What to do? (Regd Surg Resid)

[Sarcoidosis]

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I need advice, preferable attendings that have interviewed students. I started my Surgery clerkship super enthusiastic. Made my enthusiasm known in Surgery. Scrubbed into many cases with the main faculty members, one of them the director of the program.

I had problem during the rotation with one of the 4th year residents, who was a superstar resident with extraordinary Absite scores. Near the end of the rotation my performance according to this resident was that, I had learned nothing during the rotation, had not improved at all.

I was complemented by the other 4th year resident and some other residents during the rotation. Overall my performance in my other clerkships have been very good. Mostly A's and a few B's. I have been complemented by everyone that I have rotated with except this rotation.

I had good rapport with the faculty member's when I scrubbed into their cases. At then end of the rotation, we had oral exam, presentation and written exam.

I performed according to myself: average on the oral exam (it was a group exam), performed above average on the presentation and average on the written exam (we scored the written exam by exchanging papers). And rotating with the residents during the clerkship, I believe I was very active and positive.

After this I received an evaluation of "C" in the rotation. My only "C" so far (I hope to prevent any other such scores, only electives left). And the comment left for me for the dean's letter was "Student is hard worker, however the quality of his work did not match his apparent effort input" Whoa...

I was given a 75 in the different categories and 80 for knowledge of pathophysiology and an 80 on rapport with staff. 80 on rapport with staff!!

My problem here is not that they gave me a C... My problem is how do I understand that C, what should I learn from this... what should have I done... nothing no constructive feedback at all.

I should mention that I spoke with the program director a week before the end of the rotation, we had a very comfortable and lengthy conversation. His only hesitation before agreeing to write a letter of recommendation was, I have wait for your exam scores and evaluation from the residents.

Ironically, I had asked the Program Director for the letter of recommendation and after receiving my evaluation from the rotation, I requested that he hold off on providing me a letter. Well lo and behold a letter is uploaded from the program director onto the ERAS website after I had asked him not to, and I am sure that he had read my email and then sent the letter out. I contacted the program director by email and he has not replied back at all and I have not recieved any justification for my C.

I spoke with the Dean from my school. He is sympathetic to my situation, but he admittedly states that his hands are tied... he cannot do anything about the C.

What do I make of this? I am an FMG with 90+ Step 1, haven't written Step 2CK yet passed Step 2CS. I have applied for only preliminary Gen Surg positions.

I have no problem learning from my mistakes... but it is hard to do when I know I did everything I could during the rotation. Since then I have taken a more laid back approach to my rotations, don't want to seem too eager to perform, keep my "apparent effort input" low. And I regret ever telling them that I was interested in Surgery.

My question... where did I go wrong... or how should I interpret this story... because I have one view of this and need other critical opinions.

thanks for reading

 

[michaelrack]

I need advice, preferable attendings that have interviewed students. I started my Surgery clerkship super enthusiastic. Made my enthusiasm known in Surgery. Scrubbed into many cases with the main faculty members, one of them the director of the program.

I had problem during the rotation with one of the 4th year residents, who was a superstar resident with extraordinary Absite scores. Near the end of the rotation my performance according to this resident was that, I had learned nothing during the rotation, had not improved at all.

I was complemented by the other 4th year resident and some other residents during the rotation. Overall my performance in my other clerkships have been very good. Mostly A's and a few B's. I have been complemented by everyone that I have rotated with except this rotation.

I had good rapport with the faculty member's when I scrubbed into their cases. At then end of the rotation, we had oral exam, presentation and written exam.

I performed according to myself: average on the oral exam (it was a group exam), performed above average on the presentation and average on the written exam (we scored the written exam by exchanging papers). And rotating with the residents during the clerkship, I believe I was very active and positive.

After this I received an evaluation of "C" in the rotation. My only "C" so far (I hope to prevent any other such scores, only electives left). And the comment left for me for the dean's letter was "Student is hard worker, however the quality of his work did not match his apparent effort input" Whoa...

I was given a 75 in the different categories and 80 for knowledge of pathophysiology and an 80 on rapport with staff. 80 on rapport with staff!!

My problem here is not that they gave me a C... My problem is how do I understand that C, what should I learn from this... what should have I done... nothing no constructive feedback at all.

I should mention that I spoke with the program director a week before the end of the rotation, we had a very comfortable and lengthy conversation. His only hesitation before agreeing to write a letter of recommendation was, I have wait for your exam scores and evaluation from the residents.

Ironically, I had asked the Program Director for the letter of recommendation and after receiving my evaluation from the rotation, I requested that he hold off on providing me a letter. Well lo and behold a letter is uploaded from the program director onto the ERAS website after I had asked him not to, and I am sure that he had read my email and then sent the letter out. I contacted the program director by email and he has not replied back at all and I have not recieved any justification for my C.

I spoke with the Dean from my school. He is sympathetic to my situation, but he admittedly states that his hands are tied... he cannot do anything about the C.

What do I make of this? I am an FMG with 90+ Step 1, haven't written Step 2CK yet passed Step 2CS. I have applied for only preliminary Gen Surg positions.

I have no problem learning from my mistakes... but it is hard to do when I know I did everything I could during the rotation. Since then I have taken a more laid back approach to my rotations, don't want to seem too eager to perform, keep my "apparent effort input" low. And I regret ever telling them that I was interested in Surgery.

My question... where did I go wrong... or how should I interpret this story... because I have one view of this and need other critical opinions.

thanks for reading

It sounds like you are an FMG who did an audition clerkship away from your medical school? One area where you went wrong is not acing the exams.

 

[Sarcoidosis]

I agree... my performance on the exam was not what I was aiming for. And I have plenty of valid.. excuses.. for my poor performance on the exam. And unfortunately this is the only objective evaluation during the rotation. I was studying throughout the rotation, made notes from chapters that I was reading etc... but no luck on the exam.

That said and done... what do I make of his letter of recommendation which I can't even read? I remember mentioning to him that I need a strong letter of recommendation...

And, are there programs out there that will call me up and tell me "You are rejected and Oh buy the way your letter or recommendation was very bad" If that isn't the case, and by some luck of the draw I get an interview... How do I justify the C, without sounding like I am making excuses? (because the highest score on the exam was an 83 from a student who had just written his step 2CK before starting this rotation and had a Step 1 score of 260)...I know this would be an example of an excuse...

Oh, I am from a caribbean school, so all my clerkship have been in US and every clerskship has been in different hospitals never done more than one rotation at a hospital.

Argggh! what to do? what to do?

 

[Blade28]

Just to clarify, you're worried about your eval, or letter of recommendation?

 

[dragonfly99]

Rotating at so many different hospitals and never staying at one more than a month or two as a med student has many negative consequences...those planning to attend Caribbean med schools should read this as a word of warning. I can't say if you'd make a good surgeon vs. not, but I'm not sure 1 surgical clerkship really determines that, to be honest. There are many reasons (valid and invalid) these surgeons may have decided they don't like you...but I would not expect that LOR that you got to be great. You can "uncheck" the little box on ERAS to keep the letter from going out to any more programs...you can even apply to more/new ones without this letter, and they will never see it. I think the C surgery grade is more of a problem than one LOR that isn't great (that you could just not use if you later get a better one...).

I would say the only thing to do now would be to try and rotate/do a surgical subI at some other hospital, and see if you can do better. Also, do as well as you can on your USMLE Step II. Also, get as many good LOR's as you can (surgical and nonsurgical, but you really need to get at least one or two good surgery ones). You can still try for a surgery prelim spot, but just understand it isn't a guarantee of anything - you might do the year and then never be able to get an upper level surgery spot, and might have to switch to some other specialty (i.e. internal med or anesthesia, etc.) in the end. You might have to repeat your intern year if you end up switching to some other field. You have to decide if you are willing to give up at least one, maybe 2 or more, years of your life in this way...surgery prelim year = likely to be painful/hard compared even to other internships.

It sounds like you really want to be a surgeon...if so, you should probably just try and go for the surgery spots. Just have a backup in case you can't match into surgery. I know it sounds glamorous, but surgery, particularly general surgery, is a pretty crappy lifestyle and lot of students who thought it was sexy and cool when they were in med school became residents who ended up not liking it and dropping out or switching to some other specialty. Just be sure you want it. If you do, just go for it...if they reject you, so be it, but at least you tried.

 

[Sarcoidosis]

I have gotten myself into a real pickle... one that may change the course of my life (for better or for worse)...

I am worried about both the eval and the letter or recommendation. And what I want to know is can I get any interviews based on such a bad score? I am still waiting for my MSPE... don't know what the Dean has to say about it?

Now a smart or dumb thing I did was... I applied to 42 prelim surgery programs and 1/2 of them I sent the Letter of recommendation to from this Director and the other 1/2 I didn't and all the letters have been uploaded by the programs so no use un-checking them now (right?).

I did apply to 38 Prelim/Categ internal medicine programs as a backup. I believe I have a decent letter from my internal medicine doctor, and I was offered a pre-match with my family medicine hospital and I explained that I was interested in Internal Med or Surgery and they were understanding.

I did do another surgery elective at a University Hospital, however didn't perform stellar according to me, no exams at the end of this elective. And the attending sat with me and evaluated me and I ended up with an "A". I am still waiting for his letter to be uploaded to ERAS.

I would like to try for surgery, don't want to let this incident completely change my mind.

1) Can I get any interviews based on a score of "C"?
2) How do I explain my bad score without making excuses?

 

[BlondeDocteur]

Your post seemed to describe the core MS3 surgery clerkship. Have you done only the one 4th year elective, this one at University Hospital where you got an A? In general your strongest letters come from your 4th year rotations. It is worth trying to get letters from those other elective(s).

Also, why not apply to at least a few categorical general surgery programs-- even if you feel you're not competitive, you can't match if you don't try.

 

[Sarcoidosis]

Yes C in my Core and A in the elective. That is a good point... I will consider applying to Categorical, try my luck at it.

 

[dragonfly99]

actually, blonddocteur is right
you should just throw out some applications to categorical general surgery...why not try? Just pick out 7 or 8 or 10 places, and apply. You've already spent so damn much money on your other applications, that it doesn't really matter any more.

And don't worry...it sounds like you are going to make a good career for yourself. I don't think you need to worry about getting in to IM...you ought to be able to get a spot somewhere, even if it's your fallback plan. I would suggest that when you go to IM interviews, you not confess to having applied to surgery programs, unless they have some way of knowing/finding out.

I actually don't think that you did a stupid thing with your surgery LOR's. You did actually exactly what I would have done in your situation...since you don't know what is in that LOR from the surgery clerkship director. I'm suspecting it's not a great LOR, though.

You should try and get hold of a copy of your dean's letter as soon as it gets out. If the narrative comments are all positive, or mostly positive, and you still got a C, that's definitely bad but perhaps not the kiss of death for all surgery programs if you got an A in your surgery subI and if you do well on USMLE Step 2 (no pressure....LOL).

 

[Blade28]

Also, why not apply to at least a few categorical general surgery programs-- even if you feel you're not competitive, you can't match if you don't try.

I agree - why only apply to Prelim G Surg if you want to stay in General Surgery? Apply for Categorical positions as well.

 

[Sarcoidosis]

Well, I am switching some of the programs that I applied to as Categorical and will apply to a few more. I applied Sunday and already have two rejections for Prelim Surg... from the ones that recieved the letter from the Program Director... Shoot... shouldn't have sent his letter... Have one hold from internal medicine...

Should I start writing to Program Directors and explaining my interest now that they have my apps... I mean it couldn't hurt right?

 

[dragonfly99]

If you get more than 3 or so rejections from the programs that got the letter from the surgery clerkship director, then I would start de-assigning it from all the other places that got that letter. They'll probably be able to read it anyhow, but you can try. And I would use that "good" surgery letter (i.e. the one from the guy who gave you an "A") at every single surgery program you apply to.
Too early for panic though.

 

[Sarcoidosis]

I got to review my MSPE today and it was basically very factual, it regurgitated my CV in like a paragraph. However what I am really happy about is the evaluations that I have received from my other rotations. Basically whatever attending's had written was included in the Dean's letter with some omissions. My Dean "highly recommended me"...

As for my surgery rotation... only thing included was "Hard Worker", nothing about "apparent effort input". One of them read "man of convictions and self knowledge, excellent student"... wasn't expecting this from the attending but I am glad.

I still have to explain the "C" in the Surgery rotation, this is what I am going to say... got this from Dr. Conrad Fisher (not personally but from a website)
"I did not do as well as I would have liked, I worked hard, but I should have worked harder. This grade does not reflect as much as I believe I have to offer this program. I can do better!"

So now I am going to pray for interviews and spend some time preparing my answers.

thanks for the replies

 

[thinktank]

You will do fine, programs always look at the big picture. You have earned an 'A' in 4th year Advanced Clerkship in surgery. You should take CS and rock CK early (i.e. now). Apply broadly to as many programs as you could afford. I would do so if I was in your shoes.
Good luck.