Pass in psychiatry?

[mrbreakfast]

In considering what specialities to more seriously consider for residency, I've thought a lot about psych, which I enjoyed. However, a major issue for me is that I only Passed psychiatry. I have been told (for other more-competitive specialties) that this is a red flag.

In my school, ~45-50% of students pass a given rotation, with some variation. We're assessed on a 1-5 scale with 3 being average, but it's weighted in such a way so that my average psych assessment (3.9) and NBME percentile (89%) still comes out to a pass. I got good evals from some preceptors but average ones from others I barely worked with. M3 problems, blah blah.

My question: this is an obvious issue, but does it pretty much exclude psych in my decision-making process? I have 1 other P (first rotation), 1 HP, 2 H (including neuro), and have reason to believe my remaining rotations will be HP/Hs. For my school this is above average - no grade inflation, so the average student gets a mix of Ps/HPs - but I realize it doesn't look that way.

If I decide I want to do psych, how can I rectify this? I can get multiple letters from the people that liked me, but would a letter (following another rotation, obviously) from one of the people I barely worked with - who gave me average marks - help?

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[mk04447]

Honestly, just get letters. Do your thing and apply where you seem to fit. I'm in your shoes, but I don't think this is the stressful process it's made out to be. Pick, tailor your ****, and apply. Seems much of the stress involved is self driven.

 

[FlowRate]

There might be specific institutions that screen for pass in psychiatry, but it won't kill you overall if the rest of your application is solid. It's more easily forgiven in cases like yours--good clinical grades on other rotations, not grade inflated institution.

 

[TexasPhysician]

Very small problem to have.

 

[CielloStelatto]

I agree with the above - in now way should this stop you from applying to psych. If it is where your interests lie and are passionate about it, that will come across, and the remainder of your clinical progress/achievements are going to be considered as well.

Though I will say - do yourself a favor and don't go asking for mediocre recommendation letters from people who you hardly worked with. Consider an elective in psych or a related topic for a strong letter, or simply use strong connections you made with any other attending in a different field.

 

[DisorderedDoc417]

Easiest way to ‘rectify’ this would be to do a sub-I. Preceptors who know you are interested and doing extra psychiatry won’t just write you off as above — if you do well enough you may even honors this and negate the initial problem. Otherwise, it won’t be a problem given you continue to do fine in school, steps, and interviewing. It may shut doors at fancy programs — but in non competitive or average regions and average residencies, which I might add are perfectly fine, you will carry-on with becoming something awesome, mainly a wizard ‍.

 

[DisorderedDoc417]

I agree with the above - in now way should this stop you from applying to psych. If it is where your interests lie and are passionate about it, that will come across, and the remainder of your clinical progress/achievements are going to be considered as well.

Though I will say - do yourself a favor and don't go asking for mediocre recommendation letters from people who you hardly worked with. Consider an elective in psych or a related topic for a strong letter, or simply use strong connections you made with any other attending in a different field.

I like this advice. My letters came from 2 psychiatrists, 1 internist, 1 surgeon, and a pediatrician!

 

[Celexa]

I like this advice. My letters came from 2 psychiatrists, 1 internist, 1 surgeon, and a pediatrician!

Is this not standard advice? I was told not to overdo it on psychiatry letters even if I had many options for strong psych letters. I did 2 psychs, 2 internists (only 4 letter spots in ERAS). I think most applicants in my school did this split, 2 letters from psychiatrists and 2 from other fields.

 

[DisorderedDoc417]

Is this not standard advice? I was told not to overdo it on psychiatry letters even if I had many options for strong psych letters. I did 2 psychs, 2 internists (only 4 letter spots in ERAS). I think most applicants in my school did this split, 2 letters from psychiatrists and 2 from other fields.

Yes, this is a good idea.

 

[aim-agm]

The advice I've heard is 2 from psychiatrists, 1 from an internist, and 1 from another specialty. Any thoughts on what that last specialty should be or does it not matter?

 

[FlowRate]

The advice I've heard is 2 from psychiatrists, 1 from an internist, and 1 from another specialty. Any thoughts on what that last specialty should be or does it not matter?

Doesn't matter. The fourth letter is also often a research mentor (even if they're not a MD). IM letter can probably also be from IM subspecialties.

 

[Bartelby]

Most reasonable people understand there is some arbitrariness to clerkship grading. One "pass," even in psychiatry, should certainly not sink you! You have some good grades in other clerkships, and with an early Sub-I and good letters I think you can smooth this problem out quite well.

 

[ziggyhope]

I had 2 letters from psychiatrists, 1 from family medicine, 1 from IM. Honestly don't think it matters all that much as long as you have 1 or 2 from psychiatrists. If you had a great experience on your EM or Ortho elective, and the attendings you worked with got to know you really well and can write a strong letter or rec, do you really want to use a mediocre IM one instead?