QUOTED: Failed IM Boards

[NotAProgDirector]

Hi -

I am currently a heme/onc fellow at a very prestigious academic program on the west coast. To my horror, I failed my Internal Medicine Boards this August. I went to a very good medical school but standardized tests have always been a problem for me...had horrible Step 1 scores, studied much harder and did average on Step 2. Took step 3 and was worried I didn't pass, but also passed and got an average score. Did my Internal Medicine Residency at a pretty mediocre/middle tier program, but did a ton of research and got into a great fellowship. I studied very hard for my IM boards, but think I didn't do enough practice questions in the end.

I have been extremely depressed about this since I found out...was barely able to drag myself to work. The first two months after I found out were horrible. I felt like quitting medicine altogether. My program is a pretty snotty place and there are no attendings that I am able to discuss this with (not to mention that it's not a good thing to advertise). I feel that it would be a huge mistake to tell the program director and would be very upset if he ever found out. I have a ton of questions...to begin with, I feel completely overwhelmed by my fellowship and think I need to focus now on learning oncology...as a result, I'm not sure that re-taking the exam in August of 2009 is realistic...I only have 18 months of clinical work and then I have another 18 months of research, with only minimal clinical requirements...I think taking the exam in August of 2010 might be a better idea, as I would have more time to devote to studying Internal Medicine. My fear is that if I try to study both for the Internal Medicine boards and also study oncology, I will do neither well, and might end up failing the boards again, and not learning oncology because I was distracted by studing for the boards. I have been so depressed for the past few months that I haven't been reading enough and although I'm feeling better now, I think I need to put the time into oncology, not internal medicine.

I plan to go into private practice after my fellowship (something I also don't feel I can discuss openly with attendings in my program). I am worried about how this will affect my ability to get a job. What will I say when they see that I completed my IM residency in 2008 but was board certified in 2009? or 2010? I feel like any practice I interview with will worry that I won't pass the heme/onc boards (which I would normally take in the fall after starting practice in July).

I'm completely overwhelmed and unsure of what to do. My gut feeling is that I should focus on learning heme/onc and take the boards in 2010. But i'm not sure if this is the right decision.

1. Your #1 priority needs to be not failing out of your Heme/Onc fellowship. So, I agree that you need to focus on Heme/Onc, and postpone the IM boards for now.

2. You need to check to see if passing the IM boards is a requirement for graduation or promotion in your program. This is NOT an ACGME rule, so it will be specific to your program if it exists. For example, I require that everyone pass Step 3 prior to graduation -- if you can't pass, you don't graduate. Hopefully this is on your program's website somewhere, as you certainly don't want to ask your PD.

3. Your ABIM status is public info. Anyone can look it up, including your PD. If your PD looks it up, it will simply say that you are "not certified" -- he or she won't be able to tell whether you failed or didn't take it (unless you took time off from the program to take the boards, at which point it will be obvious what happened)

4. I think from your description above that your program is front loaded -- the 18 months of clinical work come in the first 2 years of fellowship, and then the last 12 months are pure research and clinic. If that's the case, you'd want to consider studying for the exam again during your F2 year, and take it in Aug of your F3 year -- or, you could study during your F3 year and then take the IM exam after you actually finish your fellowship. The former would allow you to take the H/O boards right after you finish your fellowship. The latter would require that you take them a year later, as you can't take the H/O boards until you pass the IM boards.

5. Will this affect your ability to get a job? Interestingly, probably not. When you graduate from your Heme/Onc fellowship, no one will expect you to have passed the H/O boards yet, obviously. They are unlikely to even think about asking about your IM certification status. If you take the exam at the beginning of your F3 year, you'll have your results before you'll be looking for a job anyway -- making this a safer pathway but only if you'll have time during the latter half of your F2 year to study aggressively.

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