Barely Passed 2nd year/May Repeat/Interested in ER

[Kaposi]

For any Emergency Med 4th years or residents out there,

I barely passed 2nd year (failed 2-3 exams by 1point, so was allowed to slide....Bad move), and am currently doing research for a year while contemplating my next moves. I have been taking Step 1 diagnostic exams, and can't pass any of them, mainly because I had such weak preparation in terms of my understanding from courses in my first two years. I feel I am teaching myself all of pathology and microbio and biochem. The beauty of a class curve is those that just passed, you don't know whether they really understood, or just knew enough to get by. I was the latter, and now, I feel lost.

Anyway, I wanted to redo the entire 2nd year, and work on my holes in knowledge, an opportunity that my school is offering. I am absolutely abominable in the clinical situation, mainly because my background knowledge is lacking. Plus, I feel redoing those tests and changing my study habits will give me some confidence for approaching Step 1 next year.

The problem is I am very interested in EM, but wonder if my redoing a year will look bad, or end any chances I have of pursing the specialty before I even get started. This has been difficult because I want to complete the degree and pursue the speciatly, but my family is urging me to leave school, and avoid the stress altogether. Lost in limbo...... Please help!

Kaposi

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[Dr.Evil1]

I will preface this with the statement that I am only a MSIV and still just applying for residency. I personally did not have any leaves of absence or failed any classes but I do NOT believe that these are automatic dings at ALL of the EM programs. While EM has become a more competitive specialty there still are a huge number of programs out there. Now will you match at Cincy or somewhere big time competitive...probably not. Will you be able to match somewhere where you will get an excellent clinical training and go on to become a great doc. I believe you will.

Surveys given to program directors (published this summer in Annals of EM) place your EM elective rotation grade, your clinical performance and USMLE step 2 scores all higher than your preclinical grades. My advice is to do something like take a USMLE Step 1 intense prep class (several offered...search the internet for specifics) and PASS Step 1. Next you have to start doing 3rd year rotations. Don't let your lack of confidence in your preclinical work effect you. Clinical knowledge is only partly based on your understanding of the details of biochem etc. You are probably a better studier now anyway and will do better in your clerkships. Do well in your EM clerkship and make friends in the EM department wherever you are...a great letter can go a long way. Apply and at least you will have something to talk about during interviews. If you get this far then you could think about backing EM up with FP or whatever. You could also think about doing an intern year and reapplying if you don't match the first time around.

The last thing that I have to say is that this is going to be really really HARD. Why did you originally come to medical school? Why do you want to be an EM physician? If you are committed to medicine because it is the one thing that you want to do then the rest will fall into place with HARD WORK. One of the defining characteristics of a MD is that we have great perseverance. You don't have to have a sparkly clean record to become a great physician. A program director I just interviewed with told me he didn't graduate high school. If you know what you want and are committed to getting there then you can and eventually will. Good luck

 

[Sessamoid]

Dr.Evil1 is right (I just like the sound of that). It sounds like your options are:

1) retake second year
2) continue on with standard track
3) leave medical school altogether

I'll start with saying that if you're still motivated to become a physician, then whatever you do don't quit now. The toughest part is getting in, the rest is just putting in the time and effort.

Option 1: Repeat 2nd year. If you and your advisor feel that your knowledge of the basic sciences is so deficient that you would be in danger of failing rotations your third year, then take the offer to repeat 2nd year and learn the material better. I wouldn't make this decision completely on your own, because honestly at that point in your training you're not really qualified to say whether or not your grasp of the material would be hindrance to practicing medicine.

One of my clinical faculty said in medical school that medical school is really nothing more than a long, elaborate vocabulary lesson so that you can understand medicine from the people that will teach it to you in residency. I think that's probably the best way to keep it all in perspective. The basic sciences are important to learning medicine, but you don't have to know the Kreb's cycle down cold or be able to spout off obscure enzyme pathways for the medications you use. Concepts are the most important thing.

If you are in danger of not passing Step 1, then I would lean towards repeating 2nd year until you're more sure of yourself. Preclinical grades are of little importance in residency matching, but the Step 1 score is fairly important. A non-pass on Step 1 would hurt a lot more than repeating 2nd year, IMHO.

Would this hurt your chances of matching EM? Yes, somewhat. It obviously will put the more competitive programs out of reach, but there are lots of programs that provide very good clinical training that don't take an AOA to match in. As long as you aren't at the bottom of your class, not killing patients during clinicals, and have a reasonable (say median or somewhere close to it) Step 1 score, you should be able to match in EM somewhere.

If you can prep yourself for Step 1 enough, then I'd choose to go through without repeating second year.

 

[gpops]

here's the deal; much like applying to medical school, the main goal when applying to a competitive residency is to make yourself look as good as possible. If that's not in the cards, than middle of the road will have to do, but by all means.....avoid red flags. Program directors have to filter through a huge number of applications. It may sound heartless, but the first pass is always looking for any reason NOT to interview like low board scores (yes, programs have cut-off's.....usually around the mean), a warning LOR ( you've heard the rumors about the various code words that are used.....it's true, and there are bad ones as well as good ones), unexplained leaves-of-absence, failed rotations, and repeated years. I agree with one of the above posts that stated that it would be better to have a repeated year than to fail STEP 1. However, if you repeat your second year and have only lacluster STEP 1 scores to show for it, that would probably be worse than had you trudged on through and gotten somewhere around the mean on your STEP1. You see, the former example has a red flag (bad), that you have to make up for some way. That being said, failing STEP1 will be a pretty hard bump in the road. Also, your clinical grades are much more important than the first 2 years. I have not needed to use a great deal of histology or biochem while in the ED, but I daily use the clinical fund of knowledge from almost every specialty.
My advice to you is to take a prep course for STEP1 and work your butt off on your clinical rotations. If you do OK in your clinicals, get honors in your EM rotation (talk to the PD at your school during your 3rd year and let him/her know that you are interested in EM) and score somewhere near the mean on STEP1, you should be able to match.

Good luck

 

[Kaposi]

Thanks guys,

Appreciate the advice. Got lots to think about.

 

[srlondon]

The idea others have mentioned about taking the review course is an interesting idea. I'd also agree that failing step 1 and being a lackluster performer in your clinical rotations would be the worst scenario--you need to do what you have to do at this point to regain your footing. Repeating 2nd year doesn't seem like it would be the worst thing in the world if it was done with the support of your dean and would improve your clinical performance.

However, I'd also suggest that you try to find the root of the problem... why did you manage to slide through these classes and not get anything out of them? Did you sit through lectures and not study? Do you have an undiagnosed learning disorder? Not easy questions, but you are going to have an even tougher time in residency if you don't sort this out now, as you'll find it even easier to slide by without learning more then the superficial details when you are expected to be an independent learner.

 

[Hornet871]

Kaposi, at any and all costs, do not repeat your second year. If you do, it's over. You'll never get EM.

Never say never, but it will damage your chances by 95%. I did horribly in my first two (and even last two) years of med school, graduated in the bottom 10% of my class, but received about 40 interview requests, ranked 23 programs, and matched at my #2.

Did I have research? No. Great Step I and II scores? No. In fact, I had to take off the first two months of my third year to study for Step I - essentially, to learn the preclinical sciences and make up for the two years of pi$$ing around I had done - to ensure that I passed it.

All I had going for me was one very good EM rec and A's in both of my EM rotations in fourth year. That's it.

My friend applied with almost the identical application, except he repeated PATH and Anatomy. Dead in the water. Two interviews, both at places he rotated at, and HE didn't match. He applied again the following year and had the same result. Now he's stuck doing internal med in the middle of nowhere.

The only conceivable difference between us is that the PDs saw "repeated coursework" on his transcript and instantly set fire to his app.

 

[srlondon]

Two applications with the same grades are not equivalent. A lot of weight is placed on the actual comments in your letters as well as the summary evaluations for each rotation. Mediocre comments with a good grade can still sink you.

Also, your mileage may vary in the applications process. How many programs did your friend apply to? Did he confine himself to a particular geographic area?

Remember... particuarly in the applications process, nothing is written in stone.

My friend applied with almost the identical application, except he repeated PATH and Anatomy. Dead in the water. Two interviews, both at places he rotated at, and HE didn't match. He applied again the following year and had the same result. Now he's stuck doing internal med in the middle of nowhere.

The only conceivable difference between us is that the PDs saw "repeated coursework" on his transcript and instantly set fire to his app.

 

[A-non-y-mous]

Just wondering if anyone else has input on this. I failed second year, repeated it and passed. passed Step 1 with a 206. I'm applying broadly (50 programs)....hoping I have a chance.

 

[AmoryBlaine]

Just wondering if anyone else has input on this. I failed second year, repeated it and passed. passed Step 1 with a 206. I'm applying broadly (50 programs)....hoping I have a chance.

So I'm not an expert, or a PD, but these are two pretty big hits against you. If I were you I would try to talk to an expert (like a PD).

I'm not sure that 50 is going to be enough for you. I mean I know that might sound crazy but like I said, I think you should discuss it with someone who actually reviews applications.

You might be someone who needs to apply to even more EM programs while at the same time trying to plan for a back-up (i.e. prelim med/surg, TY etc). I think at bare minimum you need to apply to basically every community EM program in your extended geographical area....

Best of luck whatever happens.

 

[GeneralVeers]

Repeating a year in medical school and taking a year off to do research would be automatic first-pass rejects for the vast majority of programs.

You might have a shot at some new programs, or those places that are "locationally challenged" like Nebraska.

 

[deleted65604]

Kaposi, at any and all costs, do not repeat your second year. If you do, it's over. You'll never get EM.

Never say never, but it will damage your chances by 95%. I did horribly in my first two (and even last two) years of med school, graduated in the bottom 10% of my class, but received about 40 interview requests, ranked 23 programs, and matched at my #2.

Did I have research? No. Great Step I and II scores? No. In fact, I had to take off the first two months of my third year to study for Step I - essentially, to learn the preclinical sciences and make up for the two years of pi$$ing around I had done - to ensure that I passed it.

All I had going for me was one very good EM rec and A's in both of my EM rotations in fourth year. That's it.

My friend applied with almost the identical application, except he repeated PATH and Anatomy. Dead in the water. Two interviews, both at places he rotated at, and HE didn't match. He applied again the following year and had the same result. Now he's stuck doing internal med in the middle of nowhere.

The only conceivable difference between us is that the PDs saw "repeated coursework" on his transcript and instantly set fire to his app.

Just some observations from 3 different "Rank List Meetings". I've never heard anybody mention repeating coursework as being worse than just having low grades, or taking a year off. Whenever applicants with borderline scores and other "red flags" would get brought up, they usually had other shining qualities about their background, personality, or application that made the PD willing to consider them in the first place. Every year, there was a war amongst residents on certain applicants that would wage (and talking with faculty, the same war wages on amongst them every year). There are usually two camps, we'll call them the "Testers" and the "Cool People".

The Testers have the attitude that, " I scored well because I have good study skills, and I work extremely hard." Testers believe that if people consistently score low on tests, that indicates that: A. They have a learning disability, or B. They don't work hard. Testers think that either possibility is unacceptable. Testers often advocate for applicants that have great scores and grades, saying, "This person is a genious, they would increase our board score average by 10 percentage points by themselves. They are obviously hard workers and would contribute in education by teaching junior residents and the program in general, from their vast knowledge-base.

The Cool People invariably argue that scores have no impact on clinical performance, and that tests aren't representative of real practice (real medicine is open-book, with several lifelines: Textbooks, Google, Phone a Friend, etc.) The Cool People often advocate for particular applicants when they met them at dinner, or interviewed them, and say, "Listen, this person is really, really cool. I could like, totally go out and drink with them. They would totally fit into the program."

The Cool People and the Testers have loud and vigorous arguments over particular applicants and whoever yells loudest and convinces the fence-sitters best wins out. The future, training, and fate of applicants hangs in the balance as these political contests are fought. Ultimately, the decision usually comes down to random things like size of people's nose, how big their butt was, and how bad people want to stop talking about applicants and go home. Comments like "Listen, he's dumb, and he's ugly, I veto this schmuck" (general laughter, pause, mouse-click, and there goes that applicants chances to get into ER residency). There is also the classic Cool people tactic "I couldn't carry on 30 seconds of conversation with the dork, let alone bear to spend 2-3 years of residency with him. I don't care that his step 1 was 262, he needs to go into the bottom third at least" (awkward silence, a few nods of agreement, click, drag, and an applicant who thought they had great chances at getting into your program gets thrown into the depths of the rank list, never to be seen again).

 

[A-non-y-mous]

So I'm not an expert, or a PD, but these are two pretty big hits against you. If I were you I would try to talk to an expert (like a PD).

I'm not sure that 50 is going to be enough for you. I mean I know that might sound crazy but like I said, I think you should discuss it with someone who actually reviews applications.

You might be someone who needs to apply to even more EM programs while at the same time trying to plan for a back-up (i.e. prelim med/surg, TY etc). I think at bare minimum you need to apply to basically every community EM program in your extended geographical area....

Best of luck whatever happens.

Thanks for the advice. On second thought, I will up my application number to 75 and hope for the best.

 

[vtucci]

There was a member of our medical school who graduated in 2008 who had to repeat second year and matched in EM. I understand this individual did very well in her EM rotations and had some research as well. I cannot speak to the Step 1 score.

I think perserverance is key. Doing well in your EM clerkships and core clerkships in third year (different skill set from the first two years).

Research is nice if you can.

Make contacts with faculty and get a strong mentor at your school who can make a few phone calls on your behalf when the time comes.

Good luck.

 

[tybalt]

Just some observations from 3 different "Rank List Meetings". I've never heard anybody mention repeating coursework as being worse than just having low grades, or taking a year off. Whenever applicants with borderline scores and other "red flags" would get brought up, they usually had other shining qualities about their background, personality, or application that made the PD willing to consider them in the first place. Every year, there was a war amongst residents on certain applicants that would wage (and talking with faculty, the same war wages on amongst them every year). There are usually two camps, we'll call them the "Testers" and the "Cool People".

The Testers have the attitude that, " I scored well because I have good study skills, and I work extremely hard." Testers believe that if people consistently score low on tests, that indicates that: A. They have a learning disability, or B. They don't work hard. Testers think that either possibility is unacceptable. Testers often advocate for applicants that have great scores and grades, saying, "This person is a genious, they would increase our board score average by 10 percentage points by themselves. They are obviously hard workers and would contribute in education by teaching junior residents and the program in general, from their vast knowledge-base.

The Cool People invariably argue that scores have no impact on clinical performance, and that tests aren't representative of real practice (real medicine is open-book, with several lifelines: Textbooks, Google, Phone a Friend, etc.) The Cool People often advocate for particular applicants when they met them at dinner, or interviewed them, and say, "Listen, this person is really, really cool. I could like, totally go out and drink with them. They would totally fit into the program."

The Cool People and the Testers have loud and vigorous arguments over particular applicants and whoever yells loudest and convinces the fence-sitters best wins out. The future, training, and fate of applicants hangs in the balance as these political contests are fought. Ultimately, the decision usually comes down to random things like size of people's nose, how big their butt was, and how bad people want to stop talking about applicants and go home. Comments like "Listen, he's dumb, and he's ugly, I veto this schmuck" (general laughter, pause, mouse-click, and there goes that applicants chances to get into ER residency). There is also the classic Cool people tactic "I couldn't carry on 30 seconds of conversation with the dork, let alone bear to spend 2-3 years of residency with him. I don't care that his step 1 was 262, he needs to go into the bottom third at least" (awkward silence, a few nods of agreement, click, drag, and an applicant who thought they had great chances at getting into your program gets thrown into the depths of the rank list, never to be seen again).

This is hilarious. This is exactly why I love EM people.

Note to self: Get nose job prior to residency interviews.

(no worries, I don't really have a big nose. I will, however, make sure to wear some serious booty pants ;-)

 

[Termwean]

I love this post. I have been told many times that this is exactly how it works.


QUOTE=Jarabacoa;7161067]Just some observations from 3 different "Rank List Meetings". I've never heard anybody mention repeating coursework as being worse than just having low grades, or taking a year off. Whenever applicants with borderline scores and other "red flags" would get brought up, they usually had other shining qualities about their background, personality, or application that made the PD willing to consider them in the first place. Every year, there was a war amongst residents on certain applicants that would wage (and talking with faculty, the same war wages on amongst them every year). There are usually two camps, we'll call them the "Testers" and the "Cool People".

The Testers have the attitude that, " I scored well because I have good study skills, and I work extremely hard." Testers believe that if people consistently score low on tests, that indicates that: A. They have a learning disability, or B. They don't work hard. Testers think that either possibility is unacceptable. Testers often advocate for applicants that have great scores and grades, saying, "This person is a genious, they would increase our board score average by 10 percentage points by themselves. They are obviously hard workers and would contribute in education by teaching junior residents and the program in general, from their vast knowledge-base.

The Cool People invariably argue that scores have no impact on clinical performance, and that tests aren't representative of real practice (real medicine is open-book, with several lifelines: Textbooks, Google, Phone a Friend, etc.) The Cool People often advocate for particular applicants when they met them at dinner, or interviewed them, and say, "Listen, this person is really, really cool. I could like, totally go out and drink with them. They would totally fit into the program."

The Cool People and the Testers have loud and vigorous arguments over particular applicants and whoever yells loudest and convinces the fence-sitters best wins out. The future, training, and fate of applicants hangs in the balance as these political contests are fought. Ultimately, the decision usually comes down to random things like size of people's nose, how big their butt was, and how bad people want to stop talking about applicants and go home. Comments like "Listen, he's dumb, and he's ugly, I veto this schmuck" (general laughter, pause, mouse-click, and there goes that applicants chances to get into ER residency). There is also the classic Cool people tactic "I couldn't carry on 30 seconds of conversation with the dork, let alone bear to spend 2-3 years of residency with him. I don't care that his step 1 was 262, he needs to go into the bottom third at least" (awkward silence, a few nods of agreement, click, drag, and an applicant who thought they had great chances at getting into your program gets thrown into the depths of the rank list, never to be seen again).[/QUOTE]