QUOTED: What do I do now?

[NotAProgDirector]

I had the most difficult day of my medical school career today.

I am at the end of my Emergency Medicine elective at my home institution. This was the field I was hoping to match into come this spring. However, my clerkship director called my dean's office today to tell them she did not think I should be an emergency room doctor, because I wasn't fast enough/didn't think fast enough on my feet. She also said she could not write me a letter of recommendation because of this. The dean's assistant broke this to me as gently as she could, and to say the least it was an embarrassing and very humbling experience.

The truth is no one likes to be told that they're not good at something--especially if it's something they enjoy doing. However, now I am stuck. I had already sent out 27 ERAS applications under the assumption that I was performing to the standard of other students.

I know that the cost of the applications is non-refundable, but is there any way for me to recall these applications through ERAS, now that I'm aware that I cannot apply for positions in this specialty? I guess I'm just trying to save some face should a program contact me and ask me why my application isn't complete...

Perhaps the bigger problem now is that it's nearly October in my 4th year, and now I have no idea what to do with myself. I hadn't really felt a calling to do any of the clerkships that I've completed up to now, and now I don't have the time to go about experimenting with different career options and still get letters of recommendation.

I'm hoping anyone can offer a little advice, because I feel rotten about sitting where I am right now. And with deadlines looming, sitting around right now is the thing I have the least amount of time for.

This is a difficult situation, and the first thing to do is not to panic. As a third year student you likely had limited ED exposure, so you scheduled your ED rotation in your fourth year and now get this feedback, when the application process has already started. Not exactly fair, and is an argument for medical schools to allow students to do one elective their third year and defer a core to the beginning of the fourth to avoid this sort of thing.

Be that as it may, where do you go from here?

Two questions for you to think about:
1. Was this a single person's opinion or a group assessment?
If this is a single person's assessment, then should that really define your future career? Is there anyone else in the ED who can write you a letter? Probably not, because ED has a standard letter format that is supposed to be completed by the clerkship director / ED leader. However, if there is some disagreement within the ED staff regarding your performance, then perhaps this could mitigate this person's assessment.

2. How were your evaluations from your third year rotations?
If you did well in your other rotations, then this seems an outlier. Thinking quickly is needed for many fields. It is sometimes difficult to know if you did well in rotations -- you may have gotten a "pass", but that could represent the bottom 10% of your class.

Here's what I'd suggest as options to go forward:
1. Contact the person that you worked with the most / trust the most in the ED and ask them for frank, honest feedback. If this is the way that all of the ED staff feel, you want to hear it directly from them. Ask for specific examples, not so that you can challenge them but so that you can set targets for improvement.

2. Contact your Dean's office and review all of your evaluations. You will likely be doing / have done this as part of the MSPE writing process. You want to know where you fall in your class, and how you did on your core rotations.

3. If you feel after #1 and #2 that this is an unfair evaluation, consider doing another ED rotation immediately. Hopefully in a different ED (perhaps your med school has some other institutions affiliated). Perhaps you can get a letter in time.

4. Consider dropping out of the match and take the pressure off. Do another ED rotation in Feb/Mar when none of your classmates are there. Do other challenging rotations to build up your skills. Plan on doing a year of research, or you will be able to search for an ED spot outside the match.

5. Consider splitting your last year of medical school in two. Many schools allow you to do this without charging you extra tuition. Will allow you to do some "practice" ED rotations before doing another ED Sub I. It will also give you more time to figure out what you want to do, if it's not ED. If you think that additional clinical time would be more helpful, this is an option.

6. After you get some advice above (from the ED and your Dean's office), take a few days "off" to help sort this out. Forget about the money spent on ERAS so far -- in the long run, it's a drop in the bucket (I know, easier said when you're making a salary and not living off loans), the biggest cost in residency applications is the travel and you don't want to start that until you know what you want to do.

Let's see what others here say.

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[thewebthsp]

I don't understand how your medical school can bar you from a specialty. Is it possible to apply without their support?

Not matching is one thing -- but this...

 

[anonodoc]

To the OP:

I can fully sympathize with you. I had a similiar thing happen to me when I was a fourth year, and like you I was shocked. I had felt as though I was doing fine in the rotation. The only difference was it was earlier in the year, and I had a second rotation scheduled, and while the implication was clear that the clerkship director would not give me a letter, they didn't call my dean's office. The eval was "average". After getting over the shock, and nearly cancelling the second rotation (which was an away rotation), I went ahead and went to that rotation, where they had an entirely different opinion (perhaps because I'd learned something during the first rotation).

Is it possible for you to get another EM rotation before applications are due? I know it's getting late, but is whoever coordinates these things for you willing to help you get an elective quickly? You might find they have an entirely different view of you, and be willing to write a letter for you. In my case, midway through the second rotation,I spoke with the program director where I was doing the elective and was entirely upfront about the situation at my institution. At that point, he'd had a chance to work with me, and he walked me through a lot of different options, and said that not having a letter from my first rotation might be a problem, but it wasn't insurmountable.

Now, the ironic part of the story is that while the second rotation was a much better experience in many ways, and I got a very good eval... during that rotation I realized I didn't like EM all that much, and ended up applying in an entirely different field. So, even though right now EM seems like the only thing you want to do (that was how I felt at the start of 4th year) you might change your mind and find something else you like. And, in many fields, it doesn't really matter WHO you get the letters from. I got my letters from the preceptors that I thought would write the strongest letters, and only one of them was from the field I was applying to.

Good luck. I know getting that kind of news is devastating. (The EM preceptor was a coward to not discuss it with you personally. Your evaluation should NOT have been a surprise.) But once the hurt wears off, you'll start to see that you still have options.