Step 1 failure + 1 failed clerkship. How do I come back from this?

[owlsandturtles]

I'm a student at a US MD mid-tier school. Unfortunately 3rd year has been really difficult for me so far - I ended up failing Step 1 and also my first clerkship (will show up as an F on transcript). I'll have to redo the clerkship and will also retake Step 1 soon.

Considering I pass and score well on the Step 1 retake, score well on Step 2, and pass all remaining clerkships, what can I expect when applying to residencies? Obviously, I know this is a major red flag but I'm hoping being able to come back from all of this will show resiliency? What else can I do at this point to be a better applicant?

I'm (extremely) interested in Psychiatry and don't really see myself in any speciality outside of that, although I'll obviously go into any speciality that will take me.

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[Lawpy]

Oof, another Step 1 failure. Well that and a clerkship failure will hurt, especially if that failed clerkship was on psych. What happened?

There's a lot of hypotheticals and assumptions here that makes it hard to give advice. Your goal first and foremost should be to pass on the retake for both Step 1 and the clerkship and make sure you don't fail other rotations.

There may be a chance to match in psych after all that but i'm also going to tag @Mass Effect @Stagg737 for thoughts

 

[Mass Effect]

I'm a student at a US MD mid-tier school. Unfortunately 3rd year has been really difficult for me so far - I ended up failing Step 1 and also my first clerkship (will show up as an F on transcript). I'll have to redo the clerkship and will also retake Step 1 soon.

Considering I pass and score well on the Step 1 retake, score well on Step 2, and pass all remaining clerkships, what can I expect when applying to residencies? Obviously, I know this is a major red flag but I'm hoping being able to come back from all of this will show resiliency? What else can I do at this point to be a better applicant?

I'm (extremely) interested in Psychiatry and don't really see myself in any speciality outside of that, although I'll obviously go into any speciality that will take me.

Which clerkship was it that you failed? That may help with giving advice.

 

[owlsandturtles]

Which clerkship was it that you failed? That may help with giving advice.

Failed my peds clerkship (due to the shelf exam score, evals were fine/no other issues).

 

[Mass Effect]

Failed my peds clerkship (due to the shelf exam score, evals were fine/no other issues).

As long as you didn't get a bad eval, you may be ok, but chances are definitely diminished somewhat. You need to make sure you pass Step 1 and you need to pass Step 2 on first try. Redo peds and blow it out of the water. Your school has a terrible policy of failing people due to the shelf, but nothing you can do to change that so you need to learn the game and play it well. No more fails. Psych is still within reach (not top programs), but will need some serious rehab to get there.

 

[Redpancreas]

I am so sorry this has happened. I can only imagine what it feels like to have strived for a difficult path like medical school and being sold on a field and now feeling like it's out of reach putting into question all your previous work to some extent.

I haven't been through Psychiatry applications but the field has been generating a lot of interest lately and it seems at least mildly competitive so I imagine a Step 1 failure is definitely a huge road block to matching. A lot of SDN posters over the last year here have talked about matching Psych with similar issues (Step failures, etc.) and the general community's rightfully recommended forgetting it and applying family BUT most of those posters are Caribbean grads...For you as a US M.D., it may be more nuanced. The pediatrics shelf failure to me isn't as alarming because you've already shown that your test-taking is weak and if your evaluations and clinical work are truly preserved, there may be some Psych programs willing to give you a look if there are no more issues on shelves and your Step 2 comes back solid (i.e. average). You may be able to address the Step 1 failure in your PS, have your psych mentors talk about how awesome you are in LORs, point to your (currently hypothetical) improvement with Step 2, and your answer to "describe a time you faced a challenge" is cut out for you (again if you do well on Step 2). If that's the situation that unfolds, I think you've got a fighting chance at matching.

How feasible is turning this around though? Frankly, the actual way to fix this is to have you go back and repeat M1/M2 and come back because you clearly lost your way somewhere along that path. Realistically that's not an option so you need to do the next best thing and get a high quality private tutor that:

1) Re-teaches you Step 1 while covering Step 2
2) Gives you high yield stuff to do everyday. Everyday matters and you don't have time to waste struggling to figure out what to study.
3) After time, identifies areas you struggle in particularly with and then focuses on those with you.

Even forgetting Psych for a second, what's the chance that you pass the next shelf exam without serious intervention? Probably not very high.

 

[mrbreakfast]

(due to the shelf exam score, evals were fine/no other issues).

This is such a strange policy that I'm honestly surprised to hear everything else was fine. I've never heard of failing students due to the shelf alone. In my med school failing the shelf (getting <5th percentile) meant you had to retake the shelf; you'd only fail the clerkship if you failed the shelf again on the retake.

As noted above, the biggest obstacle is a potential issue with standardized tests. The question isn't whether it's possible to recover from this - it is - but how you can ensure you won't fail more shelves or do poorly on the step 1 retake. I would talk to someone about study/test-taking strategies.

 

[operaman]

I have definitely seen people come back from this but it is not for the faint of heart. I think your biggest obstacle right now is whether you will be able to graduate at all. I know it’s tempting to want to focus on long term strategy right now, but a step 1 failure plus a peds failure does not bode well for the more difficult shelves or step 2. The best thing you could do right now is start getting help from your school to figure out what’s going on so you can fix whatever needs fixing.

If you can figure out what’s going on and fix it, I think you do have a chance IF you’re good clinically and make a great impression on your home faculty. For anyone with major red flags, your best shot of matching anything is going to be your home program. In addition to studying and passing, impressing your psych faculty is a top priority. Definitely consider backup options too; all my friends doing primary care complain that they’re practicing a ton of psych.

 

[owlsandturtles]

Thank you everyone for all the responses. I've been talking to the education office at my school and discussing a revised schedule/accommodations and will also start treatment for ADD. Hopefully I'll be able to move forward and perform well on everything that's upcoming - and match into literally any psychiatry program.

 

[Stagg737]

@owlsandturtles , agree with both Mass Effect and Operaman. First things first, pass Step 1, get through your peds clerkship. Do NOT fail anything else. Make sure you kill your psych rotation, get a strong LOR there and recommend 2 solid psych letters and 2 solid non-psych letters total (to show you can work with other fields). Make sure the letters are clear you're going for psych though.

Like ME said, you're not out for psych, but you're going to have to apply more broadly than most other MD students and significantly limit your reach programs. To give you a reference, I'm a US DO with no Level failures, one M2 remediation, and straight P's in 3rd year. Got great comments from attendings (likely would have had quite a few H's or HP's at other schools d/t this) and strong letters. Applied to 75 ACGME programs with 3-5 true reaches and 30+ "safety" programs. Ended up with 8 interviews, 2 of which were very surprising to me, and matched at my #1 ("mid-tier" academic where I had a very strong audition rotation).

You've still got a shot at psych, but don't get ahead of yourself and focus on what you need to do now. Best of luck!

This is such a strange policy that I'm honestly surprised to hear everything else was fine. I've never heard of failing students due to the shelf alone. In my med school failing the shelf (getting <5th percentile) meant you had to retake the shelf; you'd only fail the clerkship if you failed the shelf again on the retake.

My school had the same policy. You could fail if you either failed the shelf or performed so poorly on the rotation that the attending failed you (only heard of this once, and the student literally skipped most of the rotation). Shelf score was 100% of our grade. Idr what the standard was, but I think below 5-10th percentile nationally was failing. Above 80th percentile was honors.

 

[DrDummyAccount]

This is such a strange policy that I'm honestly surprised to hear everything else was fine. I've never heard of failing students due to the shelf alone. In my med school failing the shelf (getting <5th percentile) meant you had to retake the shelf; you'd only fail the clerkship if you failed the shelf again on the retake.

My school has the same policy. Must get >5th percentile on the shelf to pass. They use percentile cutoffs to determine high pass and honors as well. Our clinical exams really don’t matter even though admin “claims” they do; thats really just for deans letter comments. Such a dumb policy.

My school has the same policy. Must get >5th percentile on the shelf to pass. They use percentile cutoffs to determine high pass and honors as well. Our clinical scores really don’t matter even though admin “claims” they do; thats really just for deans letter comments. Such a dumb policy.

 

[Dral]

Thank you everyone for all the responses. I've been talking to the education office at my school and discussing a revised schedule/accommodations and will also start treatment for ADD. Hopefully I'll be able to move forward and perform well on everything that's upcoming - and match into literally any psychiatry program.

That sounds like a good start. How have you performed on standardized exams in the past?

Unless things have changed with Step I since I took it, it's not an issue of exams that are translating knowledge as it applies to patient care so much, but maybe either study strategy or an exam taking issue.

As others have alluded to, I think it's best to focus on more immediate things. It's good to think ahead, but really focus on these next few months taking it one step at a time (pun honestly not intended).

 

[olek]

I'm a student at a US MD mid-tier school. Unfortunately 3rd year has been really difficult for me so far - I ended up failing Step 1 and also my first clerkship (will show up as an F on transcript). I'll have to redo the clerkship and will also retake Step 1 soon.

Considering I pass and score well on the Step 1 retake, score well on Step 2, and pass all remaining clerkships, what can I expect when applying to residencies? Obviously, I know this is a major red flag but I'm hoping being able to come back from all of this will show resiliency? What else can I do at this point to be a better applicant?

I'm (extremely) interested in Psychiatry and don't really see myself in any speciality outside of that, although I'll obviously go into any speciality that will take me.

Nothing is impossible, but it will definitely be harder. One advantage you have is time. Use this time to get involved in psych if that’s what you’re interested in: psych research, interest groups, community involvement related to psych. You’re damaged goods now, but you can still make yourself a diamond in the rough.

 

[hfiso]

I'm a student at a US MD mid-tier school. Unfortunately 3rd year has been really difficult for me so far - I ended up failing Step 1 and also my first clerkship (will show up as an F on transcript). I'll have to redo the clerkship and will also retake Step 1 soon.

Considering I pass and score well on the Step 1 retake, score well on Step 2, and pass all remaining clerkships, what can I expect when applying to residencies? Obviously, I know this is a major red flag but I'm hoping being able to come back from all of this will show resiliency? What else can I do at this point to be a better applicant?

I'm (extremely) interested in Psychiatry and don't really see myself in any speciality outside of that, although I'll obviously go into any speciality that will take me.

Out of curiosity, how were you doing in school years 1&2? Was this out of nowhere or were you struggling then as well? Sorry I can’t be of assistance

 

[GoSpursGo]

I agree with others, you really need to take this one step at a time.

First things first, you have to do better on Step 1. And not just pass it, but you have to score well above the passing cutoff. Psych is still generally not competitive, but it is becoming increasingly so. The match rate for applicants with a score <200 over the last 5 years is 76%, but if you look just at 2020 it drops to 66%. Even for 201-210 it's just 85%, which isn't high enough to feel super comfortable when you have the added red flags of an actual failure and a clerkship failure. So I would say if you get anything less than a 210, I think you really have to question whether you're up for that level of risk.

If you can get that number, then I think you need to see how you do on your psych clerkship, and at the end of it sit down with your home program PD and get an honest appraisal of your chances. Your best chance at matching with these red flags is probably going to be with your home program, so if they give you a lukewarm response... again, you need to decide for yourself how much risk you're willing to take.

 

[owlsandturtles]

Out of curiosity, how were you doing in school years 1&2? Was this out of nowhere or were you struggling then as well? Sorry I can’t be of assistance

I was able to get through the first 2 years without having to remediate anything but it was extremely difficult, not to mention terrible for my mental health. I probably should have tried to seek help earlier, but I guess some combo of pride/stubbornness/aversion to being dependent on medication got in the way.

Some advice to anyone reading this and struggling - seek help early!!! It's NOT worth it to wait, it will catch up to you at some point. And unfortunately, there's not a lot of room for mistakes in medical education.

 

[owlsandturtles]

That sounds like a good start. How have you performed on standardized exams in the past?

Unless things have changed with Step I since I took it, it's not an issue of exams that are translating knowledge as it applies to patient care so much, but maybe either study strategy or an exam taking issue.

As others have alluded to, I think it's best to focus on more immediate things. It's good to think ahead, but really focus on these next few months taking it one step at a time (pun honestly not intended).

Standardized exams were honestly a strength for me (99th%ile on ACT and SAT) but only because those did not require a lot of prior studying and reading comprehension comes easily to me. I've learned that my main obstacle really was pretty severe ADHD. The MCAT was harder because it required more concrete knowledge (and actual studying which I don't have the attention span for) so I did less well, but still scored fine - 96th%ile - thanks to a perfect score on the reading & psych sections.

Medical school hit me like a ton of bricks lol. I'm hoping that addressing study strategies, getting tutoring, and medication will help me get back on track. It is really hard to not think about long term issues/matching though.

 

[Lawpy]

Standardized exams were honestly a strength for me (99th%ile on ACT and SAT) but only because those did not require a lot of prior studying and reading comprehension comes easily to me. I've learned that my main obstacle really was pretty severe ADHD. The MCAT was harder because it required more concrete knowledge (and actual studying which I don't have the attention span for) so I did less well, but still scored fine - 96th%ile - thanks to a perfect score on the reading & psych sections.

Medical school hit me like a ton of bricks lol. I'm hoping that addressing study strategies, getting tutoring, and medication will help me get back on track. It is really hard to not think about long term issues/matching though.

Hmm well that makes the situation unusual because a good MCAT translates to good Steps, and something clearly went really wrong here. But looks like you understood what to do next, so focus on nailing Step 1 and excelling on the peds shelf

 

[Dral]

It sounds like some study strategies will help along with addressing any other underlying issue (such as ADHD). When I studied for Step I, I sat down at the beginning and outlined about a month or so time where I had basically every hour of the day accounted for (Wake up, 8-9 breakfast and UWorld quiz, 9-10 BRS physiology 3 chapters, 10-11 go for run, 11-12 read over UWorld answers, etc). If you haven't tried it before, a more structured approach like that may help you stay on track. If you have attention span issues, maybe try to break your day up into even smaller chunks with small breaks in between. You'll have to figure out what works for you.

 

[Phloston]

I'm a student at a US MD mid-tier school. Unfortunately 3rd year has been really difficult for me so far - I ended up failing Step 1 and also my first clerkship (will show up as an F on transcript). I'll have to redo the clerkship and will also retake Step 1 soon.

Considering I pass and score well on the Step 1 retake, score well on Step 2, and pass all remaining clerkships, what can I expect when applying to residencies? Obviously, I know this is a major red flag but I'm hoping being able to come back from all of this will show resiliency? What else can I do at this point to be a better applicant?

I'm (extremely) interested in Psychiatry and don't really see myself in any speciality outside of that, although I'll obviously go into any speciality that will take me.

Do well on 2CK. Don't fail anything else in school. You will get eliminated by various programs, but it's not insurmountable. People fail stuff all of the time and match. Oh and also, don't listen to negative people here.

 

[wildkitten]

@owlsandturtles , agree with both Mass Effect and Operaman. First things first, pass Step 1, get through your peds clerkship. Do NOT fail anything else. Make sure you kill your psych rotation, get a strong LOR there and recommend 2 solid psych letters and 2 solid non-psych letters total (to show you can work with other fields). Make sure the letters are clear you're going for psych though.

Like ME said, you're not out for psych, but you're going to have to apply more broadly than most other MD students and significantly limit your reach programs. To give you a reference, I'm a US DO with no Level failures, one M2 remediation, and straight P's in 3rd year. Got great comments from attendings (likely would have had quite a few H's or HP's at other schools d/t this) and strong letters. Applied to 75 ACGME programs with 3-5 true reaches and 30+ "safety" programs. Ended up with 8 interviews, 2 of which were very surprising to me, and matched at my #1 ("mid-tier" academic where I had a very strong audition rotation).

You've still got a shot at psych, but don't get ahead of yourself and focus on what you need to do now. Best of luck!



My school had the same policy. You could fail if you either failed the shelf or performed so poorly on the rotation that the attending failed you (only heard of this once, and the student literally skipped most of the rotation). Shelf score was 100% of our grade. Idr what the standard was, but I think below 5-10th percentile nationally was failing. Above 80th percentile was honors.

Hey! Can I message you about your experience applying?