Question about excluding criteria for match selection

[Jean C]

Hi all.

I registered to this site because I was hoping someone could help me out, since I've been extremely down lately, and was hoping that there was some information out there that I just haven't seen - because my school has been extremely unhelpful to me, and seems to just expect us to fend for ourselves now that we're paying them (a very different reality from the one they painted during the interviews and post-acceptance tours).

Basically, I failed a block a few months ago (by .02%...), mainly due to my having a lot of problems in my personal life with various things (not a legitimate excuse in medicine/academics, I know, but I felt as though I may as well say it).

I'm not really in the top of the class by any means, but at the same time, I'm not in the business of failing my classes and I've always gotten extremely positive clinical evaluations, and have generally impressed every doc I've worked with closely - I have received multiple evals stating that I was the best student that they've worked with/best in the group. I'm not just sitting around stewing over this personal failure either, since that's just counterproductive - I'm trying to look to the future and move forward. I have worked with other MS-IVs to create a very intensive study schedule for the USMLE, and have been doing well with Q-bank questions, which is weird, because I'm much better with Step-I questions than I am with my school's multiple choice exams - I think the reason for this is that my school tests your ability to regurgitate minute details, and I'm not a very good rote memorizer - I'm a critical thinker, which is also what has helped me do extremely well clinically and in small groups. I'm also trying to get involved in some research this summer, but it's difficult as I'm being forced into remediation that will use up most of my summer.

My school has not been very supportive of my situation from the get-go, and have just said that I won't have trouble matching at all, and that I'd always been welcome into Internal Medicine if I happened to not match. When I asked for help starting a study schedule for the Step 1, they just scoffed and said that I should worry about it when I'm a second year. This school/hospital doesn't even have a plastics department - all cases are handled by general surgeons.

I wanted to know if my chances of matching into plastics is over based on this one 4 week long block. Would this also preclude me from matching into general surgery and then moving into a plastics fellowship? I don't really care what route I have to take, so long as I ultimately arrive at my goal.
At the same time, if I'm doomed into internal medicine as a result of this, I think I'd probably like to leave medicine, since I've not enjoyed my experiences outside the OR, and feel that I would always be unhappy in that position.

Basically, I don't mean this to be a sob story, or a "please say some encouraging words to me!" kind of post. I just want to know if I should pack my bags and go home then do some soul-searching to think of a career that would make me happy, because I don't really have a legitimate chance anymore, or if I do still have a possible route to practice as a reconstructive/plastic surgeon in the US, what I can do to help optimize my chances to achieve that end. Like I said, I don't mind going general surgery, then plastics fellowship, so as long as that option is realistically open, then I'll keep moving forward.

Thank you for your time/input, I really do appreciate it.

 

[DrDre311]

This question and other WAMC threads have been discussed extensively in the PRS forum. Specifically, a post almost identical to yours was made by 'drseanlive'--look up his posts for a thorough discussion of this topic.

 

[Jean C]

Thanks for the tip.

What I take away from that thread was that it's still easily possible to match into a decent gen surgery program, and go the traditional route, provided I perform strongly on the boards and the 3rd year clinicals, despite the fact that getting into an integrated program is more or less unrealistic at this point (the chances are already slim enough with a spotless record, that now it's that much more unrealistic). Would you guys say that's more or less correct?

Like I said, I'm perfectly fine with going the traditional route, but what would I need to do to help increase my chances of getting into a good gen surg. program, and then the subsequent plastics fellowship? Or is this a question I should take to the general surgery board?

 

[GSresident]

If I were you I would RAWK step 1 and 2. If you do really well in your 3rd year clinicals and get good evals from surgery you would probably be able to match into general surgery, although it has gotten really competitive lately. Also remember that at least 40% of the other general surgery residents in the country have the same idea you do. The independent match is ridiculous now.

Choose a good general surgery program with an attached plastics fellowship. That is your best bet. I wouldn't even bother interviewing at places that don't have plastics fellowships if you want to do plastics.

 

[smq123]

Like I said, I'm perfectly fine with going the traditional route, but what would I need to do to help increase my chances of getting into a good gen surg. program, and then the subsequent plastics fellowship?

For starters, take things one step at a time!

I've been extremely down lately, and was hoping that there was some information out there that I just haven't seen - because my school has been extremely unhelpful to me, and seems to just expect us to fend for ourselves now that we're paying them (a very different reality from the one they painted during the interviews and post-acceptance tours).

I have worked with other MS-IVs to create a very intensive study schedule for the USMLE, and have been doing well with Q-bank questions [...]

I'm also trying to get involved in some research this summer, but it's difficult as I'm being forced into remediation that will use up most of my summer.

My school has not been very supportive of my situation from the get-go, and have just said that I won't have trouble matching at all, and that I'd always been welcome into Internal Medicine if I happened to not match. When I asked for help starting a study schedule for the Step 1, they just scoffed and said that I should worry about it when I'm a second year.

(1) First, do you attend an allopathic school in the United States? If that's the case, then there is no reason why a failure in first year should "doom" you to internal medicine.

(2) If you're a first year, I agree with your dean that it is MUCH too early to be worrying about Step 1 study schedules and (even worse) Q-Bank. Why are you spending so much money on Q-Bank now? And don't waste your time and mental energy on putting together a Step 1 study schedule at this time - use that time and mental energy to study, so that you can successfully remediate the course in the summer.

GSResident is totally right - you DO need to do really well on Step 1 and Step 2. But, FIRST, you need to do well in 2nd year before you can even begin to think about Step 1!! There is no point to putting together a study schedule for Step 1 if you end up doing very poorly during 2nd year.

(3) Make sure that you really want to do plastics and/or gen surgery. Maybe you'll think so now, because you "enjoy" being in the OR. Sure, it's easy to "enjoy" being in the OR when you've gotten 9 hours of sleep the night before, when you woke up at 5:30 AM that morning, and you'll be going home at 5 PM that day. And you won't be coming back to the OR for another week or so.

It's much harder to "enjoy" being in the OR when you've gotten 4 hours of sleep the night before, when you woke up at 3 AM that morning, and you'll be going home at 8 PM that day. And you'll have to wake up at 3 AM the NEXT morning...to start the whole cycle all over again.

(4) Stop making excuses. Your school might not be as "supportive" as you'd like, but come on - you're an adult. What do expect them to do in order to be as "helpful" as you seem to demand that they be? They're letting you remediate. They're telling you (very correctly) that it's too early to worry about Step 1. Really, the rest is up to YOU...it's not your school's responsibility to make sure that you match into plastics or gen surg. It's YOUR responsibility.

 

[Celiac Plexus]

I agree with the above replies to the OP. Excellent advice. Though I would add that the idea that one can walk into any old general surgery program regardless of academic record and match through the independent pathway is delusional.

Having just gone through the independent match (match day was last Wed) I can tell you that it is atrociously competitive. People with stellar records whom interviewed at 15-20 programs did NOT match. We don't have the data yet, but based on published match data from the last few years, and my own estimations, the overall match rate will turn out to be ~35% this year.

In retrospect, it is unreal how many applicants had inside connections at just about every program I interviewed at. There were a number of people with hand, or burn fellowships, or whom had done research with this prestigious chairman, or at that top program. There were a fair number of reapplicants as well. Everyone had an angle. I can remember having moments during interviews where I felt like I was just wasting my time and that I had no chance. It was scary.

Also, trying to get time off to go to interviews is not as easy as it was as a 4th year med student. You have to work out last minute interviews with your co-residents, and attendings/pd. And the ca$h... ugh. You need between 5 and 10 grand to fly all over the country, and pay for all of the hotels, and rental cars.

I am only now hearing about all of the incredible applicants whom did not match. It's really sobering in retrospect, and I feel incredibly lucky to have matched. When my future chairman called me the day of the match, I wanted to record the conversation so that I could keep replaying it to convince myself that I actually matched.

My advice is to optimize your match chances in the independent pathway, go to a gs program with an independent program, be an awesome general surgery resident, be nice to EVERYONE, do not get in any trouble, crush the inservice every year, do some meaningful research, and generally be as perfect as possible. It is a long road, and there are many opportunities to excel, or possibly derail your chances. It can be done, but be prepared to not match and do additional fellowship training to eventually match. Also be prepared to never get a spot, and be happy doing general surgery.

One other idea... there were urology residents, and ent residents who matched this year, and in the past there were ortho residents who matched. You might think about those residencies as well, although with a failure in medical school, matching in those fields will be very difficult as well.

I wish that I could give you some good news, but I'm just telling it like I know it. It's not impossible for you to match (no one can know that), but it will require you to be ready to traverse a very long, and arduous path.

 

[GSresident]

Grats on matching Celiac! Welcome to the club. Do you mind if I ask where you matched?

PS - I agree with everything you just posted about the competitiveness of the independent match. Preparation is everything and even with a perfect record and perfect scores many do not match.

 

[DrDre311]

I was looking at some of the independent match data from the last couple of years...it has significantly increased in competitiveness just as the integrated plastics match has. Pretty ridiculous when you look at the difference in match percentage from '94 to now.

I think it will only get worse for independent applicants as more programs switch to the integrated model, although I do not think that the independent model will ever vanish totally.

Celiac, congratulations man! I know exactly how you feel about the match insanity, dropping 10+ G's interviewing (I actually spent 13-14 G), freaking out about matching, the relief when you find out you matched, and then realizing there were people who interviewed at 18 places but didn't match when you were sure they would, etc. If you don't mind sharing, where did you end up?

 

[maxheadroom]

Congratulations, CP. Welcome to the circus that is Plastic Surgery.

 

[pagemmapants]

I want in!