QUOTED: Post Scramble Reality Check

[NotAProgDirector]

Hi. I graduated from a US med school in 2007. I had difficulty deciding what I wanted to do. I also had some personal/family difficulties during my clinical years and took a medical leave for ~1 yr to resolve them. My step I score: 188, my 2nd attempt step II CK: 204, step II CS: pass. I remediated two rotations, Psychiatry and Peds SUBI, but pulled it together after my medical leave and received a NH in surgical oncology, NH trauma and surgical critical care SUBI, and H in IM SUBI my fourth year. I've tried the match and scramble twice for different specialties (highly competitive) without success.

I didn't do an EM rotation as a med student. I shadowed for a couple months to get letters for ERAS 2008, but I was warned it would most likely not be enough. For 2009, I'm debating between EM and anesthesia. There are no other specialties I am interested in. I'm obviously a suboptimal candidate for these highly competitive fields. Do I have a chance? I need clinical exposure where I can make contacts. I'm sure I can do the work and need a chance to prove myself. What do you suggest is the best method to do that?

Please help me. Thanks.

You've got an application with some "red flags" -- a leave of absence, poor USMLE's (multiple attempts), and remediations of some clinical rotations. Many programs will not care much if you need to remediate a pre-clinical course (i.e. biochem), but having to remediate a clinical rotation is a much bigger deal.

On a good note, your grades seem to have improved at the end.

Both EM and Anesthesia are reasonably competitive. If you were unable to get a spot in 2007 and now in 2008, you need to be realistic about your chances. At this point, I think your best choice is a prelim IM year. This will do several things: 1) it will let you "prove yourself" in the clinical setting, 2) you might be able to take the ITE (in training exam), a standardized exam given in October which could give you a chance to prove that you can do well on exams, and 3) you could do Anesthesia or EM rotations / electives and generate letters of rec. In addition, both of these fields need a PGY-1 and so this would allow you to apply for both PGY-1 and PGY-2 spots.

Alternatively, you could try to get a surgical prelim year. This will be less flexible, and will clearly depend on the program involved as to how helpful it will be.

Given your background, you will need to apply very broadly. You cannot afford to limit your choices based on geography. You might still be able to get a PGY-1 for this year, if someone drops out for any reason. The only way to find these spots is to keep looking around. Use resources at your medical school, contacts, etc.

Being honest, you may never get an EM or Anesthesia spot. A prelim IM year still gives you many choices about where to proceed from there.

Good luck!

---

Members don't see this ad.

 

[NotAProgDirector]

Thank you, aProgDirector. Your suggestions/thoughts were very helpful. I'll try for IM prelim off-cycle spots and if nothing shows up, IM prelim for match 2009.

I've got another question for you: I just recently quit my basic science postdoc research job b/c I felt frustrated; it wasn't going/taking me anywhere. I can't afford to wait around and hope that an off-cycle spot will show up soon. Are there ways I can get clinical experience while in this transition state or do you think research at a place where I'm interested in applying to (and thereby making contacts) is the only/best way?

Thanks again for your help.

There is no easy way to get clinical experience in your situation. You're no longer a medical student, and you don't have a training license, so you simply slip through the cracks. Your best options are: 1) volunteering with someone, hopefully someone you know already; 2) trying to get something from your prior school, if you're still in the area; 3) finding a research position with someone who also has a clinical practice, and then getting to volunteer there, or 4) doing research (usually at a univ program) and trying to get a true clinical rotation set up -- this usually requires a great amount of policital help from your research mentor and may be impossible.

Problem is that volunteering or shadowing a clinician really tells a PD nothing about how you'll do as an intern, since the jobs are so different.

That's why a good option is an off cycle spot. Some program has an opening and needs someone. They're willing to try someone. If they seem to be ready to nibble, suggest that they give you a 3 month contract -- that will give you three months to prove your skills.

 

[EctopicFetus]

Also be on the look out thru SAEM for residency openings. Often times a spot or 2 will open up in EM for one reason or another and this could be a good opportunity for you. Truth is at this point you will have to do a lot of leg work on your own. Do not lose hope.

 

[Doodledog]

posted for the OP

Thanks, aProgDirector and Ectopic Fetus. I called a handful of program directors to ask for advice as well. Some suggested that I've got a better chance if I try for an IM/FM categorical program and then reapply after finishing up. This obviously isn't exactly what I was hoping to hear, but ~3 months before having to reapply again does seem to be a short period to evaluate performance. My question is if I'm lucky enough to find a prelim spot but not able to find something for the following year, would I be able to apply for a second prelim year? Thanks again.

Edit: Added new info from OP: thanks! i was recently offered an IM position