Quoted: Regaining confidence as a medical student

[Doodledog]

A medical student asks

I have a confidential question for the forum. I am current fourth year and while I had a good application to medical school and did well in the first two years (no honors but good solid work), I had some struggles in third year. I found it hard adjusting to the harsh environment and the lack of teaching and support. I got wacked by a few residents and ended up with some harsh evals. When I went to our administration to try and figure out how to deal with this, I did not receive much support.

I have no idea what I want to do for a residency or what I could do now with my poor third year record. I did well on several rotations, but there were some angry comments on a few. I have tried to learn from this and to figure out how to be effective in this environment and I am working hard to overcome this experience. It has been difficult because some attendings seem to have just 'written me off,' and I feel like I have no chance in their specialties as a result.

I used to feel very confident and well respected, I used to feel smart! But now I am not sure what area to go into - what I want to go into or what I could get into now with this record. I am a solid student, well liked by many staff, patients and residents. But my biggest concern is my MSPE, which since it is based on my third year clerkships is likely to be negative. My step one is just over 200, so that is also a strike against me, and I have no honors or significant research or volunteer projects. Thinking of anesthesia, or IM/FM.

What can a student do to overcome a weak or actually negative MSPE? I am currently doing some research and have taken time off to focus on what I want to do, and to rebuild my confidence and clinical skills.

Thanks for your suggestions or ideas.

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[Doodledog]

In addition to the research time you are doing, setting up "confidence building electives" and the like, I want you to consider carefully how you feel about attendings and what can be done about that. You are, perhaps justifiably, upset that the faculty don't respect you or care about you. Now, I can't say how much that is true or why it has happened, but I am certain that there are faculty who do care about students and will want to help you. Your task is to, 1) find these supportive faculty mentors and, 2) be honest with them about your experiences and what your weaknesses and strengths are. This will help them work with you on these areas - whether they be strictly "medically" related or be more time/teamwork related.

This can be difficult, much like working on a personal relationship, but it is very important in the long-term. As you move towards residency, you have to have faith that at least some faculty will support you and care about you and your career. They are out there, you will need to work to find them and make it possible for them to help you.

As far as career options, remember that if you choose a field such as IM, that doesn't mean primary care necessarily. You could choose a specialty later. The options of a transitional year also exist. I would discourage you in general from matching into something that you really don't like just to match. That is unlikely to lead to a good result.

Finally, consider taking an extra year to do an MPH or MBA, etc. This can provide some useful skills and knowledge and a chance to regain confidence and finish your clinical time in medical school with a bit of extra knowledge and hopefully some good final rotations.

Good luck!

 

[NotAProgDirector]

I can try to give you a PD's insight on this.

First, the MSPE is the most important piece of information we get on allopathic grads. This depends somewhat on the school -- some school's MSPE's are better than others, but they all are reasonably standardized and helpful now. So, you are correct that a less-than-stellar MSPE will have a big effect on your match.

3rd year and 2nd year are very different. the first two years are very structured -- you are given textbooks / lectures followed by exams, and what's in the lectures / textbooks is what's tested on the exam. In the third year, you are expected to "perform in the clinical setting". There really isn't a textbook to read, as many different services require different clinical skills. Medicine and Surgery are very different rotations, and behaviors / skills that serve you well on one will not work well on the other. Many students find this challenging.

You describe that you had several rotations with less than stellar performance. All students have a bad evaluation somewhere along the line, but multiple evaluators from multiple rotations suggests a bigger problem. From a PD's perspective, this suggests one of several problems:

1. You may have difficulty picking up on the nuances of each clinical setting, what is expected of you, and how to best perform.
2. Your medical knowledge may be poor enough to affect you ability to perform on the wards (likely not true in your case given your decent but not stellar Step 1 score).
3. You may be very quiet / introverted, or you could have another problem with your interpersonal skills which impacts your preformance.
4. Depression or other medical / psychiatric problem.
5. I'm sure there are others.

Regardless, trying to fox this would greatly help your career moving forward. Options:

1. Some medical schools allow you to split your fourth year in two, charging only half tuition for both. You'll still have your living expenses both years, but this would give you more time / rotations to improve.
2. Getting an MBA/MPH is a mixed blessing. If your problem (with your application) is poor clinical evals, getting more training outside of the clinical arena may not help. If you think that a career in these directions makes more sense than a clinical career for you, then this is a reasonable plan.
3. If you have difficulty matching, you should start planning now for what you would do with an extra year.

Hopefully your dean's office can help with all of this.

 

[WallowaWanderer]

Just a few of my thoughts (MS4). I would definitely meet with your dean - probably several meetings. Tell him you need to get to the bottom of this, and that you want him to wrestle through your evals with you to help you figure out what you could do to improve. What themes are there in your evals - are you not participating on rounds? Is your fund of knowledge inadequate? Are you getting into conflicts with the professors? Not showing enthusiasm?

I think the key is to have a concise, well thought out reason why this happened followed directly by what you did to fix it and evidence of how that was successful.

 

[Amelia]

I would go to the Dean's office and ask what they or their attendings are looking for in a particular clerkship, often times there "nuances" as one of the posters said or invisible little requirements or rules or often times there are just attendings who make a clerkship more of a political exercise than evaluation of your clinical skills. Talking with the dean's office would at least give the feedback of "hey, I didn't understand what happened in these clerkships, why are attendings "whacking" students for no reason?" I doubt the dean's office will give you anything helpful or constructive other than general advice, but at least it will let them know that you are taking their game seriously and maybe even let them reconsider any falsely damaging comments in the MSPE, remember you can file a lawsuit for false or degrading information . . .

Things aren't as bad as you think they are, remember, that you could do a medicine sub-I and really get a great evaluation and then use that as a LOR and I am 99.9% sure you would get an IM spot somewhere if you like seeing adult patients. So, while the MSPE is an "important" piece of the application, probably more so for hyper-competitive residencies, you shouldn't take these evaluations so seriously that it affects your future performance, your good step 1 argues that you do know more than a lot of medical students at least . . . third year of medical school is game, nothing more or less (this is what a medicine clerkship director admitted in private) and bad evals just means you haven't learned to play the game yet, . . . you will feel a lot better if you do an elective you like and when you go elsewhere for residency.

 

[CXJFKHKG]

In addition to the factors listed, there can be an inherent bias against people who don't fit the "mold," i.e. minorities, LGBT, guys who wear nose rings. But with that aside, the best thing to do is ask for feedback on a daily basis from EVERYONE (nurses, attendings, residents, fellow medical students). It's far better to find out in week 1 of a clerkship that people are having a problem w/ you than to receive this feedback on your evaluations (which are permanent).

There are also a lot of little things you can do to win the favor of your team-- holding doors open, volunteering for SCUT, bringing in food/candy, having gum on hand, asking the residents "how was your weekend/how was your night?," that kind of thing. In First Aid there is a whole section of expectations of medical students on each rotation. The best advice someone gave me about medical school is to think like a beauty pageant contestant: Always smile, be friendly, have impeccable manners. If people on your team really like you then it doesn't matter on your evals if you have no clue what acanthosis nigricans is, etc...

Good luck and hang in there!