Personal LOA for 1 year - Step 1 - research - really need some advice

Jul 23, 2016
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Medical Student
(new acct created for some anonymity).

I was an MS2 (completed) and experienced a lot of personal distractions (not depression/anxiety) and most recently family health problems during my dedicated step 1 prep time that just tipped everything over. Simply put, life happened. I have already been on a personal LOA for a few weeks with family, and I know I've made the right decision for myself in this aspect.

Through extensive (I did my homework) research on sdn/other forums, I've come across posts that say a "210 >> 250+personal LOA" to "personal LOA is looked incredibly unfavorably and will hinder all chances for competitive specialties" to "it's okay, it's your decision and make the year count - directors want to see you succeed once you come back, and kill the boards, explain to them if they grant an interview that this is a 1 time occurrence and will not happen again." None have been definitively helpful and all are in polar opposites with more attendings giving the former red flag opinion.

My background
Preclinical H/P/F school, All passed and honored a few (think 3 or 4 out of many). No fails, no repeats. In the process of working to get my focus back. It's been tough, but I definitely needed this time for myself and most importantly, for my family. I have a few mid-author publications.

Residency
In terms of residency, I believe our letter from med school will be supportive in my decision for this personal LOA. My student Dean has been supportive and tells me it's not a huge red flag and will not close doors. Get better. own the boards. --- I am taking a few more weeks with family before a dedicated step 1 study time - where I am going to put in 3+ months d/t being distracted and not doing myself justice second year. I could have passed with low low 200's think single digit as projected through NBMEs, but I wouldn't have been ready with all the personal things going on to start MS3. It would have been a disaster. Therefore, I still stand in my decision.

Realistically, I understand in director's eyes I would've had 1 extra year compared to my fellow classmates, especially since this isn't a medical LOA. Moreover, this isn't a research year through a formal program, which some attendings have stressed the importance of. If everything works out, which is already at least at home, I believe I can/will bust my ars for a solid step 1 score (but the date would be delayed obviously) and can put in ~7 months of research before starting 3rd year clinical rotations. I would like to maximize my chances for a solid program (unsure specialty). Do I still have a shot? or are all the really competitive ones (e.g. ophtho, ortho, rad, derm, or say cardiology after IM) out of question?

Any advice would be greatly appreciated.

Thanks!
 
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Syncrohnize

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(new acct created for some anonymity).

I was an MS2 (completed) and experienced a lot of personal distractions (not depression/anxiety) and most recently family health issues (but not death) during my dedicated step 1 prep time that just tipped everything over. Simply put, life happened. I have already been on a personal LOA for a few weeks with family.

Through extensive (I did my homework) research on sdn/other forums, I've come across posts that say a "210 >> 250+personal LOA" to "personal LOA is looked incredibly unfavorably and will hinder all chances for competitive specialties" to "it's okay, it's your decision and make the year count - directors want to see you succeed once you come back, and kill the boards, explain to them if they grant an interview that this is a 1 time occurrence and will not happen again." None have been definitively helpful and all are in polar opposites with more attendings giving the former red flag opinion.

My background
Preclinical H/P/F school, mid tier school. All passed and honored a few (think 3 or 4 out of many). No fails, no repeats. In the process of working to get my focus back. It's been tough, but I definitely needed this time for myself and most importantly, for my family. I have a few mid-author publications before med school from time off and a paper (not first author) in med school so far.

Residency
In terms of residency, I believe our letter from med school will be supportive in my decision for this personal LOA. My student Dean has been supportive and tells me it's not a huge red flag and will not close doors. Get better. own the boards. --- I am taking a few more weeks before a dedicated step 1 study time - where I am going to put in 3+ months d/t being distracted second year. I could have passed with low low 200's think single digit as projected through NBMEs, but I wouldn't have been ready with all the personal things going on to start MS3. It would have been a disaster. Therefore, I still stand in my decision.

Realistically, I understand in director's eyes I would've had 1 extra year compared to my fellow classmates, especially since this isn't a medical LOA. Moreover, this isn't a research year through a formal program, which some attendings have stressed the importance of. If everything works out, which is already at least at home, I believe I can/will bust my ars for a solid step 1 score (but the date would be delayed obviously) and can put in ~7 months of research before starting 3rd year clinical rotations. I would like to maximize my chances for a solid program (unsure specialty). Do I still have a shot? or are all the really competitive ones (e.g. ophtho, ortho, rad, derm, or say cardiology after IM) out of question?

Any advice would be greatly appreciated.

Thanks!

OP, I think this is one of those things you'll have to ignore. Get everyone else's advice on the weight. I am also an MS2 taking an extra month for Step Prep so my situation is different, but I sometimes talk to people who did what I did, but then panicked and delayed their step further which required them to take a year off. Apparently it is a flag, but I don't think it's a OMG, RED FLAG, stay clear. It's something residencies will see and put you at a disadvantage, especially for something like Ophtho, but I don't think it's something worth 40 points on Step especially since there was a family emergency! Also, you will probably be given some chances to explain it during interviews. I definitely don't think IM is out of the question.
 
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lymphocyte

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Simply put, life happened. I have already been on a personal LOA for a few weeks with family.

Through extensive (I did my homework) research on sdn/other forums, I've come across posts that say a "210 >> 250+personal LOA" to "personal LOA is looked incredibly unfavorably and will hinder all chances for competitive specialties" to "it's okay, it's your decision and make the year count - directors want to see you succeed once you come back, and kill the boards, explain to them if they grant an interview that this is a 1 time occurrence and will not happen again." None have been definitively helpful and all are in polar opposites with more attendings giving the former red flag opinion.

My background
Preclinical H/P/F school, mid tier school. All passed and honored a few (think 3 or 4 out of many). No fails, no repeats. In the process of working to get my focus back. It's been tough, but I definitely needed this time for myself and most importantly, for my family. I have a few mid-author publications before med school from time off and a paper (not first author) in med school so far.

Residency
In terms of residency, I believe our letter from med school will be supportive in my decision for this personal LOA. My student Dean has been supportive and tells me it's not a huge red flag and will not close doors. Get better. own the boards. --- I am taking a few more weeks before a dedicated step 1 study time - where I am going to put in 3+ months d/t being distracted second year. I could have passed with low low 200's think single digit as projected through NBMEs, but I wouldn't have been ready with all the personal things going on to start MS3. It would have been a disaster. Therefore, I still stand in my decision.

I believe I can/will bust my ars for a solid step 1 score (but the date would be delayed obviously) and can put in ~7 months of research before starting 3rd year clinical rotations. I would like to maximize my chances for a solid program (unsure specialty). Do I still have a shot? or are all the really competitive ones (e.g. ophtho, ortho, rad, derm, or say cardiology after IM) out of question?
With so few data about your application, I don't know if you're going to get a definitive answer. But I think what you want more is reassurance.

Friend, the decision has been made. Based on what you wrote, it was probably the right decision for you. Now, you need to focus on minimising the fallout from that decision. Nobody can help that much without knowing 1) Step 1, 2) clinical evaluations, and 3) your actual specialty of interest. (For example, cardiology is a fellowship that comes after IM, and, I'd imagine a fellowship would care much more about research and performance in residency as evaluated through LORs).

If you had a non-recurring illness/family crisis explained with detail on ERAS and went on to smash Step 1 and your clinical rotations, then programmes will naturally be much more forgiving. Is all hope lost for a competitive residency? Of course not. But the answer to that question still won't change the most obvious advice to give: you need to bust your ass regardless. Because that's what everyone should be doing anyways (with some leniency for sanity), and you more so than most because of your situation. What's in your circle of control?

I'm sorry for the tough times you're enduring.
 
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OP
M
Jul 23, 2016
9
5
Status
Medical Student
With so few data about your application, I don't know if you're going to get a definitive answer. But I think what you want more is reassurance.

Friend, the decision has been made. Based on what you wrote, it was probably the right decision for you. Now, you need to focus on minimising the possible fallout from that decision. Nobody can help that much without knowing 1) Step 1, 2) clinical evaluations, and 3) your actual specialty of interest. (For example, cardiology is a fellowship that comes after IM, and, I'd imagine a fellowship would care much more about research and performance in residency as evaluated through LORs).

If you had a non-recurring illness/family crisis explained with detail on ERAS and went on to smash Step 1 and your clinical rotations, then programmes will naturally be much more forgiving. Is all hope lost for a competitive residency? Of course not. But the answer to that question still won't change the most obvious advice to give: you still need to bust your ass regardless. Because that's what everyone should be doing anyways (with some leniency for sanity), and you more so than most because of your situation. What's in your circle of control?

I'm sorry for the tough times you're enduring. I wish you all the best.
Thanks for the response. I think you are right...in this tough times, I do want some reassurance that not all hopes lost based on what scary things have been said of such personal LOA.
I'll definitely be busting my ass as we all are and should be doing.
 
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lymphocyte

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Thanks for the response. I think you are right...in this tough times, I do want some reassurance that not all hopes lost based on what scary things have been said of such personal LOA.
I'll definitely be busting my ass as we all are and should be doing.
Be sure to check back when you have more data about your application, like Step 1, clinical evaluations, etc. And there are always strategies to address LOAs on ERAS and interviews (for example, vagueness is generally regarded as less than awesome--but it depends). I'm seriously wishing you well. All hope is definetly not lost. But bust your ass like it is. Good luck OP!
 
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OP
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Jul 23, 2016
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210>>250 + LOA ? Did a PD say that?


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No, don't think so. I just gave some examples of what's been said over the years on different forums, including this one (I did hours of looking up effects of LOA before making the decision), which really freaked me out initially.

I think ultimately only PDs can give solid advice (even then I think opinions will differ on LOA) and better yet the ones at our own institutions!
 

Crayola227

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You gotta do what you gotta do, period.

That said, if there is any way to not take a LOA.... I've heard programs can filter out anyone that took longer than 4 years if it doesn't fall in the research/MPH/etc pursuit category.

So the next ideal thing is if you can make this into a cush research year.... I'm really surprised the school isn't helping you to do that.

EDIT: a program director below corrected me, they can filter out anyone with gaps in training, but not based on why. they say thought that they still review these apps.
 
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OP
M
Jul 23, 2016
9
5
Status
Medical Student
You gotta do what you gotta do, period.

That said, if there is any way to not take a LOA.... I've heard programs can filter out anyone that took longer than 4 years if it doesn't fall in the research/MPH/etc pursuit category.

So the next ideal thing is if you can make this into a cush research year.... I'm really surprised the school isn't helping you to do that.
^exactly what scared me...majority of posts out there over the years are people saying PDs screen out LOA not due to official research or medical.

Not sure what or how my school will show this LOA, I'm assuming you mean that PDs can easily filter all out through ERAS?
 

Crayola227

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I believe through ERAS

@IMPD or @aProgDirector are the best bets for settling this, and I'll try to remember their answer if they do us the honor
 

IMPD

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I believe through ERAS

@IMPD or @aProgDirector are the best bets for settling this, and I'll try to remember their answer if they do us the honor
I'm not a guru with ERAS, but I've never seen any kind of filter for LOA with an "if". That is, you can filter out "Gaps in training", but not by "why".

For the most part, LOAs are not common and most of them get individual review.

I agree with previous posts above that the effect of your LOA will be vary greatly depending on how competetive the rest of your application is for the specialty you're applying to. No single event would preclude consideration for any field (baring a huge red flag). LOAs in general are not huge red flags, but they do invite more detailed consideration and questions at interview.

More reassurance is only possible with a considerably more detailed "Who I am and what I want" type post.