So my 3rd year IM rotation didn't go so well, what to make of it?

[SLC]

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I'm at the end of 3rd year, and I am worried that I've found myself at a crossroads.

I did my last IM rotation at a local community hospital, one that happens to operate an IM residency. unfortunately the rotation didn't go as well as I'd hoped; it actually went kinda horrible. I could give you a sob story as to why, but in the end it doesn't really matter since it won't change my grade.

About the only positive I have coming out of that hellish month is that if I do decide to pursue IM (I want a Heme-Onc fellowship in a bad way) I know for certain one place I won't be applying to. I definitely don't think that program would be worth my time applying to.

So here's the deal, I got a High-Pass on my eval from my outpatient IM rotation, and a pass on the inpatient rotation mentioned above. I honored the shelf exam, which brings my grade in both rotations to a high-pass (have to get honors from the eval to get honors overall). I know High-pass isn't horrible, but it gets worse.

On the comments from the inpatient rotation, there were some things written that were less than flattering. Things like "could use work on oral presentation", or "differential diagnosis list shorter than expected 2/2 somewhat limited knowledge base" (nevermind that my principle diagnosis was correct on every single patient I worked up).

On the other hand, I have a few comments on there from some of the other attending docs that were very flattering; things like: "Had an excellent knowledge base", or "explained pathophysiology better than many of the residents" etc.

Some of the comments from different attendings on the same rotation actually contradict each-other. It's so frustrating, and I feel like most of the problems I had were a result of a horrible senior resident, and the havoc she wreaked on my last two weeks on the service. I know, I know; I should get used to this type of thing and not let it affect my rotation; but she was really bad and I didn't know how to handle it since all of my other experiences had been so positive up until that point.

So I guess my question is: how much do you think this rotation is going to affect my chances at a Heme-Onc worthy residency? Should I be worried, or is it not that big of a deal?

In case anyone is wondering: I'm a DO students, in the top 40% of my class, I have a USMLE-1 of 227, and I have very consistent and above average performance in the pre-clinical years, and on my 3rd year rotations so far. I know those comments are going to find their way onto my dean's letter, how concerned should I be?

I like outpatient medicine, but I really liked OB, and I sorta liked Peds, so if I were going to go the Primary Care route, I think I'd be happier with Family Med. But I did an elective in Heme-Onc earlier in the year and I really really loved it; and I feel I have what it takes to do well there both as a knowledgable doctor, and emotionally.

Do I need to be thinking about Family Med now? In other words, are my chances at a good IM residency going to be significantly impacted by those comments?

TL;DR: How bad are some less than positive comments on a CPE that will likely end up in a dean's letter for my chances at a good IM residency? Even if I got a High-Pass overall on the rotation?

 

[Raryn]

I'm at the end of 3rd year, and I am worried that I've found myself at a crossroads.

I did my last IM rotation at a local community hospital, one that happens to operate an IM residency. unfortunately the rotation didn't go as well as I'd hoped; it actually went kinda horrible. I could give you a sob story as to why, but in the end it doesn't really matter since it won't change my grade.

About the only positive I have coming out of that hellish month is that if I do decide to pursue IM (I want a Heme-Onc fellowship in a bad way) I know for certain one place I won't be applying to. I definitely don't think that program would be worth my time applying to.

So here's the deal, I got a High-Pass on my eval from my outpatient IM rotation, and a pass on the inpatient rotation mentioned above. I honored the shelf exam, which brings my grade in both rotations to a high-pass (have to get honors from the eval to get honors overall). I know High-pass isn't horrible, but it gets worse.

On the comments from the inpatient rotation, there were some things written that were less than flattering. Things like "could use work on oral presentation", or "differential diagnosis list shorter than expected 2/2 somewhat limited knowledge base" (nevermind that my principle diagnosis was correct on every single patient I worked up).

On the other hand, I have a few comments on there from some of the other attending docs that were very flattering; things like: "Had an excellent knowledge base", or "explained pathophysiology better than many of the residents" etc.

Some of the comments from different attendings on the same rotation actually contradict each-other. It's so frustrating, and I feel like most of the problems I had were a result of a horrible senior resident, and the havoc she wreaked on my last two weeks on the service. I know, I know; I should get used to this type of thing and not let it affect my rotation; but she was really bad and I didn't know how to handle it since all of my other experiences had been so positive up until that point.

So I guess my question is: how much do you think this rotation is going to affect my chances at a Heme-Onc worthy residency? Should I be worried, or is it not that big of a deal?

In case anyone is wondering: I'm a DO students, in the top 40% of my class, I have a USMLE-1 of 227, and I have very consistent and above average performance in the pre-clinical years, and on my 3rd year rotations so far. I know those comments are going to find their way onto my dean's letter, how concerned should I be?

I like outpatient medicine, but I really liked OB, and I sorta liked Peds, so if I were going to go the Primary Care route, I think I'd be happier with Family Med. But I did an elective in Heme-Onc earlier in the year and I really really loved it; and I feel I have what it takes to do well there both as a knowledgable doctor, and emotionally.

Do I need to be thinking about Family Med now? In other words, are my chances at a good IM residency going to be significantly impacted by those comments?

TL;DR: How bad are some less than positive comments on a CPE that will likely end up in a dean's letter for my chances at a good IM residency? Even if I got a High-Pass overall on the rotation?

How certain are you that those comments will actually end up in a Dean's letter? The dean's at my medical school (or at least, the one dean I went to) made a distinction between "formative" feedback and "evaluative" feedback, and did not include the specific stuff like "could use work on oral presentation." Not 100% consistent with the intention behind the dean's letter I'm sure, but the impression I got was that everybody did it. The only negative comments that we were told would end up on it were ones that demonstrated *patterns* of behavior.

Either way, the comment doesn't matter as much because no one expects 3rd years to be masters of the oral presentation. It's a little more concerning because it's at the end of your third year, but doing a subi or equivalent at the beginning of your fourth year and getting a good letter will likely more than make up for it.

 

[heyya]

No, it won't matter in the long run. Your opportunities to get into a good residency/heme/onc fellowship will not be derailed by what 1 attending said as it appears everybody else was impressed with you. And why are you so convinced that will even be included in the letter? The purpose of the dean's letter is to highlight what's good about you. Unless you have some glaring red flags on your application that can't not be mentioned in the deans letter, I wouldn't worry. And just remember, your dean's letter is just 1 aspect of your overall profile. Your Step scores will open up doors for you and once you start getting interviews, you take it from there. You're a DO so I'm not sure about what IM programs out there are more DO friendly than others. You will have to do the research on that. But it sounds like you'll get into a solid program regardless. If I was a residency program director? I'd offer you an interview based strictly on your avatar. 👍

 

[SLC]

No, it won't matter in the long run. Your opportunities to get into a good residency/heme/onc fellowship will not be derailed by what 1 attending said as it appears everybody else was impressed with you. And why are you so convinced that will even be included in the letter? The purpose of the dean's letter is to highlight what's good about you. Unless you have some glaring red flags on your application that can't not be mentioned in the deans letter, I wouldn't worry. And just remember, your dean's letter is just 1 aspect of your overall profile. Your Step scores will open up doors for you and once you start getting interviews, you take it from there. You're a DO so I'm not sure about what IM programs out there are more DO friendly than others. You will have to do the research on that. But it sounds like you'll get into a solid program regardless. If I was a residency program director? I'd offer you an interview based strictly on your avatar. 👍

Thanks for this, and for @Raryn comments as well.

The only reason I'm convinced it will end up in my letter is because we were informed that the comments from our evals go into the letter. I guess I should ask a little more about what that means specifically as it sounds like that might not be as literal as I was taking it.

I really do hope my step scores will keep options open. They're not phenomenal by any stretch, but I think they should be good enough to get me a HemeOnc worthy residency, which is the only thing I really care about with respect to the program I match to.

I have done my research with respect to DO friendly programs, basically by a combination of looking at DO HemeOnc docs and tracing their training backward through apps like vitals.com etc. I've also just looked for university IM programs that have a good amount of DO's on house-staff. Places I have seen that seem like they'd be great include UofIowa, UofMissouri, UNM, UofA, UofKansas etc.

I'll hope that my taste in good Punk Rock opens a few doors as well 😀

In the meantime, I'm really enjoying my FM rotation at the moment; I don't think it is a bad fallback option should I decide to go that route. Like I said, if it's not HemeOnc, I think I'd be happiest as a PCP, and if I'm going to be a PCP, I'd probably rather be a Family Practitioner than an Internist due to the more comprehensive practice involved.