Psychotic Break in Medical school

[8215]

Hi. I was gravely affected by a psychotic depression while in medical school which lead me to fail 2 step 2 ck board exams. I don't know what to do about this mess that I'm in. I was gravely affected by this issue and had some degree of memory loss. I'm currently on treatment and doing much better, but if you had any advice on how to approach residency applications

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[laricb]

Sorry about your situation. But why did you take the step 2 a second time if you new you were sick.... These are some of the question's they might ask.

 

[Anastomoses]

knew

 

[jdh71]

Hi. I was gravely affected by a psychotic depression while in medical school which lead me to fail 2 step 2 ck board exams. I don't know what to do about this mess that I'm in. I was gravely affected by this issue and had some degree of memory loss. I'm currently on treatment and doing much better, but if you had any advice on how to approach residency applications

Did you pass a third attempt?

 

[jdh71]

Sorry about your situation. But why did you take the step 2 a second time if you new you were sick.... These are some of the question's they might ask.

Yeah. That's kind of the problem with being mentally ill. You don't have the same insight because the organ you use for insight isn't working right. It's not like he has the flu or a new diagnosis of cancer and took the test. It's a bit more complicated and nuanced than that.

 

[thefritz]

Edit: Reading your post again, you really only have one option: Take it a third time and do very well. Don't mention it on your application. Apply broadly. If it comes up during interviews, own up to it and don't try to make excuses. You'll be ok. Just don't sit for the exam again without being comfortable you will pass with a wide margin.

 

[jdh71]

You can't NOT mention it on the application. The fails will automatically show up.

 

[bashir]

I'm just an M3 and have no special insight into the residency application process, but I would think you would be best served by making a brief explanation in your application that you suffered a severe depression which is now in full remission. Many programs will of course (fairly or unfairly) view this itself as a red flag, but I'm sure there are others who would view it as a reasonable explanation for why a good candidate would fail step 2 CK twice. I think if I were you I would avoid divulging the psychosis; bearing the stigma of depression is enough without opening yourself up to the stigma that any kind of psychotic episode unfortunately brings, and I think you can explain the failures adequately without that detail.

As far as interviews, I think you should practice, practice, practice talking about this until you're confident you can discuss it matter-of-factly. The key is to acknowledge how gravely it affected you at the time without sounding defensive or like you're making excuses. Project competence and self-confidence so any interviewer can tell it would be their loss if they didn't rank you due to this now well-controlled medical condition.

It probably would't be a bad idea to talk to an advisor at your school about this if you haven't already. They generally have years of experience advising students on how to handle red flags in their residency applications.

I'm sorry you've had to go through this and hope you land the residency of your dreams.

 

[SouthernSurgeon]

You can't NOT mention it on the application. The fails will automatically show up.

I think thefritz meant not to mention or use the "psychotic break" term, since that's probably an even bigger red flag to a program than a failed step.

 

[jdh71]

I think thefritz meant not to mention or use the "psychotic break" term, since that's probably an even bigger red flag to a program than a failed step.

Oh for sure. I wouldn't phrase it as such, but there is really no way to not talk about. The fact that there was a personal issue related to depression should be on the table from the get go. This is why we have personal statements.

 

[thefritz]

I disagree. I would not voluntairly bring up and mention of mental problems. The medical field is extremely unforgiving of things like depression and ADHD, and view these either suspiciously (as if you are using them as an excuse for subpar performance and trying to achieve something other people worked harder to achieve) or with the concern that it would happen again during residency.

It is absurd, but it's the way it is. I would not pre-emptivley try to make any explanation of your failed exam in your personal statement. It will look like an excuse and there is no way to prove/disprove anything you say, so it doesn't really matter anyway -- saying it was due to a depression isn't going to get you an interview when it wouldn't have otherwise. If anything mentioning depression on the personal statement might scare people off. If you get the interview, then the program is clearing considering overlooking the failure, and you don't want to sink yourself if the question comes up "why did you fail step 2 twice?" A lot of programs will only consider applicants with a single failure or no failures. So it's important to apply wisely. If you're out of school already you might want to take step 3 as well and perform well on it. This will ease the worry of programs worrying that you won't pass step 3 and have to not renew your contract.

 

[thefritz]

Oh for sure. I wouldn't phrase it as such, but there is really no way to not talk about. The fact that there was a personal issue related to depression should be on the table from the get go. This is why we have personal statements.

The personal statement should highlight the best of who you are and why you would be a good fit. Highlighting your shortcomings doesn't jive with this goal. You don't need to tell everyone you failed step 2 twice in your personal statement. They will see it on the score report. There isn't really a good excuse for a failure unless it was something out of your control like computers freezing up, and you have documentation that proves that it wasn't a performance issue on your part. So trying to make any excuse is futile at best IMO. Deal with it after you get the interviews IMO because it's not going to make any difference before you get the interview.

 

[jdh71]

The personal statement should highlight the best of who you are and why you would be a good fit. Highlighting your shortcomings doesn't jive with this goal. You don't need to tell everyone you failed step 2 twice in your personal statement. They will see it on the score report. There isn't really a good excuse for a failure unless it was something out of your control like computers freezing up, and you have documentation that proves that it wasn't a performance issue on your part. So trying to make any excuse is futile at best IMO. Deal with it after you get the interviews IMO because it's not going to make any difference before you get the interview.

How many residency application processes have you been through exactly? How many applications have you filled out that included red flags? How man committees have you sat on. What exactly is your expertise?

You're giving horrible advice and don't realize it. The personal statement is the EXACT appropriate place to explain what happened. If you have two fails and don't bring it up, you will not be taken seriously. Programs don't have time or money to waste bringing people in to "explain" themselves in person if they don't have an idea of what the hell was going on in the first place.

And those are the programs that don't simple toss any application that has two failed attempts.

 

[Akali]

What bashir said.

 

[WGB]

The personal statement should highlight the best of who you are and why you would be a good fit. Highlighting your shortcomings doesn't jive with this goal. You don't need to tell everyone you failed step 2 twice in your personal statement. They will see it on the score report. There isn't really a good excuse for a failure unless it was something out of your control like computers freezing up, and you have documentation that proves that it wasn't a performance issue on your part. So trying to make any excuse is futile at best IMO. Deal with it after you get the interviews IMO because it's not going to make any difference before you get the interview.

Every person I've spoken with who is directly involved with the application process would completely disagree with this. They all said that if you had any major red flags, they need to be addressed in the PS. You're right about presenting yourself in the best light, though.

 

[thefritz]

I still disagree. I don't see the point in bringing up poor test scores. A lot of people don't do well and it doesn't really matter why they didn't do well. If somebody fails an exam because they were unprepared and had a lack of knowledge, what's stopping them from writing in their personal statement a totally made up excuse about life or family issues, illness in the test center, solar flares, aliens tapping into their brain, literally anything else besides lack of knowledge, etc? Nothing. I am sure everybody who failed an exam because of lack of knowledge has got some reason for it other than lack of knowledge. This is why I fail to see how trying to make an excuse in your personal statement makes any difference at all. The only excuse that matters is a retake with a high score. This is my opinion. If you think my advice is horrible, I don't really care. Sure, mention it in your personal statement "I failed step 2 twice. This was a humbling experience and I learned from my mistakes and overcame it with a great score the third time and on step 3." But do you really need to say this? I don't think so. If you write anything other than this in a form of an excuse, there is absolutely no way of validating it, and I therefore can't see what possible purpose it could serve.

 

[thefritz]

They all said that if you had any major red flags, they need to be addressed in the PS. You're right about presenting yourself in the best light, though.

The reality is that most people with "red flags" have those flags for legitimate reasons and can't be explained away in the personal statement with an excuse. They failed step 1 because they only studied for a week. They graduated from a Caribbean medical school because they had a 3.0 GPA in college. They took 6 years to graduate because they were a questionable admit and kept failing classes. They have a disciplinary action on their record because they got caught cheating. They have a string of DUIs because they have substance abuse problems. Etc. Etc. Etc.

Nobody's perfect, and the idea that every "red flag" needs to be explained implies that you must be a perfect applicant to get a residency. Come on. I think it makes more sense to try to highlight recent accomplishments rather than try to spin past failures. Sure there will be people that won't let you in the door because of them, but I highly doubt that an attempt to spin it would have made much a difference with them anyway.

 

[jdh71]

I still disagree. I don't see the point in bringing up poor test scores. A lot of people don't do well and it doesn't really matter why they didn't do well. If somebody fails an exam because they were unprepared and had a lack of knowledge, what's stopping them from writing in their personal statement a totally made up excuse about life or family issues, illness in the test center, solar flares, aliens tapping into their brain, literally anything else besides lack of knowledge, etc? Nothing. I am sure everybody who failed an exam because of lack of knowledge has got some reason for it other than lack of knowledge. This is why I fail to see how trying to make an excuse in your personal statement makes any difference at all. The only excuse that matters is a retake with a high score. This is my opinion. If you think my advice is horrible, I don't really care. Sure, mention it in your personal statement "I failed step 2 twice. This was a humbling experience and I learned from my mistakes and overcame it with a great score the third time and on step 3." But do you really need to say this? I don't think so. If you write anything other than this in a form of an excuse, there is absolutely no way of validating it, and I therefore can't see what possible purpose it could serve.

Are you ******ed? You are not excusing anything. You are explaining two failed attempts. You failing to see how it makes any difference is you failing to know anything about the process. I'm glad you are full on uninformed opinions - part of the cancer slowly killing this place on a regular basis - but it's not helpful and could seriously hurt someone who actually takes your stupid advice seriously. I've filled out both residency and fellowship applications with "red flags" and know how and why to use the personal statement effectively. I've sat on residency and fellowship application review committees and can tell you that applications with red flags and no explanation in the personal statement get tossed riki tik. And why? Because it matters - perhaps it's not "fair" but the world isn't. It ALL matters and anyone who takes your advice deserves what happens to them.

 

[Plecopotamus]

How many residency application processes have you been through exactly? How many applications have you filled out that included red flags? How man committees have you sat on. What exactly is your expertise?

You're giving horrible advice and don't realize it. The personal statement is the EXACT appropriate place to explain what happened. If you have two fails and don't bring it up, you will not be taken seriously. Programs don't have time or money to waste bringing people in to "explain" themselves in person if they don't have an idea of what the hell was going on in the first place.

With all due respect, if you are offering advice on this, how many have you filled out that had a red flag? I presume you only applied to residency and fellowship once if you're giving advice on how to do it properly. If you had a red flag, or if you've been really active in reviewing residency apps, I assume you'd realize there are spaces other than the PS to address red flags (even if they weren't there when you filled out ERAS).

As someone who has filled it out with a red flag, I agree that using the PS to explain a red flag wastes space in which one should be selling him/herself to offer info that is redundant and available elsewhere in the application packet. I take offense in the fact that you're unprofessionally calling the other med student who has said this ******ed and calling his advice stupid, because it is the same advice I have received from my advisers at a well regarded medical school that does very well when it comes to matching us into competitive residencies. It is advice that I took, and that thus far seems to be serving me well in the application process.

I have a "red flag" due to a severe, non-psychiatric medical condition that was repeatedly mis-diagnosed as "in my head" and "depression" while I was in medical school. It is something that is now completely resolved. I did not mention this in my ERAS personal statement at all, because there are two other locations in which it is more appropriately addressed -- there is a check box that opens a space to discuss disruptions to your academic progress, and there is the MSPE written by your school. I have received interview invitations to more than 2/3 of the programs I applied to, including some that are extremely competitive. I received my invitations early I the cycle and do not fear that they were reticent to offer me the interviews or that I am at the bottom of their pile. I cannot speak for the <1/3 of programs that have not invited me to interview (only 2 outright rejections to date), but all of the others had clearly taken the info in those 2 other portions of my application to heart and many have brushed off discussing it in interviews, saying "if we were concerned and did not feel it was adequately explained, we would not have invited you for interview or would have asked about it."

To me, the hurdle that the OP has that I did not is that s/he is dealing with a psychiatric condition. Physical medical conditions do not have the same stigma as psychiatric, so I was able to allow my dean to disclose my condition in the MSPE -- something along the lines of "Plecopotamus was non-promotable due to XYZ, which he has given me permission to disclose was the direct result of a major medical illness, which unfortunately had delayed diagnosis and treatment. Since surgical intervention, Plecopotamus has had no further academic difficulties due to his condition and has performed (remaining blah blah blah that you normally find in the MSPE)". I was able to reiterate this in the paragraph on academic disruption and emphasized that my condition was treated and wouldn't compromise my ability to succeed or participate in residency.

Technically, the OP can refer to his/her illness vaguely as a "medical condition" and not be lying. However, the stigma of psych diagnoses is specifically why I gave my dean permission to fully disclose the nature of my illness -- I think unspecified "medical illness" tends to be interpreted as "psychiatric disorder" or "inability to handle stress." And I do not know that it would be honest for the OP to report his condition as resolved without risk to success in residency.

 

[Plecopotamus]

Every person I've spoken with who is directly involved with the application process would completely disagree with this. They all said that if you had any major red flags, they need to be addressed in the PS. You're right about presenting yourself in the best light, though.

Why wouldn't you use the optional section in ERAS that allows you to explain abnormalities in your academic progress?

 

[jdh71]

With all due respect, if you are offering advice on this, how many have you filled out that had a red flag? I presume you only applied to residency and fellowship once if you're giving advice on how to do it properly. If you had a red flag, or if you've been really active in reviewing residency apps, I assume you'd realize there are spaces other than the PS to address red flags (even if they weren't there when you filled out ERAS).

As someone who has filled it out with a red flag, I agree that using the PS to explain a red flag wastes space in which one should be selling him/herself to offer info that is redundant and available elsewhere in the application packet. I take offense in the fact that you're unprofessionally calling the other med student who has said this ******ed and calling his advice stupid, because it is the same advice I have received from my advisers at a well regarded medical school that does very well when it comes to matching us into competitive residencies. It is advice that I took, and that thus far seems to be serving me well in the application process.

I have a "red flag" due to a severe, non-psychiatric medical condition that was repeatedly mis-diagnosed as "in my head" and "depression" while I was in medical school. It is something that is now completely resolved. I did not mention this in my ERAS personal statement at all, because there are two other locations in which it is more appropriately addressed -- there is a check box that opens a space to discuss disruptions to your academic progress, and there is the MSPE written by your school. I have received interview invitations to more than 2/3 of the programs I applied to, including some that are extremely competitive. I received my invitations early I the cycle and do not fear that they were reticent to offer me the interviews or that I am at the bottom of their pile. I cannot speak for the <1/3 of programs that have not invited me to interview (only 2 outright rejections to date), but all of the others had clearly taken the info in those 2 other portions of my application to heart and many have brushed off discussing it in interviews, saying "if we were concerned and did not feel it was adequately explained, we would not have invited you for interview or would have asked about it."

To me, the hurdle that the OP has that I did not is that s/he is dealing with a psychiatric condition. Physical medical conditions do not have the same stigma as psychiatric, so I was able to allow my dean to disclose my condition in the MSPE -- something along the lines of "Plecopotamus was non-promotable due to XYZ, which he has given me permission to disclose was the direct result of a major medical illness, which unfortunately had delayed diagnosis and treatment. Since surgical intervention, Plecopotamus has had no further academic difficulties due to his condition and has performed (remaining blah blah blah that you normally find in the MSPE)". I was able to reiterate this in the paragraph on academic disruption and emphasized that my condition was treated and wouldn't compromise my ability to succeed or participate in residency.

Technically, the OP can refer to his/her illness vaguely as a "medical condition" and not be lying. However, the stigma of psych diagnoses is specifically why I gave my dean permission to fully disclose the nature of my illness -- I think unspecified "medical illness" tends to be interpreted as "psychiatric disorder" or "inability to handle stress." And I do not know that it would be honest for the OP to report his condition as resolved without risk to success in residency.

This isn't a "disruption" in in academic progress, it's a failure of a medical licensing exam, TWICE, and in many states more than ONE fail equal no license ever, and if that state requires you to have a license in residency, no good. And since I been in on residency and fellowship application committees I can tell you people who say something in the section you are referencing, are also checked to see if you they mention it in the personal statement if we think it's a big deal, and failing step two twice is. OP cannot sneak by in this instance with a throw away sentence or two in some side section of ERAS; this isn't a repeat of an academic year because they failed a class. OP needs to explain what happened, why it happened, and why this will not be a problem going forward.

Also, for the most part, no one cares about your personal statement other than it's there and doesn't say something stupid. It's like wearing pants to work, no one really thinks too much about that you do, everyone agree you should, but it's not a problem unless you don't wear pants or wear really, really weird pants. We roll our eyes at most of your personal statements. Most of you don't even know how to write - it's a dying art apparently, that most of your never learned how to properly do anyway.

 

[WGB]

Why wouldn't you use the optional section in ERAS that allows you to explain abnormalities in your academic progress?

I expect you would. You wouldn't explain any red flags in your PS, however, you would address the major ones, and only the major ones.

The purpose of your Statement is to market yourself in a way that your numbers don't permit you to. Part of that is putting the committee at ease about said red flags. There is no ideal way to address red flags, as what works for one PD won't work for another, but a good rule of thumb is to be positive and unapologetic (which doesn't mean arrogant).

 

[thefritz]

Are you ******ed? You are not excusing anything. You are explaining two failed attempts. You failing to see how it makes any difference is you failing to know anything about the process. I'm glad you are full on uninformed opinions - part of the cancer slowly killing this place on a regular basis - but it's not helpful and could seriously hurt someone who actually takes your stupid advice seriously. I've filled out both residency and fellowship applications with "red flags" and know how and why to use the personal statement effectively. I've sat on residency and fellowship application review committees and can tell you that applications with red flags and no explanation in the personal statement get tossed riki tik. And why? Because it matters - perhaps it's not "fair" but the world isn't. It ALL matters and anyone who takes your advice deserves what happens to them.

You're calling me ******ed? What is this, middle school?

I have repeatedly stated that my advice was MY OPINION and posted why I thought what I did, even before you began dishing out personal attacks. On the other hand, your advice is somewhat arrogant as you confidently proclaim that I am wrong and your advice is not only your opinion, but completely correct everywhere. Way to not address a single argument I wrote. An excuse is the same thing as an explanation in this regard. Neither carries any weight because they cannot be objectively verified to be the source of the failure. If you can't see this, then I don't know what to tell you. I choose to believe that the system is smarter than you say it as and can see through a B.S. attempt to try to explain a red flag. It is common sense to try and sell yourself in the best light on your application. Making up excuses is not selling yourself.

Let me ask you a direct question. Suppose I got a 180 on step 1. I got a 180 on step 1 because I go to a good medical school that had a hands-off P/F preclinical curriculum and I was lazy and played video games during most of my dedicated study time. You are saying that I must explain my failure in my personal statement. Should I explain that I was lazy and played video games and that is why I failed or should I make up an outright lie about some personal life trauma out of my control?

Hopefully this example demonstrates that trying to pre-emptively trying to excuse/explain a failure on your personal statement is a losing proposition.

 

[jdh71]

You're calling me ******ed? What is this, middle school?

I have repeatedly stated that my advice was MY OPINION and posted why I thought what I did, even before you began dishing out personal attacks. On the other hand, your advice is somewhat arrogant as you confidently proclaim that I am wrong and your advice is not only your opinion, but completely correct everywhere. Way to not address a single argument I wrote. An excuse is the same thing as an explanation in this regard. Neither carries any weight because they cannot be objectively verified to be the source of the failure. If you can't see this, then I don't know what to tell you. I choose to believe that the system is smarter than you say it as and can see through a B.S. attempt to try to explain a red flag. It is common sense to try and sell yourself in the best light on your application. Making up excuses is not selling yourself.

Let me ask you a direct question. Suppose I got a 180 on step 1. I got a 180 on step 1 because I go to a good medical school that had a hands-off P/F preclinical curriculum and I was lazy and played video games during most of my dedicated study time. You are saying that I must explain my failure in my personal statement. Should I explain that I was lazy and played video games and that is why I failed or should I make up an outright lie about some personal life trauma out of my control?

Hopefully this example demonstrates that trying to pre-emptively trying to excuse/explain a failure on your personal statement is a losing proposition.

Yes. I'm calling you ******ed and I addressed why your argument was wrong. I suggest reading, and trying comprehension next time.

 

[thefritz]

Yes. I'm calling you ******ed and I addressed why your argument was wrong. I suggest reading, and trying comprehension next time.

No, you didn't. Not even close. And here we have more personal attacks and failing to address posed arguments/questions. Ok.

 

[jdh71]

No, you didn't. Not even close. And here we have more personal attacks and failing to address posed arguments/questions. Ok.

Yes. I did address your arguments, you are clearly too stupid to tell. This doesn't bode well for medical school. Please point out an argument I didn't address so I can spell it out for you. Finally, how are personal attacks even relevant? Hurt your feels? Did you get mad?

 

[Winged Scapula]

Cool it guys. Insulting each other is a violation of the Terms of Service. This is a legit discussion topic but needs to be handled without calling each other names/invoking Burnett's Law and with a modicum of civility.

 

[jdh71]

 

[Plecopotamus]

This isn't a "disruption" in in academic progress, it's a failure of a medical licensing exam, TWICE, and in many states more than ONE fail equal no license ever, and if that state requires you to have a license in residency, no good. And since I been in on residency and fellowship application committees I can tell you people who say something in the section you are referencing, are also checked to see if you they mention it in the personal statement if we think it's a big deal, and failing step two twice is. OP cannot sneak by in this instance with a throw away sentence or two in some side section of ERAS; this isn't a repeat of an academic year because they failed a class. OP needs to explain what happened, why it happened, and why this will not be a problem going forward.

Also, for the most part, no one cares about your personal statement other than it's there and doesn't say something stupid. It's like wearing pants to work, no one really thinks too much about that you do, everyone agree you should, but it's not a problem unless you don't wear pants or wear really, really weird pants. We roll our eyes at most of your personal statements. Most of you don't even know how to write - it's a dying art apparently, that most of your never learned how to properly do anyway.

I don't remember the exact term used in ERAS, but yes this is going to represent a disruption in academic progress, because the OP will not be at the appropriate benchmark for his time in medical school. I noticed that you essentially ignored my question as to whether you had to present a red flag in your application, so I presume you did not. That means that you are calling people here ******ed on the basis of what your (n=1) residency does/expects. There are varying ways that programs handle these things, and clearly there are people further along in their career and with more experience than you who disagree with you, because I and others like me have been advised by deans, departmental advisers, and even program directors to not address this very issue in the Personal Statement. I suppose they are all ******ed and stupid. While you use your residency program as a standard by which all programs review applications, as someone who has had to address this personally, I have received advice from several alumni who were in this situation at their time of application -- I wanted to make sure I wasn't shooting myself in the foot by following our deans' advice -- indeed, the 1 to 2 graduates per year who have had an academic red flag secondary to health issues have landed residencies in good programs (clearly not your program) in multiple fields without discussing it in the PS. That said, I'm sure some people are better off doing it in the PS. In short, your way is not the only way to succeed. Based on the way you speak to people who disagree with you, I'm pretty relieved that your program would not consider my application -- if you call someone ******ed for giving the same advice given by people who have been advising and educating for longer than you've been in medicine, I shudder to imagine how you speak to residents and students who make an objective error.

Also, individual programs aside, I don't know how you could make sweeping generalizations that you are confident would apply to every field -- the scrutiny a plastics or ortho applicant is subjected to is completely different than that of a psych or family med candidate. Indeed, the latter have plenty of programs (including some decent ones) that require passing step 2 in 3 attempts.