I agree. Unless there's one red flag in your app that you know about and can remove (bad letter), then a prelim year won't help you. I mean, you'll be a better intern by far, but your odds go way down. You're not going to fix bad step scores, a low GPA, or a personality disorder.
But I will say it is pretty important that you go to a place with an EM residency if at all possible. Doing an EM elective isn't that hard during a prelim year usually. Doing an away elective is much, much harder.
I do have a red flag, I failed the COMLEX Level 2 PE on my first attempt, passed it the second time. Honestly, I have no idea why I failed it. None, whatsoever. I have never failed a clinical rotation, OSCE, or simulated patient encounter. After my failure, my school reviewed my OSCEs and found no red flags, so they let me stay on rotations, retake the exam, and I passed. This is exactly how I explained this to the PDs at the places that I interviewed. I was trying to be truthful, because I have NO IDEA why I failed the first time since the NBOME doesn't provide a rubric/reason why the applicant failed. The PDs that I spoke with seemed like they could look past my initial failure but who knows, I'll have a better idea come Monday.
I interviewed only at 4 programs - 3 of which I rotated at. I rotated at a program late in the cycle. I received a phenomenal end of rotation evaluation. For the sake of anonymity, I wont discuss all of the comments that were written on my eval but I was evaluated by 9 different physicians that I worked with. Their comments were anonymous but a few of them included:
- functions well above his class and better than some of our PGY-2
- smart, nice, skilled interpersonally, would be a great addition to the residency program
- great evaluation of patients, history and ddx significantly above most. I would be pleasantly happy if student matched at our program
- excellent work ethic, teachable, history and ddx well above peers
-demonstrates advanced thought process for level of training. Excellent work ethic. Well liked by patients and staff. Helpful in ultrasound
-needs to be ranked in top 25%
This program promised my an interview but I never got one. The chief talked to the PD for me twice and one of the physicians who I worked with also talked to the PD on my behalf, but I was not given an interview. I actually just ran into one of the docs who wrote some of the comments on that eval and he said that he looked forward to me matching with them. I had to inform him that I didn't even get an interview. He was very surprised but wished me well and told me that I would make a great resident. I don't feel sour about this, I genuinely really liked the program and grateful for the opportunity to rotate in that department. One thing that I've taken away from this is that it will be highly unlikely that I will match (and need to plan accordingly) if I can't even get a a program that wrote such a great eval for me to even offer me an interview.
I'm just afraid that this one failure on the PE is going to be something that nobody is going to be able to look past. This is the reason I wanted to do pre-lim because I truly believe that If I do prelim at an insitution with an EM program, that I will be able to impress the residents and faculty by doing an early, dedicated EM rotation and possibly EM as an elective. I would really appreciate any advice on how to proceed given my situation.
