Residency outlook with red flag app

[totoroooo]

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Hi guys,

I'm an M3 looking for some honest opinions regarding my residency options. M1 was a rough year for me, as my father was diagnosed with cancer and I struggled to balance this with my academic load. I ended up failing two courses and consequently had to repeat the second semester of M1. I returned on academic probation and worked extremely hard to succeed throughout M1 and M2 not only in courses but also my step prep. The hard work paid off as I was removed from probation and went on to score 257 on step 1.

I've also built a decent research background with 4 publications, 3 posters, and more projects in the works. Almost all of this research has been in ortho under the same mentor since I started med school. She has supported me through everything and strongly advocates for me to pursue ortho for residency, particularly at our program. She's on the admissions committee and assuming M3 goes well, I could be relatively competitive. However I have my doubts about my chances in such a selective specialty with my M1 red flag. I could see my app getting thrown out immediately in some cases... but how often? The uncertainty has been kind of unsettling.

I really love ortho given my exposure thus far, but I realize I may need to be realistic and consider other options... and that isn't the end of the world. At the end of the day I'm thankful I was able to have another chance at this career and find success with the preclinical years. My Dad is also doing really well so I couldn't ask for anything more.

Other info:
top 40 US allopathic school
some interesting extracurriculars and probably average leadership/ volunteering experiences

 

[twospadz]

Dude your not getting into ortho. Too many applications with a similar step 1 and no red flags of that caliber. Failing M1 and then having to do med school for 5 years will basically get your app thrown in the trash. I know people who failed to match in ortho and then applied to ortho again during their first year in residency at a prelim program and failed. They are re-doing another pgy-1 surg prelim year. Cut your losses now before life teaches you the hard way. Your advisors are not gonna tell you the truth. And when you fail to match, there won't be any way they can help you.

 

[DocWinter]

The above post may be a little bit harsh here. While a failure of any kind is certainly Nearly a death sentence for getting into higher end fields, having a parent diagnosed with cancer and battling through and coming out with a near 260 step score may certainly be the thing to turn some heads. Others would probably know this field better than I, But if anyone has shown resilience and a darn good excuse for having a failure on their record, it would be you. @OrthoTraumaMD may have some thoughts

 

[Med Ed]

Hi guys,

I'm an M3 looking for some honest opinions regarding my residency options. M1 was a rough year for me, as my father was diagnosed with cancer and I struggled to balance this with my academic load. I ended up failing two courses and consequently had to repeat the second semester of M1. I returned on academic probation and worked extremely hard to succeed throughout M1 and M2 not only in courses but also my step prep. The hard work paid off as I was removed from probation and went on to score 257 on step 1.

I've also built a decent research background with 4 publications, 3 posters, and more projects in the works. Almost all of this research has been in ortho under the same mentor since I started med school. She has supported me through everything and strongly advocates for me to pursue ortho for residency, particularly at our program. She's on the admissions committee and assuming M3 goes well, I could be relatively competitive. However I have my doubts about my chances in such a selective specialty with my M1 red flag. I could see my app getting thrown out immediately in some cases... but how often? The uncertainty has been kind of unsettling.

I really love ortho given my exposure thus far, but I realize I may need to be realistic and consider other options... and that isn't the end of the world. At the end of the day I'm thankful I was able to have another chance at this career and find success with the preclinical years. My Dad is also doing really well so I couldn't ask for anything more.

Other info:
top 40 US allopathic school
some interesting extracurriculars and probably average leadership/ volunteering experiences

Quite a dilemma, but I agree with the harsh assessment above. Ortho programs can have their pick of people with near flawless academic records. You will get screened out and almost certainly go unmatched.

That, in and of itself, is only part of the problem. To attempt ortho in spite of the long odds will require you to do a lot of ortho clerkships, including audition rotations. Your transcript will declare your true intention in no uncertain terms. This will damage your competitiveness for other specialities, which combined with a 5-year graduation and academic probation will only serve to lessen your appeal.

Your best bet is to find a moderately competitive specialty that you enjoy and go all in. You will find many more PDs who are willing to look at your entire application and see your upside. Good luck.

 

[VA Hopeful Dr]

The above post or may be a little bit harsh here. While a failure of any kind is certainly Nearly a death sentence for getting into higher end fields, having a parent diagnosed with cancer and battling through and coming out with a near 260 step score may certainly be the thing to turn some heads. Others would probably know this field better than I, But if anyone has shown resilience and a darn good excuse for having a failure on their record, it would be you. @OrthoTraumaMD may have some thoughts

That was my initial thought as well.

Maybe talk to your local ortho department, if you have one, and get their thoughts.

 

[ed*26]

This is where having a couple well-known mentors who have your back will make or break you. If M3 and Step II go well and your research activities continue to go well, you should have a decent shot. Yes, some residencies will screen you out automatically. You need to get human eyes on your app. The key is that when applications go out, you have your mentors put in a good word for you before interviews start going out. This means your mentor gets on the phone and explains your situation and why you're actually a great candidate. Obviously your chances are higher if you have more than one advocate, since you can't ask one person to call dozens of schools.

Source: Upperclassmen who have matched into similarly competitive fields with a similar red flag impacting grades. We have an excellent advisor.

 

[WiseOne]

I don't think it's a very red "red" flag. More like light pink. You definitely have a good-fair chance based on what I'm reading. It happened M1 year and you have a very good explanation for what happened. Ignoring that the rest of your app seems very competitive. I'm sure you will at least get a handful of interviews and during the interview you can easily assuage their concerns (if you haven't already in your ERAS app). But I agree with other posters that you need to leverage connections.

 

[puahate]

You probably need strong letters that will vet for you 110%

 

[bananafish94]

I think that very few people on SDN will be able to advise you in this situation. You should talk to your home orthopedics program and get their opinion. I'm only an M3 as well but I would be inclined to think that with a Step 1 that high and in the context of such a stressful life event there would be programs that would be interested, especially if your research, letters, clinical/aways are in order.

 

[totoroooo]

Thank you everyone for the candid feedback.

That was my initial thought as well.

Maybe talk to your local ortho department, if you have one, and get their thoughts.

I think that very few people on SDN will be able to advise you in this situation. You should talk to your home orthopedics program and get their opinion. I'm only an M3 as well but I would be inclined to think that with a Step 1 that high and in the context of such a stressful life event there would be programs that would be interested, especially if your research, letters, clinical/aways are in order.

My mentor has been supportive of me pursuing ortho and even mentioned the program having accepted students with issues such as repeated years or step failures. Of course, these situations were exceptions to the norm. I agree I should get more info from my program regarding my chances. As far as SDN goes, I was hoping I could hear from others who have been in a similar situation but any insight is great.

 

[Med Ed]

As far as SDN goes, I was hoping I could hear from others who have been in a similar situation but any insight is great.

My n is low, but 100% of the students I know who have attempted ortho with a red flag have gone unmatched.

 

[SeldingerFan78]

You might have a chance with the right spin. Not all med schools share whether or not you failed something your first year. If all residency programs see is extra time, I think you could say that you took the time to be with your family and reflect on your goals/priorities. Perhaps you realized that you had a passion for ortho and focused your energy into that passion to best care for your future patients. You could also note how your experience may allow you to better empathize with patients who are struggling with their own challenges in life. Might be worth having a back up plan, but I think I could market you into ortho.

 

[totoroooo]

My n is low, but 100% of the students I know who have attempted ortho with a red flag have gone unmatched.

were these cases with an otherwise competitive application? I would think an academic red flag may usually be correlated with average or less competitive applicants (lower board scores/clinical grades, less research and networking) and thus it was a collection of associated factors that typically come along with the red flag itself that led to going unmatched. Then again, if they tried to match ortho they probably had some strong points that gave them enough confidence to try.

 

[bananafish94]

My n is low, but 100% of the students I know who have attempted ortho with a red flag have gone unmatched.

Just out of curiosity, is this really that red a flag? This person had to repeat a semester because they did poorly during a pretty major life stressor, but came back with a phenomenal Step 1 and an otherwise very solid application. Of course I may be wrong, but it sounds like this should assuage any concerns people might have about their pre-clinical knowledge base or deficits at all.

 

[kb1900]

Just out of curiosity, is this really that red a flag? This person had to repeat a semester because they did poorly during a pretty major life stressor, but came back with a phenomenal Step 1 and an otherwise very solid application. Of course I may be wrong, but it sounds like this should assuage any concerns people might have about their pre-clinical knowledge base or deficits at all.

This would require the application reader to actually think when reading the app rather than just fixating on the F and throwing it out.

I can’t imagine anyone actually thinks this person has a knowledge deficit with a 257

 

[Med Ed]

were these cases with an otherwise competitive application?

Yes. The problem for the OP is that the ortho applicant pool is filled with people who have 250+ step 1 scores, productive research, and zero academic blemishes. Every year people with great apps fail to match simply because they are unlucky.

 

[WiseOne]

I've seen people with sub-240 step scores match derm and ophtho from my school simply due to having the right connections and doing well on away rotations. People matching in their field of choice despite only having two interviews. So it's not as if you have no chance. PDs want human beings in their programs not applications. Someone they'd like being around for 5 years. So the application will either get you the interview or not (in your case I'm pretty sure you'll get at least a handful). From there more subjective factors take hold.

 

[twospadz]

I've seen people with sub-240 step scores match derm and ophtho from my school simply due to having the right connections and doing well on away rotations. People matching in their field of choice despite only having two interviews. So it's not as if you have no chance. PDs want human beings in their programs not applications. Someone they'd like being around for 5 years. So the application will either get you the interview or not (in your case I'm pretty sure you'll get at least a handful). From there more subjective factors take hold.

I still think he has no chance. His application will get auto filtered before they can even see it. Programs don't have time to shuffle through 500+ applications. He would only possiblely get interviews from programs he rotated at or his home program.

 

[IMreshopeful]

Yeah unfortunately I have to agree with those saying that this makes your chances for ortho pretty slim. I feel for you OP - I would never wish what happened to you on anyone. The problem is as others have stated is that the applicant pool is so insanely competitive for ortho that you may simply get screened out due to very strict criteria. That being said I would talk to your ortho mentors about it and see what they say.

I would consider having a backup specialty. Surprisingly all four people I know who were unsuccessful for ortho actually applied to IM instead (they obviously had competitive applications) and matched very well. Two are cardiology fellows and two are heme/onc fellows. I would consider looking into what else you would like as a career potentially that would otherwise also satisfy your interest - whether it’s gen surg, IM, anesthesia, psych, whatever. Understand that other competitive subspecialties will also be very tough to get into with that issue (ENT, ophtho, derm, etc).

 

[IMreshopeful]

Yes. The problem for the OP is that the ortho applicant pool is filled with people who have 250+ step 1 scores, productive research, and zero academic blemishes. Every year people with great apps fail to match simply because they are unlucky.

Ehh “productive” is perhaps a stretch. Maybe in terms of numbers of papers etc but not so much actual useful research. There’s a lot of resume padding with any medical school level research which exists solely to help bolster residency prospects. Let’s be honest.

 

[Med Ed]

Ehh “productive” is perhaps a stretch. Maybe in terms of numbers of papers etc but not so much actual useful research. There’s a lot of resume padding with any medical school level research which exists solely to help bolster residency prospects. Let’s be honest.

Given the time constraints of medical school I generally consider "productive" to mean any work that generates at least an abstract. A lot of student research (and research in general) does not culminate in anything publishable.

 

[IMreshopeful]

Given the time constraints of medical school I generally consider "productive" to mean any work that generates at least an abstract. A lot of student research (and research in general) does not culminate in anything publishable.

Agree. Makes you wonder what’s the point - clearly these people aren’t doing the research because they LOVE doing ortho research, let alone the specific project they’re working on. But that’s how the system is

 

[OrthoTraumaMD]

Have a backup plan.
And if you are still gunning for ortho, you absolutely need stellar letters AND someone to make a phone call for you to a PD. Otherwise people may not look at your application closely enough and will dismiss you. But the failure of M1 and a step of 257 is incongruous enough that I would consider, provided someone I respected vouched for you. If your mentor is well connected, you have a shot.


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[dpmd]

I think that while the odds are against you it probably isn't unreasonable to try for it. Either with a backup specialty or with a plan for what you will do if you fail to match. Or you can decide to pursue a plan b field up front. I don't think that pursuing ortho means you won't be able to get a backup specialty. Biggest thing will be to decide if you are ready to commit to that specialty or if you are going to keep trying to get in. If the former, then just make it clear and have a reason why you decided to change (or why it is your backup but you are ready to follow through if selected). If the latter then stick to preliminary spots.

 

[NYCdude]

Honestly, if it were me in your situation, I tend to be more risk averse and would just apply to Gen Surg. That way I'd have the opportunity to do surgery, but still be able to subspecialize in something cool later.

 

[WiseOne]

worst case scenario you can apply to some backup preliminary surgery programs. I've seen at least one person from my school do this successfully and match the second time he applied.

 

[dpmd]

worst case scenario you can apply to some backup preliminary surgery programs. I've seen at least one person from my school do this successfully and match the second time he applied.

Not exactly a worst case scenario there. Worst case would be more like trying in vain to get into ortho over multiple years until finally giving up but now it has been long enough that programs that would have considered you in your backup specialty are no longer willing to and you end up as a prelim for years trying to get in to your back up until finally settling on a specialty you have no real interest in at a malignant program and you hate your life until you die.

 

[Angus Avagadro]

I would target a specific program, audition there, and shine. Keep letting know they are too out #1 choice. Your attitude and work ethic might save the day. I would target a middle tier program