QUOTED: Maybe Repeat a Clerkship

[NotAProgDirector]

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Hi. I am a fourth-year from an American medical school. I just received an e-mail from the General Surgery clerkship director at my school indicating I need to meet with him to discuss my performance on the clerkship. It looks very likely that I have to repeat the clerkship. So I have a couple of questions:

1. Is there anything I can say/do that may help me not have to repeat the clerkship? (There was not one single incident that was really stood out. I guess one time, one of the surgeons yelled at me for touching the wrong cord and made me re-scrub but besides that, I do not remember any one thing that happened during the rotation that could explain my poor performance. I was also never late and felt like I was getting along with my team. I really am not sure where this is coming from.)

2. If I do have to repeat this clerkship, how does this affect my application to an anesthesiology residency? Will program directors think I can not get along with surgeons? I only have a step 1 score of 210 and fairly unimpressive pre-clinical course grades.

If anyone has any advice, especially before I go to meet with the course director next week, I would greatly appreciate it.

There are two major reasons that someone has to repeat a clerkship. You could fail the end of clerkship exam -- usually the NBME shelf exam but some schools use their own exam; or, your clinical evals could be unsatisfactory.

If the former, most schools will give you another chance to pass the exam. if you pass the second time, you pass the clerkship. Some schools note that you needed to take the exam twice. Some do not.

If your clerkship clinical performance is unsatisfactory, then you will need to repeat the clerkship. If so, and you are only finding out about this now, there is obviously a problem with mid clerkship feedback -- note that could mean that they never told you that you were failing, or that they did tell you and you didn't hear it. By the latter, I mean that in my experience, many faculty do not openly say "You are failing this clerkship" but give other clues about how unhappy they are with your performance, and I have seen students not pick up on this.

I had a student on the medicine service who was doing very poorly. I pulled him aside at the end of the 2nd day of rounds, and had a long talk. I used the "feedback sandwich" -- something good, followed by the bad stuff, followed by something good. Most students would have picked up, from my tone and concern, that they were in big trouble. This guy totally missed it, and did no better the next day. I pulled him aside and asked him what we talked about the day before. His sense was that "everything was fine" and that he had a few things to work on. That's when I told him that his current performance was failing. He did improve and passed.

So, advice (assuming it's not thex exam):

1. If you failed, take responsibility for that. Don't blame the attendings, residents, or anyone else. Unless you truly think you have been the victim of discrimination (which is VERY difficult to prove).

2. Try to get honest feedback on why you failed. Meet with the faculty who failed you. Don't pull any punches, simply say to them, "I failed this rotation. I'm mortified, and somehow I missed that my performance was unsatsifactory. I apologize for that. I would really like honest, blunt feedback on why I failed so I can improve."

Will this affect your chances of getting an anesthesia residency? It certainly won't help. Will it prevent you? Probably not, but you'll need to apply very broadly, consider at least 50-60 applications at your first pass. You'll also need a backup plan.