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Red flags on my application - Is there hope?
- Thread starter AbsenceSeizure
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First off, for at least half, maybe 75% of programs in the US, your "red flags" are merely yellow, and largely offset by the green flags you list. The only one that would be concerning at our program, for example, is the need to retake an entire year--so we'd expect you to maybe be ready to say something about that in your interview.
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Some good news.
When applying, several applicants are usually filtered out before the admissions committee actually reads their applications for real. For example, some places might automatically toss out an application where the person failed USMLE a certain amount of times.
The filters that were in my residency program (where I trained, not where I'm at now) didn't include failed classes, and common-sense-wise you'd think they would. I don't think many would. Why? Because they'd rather just look at your USMLE score than every single one of your grades. I've seen this happen with several applicants. Another factor is that in some institutions certain classes are next to impossible and unfairly so. In such cases, they might be willing to put less weight on a failed class.
So you could slip past the initial filters.
But the bad news (but likely not as bad as you think) is when you do slip past, and actually read the application for real, yes, several will likely detect the failed class, but even then I've seen a lot of people miss it.
The reality of the situation is that most programs don't give their attendings and chiefs enough time to spend hours per applicant. Usually a brief scan is done per application and the grades are often times skipped because of what I mentioned above. If they are reviewed, it's often times very quickly so. I can think of only one or two situations where I could tell with certainty that the person interviewing me actually critically reviewed by report card.
In short, yes, the red flags you mention are worrisome and may knock you out of top competitive programs but you still got a good chance to get into a program, several of them very good.
When applying, several applicants are usually filtered out before the admissions committee actually reads their applications for real. For example, some places might automatically toss out an application where the person failed USMLE a certain amount of times.
The filters that were in my residency program (where I trained, not where I'm at now) didn't include failed classes, and common-sense-wise you'd think they would. I don't think many would. Why? Because they'd rather just look at your USMLE score than every single one of your grades. I've seen this happen with several applicants. Another factor is that in some institutions certain classes are next to impossible and unfairly so. In such cases, they might be willing to put less weight on a failed class.
So you could slip past the initial filters.
But the bad news (but likely not as bad as you think) is when you do slip past, and actually read the application for real, yes, several will likely detect the failed class, but even then I've seen a lot of people miss it.
The reality of the situation is that most programs don't give their attendings and chiefs enough time to spend hours per applicant. Usually a brief scan is done per application and the grades are often times skipped because of what I mentioned above. If they are reviewed, it's often times very quickly so. I can think of only one or two situations where I could tell with certainty that the person interviewing me actually critically reviewed by report card.
In short, yes, the red flags you mention are worrisome and may knock you out of top competitive programs but you still got a good chance to get into a program, several of them very good.
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The flags you indicate do lessen your competitiveness but I would think you should still find a slot if you apply broadly enough. Highly competitive programs probably won't give you an interview. The best things you could do for your application are: 1) do as well as you can on Step 2/Level 2, 2) identify a place where you would really like to go for residency and do a sub-I there, 3) do well on your interview. As long as your letters are reasonable they will not substantially hurt or help your application.
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I don’t know much about AOA programs, but as far as ACGME the West coast isn’t all that complicated. Washington has Wash U (probably not likely), Oregon has OHSU (also a bit of a reach). That leaves California. You can look at metropolitan areas, but there are a fair number of likely candidates further off the beaten path. You should look at:
UCLA-Kern Psychiatry Residency Program
Kaweah Delta
Kaiser Fontana
UCSF Fresno
None of these are “on the West Coast”, but they are more on the coast than Arizona or Nevada.
UCLA-Kern Psychiatry Residency Program
Kaweah Delta
Kaiser Fontana
UCSF Fresno
None of these are “on the West Coast”, but they are more on the coast than Arizona or Nevada.
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This is huge. Doing great work for directly for people can make up for a lot of flags...
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Note: Washington does not have Wash U. Wash U is in Saint Louis. Washington has University of Washington.
dude, as olddoc said for psych those aren't really red flags. Red flags in psych are 'I have a felony conviction' or 'I have an active investigation for patient misconduct by my state medical board'.
Your red flags, for psych, can actually be seen as positives:
DO school? Well at least an american grad....
196 step 1? Well you passed!
failed anatomy twice? Perseverance!
These aren't big deals for psych. frame it this way in your head- you're an american grad who has passed step1 who is interested in psych. You don't have any legal or ethics red flags. Based on that alone you're in decent shape.
Now are you a great candidate? No, of course not. But you're plenty good enough to go somehwere, and at probably not that bad of a program in terms of the training. Would you match something ultracompetitive? No. Would you even match something mid level competitive?(er, gas, rads, etc)....probably not. But will you match psych, family, community IM, etc if you apply broadly enough? Sure
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OP, your situation is eerily similar to what mine was last year when I applied... pretty much identical.
Despite my red/yellow flags, I matched into an excellent MD psych program in the midwest, which I'm thrilled about. Although I was interested in the west coast due to weather and proximity to family, I didn't get much love there. I did get a good deal of interest from Nevada and Arizona, as these states seem to be lesser competitive as compared to other west/southwest states.... and the fact that I have ties to these areas probably helped. However, in terms of caliber of program, I got interviews at some wonderful midwest programs (in states such as Wisconsin and Ohio), which offer great training but are probably lesser competitive than they should be due to location/weather.
I certainly believe you can match (as I did, having the same strengths and weaknesses as you, based on everything you described). However, you will have to play things smart:
1.) Work hard to do well on your COMLEX II.
2.) Take it early enough for the score to count (this was one of my mistakes, as I waited too long - and with a low passing level 1 boards, programs are hesitant to offer you one of their precious interview spots, as they don't want you to then fail level 2 and have problems later.) By the time I got my COMLEX level 2 results in late-November (I did a good deal better than level 1), it was already too late as nearly all programs had given out all of their interviews.
3.) Apply to programs on the day that ERAS opens, and have all of your LORs uploaded and ready to go, so that your application can get screened right away.
4.) Apply widely (to about 80-100 ACGME programs -- primarily mid-tier programs known to be resident-friendly). People told me not to apply to so many programs, but looking back, I'm so glad I did (though I probably made the mistake of applying to too many top-tier programs). If you want to apply to mostly West coast programs, it's up to you, but don't discount awesome programs in the midwest or south that might offer great training of likely a higher caliber than many other programs that are merely competitive due to location. Once you've been fortunate to get the interviews, then you can certainly use location into consideration for your rank list, but don't dismiss good programs when you are applying in ERAS.
5.) Know your application in-and-out, as your interviewers will ask about specific details of your application (like your research or volunteer experience).
6.) Accept nearly every interview that comes your way, until you've lined up at least 13-15 interviews, then you can start declining interviews or cancelling one to accept another. Avoid programs with probationary status.
7.) Continue to try to get away rotations, especially at rotations that are just opening their spots (as they'll give you max chances of getting a spot). Doing an away rotation will likely help you at other interviews where you didn't rotate, as you will have the chance to talk about what you learned from your psychiatry elective experiences. I was very enthusiastic about the breadth of psychiatry experience I got from my electives, and I talked about it at every interview.
On my interviews, I was asked about my preclinical failures.... at several programs. So be prepared to discuss this. Luckily for me (and you too), the failures were early on in my first year, so I could talk about what I learned from the experience, and how I developed my skills to be successful thereafter. No one really seemed to care that my COMLEX 1 was on the lower end - though one of my interviewers told me that she didn't really know how to interpret the COMLEX score (as I didn't take the USMLE). A few of my interviewers (granted these were at lesser competitive programs) just commented on the fact that they were thrilled that I passed (I suppose they routinely get interviewees who failed??
). So thankfully no one asked about my board scores since they were all passing on the first attempt, though I figure it's probably good to have something to say in case you get asked that on your interviews. No one asked about my taking an extra year, as I explained on my ERAS application that my extra year was due to the scheduling issues of the few classes I repeated (there is a section on ERAS that asks if you had any breaks or extension in your medical school, which is where I explained that). However, at one of my interviews, I saw that one of my interviewers had made a comment '5 years' on my ERAS file (as she was sitting right next to me with my paper file laid open in front of both of us). So I'm not going to say that the extra year doesn't matter, as I'm sure it does have a bit of a negative impact... though this can still be overcome, as I'm proof that there are programs that give second chances.
Although I did not rotate at the place I matched at, there were a few things I suspect may have helped my candidacy. First of all, there were a few extracurricular things in the area which drew my interest, and made me ever more excited about the city. I mentioned that in my interview with the program director. (I can only imagine this was seen positively as I had no other ties to the area whatsoever, nor had I ever been there prior to my interview.) There were also certain features of my program which were different than others, and really excited me - and I was able to link back to some of my med school activities showing a particular interest in that area. I'm just speculating how I might have gotten into a great program... maybe I was just pleasantly conversant, who knows. I'm just grateful that they ranked me...
Anyway, I hope this is a good start to your questions, as I tried to be comprehensive. If you want any more specific advice, just shoot a PM my way...
Despite my red/yellow flags, I matched into an excellent MD psych program in the midwest, which I'm thrilled about. Although I was interested in the west coast due to weather and proximity to family, I didn't get much love there. I did get a good deal of interest from Nevada and Arizona, as these states seem to be lesser competitive as compared to other west/southwest states.... and the fact that I have ties to these areas probably helped. However, in terms of caliber of program, I got interviews at some wonderful midwest programs (in states such as Wisconsin and Ohio), which offer great training but are probably lesser competitive than they should be due to location/weather.
I certainly believe you can match (as I did, having the same strengths and weaknesses as you, based on everything you described). However, you will have to play things smart:
1.) Work hard to do well on your COMLEX II.
2.) Take it early enough for the score to count (this was one of my mistakes, as I waited too long - and with a low passing level 1 boards, programs are hesitant to offer you one of their precious interview spots, as they don't want you to then fail level 2 and have problems later.) By the time I got my COMLEX level 2 results in late-November (I did a good deal better than level 1), it was already too late as nearly all programs had given out all of their interviews.
3.) Apply to programs on the day that ERAS opens, and have all of your LORs uploaded and ready to go, so that your application can get screened right away.
4.) Apply widely (to about 80-100 ACGME programs -- primarily mid-tier programs known to be resident-friendly). People told me not to apply to so many programs, but looking back, I'm so glad I did (though I probably made the mistake of applying to too many top-tier programs). If you want to apply to mostly West coast programs, it's up to you, but don't discount awesome programs in the midwest or south that might offer great training of likely a higher caliber than many other programs that are merely competitive due to location. Once you've been fortunate to get the interviews, then you can certainly use location into consideration for your rank list, but don't dismiss good programs when you are applying in ERAS.
5.) Know your application in-and-out, as your interviewers will ask about specific details of your application (like your research or volunteer experience).
6.) Accept nearly every interview that comes your way, until you've lined up at least 13-15 interviews, then you can start declining interviews or cancelling one to accept another. Avoid programs with probationary status.
7.) Continue to try to get away rotations, especially at rotations that are just opening their spots (as they'll give you max chances of getting a spot). Doing an away rotation will likely help you at other interviews where you didn't rotate, as you will have the chance to talk about what you learned from your psychiatry elective experiences. I was very enthusiastic about the breadth of psychiatry experience I got from my electives, and I talked about it at every interview.
On my interviews, I was asked about my preclinical failures.... at several programs. So be prepared to discuss this. Luckily for me (and you too), the failures were early on in my first year, so I could talk about what I learned from the experience, and how I developed my skills to be successful thereafter. No one really seemed to care that my COMLEX 1 was on the lower end - though one of my interviewers told me that she didn't really know how to interpret the COMLEX score (as I didn't take the USMLE). A few of my interviewers (granted these were at lesser competitive programs) just commented on the fact that they were thrilled that I passed (I suppose they routinely get interviewees who failed??
). So thankfully no one asked about my board scores since they were all passing on the first attempt, though I figure it's probably good to have something to say in case you get asked that on your interviews. No one asked about my taking an extra year, as I explained on my ERAS application that my extra year was due to the scheduling issues of the few classes I repeated (there is a section on ERAS that asks if you had any breaks or extension in your medical school, which is where I explained that). However, at one of my interviews, I saw that one of my interviewers had made a comment '5 years' on my ERAS file (as she was sitting right next to me with my paper file laid open in front of both of us). So I'm not going to say that the extra year doesn't matter, as I'm sure it does have a bit of a negative impact... though this can still be overcome, as I'm proof that there are programs that give second chances.Although I did not rotate at the place I matched at, there were a few things I suspect may have helped my candidacy. First of all, there were a few extracurricular things in the area which drew my interest, and made me ever more excited about the city. I mentioned that in my interview with the program director. (I can only imagine this was seen positively as I had no other ties to the area whatsoever, nor had I ever been there prior to my interview.) There were also certain features of my program which were different than others, and really excited me - and I was able to link back to some of my med school activities showing a particular interest in that area. I'm just speculating how I might have gotten into a great program... maybe I was just pleasantly conversant, who knows. I'm just grateful that they ranked me...
Anyway, I hope this is a good start to your questions, as I tried to be comprehensive. If you want any more specific advice, just shoot a PM my way...
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alternatively, if he applies selectively to 10 programs and simply passes step2 with a 198(or whatever passing is), he will also be alright.
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I'm overwhelmed by all of your posts! Thank you so much. I'm beyond grateful you took time out of your days to offer me your insight. I feel like I have a far greater focus and am ready to try my hand at the challenge that awaits! I'm hopeful I'll get in somewhere. I'm certainly open to going wherever I get in and already intend to apply broadly - even if that means dozens upon dozens of programs all across the country. You guys are wonderful. 🙂
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Yeah, but if you barely pass and you have some red/yellow flags, it'd be pretty risky to apply to only 10 programs.
depends on the 10. If one knew they wanted to be in one whole region of the country and applied to 10 programs there where they would fit in with and only 'reached' on a couple(and for psychiatry I mean a relative reach), that would be more than enough.
In my region(Southeast), if a poor US student with a barely step 2 pass and a yellow/red flag(but nothing truly terrible...like serious ongoing ethical issues) applied to the following 10 programs:
University of South Carolina
MUSC
Medical College of Georgia
University of Florida
UAB
South Alabama
University of Mississippi
University of Tennessee-Memphis
LSU-Shreveport
USF
I'd bet they have a >90-95% chance to match. You have a couple programs which would be reaches but stranger things have happened(MUSC, USF), a large group of programs where they would likely fit in quite well(MCG, UAB, UF, USC) and then 4 other programs which have trouble attracting competent applicants without visa or cultural issues many years. The first 6 of those programs(and maybe 8/10 total) I wouldn't mind going to for one.
You could do the same exercise for any region of the country, minus maybe california.
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So you go to one of the last four?
As a side note for future applicants, the psychiatry program at University of Mississippi was placed on probation by ACGME last year.
No, I don't. But there are a few programs amongst those 4 that I probably wouldn't have minded going to.
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OP, @rkaz's post is gold. Memorize it. I can tell you that I have a friend I met on away rotations and the interview trail who was also a DO and had a red flag of repeating a year. She didn't take the USMLE and said she did below average on her COMLEX. But she was a very good conversationalist and ended up matching into a very good ACGME program in the northeast.
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