managed to pass my classes and put everything into my step study, ultimately scoring a 240, but thanks to my cram-and-purge approach, didn't have the underlying knowledge base necessary for success going forward. Everything finally came to a head in 3rd year - a time that rewards diligent, professional, and organized students who can manage their studies amidst the newfound clinical workload. I was none of those things and my wake-up call was failing my IM shelf exam. I sought advice from our academic advisers and began a seismic shift in my attitude and my habits. Like all things seismic, the change took time. I passed my remaining shelf exams and remediated my IM shelf, but my lingering immaturity did not go unnoticed by faculty and I accumulated 3 notices of concern which were noted in my MSPE. If I'm completely honest with myself, I'm lucky there weren't more, especially from early in the year when my growing pains were at their worst. I grew a lot during that year and by fourth year I had begun to find my stride and was becoming the professional I wanted to be. I look back at how I was in the beginning and even up through just last year and can't believe how immature and entitled I was, but I also see just how far I've come. "

4) You need advocates. In addition to your own attitude shift, you need some faculty who will vouch for your professionalism and integrity as it stands now. How is your relationship with your home peds department? I think a research year there or in some peds department would be something to consider. Bust your tail, be productive, and get some great letters and phone calls on your behalf. I would reach out to any faculty you clicked with on that rotation and start seeking advice, though be sure your narrative is adjusted first as mentioned above.

5) You will probably want to take Step 3 earlier than later. Programs are risk averse and this is one more thing you can check off the list. Obviously you need to pass it and you really need to do well on it. A great score would be a nice feather showing your academic redemption.

6) EM seems highly unlikely. Too competitive. Your route to Peds EM would be through a Peds residency. You should also apply to FM again through the regular match as a backup. Here again, your home programs are your best bet unless you made such a poor impression on your rotations that you've closed that door. In any case, I would start meeting with people and display your changed attitude and see how they respond.

Did you just rewrite his story but with a positive spin? Damn thats impressive

operaman · Mar 20, 2016

buffpenguin said:
So after three infractions it's stated that it will go on mspe evaluation. The school sent out an email with our mspe and it was no where in there. Later that day it was uploaded and said to be final according to the email. So I was happy that it didn't go on my mspe. Somehow two weeks later it was reuploaded and by the time I even figured it out it was a week after that. The dean told me at that time and after speaking with him about how it wasn't there and they said it was final but somehow changed it. I also think that if I knew he was gonna change it I would have applied to another specialty that would be less competitive. Either way I felt them changing without notifying after stating the final copy was uploaded to be wrong. And I'm wondering if here are grounds to fight them over that. Even though I know it should have been written according to school policy.

Might be a dumb question, but are you certain the new MSPE had the professionalism stuff in it? I don't recall being able to download that stuff from ERAS. I know some programs had mentioned professionalism, but are you 100% certain this came from changes to your MSPE? Are you sure it wasn't mentioned in one of your other letters? Either way, I would make sure you get a copy of the real MSPE that went to schools.

I would certainly document everything, print out screenshots of anything on ERAS with dates and times and whatnot. I think suing your school is the absolute last resort and even then probably of minimal help, but I would collect every bit of documentation I could on the off chance it comes to that in the future. Don't even give them a whiff of that though; ideally you want them to help you match so you can move on with life.

operaman · Mar 20, 2016

Merely said:
Did you just rewrite his story but with a positive spin? Damn thats impressive

Sometimes it's easier to give an example rather than just say "tell your story in a way that takes complete responsibility for your actions and shows you've learned from them." I think OPs follow up posts displayed a VERY different tone than the original and one that's much more likely to help him match. I don't know if i'd call it a positive spin, but I think it has that effect. When they're in trouble, people tend to fall into the trap of excuse-making which only digs the hole deeper. Sometimes the most expedient and effective way to approach an issue where you're in the wrong is to simply say, "I was wrong. No excuse for my actions. I deserved what consequences I had. I've learned from it. I'm a better person now."

buffpenguin · Mar 21, 2016

operaman said:
Sometimes it's easier to give an example rather than just say "tell your story in a way that takes complete responsibility for your actions and shows you've learned from them." I think OPs follow up posts displayed a VERY different tone than the original and one that's much more likely to help him match. I don't know if i'd call it a positive spin, but I think it has that effect. When they're in trouble, people tend to fall into the trap of excuse-making which only digs the hole deeper. Sometimes the most expedient and effective way to approach an issue where you're in the wrong is to simply say, "I was wrong. No excuse for my actions. I deserved what consequences I had. I've learned from it. I'm a better person now."

Operaman, meded and atomi, I want to extend a big thank you! really needed more people to say the truth to me. Honestly deep down inside I know that I have these issues and I want to change them. But I felt the actions I did didn't merit the punishment I got. It was a constant battle saying it wasn't fair the punishment for those mistakes, but on the inside I knew there were deeper issues that needed to be addressed.

group_theory · Mar 21, 2016

operaman said:
1) highly incongruent performance is a hallmark of substance abuse, mental illness, etc. It's rarely wrong. Applies to premeds with a 3.0/40 as it does to ms4s with top 5% and a 240 alongside a shelf failure. I know this is highly personal, but even if you feel like you don't have such problems, please see someone just to be sure. Now is the time for unfettered introspection.

2) you need a seismic shift in attitude. If even 10% of the attitude in your post was present in your PS or in interviews, then I totally understand why you didn't match. Sorry if this is harsh, but I'm assuming that by posting here you are seeking honest feedback. You've got to own your professionalism issues and how you address it going forward can't have even the slightest soupcon of excuses. The reality is that professionally minded students, after getting ONE such notice, would walk the straight and narrow path terrified of getting a second. If one of them got TWO - whoa! They'd be neurotically perfect from that day forward -- forget being late for an autopsy, they'd probably camp outside the door just to make sure they were on time! Yours have the added issue of being part of a larger pattern.

3) Along with the shift in attitude, you need a corresponding shift in narrative going forward. I don't know what the right one is for you, but it can't be the one above. Listen to this hypothetical rewrite of your story and notice the difference:

"Medical school is what ultimately forced me to grow up. I came in to medical school with the mindset and habits of a bright, entitled, and immature undergraduate student. First year went well and I honored everything and was in the top 5% of my class, but my habits and attitude began to be my undoing under the increased workload of second year with the looming specter of Step 1. I managed to pass my classes and put everything into my step study, ultimately scoring a 240, but thanks to my cram-and-purge approach, didn't have the underlying knowledge base necessary for success going forward. Everything finally came to a head in 3rd year - a time that rewards diligent, professional, and organized students who can manage their studies amidst the newfound clinical workload. I was none of those things and my wake-up call was failing my IM shelf exam. I sought advice from our academic advisers and began a seismic shift in my attitude and my habits. Like all things seismic, the change took time. I passed my remaining shelf exams and remediated my IM shelf, but my lingering immaturity did not go unnoticed by faculty and I accumulated 3 notices of concern which were noted in my MSPE. If I'm completely honest with myself, I'm lucky there weren't more, especially from early in the year when my growing pains were at their worst. I grew a lot during that year and by fourth year I had begun to find my stride and was becoming the professional I wanted to be. I look back at how I was in the beginning and even up through just last year and can't believe how immature and entitled I was, but I also see just how far I've come. "

4) You need advocates. In addition to your own attitude shift, you need some faculty who will vouch for your professionalism and integrity as it stands now. How is your relationship with your home peds department? I think a research year there or in some peds department would be something to consider. Bust your tail, be productive, and get some great letters and phone calls on your behalf. I would reach out to any faculty you clicked with on that rotation and start seeking advice, though be sure your narrative is adjusted first as mentioned above.

5) You will probably want to take Step 3 earlier than later. Programs are risk averse and this is one more thing you can check off the list. Obviously you need to pass it and you really need to do well on it. A great score would be a nice feather showing your academic redemption.

6) EM seems highly unlikely. Too competitive. Your route to Peds EM would be through a Peds residency. You should also apply to FM again through the regular match as a backup. Here again, your home programs are your best bet unless you made such a poor impression on your rotations that you've closed that door. In any case, I would start meeting with people and display your changed attitude and see how they respond.

This was a really good post that was very helpful to the OP as well as others who might be in similar situation.

Just sent @operaman a $10 Amazon gift card on behalf of SDN for this extremely helpful post. 🙂

Merely · Mar 21, 2016

group_theory said:
This was a really good post that was very helpful to the OP as well as others who might be in similar situation.

Just sent @operaman a $10 Amazon gift card on behalf of SDN for this extremely helpful post. 🙂

Omg I was just about to say his posts have honestly been invaluable to this website for the time he's been on here, that's very nice of you!

Need some advice. I screwed up my future pretty bad

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