Terrible 1st year due to personal/family issues- no chance at competitive specialties?

[CupcakeCarabiner]

Hi all,

Was hoping I could get some advice here. I'm a really good student actually at med school on a scholarship and had the worst first year. Had a lot of health problems in my fam including autoimmune diseases, stroke, yada yada
Actually just had my first exam of second year and failed it which I've never done in my life. So far almost all my grades are B's so I'm sitting at an abysmal 3.3 GPA or something thereabouts

I'm wondering if I've basically destroyed any chance to get into a competitive specialty/institution, especially with STEP 1 being P/F so I can't "redeem" myself there (although honestly with the way everything is going, my chances of doing that are slim).

Anyone have any thoughts on this?

Also, when applying for residency, do you get a chance to explain poor grades anywhere in the application? Would anyone reviewing it care about your circumstances? Anything I can do to make up for these poor grades?

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[Chelsea FC]

Hi all,

Was hoping I could get some advice here. I'm a really good student actually at med school on a scholarship and had the worst first year. Had a lot of health problems in my fam including autoimmune diseases, stroke, yada yada
Actually just had my first exam of second year and failed it which I've never done in my life. So far almost all my grades are B's so I'm sitting at an abysmal 3.3 GPA or something thereabouts

I'm wondering if I've basically destroyed any chance to get into a competitive specialty/institution, especially with STEP 1 being P/F so I can't "redeem" myself there (although honestly with the way everything is going, my chances of doing that are slim).

Anyone have any thoughts on this?

Also, when applying for residency, do you get a chance to explain poor grades anywhere in the application? Would anyone reviewing it care about your circumstances? Anything I can do to make up for these poor grades?

As someone who similar stuff happened i am here to tell you it's okay. It's okay not going into a competitive specialty and all these real-life events will show you how unimportant alot of this prestige/competitive chasing really is. You will find to love something else that you are more competitive for or you will able to turn it around and land that competitive specialty you are looking for. At the end of the day it doesnt matter as much as you think it does.

 

[operaman]

You are asking the wrong questions. The only question worth asking right now is: how do I make sure I start passing my exams? Am I on track to pass step 1?

Yes, most everyone passes, but you’re now in that subgroup that’s at higher risk. I hope you’re meeting with all your support services and devising a plan to ensure you turn things around ASAP. Or if the other life things are bad enough, possibly taking some time away to deal with them. Going from a B average to failing is a big red flag that needs immediate attention before it’s too late.

IF you turn things around, you should still have a good shot at competitive fields. Preclinical grades are typically less important than other factors. While nobody knows how the new post-p/f meta will play out, I think it’s reasonable to assume clinical grades and step 2 will become more important.

What you need to worry about is developing the base of knowledge that will allow you to get good clinical grades or a good step 2 score. If you turn things around you won’t even need to explain your grades as everyone will see it was a rough start but you found your stride. If your preclinical issues turn into more failing MS2 grades, below average clinical grades, and a low step 2, then you won’t need to explain anything for a whole different reason.

If things don’t change and you fail the year or fail step 1, then it’s almost certainly game over for competitive fields. If you never pass, then it’s a moot point entirely. Time for some urgent face to face meetings with your faculty and admin to right the ship while there’s still time.

 

[CupcakeCarabiner]

You are asking the wrong questions. The only question worth asking right now is: how do I make sure I start passing my exams? Am I on track to pass step 1?

Yes, most everyone passes, but you’re now in that subgroup that’s at higher risk. I hope you’re meeting with all your support services and devising a plan to ensure you turn things around ASAP. Or if the other life things are bad enough, possibly taking some time away to deal with them. Going from a B average to failing is a big red flag that needs immediate attention before it’s too late.

IF you turn things around, you should still have a good shot at competitive fields. Preclinical grades are typically less important than other factors. While nobody knows how the new post-p/f meta will play out, I think it’s reasonable to assume clinical grades and step 2 will become more important.

What you need to worry about is developing the base of knowledge that will allow you to get good clinical grades or a good step 2 score. If you turn things around you won’t even need to explain your grades as everyone will see it was a rough start but you found your stride. If your preclinical issues turn into more failing MS2 grades, below average clinical grades, and a low step 2, then you won’t need to explain anything for a whole different reason.

If things don’t change and you fail the year or fail step 1, then it’s almost certainly game over for competitive fields. If you never pass, then it’s a moot point entirely. Time for some urgent face to face meetings with your faculty and admin to right the ship while there’s still time.

Little bit of a reality check here haha but thank you. Yeah some personal issues got significantly worse this summer and I came back to school just completely unready to deal with it to be honest, hence the sudden drop. Trying to take steps to fix all of that as you've mentioned. Thank you for the advice

 

[Dral]

My med school was P/F but I mostly got Bs and a few A-'s based on my personal calculations. I was probably in the bottom part of the top half maybe? Maybe top part of bottom half?

Anyway, I failed an exam. Granted it wasn't in one of the core courses, but it was still a fail.

I got around a 250 on Step I and ended up in a competitive specialty.

As mentioned above, I would focus more on the here and now at this point. One failed exam isn't necessarily a game changer. Turn things around and it will just be a blip on your record (mostly just in your mind).

 

[Dave1980]

Hi all,

Was hoping I could get some advice here. I'm a really good student actually at med school on a scholarship and had the worst first year. Had a lot of health problems in my fam including autoimmune diseases, stroke, yada yada
Actually just had my first exam of second year and failed it which I've never done in my life. So far almost all my grades are B's so I'm sitting at an abysmal 3.3 GPA or something thereabouts

I'm wondering if I've basically destroyed any chance to get into a competitive specialty/institution, especially with STEP 1 being P/F so I can't "redeem" myself there (although honestly with the way everything is going, my chances of doing that are slim).

Anyone have any thoughts on this?

Also, when applying for residency, do you get a chance to explain poor grades anywhere in the application? Would anyone reviewing it care about your circumstances? Anything I can do to make up for these poor grades?

What are you interested in? Most specialties outside of the surgical sub specialties will still be on the table.

You need to refocus doing forward. You really can't let social issues and family issues affect your performance. This isn't undergrad so that excuse doesn't fly.

 

[Chelsea FC]

What are you interested in? Most specialties outside of the surgical sub specialties will still be on the table.

You need to refocus doing forward. You really can't let social issues and family issues affect your performance. This isn't undergrad so that excuse doesn't fly.

Man, this sort of sentiment makes doctors burn out or hurt themselves. All im hearing from this is "screw your own personal health and be a robot." This leads to the toxic nature of medicine.

 

[Dave1980]

Man, this sort of sentiment makes doctors burn out or hurt themselves. All im hearing from this is "screw your own personal health and be a robot." This leads to the toxic nature of medicine.

As a med student it is a little different but as a resident and Attending you do somewhat have to be a robot when working.

You aren't allowed to underperform because of social issues.

You may have been brainwashed by wellness lectures.

 

[Chelsea FC]

As a med student it is a little different but as a resident and Attending you do somewhat have to be a robot when working.

You aren't allowed to underperform because of social issues.

You may have been brainwashed by wellness lectures.

So if your spouse/Kid or parent passed away you think that wouldn't affect your performance? There are the people who admit that they are human and take a step back and those who buy into the B.S culture of medicine and provide suboptimal care because they arent true to the realities of whats going on in their own life. I dont think we will agree on this, different cultures and outlook on what medicine should be.

 

[Dave1980]

So if your spouse/Kid or parent passed away you think that wouldn't affect your performance? There are the people who admit that they are human and take a step back and those who buy into the B.S culture of medicine and provide suboptimal care because they arent true to the realities of whats going on in their own life. I dont think we will agree on this, different cultures and outlook on what medicine should be.

If something affects your performance you take time off to deal with it. You don't show up to the OR or the clinic if you aren't ready to deliver high quality care.

You may change your mind in the future once you have made a mistake that hurt or killed a patient (we all do eventually) and realize that this isn't a game and there isn't room for letting your personal issues affect your performance.

I can just imagine:

"Sorry ma'am your husband is in the ICU. The CABG didn't go quite as planned and we had a lot of blood loss. You see my wife and I are having marital issues and my son is acting out. I was kind of distracted...but we're all human right?"

 

[CupcakeCarabiner]

What are you interested in? Most specialties outside of the surgical sub specialties will still be on the table.

You need to refocus doing forward. You really can't let social issues and family issues affect your performance. This isn't undergrad so that excuse doesn't fly.

Hmm so just from shadowing, I like ENT, ophthalmology, and ortho as well as IR...hoping I can do a bunch of research in one of those to make up and then kill relevant rotations
Also into rheum, pulm, interventional cardio, and gastro

 

[Dave1980]

Hmm so just from shadowing, I like ENT, ophthalmology, and ortho as well as IR...hoping I can do a bunch of research in one of those to make up and then kill relevant rotations
Also into rheum, pulm, interventional cardio, and gastro

Damn, the first 4 you listed are all very competitive.

DR and anesthesia are sometimes perceived as competitive but there are so many programs that it's not all that hard to get into a mid or lower tier program.

 

[collegestud2013]

Hi all,

Was hoping I could get some advice here. I'm a really good student actually at med school on a scholarship and had the worst first year. Had a lot of health problems in my fam including autoimmune diseases, stroke, yada yada
Actually just had my first exam of second year and failed it which I've never done in my life. So far almost all my grades are B's so I'm sitting at an abysmal 3.3 GPA or something thereabouts

I'm wondering if I've basically destroyed any chance to get into a competitive specialty/institution, especially with STEP 1 being P/F so I can't "redeem" myself there (although honestly with the way everything is going, my chances of doing that are slim).

Anyone have any thoughts on this?

Also, when applying for residency, do you get a chance to explain poor grades anywhere in the application? Would anyone reviewing it care about your circumstances? Anything I can do to make up for these poor grades?

Your class rank matters more in med school than your absolute GPA. That's of course assuming your med school uses pre-clinical grades to rank students. If your med school is true P/F for pre-clinical year and doesn't report pre-clinical ranks to your residency program then you shouldn't be out of the running for anything competitive just yet as long as you are still passing every class as a whole. Residency programs can't really interpret individual GPAs from med school since some use them but many don't so it's not universally comparable.

Agreed that you need to turn things around to make sure you pass Step 1 first. But in the era of P/F Step 1, Step 2 and reputation of medical school and research will play bigger roles in resident selection. And as stated as above, don't be surprised if you won't be able to match to a competitive specialty. Every year, among incoming M1s there's a disproportionally high percentage of students at most med schools who say they want to do competitive specialties like neurosurgery, derm, plastics, ENT, ortho, etc... and very few that want to do FM. However, by the end of M4 a much smaller percentage will actually match into those specialties (this happens especially more so at lower tier med schools). Some will switch to a different specialty out of purely interest, but most of the time it's because they begin to find out that their grades and scores aren't competitive for those specialties. However, in the era of P/F Step 1 and more schools also moving toward a P/F pre-clinicals I suspect less students will select out of going into competitive specialties since it's very hard to differentiate students based on their pre-clincal performance in P/F world (except for the small percentage of students that failed a pre-clinical course or failed Step 1).

 

[Lawpy]

Man, this sort of sentiment makes doctors burn out or hurt themselves. All im hearing from this is "screw your own personal health and be a robot." This leads to the toxic nature of medicine.

The system of medicine doesn't care about the personal or health issues of doctors. It's entirely about performance and maximizing patient satisfaction scores. Blame the corporatization of medicine and the self-flagellation nature of medical education for the burnout.

 

[CupcakeCarabiner]

Damn, the first 4 you listed are all very competitive.

DR and anesthesia are sometimes perceived as competitive but there are so many programs that it's not all that hard to get into a mid or lower tier program.

Yeahhhhhh. That's part of why I asked if they consider unusual/trying circumstances when you're applying or if you get to explain those anywhere but it sounds like that's not really a thing.
Will just have to try to do my best going forward I suppose.

 

[Chelsea FC]

The system of medicine doesn't care about the personal or health issues of doctors. It's entirely about performance and maximizing patient satisfaction scores. Blame the corporatization of medicine and the self-flagellation nature of medical education for the burnout.

Agreed but its a little disappointing when the same people who suffer from this system try and uphold it.

 

[mrbreakfast]

So if your spouse/Kid or parent passed away you think that wouldn't affect your performance? There are the people who admit that they are human and take a step back and those who buy into the B.S culture of medicine and provide suboptimal care because they arent true to the realities of whats going on in their own life. I dont think we will agree on this, different cultures and outlook on what medicine should be

While that is a great thought, in reality there is a need for a job to be done and if you are unable to do that job, you'll get replaced. I'm not sure where you are in your training/career but if you haven't yet met people in medicine who don't care at all about your personal issues, you will. The culture is definitely changing, but unfortunately in some programs/fields the attitude that "there is no excuse for a mistake" and "bad performance will be punished" is quite well alive. One of my most memorable experiences as a med student was working in clinic with an attending whose mother had died the night before. I would've never guessed had one of the MAs whispered it to me. Bad culture, maybe, but ya gotta deal with it first in order to change it.

Yeahhhhhh. That's part of why I asked if they consider unusual/trying circumstances when you're applying or if you get to explain those anywhere but it sounds like that's not really a thing.
Will just have to try to do my best going forward I suppose.

Unfortunately, no one is going to care about your trying circumstances. See above; they'll just pick someone else who didn't have that bad luck.

You've identified several general interests: surgery, procedures (pulm, interventional cardio, GI, IR) and medicine (rheum). I think you should focus this year on both doing well in your remaining coursework and trying to narrow your interests down a bit. If you love surgery, you may or may not be able to focus on one of those specialties and match, or you may nevertheless be competitive for general surgery. If you like procedures, you can try for something like IR, or probably match without difficulty into medicine (which is how you get to pulm/cards/GI) or anesthesia. If you like the medical approach, you've got many options including internal medicine, peds, neurology, etc. No doors are necessarily closed, but it'll be better to narrow and focus your energies.

 

[Redpancreas]

Hi all,

Was hoping I could get some advice here. I'm a really good student actually at med school on a scholarship and had the worst first year. Had a lot of health problems in my fam including autoimmune diseases, stroke, yada yada
Actually just had my first exam of second year and failed it which I've never done in my life. So far almost all my grades are B's so I'm sitting at an abysmal 3.3 GPA or something thereabouts

I'm wondering if I've basically destroyed any chance to get into a competitive specialty/institution, especially with STEP 1 being P/F so I can't "redeem" myself there (although honestly with the way everything is going, my chances of doing that are slim).

Anyone have any thoughts on this?

Also, when applying for residency, do you get a chance to explain poor grades anywhere in the application? Would anyone reviewing it care about your circumstances? Anything I can do to make up for these poor grades?

Agree with Operaman. It may be an uphill climb (because the material builds off previous material) but all your goals are still ahead of you. That said, turning things around is easier said than done.

 

[Candidate2017]

Man, this sort of sentiment makes doctors burn out or hurt themselves. All im hearing from this is "screw your own personal health and be a robot." This leads to the toxic nature of medicine.

As a med student, you are free to do whatever you want because you answer to no one.

As a fully licensed attending physician, you answer to your patients, their families, their malpractice lawyer, the courts, your partners, and your state licensing board. None of these people will hold you to a lesser standard based on tribulations going on in your life. Most medical students don't understand this very well, despite the fact the goal of med school and undertaking years of medical training is to become a fully licensed professional (with concomittant professional responsbilities to one's patients). This is not an easy career you are choosing.

More newly minted physicians are choosing employed jobs working for The Man because of perceived work-life balance. But the irony is the The Man will use your professional responsibilities to patients as a stick against you. Just look at how often your med school uses the "professionalism" stick against you despite you having zero professional or legal obligations to anyone.

 

[GoSpursGo]

Yeahhhhhh. That's part of why I asked if they consider unusual/trying circumstances when you're applying or if you get to explain those anywhere but it sounds like that's not really a thing.
Will just have to try to do my best going forward I suppose.

You also need to be realistic at some point. It's just like med school--there are a limited number of seats for these competitive specialties, and while a program may be "understanding" of your circumstances they are still going to take the candidate who is stronger than you.

If your one true love is one of those hypercompetitive specialties, then you need to completely turn things around, immediately, or take a break until you can. And you need to wind up with BETTER than average research to make up for your class rank.

 

[coolknight99]

What are you interested in? Most specialties outside of the surgical sub specialties will still be on the table.

You need to refocus doing forward. You really can't let social issues and family issues affect your performance. This isn't undergrad so that excuse doesn't fly.

Is this satire????? Medicine can't be your life..... That's just not healthy

 

[Dave1980]

Is this satire????? Medicine can't be your life..... That's just not healthy

No it's not satire and you missed my point by a mile.

The point is that you can't make excuses for poor performance as a doctor. No one cares that you are having social/family issues. They want the highest quality of care for themselves and their loved ones and don't give a **** what is going on in your life.

You need to work on your reading comprehension.

I chose a lifestyle specialty for a reason. Medicine is NOT my life. I also would never let any problems in my personal life bleed over into my job.

 

[altblue]

As a med student, you are free to do whatever you want because you answer to no one.

As a fully licensed attending physician, you answer to your patients, their families, their malpractice lawyer, the courts, your partners, and your state licensing board. None of these people will hold you to a lesser standard based on tribulations going on in your life. Most medical students don't understand this very well, despite the fact the goal of med school and undertaking years of medical training is to become a fully licensed professional (with concomittant professional responsbilities to one's patients). This is not an easy career you are choosing.

More newly minted physicians are choosing employed jobs working for The Man because of perceived work-life balance. But the irony is the The Man will use your professional responsibilities to patients as a stick against you. Just look at how often your med school uses the "professionalism" stick against you despite you having zero professional or legal obligations to anyone.

I agree that one shouldn't be at the hospital or clinic if they aren't in a good spot to practice at a particular time. Patient care is demanding, and mistakes committed by exhausted physicians can have consequences for patients and their careers. Clinical-level med students, residents and attendings should all take care of themselves as a preventative measure, yeah.

But I think we're being too pessimistic about the OP's ability to cope in clinic. Sure, they're not where they are at right now, but they've passed everything else thus far and likely just need to work on a set of specific skills. They're not even halfway through M2 which gives them plenty of time to grow. Hell, people worse off them than them with poorer academic performance end up becoming well-rounded physician. And that's because developing emotional and professional resilience is a skill that's built over time, and many M3's and M4's most of us are working on it.

We're all on the journey to develop that wall to prevent our personal lives from interfering with our professional or academic lives, and it seems the OP just needs a little more work in that domain. I know I do. Many of my classmates do. There's a spectrum of one's ability to function under duress. Just because you fail exam, or in clinic you're unable to concentrate during rounds or take feedback a little too personally because your first cousin is in the hospital doesn't mean you're set to commit a severe, unforgivable mistake.

Once again, I understand the efforts in this thread to warn the OP that one needs to compartmentalize their outside problems to protect themselves and their patients, and I don't disagree with that. Successfully adapting to the stress of M3 has been a struggle for me and some classmates, and I know it has to happen. I just say these things to underscore the idea that struggling with outside stressors isn't all that unusual and that building insight and self-awareness over time can combat it.

 

[YCAGA]

Outside of AOA , I have heard from multiple PD directors at "top" programs in "top" specialities that class rank with step 1 P/F is not going to be a major factor, for a number of reasons. First, again outside of AOA, class rank has never been given as much weight as Step 1/2, clinical grades, recommendations, sub-I's, and interviews. According to these PD's, Step 2 will replace Step 1 as their initial screen when they get the 1,000 applications in ERAS, then more weight will be given to people they had come and do aways. Those people are the most known quantity which is what you want when committing to someone for 3-8 years. Then it will be people who got personal recommendations from people they know (former co-residents, former residents/fellows, other PD's they talk with, etc). Classic "it's not what you know, it's who you know" stuff.

Much more importantly to you this year, why did you fail? Did you just not study for that block? Perhaps due to depression/anxiety/apathy/etc? Or did you feel like you studied hard but still failed? The difference between failing due to depression/apathy and bad studying strategies is huge because their "treatment" is entirely different.