Repeating third year + matching psych

[deleted445355]

Hi All,

I am an MS3 likely needing to repeat my clinical year due to mental health issues affecting my academic performance and causing me to have Incompletes/failures in 3 courses. I had anxiety that came to light on my psych rotation and undiagnosed ADHD that only became apparent later but I got treated a bit too late. I also struggled with side effects of psych meds I took. I'm doing fine now but made my third year very difficult and did not do as well as I had hoped. My step 1 is 233 and I go to a top 30 school with a strong home department. I was hoping to compensate with step 2, away rotations, letters, research, and ec's.

Can I even match psych at this point? And do you all know any stories of people that have matched the specialty with MAJOR red flags on their ERAS apps?

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[Lawpy]

Paging @NickNaylor @Mass Effect @Stagg737 @sloop

 

[NickNaylor]

1) If you're quite sure that you plan to go into psychiatry, I would start meeting with a mentor now so that you can have a clear strategy for how to approach the application process and potentially strengthen your application.

2) Obviously the course failures are going to be a problem, but they may not necessarily be fatal. You're probably going to have to apply broadly, and assuming that you're reasonably well-liked in your home program, you may need to lean heavily on trying to match at your home program.

3) A big question will be whether or not this is something you want to address directly in your application - whether in the personal statements or elsewhere. Again, a mentor who knows the totality and details of your application will be critical here in advising you on how to approach this.

Based on the information you provided, it's hard to say how things will fare for you. Your step 1 score is decent, so I don't think that will be a huge problem for you. What about your grades so far apart from the failures/incompletes? Any other professionalism issues? Any research experiences? Are you going to be able to get strong LORs? Do you interview well? You don't need to answer these questions here, but these are other aspects of your application that will need to be strong in order to maximize your chances of matching. Once again, a good mentor - ideally someone involved in the residency selection process - will hopefully be able to guide you in these matters.

You might want to take a look at the Charting the Outcomes data for psychiatry, available here: https://www.nrmp.org/wp-content/upl...utcomes-in-the-Match-2020_MD-Senior_final.pdf. As you can see from that data, your goal is going to be to interview at least 10 programs as this is strongly correlated with matching. You'll probably want to interview at more, if possible, given the issues with your grades.

 

[GoSpursGo]

I completely echo @NickNaylor ‘s recommendation to meet ASAP with a mentor. It is conceivable that you could match, but you need a clear plan for what to focus on in order to show that the problems that led to your failures have been addressed and won’t recur.

I also generally think the mentor will be able to give you an idea of whether they would consider you at your home program. The easiest and cleanest way to match is to convince your home program that you’re good and have overcome your red flags. Hopefully your mentor could be honest with you about whether that’s possible. If that isn’t possible, you need to decide whether to apply broadly vs consider a backup plan.

 

[deleted445355]

Hi All,

Thanks for your replies. I will try my best to maximize other aspects of my application.

1. What are your thoughts on away rotations? My plan is to get preceptor to practice even more and I’m willing to put in as much effort to shine on my aways as possible.

2. I was also advised by my advisor to not disclose mental health in my application due to stigma and being perceived as “incompetent” to do the job. Residency programs want someone mentally strong to deal with mentally ill and not cause hassle. That being said, programs will want to know what happened to my grades. It’s kinda inevitable in my opinion.

3. Applicants meet the program director at their home programs and try to get them to “like them.” However everything is over Zoom now and I can meet him once but requesting multiple zoom sessions is annoying. The entire department is virtual so I can’t just stroll into his office.

 

[ortnakas]

Hi All,

Thanks for your replies. I will try my best to maximize other aspects of my application.

1. What are your thoughts on away rotations? My plan is to get preceptor to practice even more and I’m willing to put in as much effort to shine on my aways as possible.

2. I was also advised by my advisor to not disclose mental health in my application due to stigma and being perceived as “incompetent” to do the job. Residency programs want someone mentally strong to deal with mentally ill and not cause hassle. That being said, programs will want to know what happened to my grades. It’s kinda inevitable in my opinion.

3. Applicants meet the program director at their home programs and try to get them to “like them.” However everything is over Zoom now and I can meet him once but requesting multiple zoom sessions is annoying. The entire department is virtual so I can’t just stroll into his office.

In terms of aways - be absolutely 100% sure that your clinical performance has improved dramatically since you failed your earlier rotations. It may have, now that you're addressing your issues. And while it may have all been the fault of untreated ADHD, 3 failed MS3 rotations doesn't seem to predict a person who's going to stay on their A game for four weeks straight on an away; there are enough SDN posts cautioning about aways backfiring even to people who aren't in your scenario.

To be clear - I don't think having ADHD means you're going to be a bad doctor, and I think the stigma isn't fair especially since you're actively working on finding solutions - but I'm not sure that away rotations are one of those solutions for you specifically.

 

[sloop]

You can probably still match in psych, but many of the competitive programs will not consider your application because of the fact you repeated third year. The exception to this might be your home program. If they like you and, from their perspective, you’ve really fixed all of the problems associated with your repeat, they might give you a shot. As has been mentioned, it’s probably a good idea to seek a mentor at your institution. They might be able to give you a sense of your chances there or advocate for you if you have a good relationship with them.

When it comes to applying, you should apply broadly to a range of places and not just academic places in cities. There are a lot of things we don’t know about you, but assuming that you don’t have any further red flags and you’re not picky about where you go to residency, my guess is that you’ll probably still be able to match.

 

[sloop]

Hi All,

Thanks for your replies. I will try my best to maximize other aspects of my application.

1. What are your thoughts on away rotations? My plan is to get preceptor to practice even more and I’m willing to put in as much effort to shine on my aways as possible.

2. I was also advised by my advisor to not disclose mental health in my application due to stigma and being perceived as “incompetent” to do the job. Residency programs want someone mentally strong to deal with mentally ill and not cause hassle. That being said, programs will want to know what happened to my grades. It’s kinda inevitable in my opinion.

3. Applicants meet the program director at their home programs and try to get them to “like them.” However everything is over Zoom now and I can meet him once but requesting multiple zoom sessions is annoying. The entire department is virtual so I can’t just stroll into his office.

With aways, I think you have to be sure that you’ll perform well. It’s definitely possible that these could be helpful, though. They might help to build bridges with another program and you might get a letter from somebody at another program which could carry weight.

In terms of disclosing mental health issues, unfortunately there is just no good way to handle this. On the one hand, what your advisor said is reasonable because it’s true that mental illness is stigmatized and a history of mental illness that has seriously impacted performance poses a real risk to the program. On the other hand, having to repeat a year of med school and offering no explanation also looks terrible. It’s up to you how to handle this, but I’m not sure there’s a “right answer” here.

 

[samac]

You will easily match @samac

Hey yep, thanks for the tag.
I had an extra year to graduate and a level 1 (DO) failure. Matched psych with my top choice

Hi All,

Thanks for your replies. I will try my best to maximize other aspects of my application.

1. What are your thoughts on away rotations? My plan is to get preceptor to practice even more and I’m willing to put in as much effort to shine on my aways as possible.

2. I was also advised by my advisor to not disclose mental health in my application due to stigma and being perceived as “incompetent” to do the job. Residency programs want someone mentally strong to deal with mentally ill and not cause hassle. That being said, programs will want to know what happened to my grades. It’s kinda inevitable in my opinion.

3. Applicants meet the program director at their home programs and try to get them to “like them.” However everything is over Zoom now and I can meet him once but requesting multiple zoom sessions is annoying. The entire department is virtual so I can’t just stroll into his office.

The advice you got here is helpful and I won’t rehash all that.
An away rotation was how I got my foot in the door at the program I’m at. I highly recommend that if you’re solid doing one at your top choice and proving that you’ve moved past your short comings.

The mental illness aspect is also tough. Ironically, many psych programs could see it as a liability. You have to play it careful here.

 

[Mass Effect]

Hi All,

I am an MS3 likely needing to repeat my clinical year due to mental health issues affecting my academic performance and causing me to have Incompletes/failures in 3 courses. I had anxiety that came to light on my psych rotation and undiagnosed ADHD that only became apparent later but I got treated a bit too late. I also struggled with side effects of psych meds I took. I'm doing fine now but made my third year very difficult and did not do as well as I had hoped. My step 1 is 233 and I go to a top 30 school with a strong home department. I was hoping to compensate with step 2, away rotations, letters, research, and ec's.

Can I even match psych at this point? And do you all know any stories of people that have matched the specialty with MAJOR red flags on their ERAS apps?

I'm going to be very honest and blunt here. My point is not to offend, but is to tell you the truth as others did with me when I was a premed.

First, immediately discount the opinion of anyone who tells you that "you will easily match". Immediately. You may match, but it will not be easy by any objective standard of the word. Frankly, no one will "easily match" these days in many fields, including psych.

Second, I'll be honest, failing 3rd year is much, much worse than failing 1st or 2nd year when it comes to psych. In psychiatry, the bulk of what you do is talk to people. Failing 3rd year is a red flag for either inability to talk to patients or interpersonal difficulties, both of which no psych program wants anything to do with. So you may have to be honest. I would never call it "mental health issues" because that leaves the door open for potentially much more debilitating illnesses (like, I had undiagnosed schizophrenia and lost touch with reality for a while). I would call it what it was - undiagnosed ADHD or anxiety (choose one to reveal).

Third, I have to ask, is psychiatry one of the rotations you failed? Because that makes your situation much more...challenging.

Fourth, I have to ask because programs will too. If you had undiagnosed ADHD, how did this not come through during years 1 and 2 or Step 1 studying? It's possible for ADHD not to be debilitating until later in life, but it's surprising for it to cause an issue to the point of failure during clerkships, unless it was causing you to make mistakes and/or unintentionally harm patients?

Fifth, when it comes to anxiety, are we talking social anxiety? Because again, it's difficult to understand a situation in which anxiety didn't cause you major problems before clerkships but somehow caused you to fail three clerkships when the bar for passing clerkships isn't that high. So are we talking social anxiety? And what are you doing about it if so?

I think you may match, especially at your home program, but you have to consider all of the above and make sure you can explain it all.

 

[TelemarketingEnigma]

I can meet him once but requesting multiple zoom sessions is annoying

So I've had the benefit of applying into a small speciality with a really supportive home PD, but if they are serving as your advisor it shouldn't be weird to have multiple sessions with them as you prepare to apply. If it's a bigger specialty/busy PD, then you might want to find someone else in the department who can serve as an advisor - APD, clerkship director, another attending, etc. I'd be very surprised if there wasn't someone in the department who is used to meeting with applicants on multiple occasions, who could give you the feedback and insight you need

 

[deleted445355]

So I've had the benefit of applying into a small speciality with a really supportive home PD, but if they are serving as your advisor it shouldn't be weird to have multiple sessions with them as you prepare to apply. If it's a bigger specialty/busy PD, then you might want to find someone else in the department who can serve as an advisor - APD, clerkship director, another attending, etc. I'd be very surprised if there wasn't someone in the department who is used to meeting with applicants on multiple occasions, who could give you the feedback and insight you need

I'm fortunate to go to a home institution with a big department, fellowships in nearly every specialty. Program director seems engaged with residents, friendly, and genuinely enjoys his role it appears. He's not involved in advising medical students.

There are two advisors involved only with medical students, helping them prepare applications, advocating for them to program director, but not involved directly with admissions (interviewing, ranking, etc.). I'd think their opinion of med students hold a lot of weight here. My psychiatrist at student mental health is actually the associate program director, but will excuse herself from decision-making due to knowing me as a patient. I've interacted with both of my advisors and plan to ask them for guidance.

As for my chances at my home school, I'm not sure but will still show interest regardless. I don't take anything for granted and I don't think it's a good choice to put all my eggs in one basket given some of the interactions I've had. Who knows?

 

[NotAProgDirector]

Going to a Top 30 school is both a blessing and a curse. The blessing is that the school name may help open doors for you for residency. The curse is that a "top 30" psych program might not be willing to consider a student who has struggled enough to repeat 3rd year -- even if there is a "good reason" and it's been addressed so no longer is an issue.

Also, you posted this thread: Mean and discouraging psych specialty advisor. What are your thoughts? The feedback you're getting in psych is not good. You would really need to turn this around to have them seriously consider you, and sometimes that's impossible -- people have formed impressions which can be difficult to change.

Given the content in the other thread, I think matching in psych is going to be an enormous challenge. You would need to markedly change your performance on treatment. Due to the unique situation in your case, no amount of reviewing match data is going to help. You should decide up front whether you want to go "all in" for psych and plan for a gap year if you don't match, or if you want to dual apply to psych and FM (or another less competitive field like Neuro).

No matter what, it's critical that your issues are under control. If not, take an LOA and get treated. Further problems or failures will magnify your issues. Best of luck.

 

[futureapppsy2]

Interpersonal issues that lead to you failing third year are going to be significant barriers for both psych and FM, probably, because both really hinge on good interpersonal rapport building and history-taking with patients. Like @NotAProgDirector said, repeating third year and doing well enough to match is going to take a lot of being able to listen to and proactively respond to feedback, including feedback that may be hard to hear or seem harsh.

 

[Candidate2017]

The mental illness aspect is also tough. Ironically, many psych programs could see it as a liability. You have to play it careful here.

OP mentions anxiety in the setting of poor performance on a psych rotation and "untreated ADHD". This isn't necessarily mental illness.

As pointed out above, OP started a prior thread dismissing useful feedback from their school's psych department (and all useful advice from SDN) under the distorted perception that everyone is being "mean" to OP. At the very least, to competently treat patients with mental illness, it's important to have a minimum amount of insight into one's own flaws.

And if a student or physician does indeed have mental illness, it needs to be handled to be able to properly treat patients. Residency is hard enough on those without mental illness. Despite lighter hours, psych residency is a beast unto itself emotionally. Psych has a difficult population, especially in residency where most of a resident's time is spent with the psychotic/manic, substance abusers, criminals, perpetually suicidal and/or those with very nasty personalities, You will not get through psych residency without encountering patients that hurl insults (yes OP, actual meaness), threats of assault, rape, death, lawsuits etc. Even a few of your nice patients will unexpectedly commit suicide, some of which may lead to actual lawsuits. So yeah, one's own untreated mental illness can be a liability.

 

[Lawpy]

You will easily match @samac

This post is looking unlikely based on the recent discussions. I forgot about OP's earlier thread until now and that makes the situation a lot more concerning.

 

[djiboutiman]

There are Psychiatry programs out there that take students with board failures, class failures, and other red flags. As others have said, it’s going to be an uphill battle for you, but it’s not impossible. Your school pedigree, demonstrated interest in Psychiatry, excellent letters of rec and hopefully killer performance on away rotations can save your application. If I were you, I’d still apply broadly and have a backup in mind (FM still does a good amount of Psych work and might be more forgiving of your situation).

 

[Mass Effect]

There are Psychiatry programs out there that take students with board failures, class failures, and other red flags.

Those are usually not during clerkships. Psych is one specialty where your ability to communicate and build rapport on clerkships may matter more than your performance during MS-1 or even MS-2 for most programs.

I agree with the rest of your post. The OP has an uphill battle, but not impossible.

 

[NickNaylor]

This post is looking unlikely based on the recent discussions. I forgot about OP's earlier thread until now and that makes the situation a lot more concerning.

I didn't recognize the username - good catch.

OP, I'll revise my advice and say that you are probably going to need some major assistance and help. Seek out that help now. The evolution of that other thread suggests that interpersonal relationships - at least in the academic setting - may be a challenge. It also sounds like you are unlikely to be a desired candidate at your home program, and your home program may not necessarily be all that supportive of your application - which is going to be a huge problem.

Failing clerkships is a huge problem but can be overcome. However, combine that with what I would summarize as a sensitivity to criticism, a limited ability to mine useful nuggets from that criticism, and some degree of stubbornness with respect to persisting in your approach will be fatal. You need to fundamentally shift your approach to how you deal with others, at least in this aspect of your life. Get humble, listen to what others are saying, be willing to take in the advice and guidance that others provide (even if you find it hurtful), and you might be able to recover. If you don't change your approach, though, you probably aren't going to be successful.

 

[deleted445355]

Hi All,

Thanks for your input. My interpersonal and communications skills improved after my school set me up with coaching with a psychologist. Therapy really helped too "zooming" out the room to see other's perspectives. I'm naturally introverted but can be extroverted with some effort. I'm on surgery now and things are going pretty well surprisingly. No concerns at all. I just wish I got these resources earlier in third year so I could have done better.

My mental health issues did not become apparent until this year simply b/c demands are higher and being placed into different kind of learning environment. My mom is a neurologist, thought I had ADHD as a kid, but I always did well in school and top of class. I will say I have a sharp memory and that may have masked the forgetfulness. My memory is not as good anymore.

I high passed by psych rotation. Probably would have done better if anxiety and ADHD was under control.

I take criticism now without being defensive. I think it was part of my anxiety which got treated. Got compliments on that on rotations.

 

[Dral]

I take criticism now without being defensive. I think it was part of my anxiety which got treated. Got compliments on that on rotations.

This is important and good to hear. I agree with NaPD's advice. What you're working on is tough because there is no great way to objectively measure it, but it sounds like you're making progress.

 

[deleted1100659]

Hi All,

I am an MS3 likely needing to repeat my clinical year due to mental health issues affecting my academic performance and causing me to have Incompletes/failures in 3 courses. I had anxiety that came to light on my psych rotation and undiagnosed ADHD that only became apparent later but I got treated a bit too late. I also struggled with side effects of psych meds I took. I'm doing fine now but made my third year very difficult and did not do as well as I had hoped. My step 1 is 233 and I go to a top 30 school with a strong home department. I was hoping to compensate with step 2, away rotations, letters, research, and ec's.

Can I even match psych at this point? And do you all know any stories of people that have matched the specialty with MAJOR red flags on their ERAS apps?

I did recruitment while in residency, at a university psych program. You would of still had a chance at my program, especially if you did well on the interview and explained what happened.

 

[hamstergang]

I will say I have a sharp memory and that may have masked the forgetfulness.

Maybe this is just using imprecise language, but I don't really understand how you can claim to have a great memory and be very forgetful at the same time. Though this is just a minor quibble and doesn't really need to be addressed in the context of this thread.

 

[deleted445355]

Hi All,

I'm working with the Dean of Advocacy at my school now to get some of my grades turned into passes or incomplete. He's been doing this for 30 years, longer than I have been alive, and has been super helpful just after meeting him via Zoom. He will also help speak on my behalf. Has helped numerous students over the years and been successful.

Perhaps I won't have to repeat third year after all. May just have two "incomplete" and "pass with remediation" on my transcript. A few boo boos....

 

[deleted1100659]

Hi All,

I'm working with the Dean of Advocacy at my school now to get some of my grades turned into passes or incomplete. He's been doing this for 30 years, longer than I have been alive, and has been super helpful just after meeting him via Zoom. He will also help speak on my behalf. Has helped numerous students over the years and been successful.

Perhaps I won't have to repeat third year after all. May just have two "incomplete" and "pass with remediation" on my transcript. A few boo boos....

Turned into passes? How does that work?

 

[MDMechEngr]

Hi All,

I'm working with the Dean of Advocacy at my school now to get some of my grades turned into passes or incomplete. He's been doing this for 30 years, longer than I have been alive, and has been super helpful just after meeting him via Zoom. He will also help speak on my behalf. Has helped numerous students over the years and been successful.

Perhaps I won't have to repeat third year after all. May just have two "incomplete" and "pass with remediation" on my transcript. A few boo boos....

I know first hand that you attend an amazing school with amazing faculties and home programs. It sounds like you are working out your situation, and hopefully, your issue with your school. I came accross your post when I was a pre-med two years ago. All the best.

 

[Lawpy]

Hi All,

I'm working with the Dean of Advocacy at my school now to get some of my grades turned into passes or incomplete. He's been doing this for 30 years, longer than I have been alive, and has been super helpful just after meeting him via Zoom. He will also help speak on my behalf. Has helped numerous students over the years and been successful.

Perhaps I won't have to repeat third year after all. May just have two "incomplete" and "pass with remediation" on my transcript. A few boo boos....

If this is true, you should thank your lucky stars and do everything your school suggests going forward

 

[Styrene]

Hi All,

I'm working with the Dean of Advocacy at my school now to get some of my grades turned into passes or incomplete. He's been doing this for 30 years, longer than I have been alive, and has been super helpful just after meeting him via Zoom. He will also help speak on my behalf. Has helped numerous students over the years and been successful.

Perhaps I won't have to repeat third year after all. May just have two "incomplete" and "pass with remediation" on my transcript. A few boo boos....

I remember your other related thread. The underlying personal issues that led to the boo boos are the more important concern. Reversing failures on the transcript may increase odds of matching but don't mean much if they don't reflect what really went on. Were the failures justified? If so, it could even be better to have the transcript reflect that so programs that are unwilling or unable to handle significant personal issues with residents do not rank. Psychiatry residency is a sometimes shocking never-ending test of interpersonal skills, emotion regulation, and stress tolerance--incredibly sad cases, screaming family members, destitution, malingering, psychopathy, being physically attacked, constant threat of violence, etc.

The real goal here is to perform well in residency and beyond and help patients. Matching doesn't matter if the same issues crop up during residency.

Best of luck in addressing all of this. Given the nature of psych residency, taking the dramatically wide spectrum of quality of psychiatrists as a proxy, you can probably match regardless if you apply very broadly.

 

[deleted1022040]

Maybe this is just using imprecise language, but I don't really understand how you can claim to have a great memory and be very forgetful at the same time. Though this is just a minor quibble and doesn't really need to be addressed in the context of this thread.

I guess it may be something similar to what I deal with. I'm solid at retention, though I do get a bit scatterbrained in the moment.