Time for me to come clean

[samac]

So I’ve been harboring a secret. I failed level 1. I didn’t want to tell anyone and kept it from my classmates and SDN. I’m admitting it to the world now.
My step father very unexpectedly passed away during my dedicated time and I should have taken the time off but I thought I could power through it. I couldn’t.
I got my **** together, took the exam again and got a 53x. Not perfect but a significant improvement.
Now I’m at an impass on what to do. If I take time off for Step 2 I will graduate after residencies start. To let you all know I’m interested in psych, and while I get that it’s more competitive I’m willing to go to a low tier program in the middle of nowhere. My school still thinks it’s a viable option.
I have a few options going forward and my school basically told me they all suck and they didn’t have much to help with. So here they are:
1. Don’t take time off for step 2. This seems extremely risky for me since I already have a failure and I’m scared to fail/score low. I have to prove I don’t suck.
2. Walk with the class of 2019 and finish in Aug. From that point I can see if residencies will take me starting late, it seems unlikely. I could also wait and apply for 2020. But does graduating in the class a year sooner look awful?
3. Graduate with the class of 2020. The school doesn’t seem to like this option, I assume because it hurts their attrition rates. But this would put me graduating with the class when I would be applying.

I’ve appreciated SDN for a long time and I appreciate your feedback.


Edit for update:
I passed PE and got a 51x on my CE. I didn’t have much of a choice when it came down to it and I will Be graduating in 2020. I’m filling my free time with some depression research with a local doc.

Edit #2 because someone liked this and reminded me it existed:
I matched! A midtier university psychiatry residency. I networked like crazy, worked my butt off on AIs, and proved myself better than failing score. I'm actually very thankful I matched in 2020 post-merger because I ended up at a program that was a reach and always ACGME. I feel very likely that last year I would have ended up at one of the 3 programs I interviewed at that were still AOA. I appreciate all the feedback and support, I have an AMA thread if someone wants to ask me a question without bumping a 2 year old thread.

---

Members don't see this ad.

 

[QueenJames]

Damn bro/sis.

Prayers out to you fam.

Whatever you end up doing, I wish you the best.

God only gives His toughest battles to his strongest soldiers.

You got this!

I got ur back regardless if nobody else does.

 

[BorntobeDO?]

So I’ve been harboring a secret. I failed level 1. I didn’t want to tell anyone and kept it from my classmates and SDN. I’m admitting it to the world now.
My step father very unexpectedly passed away during my dedicated time and I should have taken the time off but I thought I could power through it. I couldn’t.
I got my **** together, took the exam again and got a 531. Not perfect but a significant improvement.
Now I’m at an impass on what to do. If I take time off for Step 2 I will graduate after residencies start. To let you all know I’m interested in psych, and while I get that it’s more competitive I’m willing to go to a low tier program in the middle of nowhere. My school still thinks it’s a viable option.
I have a few options going forward and my school basically told me they all suck and they didn’t have much to help with. So here they are:
1. Don’t take time off for step 2. This seems extremely risky for me since I already have a failure and I’m scared to fail/score low. I have to prove I don’t suck.
2. Walk with the class of 2019 and finish in Aug. From that point I can see if residencies will take me starting late, it seems unlikely. I could also wait and apply for 2020. But does graduating in the class a year sooner look awful?
3. Graduate with the class of 2020. The school doesn’t seem to like this option, I assume because it hurts their attrition rates. But this would put me graduating with the class when I would be applying.

I’ve appreciated SDN for a long time and I appreciate your feedback.

If there is an option where you stay in 2019 and are able to graduate before Jul 1st (i.e. so you can match), I would do that. Going off cycle or graduating a year late is just adding another red flag to your app IMO. I think you should schedule as cush rotations as you can and spend as much time as possible to study level 2 material.

Also having 800 less people to compete against for residency is a good thing (400 more DO, and 400 more MD in 2020). So thats another reason to stay the course.

I am so sorry, it must suck and be very scary to be where you are, but I think that the best path is forward. Level 2 does not seem to cause as much trouble as level 1, so I think you will probably do alright there. I think you need comquest or uworld or w/e combo worked for you last time and put it towards this next level. I would schedule in late august/september so that it wouldn't automatically be on your app, and simply update programs if it goes well.

This situation is tough, but thats what I personally would try and do.

 

[trs88]

It's happens to the best of us. I would know, I got a thread in here somewhere where I talk about failing comlex 1 as well. It's funny, our 2nd try scores are less than 10 points apart.

What are your grades or study habits like right now? Does your school have your class take comats? How are you scoring on those? Are you doing any question banks to start practicing for level 2?

And the big question, when are you scheduled for level 2? Or have you scheduled yet? I'm scheduled for end of July.

The reason I ask a lot of questions, is to help gauge where you are. I'm in the same boat as you, so I would like us to stick together and take level 2 as scheduled with no time off. I know studying with no time off is super scary, I still have random nights where those thoughts of failing again come flooding back and it take hours to get to sleep afterwards. But, you can't let fear win.

 

[2021Doctor]

Good luck on your Level 2 exam.

 

[samac]

It's happens to the best of us. I would know, I got a thread in here somewhere where I talk about failing comlex 1 as well. It's funny, our 2nd try scores are less than 10 points apart.

What are your grades or study habits like right now? Does your school have your class take comats? How are you scoring on those? Are you doing any question banks to start practicing for level 2?

And the big question, when are you scheduled for level 2? Or have you scheduled yet? I'm scheduled for end of July.

The reason I ask a lot of questions, is to help gauge where you are. I'm in the same boat as you, so I would like us to stick together and take level 2 as scheduled with no time off. I know studying with no time off is super scary, I still have random nights where those thoughts of failing again come flooding back and it take hours to get to sleep afterwards. But, you can't let fear win.

I remember your thread. I followed it closely.
I have nothing scheduled yet. The school doesn’t know what I should do in this situation and neither do I.
I have some COMATs done which didn’t go well, they were all pretty low scores. It’s a weird schedule though, they were right after I failed my boards and I was kind of helpless. My school had me finish the semester than take January, February and half of March off for my retake. I suspect this comat is going to be better now that I found my groove.
So no, at this point I’m not doing anything for level 2 because I’m barely separated from my level 1.

 

[trs88]

Thanks for answering all that. I definitely see where you're coming from. For someone still licking their wounds - it's not the best idea to toss them back into the brawl.

But, I hope there's nothing anxiety inducing about just planning to take level 2. What I'd like to suggest is seeing if all your course work will be completed before July 1st 2019. That will be the ultimate "yes take level 2 or wait to take level 2" because if everything isn't completed by July 1st 2019, you cannot participate in the match. This was confirmed by my Dean at school to be correct.

Next, if you wont be done. Stress is off, point it out to the school because if you wont be done, it's probably best to stall graduation then and see if you can't squeeze a research year in or get another degree in something.

If you will be completed, that's great. Just schedule level 2 for August that way your score will be back before September for ERAS. Because, I feel if your score isn't back, you'll loose out on interviews. I say just schedule for now, because test dates can get taken up and the fact that you can study up to that point and if you aren't ready you can reschedule the exam.

Next, if your heart of hearts is saying you know you wont be ready. Start now by gathering "evidence". Your "evidence" is you prepping for level 2. Before you roll your eyes and think I'm trying to trick you into studying -it's the same situation as with medical insurance. You got a patient with back pain and some numbness/tingling in their extremities. You know you're eventually going to want some advanced imaging but insurance most likely wont pay until the patient went to physical therapy first (at least, that's what happened at clinic a few times). By you going to "physical therapy/board prep" you'll have what you need for later on when you talk to your school about why you can't take level 2 when everyone else is. Because you need extra time or else you could fail again and now show them your: question bank grades, point out your new comat scores, comsae scores, and anything else that will point out that you tried but it just didn't work in time.

For a nice, easy, early, test the waters type board prep, I recommend OnlineMedEd. He explains everything extremely well and is a great lecturer.

 

[Goro]

So I’ve been harboring a secret. I failed level 1. I didn’t want to tell anyone and kept it from my classmates and SDN. I’m admitting it to the world now.
My step father very unexpectedly passed away during my dedicated time and I should have taken the time off but I thought I could power through it. I couldn’t.
I got my **** together, took the exam again and got a 531. Not perfect but a significant improvement.
Now I’m at an impass on what to do. If I take time off for Step 2 I will graduate after residencies start. To let you all know I’m interested in psych, and while I get that it’s more competitive I’m willing to go to a low tier program in the middle of nowhere. My school still thinks it’s a viable option.
I have a few options going forward and my school basically told me they all suck and they didn’t have much to help with. So here they are:
1. Don’t take time off for step 2. This seems extremely risky for me since I already have a failure and I’m scared to fail/score low. I have to prove I don’t suck.
2. Walk with the class of 2019 and finish in Aug. From that point I can see if residencies will take me starting late, it seems unlikely. I could also wait and apply for 2020. But does graduating in the class a year sooner look awful?
3. Graduate with the class of 2020. The school doesn’t seem to like this option, I assume because it hurts their attrition rates. But this would put me graduating with the class when I would be applying.

I’ve appreciated SDN for a long time and I appreciate your feedback.

Samac, you're one of my favorite SDNers, and I'll give you the same advice I'd give any of my students.
First off, many students of mine have survived a Level I failure to finish strong and end up in decent residencies. Can you rule out UCSF or Emory Psych? Most probably, but there are still plenty of decen programs out there for you. Best advise on programs will come from our wise SDNers like @WingedOx .

Why do you think that you need extended time to prepare for Step II/Level II? You failed Level I because life hit you with a 2x4 upside the head, not because you're a weak student. (Teaching moment: outside life events are the most common cause of Boards failures for good students).

Keep in mind that Level II is much more about Dx and mgt than the basic science knowledge that level I is. The latter only makes up some 10% of Level II.

On the surface, I suggest NOT delaying a year to graduate.

Good luck!

 

[ortnakas]

My condolences for your loss. I can’t imagine losing a parent during med school.

I don’t think option 2 is a viable option— most of the AOA psych residencies will be ACGME by next year, and per the best of my knowledge, you have to be available by July 1 on the ACGME side (someone correct me if I’m wrong).

I think option 1 really is viable, given the failure was probably a fluke due to awful circumstances, but doing well and postponing graduation would be better than having a second failure, if you’re truly concerned that will happen.

 

[ThreeCheers]

I'm very sorry to hear about your loss. It is commendable that you still managed to come through with the improved score.

Will you have ANY time at all to study for Step 2? Even if you're behind the 8 ball in terms of COMAT scores, I think having even just a week or 2 of dedicated study time could make a difference. Especially if you combine those 2 weeks with a "research" elective or "radiology" "rotation". You will likely have to sacrifice some away rotations, though.

Good luck!

 

[samac]

I appreciate all the kind words and sentiments. The support means a lot to me, especially from those of you I see here often and have a lot of respect for.

So if I was going to go straight through I would finish 6/14. That is with straight rotations, I might be able to get a cushier one for the month of board study. If I took it around August- September I can still go on 3-4 auditions.

I guess my worry is my school gives most people a month off for strictly Step 2 focus and in my head I feel like I have to have that to succeed.

 

[hallowmann]

So I’ve been harboring a secret. I failed level 1. I didn’t want to tell anyone and kept it from my classmates and SDN. I’m admitting it to the world now.
My step father very unexpectedly passed away during my dedicated time and I should have taken the time off but I thought I could power through it. I couldn’t.
I got my **** together, took the exam again and got a 531. Not perfect but a significant improvement.
Now I’m at an impass on what to do. If I take time off for Step 2 I will graduate after residencies start. To let you all know I’m interested in psych, and while I get that it’s more competitive I’m willing to go to a low tier program in the middle of nowhere. My school still thinks it’s a viable option.
I have a few options going forward and my school basically told me they all suck and they didn’t have much to help with. So here they are:
1. Don’t take time off for step 2. This seems extremely risky for me since I already have a failure and I’m scared to fail/score low. I have to prove I don’t suck.
2. Walk with the class of 2019 and finish in Aug. From that point I can see if residencies will take me starting late, it seems unlikely. I could also wait and apply for 2020. But does graduating in the class a year sooner look awful?
3. Graduate with the class of 2020. The school doesn’t seem to like this option, I assume because it hurts their attrition rates. But this would put me graduating with the class when I would be applying.

I’ve appreciated SDN for a long time and I appreciate your feedback.

Forget option 2. Unless you just want to risk scrambling, its a non-starter. Your real options are Option 1 or Option 3.

The option that looks best provided you can pass and get equal or slightly higher than Level 1 is Option 1. You would pass on-time, wouldn't have an LOA delaying you, and your only redflag would be a board failure due to a real life event.

If I were you, I'd start preparing for Level 2 and take some practice exams. If things are looking OK, just take it. If things look bad, consider taking an LOA and delaying graduation so that you graduate with the next class. When you're on the LOA, I'd do research or work/volunteer in a behavioral health setting to demonstrate that you stayed relevant with regards to medicine and your interest. Good luck! You can get past this..

 

[samac]

Small update:
So My school and I are doing a back and forth. They’re insistent on me taking time off for step 2.
I figured out a secret. That you can do an EM rotation in 2 weeks working for 14 days straight. If I was to do that I could take a month for Step 2 and still finish on June 14th. It won’t be pleasant but I’ll happily do it.

The schedule they’ve made for me blocks off 3 months for Step 2 (lol).
They’re telling me I will be at a disadvantage with audition rotations and that it’s not in my best interest to do that since I’m off schedule, and that the biggest red flag I could have is a failure on Step 2 (I agree, that’s true). And to just apply the next year.

I countered that we can try it my way, and if I’m scoring acceptably on COMSAEs to let me go for it. And if I’m not to do it their way. Hope they’ll bite.

 

[DocWinter]

Good luck! Only consideration I would say is do not underestimate the wear of 2 consecutive weeks of ER...14 days of 12 hr ER shifts will burn you to beef jerky.

 

[libertyyne]

Research Year.

 

[samac]

Good luck! Only consideration I would say is do not underestimate the wear of 2 consecutive weeks of ER...14 days of 12 hr ER shifts will burn you to beef jerky.

I know it would suck, hard, but I know a few people who’ve done it to graduate on time. They wouldn’t do it any other way. I can sleep when I’m dead, hahaha.....

 

[samac]

Research Year.

Honestly I have no contacts for psych research and have no idea where to find them. It would also be that if I took the time I’d be done in October and wouldn’t have a full year to dedicate. It’s definitely a weird situation I’m in

 

[libertyyne]

Honestly I have no contacts for psych research and have no idea where to find them. It would also be that if I took the time I’d be done in October and wouldn’t have a full year to dedicate. It’s definitely a weird situation I’m in

Option 2 is worst for you IMO. Makes you look like you didnt match once and less attractive to PDs.
Offcycle matching is not something that happens that often, and PDs are not going to wait two months.

Option one is the best, but only if you will pass and be able to get everything else you need to match in time and on schedule.

Option three is better than 2, but worse than one.


Option three gives you the option to do a research year . I understand this can be difficult but cold call some places and hospitals etc to figure out if they will take you.

 

[Dr.Jekyll75]

id lean on the side of option 1. Best way to gauge if it will be a successful pass is to be honest with yourself. How have your comats been? they are crappy question but they do generally predict well if you will pass level 2. not how high your score is but if you will pass. Lastly, are you taking just level 2 or step 2 as well? will your P.E also be finished by application time ? people have told me that not having a "complete " application came back to bite them because programs dont invite without knowing everything is set

 

[samac]

id lean on the side of option 1. Best way to gauge if it will be a successful pass is to be honest with yourself. How have your comats been? they are crappy question but they do generally predict well if you will pass level 2. not how high your score is but if you will pass. Lastly, are you taking just level 2 or step 2 as well? will your P.E also be finished by application time ? people have told me that not having a "complete " application came back to bite them because programs dont invite without knowing everything is set

My PE will be finished around interview time but that’s because a lack of dates, everything being out of sorts I’ll have to take it later than others, but not the latest in my class.
I’ll let you know how the next comat goes. My first few I passed, but didn’t really do well on. I’ve got better methods now.
I’m not taking step 2. I’m not tempting the fates. Fortunately, psych is a pretty COMLEX friendly world.

 

[Dr.Jekyll75]

My PE will be finished around interview time but that’s because a lack of dates, everything being out of sorts I’ll have to take it later than others, but not the latest in my class.
I’ll let you know how the next comat goes. My first few I passed, but didn’t really do well on. I’ve got better methods now.
I’m not taking step 2. I’m not tempting the fates. Fortunately, psych is a pretty COMLEX friendly world.

if you are getting in the 100s and above on the comats you should be good.
check every day for new dates for the p.e i got one in september and was able to switch to this april. its a crap shoot i know.
if itll be ready by interview time then its better than nothing i suppose. but option 2 sucks. 3 is also crappy in my opinion. Psych is becoming increasingly competitive, so the AOA match might be your saving grace

 

[BorntobeDO?]

Small update:
So My school and I are doing a back and forth. They’re insistent on me taking time off for step 2.
I figured out a secret. That you can do an EM rotation in 2 weeks working for 14 days straight. If I was to do that I could take a month for Step 2 and still finish on June 14th. It won’t be pleasant but I’ll happily do it.

The schedule they’ve made for me blocks off 3 months for Step 2 (lol).
They’re telling me I will be at a disadvantage with audition rotations and that it’s not in my best interest to do that since I’m off schedule, and that the biggest red flag I could have is a failure on Step 2 (I agree, that’s true). And to just apply the next year.

I countered that we can try it my way, and if I’m scoring acceptably on COMSAEs to let me go for it. And if I’m not to do it their way. Hope they’ll bite.

Get it girl! You got this!

 

[ortnakas]

The schedule they’ve made for me blocks off 3 months for Step 2 (lol).
They’re telling me I will be at a disadvantage with audition rotations and that it’s not in my best interest to do that since I’m off schedule, and that the biggest red flag I could have is a failure on Step 2 (I agree, that’s true). And to just apply the next year

If they want 3 months and you want 0 months, is there any compromise that lets you graduate on time (or at least graduate before July 1)?

Highly discourage the 14 days of ED in a row plan. I had 6 days in a row to end my second EM month and I wasn’t fit for anything other than Netflix for days after that; trying to jump from working 168 out of 336 hours to hardcore studying sounds like torture.

 

[samac]

If they want 3 months and you want 0 months, is there any compromise that lets you graduate on time (or at least graduate before July 1)?

Highly discourage the 14 days of ED in a row plan. I had 6 days in a row to end my second EM month and I wasn’t fit for anything other than Netflix for days after that; trying to jump from working 168 out of 336 hours to hardcore studying sounds like torture.

The only way to get 1 month of board study is to do the ER thing. The good thing about the DO world is I’m in a small town and can probably do it in a low volume ER.
If the goal is just July 1st I can get 2 weeks in my schedule if I have to. I’d prefer to finish by my personal goal of June 14th to be able to have adequate time to relocate.

if you are getting in the 100s and above on the comats you should be good.
check every day for new dates for the p.e i got one in september and was able to switch to this april. its a crap shoot i know.
if itll be ready by interview time then its better than nothing i suppose. but option 2 sucks. 3 is also crappy in my opinion. Psych is becoming increasingly competitive, so the AOA match might be your saving grace

You’re right psych is becoming more competitive, and there’s only about 6 programs left in the DO match for this cycle. One hasn’t received pre accreditation and I’m picky enough to not apply to that one. Otherwise I’ll apply to the others. Fortunately if you’re willing to go anywhere it’s still a pretty doable speciality.
I also agree option 2 sucks. I’ve pretty much discredited that and if they’re going to force me to go a year behind I’ll walk with the class of 2020, not 19.
I’ll keep checking for the PE. I guess I wouldn’t beat interviews with the scores because I have an October date. I can’t take it until after June at the earliest as our school has a 3 day capstone course that’s just testing us for the PE.

 

[Stagg737]

1. Don’t take time off for step 2. This seems extremely risky for me since I already have a failure and I’m scared to fail/score low. I have to prove I don’t suck.
2. Walk with the class of 2019 and finish in Aug. From that point I can see if residencies will take me starting late, it seems unlikely. I could also wait and apply for 2020. But does graduating in the class a year sooner look awful?
3. Graduate with the class of 2020. The school doesn’t seem to like this option, I assume because it hurts their attrition rates. But this would put me graduating with the class when I would be applying.

I’ve appreciated SDN for a long time and I appreciate your feedback.

If you feel like you can do decently on Level 2 (500+), option 1 is your best bet. Option 2 is a no go. Too many questions can be raised and unless you're willing to take the scraps and accept a position outside of the match/SOAP, it's not gonna happen. Keep in mind those positions will either be at new programs or programs that can't fill with stronger applicants. The school probably doesn't like option 3 because it means it'll look like you had to repeat a year, which would basically be a second red flag. If you could do a research year after 3rd year, use some of that time to study and knock out Level 2 and PE, then apply for the Match during your 4th year, it may be a valid option. 5 years to graduate doesn't reflect that poorly on the school, as they can chalk it up to research and fellowship years. What does look bad is if you took a year off and didn't match, because then it affects their match rate.

The schedule they’ve made for me blocks off 3 months for Step 2 (lol).

That's a ridiculous amount of dedicated time. Imho, I don't think one would get much more past 1 month of dedicated for Level 2, but others might disagree.

if you are getting in the 100s and above on the comats you should be good.
check every day for new dates for the p.e i got one in september and was able to switch to this april. its a crap shoot i know.
if itll be ready by interview time then its better than nothing i suppose. but option 2 sucks. 3 is also crappy in my opinion. Psych is becoming increasingly competitive, so the AOA match might be your saving grace

Unfortunately, there are basically no programs left in the AOA match for psych. Last April there were about 20, but by the time I applied there were only 10 or 11 left. I wouldn't be surprised if there were only 2 or 3 left by the time the next cycle starts. Fortunately, there are a good number of new/weaker programs in the ACGME if people are willing to shotgun the application process.

The only way to get 1 month of board study is to do the ER thing. The good thing about the DO world is I’m in a small town and can probably do it in a low volume ER.
If the goal is just July 1st I can get 2 weeks in my schedule if I have to. I’d prefer to finish by my personal goal of June 14th to be able to have adequate time to relocate.

Cramming ER shifts is rough, but it can be done. There's one ER rotation at my school that's notoriously easy because it's in the boonies and the attending apparently lets you go after only 6-8 hours. If you can find something like that, it's a totally plausible plan. If you're going to be at a Level 1 trauma center or will have to work night shifts, knocking out 12 shifts in 2 weeks is going to be extremely rough.

I’ll keep checking for the PE. I guess I wouldn’t beat interviews with the scores because I have an October date. I can’t take it until after June at the earliest as our school has a 3 day capstone course that’s just testing us for the PE.

Absolutely do this. I took my PE mid-August and got my score back in time for the Sept 15th deadline, so I'd say if you can take it in July or early August you'll still be good. You've got one pretty big red flag on your app (even though it can be well-explained), so from here on out you need it to look like you've got your s*** 100% together. If possible, your app should be totally complete including all tests, LORs, and everything by the Sep 15th deadline. Your goal from here on out is not just to be the strongest applicant possible, but to prove that your Level 1 failure was a fluke. Convince PDs of that and you're looking alright for psych.

 

[Dr.Jekyll75]

sorry wasn't aware that the AOA spots had decreased so much. Def apply to both have strong letters ready. its a crappy situation but have your crap together for apps and i mean all of it. Letters, personal statement...etc ready to go on September 16th or 15th whenever the first day is . Back up app to family med would also be recommended

 

[ThreeCheers]

I'm going to give my perspective because I was in a similar time crunch last year. I didn't fail, but I pushed step 1 back 4 weeks and found myself with very little flex time for step 2 as a result (my school has a crazy amount of M4 clinical rotation requirements). Oddly enough, my school gave the exact opposite reaction- I wanted to take a gap year after M3, while my school pushed me to graduate on time.

First thing I'd like to note is that having a Step 2 score by September 15th (or at least not long after that date) is a necessity these days. Make this a priority if you plan on applying this upcoming cycle.

My research month was by far the best ace up my sleeve for getting dedicated prep time. You'd need to find a project to join, and you'd need to make sure you understand your school's requirements for a research month, but the schedule can be very flexible if you find the right project. I did writing for the pub, data extraction, etc i.e. things I could do by myself in my own time. I went above and beyond my school's rotation requirements, and still only needed to put in about 32 hours worth of work. I completed this easily in one week, which left me 3 weeks to study.

If a research month is not a possibility, I also did the same thing you plan on doing with my EM rotation. If you can be selective about your site, my preceptor was very understanding and sent me home early (or even gave me full days off) to study. I've heard of a several other EM sites that are also very lenient. EM physicians are generally pretty chill, and too focused on their busy shifts to worry about the precise number of hours you've worked.

There's always the possibility looming that you won't finish in time so you can't blow off your rotations (the way some of your classmates might be) under the assumption that your M4 grades will never see the light of day. Be upfront with your preceptors about your situation, and hopefully they'll try to help you get more time to study.

Finally, losing time for audition rotations IS going to be a problem so have a backup plan. Pick which of FM or IM you like best, and plan to either make a second application or scramble.

tl;dr: Take Step 2 early. Research rotations are clutch. M4 preceptors are generally more lax than you're used to as an M3. Have a plan b.

 

[samac]

I'm going to give my perspective because I was in a similar time crunch last year. I didn't fail, but I pushed step 1 back 4 weeks and found myself with very little flex time for step 2 as a result (my school has a crazy amount of M4 clinical rotation requirements). Oddly enough, my school gave the exact opposite reaction- I wanted to take a gap year after M3, while my school pushed me to graduate on time.

First thing I'd like to note is that having a Step 2 score by September 15th (or at least not long after that date) is a necessity these days. Make this a priority if you plan on applying this upcoming cycle.

My research month was by far the best ace up my sleeve for getting dedicated prep time. You'd need to find a project to join, and you'd need to make sure you understand your school's requirements for a research month, but the schedule can be very flexible if you find the right project. I did writing for the pub, data extraction, etc i.e. things I could do by myself in my own time. I went above and beyond my school's rotation requirements, and still only needed to put in about 32 hours worth of work. I completed this easily in one week, which left me 3 weeks to study.

If a research month is not a possibility, I also did the same thing you plan on doing with my EM rotation. If you can be selective about your site, my preceptor was very understanding and sent me home early (or even gave me full days off) to study. I've heard of a several other EM sites that are also very lenient. EM physicians are generally pretty chill, and too focused on their busy shifts to worry about the precise number of hours you've worked.

There's always the possibility looming that you won't finish in time so you can't blow off your rotations (the way some of your classmates might be) under the assumption that your M4 grades will never see the light of day. Be upfront with your preceptors about your situation, and hopefully they'll try to help you get more time to study.

Finally, losing time for audition rotations IS going to be a problem so have a backup plan. Pick which of FM or IM you like best, and plan to either make a second application or scramble.

tl;dr: Take Step 2 early. Research rotations are clutch. M4 preceptors are generally more lax than you're used to as an M3. Have a plan b.

There’s nothing in our handbook for research months. I don’t believe they count them.
I’m not making a second application. I’ll scramble if I have to, but I don’t want either of those careers.
But I physically can’t have a score by September 15th because of my school’s requirements to finish cores before taking step 2. The earliest I can take it is early September.
(2 Gen Surg, 1 Women’s Health, 1 Peds, 1 Psych, 2 Family med and 2 IM).

sorry wasn't aware that the AOA spots had decreased so much. Def apply to both have strong letters ready. its a crappy situation but have your crap together for apps and i mean all of it. Letters, personal statement...etc ready to go on September 16th or 15th whenever the first day is . Back up app to family med would also be recommended

There is no way the step 2 score can be ready on the 15th. The earliest I can take it is the beginning of September.
I’m not applying family med. whatever happens happens and I’ll scramble if I have to, but psych still seems to be a very viable option considering I’m not picky about my applications. I know SDN is all doom and gloom about the future of psych, but from a couple PDs in the area, current psych residents, and my school that if I apply broadly I’ll be ok.


Edited to add that I just looked at score release dates and it doesn’t matter when in September I would take it, it’ll be released October 15/16.

 

[ortnakas]

Instead of hardcore month of EM in two weeks, is it possible to do EM another time and put an easy elective that month? A lot of sites tend to have rotations where you can get away with half days, which at the end of the day would buy you more functional time to study than half of an EM month.

I wasn’t in your shoes, but I did want extra Step 2 time without extra time off, so I did a block that let me do a LOT of qbank every day so it was the best of both worlds.

 

[samac]

Instead of hardcore month of EM in two weeks, is it possible to do EM another time and put an easy elective that month? A lot of sites tend to have rotations where you can get away with half days, which at the end of the day would buy you more functional time to study than half of an EM month.

I wasn’t in your shoes, but I did want extra Step 2 time without extra time off, so I did a block that let me do a LOT of qbank every day so it was the best of both worlds.

Oh I wouldn’t do my EM going into it, I would actually do it at the end of my schedule, and probably break them up since our school is about 2 weeks off from typical audition schedule. Just gain the month by scheduling it that.

 

[Dr.Jekyll75]

There’s nothing in our handbook for research months. I don’t believe they count them.
I’m not making a second application. I’ll scramble if I have to, but I don’t want either of those careers.
But I physically can’t have a score by September 15th because of my school’s requirements to finish cores before taking step 2. The earliest I can take it is early September.
(2 Gen Surg, 1 Women’s Health, 1 Peds, 1 Psych, 2 Family med and 2 IM).


There is no way the step 2 score can be ready on the 15th. The earliest I can take it is the beginning of September.
I’m not applying family med. whatever happens happens and I’ll scramble if I have to, but psych still seems to be a very viable option considering I’m not picky about my applications. I know SDN is all doom and gloom about the future of psych, but from a couple PDs in the area, current psych residents, and my school that if I apply broadly I’ll be ok.


Edited to add that I just looked at score release dates and it doesn’t matter when in September I would take it, it’ll be released October 15/16.

not to sound like a douche but i highly recommend a back up unless you want to risk reapplying in 2020 . Even people who applied with 240s this didnt match and they regret not havign a back up.

 

[Dr.Jekyll75]

I know multiple people who matched this year with both red flags and sub 500 level 1/2s. Multiple and I'm just one person

theres def people that can pull miracles. But maybe im a worry ward. id play it safe.

 

[libertyyne]

theres def people that can pull miracles. But maybe im a worry ward. id play it safe.

Yeah , risk tolerances are different I suppose. I would be in the keep plan B alive camp as well.

 

[BorntobeDO?]

Samac needs to do what she wants guys. If she applies broadly and is not geographically limited, I think she will be alright. I am totally with her mentality. She needs to go for the gold. Don't let fear pick your specialty. Psych isn't that crazy.

 

[samac]

not to sound like a douche but i highly recommend a back up unless you want to risk reapplying in 2020 . Even people who applied with 240s this didnt match and they regret not havign a back up.

I totally understand your concern. I know speaking to people a lot who didn’t match didn’t apply community, were geographically restricted, or didn’t apply to safety programs. I plan on being broad, applying low tier, and I’m more than willing to do community programs.
If I don’t match I will scramble. I don’t want to prepare 2 separate apps and start into a family medicine residency under the pretense that it was my first choice. If I scramble into one I plan to let them know straight up I wanted psych and that I would attempt to match into a Psych PGY 2. I understand the risks.

Samac needs to do what she wants guys. If she applies broadly and is not geographically limited, I think she will be alright. I am totally with her mentality. She needs to go for the gold. Don't let fear pick your specialty. Psych isn't that crazy.

Thanks. That’s what I’ve heard from many people that as long as I don’t limit myself I should be ok. I know a couple people who had even more red flags than me and matched.
I like that line, “don’t let fear pick your speciality”

 

[ThreeCheers]

It is definitely not a bad idea to focus your primary efforts on matching psych. If your backup plan is reapplying psych (which is reasonable), is there a reason why you'd prefer to scramble into FM over an intern year? My understanding is that reapplying is less of a headache with an intern year.

I do want to emphasize that you should take step 2 at the absolute earliest possible date. I applied to a uncompetitive specialty, and a late step 2 score alone lost me a ton of interviews (despite a 550+ step 1). Although this was the AOA match, which starts 2 months earlier, so I don't anticipate that it will be as much of a problem if you're doing the ACGME match. Taking it early September should be fine, but don't delay it much further. Audition rotations and M4 letters can be saved for later in the cycle, provided that you already have strong letters from your M3 preceptors.

 

[samac]

It is definitely not a bad idea to focus your primary efforts on matching psych. If your backup plan is reapplying psych (which is reasonable), is there a reason why you'd prefer to scramble into FM over an intern year? My understanding is that reapplying is less of a headache with an intern year.

I do want to emphasize that you should take step 2 at the absolute earliest possible date. I applied to a uncompetitive specialty, and a late step 2 score alone lost me a ton of interviews (despite a 550+ step 1). Although this was the AOA match, which starts 2 months earlier, so I don't anticipate that it will be as much of a problem if you're doing the ACGME match. Taking it early September should be fine, but don't delay it much further. Audition rotations and M4 letters can be saved for later in the cycle, provided that you already have strong letters from your M3 preceptors.

Thank you for the information. I’d scramble into an internship too, really what I mean was I’d take what I can get at that point if I needed to.
Early September is pretty much when it’ll happen, I just hate that score are released in October. Oh well.
My PE will be early August if a spot opens up, it’s late september now because that was it.

Thank you for your input!

 

[AlbinoHawk DO]

Small update:
So My school and I are doing a back and forth. They’re insistent on me taking time off for step 2.
I figured out a secret. That you can do an EM rotation in 2 weeks working for 14 days straight. If I was to do that I could take a month for Step 2 and still finish on June 14th. It won’t be pleasant but I’ll happily do it.

The schedule they’ve made for me blocks off 3 months for Step 2 (lol).
They’re telling me I will be at a disadvantage with audition rotations and that it’s not in my best interest to do that since I’m off schedule, and that the biggest red flag I could have is a failure on Step 2 (I agree, that’s true). And to just apply the next year.

I countered that we can try it my way, and if I’m scoring acceptably on COMSAEs to let me go for it. And if I’m not to do it their way. Hope they’ll bite.

Do you know if the site will allow you to do 14 days straight? In theory it sounds possible, but I can also see high burnout or them wanting to spread it out so other students can pick dates they want.

 

[samac]

Do you know if the site will allow you to do 14 days straight? In theory it sounds possible, but I can also see high burnout or them wanting to spread it out so other students can pick dates they want.

Our EM is a selective so we can set it up where we want. I plan on setting it up in a small, low volume ER where my step mother is a nurse. The hospital big wigs have said they wouldn’t have a problem as long as the docs are fine with me being there.

 

[W19]

Thank you for the information. I’d scramble into an internship too, really what I mean was I’d take what I can get at that point if I needed to.
Early September is pretty much when it’ll happen, I just hate that score are released in October. Oh well.
My PE will be early August if a spot opens up, it’s late september now because that was it.

Thank you for your input!

Getting your score release mid October is not that bad since program tend to send invites to stronger applicants first... If you are willing to go anywhere and you apply broadly (~100 programs), you should be ok IMO.

Taking a year off will add another red flag to your application.

Even if your school does not have a research month, some schools are usually flexible in term of making anything fit if it is an elective... Talk to someone in charge to find out how flexible they can be...

 

[samac]

Update time!

I presented a schedule to the school that had me finishing June 14th. I’ve emailed them multiples times, finally said ok I’ll follow my plan and then I was absolutely shut down. Here’s the response:
The plan that you were sent was approved by myself, the registrar's office and financial aid so you must follow it. You have been moved to the class of 2020 officially. Any fourth year rotations you attempt that don't follow the plan will not be approved by the rotations office and will not count as part of your curricular requirements. You should follow that plan and prepare for your Level 2 exam accordingly as tuition charges and financial aid disbursement will follow that schedule. That means PE in September and CE in November as far as exams are concerned. As you were told, this plan was developed to give you the best chance at getting into your residency of choice.”

Haha so I got a big “bugger off” response.
The schedule they presented me has 3 months off for level 2 CE, and quite frankly I don’t want that amount of time because I’ll procrastinate and then screw myself. It’s what I do.

So anyone have a good idea to do with the 5 months I’ll have off after I finish rotations next fall? I’m kind of at a loss of what to do with my time.

 

[Giovanotto]

Update time!

I presented a schedule to the school that had me finishing June 14th. I’ve emailed them multiples times, finally said ok I’ll follow my plan and then I was absolutely shut down. Here’s the response:
The plan that you were sent was approved by myself, the registrar's office and financial aid so you must follow it. You have been moved to the class of 2020 officially. Any fourth year rotations you attempt that don't follow the plan will not be approved by the rotations office and will not count as part of your curricular requirements. You should follow that plan and prepare for your Level 2 exam accordingly as tuition charges and financial aid disbursement will follow that schedule. That means PE in September and CE in November as far as exams are concerned. As you were told, this plan was developed to give you the best chance at getting into your residency of choice.”

Haha so I got a big “bugger off” response.
The schedule they presented me has 3 months off for level 2 CE, and quite frankly I don’t want that amount of time because I’ll procrastinate and then screw myself. It’s what I do.

So anyone have a good idea to do with the 5 months I’ll have off after I finish rotations next fall? I’m kind of at a loss of what to do with my time.

Sort of off topic, (sorry), but are they charging you an extra year of tuition!?

 

[gensurghopeful]

I was under the impression psych was relatively easy to get...
In either case, I agree w Goro, you seem like a fine student and step 1 just caught you at a bad time
Good luck my friend

 

[samac]

Sort of off topic, (sorry), but are they charging you an extra year of tuition!?

No totally fair question. I wondered it too. From what I understand it’ll be an extra semester. I’ll be done before December.

I was under the impression psych was relatively easy to get...
In either case, I agree w Goro, you seem like a fine student and step 1 just caught you at a bad time
Good luck my friend

It historically isn’t competitive, but recently more are going unmatched. I don’t think the sky is falling (yet) and most people who went unmatched did so because they didn’t apply broadly enough, but what do I know.

 

[W19]

No totally fair question. I wondered it too. From what I understand it’ll be an extra semester. I’ll be done before December.

It historically isn’t competitive, but recently more are going unmatched. I don’t think the sky is falling (yet) and most people who went unmatched did so because they didn’t apply broadly enough, but what do I know.

I would suggest FM as a back up...

 

[sunshinefl]

No advice, just came to say I’m sorry they didn’t accept your plan. Keep working hard going forward.

 

[NotAProgDirector]

You'll apply for residency in September, and graduate in December. For the six month gap, you have several options. You can likely get a clinical job of some sort -- scribing, for example. Or a medical assistant. You mentioned that your mother works in an ER -- you might want to start there, but I expect you can find something. Anyone hiring you knows it's a short term gig, so it needs to be something you can do with minimal additional training and that they are willing to hire you for a short period.

When you apply for residencies, programs will see that you've graduated in December. If a program has an off cycle opening (i.e. someone has dropped out, illness, etc), they may interview you and then offer you a spot outside the match to start early. That would also fill the gap.

At the moment, your focus needs to be on doing well on COMLEX L2. You mentioned that you'll procrastinate over 3 months. You need a plan to avoid that.

 

[samac]

You'll apply for residency in September, and graduate in December. For the six month gap, you have several options. You can likely get a clinical job of some sort -- scribing, for example. Or a medical assistant. You mentioned that your mother works in an ER -- you might want to start there, but I expect you can find something. Anyone hiring you knows it's a short term gig, so it needs to be something you can do with minimal additional training and that they are willing to hire you for a short period.

When you apply for residencies, programs will see that you've graduated in December. If a program has an off cycle opening (i.e. someone has dropped out, illness, etc), they may interview you and then offer you a spot outside the match to start early. That would also fill the gap.

At the moment, your focus needs to be on doing well on COMLEX L2. You mentioned that you'll procrastinate over 3 months. You need a plan to avoid that.

My technical graduation date will be held until May, I’ll just be finished with rotations.
I appreciate the advice.

I would suggest FM as a back up...

I appreciate the advice, but I’ve been very upfront that I won’t do that. If I have to scramble into something so be it, but I don’t want to apply to FM programs from the get go trying to sell myself as someone who wants to do it. Because I don’t.

 

[UnoMas]

My technical graduation date will be held until May, I’ll just be finished with rotations.
I appreciate the advice.

I appreciate the advice, but I’ve been very upfront that I won’t do that. If I have to scramble into something so be it, but I don’t want to apply to FM programs from the get go trying to sell myself as someone who wants to do it. Because I don’t.

So you would rather go unmatched and reapply the following year with 1 Board Failure + gap in medical education than to match into FM the first time around? I am sorry I am not being rude but I hope you do see the risks of being so inflexible.

 

[samac]

So you would rather go unmatched and reapply the following year with 1 Board Failure + gap in medical education than to match into FM the first time around? I am sorry I am not being rude but I hope you do see the risks of being so inflexible.

I don’t think you’re being rude, but no.
I’d rather scramble into an unmatched FM/IM program and then attempt to get into into a PGY-2 psychiatry position than apply to one of those that I don’t want.
I don’t want to apply to those from the get go, get one and then try and get out of it into psych.