So I think I may have failed IM

[chocomorsel]

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So basically, I kinda got screwed. In both my general medicine months, (I had two), I had more than one attending. The first month, they split it half and half. But only one turned in an eval. The other month, we had 5 attendings. The one who lasted the longest is the one who gave me the eval. He was with us two weeks. The others were there about 3 or so days each. So of course, no evals. So on my last month, my attending gives me a bad eval. States that "I might benefit from remediating the course." My elective (consult) month I got an average eval, but no recommendation for remediation, although I did get quite a few deficiencies.

The committee is meeting tomorrow to decide about whether I have to remediate or not. I passed my OSCE and my shelf.

While I admit, I am an average student with many deficiencies, I showed up and tried. Sure sometimes I didn't see the big picture with the assessment and planning, or missed some details about my patients, but I friggin' TRIED!!!!

Anyway, just venting. The head of the curriculum is supposed to page me tomorrow so I can talk to her since I didn't talk to her before I left for an away rotation. The grades took so long to come out, and by the time they let me know that my grade was on the fence, it was just about time for me to move.

I hate third year. I miss when a test was all that mattered and you weren't graded on whether or not you were "professional", or "prepared" or whatever. All this subjective crap is going to be my serious downfall.

 

[SLUser11]

While I admit, I am an average student with many deficiencies, I showed up and tried. Sure sometimes I didn't see the big picture with the assessment and planning, or missed some details about my patients, but I friggin' TRIED!!!!

I hate third year. I miss when a test was all that mattered and you weren't graded on whether or not you were "professional", or "prepared" or whatever. All this subjective crap is going to be my serious downfall.

I think if you want us to sympathize, you might have to make a better case for why you shouldn't remediate....."I tried," and then "prepared or whatever" in close succession, along with pretty much everything else in your post suggests that you should remediate.

Medical school is supposed to be difficult, and I don't believe effort without display of knowledge or skill is worth much....at least not to me.

then again, maybe this thread is a joke, as the caricature you've created sounds almost too bad to be true.........

 

[fuzzyerin]

"i'm sorry, i tried to save your loved one. i swear i tried!"

umm....

yes, trying hard is important. but so is knowledge, which includes much more than just the correct diagnosis - it includes the paperwork, the orders, the tests, the attitude, everything.

 

[deleted87716]

I miss when a test was all that mattered and you weren't graded on whether or not you were "professional", or "prepared" or whatever. All this subjective crap is going to be my serious downfall.

Um...you mean, like real life? 😉

Tough medicine, but you've gotta swallow it. The point of it all is to make you better at what you do, not to torment you.

 

[metabolite]

States that "I might benefit from remediating the course." My elective (consult) month I got an average eval, but no recommendation for remediation, although I did get quite a few deficiencies.

By remediation, how much? If just a few weeks, you can still get satisfactory with your classmates. If the entire internal med, then maybe you can vest your time in research of something. In a long run, this could be an opportunity to better prepare yourself to be a real doctor rather than the downfall of your career. Believe me, in twenty years, none of this matters as long as you become M.D.

While I admit, I am an average student with many deficiencies, I showed up and tried. Sure sometimes I didn't see the big picture with the assessment and planning, or missed some details about my patients, but I friggin' TRIED!!!!

Depending on where you do rotations, you may be able to get away without ever showing your ability to come up with all these things. However, as I learned the hard way, if there is anyone out to get you, being unprepared or being overly nervous because you are aware that they are out to get you can only become their excuse to screw you.

Chin up! As they say, what doesn't kill you will only make you stronger...

 

[chocomorsel]

I think if you want us to sympathize, you might have to make a better case for why you shouldn't remediate....."I tried," and then "prepared or whatever" in close succession, along with pretty much everything else in your post suggests that you should remediate.

Medical school is supposed to be difficult, and I don't believe effort without display of knowledge or skill is worth much....at least not to me.

then again, maybe this thread is a joke, as the caricature you've created sounds almost too bad to be true.........

Nope, not a joke at all. And I do believe that I know a lot more than I don't. I passed first and second year without any problems. I'm not a complete *******. As, for skill, well no one really got much practice in that department. All the specialists pretty much do it all. Maybe in a rotation like surgery or anesthesia or ER or something I would get a chance to practice stuff.
And you don't have to sympathize. I was just venting online. I was just stating that the subjectivity of it all varies person to person. Obviously, because not all the attendings gave me bad evals, just one. And I actually thought that I had improved on the third month.

 

[chocomorsel]

By remediation, how much? If just a few weeks, you can still get satisfactory with your classmates. If the entire internal med, then maybe you can vest your time in research of something. In a long run, this could be an opportunity to better prepare yourself to be a real doctor rather than the downfall of your career. Believe me, in twenty years, none of this matters as long as you become M.D.



Depending on where you do rotations, you may be able to get away without ever showing your ability to come up with all these things. However, as I learned the hard way, if there is anyone out to get you, being unprepared or being overly nervous because you are aware that they are out to get you can only become their excuse to screw you.

Chin up! As they say, what doesn't kill you will only make you stronger...

Thanks. I hope that it's just a few weeks. Maybe the month that I did with him. But my grade is still not back yet. I'm hoping for the best.

 

[chocomorsel]

Um...you mean, like real life? 😉

Tough medicine, but you've gotta swallow it. The point of it all is to make you better at what you do, not to torment you.

Yup, and it is making me stronger. Guess I have to try to be a little less nervous and study a whole lot more. Let's hope that the worst case scenario is one month of remediation.

 

[chintu]

This is complete BS. It sounds like you've done well in your other rotations without any trouble and you got shot down by the subjectivity of your attendings in IM. Lots of students make mistakes in 3rd year, I mean as long as you work hard and try your best thats all that should matter as a STUDENT. Its different whey you are a PGY 3 or an attending and you have to make a diagnosis and plan for your patient. This is why we have standardized written and step II CS to ensure that all medical students are learning what they need to. If you have passed your boards and all your shelf exams and OSCE that means you have the working knowledge that an MS III should have. I have personally never heard of any student passing the shelfs but failing a rotation at my school. I'm really sorry to hear about this.

 

[njbmd]

So basically, I kinda got screwed. In both my general medicine months, (I had two), I had more than one attending. The first month, they split it half and half. But only one turned in an eval. The other month, we had 5 attendings. The one who lasted the longest is the one who gave me the eval. He was with us two weeks. The others were there about 3 or so days each. So of course, no evals. So on my last month, my attending gives me a bad eval. States that "I might benefit from remediating the course." My elective (consult) month I got an average eval, but no recommendation for remediation, although I did get quite a few deficiencies.

The committee is meeting tomorrow to decide about whether I have to remediate or not. I passed my OSCE and my shelf.

While I admit, I am an average student with many deficiencies, I showed up and tried. Sure sometimes I didn't see the big picture with the assessment and planning, or missed some details about my patients, but I friggin' TRIED!!!!

Anyway, just venting. The head of the curriculum is supposed to page me tomorrow so I can talk to her since I didn't talk to her before I left for an away rotation. The grades took so long to come out, and by the time they let me know that my grade was on the fence, it was just about time for me to move.

I hate third year. I miss when a test was all that mattered and you weren't graded on whether or not you were "professional", or "prepared" or whatever. All this subjective crap is going to be my serious downfall.

Who makes the final decision? Is it the head of the curriculum or the committee? If the final decision is in the hands of the head of the curriculum, state your case and you may not have to remediate. After all, you should have been evaluated by everyone that was a preceptor and you DID pass your shelf and OSCE.

Um...you mean, like real life? 😉

Tough medicine, but you've gotta swallow it. The point of it all is to make you better at what you do, not to torment you.

Unfortunately this is correct. Throughout residency, you are going to be graded more like this clerkship than like your pre-clinical stuff. It is a very, very subjective process and sometimes it is just unfair especially when a personality conflict gets in the middle. I am not sure if the system "makes you better" but you DO have to make some adjustments or you pay the price.

Nope, not a joke at all. And I do believe that I know a lot more than I don't. I passed first and second year without any problems. I'm not a complete *******. As, for skill, well no one really got much practice in that department. All the specialists pretty much do it all. Maybe in a rotation like surgery or anesthesia or ER or something I would get a chance to practice stuff.
And you don't have to sympathize. I was just venting online. I was just stating that the subjectivity of it all varies person to person. Obviously, because not all the attendings gave me bad evals, just one. And I actually thought that I had improved on the third month.

Make your adjustments, learn from your mistakes and keep moving forward. The first thing to do is, if you have to remediate, suck up every morsel of knowledge that you can get from the remediation. The second point is that Internal Medicine is a huge part of USMLE Step II CK so you will be that much better prepared. Third, keep moving forward, put this behind you and remember that the worse thing you are likely going to have to do is explain this at an interview. If that happens and you sail through the remediation process and have a great USMLE Step II score, just explain your remediation as the best thing that ever happened and leave it at that.

Hope you don't have to remediate because I know you just want to move on.

 

[mdphd2b]

As bleak as it may look now, things could be worse. I have a classmate who has to repeat the ENTIRE MS3 year. Basically the rule at our school (Pitt) is if a student fails 2+ clerkships, they must repeat the whole year, even the clerkships that were pass or higher. This student did not learn about the final faculty committee decision until he was in 4th year half-way thru his AI (which now doesn't count), and he had already registered for step2. Unfortunately, these late-breaking decisions from the Promotions Committee can be very costly in terms of extra time and extra loans 😡

 

[dynx]

I have a classmate who has to repeat the ENTIRE MS3 year...This student did not learn about the final faculty committee decision until he was in 4th year half-way thru his AI (which now doesn't count).

What a kick in the nuts! Jeezus christ, what are they trying to do to this poor guy? I have very little empathy left after third year (per the other thread) but this is beyond cold hearted. Did he screw around with one of the comittee members daughters?

 

[Paws]

I think if you want us to sympathize, you might have to make a better case for why you shouldn't remediate....."I tried," and then "prepared or whatever" in close succession, along with pretty much everything else in your post suggests that you should remediate.

Medical school is supposed to be difficult, and I don't believe effort without display of knowledge or skill is worth much....at least not to me.

then again, maybe this thread is a joke, as the caricature you've created sounds almost too bad to be true.........

Harsh man, way harsh.

Of course, Paws is going to side with Choco because I am also finding the subjective **** of third year is making me completely insane. Insane, I tell you!

Ok, seriously. This is really BS. I think the lack of oversite in third year clerkships, and students' well known fear of any sort of anything - like, um reprisals? - makes it completely open field for really poor management skills. As I read somewhere else on SDN, if residency was a real job, then the company would be out of business because no one would put up with that cr@p. Seriously, if residency was a free agent system, then people would be moving all over the place, switching out of malignant programs and then programs would have to somehow shape up and offer better benefits, management, etc.

In the meantime, there is huge abuse of the system. So, here is a student who has managed to get this far in her life without significant trauma or being told to remediate third grade or anything. Now suddenly, after a mad swirl of attendings she is told she is a poor student. What is that?

Bad system produces bad product. Sister, go and see if any of the other attendings/residents might say something good on your behalf. Fight for some good, someone must have thought you were decent, go find them and ask them to write their eval on you. People know it's hard, they just might come through for you. Do you have a decent dean of students? anyone on the faculty or admin that you think might be any sort of ally for you? What njbmd says is right, you would come out ahead IF you had to do it, but fight back until then. You did pass the OSCE and the shelf, which are not subjective. I am constantly amazed how we are being evaluated on knowing stuff that no one is teaching us. I mean, isn't it typical to teach first and then grade? So far I am not seeing too much teaching. To me, this is a very poor way to learn and it fosters incredible anger and resentment in the medical system.

Chin up buddy! 👍

 

[metabolite]

Choco: Most important thing is though, don't doubt yourself. As one of the post states in this thread, if you've passed your Step I, went through other rotations without problems, then right there you ARE at least where you are expected to be at. Shelf exam, yeah passing would make better argument but even if someone did not pass the shelf that doesn't mean their clinical rotation was horrible enough to fail. Seriously, how can you expect MSIII to perform at attending level? If I can do that, then I want my degree now without going through this b*lls!!t for $40+K per year!!!

 

[mdphd2b]

What a kick in the nuts! Jeezus christ, what are they trying to do to this poor guy? I have very little empathy left after third year (per the other thread) but this is beyond cold hearted. Did he screw around with one of the comittee members daughters?

Basically not passing 2 clerkships is the kiss of death at Pitt Med: For this person, one was OB/GYN and the other a 2-mo med/peds clerkship. Not passing means both failing the exam AND getting poor evals. There was no option offered to repeat the exam, or even to repeat just the two failed clerkships. What really messed things up was that OB/GYN grades at our school were submitted 10-11 mos after finishing the clerkship (and it's not even a friggin "shelf" exam!!!), hence the promotion committee's delayed response also 😡

To the OP...I know your situation sucks and you may not wanna hear this, but at least your school has offered you a more reasonable option.

 

[chocomorsel]

Basically not passing 2 clerkships is the kiss of death at Pitt Med: For this person, one was OB/GYN and the other a 2-mo med/peds clerkship. Not passing means both failing the exam AND getting poor evals. There was no option offered to repeat the exam, or even to repeat just the two failed clerkships. What really messed things up was that OB/GYN grades at our school were submitted 10-11 mos after finishing the clerkship (and it's not even a friggin "shelf" exam!!!), hence the promotion committee's delayed response also 😡

To the OP...I know your situation sucks and you may not wanna hear this, but at least your school has offered you a more reasonable option.

Yup, you are right. That other situation would likely end up with me on some psych meds. Sorry about your friend. But the thing that sucks with me is that I only didn't do well on the subjective component. Passed the OSCE and the shelf. But what do you do. Gotta squeeze in those three months into my schedule some kind of way. Means, no interview time off, no Christmas, no step 2 study time. But I'll keep trucking right along and keep my head up knowing that third and fourth year is not going to last forever. These bastards are not gonna flunk me out.

 

[chocomorsel]

Who makes the final decision? Is it the head of the curriculum or the committee? If the final decision is in the hands of the head of the curriculum, state your case and you may not have to remediate. After all, you should have been evaluated by everyone that was a preceptor and you DID pass your shelf and OSCE.



Unfortunately this is correct. Throughout residency, you are going to be graded more like this clerkship than like your pre-clinical stuff. It is a very, very subjective process and sometimes it is just unfair especially when a personality conflict gets in the middle. I am not sure if the system "makes you better" but you DO have to make some adjustments or you pay the price.



Make your adjustments, learn from your mistakes and keep moving forward. The first thing to do is, if you have to remediate, suck up every morsel of knowledge that you can get from the remediation. The second point is that Internal Medicine is a huge part of USMLE Step II CK so you will be that much better prepared. Third, keep moving forward, put this behind you and remember that the worse thing you are likely going to have to do is explain this at an interview. If that happens and you sail through the remediation process and have a great USMLE Step II score, just explain your remediation as the best thing that ever happened and leave it at that.

Hope you don't have to remediate because I know you just want to move on.

Ended up having to remediate, but as always, thanks for your sound advise and support.

 

[chocomorsel]

Harsh man, way harsh.

Of course, Paws is going to side with Choco because I am also finding the subjective **** of third year is making me completely insane. Insane, I tell you!

Ok, seriously. This is really BS. I think the lack of oversite in third year clerkships, and students' well known fear of any sort of anything - like, um reprisals? - makes it completely open field for really poor management skills. As I read somewhere else on SDN, if residency was a real job, then the company would be out of business because no one would put up with that cr@p. Seriously, if residency was a free agent system, then people would be moving all over the place, switching out of malignant programs and then programs would have to somehow shape up and offer better benefits, management, etc.
In the meantime, there is huge abuse of the system. So, here is a student who has managed to get this far in her life without significant trauma or being told to remediate third grade or anything. Now suddenly, after a mad swirl of attendings she is told she is a poor student. What is that?

Bad system produces bad product. Sister, go and see if any of the other attendings/residents might say something good on your behalf. Fight for some good, someone must have thought you were decent, go find them and ask them to write their eval on you. People know it's hard, they just might come through for you. Do you have a decent dean of students? anyone on the faculty or admin that you think might be any sort of ally for you? What njbmd says is right, you would come out ahead IF you had to do it, but fight back until then. You did pass the OSCE and the shelf, which are not subjective. I am constantly amazed how we are being evaluated on knowing stuff that no one is teaching us. I mean, isn't it typical to teach first and then grade? So far I am not seeing too much teaching. To me, this is a very poor way to learn and it fosters incredible anger and resentment in the medical system.

Chin up buddy! 👍

I agree, the system kinda sucks. We are paying to teach ourselves sometimes. And where is the support. Anyway, thanks for these words. They made me feel better.

 

[chocomorsel]

" I am constantly amazed how we are being evaluated on knowing stuff that no one is teaching us. I mean, isn't it typical to teach first and then grade? So far I am not seeing too much teaching. To me, this is a very poor way to learn and it fosters incredible anger and resentment in the medical system."


So much wisdom in this statement. I feel like so much of medical school is just like this though. We pay ridiculous amounts of money to...teach ourselves??? That's what I did in the first two years....and that seems to be a little less true in third year but still somewhat true.

I feel for u choco...that SUCKS. of course we want to do the best we can...but everyone always says as long as you try hard in third year and as long as you have a good attitude that you will succeed....so that's what I expected it to be like...i think also people tend to say a lot of ridiculous things like "medical school isnt that bad, you have to try hard to fail"....such bs. medical school is really hard enough just academically...then you throw in the responsibilities and uncertainties of third year and it's even MORE difficult.

i REALLY hope this is all worth it in the end

I hope it is worth it too, because now I'm questioning myself and my decisions. Anyway, sucks. Have to remediate three months. Yeah, third year is definetly more difficult than the first two. I never thought I would miss second year, but now I kinda do. Thanks for your support.

 

[chocomorsel]

"i'm sorry, i tried to save your loved one. i swear i tried!"

umm....

yes, trying hard is important. but so is knowledge, which includes much more than just the correct diagnosis - it includes the paperwork, the orders, the tests, the attitude, everything.

I have been trying to ignore this post for a few days but I can no longer resist. Do you really think you are going to be able to save everyone who comes to you as a patient? If so, then maybe you are a little misguided.
We try our best and sometimes our best isn't good enough. And good enough varies from person to person when you are a med student.
I'm not saying knowledge isn't important. Definetly is. But I haven't had a problem with that part over the past two years. Just now in the clinical setting. And maybe I have a problem communicating some of that knowledge. I get a little anxious presenting sometimes, you know being in front of people, being silently judged, asked questions. Again, there are some things that I didn't understand and didn't get. I'm in the middle third of my class, and acknowledge that. But I wasn't completely clueless. Don't think I would have made it this far if I had been.

 

[sophiejane]

Hang in there, choco.

You will get through it...I've rotated with people who have had to remediate IM and you are in good company--it often comes down to personality conflicts.

I personally think it's wrong if you passed both shelf and OSCE and showed up and tried hard and didn't slack off that you should have to remediate, but again, I don't know the whole story.

You had medicine pretty early in 3rd year and that's tough--it's one of the hardest rotations and you had it when you were pretty green, still.

Try to brush off rude comments like the one above. Unfortunately, medicine has its share of arrogant, self-righteous jerks. Just keep working hard and playing nice and I promise you it will pay off.

SJ

 

[sophiejane]

And maybe I have a problem communicating some of that knowledge.

You are right on with this observation...communicating what you know is one of the hardest things to learn in 3rd year. I still freeze up in front of attendings sometimes, but you do gain confidence as you go along.

Giving the impression of confidence is key. You may be freaking out inside, but acquiring the skill of faking it will serve you well in the future...😉

 

[Paws]

And maybe I have a problem communicating some of that knowledge. I get a little anxious presenting sometimes, you know being in front of people, being silently judged, asked questions. Again, there are some things that I didn't understand and didn't get. I'm in the middle third of my class, and acknowledge that. But I wasn't completely clueless. Don't think I would have made it this far if I had been.

Hey Choc-y,

Tough news, I am sorry to hear they were so harsh on you. I have also felt some of that sting as I move through third year. I am a smart enough person, and nice, most people who meet me seem to like me ok and think I am smart. But! now on third year, suddenly I am encountering all kinds of residents/interns/attendings who seem to enjoy telling me how stupid and incompetent I am. ???

Suddenly, I am a person I (or anyone who knows me) no longer recognizes. It's very disorienting to have this new label, that I really think is completely inaccurate. Plus, I have found that some residents have been really unwilling to teach. So, I am now a "stupid" person? how did that suddenly happen? I think if they would teach me something I might actually look 'smarter.'

Yeah, it's a way weird system and I think SophieJane is right. "Personality conflicts" is a polite way of saying: someone was a huge a$$**** and was able to get away with it. Most students are sincere enough and are trying hard, I find it hard to believe that a system would produce a student that was suddenly "incompetent." Maybe the system is messed up.

 

[sophiejane]

Maybe the system is messed up.

Hell yeah it's messed up. But who has the time or the determination to change it? We march along, cogs in the wheel, knowing it sucks, but unable to change it as students and unwilling as attendings.

I think I lucked out in that most of my rotations have been very benign--not alway superb learning experiences, though some certainly were.

I have a dream medical school in my head...and some ideas about how we could train doctors better than the current system of shoddy teaching and public humiliation that so many experience. Maybe someday...

 

[chocomorsel]

Thanks for your replies Sophie and Paws. I really appreciate it. I am going to try and dispute this issue and see where it takes me because I feel that it was subjectively unfair.

 

[raidermedic]

I have a dream medical school in my head...and some ideas about how we could train doctors better than the current system of shoddy teaching and public humiliation that so many experience. Maybe someday...

It would be interesting to see someone create a school with friendly faculty and reasonable hours and see how their students stack up against the traditional model. You just have to believe that one can be a good doctor without having to go through the unreasonable hours and humiliation that is rotations. On the other hand there is a lot to be said about a person who is able to cowboy up and plow through the BS that is medical training.

PS if you ever start this school up let me know and maybe I can be an attending there.

 

[sophiejane]

PS if you ever start this school up let me know and maybe I can be an attending there.

It's a deal. 🙂

 

[sophiejane]

Thanks for your replies Sophie and Paws. I really appreciate it. I am going to try and dispute this issue and see where it takes me because I feel that it was subjectively unfair.

Good for you. Keep us updated.

 

[Paws]

👍 Go for it, what do you have to lose? At least you will have the experience of having advocated for yourself, which is always a valuable thing.

 

[njbmd]

Ended up having to remediate, but as always, thanks for your sound advise and support.

Sorry to hear about this but put it behind you. You have the opportunity to pick up some extra internal medicine knowledge that can make you "rock" on Step II.

Also, as SJ said, "Fake it and eventually you will make it". Pretend like you are confident and above all, pretend like you are not remediating. Pretend that this is your first time and you are going to take every advantage of it. Pretend that you are enthusiastic even if you are dying inside because you DO have an opportunity to rack up some excellence here and experience is a good teacher sometimes.

The positives of this situation far outweigh the negatives. It's not going to be an easy situation for you but it will be something that you can grit your teeth, dig in and make the best of. The more positive your outlook, the more positive the situation will be. Soon, those months will be behind you and a year from now, it won't matter at all.

 

[ocean11]

Thanks for your replies Sophie and Paws. I really appreciate it. I am going to try and dispute this issue and see where it takes me because I feel that it was subjectively unfair.

Hey dude,

what's up? I've heard of student having a tought time at my school too, don't worry you'll get through it, you'll remediate and move on and it will be ok, if you can get through medicine you can get through the others as per what I've heard....

Anyhow, your situation kind of reminds me how I felt when I got fierd from this job that I actually tried REALLY REALLY hard at. This was 3 years ago b/fo med school, but you know what? the experience STILL hurts my self confidence and sometimes I think and doubt myself 'what happens if I will make mistakes when I graduate med school and get 'kicked out' of my profession' but I think 'everyone makes mistakes' and I've seen so many TOP attendings and residents make them, people can't fault us for making them either. Our attending today admitted that he made a mistake in diagnosing one of his long term patients and now she is here in the hospital seriously ill (sorry can't get more specific). ALSO this is a REALLY bad story: a seasoned nurse on the ICU removed a chest tube of some sort from a patient--> patient immediatly coded. The patient now is brain dead. THis happened 2 days ago or so and I was shocked to hear it this morning. SO BOTTOM LINE: everyone makes mistakes and I'm so sick of hearing that ONLY medical students get blamed, especially when we now the least..... sure residents get it once in a while but we get the brunt of it!

So CHOCO keep your head up, things will work out! 🙂

Cheers,

Ocean11