"Scrambled" into prelim surgery...now what?

[this is madness]

Hi everyone. Before I start I just wanna mention I did a few searches on this but I'm trying to gather some definitive answers (as definitive as I can get anyway).

Situation: I'm a US medical student who will be graduating in a few months from a state medical school. Med school was pretty tough for me (I know, another one of these); I had repeated third year (and also at one point appealed a dismissal decision). It was a bunch of factors including poor stress and time management and very bad burnout. Nonetheless, I overcame a lot particularly in the end of my third year leading into fourth year, and just kept persisting. I still passed my boards all on first attempts, but scores are not good. Step I 184, II was 203 and CS pass. Clinical evals were pretty solid.

Anesthesia was my goal and I ended up securing and doing well on two externships during my fourth year. I only ranked one program, however, because I had no other interviews. I also ranked a few medicine programs, including my home program, but ended up not matching into anything, and scrambling. After a long arduous process, I ended up with a surgery prelim position that my school opened up for me because I couldn't find anything else (they did this for some other students too).

I know this is somewhat of a new beginning and a fresh start in a way, but I want to move on with a solid plan especially since I'm going to be doing this whole residency search over again anyway. I have a few questions I need help with:

1) I performed well on my externships and want to do anesthesia again. A PD at my one of my externships mentioned that they look favorably on surgical prelims because of how hard they are. How hard would it be to pursue anesthesia again given my med school record, assuming I do well on my prelim and get good LORs, etc. Will I get more interviews because I did a prelim year? Should I apply to the match again or look for a PGY-2 position outside the match?

2) If I go through the match again, should I set my goals lower perhaps on IM or maybe FM? (I'm only saying that they're less competitive than anesthesia....I have respect for all fields). Or should I apply to anesthesia with some back up IM/FM programs? I also know time and money for interviewing will be a factor since I won't have much of both as a surgery prelim intern.

3) Just for the heck of it, can I actually consider anything more competitive like categorical radiology after my prelim year (assuming did well) or just forget it?

4) Any advice for surgery prelim year so I can have a successful match next year??

I appreciate any help I can get. I know I wasn't handed any of this on a silver platter and I have much to make up for. I did well in high school and college and got into med school on first try, so this is really the first time in my life that I'm facing the consequences of chronic academic difficulties from med school. I'm doing better now at the end of my med school career and I know I have better character qualities from my experiences that will help me move on. I want to do well and do what it takes to get my goal, just like anyone else. It just took me a while to realize how to do that.

Thanks for reading.

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[Law2Doc]

Hi everyone. Before I start I just wanna mention I did a few searches on this but I'm trying to gather some definitive answers (as definitive as I can get anyway).

Situation: I'm a US medical student who will be graduating in a few months from a state medical school. Med school was pretty tough for me (I know, another one of these); I had repeated third year (and also at one point appealed a dismissal decision). It was a bunch of factors including poor stress and time management and very bad burnout. Nonetheless, I overcame a lot particularly in the end of my third year leading into fourth year, and just kept persisting. I still passed my boards all on first attempts, but scores are not good. Step I 184, II was 203 and CS pass. Clinical evals were pretty solid.

Anesthesia was my goal and I ended up securing and doing well on two externships during my fourth year. I only ranked one program, however, because I had no other interviews. I also ranked a few medicine programs, including my home program, but ended up not matching into anything, and scrambling. After a long arduous process, I ended up with a surgery prelim position that my school opened up for me because I couldn't find anything else (they did this for some other students too).

I know this is somewhat of a new beginning and a fresh start in a way, but I want to move on with a solid plan especially since I'm going to be doing this whole residency search over again anyway. I have a few questions I need help with:

1) I performed well on my externships and want to do anesthesia again. A PD at my one of my externships mentioned that they look favorably on surgical prelims because of how hard they are. How hard would it be to pursue anesthesia again given my med school record, assuming I do well on my prelim and get good LORs, etc. Will I get more interviews because I did a prelim year? Should I apply to the match again or look for a PGY-2 position outside the match?

2) If I go through the match again, should I set my goals lower perhaps on IM or maybe FM? (I'm only saying that they're less competitive than anesthesia....I have respect for all fields). Or should I apply to anesthesia with some back up IM/FM programs? I also know time and money for interviewing will be a factor since I won't have much of both as a surgery prelim intern.

3) Just for the heck of it, can I actually consider anything more competitive like categorical radiology after my prelim year (assuming did well) or just forget it?

4) Any advice for surgery prelim year so I can have a successful match next year??

I appreciate any help I can get. I know I wasn't handed any of this on a silver platter and I have much to make up for. I did well in high school and college and got into med school on first try, so this is really the first time in my life that I'm facing the consequences of chronic academic difficulties from med school. I'm doing better now at the end of my med school career and I know I have better character qualities from my experiences that will help me move on. I want to do well and do what it takes to get my goal, just like anyone else. It just took me a while to realize how to do that.

Thanks for reading.

I'm surprised your school didn't try to steer you out of putting all your hopes into gas, given your low step 1 and your repeat of 3rd year. This was a difficult match year even if you had good credentials, and yours were a bit blemished. You should have either applied to less competitive fields (either exclusively or more significantly as a back-up) or sat out of the match doing targeted research for a year.

If I were in your shoes, I would forget about more competitive things like rads. You can still apply to gas, but I would put equal, if not greater focus on getting something more attainable and less competitive. Your surgery year will help, but the question is how much. I expect next year's match to be even more competitive, given that the number of students is continuing to increase faster than residency slots.

 

[BlondeDocteur]

It sounds like you need a bit of clarity, friend.

1) Your school was kind enough to create a position for you-- which is much more than many others (esp IMGs/FMGs with superior credentials) would get.

2) You barely passed Step 1, hence demonstrating that your basic science and preclinical knowledge is in the bottom 5% of all US medical students.

3) You repeated your third year, demonstrating that your clinical performance (patient care, time management, oral presentations, written notes, assessments and plans, reliability, punctuality, shelf exam scores or all of the above) were not considered to be good enough to function on the wards, compared to your peers.

4) You did better on Step 2 CK-- 203 is a respectable score-- so you can feel confident that you have the intellectual ability to handle clinical medicine.

So you should feel quite lucky to have gotten a surgery internship at what I assume is an academic hospital.

Next step:
If you can prove yourself during internship-- including preparing for and doing well on the ABSITE, if NDPs take it at your hospital-- then you will perhaps address a few of the fears raised by your failure of your MS3 year. You could quite likely match into a categorical residency of some kind, if your letters were good, if you studied for and passed Step 3 with at least a 200, and if you did well on the ABSITE.

Looking at Charting Outcomes, in 2007 there were 12 people (out of 51, so 19%) who applied to anesthesia as independent candidates with a board score in the 180s who matched. You would obviously have to be open to going anywhere in the country, but they did it.

Your chances would be greater in internal medicine (124/561-- 22%-- in the 180s matched into it), and MUCH greater in family practice (228/609, 37%). Pediatrics, too, would give you more of a shot (62/183, 34%), as would PM&R (10/27-- 37%) and psych (64/184- 35%).

Granted, all of these people got at least one inteview. You mentioned difficulty getting interviews. But the bottom line is, be grateful that you got a second chance, and make the most of it next year! Work hard, impress your attendings, read, read, read and figure out which specialties to target, how you're going to get letters, etc.

 

[this is madness]

Oh I'm lucky, no question about it. I only said that I wasn't handed this on a silver platter because scramble was so traumatic. I never said I wasn't grateful, I really am, especially compared to better IMGs and FMGs like you mentioned.

Nonetheless, thank you for your advise (and law2doc) about potential specialties to consider.

 

[Danbo1957]

But I'm not really sure why you felt the need to clarify what my credentials and records reflect.

Doctor, you have to get past the negative emotions that stick with you when reflecting on your med-school experience. That's over. You need to look forward, forward, and forward. You got a job by the skin-of-your-teeth - go kick some ass!

 

[BlondeDocteur]

I wasn't trying to kick you when you're down. It sounded in your original post that you were complaining that you didn't match into anesthesia, and I thought it was important to be realistic when assessing things.

 

[SouthernSurgeon]

"clinical evals were pretty solid" + "had to repeat third year" = does not compute

Blondedoctor's advice is good, though she is blunt. Don't get upset by her criticisms - they are things you need to address.

 

[Law2Doc]

...
Blondedoctor's advice is good, though she is blunt. Don't get upset by her criticisms - they are things you need to address.

In a prelim surgical year, I suspect the OP is going to have to deal with worse "bluntness". I actually also thought blondedoctor wasn't out of line and that the OP needed a reality check because the credentials were not those that most schools would even "let" you go ahead and put all your stakes on one gas interview, and now the OP seemed to want to add rads (an even more competitive path) to the mix...

If the OP was smart, s/he'd find a way to get really excited about one of the less competitive fields, and consider gas only as the longshot.

 

[this is madness]

Third year problems were due to shelf scores...evals were fine the second time around. Regardless though, I'm not upset at anyone. I can swallow my pride. I was perhaps a bit defensive but bit my tongue and edited my post. As was said, I need to look "forward, forward" so thank you for the encouraging comments

I have a few mentors in my mind at my institution that I will speak to about strategies for the next match....but importantly I will focus on just doing well during this prelim year, without looking back.

Since match starts again in September, do I need to start securing LORs during July and August?? Also the ABSITEs aren't even until January, so how can I bring this up?

Should I take step III before intern year? I'll need time for that too.

Too many things to think about.

 

[mercaptovizadeh]

Third year problems were due to shelf scores...evals were fine the second time around. Regardless though, I'm not upset at anyone. I can swallow my pride. I was perhaps a bit defensive but bit my tongue and edited my post. As was said, I need to look "forward, forward" so thank you for the encouraging comments

I have a few mentors in my mind at my institution that I will speak to about strategies for the next match....but importantly I will focus on just doing well during this prelim year, without looking back.

Since match starts again in September, do I need to start securing LORs during July and August?? Also the ABSITEs aren't even until January, so how can I bring this up?

Should I take step III before intern year? I'll need time for that too.

Too many things to think about.

Before you start the surg prelim, try to find some work that will bridge anesthesia and IM. Perioperative stuff or physiology or something of that kind (not basic anesthetic pharmacology), and perhaps you could get a co-authorship on a publication. The other option is to cultivate contacts with anesthesia and/or IM at your institution.

Only take Step III if you are confident you could pass it well. Otherwise it will be just another blow to your application if you fail it or barely pass.

 

[NotAProgDirector]

I'm an IM PD, so take this with a grain of salt:

1. Anesth PD's looking "favorably" on surgical prelims is probably not true, or at least a major overstatement. As you have already pointed out, you'll be applying in the match next year again in September. There will be no way to "prove yourself" before your application is due. Still, a surgical prelim is clearly better than nothing. If you apply to anesthesia next year you will be competing with all the new 4th years and everyone who didn't get a spot last year -- not a good set up. You should absolutely do everything you can before you graduate to improve your application -- more anesthesia rotations, research, etc.

2. You will apply to the match AND look for PGY-2's outside the match. The best way to do so is to apply via the match. if someone has an off cycle spot open and they see your app and recognize that you could fill an off cycle spot, they will contact you.

3. It is going to be hard to go on lots of interviews as a prelim. You only got one anesthesia interview this year, your chances of getting more are poor almost regardless of what you do. So, you will definitely need a plan A (some other field), anesthesia will be your Plan B (if you get an interview, you're happy and you rank it).

4. Forget rads, derm, or anything more competitive. It's not going to happen, and it doesn;t sound like your heart is in it anyway.

 

[this is madness]

I'm an IM PD, so take this with a grain of salt:

1. Anesth PD's looking "favorably" on surgical prelims is probably not true, or at least a major overstatement. As you have already pointed out, you'll be applying in the match next year again in September. There will be no way to "prove yourself" before your application is due. Still, a surgical prelim is clearly better than nothing. If you apply to anesthesia next year you will be competing with all the new 4th years and everyone who didn't get a spot last year -- not a good set up. You should absolutely do everything you can before you graduate to improve your application -- more anesthesia rotations, research, etc.

2. You will apply to the match AND look for PGY-2's outside the match. The best way to do so is to apply via the match. if someone has an off cycle spot open and they see your app and recognize that you could fill an off cycle spot, they will contact you.

3. It is going to be hard to go on lots of interviews as a prelim. You only got one anesthesia interview this year, your chances of getting more are poor almost regardless of what you do. So, you will definitely need a plan A (some other field), anesthesia will be your Plan B (if you get an interview, you're happy and you rank it).

4. Forget rads, derm, or anything more competitive. It's not going to happen, and it doesn;t sound like your heart is in it anyway.

Thank you for your advise. My year is already full and I'm finishing up required rotations until graduation. The contacts I have in anesthesia will be from the two externships I did earlier; I'll make sure to get in touch again.

Question re applying in the match: should I mention anywhere in my app that I'm looking for a PGY2 spot? I'm wondering if I need to do this so someone who sees my app can fill a potential PGY2 spot.

 

[BlondeDocteur]

They'll know because you a) graduated medical school in 2009 and b) are a current surgical intern. However, mentioning that you'd be thrilled to take up a CA-1 spot in 2010 would be kosher-- probably obvious, but kosher.

 

[this is madness]

They'll know because you a) graduated medical school in 2009 and b) are a current surgical intern. However, mentioning that you'd be thrilled to take up a CA-1 spot in 2010 would be kosher-- probably obvious, but kosher.

Maybe I can send some Benjamins too