Not the start I envisioned to 3rd Year

[discontinuebed]

So I just completed my very first rotation in Year 3 two weeks ago and I have to say, I’m a bit disappointed. My school grades us on a scale of 1-5 (obviously 5 being the score you want) and to make matters worse, each grade counts twice as our grading system in Year 4 is currently being overhauled.

I finished my very first rotation with a 4. Not horrible by any stretch of the imagination but not the perfect success that I had grown accustomed to in my 2 previous years of medical school. (I freak out at the tiniest things…I’m quite gifted in that regard)

In the event my grades continue to remain the same all throughout my 3rd year (4 out of 5 is considered excellent at our school. I believe 5 out of 5 probably corresponds to honors. 3 out of 5 is considered to be good. 2 out of 5 is considered below average. 1 out of 5 is probably failing.), would I be in bad shape in terms of wanting to apply to a dermatology position?

Thanks for indulging me. I realize my score isn’t horrifically low as to start scrapping my plans for a competitive residency but I did expect to do much better. Finally, I should note that this rotation wasn’t medicine as I’ve heard from many people that medicine is usually the big rotation that residencies look at during the 3rd year.

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[EC3]

3rd year is a different animal than the first two years. I've seen many of my "honors" classmates get short-ended on 3rd year clerkships and usually there is no legitimate reason for them to not have gotten honors. Some times it was one bad interaction with a resident, some times it was an attending who didn't particularly care for the student, some times it was the other student on the service was better friends with the residents...the list of nonsense reasons goes on and on.

I think the problem you're going to have and the problem that most AOA-caliber students have is that you have to relinquish command during 3rd year and accept a large portion of unpredictability in the grading; this is something that can almost certainly not be said during the first two years where simply studying your butt off = honors.

In addition to the advice you've already probably gotten about doing well 3rd year (be on time, look motivated, etc.), let me give you another piece of advice that I think will help you stand out. Whenever you get on a new service, pull your resident aside and basically tell them that you want to make their life easier. Offer to round on their patients, offer to draw the labs, offer to follow up the labs...basically you need to be their scut monkey and make it known that you will be happy to do even the most menial task if if makes their life easier. Because at the end of the day, if you save your resident work, they're much more likely to hook you up with a solid eval. With this said, though, even sometimes you'll only get a high-pass; the problem is you can't let this discourage you and you have to put it behind you and keep focused on the larger picture (which is much more easily said than done).

To answer your question about how this will specifically affect your derm chances, the answer is that one "high pass" probably isn't such a big deal. The better answer, though, is "who cares?" What I mean by this is that your grade has already been determined and it's very unlikely that you will change it. Are you really going to give up now that you've gotten one 4/5 after you've probably busted your ass studying day and night for 2 years? The answer is no. So what you need to do is learn from the 4/5. Go ask your residents what you could've done better, go ask your attending for feedback; you want to find out where your weak points are so you can improve. So don't worry about this high-pass so much as learn from it and move on.

 

[abefromann]

If you're already AOA and 99th on Step 1 for grades then just concentrate on the shelves. Everyone knows the grading system for clerkships is bullcrap.

 

[sdnetrocks]

Whenever you get on a new service, pull your resident aside and basically tell them that you want to make their life easier. Offer to round on their patients, offer to draw the labs, offer to follow up the labs...basically you need to be their scut monkey and make it known that you will be happy to do even the most menial task if if makes their life easier. Because at the end of the day, if you save your resident work, they're much more likely to hook you up with a solid eval.

This is VERY dangerous advice. If I was to be approached in this manner, the student's desperateness and grade-grubbingness (if you will) would shine through much more than any genuine desire to help. If you're helping me out, believe me, I already know it.

It's annoying enough to get the daily "is there anything else I can help you with?", and they still don't leave when I say NO.

 

[discontinuebed]

This is VERY dangerous advice. If I was to be approached in this manner, the student's desperateness and grade-grubbingness (if you will) would shine through much more than any genuine desire to help. If you're helping me out, believe me, I already know it.

It's annoying enough to get the daily "is there anything else I can help you with?", and they still don't leave when I say NO.

Hmm...good point. I'd like to think I'm striking a decent balance between being helpful and not crossing into the territory of being annoying.

Out of curiosity, would I still be considered a decent candidate for a dermatology residency with no honors at all during my clinical years? (I've reached the halfway point and sadly, they just aren't there for the taking)

--board score > 250
--preclinicals = almost all honors
--clinicals = high passes only in medicine, obgyn, psych (HP is outlined as top 30% in our Dean's letter but it still doesn't make me feel warm and fuzzy)
-- + summer research but no publications (one miniature presentation to a small group of med students as part of my summer research program)
--1 LOR from a medicine doctor, 1 "split" LOR from the derm chairman (because he doesn't work directly with students, he only co-signs letters)

I'm getting to the point where I'm thinking I should be seriously considering a backup if not completely alternative plan.

 

[abefromann]

You still are a decent candidate but to be sure, there more competitive ones. You have no real research and no real letters and you didn't honor anything in 3rd year. However, your board score is quite good and you honored everything first two years. I would do some aways EARLY and get more letters. You may want to think seriously about applying to a backup program, which is usually path or medicine for dermies.

 

[Long Dong]

Hmm...good point. I'd like to think I'm striking a decent balance between being helpful and not crossing into the territory of being annoying.

Out of curiosity, would I still be considered a decent candidate for a dermatology residency with no honors at all during my clinical years? (I've reached the halfway point and sadly, they just aren't there for the taking)

--board score > 250
--preclinicals = almost all honors
--clinicals = high passes only in medicine, obgyn, psych (HP is outlined as top 30% in our Dean's letter but it still doesn't make me feel warm and fuzzy)
-- + summer research but no publications (one miniature presentation to a small group of med students as part of my summer research program)
--1 LOR from a medicine doctor, 1 "split" LOR from the derm chairman (because he doesn't work directly with students, he only co-signs letters)

I'm getting to the point where I'm thinking I should be seriously considering a backup if not completely alternative plan.

I too had the same problem of not doing so hot in 3rd year and I agree with most of what abefroman said and would add it is imperative to get published. So start cooking up something asap so this time next year any research you've done would have been published or at least accepted for publication.

 

[discontinuebed]

I too had the same problem of not doing so hot in 3rd year and I agree with most of what abefroman said and would add it is imperative to get published. So start cooking up something asap so this time next year any research you've done would have been published or at least accepted for publication.

Hmm...that might be difficult with surgery being one of the few remaining rotations left.

My dean has always suggested taking a year off for research.

Looks like I may have to go that route in order to make something stand out about me...