Red flag occurring in 4th yr AFTER ERAS submitted??

[theone1979]

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Hi

I believe I have a unique and concerning the situation but I would appreciate some input. I am a fourth-year medical student applying to residency. My application up until the time I submitted Eras was totally clean and therefore I did not disclose any red flags because there were none to declare. However, several months after ERAS was submitted, I was dismissed from a rotation and given a failing grade and my school forced me to take a one month leave of absence. I am confused and concerned about how this will affects my match coming up in several weeks and if programs will be notified or have any knowledge of these red flags. I have heard that once your ERAS Application has been submitted programs almost never received an updated copy of your transcript prior to the match. However, I am still concerned that residency programs will be made aware of these red flags and this will have a negative impact on my matching. I would appreciate any input or suggestions regarding the situation specifically whether or not it is likely that residency programs will be aware of these red flags since they occurred after my ER a S application was submitted. Also I am unsure about how to proceed if I should notify the prospective residency program about these red flags prior to the match. Some people have told me that I definitely should not notify these residency programs as it is very unlikely they will be aware of these red flags since they occurred after they received my ER a S application and I will only be giving them reason to disregard me as an applicant. However others have told me that it would be unethical not to notify the programs. I am truly confused as to what I should do and would love to hear opinions and input from those that may have knowledge or experience in these matters.

incidentally I am a allopathic fourth-year medical student at a good program in the Midwest and am applying to psychiatry programs. One last detail is that I received two letters from residency programs that made it clear that they would be offering me a seat in their upcoming match. While this is very encouraging I am still very concerned that they will become aware of these red flags and reconsider or completely disqualify me from the match despite their prior interest.

So in short my main concern is whether or not it is likely that these programs will be made aware of these red flags that occurred after they reviewed my eras application and decided that they wanted to offer me a seat in their residency program, and what obligations I have if any to disclose this information to them prior to the match or after the match.

 

[Taurus]

I would wait to find out where you match before I would be contacting anyone. Most likely this red flag will have no long term consequence.

 

[PlasticSurgMD]

Couple things come to mind here (I'm not a lawyer and am not giving any legal advice, just outsider thoughts):
1. We are all speculating as to the events that led to a "clean" record up to your 4th year, but for some reason got you a failing grade and a reprimand of 1 month leave of absence. We can't really advise if we don't know the situation, but seems like something serious if they came down on you like that while you are almost done. Seems like a lying/pt care issue vs doing something unsupervised you shouldn't be doing vs drugs/EtOH. Don't know so can only speculate.
2. If it is a "legal matter" then you are innocent until proven guilty. Get lawyers up, hope to get the thing dismissed, and then work on getting it expunged ASAP. Unless you were clearly "caught red-handed" doing something that was witnessed and undeniable, everyone has an appeals process. It would probably behoove you to get a lawyer now and see if the 1 month suspension can be overturned because that is a bigger deal than failing a course (which can be explained by whatever reason you choose to give people in the future).
3. Your eventual program director will likely have to share the pain of disclosure with you multiple times during your residency. For example you will have to disclose this on your FCVS physician profile (worry about this if you need to later), you will have to disclose this when applying for your state medical licenses not so much the failing grade but rather the fact that they made you take a leave of absence from training. Luckily you don't have an NPI number so I think it won't make it onto a national practitioner database check. Also when applying for medical licenses you have to get state and FBI background checks so if it is indeed a legal matter then it will become disclosed unless it's dismissed and expunged (in California you even have to disclose legal issues that have been expunged)
4. Will failing that class have implications on your graduation? Ie will you be available to start residency July 1st and will you get your diploma on time? If not then non-disclosure will probably lead to eventual termination of the contract from your future residency program director who will just pursue someone in the scramble etc.
5. I think the theme here is that you should already have a lawyer on retainer or go get one today that practices in med-mal law and more specifically lawyers that do well representing doctors in credentialing committees etc. search your states medical association publications where they always advertise. Your lawyer is going to have to be savvy and up to date on all the legalities of the match, the states medical board, your future residency contract, etc etc.
6. I would read the match contract very carefully word for word and see if there is any language in it that pertains to your issue. I would also go online and look at the state's medical licensure application/wording/disclosures in which you hope to eventually end up practicing in. It will be insightful as to the questions you later will have to answer and the forms your future program director will have to answer on your behalf.

This is my 2-cents as I don't have anything disclosable like your situation but am currently pending 2 state board licensure applications and have recently gone through all the BS they require.

Hope things work out for the best

 

[NotAProgDirector]

There are a couple of angles to this:

1. Was the event a legal issue, interfere with your date of graduation, or have ramifications regarding licensing?

If yes, then you have a big problem. If your graduation will be pushed beyond July 1st, then your school will remove you from the match completely. Each school is required to certify, right at the ROL deadline, that all of their students remain on track to graduate by July.

If your problem includes true legal issues (i.e. you have been accused of a crime) or if there is some professionalism issue that is likely to cause problems with licensing (i.e. a boundary violation with a patient), then nothing will stop you from matching, but you might find that you won't get credentialed at the hospital, or licensed by the board in time, will will negate your match.

In all of these cases, you're likely going to need to disclose. You'll want a PD who will support your credentialing and licensing.

2. Do you have any requirement to report this to the programs to which you have applied?

No. Your application was accurate the day you signed it. Unless asked about it, you do not need to release this information. Much like if you failed Step 2, there is no requirement to release damaging information that wasn't available at the time of application. Unless a program specifically told you that this was a requirement. [Note to self: this is a good idea to consider in the future].

3. Can my school forward this information to the programs which I have applied without my consent or knowledge?

Yes. Your school sent each program an MSPE and a transcript. They can amend either of them and release them to programs at their discretion. Will they do so is an open question. Even if they do, will programs notice? That's hard to say -- I'm not really looking at MSPE's any more, unless they called me or otherwise contacted me, I would probably not look. Although, now, I'll probably try to look tonight -- not certain how easy it will be to look at only updated MSPE's.

4. Should I get a lawyer?

It depends. If you feel you are being "framed" -- you didn't do what they said, or if you can prove the punishment is more severe than others who have done the same thing, then there may be some benefit. But in general a lawyer will not be able to help you much. If you want some private advice, especially if the event in question may have licensing issues in the future (or you're not certain), then that's fine. In that case, you might be able to have one of your school's lawyers help you. Having your lawyer contact your school is likely to rile things up and not make things any better.

5. Assuming the answer to #1 is No, and my school isn't contacting programs, what's the "right" thing to do?

There's no clear answer here. There are two basic paths forward.

You could keep this quiet, not mention it to anyone. The match proceeds and you match somewhere. If you graduate on time and the issue has no licensing problems, your PD may never find out about it at all. We ask for a certification of graduation, but I don't routinely review final transcripts. Even if I do find out about it, I am legally required to start your training whether I like it or not. But if I was really angry, I could imagine that at the first sign of any trouble, I might not cut you any slack. Having your PD angry at you before you even start training is not a great plan.

Or, you could be honest with programs and let them know. In that case, expect to be dropped down ROL's, or dropped altogether. You could easily end up not matching at all. But if you do match at a program, at least they would know about this issue and be willing to work with you on it.

No easy answer.

 

[theone1979]

Thanks for the responses guys.
Regarding the details of my being dismissed from a rotation, I'm afraid I won't be of much help because the reason given to both myself, and my school, was incredibly vague. It was a sub-I and The program director stated that he had received several calls (he wouldn't say who made these complaints), that I exhibited "odd behavior". When asked to elaborate he said he didn't really have specifics, but that they reserve the right to terminate a rotation at any point if they feel it's appropriate. I understand that I was a guest at this hospital and that they of course have the right to end an elective rotation and i suppose technically they are not required to give me or my school a specific reason.

When my school gave me a failing grade for the rotation, I was of course upset, but they somehow convinced me that they had no choice since I did not complete the rotation, and was not given any sort of review or evaluation from the preceptor or program director. However after reading some of the responses here, I've become pretty livid as I've realized my school had no grounds to fail me and should have supported me considering that neither myself, nor my school were given any specific reason for my dismissal. My school contacted the program and did a thorough investigation, and all they were told was that there were some complaints or concerns about odd behavior.....to this day I have no idea what was meant by that. All of my evaluations from 3rd and 4th year were extremely positive, and there was not a single instance in which my "behavior" was questioned (with the obvious exception of this).

So....what should I do? I feel this was incredibly unfair on my school's behalf, but i really don't like the idea of suing or even threatening to sue my own med school. All suggestions welcome.

Thanks guys

 

[Raryn]

Thanks for the responses guys.
Regarding the details of my being dismissed from a rotation, I'm afraid I won't be of much help because the reason given to both myself, and my school, was incredibly vague. It was a sub-I and The program director stated that he had received several calls (he wouldn't say who made these complaints), that I exhibited "odd behavior". When asked to elaborate he said he didn't really have specifics, but that they reserve the right to terminate a rotation at any point if they feel it's appropriate. I understand that I was a guest at this hospital and that they of course have the right to end an elective rotation and i suppose technically they are not required to give me or my school a specific reason.

When my school gave me a failing grade for the rotation, I was of course upset, but they somehow convinced me that they had no choice since I did not complete the rotation, and was not given any sort of review or evaluation from the preceptor or program director. However after reading some of the responses here, I've become pretty livid as I've realized my school had no grounds to fail me and should have supported me considering that neither myself, nor my school were given any specific reason for my dismissal. My school contacted the program and did a thorough investigation, and all they were told was that there were some complaints or concerns about odd behavior.....to this day I have no idea what was meant by that. All of my evaluations from 3rd and 4th year were extremely positive, and there was not a single instance in which my "behavior" was questioned (with the obvious exception of this).

So....what should I do? I feel this was incredibly unfair on my school's behalf, but i really don't like the idea of suing or even threatening to sue my own med school. All suggestions welcome.

Thanks guys

Talk to your dean of student affairs and figure out the implications this has for your graduation and everything else. We aren't equipped to give you details of what this means to you because we don't have the information.

 

[PlasticSurgMD]

"incidentally I am a allopathic fourth-year medical student at a good program in the Midwest" Does this fit under AZCOM's umbrella?

 

[NotAProgDirector]

They can't fail you without a good explanation why.

There's a big part of the story that you're either not telling us, or that they haven't told you.

If your school thought this wasn't a problem on your end, they would not have failed you. "It was their only choice" is crap. They could have given you an incomplete, or withdrawn,or any number of other options.

 

[hamstergang]

my school forced me to take a one month leave of absence.

This part also doesn't make sense with only what we're being told. Why would the leave of absence be necessary? Something from the OP doesn't smell right here.

 

[hamstergang]

I'm assuming that's the time when he should have been at this away rotation but the away rotation told him to leave?

And his school couldn't find a month long rotation instead of forcing a LOA? Maybe, just seems odd to me.

 

[PlasticSurgMD]

Also seems odd that he's all over the AZCOM message board stating he is there and loves it but then states he's from a Midwest allopathic school, either he did something unspeakable or he's just trolling. Either way I feel like I need to cleanse myself of this thread.

 

[theone1979]

Thanks for the replies.

I think there is some confusion about a few issues.

Regarding my dismissal..no I'm not leaving any significant details out as that would defeat the purpose of someone voluntarily sharing something and seeking advice on the subject. The PD called me in and stated he had received some reports that I was possibly exhibiting "odd" behavior. It was never stated, but I felt like he was hinting at some sort of impairment due to drugs or alcohol. I was then told that they reserve the right to terminate a rotation at any time, and that they had made the decision to terminate the rotation. I went straight to my school as they had already been informed of this decision. They were understandably concerned, confused, and suspicious I had left something out. I then immediately went to get a drug screen in the event that I was correct that this was what was being suggested. My school proceeded to investigate things themselves and contacted the program. They were told exactly what I was-vague references that seemed to suggest someone thought there may have been an impairment issue. Drug screen came back negative for everything and so my school was left with no specific reason for dismissal other than this suspicion I mentioned and a negative drug test. The admin at my school seemed genuinely sympathetic and felt the dismissal was an extreme response, but when push came to shove, their position was that the fact remained I was booted from the rotation and was therefore unable to complete the rotation, and that they felt they had to fail me. For those saying they had other options....you're preaching to the choir.


As for the leave of absence, it was completely unrelated. Several months after the issue above, I did not attend a required orientation at the start of rotation at a different hospital. There was of course a reason that I missed this orientation, but it is of no consequence. The fact is that it was required and I was not there and I take complete responsibility for the fact that I was not there. Because I missed the orientation, the hospital would not permit me to rotate, which is completely understandable, as was the fact that my school was not happy with me for missing orientation. However, before meeting with my school I had secured an alternative rotation that agreed to take me for the month. My school, however, decided that my missing the orientation, regardless of the reason, was unacceptable and therefore stated that I would not be permitted to rotate anywhere that month, and forced me to take the leave of absence for the remainder of the month. While I agree that missing the orientation was warranted some action, by forcing me to take the month off, my school knowingly put me in a position of having my rotations extend dangerously late in the season. And I am now left having no idea what I should do, who I should tell, if I was wronged, and if so, to what degree.

So there you have it.

As for the azcom question..i have to imagine you guys can figure that out. If not, it has no bearing anyway.

 

[PlasticSurgMD]

There is no law against acting "odd" or droves of med students across the country would become part of the next attrition statistics. Get a lawyer or this will not end well.