What should I do when I don't match? I am applying ENT

[OrphanedDoc]

I just wanted to sort of map out next steps in my life and I am weighing options and such. What should I should do when I don't match? Try to find a job and reapply? Give up? What happens if I find a way to survive the year and don't give up? medical school didn't go my way but I really like the specialty and I find myself far too happy when I work with my home program that I have to give it an earnest shot I wouldn't sleep at night if I bailed type of thing, even knowing I won't match. So the plan is to apply as broadly as my limited funds will allow. I'll give a brief app overview but yeah I definitely feel defeated the specialty is pretty cool I definitely recommend for whoever can pull it off. Not really asking what're my chances because it's obvious.

Application picture kinda long:

Subjective:
- 3rd year (just started) First-gen college African American, Foster kid since like 6 months so not much support, very happy to get to maybe do medicine but burned out from a rough clerkship year, mid-tier MD in top third for rankings when I applied haven't followed
- Volunteering: Community service mainly I did some logistics for my school's community service program, some ent community service with my home program, and some other things I can't think of right now.
- Research: Only 2 projects completed but I plan on taking on more once I take my step exams this December so I will have 2 years of a pretty free schedule to do this
- Other ECs: Head TA for a program focused on imparting evidenced study skills to medical students, medical student advisor, and TA for graduate students, I work on and off where I can to make needed money (uber, clinic, TA, tutoring)
- Narratives: Mid - bad except surgery nothing great because even on OBGYN where I had the best commentary something unfortunate happened to make that narrative bad -- I haven't read it yet'
- Evaluations: Can be good but occasionally not great, negative commentary (can probably find a comment within the same service that contradicts so I don't know anymore...) includes "quiet at first" "hard to read abilities" "Looked disinterested (on peds and I love working with kids and even begged to go see a patient with the resident who left me anyways after being told by the senior resident to take me and that I was interested)" Also got that2 one from an attending that hardly spoke to me on that service. ENT elective was probably the best if not top three evaluations but they were nice. All eval grades in 90s except for IM.
Only got performs like a resident once out of like 15 evals over the year despite my efforts.

Objective:
- Step exams: Will take both this December, unsure where I will score I tended to do very well on the pretest for NBME shelf exams but you will see what happens shortly but unfortunately even a good score won't help
Preclinical grades: I think I either passed them all or got 1 F on the transcript for not having 75% attendance they weren't clear but this isn't the worse thing passed all the actual courses
Clinical grades : Slowly watched my hopes and dreams die here. I made adjustments after adjustment. Reddit search after Reddit search. Even met with the academic coach whose only suggestion was that I get an extended time accomadation. To preface I went in saying I should take a leave of absence prior to clerkship but I honestly had no idea how'd it help so I said F it we ball. No balling was done... A myriad of health, financial, and eventually stress problems go on that have been difficult getting a handle on.

In chronological order:

Surgery: High pass (Missed Honors by 2-3%) Poor shelf performance barely passed.
Anesthesia: High pass (Missed Honors cut off by 0.4%) Never met the evaluator but he gave me a random poor score in a category I felt I performed well in but no need to get into it, I wasn't going to complain lol but had I'd know how this year go maybe I should have)

EM: High Pass (mainly mid evals) (also timed out on the exam that could've saved it because I lost time when the intern didn't know how to do a wound vac change :/ she just watched and said don't leave and I didn't have anyone to step in which sucked)

Let's start the end of my hopes and dreams... You were probably thinking salvageable at this point haha

Pediatrics: Pass (Time out on the exam ~ 20 questions only sped through maybe 10 so maybe 10 blank so barely passed) evals fine with great ones (bless their soul) and bad ones mentioned before

OBGYN: F lol. Caught me off guard, I didn't even know I failed because the grades didn't reflect it. They failed my OSCE which was easy but I was late and a little disoriented so it was a bit clumsy I actually appealed it as I felt I hit the checkmarks on the rubric fairly well despite this but it's unlikely to be successful. Again poor shelf performance is probably the only shelf I will say studying more would've led to a better performance all my personal problems got big here and then got professionalism points off for being 15 minutes late the OSCE. Sigh... Also did the assignments but found out later I uploaded them incorrectly. Yeah, I went mad during this clerkship. If the appeal fails I will be repeating 2 weeks taking away from step time, evaluations here were great, course director literally paused reading them. This will be the weirdest contradicting narrative ever probably because they require failures to be included.
IM: P or F (just finished I definitely passed borderline but they are discussing points being taken away which would put me in the F area)
Family Med: Pass (OSCE)
Psychiatry: Pass probably (Time out on the shelf and rushed through half so barely passed was projected to score at least a 90 on all pretests included form 5 which people score about an 82 usually havent had a bait and switch that hard since peds where my pretests were also good)
Neurology: Pending just started hopefully high pass since I have a masters degree in neuro but who knows... I'll probably fail the shelf

*It may be important to mention I have researched extensive timing strategies but they do not work for me* During the first third of the exam I average about 1 minute a question then something uncontrollable and weird happens no matter how much clock watching I do*

- Mid evals (below average 3-5% except surgery which was above average by 2%) (These are all in the 90s except IM)

Sub Is: Plan on doing 2-3 aways and home program. Not expecting too much of a problem here I performed well with the my home program the first time and I know the anatomy well. I can show up early and do the hours and list fairly easily and my program tends to be more rigorous compared to other programs according to other students. Plus hopefully my personal problems will be resolved and controlled at this point since I can take a break now.

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[coffegroundemesis]

Is this for real? Psychology? Instead of psychiatry? Are you making it up?

 

[MateoGM416]

Is this for real? Psychology? Instead of psychiatry? Are you making it up?

What is the point of this reply? You know what he meant

 

[Goro]

Jeeze...a ton of red flags there, OP.

Let's see what the experts say.
@NotAProgDirector
@operaman
@Tenk
@gyngyn
@Dral
@Angus Avagadro
@HomeSkool

What say you??

 

[Tenk]

Unless you got an ENT program director friended on Instagram or Snapchat, I would say pick a different specialty.

 

[Angus Avagadro]

Sorry you are going through this. The language in your post is pressured and all over the place. Your Step scores aren't available yet. It would be hard to supply definitive advice, but your stress level appears quite high. Have you any military, athletic, or musical experience? These areas help you set realistic goals, then work to achieve them. They help to teach you how to deal with setbacks and success. If you apply ENT, you will need a sober, introspective analysis of your residency app. Your successes and failures. I would consider sitting down with your home ENT PD, go over your app , good points and bad. Then, try to determine with them how you can rehabilitate your app, possibly through a gap yr. I'm sure you are aware that ENT is the most competitive residency and you will be applying along with some rock stars. After meeting with the PD, if you decide to move forward with ENT, you will feel better having a definite plan. As with any plan, develop a Plan B, C,D,E, and F for backup. Good luck and best wishes. Keep us posted with your progress.

 

[voxveritatisetlucis]

Apply for a backup

Also what does two completed projects mean? Two pubs are much better than two presentations/posters but even two pubs is on the low side for ent

 

[operaman]

Yeah sounds like you've had a rough time. Big variables still outstanding are your Step scores, but given the shelf troubles I wouldn't expect these to save you, and a failure on either would definitely be the end of any ENT chance.

You definitely need to have an honest sitdown with some local mentors and discuss your chances. My sense is that your chances are zero anywhere that doesn't know you. Failed clerkship plus borderline performance in others is too big a risk for programs that take 1-5 residents per year. If you're somehow able to turn things around and make people think you're a star clinically, then you've got a slim chance. This basically means your home program and maybe an away. Chances for both are slim given your other clinical struggles. I think the odds that your clinical shortcomings aren't obvious on ENT are slim to none; I suspect the ENT folks are just being nice and not saying anything since we're not usually a core clerkship for anyone.

You're definitely someone who should consider a dual application. Your odds of matching ENT are low single digits at this point. Ordinarily I would say consider a research year because you don't have any of that either, but even with 10 ENT pubs you'd still be a long shot - maybe slightly higher single digits. There's also the fact that no reputable research year is going to take you as they like to see their students match and tend to take people with 90th percentile step scores and otherwise solid apps who simply need a few pubs to be shoe-ins to match. So that's a lot of wasted time only to still end up not matching.

A dual app would let you shoot your shot for ENT, but then you'd have another iron in the fire as well. I should also say that those low single digits are primarily coming from the chances of a sudden downswing in number of apps like we had 5-6 years ago where there were fewer apps than spots. Even then you're looking at 5% chance of matching. If your cycle is anything like the last couple of years, your chances are near zero.

Figure out what else besides ENT you'd like to do and start working on that. Given your clinical struggles, things like Rads and Path may be possible choices since you seem to struggle with patient interactions. You should also consider the rigor of whatever field you chose given how you've struggled in med school which is remarkably easy compared to residency. Your personal struggles will only get worse and your stress level will be higher and your sleep will be lower and thus your ability to cope will be substantially decreased. You're barely getting by when you have no responsibilities; things will only get tougher. I think your odds of successfully completing an ENT residency even if you do match are also quite low. Find a way to hit the easy button and slide into rads, path, pmr, fm - something less stressful and easier to match.

 

[Angus Avagadro]

Yeah sounds like you've had a rough time. Big variables still outstanding are your Step scores, but given the shelf troubles I wouldn't expect these to save you, and a failure on either would definitely be the end of any ENT chance.

You definitely need to have an honest sitdown with some local mentors and discuss your chances. My sense is that your chances are zero anywhere that doesn't know you. Failed clerkship plus borderline performance in others is too big a risk for programs that take 1-5 residents per year. If you're somehow able to turn things around and make people think you're a star clinically, then you've got a slim chance. This basically means your home program and maybe an away. Chances for both are slim given your other clinical struggles. I think the odds that your clinical shortcomings aren't obvious on ENT are slim to none; I suspect the ENT folks are just being nice and not saying anything since we're not usually a core clerkship for anyone.

You're definitely someone who should consider a dual application. Your odds of matching ENT are low single digits at this point. Ordinarily I would say consider a research year because you don't have any of that either, but even with 10 ENT pubs you'd still be a long shot - maybe slightly higher single digits. There's also the fact that no reputable research year is going to take you as they like to see their students match and tend to take people with 90th percentile step scores and otherwise solid apps who simply need a few pubs to be shoe-ins to match. So that's a lot of wasted time only to still end up not matching.

A dual app would let you shoot your shot for ENT, but then you'd have another iron in the fire as well. I should also say that those low single digits are primarily coming from the chances of a sudden downswing in number of apps like we had 5-6 years ago where there were fewer apps than spots. Even then you're looking at 5% chance of matching. If your cycle is anything like the last couple of years, your chances are near zero.

Figure out what else besides ENT you'd like to do and start working on that. Given your clinical struggles, things like Rads and Path may be possible choices since you seem to struggle with patient interactions. You should also consider the rigor of whatever field you chose given how you've struggled in med school which is remarkably easy compared to residency. Your personal struggles will only get worse and your stress level will be higher and your sleep will be lower and thus your ability to cope will be substantially decreased. You're barely getting by when you have no responsibilities; things will only get tougher. I think your odds of successfully completing an ENT residency even if you do match are also quite low. Find a way to hit the easy button and slide into rads, path, pmr, fm - something less stressful and easier to match.

Very well said.

 

[Dral]

I agree with all that Angus Avagadro and operaman have said. I like the advice of scheduling a meeting with the ENT PD to get some advice. You should be able to hopefully 'read the room' so to speak to see if they believe you may have a shot at matching into the specialty either at home or elsewhere.

Meeting with a home PD is a good place to start for anyone who is going for whatever specialty, so you want to start there regardless (if you haven't done this already).

Failing the OB/Gyn rotation is the biggest thing that stands out in my mind. I, for all intents and purposes, got high passes in a bunch of things and still ended up in a competitive specialty. But I didn't have a failed rotation on my record. I don't think competitive specialties demand absolute perfection, but I think it's fair to assume they are not keen on someone having a failure at the level of a third year rotation on their record. Again though, the ENT PD will have better input on this.

Best of luck on your Step exams. Develop a study plan ahead of time for them and stick to said plan(s). They are one of the remaining things you have some control over to improve your chances.

 

[GoSpursGo]

I agree with @operaman and @Angus Avagadro --it's time to have an honest conversation with your mentors who know you best. If they really like you and are willing to go to bat for you, then it may be worth throwing your hat in the ring and hoping to match at your home program. In the absence of an otherwise stellar application which you don't seem to have (as noted, 2 pubs is on the low side for ENT, multiple rotations with just pass), having one clinical F is likely fatal for an ENT application let alone two if you did indeed fail IM. So you need to get direct feedback from people at the one program where you might have a shot, and likely consider a backup.

More importantly than figuring out your plan for applying, you have got to figure out what is wrong with your test taking. For EM, ok not your fault that your intern didn't let you go to the exam on time (though you should have immediately reported that to the course director). But timing out on half of your peds questions? Showing up 15 minutes late to an OSCE? Poor shelf performance in OB/Gyn, then timing out again on psych? That is a systematic problem. I get that you have "researched extensive timing strategies" and they "don't work"--well, it's time to stop trying to bootstrap through this by yourself. Talk to your school about test taking strategies. Find a mental health professional who can help you with strategies to overcome this "uncontrollable" thing that happens in the middle of exams. Heck, consider whether you need accommodations for an undiagnosed learning disorder. But if you don't ask for help, not only are you at risk for failing to match ENT, but you are at risk for failing out of medical school. Don't be one of the far too many students who insist on trying to figure things out on their own, when asking for help would lead to a much greater chance of success.

Finally, remember that there are more people apply for competitive fields like ENT than there are spots. Not everyone gets to match their preferred specialty--that isn't a negative reflection on those who fail to match, it's just math. Thankfully, a medical degree is very versatile, and you very likely can find another specialty that, while you may not love it as much as ENT, you can be happy and make a very good living. But again, first you need to fix the problem right in front of you and worry about your ENT match later.

Best of luck.

 

[OrphanedDoc]

Jeeze...a ton of red flags there, OP.

Let's see what the experts say.
@NotAProgDirector
@operaman
@Tenk
@gyngyn
@Dral
@Angus Avagadro
@HomeSkool

What say you??

It's all red... It is what it is can't change the past only move forward haha I did my best with what I had. Almost couldn't even continue medicine because my financials were so bad.

 

[OrphanedDoc]

Unless you got an ENT program director friended on Instagram or Snapchat, I would say pick a different specialty.

I appreciate the perspective, I am aware of the poor application but I still think it's important to try anyways. Its too much of a gap in my enjoyment between specialties based on my experiences for the past few years so I wouldn't live with myself not giving it all I had and trying. It's the more emotional aspect of being human at play here rather than logic. Definitely not inquiring about my chances.

 

[OrphanedDoc]

Sorry you are going through this. The language in your post is pressured and all over the place. Your Step scores aren't available yet. It would be hard to supply definitive advice, but your stress level appears quite high. Have you any military, athletic, or musical experience? These areas help you set realistic goals, then work to achieve them. They help to teach you how to deal with setbacks and success. If you apply ENT, you will need a sober, introspective analysis of your residency app. Your successes and failures. I would consider sitting down with your home ENT PD, go over your app , good points and bad. Then, try to determine with them how you can rehabilitate your app, possibly through a gap yr. I'm sure you are aware that ENT is the most competitive residency and you will be applying along with some rock stars. After meeting with the PD, if you decide to move forward with ENT, you will feel better having a definite plan. As with any plan, develop a Plan B, C,D,E, and F for backup. Good luck and best wishes. Keep us posted with your progress.

Yes, thank you for your reply. I played basketball a bit in high school but just recreational since college. I am super stressed. I feel I am looking at what may be the worse ENT application in history, with no connections or benefiting factors. I have a plan, with a low chance of matching if it goes well. Obviously, a 260+ step is required, which requires addressing why I cannot finish an exam. I believe I can obtain good research experience in addition to my two research experiences during the next year and a half which will solely be dedicated to 3-4 months of Sub-Is and research. Obviously getting extremely lucky with networking will also be necessary but it is likely I will fall into the 40% of unmatched applicants. I have a friend who matched plastics with poor grades but his demeanor and social skills are exemplary, very nice man to be around so maybe I can get some lessons from him. I have been in worse areas pre-medical school for different reasons but that obviously doesn't mean I will be successful here. I am hesitant to use my PD until I have rapport as my primary fear is seeing a bad application may worsen his willingness to help. He will have to see it eventually though. I hold positions where I need his support (exec position for ent organization) and fear he may be less amiable. My intuition says my best bet is to figure out what to do after I don't match. Whether to wait and try again or try to do surgical endocrinology, although I'd admit I am not a fan of the reduced scope of the practice.

 

[Goro]

Yes, thank you for your reply. I played basketball a bit in high school but just recreational since college. I am super stressed.

This is why you were recommended to take a LOA. You're clearly making bad choices and not thinking straight, and the "ENT or bust" mentality is frankly, unhealthy.

 

[operaman]

This is why you were recommended to take a LOA. You're clearly making bad choices and not thinking straight, and the "ENT or bust" mentality is frankly, unhealthy.

Methinks it doesn’t look good. I’m not sure how one can bomb so many shelf exams and think they will magically hit 90th percentile on a much higher stakes exam. Or how you can repeatedly show up late to mandatory things as a pampered clinical student but think a reasonable backup plan is a grueling Gen surg residency.

OP- the sooner you accept that ent isn’t going to happen, the sooner you can work on getting letters and support for what you ultimately decide to do. Remember this only gets harder as time goes on. If you foolishly make 2 passes at ENT, you’ll be going to faculty from 3 years earlier asking for letters and they likely won’t remember you at all. Your best chance to have control over where and what you do is the first cycle. Don’t waste it on a pipe dream.

Remember that the match keeps getting tougher across all fields. Your app is not even really competitive for mid tier fields, much less the hyper selective ones. You’d be better off focusing your energy on building a solid app for something more feasible even if it’s not something you like very much. When you’re applying after a failed ent match, it’s going to be one more red flag in your expanding collection of flags that speak to poor judgement and lack of insight. Other PDs will see your app and think you were nuts for applying ent at all, though that does fit in with your “Leroy Jenkins” approach to med Ed thus far.

 

[OrphanedDoc]

Hi thanks for the reply, there’s a lot to address so sorry about the extensive reply. First,
I will learn more as I go on but my understanding is that rejected applicants will have options to soap or wait a year to reapply (with much lower odds). Barring a miracle you are 100% correct, but I am also already aware and so I feel it to be more detrimental to present my application to my PD prematurely and lose any support I would need for a 0.1% chance. Im grateful to have made it into medical school and as long as I consider the risks it makes sense to pursue a field I am passionate about (the odds for me being in medical school with my background were similarly poor). That’s why I wanted to frame this question in a way that says hey I am probably not going to match ENT should I SOAP, wait a year, etc.

As for the clinical side of things I don’t have problems with patient interactions or clinical skills such as history taking or physicals fortunately. I learn pretty quickly and generally feel comfortable enough to tutor my peers with material.

My evals usually reference interest or demeanor but never, “could not perform a physical or history” if that makes sense. This is not a main contributor to poor grades and was only was a factor in anesthesiology because of the .3 difference for honors. These evals stand out to me because they don’t feel like they’re in my power to control when they do happen and wear me down admittedly.

Main culprits for borderline grading is either the shelf or standardized patients (a recent problem actually so earlier just the shelf and EM exam). I did this to myself. I performed so well on the MCAT I didn’t think to use accommodations (I’ve never used them in my life but had them). The shelves caught me off guard with their cutthroat timing. As far as content most course directors note my fund of knowledge is fine I perform above average as well on pretests which is the strangest thing. For the step pretests I scored ~10% above the class average despite my shelf struggles. Ultimately, doesn’t matter I just want you to be aware I do have insight of the situation. Even if I do not match the world will go on and I have a pretty good handle on the problems I experienced this year so I wouldn’t expect them to recur during residency unless I am severely underpaid admittedly. Which is possible since I definitely won’t have a choice where I go. I don’t shy away from hard work and I am coachable although those aren’t enough.

Bombing any other area of my application will prompt me to admit defeat admittedly although I’m not sure if I’ll waste my time at that point due to the need to prioritize funds on a back up.

Grades can potentially be:
3 HP and the rest P except neuro which can be honors or high pass or pass or F) is a possibility. Although not much better. I will say my school has performed some miracles, as a peer of mine did similar and matched plastics which to this day everyone says is insane. Not saying that’ll be me of course.

I 100% hear you but I don’t know how anyone can excel facing homelessness, not even being able to complete my degree due to finances (saved by faculty member somehow), and loss of healthcare. I felt it was too much. It flared up a lot of other health problems I haven’t had problems with for years. I don’t have a support system beyond my classmates. I never turned to drugs I kept exercising and ate somewhat well for what I could afford. So I sort of feel like I owe it to myself to try it looks like I’m a poor student but I really put in work is my reasoning. Take a shot and if it does as expected have a plan B.

 

[OrphanedDoc]

I agree with @operaman and @Angus Avagadro --it's time to have an honest conversation with your mentors who know you best. If they really like you and are willing to go to bat for you, then it may be worth throwing your hat in the ring and hoping to match at your home program. In the absence of an otherwise stellar application which you don't seem to have (as noted, 2 pubs is on the low side for ENT, multiple rotations with just pass), having one clinical F is likely fatal for an ENT application let alone two if you did indeed fail IM. So you need to get direct feedback from people at the one program where you might have a shot, and likely consider a backup.

More importantly than figuring out your plan for applying, you have got to figure out what is wrong with your test taking. For EM, ok not your fault that your intern didn't let you go to the exam on time (though you should have immediately reported that to the course director). But timing out on half of your peds questions? Showing up 15 minutes late to an OSCE? Poor shelf performance in OB/Gyn, then timing out again on psych? That is a systematic problem. I get that you have "researched extensive timing strategies" and they "don't work"--well, it's time to stop trying to bootstrap through this by yourself. Talk to your school about test taking strategies. Find a mental health professional who can help you with strategies to overcome this "uncontrollable" thing that happens in the middle of exams. Heck, consider whether you need accommodations for an undiagnosed learning disorder. But if you don't ask for help, not only are you at risk for failing to match ENT, but you are at risk for failing out of medical school. Don't be one of the far too many students who insist on trying to figure things out on their own, when asking for help would lead to a much greater chance of success.

Finally, remember that there are more people apply for competitive fields like ENT than there are spots. Not everyone gets to match their preferred specialty--that isn't a negative reflection on those who fail to match, it's just math. Thankfully, a medical degree is very versatile, and you very likely can find another specialty that, while you may not love it as much as ENT, you can be happy and make a very good living. But again, first you need to fix the problem right in front of you and worry about your ENT match later.

Best of luck.

Yes, I’ve qualified for accommodations my entire life. I just assumed I’d skate through medical school exams. When I think about it accommodations would fix all my academic problems given my pretest from the nbme generally predict me in to get a 90 or high 80s. I’d at least get High pass with those grades. I’m never going to live that down. I have applied for accommodations already but it’s difficult since I never used them. I’m trying to petition that I’ve never had the resources to get the accommodations instead of saying I simply do well on test generally. Which is true but not the whole truth so we will see. I don’t think even if I wanted accommodations I could’ve afforded them. My school has agreed to pay for the evaluation however so maybe it can save my step exams.

 

[OrphanedDoc]

Methinks it doesn’t look good. I’m not sure how one can bomb so many shelf exams and think they will magically hit 90th percentile on a much higher stakes exam. Or how you can repeatedly show up late to mandatory things as a pampered clinical student but think a reasonable backup plan is a grueling Gen surg residency.

OP- the sooner you accept that ent isn’t going to happen, the sooner you can work on getting letters and support for what you ultimately decide to do. Remember this only gets harder as time goes on. If you foolishly make 2 passes at ENT, you’ll be going to faculty from 3 years earlier asking for letters and they likely won’t remember you at all. Your best chance to have control over where and what you do is the first cycle. Don’t waste it on a pipe dream.

Remember that the match keeps getting tougher across all fields. Your app is not even really competitive for mid tier fields, much less the hyper selective ones. You’d be better off focusing your energy on building a solid app for something more feasible even if it’s not something you like very much. When you’re applying after a failed ent match, it’s going to be one more red flag in your expanding collection of flags that speak to poor judgement and lack of insight. Other PDs will see your app and think you were nuts for applying ent at all, though that does fit in with your “Leroy Jenkins” approach to med Ed If I overcome this or gain accommodations it may be possible as the nbme pretest scores are much higher than the actual shelf scores. However as always I could just fail step and match nowhere but I have solid study strategies as I worked with students on evidence based study strategies. My timing is looking 100% medically related, during the first 3rd of the shelf I calculate my pace and it comes out to a healthy minute per question, and my uworld percentages are 60-80% on blocks of those timed . My pace significantly slows after that third of an exam. I over came this with coffee and standing up intermittedly. once and ended up scoring 10% above average on a step pretest from the school without studying for it but they banned coffee for the shelf exams so it doesn’t work. As far as applying maybe SOAPing into a specialty may be a better idea. My goal is to give myself the chance while minimizing the consequences of applying ent while lacking competitiveness.

If I apply ENT this is assuming my clerkship grades are the only red flag. If I score 260 step (although you lack faith understandably), get 15 publications, and good sub I evals, with appropriate LORs. I’m not going to apply If I have other huge deficiencies such as a 240 step. I’ve been told the research is possible and I still have two years that are more free than any of the first two.

Now as far as the late thing, I’ve seen resident attendings and everyone else show up late occasionally. It’s never the goal but happens from time to time. I had an earnest reason to be late. I still showed up an hour early and completed the list on surgery (never late the entire clerkship) and stayed from 4 am until 8 pm trying to learn or help out because it’s something I enjoyed. This is not of the things I discussed with the program director. I am very organized and keep a schedule and adhere to it. I teach medical students evidenced based study techniques and know them well. My impression here is I wanted a leave of absence I could not afford to take. I had to forgo it because I had no way of ensuring I’d get back into medical school. If you think I’m being lazy and just showing up 15 minutes late because I feel like it that is fine but it is not the case. These are assumptions most people will make reading the application unfortunately…

On another note, while my question was focused on the future it seems many tend to want to discuss the previous year. I have a question, and anyone can answer if you want but it’d be nice to get information that I could have used a year ago. If you were going through medical school and wanted to go in a competitive specialty, you had very little information on how medical school works and you realized you didn’t have the resources to completed the degree without working, and even then it was by luck you had a faculty member that liked you enough to pay for you to stay, you had no health insurance and you had the recurrence of a condition that hadn’t effected you in 7 years that could take away an entire day if not controlled, and to improve your test scores you needed 200/ month medication and an assessment that costs thousands of dollars (school never mentioned they would pay for it even though I asked prior to clerkships) what would you have done differently?

Take the leave of absence if it meant risking not getting back in?

I may be uneducated on strategies here so these may be a good questions.

As I said I got here by a bit of luck grew up in foster care my entire life no idea what I’m doing just did volunteering I enjoyed did well on the mcat got decent grades and enjoyed working with patients. I just pursue what I enjoy it’s what I did for medical school why should I not for residency?

*I read most of everyone’s replies I think if not sorry I’m burned out and need sleep but thanks everyone for your input I will return another day when I free time*

 

[voxveritatisetlucis]

If I apply ENT this is assuming my clerkship grades are the only red flag. If I score 260 step (although you lack faith understandably), get 15 publications, and good sub I evals, with appropriate LORs. I’m not going to apply If I have other huge deficiencies such as a 240 step. I’ve been told the research is possible and I still have two years that are more free than any of the first two.

Now as far as the late thing, I’ve seen resident attendings and everyone else show up late occasionally. It’s never the goal but happens from time to time. I had an earnest reason to be late. I still showed up an hour early and completed the list on surgery (never late the entire clerkship) and stayed from 4 am until 8 pm trying to learn or help out because it’s something I enjoyed. This is not of the things I discussed with the program director. I am very organized and keep a schedule and adhere to it. I teach medical students evidenced based study techniques and know them well. My impression here is I wanted a leave of absence I could not afford to take. I had to forgo it because I had no way of ensuring I’d get back into medical school. If you think I’m being lazy and just showing up 15 minutes late because I feel like it that is fine but it is not the case. These are assumptions most people will make reading the application unfortunately…

On another note, while my question was focused on the future it seems many tend to want to discuss the previous year. I have a question, and anyone can answer if you want but it’d be nice to get information that I could have used a year ago. If you were going through medical school and wanted to go in a competitive specialty, you had very little information on how medical school works and you realized you didn’t have the resources to completed the degree without working, and even then it was by luck you had a faculty member that liked you enough to pay for you to stay, you had no health insurance and you had the recurrence of a condition that hadn’t effected you in 7 years that could take away an entire day if not controlled, and to improve your test scores you needed 200/ month medication and an assessment that costs thousands of dollars (school never mentioned they would pay for it even though I asked prior to clerkships) what would you have done differently?

Take the leave of absence if it meant risking not getting back in?

I may be uneducated on strategies here so these may be a good questions.

As I said I got here by a bit of luck grew up in foster care my entire life no idea what I’m doing just did volunteering I enjoyed did well on the mcat got decent grades and enjoyed working with patients. I just pursue what I enjoy it’s what I did for medical school why should I not for residency?

*I read most of everyone’s replies I think if not sorry I’m burned out and need sleep but thanks everyone for your input I will return another day when I free time*

How would you go from two to fifteen publications before you apply. That seems overly optimistic. Keep in mind many publications take 4-5 months after they are submitted

 

[OrphanedDoc]

This is why you were recommended to take a LOA. You're clearly making bad choices and not thinking straight, and the "ENT or bust" mentality is frankly, unhealthy.

I was not recommended to take a LOA. I wanted one lol. I was seriously like there’s no way im not going to fail every clerkship.. Until I realized I was unlikely to make it back in medical school. I actually performed better than expected mainly the clerkships were just easier than expected. There were times I just showed up to the clerkship and worked half the day and then chart reviewed my one or two patients and rounded them left and worked. It was really only after getting worn down did my poor performance start. I missed honors by relatively small margins given my shelf performance. I’ll be honest I know it’s bad but I don’t discount the power of hard work and people so if things look like they went as well as the could from here, yes I will apply. If I get a 240 on step and 3 publications im going to see where I’m competitive and not even bother. But I obviously have more faith in myself to perform well despite my poor performance because I trust myself I suspect I am accurate with my shelf exams and I have a good grasp of concepts. Hopefully with accommodations or if im denied (I’ll admit it’s not happening if im denied) some miracle strategy we can go from there.

My point is no one here is wrong, medical school is unforgiving if you don’t focus on it. I just have no freakin idea what I could have done differently… but I know my chances, not much math needed there.

 

[OrphanedDoc]

How would you go from two to fifteen publications before you apply. That seems overly optimistic. Keep in mind many publications take 4-5 months after they are submitted

That’s good to hear, I was told by upperclassmen that 13 publications was more than reasonable within the year (I just put two years because I’m slow) if you focus on nothing but research. I am only required to do two electives and a sub I next year that’s like 6-7 months of nothing.

 

[operaman]

You’ve definitely had a rough year and in retrospect the LOA would have been the best move. I’ve had multiple friends take them and known many students who did as well. None of them had any issues joining the next year’s class. Obviously too late for that now but I put it here for future students who may happen across this post.

So here’s the skinny on options if you don’t match: they’re terrible. You’re eligible for SOAP but you’ll mainly be looking at IM and GS prelim years and a smattering of unfilled categorical slots from other fields. The problem is that there’s limited time to make a convincing app for another field - basically from Monday of Match week when you get the bad news to Tuesday/Wednesday when you start interviewing. You’re looking at 24 hours to make a convincing app for an entirely different field. Oh and there are unmatched applicants from that field also applying, and what PD is taking the failed ent applicant over someone actually invested in their field? And to top it off, you’ll have a handful of superstars from ent and Ortho and derm looking for landing pads. Anything worth having will likely be gobbled up.

So you’re basically looking at prelim years during which you would re apply and hopefully dual apply then. But then you’re another year out and far away from your med school trying to get letters while slogging through a scut filled intern year. It’s doable but not ideal. We’re talking incredible stress levels and limited sleep.

You will absolutely not get a funded ent research year. Those programs hand pick stellar applicants who were simply unlucky and/or who had poor research in round one because they want to be able to brag about all their fellows matching. Oh and it’s a match violation to apply to them while you’re in SOAP, so you’ll be faced with prelim versus rolling the dice yet again.

Even with a 260+ and 15 pubs and decent letters, you’ll be hard pressed to overcome a failed clinical rotation and a borderline performance otherwise with mixed evals. And those are really hard numbers to hit to begin with! But alas those are about average for ENT nowadays. Average. Middle of the road, though with absolutely no red flags. Unfortunately, an average set of numbers combined with serious clinical red flags will not open any doors.

Sorry to be such a downer, but I know what awaits at the end of the road you’re on and it’s not pretty. You still have time to lay some groundwork for your plan B. Don’t blow it.

 

[OrphanedDoc]

You’ve definitely had a rough year and in retrospect the LOA would have been the best move. I’ve had multiple friends take them and known many students who did as well. None of them had any issues joining the next year’s class. Obviously too late for that now but I put it here for future students who may happen across this post.

So here’s the skinny on options if you don’t match: they’re terrible. You’re eligible for SOAP but you’ll mainly be looking at IM and GS prelim years and a smattering of unfilled categorical slots from other fields. The problem is that there’s limited time to make a convincing app for another field - basically from Monday of Match week when you get the bad news to Tuesday/Wednesday when you start interviewing. You’re looking at 24 hours to make a convincing app for an entirely different field. Oh and there are unmatched applicants from that field also applying, and what PD is taking the failed ent applicant over someone actually invested in their field? And to top it off, you’ll have a handful of superstars from ent and Ortho and derm looking for landing pads. Anything worth having will likely be gobbled up.

So you’re basically looking at prelim years during which you would re apply and hopefully dual apply then. But then you’re another year out and far away from your med school trying to get letters while slogging through a scut filled intern year. It’s doable but not ideal. We’re talking incredible stress levels and limited sleep.

You will absolutely not get a funded ent research year. Those programs hand pick stellar applicants who were simply unlucky and/or who had poor research in round one because they want to be able to brag about all their fellows matching. Oh and it’s a match violation to apply to them while you’re in SOAP, so you’ll be faced with prelim versus rolling the dice yet again.

Even with a 260+ and 15 pubs and decent letters, you’ll be hard pressed to overcome a failed clinical rotation and a borderline performance otherwise with mixed evals. And those are really hard numbers to hit to begin with! But alas those are about average for ENT nowadays. Average. Middle of the road, though with absolutely no red flags. Unfortunately, an average set of numbers combined with serious clinical red flags will not open any doors.

Sorry to be such a downer, but I know what awaits at the end of the road you’re on and it’s not pretty. You still have time to lay some groundwork for your plan B.

Yeah more so with the leave of absence I had no idea how’d I keep myself supported to make it back was the thought process.

You’ve definitely had a rough year and in retrospect the LOA would have been the best move. I’ve had multiple friends take them and known many students who did as well. None of them had any issues joining the next year’s class. Obviously too late for that now but I put it here for future students who may happen across this post.

So here’s the skinny on options if you don’t match: they’re terrible. You’re eligible for SOAP but you’ll mainly be looking at IM and GS prelim years and a smattering of unfilled categorical slots from other fields. The problem is that there’s limited time to make a convincing app for another field - basically from Monday of Match week when you get the bad news to Tuesday/Wednesday when you start interviewing. You’re looking at 24 hours to make a convincing app for an entirely different field. Oh and there are unmatched applicants from that field also applying, and what PD is taking the failed ent applicant over someone actually invested in their field? And to top it off, you’ll have a handful of superstars from ent and Ortho and derm looking for landing pads. Anything worth having will likely be gobbled up.

So you’re basically looking at prelim years during which you would re apply and hopefully dual apply then. But then you’re another year out and far away from your med school trying to get letters while slogging through a scut filled intern year. It’s doable but not ideal. We’re talking incredible stress levels and limited sleep.

You will absolutely not get a funded ent research year. Those programs hand pick stellar applicants who were simply unlucky and/or who had poor research in round one because they want to be able to brag about all their fellows matching. Oh and it’s a match violation to apply to them while you’re in SOAP, so you’ll be faced with prelim versus rolling the dice yet again.

Even with a 260+ and 15 pubs and decent letters, you’ll be hard pressed to overcome a failed clinical rotation and a borderline performance otherwise with mixed evals. And those are really hard numbers to hit to begin with! But alas those are about average for ENT nowadays. Average. Middle of the road, though with absolutely no red flags. Unfortunately, an average set of numbers combined with serious clinical red flags will not open any doors.

Sorry to be such a downer, but I know what awaits at the end of the road you’re on and it’s not pretty. You still have time to lay some groundwork for your plan B. Don’t blow it.

Dont worry, I come to SDN for the downer posts all the time… no worries. I will probably dual apply and if programs find out (hopefully not) just explain my app wasn’t very competitive.

I have made a similar post elsewhere and had feedback from other residents that (claimed they participated in their selection process) already. They said it’d come down to how I’d do on the sub I and a good step score honoring ENT (everyone who matches does). And explaining what happened and showing the aways I can complete a residency. Along with the fact I’ve seen it happen in rare instances a dual apply seems reasonable. They definitely agreed it’s a tough sell, they just stated sometimes they love someone enough they may overlook a thing or two. I have confidence in my work ethic so I’m not worried about my performance should hell freeze over. Again, I shouldn’t be going homeless in residency and I don’t need to pay to be there so even if I do, there’s no need to pick up a job I’ll sleep in my car.

I don’t think random residents would want more application fodder but ENT people are in general just nice haha. So let’s just see…

Hey I’ll come back here for sure to update everyone on the train wreck experiment.

Now there are some papers from 3 years ago analyzing ENT data and it stated that I’d be well above average if those 15 are publications not research experiences. If that has significantly changed I need more up to date statistics. These goals were formed based on applicant data so they are definitely changeable. Unless it’s 30+ research experiences necessary I can work with my peers and fellow under classmen to get manuscript writing done quicker. Also manuscript writing is now much quicker than in the past which is a blessing. So I need time to submit get rejected and hopefully accepted on the second attempt for most projects. Also, I actually drafted my own projects and wrote the abstracts for about 7 projects. I will forward them
To faculty when I have time so then all I have to do is get manuscript writing done if they agree to help. Probably won’t all get published but we will see. I actually was against a research year I have the space and time next year for research I will think of more good projects before my next phase starts to hopefully get going quicker.

At the end of the day, I’ll provide as much value as I can to my home institution and see towards the end what support they can give.

 

[mistafab]

Just looking at the data bro I would say don't apply, or at least dual apply. Even if you get tons of research, you just aren't a likely candidate - with or without an LOA. I advise not taking the LOA (unless you need to for personal or mental health reasons) as you are just wasting a year and there is almost nothing you can do to improve your app for ENT.

ENT is extremely competitive, and there are many applicants without any blemishes.

 

[OrphanedDoc]

Just looking at the data bro I would say don't apply, or at least dual apply. Even if you get tons of research, you just aren't a likely candidate - with or without an LOA. I advise not taking the LOA (unless you need to for personal or mental health reasons) as you are just wasting a year and there is almost nothing you can do to improve your app for ENT.

ENT is extremely competitive, and there are many applicants without any blemishes.

Hi, was not planning on a LOA it was just what I wanted to prior to clerkships but didn’t think I could afford it. No point now, my schedule is much lighter.

Also, I am dual-applying more than likely.

 

[GoSpursGo]

Yes, I’ve qualified for accommodations my entire life. I just assumed I’d skate through medical school exams. When I think about it accommodations would fix all my academic problems given my pretest from the nbme generally predict me in to get a 90 or high 80s. I’d at least get High pass with those grades. I’m never going to live that down. I have applied for accommodations already but it’s difficult since I never used them. I’m trying to petition that I’ve never had the resources to get the accommodations instead of saying I simply do well on test generally. Which is true but not the whole truth so we will see. I don’t think even if I wanted accommodations I could’ve afforded them. My school has agreed to pay for the evaluation however so maybe it can save my step exams.

This sounds like a perfect scenario for you to take an LOA now. This would allow you time to get accommodations, possibly do other things to address your mental health, then come back next year ready to put your best foot forward. I share everyone else’s concern that you are being unrealistic to think you are going to match ENT, but this would also allow you to potentially work on ENT projects during your LOA, make connections, and ideally discuss with your home program by the end of the LOA whether you have a realistic shot.

Trudging ahead right now and continuing to try and bootstrap your way through this is not going to work. It has not worked, and thinking a switch is going to suddenly flip without any intervention is magical thinking.

 

[OrphanedDoc]

This sounds like a perfect scenario for you to take an LOA now. This would allow you time to get accommodations, possibly do other things to address your mental health, then come back next year ready to put your best foot forward. I share everyone else’s concern that you are being unrealistic to think you are going to match ENT, but this would also allow you to potentially work on ENT projects during your LOA, make connections, and ideally discuss with your home program by the end of the LOA whether you have a realistic shot.

Trudging ahead right now and continuing to try and bootstrap your way through this is not going to work. It has not worked, and thinking a switch is going to suddenly flip without any intervention is magical thinking.

My schedule is extremely light now the worse is over. A LOA doesn't make sense at this point in my curriculum as I cannot take any more courses until I complete my step exams and I plan on scheduling those for when I am ready. I do not believe I have a small chance at matching ENT in the slightest which is what I have been trying to say since the original post haha. I've already had my chances evaluated. The primary barrier to the LOA pre-damaged application was simply I didn't think I could support myself to get back into school during that year. There were also unfavorable loan implications.

 

[GoSpursGo]

My schedule is extremely light now the worse is over. A LOA doesn't make sense at this point in my curriculum as I cannot take any more courses until I complete my step exams and I plan on scheduling those for when I am ready. I do not believe I have a small chance at matching ENT in the slightest which is what I have been trying to say since the original post haha. I've already had my chances evaluated. The primary barrier to the LOA pre-damaged application was simply I didn't think I could support myself to get back into school during that year. There were also unfavorable loan implications.

I categorically disagree. The idea that you are going to get a 260 on step 2 with no intervention is incongruent with your reality where you currently are failing your shelves and/or running out of time. Nevermind the fact that you need to not only pass, but honor your remaining rotations. I am not sure how you expect to suddenly flip a switch clinically and also become highly productive in research.

Regardless, it appears you have decided ahead of time that you don't really care about our feedback and want reassurance that your plan makes sense. I do not think your plan makes sense, but I wish you the best nonetheless.

 

[Goro]

.Regardless, it appears you have decided ahead of time that you don't really care about our feedback and want reassurance that your plan makes sense. I do not think your plan makes sense, but I wish you the best nononetheless.

I agree with my wise colleague, and just a word of warning, OP. People get dismissed from residency for being unteachable.

 

[OrphanedDoc]

I categorically disagree. The idea that you are going to get a 260 on step 2 with no intervention is incongruent with your reality where you currently are failing your shelves and/or running out of time. Nevermind the fact that you need to not only pass, but honor your remaining rotations. I am not sure how you expect to suddenly flip a switch clinically and also become highly productive in research.

Regardless, it appears you have decided ahead of time that you don't really care about our feedback and want reassurance that your plan makes sense. I do not think your plan makes sense, but I wish you the best nonetheless.

The most important thing here is I believe there is a misunderstanding of my original post. I was asking for the best plan *after* I did not match ENT. I never asked about my chances or likelihood of performing well. It is key that you understand this to not necessarily waste your time. If you wish to reply, as I am sure you are busy and I appreciate everyone's time but I have to ask that everything is read to avoid assumptions. If not, no problem thank you for your time.

Now, I also did not think it was fair you made multiple assumptions about my insight and thus intelligence and reasonability so I will explain further. I sense you were trying to help and I do not intend to offend anybody here so I hope this clarifies my post. People in general should not say things are outside of someone's capabilities in general. You don't know what plans or adjustments they need to succeed or their ability to make them happen. I wanted feedback on the best plan post-match not pre-match can't stress that enough. The only signs of poor judgement here is my desire to apply with poor competitiveness. However, that is why I am here for risk control. It is something important to me and that is all that matters. If I deem it truly 100% pointless I can make that call. I have long since contemplated dual applying.

Now, it seems to me you are saying a LOA has an advantage at this current point, despite the fact I am doing nothing at this point. I am confused about the difference. I can effectively not take my step exams and just loaf around. There are students who spent 6 months on dedicated but they were not permitted to go to move on. As someone who grew up as an orphan I have no resources I would like to avoid discontinuing school at this point because my future becomes less secure however I am completely OK with taking more time to relax during my dedicated period which I can do without filing for the whole year. My performance (I'm actually finishing up my last clerkship) on this block is much better and I am at no risk of failing. My evals have been perfect, my OSCEs are great, and the only reason my grades did not shoot up as I timed out on my exam as predicted. I will be approved for accommodations (or denied in which I am screwed). Keep in mind my performance initially was similar. One thing is holding me back when I am not going through excessive personal problems. Yes, I still need to go to appointments, and yes finances are still a little tight (much improved since two months ago which is why I'm less stressed) but improved, but the administration at my institution has been able to recently make effective interventions that ultimately took a lot of planning and time to find what worked. They have not agreed to pay for my accommodation evaluation to hopefully take care of my timing problem. Now if I come back still with borderline scores after answering 30 more questions and not rushing through 20 of them I will be surprised. I score about 7-9% below the average for my class. I do not think I am being unreasonable. But like I said this is not where I wanted insight. Although I did ask what would people have done differently but that has nothing to do with my immediate future plans. I have never stated I am going to score a 260 on Step exam without intervention, I stated it was in my capabilities based on knowledge and just my learning capabilities, assuming the timing concern is dealt with. In no event do I expect to score 90th% + when I cannot finish an exam.

Another key thing here is I provided the basis for my poor performance - the shelf exams. OSCEs on rare occasions and recently (I haven't prepared for them at all as I was scoring well on them before but I've recently been timing out on the notes and losing some points) I actually scored well on my previous OSCE so not a primary concern.

Another tidbit in untimed situations, I score very well for the shelf (80%+ and I have months to fill in any holes) I do not do untimed often as I need as much timed practice as I can get so my average uworld percentage is around 70% with some 60% one or two 50% a block if I am not having a good day with stress and time out (this is post learning though which takes me a few weeks since we do clinical second year). Also, I do well in timed situations that are short. If I receive accommodations it is likely I will score much better. Not a guaranteed 260-step scorer and as with exams of this nature a bad test day can definitely happen, but I can push my exam and work towards it, and assuming the timing isn't a problem I like my odds. Scored 98th percentile on a block a fell asleep on the MCAT I believe in myself, nothing wrong with that.

I agree with my wise colleague, and just a word of warning, OP. People get dismissed from residency for being unteachable.

This makes sense, poor insight and not being coachable is correlated with the least capacity to improve. Essentially those residents can be duds and are likely a danger to patients. I wholeheartedly agree with these dismissals.

I sort of explained that the information provided was not addressing my original post in the slightest which is fair and necessary so as not to waste anyone's time. Especially the "you decided ahead of time... reassurance" comment. Neither of these are true, just the actual post wasn't addressed. He stated I was unlikely to score 260 given my history without intervention. This communicates to me that 1.) he's assuming im under the impression that I am a guaranteed 260 scorer and 2.) I was not in the process of any interventions. Both are untrue and I am unsure where he got that information, I did say I believe in myself if that's where the problem is. But if so... that is a whole other problem.

I am being told about chances I am already aware of and spoken to as if I do not have an understanding of my situation with the limited information people have of me. This isn't a lack of teachability this is me saying I understand what you're saying but you lack a lot of information and your assumptions are premature. A conclusion I got from the fact that there are several statements stated that were inaccurate. I would not teach a student English if he wanted to take a Calculus class. Sure, English is important but that wasn't what he came to class for. That's all I'm saying...

Either way, I appreciate the input, this just wasn't a "what're my chances post?" I had already gauged that to a degree I believe is accurate based on resident input and the data that is publically available. The tags are for traffic admittedly.

 

[Esmolol]

And herein lies the problem... You are asking what you should do if/after you don't match (i.e. VERY BAD SPOT), and the wise people here are offering you advice on how to avoid this bad position in the first place. If ENT is your goal - go for it but have a backup plan in place. I am aware that this is exactly what you came here for, for the answer to "What should my backup plan be?" How about assessing your current stats (without things like a 260+ step 2 ck etc.) and picking a backup specialty to which you would have a high chance of matching? Is there any other field of medicine that you enjoy?

 

[NotAProgDirector]

I agree with others here that your chances of getting an ENT spot, even with a perfect record going forward, are not good. I hear you when you tell us that this is your dream and you need to try -- but understand that comes with a cost, which I'm not certain you fully appreciate.

I am somewhat confused on your timeline. You've completed your clinical clerkship year -- which in a traditional schedule is the 3rd year but now can be the 2nd year or run from the middle of 2nd to the middle of 3rd. If you were on a trad schedule, you would be planning to apply this September - which seems like it's not the case. Unless you've already worked out a deal with your school to extend your 4th year over two years to get more time for rotations and research. Some clarity about where you actually are, and when you would apply, might help.

That aside, here are the upcoming pitfalls I see:

1. I remain concerned that you don't have good supports / advising. I understand that you want to show your "best face" to the ENT folks -- so they can't be an honest mentor with you. You have limited familial / social supports for this. You need someone who can be 100% honest with you, whom you can share all of your struggles and issues, and can help you avoid future pitfalls.

2. Everyone will agree that you should try to get as good a S2 score as possible and pass S1 on the first attempt (if you haven't done that already). Although setting a score target of 260 is laudable, if it's unlikely you can set yourself up for disappointment and depression. Setting a goal is key. Setting a reasonable goal is wise.

3. You talk about dual applying. Let's be clear what this means -- it means you plan to submit an application to both ENT programs and to some other specialty (perhaps surgery). You might think you can just apply to two fields and it's no big deal -- perhaps more work but otherwise fine. But it's much more complicated than that. First, you only get one ERAS application -- whatever you fill out on there goes to all programs. So you can't word things differently for different fields. You can include different LOR's and different personal statements, but that's the only part of the application you can customize. Programs in your back up field will see 1) an application that maximizes ENT experiences, 2) a research year focused on ENT research, 3) multiple ENT rotations, and 4) likely no letter from your ENT research mentor since that letter is probably going to talk about how much you want to be in ENT. Many letter writers will not write you two letters for two fields (although some may). Hence when some (perhaps many) programs in your backup field are reviewing your application, they will see all this and know exactly what you are doing -- and they may decline to interview you. You'll also have the problem that you may not be able to apply to both fields at the same institution without them seeing that.

And therein lies the rub. I am worried your ENT app is not going to be competitive. I also worry that with all this ENT focus, it won't be competitive for Gen Surgery either. GS programs will see all this ENT stuff and your app and decide that either your heart isn't in GS, or that you're being completely unrealistic. or both.

4. You mention getting 15 pubs in a year. That's more than one per month. No matter what anyone has told you, this is unlikely. Or you'll end up with lots of "fluff". Again, I worry you're setting up unrealistic goals that may be very difficult or impossible to meet.

You also asked about what happens if you don't match - and that was described well above. The main challenge in the SOAP process is the very compressed timeline. You have 24-48 hours to make up your mind what you want to do, and if it's a residency spot you're most likely to end up with a 1 year prelim. Then you need to find a categorical spot which isn't easy -- and if you just apply again the next year, you'll do so in August when you have exactly 2 months done in your residency, hard to generate glowing letters at a new place in that timeframe. There are lots of ways to get a PGY-2 spot (some outside the match) but they are all diffcult and stressful.

While I've been typing this others have added more posts ahead (always a bad sign of my slow typing). This has nothing to do with your skills in ENT. You might make a great ENT doc. The problem is simply that the field is so competitive, that you might be screened out based on your past track record. It's unfortunate. But it's the way it works.

You also mentioned you're getting tested for accommodations. Totally agree -- but you may discover it may not matter. You took the MCAT and got a 510+ (it's in your prior post histry). The USMLE may look at that and say that no matter what your testing shows, you did fine without accommodations on the MCAT so you don't need them for USMLE. It's a big challenge. You should try, but it may not be successful.

You do have lots going for you. You have a very compelling backstory of success from a difficult upbringing. You'll add diversity to any program that accepts you. You seem to have some rotations that are going great. At least some of the problem is test taking which might be addrssable and a nice score on S2 would go a long way to helping.

I wish you the best.

 

[GoSpursGo]

Now, I also did not think it was fair you made multiple assumptions about my insight and thus intelligence and reasonability so I will explain further. I sense you were trying to help and I do not intend to offend anybody here so I hope this clarifies my post. People in general should not say things are outside of someone's capabilities in general. You don't know what plans or adjustments they need to succeed or their ability to make them happen.

I did not say anything about your intelligence, nor have I made any assumptions. I have drawn conclusions based on your results thus far in medical school. You recognized heading into clinicals that you were struggling based on health, financial and stress problems. You already tried to turn things around by saying "F it we ball," and your results are what they have been. Other than hoping that you get accommodations and that this completely fixes your issues, I have not heard you convey a concrete plan for improving your outcome--so a reasonable concern that I have is that you still believe you're going to flip a switch and become the kind of applicant who is competitive for ENT. I do not know what plans or adjustments you need to make to succeed on Step, but I know that what you have done thus far has not worked. If you don't like my idea of taking an LOA (or call it a research year, or whatever would not trigger you needing to repay your loans), that's fine... but again, I urge you to come up with a concrete plan for success.

FWIW... I worry that if you were going to dual apply to gen surg, you may also not be highly competitive due to your academic struggles, even independent of the fact that they'll know your heart isn't in gen surg. I think you really need to consider an IM or maybe anesthesia backup.

If none of this matters to you, then that's fine too. To answer your specific question of what to do after you fail to match, the answer is that you re-enter the match and hopefully apply to a much less competitive field. As to what you do during that year, that is a question you need to have with your school--would they support you delaying graduation for a research year and/or additional rotations? Would they create a prelim IM or surgery spot for you? Would you be SOL and SOAPing for whatever you can get? I don't know, and the answer will vary depending on your school. Again, all the more reason you need to be open and honest with your mentors now so that you can make a realistic plan B.

 

[operaman]

Yeah I think most of us are seeing the "what do I do when I don't match?" question and doing everything we can to spare you that terrible situation. It seems like you can make it work, but the logistics are brutal and most people have no idea how hard it is. You basically spend 3 years of medical school preparing to apply to residency the first time. Once you don't match, you're going to be trying to replicate that process in 24-48 hours for SOAP or in 2-3 months if you do a prelim and reapply, all while moving to a new city and learning a new system and probably not getting your first actual paycheck until August. Then you may be shelling out tons of money for ERAS before we even talk about interviews. It's a nasty, brutal system for re-applicants.

It becomes even worse if you lack significant financial resources. From your post it sounds like you don't have a lot of backup financial support, so you do need to consider how you will live through the in-between periods. Whether you SOAP to a prelim or simply work and take a year off, you won't have access to loan money anymore and there's inevitably a lag between finding/starting a job and getting paid. Unfortunately this lag will hit you right before you're reapplying for residency and need quite a bit of capital. This gap period is tough even for matched categorical applicants and many have to take out private loans to move, pay rent/deposit, and other misc costs of relocation until residency pay starts.

Do whatever you can to make your first attempt the best attempt so you can match somewhere and move on with your career.

 

[Angus Avagadro]

The most important thing here is I believe there is a misunderstanding of my original post. I was asking for the best plan *after* I did not match ENT. I never asked about my chances or likelihood of performing well. It is key that you understand this to not necessarily waste your time. If you wish to reply, as I am sure you are busy and I appreciate everyone's time but I have to ask that everything is read to avoid assumptions. If not, no problem thank you for your time.

Now, I also did not think it was fair you made multiple assumptions about my insight and thus intelligence and reasonability so I will explain further. I sense you were trying to help and I do not intend to offend anybody here so I hope this clarifies my post. People in general should not say things are outside of someone's capabilities in general. You don't know what plans or adjustments they need to succeed or their ability to make them happen. I wanted feedback on the best plan post-match not pre-match can't stress that enough. The only signs of poor judgement here is my desire to apply with poor competitiveness. However, that is why I am here for risk control. It is something important to me and that is all that matters. If I deem it truly 100% pointless I can make that call. I have long since contemplated dual applying.

Now, it seems to me you are saying a LOA has an advantage at this current point, despite the fact I am doing nothing at this point. I am confused about the difference. I can effectively not take my step exams and just loaf around. There are students who spent 6 months on dedicated but they were not permitted to go to move on. As someone who grew up as an orphan I have no resources I would like to avoid discontinuing school at this point because my future becomes less secure however I am completely OK with taking more time to relax during my dedicated period which I can do without filing for the whole year. My performance (I'm actually finishing up my last clerkship) on this block is much better and I am at no risk of failing. My evals have been perfect, my OSCEs are great, and the only reason my grades did not shoot up as I timed out on my exam as predicted. I will be approved for accommodations (or denied in which I am screwed). Keep in mind my performance initially was similar. One thing is holding me back when I am not going through excessive personal problems. Yes, I still need to go to appointments, and yes finances are still a little tight (much improved since two months ago which is why I'm less stressed) but improved, but the administration at my institution has been able to recently make effective interventions that ultimately took a lot of planning and time to find what worked. They have not agreed to pay for my accommodation evaluation to hopefully take care of my timing problem. Now if I come back still with borderline scores after answering 30 more questions and not rushing through 20 of them I will be surprised. I score about 7-9% below the average for my class. I do not think I am being unreasonable. But like I said this is not where I wanted insight. Although I did ask what would people have done differently but that has nothing to do with my immediate future plans. I have never stated I am going to score a 260 on Step exam without intervention, I stated it was in my capabilities based on knowledge and just my learning capabilities, assuming the timing concern is dealt with. In no event do I expect to score 90th% + when I cannot finish an exam.

Another key thing here is I provided the basis for my poor performance - the shelf exams. OSCEs on rare occasions and recently (I haven't prepared for them at all as I was scoring well on them before but I've recently been timing out on the notes and losing some points) I actually scored well on my previous OSCE so not a primary concern.

Another tidbit in untimed situations, I score very well for the shelf (80%+ and I have months to fill in any holes) I do not do untimed often as I need as much timed practice as I can get so my average uworld percentage is around 70% with some 60% one or two 50% a block if I am not having a good day with stress and time out (this is post learning though which takes me a few weeks since we do clinical second year). Also, I do well in timed situations that are short. If I receive accommodations it is likely I will score much better. Not a guaranteed 260-step scorer and as with exams of this nature a bad test day can definitely happen, but I can push my exam and work towards it, and assuming the timing isn't a problem I like my odds. Scored 98th percentile on a block a fell asleep on the MCAT I believe in myself, nothing wrong with that.

This makes sense, poor insight and not being coachable is correlated with the least capacity to improve. Essentially those residents can be duds and are likely a danger to patients. I wholeheartedly agree with these dismissals.

I sort of explained that the information provided was not addressing my original post in the slightest which is fair and necessary so as not to waste anyone's time. Especially the "you decided ahead of time... reassurance" comment. Neither of these are true, just the actual post wasn't addressed. He stated I was unlikely to score 260 given my history without intervention. This communicates to me that 1.) he's assuming im under the impression that I am a guaranteed 260 scorer and 2.) I was not in the process of any interventions. Both are untrue and I am unsure where he got that information, I did say I believe in myself if that's where the problem is. But if so... that is a whole other problem.

I am being told about chances I am already aware of and spoken to as if I do not have an understanding of my situation with the limited information people have of me. This isn't a lack of teachability this is me saying I understand what you're saying but you lack a lot of information and your assumptions are premature. A conclusion I got from the fact that there are several statements stated that were inaccurate. I would not teach a student English if he wanted to take a Calculus class. Sure, English is important but that wasn't what he came to class for. That's all I'm saying...

Either way, I appreciate the input, this just wasn't a "what're my chances post?" I had already gauged that to a degree I believe is accurate based on resident input and the data that is publically available. The tags are for traffic admittedly.

My wise colleagues have provided excellent advice with detailed, accurate information. Whitehead said " Wisdom is the application of knowledge" . Everyone here wants you to be successful. In essence, you are planning on not matching ENT.
The challenges of dual applications is noted above. The challenges of not matching and going through the SOAP have been discussed. Going through the SOAP might place you in a program that does not fill because it is not very good. Meaning board failures and poor teaching. I get the fact you want to take a 3/4 court shot at the buzzer. If you were to miss and have no adverse sequelae, I'd say why not take your shot. Yet, in this case, this could have dire effects on your app and ability to match at a good program, which I believe should be your primary concern. I mean, do you want to match in a good program or one that doesn't fill? You are hurting your chances being a re applicant and you have red flags. I used to sit on our local Uni's resident selection committee. There are plenty of strong applicants with no red flags. We have that resident for 4 yrs, so no one wants to hire a problem. I think you have received excellent information and polite advice. Its now up to you to synthesize all of the advice and apply it to best reach your goals. I wish you the best.

 

[LeaveNoTrace]

ENT is going to be a Hail Mary. I'd recommend applying broadly to community FM, IM, EM, or possibly psych programs. After a LoA. Good luck. You have red flags: you should be grateful to match anywhere that will take you.

 

[GoSpursGo]

ENT is going to be a Hail Mary. I'd recommend applying broadly to community FM, IM, EM, or possibly psych programs. After a LoA. Good luck. You have red flags: you should be grateful to match anywhere that will take you.

See, I'm not even sure the situation is that bleak. The OP is still a US MD student. Academic IM programs with the possibility of a fellowship afterward are absolutely still within reach; there is no reason that he needs to fall all the way to the bottom of the barrel due to what is thus far one red flag. But if he insists on applying to ENT and has to SOAP, that will be the only place the OP may find himself.

 

[OrphanedDoc]

See, I'm not even sure the situation is that bleak. The OP is still a US MD student. Academic IM programs with the possibility of a fellowship afterward are absolutely still within reach; there is no reason that he needs to fall all the way to the bottom of the barrel due to what is thus far one red flag. But if he insists on applying to ENT and has to SOAP, that will be the only place the OP may find himself.

I actually love IM-Pulmonolgy, I just hated IM... Yeah, my goal is to hopefully have the F return to being a P (long story) and just explain my situation, and if they say sorry too risky go into backups. I have great things said in my evals so hopefully my MSPE doesn't look too bad. Especially, since the bad ones don't speak on anything objective as far as my skills as a clinician.

 

[OrphanedDoc]

ENT is going to be a Hail Mary. I'd recommend applying broadly to community FM, IM, EM, or possibly psych programs. After a LoA. Good luck. You have red flags: you should be grateful to match anywhere that will take you.

Yes, I do have red flags. However, I also have fair reasons for them. I don't think it is insane to let someone have the whole story and make that decision for themselves. If I don't match, plan B.

 

[OrphanedDoc]

My wise colleagues have provided excellent advice with detailed, accurate information. Whitehead said " Wisdom is the application of knowledge" . Everyone here wants you to be successful. In essence, you are planning on not matching ENT.
The challenges of dual applications is noted above. The challenges of not matching and going through the SOAP have been discussed. Going through the SOAP might place you in a program that does not fill because it is not very good. Meaning board failures and poor teaching. I get the fact you want to take a 3/4 court shot at the buzzer. If you were to miss and have no adverse sequelae, I'd say why not take your shot. Yet, in this case, this could have dire effects on your app and ability to match at a good program, which I believe should be your primary concern. I mean, do you want to match in a good program or one that doesn't fill? You are hurting your chances being a re applicant and you have red flags. I used to sit on our local Uni's resident selection committee. There are plenty of strong applicants with no red flags. We have that resident for 4 yrs, so no one wants to hire a problem. I think you have received excellent information and polite advice. Its now up to you to synthesize all of the advice and apply it to best reach your goals. I wish you the best.

Hi, thanks for your reply, I realized that I suck at using SDN and left a whole chunk of redundant paragraphs there, must've been tiresome to read. Yes, I am all caught up on the adverse sequelae and those answers have been very helpful. I just don't want any to feel ignored or brushed off so I was explaining why I did not want this to become a what are my chances type of post. Definitely great information and didn't want to take away from that. I believe based on the information provided here my plan of action is set and risks are minimized. The next step will be addressing the red flags.

 

[OrphanedDoc]

And herein lies the problem... You are asking what you should do if/after you don't match (i.e. VERY BAD SPOT), and the wise people here are offering you advice on how to avoid this bad position in the first place. If ENT is your goal - go for it but have a backup plan in place. I am aware that this is exactly what you came here for, for the answer to "What should my backup plan be?" How about assessing your current stats (without things like a 260+ step 2 ck etc.) and picking a backup specialty to which you would have a high chance of matching? Is there any other field of medicine that you enjoy?

The thing is clerkship grades alone my options are grim unless there's a program director somewhere that will consider the circumstances surrounding the grades in ANY specialty. I will surely dual apply.

I agree with others here that your chances of getting an ENT spot, even with a perfect record going forward, are not good. I hear you when you tell us that this is your dream and you need to try -- but understand that comes with a cost, which I'm not certain you fully appreciate.

I am somewhat confused on your timeline. You've completed your clinical clerkship year -- which in a traditional schedule is the 3rd year but now can be the 2nd year or run from the middle of 2nd to the middle of 3rd. If you were on a trad schedule, you would be planning to apply this September - which seems like it's not the case. Unless you've already worked out a deal with your school to extend your 4th year over two years to get more time for rotations and research. Some clarity about where you actually are, and when you would apply, might help.

That aside, here are the upcoming pitfalls I see:

1. I remain concerned that you don't have good supports / advising. I understand that you want to show your "best face" to the ENT folks -- so they can't be an honest mentor with you. You have limited familial / social supports for this. You need someone who can be 100% honest with you, whom you can share all of your struggles and issues, and can help you avoid future pitfalls.

2. Everyone will agree that you should try to get as good a S2 score as possible and pass S1 on the first attempt (if you haven't done that already). Although setting a score target of 260 is laudable, if it's unlikely you can set yourself up for disappointment and depression. Setting a goal is key. Setting a reasonable goal is wise.

3. You talk about dual applying. Let's be clear what this means -- it means you plan to submit an application to both ENT programs and to some other specialty (perhaps surgery). You might think you can just apply to two fields and it's no big deal -- perhaps more work but otherwise fine. But it's much more complicated than that. First, you only get one ERAS application -- whatever you fill out on there goes to all programs. So you can't word things differently for different fields. You can include different LOR's and different personal statements, but that's the only part of the application you can customize. Programs in your back up field will see 1) an application that maximizes ENT experiences, 2) a research year focused on ENT research, 3) multiple ENT rotations, and 4) likely no letter from your ENT research mentor since that letter is probably going to talk about how much you want to be in ENT. Many letter writers will not write you two letters for two fields (although some may). Hence when some (perhaps many) programs in your backup field are reviewing your application, they will see all this and know exactly what you are doing -- and they may decline to interview you. You'll also have the problem that you may not be able to apply to both fields at the same institution without them seeing that.

And therein lies the rub. I am worried your ENT app is not going to be competitive. I also worry that with all this ENT focus, it won't be competitive for Gen Surgery either. GS programs will see all this ENT stuff and your app and decide that either your heart isn't in GS, or that you're being completely unrealistic. or both.

4. You mention getting 15 pubs in a year. That's more than one per month. No matter what anyone has told you, this is unlikely. Or you'll end up with lots of "fluff". Again, I worry you're setting up unrealistic goals that may be very difficult or impossible to meet.

You also asked about what happens if you don't match - and that was described well above. The main challenge in the SOAP process is the very compressed timeline. You have 24-48 hours to make up your mind what you want to do, and if it's a residency spot you're most likely to end up with a 1 year prelim. Then you need to find a categorical spot which isn't easy -- and if you just apply again the next year, you'll do so in August when you have exactly 2 months done in your residency, hard to generate glowing letters at a new place in that timeframe. There are lots of ways to get a PGY-2 spot (some outside the match) but they are all diffcult and stressful.

While I've been typing this others have added more posts ahead (always a bad sign of my slow typing). This has nothing to do with your skills in ENT. You might make a great ENT doc. The problem is simply that the field is so competitive, that you might be screened out based on your past track record. It's unfortunate. But it's the way it works.

You also mentioned you're getting tested for accommodations. Totally agree -- but you may discover it may not matter. You took the MCAT and got a 510+ (it's in your prior post histry). The USMLE may look at that and say that no matter what your testing shows, you did fine without accommodations on the MCAT so you don't need them for USMLE. It's a big challenge. You should try, but it may not be successful.

You do have lots going for you. You have a very compelling backstory of success from a difficult upbringing. You'll add diversity to any program that accepts you. You seem to have some rotations that are going great. At least some of the problem is test taking which might be addrssable and a nice score on S2 would go a long way to helping.

I wish you the best.

Hi,

These are good points and points I was arriving at in my decision-making recently. I complete almost all of my clerkships prior to starting third year and will have a month or two under two years left. How do I keep dual applying a secret? I did arrive at the conclusion that I can't. Some sources suggest that while they will be aware, they may understand why and it won't be as detrimental as one would initially think.

Yes, I did have timing problems on the MCAT (the first time doing a chem phy I only answered less than half of the questions but it was honestly easy enough that I could tank a few questions every block. So that comes back to bite me. Not sure what to do there. Also, I have methods of circumventing the timing problem a bit with mass eating caffeine and stuff (I did this during the MCAT) I can't do this on shelves due to the rules and the lack of sectioning. I did this for the step pretest where I scored considerably above average to the rest of the class so it may be viable during the steps should I fail accomodations.

I will be honest if I dual apply it won't be for general surgery, my other options are somewhat competitive unfortunately although not as competitive as ENT although the potential is always there. I love doing things with my hands but I for the life of me found gallbladders and the GI system to not be my favorite thing to spend my life doing. I am not a fan of psych due to my childhood. FM, IM, Peds (I do love kids but everything else was not a good fit). I have reasonable ideas of what I liked this year and my backup will ultimately be one of these:
1.) IM-Pulmonology - the risk of not getting a fellowship and IM itself is fairly low on the enjoyment meter and just the way it works.
2.) Gyn-onc - Hardly viable because gyn is very low w/ 60% acceptance rate for gyn onc and still can be competitive makes no sense to stress myself out also it's hard to judge because it was my first time being trusted to do what I consider actual cutting during surgery so I may be biased in how much I enjoyed it
3.) IR - Tough match probably although I heard some years are easier than rads
4.) Anesthesia - Pretty tough but I have an attending (who I have on social media - referencing the prior ENT joke said earlier) who told me they will write a letter to their program if I did an away there and he's well-liked
5.) Neurology - Completed my masters in this and was always fascinated by the brain. With procedures, it may be tolerable. Currently on this and running on autopilot I definitely feel like I do well clinically here and the patients seem to have confidence in what I'm doing, not much-attending feedback yet and I would do this because of aptitude not really enjoyment. Injecting botox w/ EMG was enjoyable but neuro is very well... cerebral.

I was recently told my undergrad experiences count for ERAS. If true this does increase my research experiences by 6 or so but not my publications.

Thank you for your feedback!

 

[Goro]

Yes, I do have red flags. However, I also have fair reasons for them.

Reasons, or excuses???????

 

[FalconSlice]

Yes, I do have red flags. However, I also have fair reasons for them. I don't think it is insane to let someone have the whole story and make that decision for themselves. If I don't match, plan B.

Who cares if you have reasons? (or more likely excuses as @Goro pointed out above). There’re are so many well qualified candidates, PDs don’t have to take chances with red flags. Do you know how many AOA, straight honors, 250+ scorers don’t match in highly competitive residencies like ENT, plastic surgery, neurosurgery, etc.?? It is not trivial

 

[PathNeuroIMorFM]

, I was told by upperclassmen that 13 publications was more than reasonable within the year (I just put two years because I’m slow) if you focus on nothing but research.

Me polishing my dinky 2 first auth manuscripts after busting my booty in my research year: 🙃

But actually, OP, before you do literally anything else, you really gotta use that noodle and think hard about what's going on here. 1 or 2 bad evals may very well be bad luck, we've all been there. 1 or 2 bad shelf exams can be bad luck, we've all had bad test days.

You, on the other hand, have consistently gotten poor preclinical grades/subpar extracurriculars, you've consistently scored poorly on shelf, and you've had consistent negative evals throughout school - which is really concerning. Think hard, maybe take time off to figure it out. What do you think is going on here? Because whatever the issue is will not magically disappear when you're a resident. Residents can still fail, drop out, or get kicked out and the stakes for them/their patients are extraordinarily higher.

Maybe mental health, maybe a learning challenge like ADHD, maybe something else, but *something* is going on here, OP, and you got to get to the bottom of it.

 

[GoSpursGo]

As I said previously, the OP has already determined what he wants to believe. I suspect only having the honest conversation with his PD (which he is delaying to fit his narrative) or actually failing to match is going to change his mind.

OP, I sincerely hope we hear from you in a couple of years and we find that you proved us all wrong, or that at some point you saw the light and found an off-ramp from this path. Good luck.

 

[Esmolol]

OBGYN: F lol. Caught me off guard (...)

+

2.) Gyn-onc - Hardly viable because gyn is very low w/ 60% acceptance rate for gyn onc and still can be competitive makes no sense to stress myself (...)

I'm out...

 

[OrphanedDoc]

+

I'm out...

LOL I was just listing specialties I liked as plan Bs not really if I am competitive for those specialties. I'd never go for gyn-onc even if I didn't have a P/ or F (not sure which) because of gyn being tough for me to enjoy that's why I pray it's a P so I never have to go back again. Hey, people are going for specialties they only got a P in for sure in my class so don't knock it... The difference in grades can be very subtle. Will they be successful? I have no idea...

 

[OrphanedDoc]

Me polishing my dinky 2 first auth manuscripts after busting my booty in my research year: 🙃

But actually, OP, before you do literally anything else, you really gotta use that noodle and think hard about what's going on here. 1 or 2 bad evals may very well be bad luck, we've all been there. 1 or 2 bad shelf exams can be bad luck, we've all had bad test days.

You, on the other hand, have consistently gotten poor preclinical grades/subpar extracurriculars, you've consistently scored poorly on shelf, and you've had consistent negative evals throughout school - which is really concerning. Think hard, maybe take time off to figure it out. What do you think is going on here? Because whatever the issue is will not magically disappear when you're a resident. Residents can still fail, drop out, or get kicked out and the stakes for them/their patients are extraordinarily higher.

Maybe mental health, maybe a learning challenge like ADHD, maybe something else, but *something* is going on here, OP, and you got to get to the bottom of it.

I have only gotten 3 bad evals in total. 2/3 from people who did not work directly with me but were on the same team and were automatically sent an eval lol which was unfair because students definitely get to pick and 1/3 was fair game because I have some problems with my health that were not controlled at all during this time. None of these except 1 should even be able to show up on my actual medical student letter as I have flagged them both. Preclinical grades are all Ps as far as I know (it's P/F). As far as research I was told as a 2nd years I should not have too many publications and just focus on school lol I didn't think I was behind. I think all the other parts of extracurriculars are fine based on AAMC data.

Now to address the "something". For the most part there a few somethings I have always had and they weren't managed due to financials and health insurance problems. I do have ADHD that I haven't had to control it much and not to sound like a butt but as said directly from my psychologist "high intelligence can be a mitigating factor to the negative effects of ADHD" which is why it wasn't much a problem before mid-clerkships where my time had to be micromanaged to the minute and the exams of course but I wasn't sure if I was having timing problems due to the ADHD at first I simply thought I was just sucking until my pretests were 20% higher than my scores and I realized that I did well until the same part of the exam every time regardless of difficulty. It is controlled now minus the accommodations I will be begging for later this month.

I have an unknown health problem which is being worked up still. Just couldn't work it up due to a lack of funds and financials.

Despite all this... most things are nothing new. I got worn down mid-clerkship year and my performance took a dive and the stress from avoiding homelessness really burned me out but it's not a major dive as it looks. For example, I've always had borderline shelf scores due to timing (this can be mitigated with lots of caffeine but is against the shelf exam rules) but I still almost honored due to everything else being fine. Now I'm passing because my standardized patient average went down a little and require organization to get the maximum points but I haven't had time to nail that part of the SP so I am collecting good information (according to the clerkship director) but I jump out of order to get everything on the checklist, this has only happened twice but each clerkship has one major SP so it matters. A recent breakdown of a P I got:
Shelf: 74
Evals: 100
Assignments: 100
OSCE: 87

That's a P... performance on two things. Early on in the year, I did good on mitigating this and got high passes but as life got harder I did a poorer job of doing. Now if I scored a 90 on the shelf as I was predicted to get by the practice exam, it's either a really high pass or borderline honors. Biggest things that would have made this year doable: Are fewer outside distractions and accommodation. I don't think medical students should be expected to excel when dealing with homelessness and lack of health insurance (the latter is against the rules btw lol so that was fun).

For testing I took the Step practice exams I scored 10% above average in my class. Less stringent rules allowed me to bring in a lot of caffeine and I finished on time. If I can do that on the real thing my score would be very good. I almost had time to go back and check my flags.

Based on this this is my analysis of the situation and the solutions should be effective. In residency if I am struggling with homelessness after taking every step possible to avoid that I don't know... I keep very tight budgets so it takes very tough COL situations to put me in this situation it is unlikely to happen in residency.

Exams are less common in residency and borderline passes hopefully won't have me removed as long as I do everything else right (which if I am able to focus on this I see no problem). I can take quite a bit of stress before I break. Also maybe I get accomodations in residency and then timing is no problem.

 

[OrphanedDoc]

Reasons, or excuses???????

Both. Excuses are not inherently bad. Again, I don't think most students would perform much better especially since you tend to become very close to students I have an idea of the effort and time that is poured in when students do well and the importance of proper sleep and breaks to maintain mental health and such. This in itself is a full-time job. I once tried to use AI apps to try to make try and optimize my schedule and each time it kept removing things. So yes, they are excuses but also reasons.