M4 Year

Interview Invite/Rejection Season

How it feels when a program you like sends you a “we will not be interviewing you” email:

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Since the MSPE came out, I’ve received a wave of interview invites in my second specialty and a wave of rejections in my first specialty. At this point I can safely say that applying to two specialties was a good idea. I have enough interview invites in my second specialty to be considered “safe to match”, but not enough to be safe in my first specialty. I would absolutely be freaking out right now had I only applied to one. We’re still in the middle of the cycle, so it will be interesting to see what pans out for specialty #1 within the next month or so.

Time to go pray to the ERAS deities.

 

-NB

 

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October 1st

I now have more interviews in my second specialty than I do in my first, which I guess goes to show that it was a good idea to apply to those programs. I’m not getting much love in my first specialty, presumably because I don’t have my Level II scores yet and because programs wait for the MSPE to be released. I also think my educational background and activities are more fitted for my second specialty, which is probably part of the reason why I’m getting interviews even though I applied relatively later.

Speaking of the MSPE, it’s recently been the center of concern for my class. For those who don’t know what an MSPE is, it’s essentially an official academic record of your performance during your first three years of medical school. It includes a blurb about what makes you a unique/great applicant for residency programs, the comments that attendings wrote in your evaluations (whether they were good or bad), along with some fancy charts and graphs that visually show programs how you stack up against the rest of your class. Basically, it’s part of your residency application and is necessary to make it “complete” for review.

Historically, the MSPE is not released by medical schools to residency programs until October 1st of the application year. Once they’re released, the residency programs review applications again with the MSPE and decide whether or not to give applicants interviews. Of course you can get an interview before October 1st without the MSPE. This obviously depends on the program, specialty, and whether the program is AOA or ACGME accredited. However, generally speaking, without the MSPE, programs will not offer interviews.

This brings us to the problem: supposedly many student’s MSPE’s had errors. Some were minor, like grammar and punctuation mistakes (although these should still be fixed immediately). However, some were huge- we’re talking incorrect grades, such as documenting a Pass when you actually got Honors, an “In Progress” grade when all the paperwork has been turned in, incorrect applicant name, and evaluations from the wrong preceptor, just to name a few. Of course, my class was furious, and with good reason. Supposedly (and this is a huge supposedly that probably depends on 1,000 other factors) some programs will auto-reject applicants if they don’t have an MSPE submitted by the time they review the application. Now, the MSPE errors aren’t the school’s fault. We were told that there was some kind of glitchy problem with the website that attendings use for submitting our evaluations. Whether this is actually true or not I’m not entirely sure, but I think my class is lucky in that October 1st actually fell on a Saturday this year. Meaning that no one in any residency program was actually working on the 1st to review applications. Therefore, there’s some buffer time to fix any mistakes and upload a 100% correct MSPE before residency programs download applications on Monday, October 3rd. At least, that’s what I’m thinking.

So to my fellow classmates that are also kind of freaking out: I think we will be okay.

Of course if I get an influx of rejections in my inbox tomorrow then I was wrong and we’re screwed.

Just kidding; I think we’ll still be okay.

-NB

I’ve got 99 problems

It’s the third week of September. The DO residency applications have been open for a couple months, but the MD residency applications have just opened for submission a couple days ago.

I feel like everyone in my class has got their application stuff together, at least judging from the non-stop influx of social media posts I’ve been getting for the past week or so. Me on the other hand, am a hot mess.

I actually decided to apply to two specialties. I guess this isn’t entirely uncommon, but the biggest problem this is causing me (other than killing my bank account) is that 1.) I have to write another personal statement from scratch, and 2.) I’m short some letters of recommendation. Since I’m limited geographically, I’m applying to both the DO and MD match. This means my DO application for my second specialty is incredibly late and this isn’t even taking into consideration how late my letters are going to be. I know people that were getting interviews in July for this specialty, and I’m going to submit an application for it in the middle of September. Why?

Because I’m scared I’m not going to match if I only apply to one specialty. I’d rather drop the money now with a later application in a second specialty than realize in November that I don’t have enough interviews and scramble to apply to more programs as a last-ditch effort. Trying to add more programs then would really be too late. The real issue I had to think about was before applying to a second specialty was, “Could I see myself in this field? Would I be happy if I matched in this instead?”. And my answer is yes, mostly because the two fields are actually similar with a bit of overlap.

The anxiety is real- I’m having some problems sleeping. I seriously considered even taking a clinical/research year and applying for the match in 2018 so I could give myself a mental break, but I don’t think it’s feasible at this point. I feel like I’m stuck in a 50 foot deep hole where the only escape is to climb out. The problem is that I keep falling back in.

 

-NB

 

Audition 1, complete

I finished my first audition rotation. I’m not sure how my fellow sub-intern and I survived a whole month of it, but we did. Honestly I think that it was one of the rougher ones that we’re going to have. I anticipate the rest of my rotations from here on out to go smoothly.

I think I ended the rotation on a good note. I tried to work especially hard the last two weeks once I got used to everything so that I could leave a positive impression. I received good feedback from the residents, most saying they hope to see me back during their interview season- hopefully a good sign. Despite how hellish the rotation itself was, I’m actually kind of sad to leave. I’m going to miss the craziness of the floor, having my own patients that I can manage, being constantly judged and under scrutiny of my seniors (okay maybe not that). I even received a compliment from Ms. Never Satisfied Senior Resident towards the end. I’d like to think that she noticed how I improved, or at least that I tried.

I also did have a chance to sit down with the Program Director and talk to him about my interest in the program. I think the meeting went well. I mentioned in a previous post that one of my top choice programs essentially rejected me before I even auditioned. This is that program. I think some people will say that I’m being too over the top/neurotic by meeting with the PD, and I probably would have thought the same thing-  but this is audition season. Sometimes you just have to do what you gotta go, even if it makes you uncomfortable. I haven’t received an official rejection from the program yet so I’m going to try to be positive and say that I still have a (teeny tiny) chance here. And as long as I have even the tiniest chance of an interview, I’m going to go all out. Not just at this program, but any program that I’m interested in.

It’s not over until it’s over.

-NB

First 2 Weeks of Auditions

Now that I’m in the thick of my audition for this month, I though I’d write a little reflection of how it’s been going.

It’s been stressful. So very stressful.

An audition rotation is kind of like a 31-day interview. You need to be at the top of your game 100% of the time. You need to assume that all the people you interact with- nurses, interns, residents, attendings- are watching your every move. If you mess up on one thing, it will stick with them for a long time and it’ll be harder to make a good impression.

For the most part, I’ve been getting along with all the residents except for this one senior. Sometimes she’s incredibly friendly and talkative with me as we discuss random non-audition related topics. Other times (maybe when she’s more stressed out) she will call me out on things I’ve done that are not to her liking by prefacing with the phrase “You know, since you’re auditioning, you have to…”. I’ve directly worked with her several times, and each time I feel like a complete idiot. I always feel regretful about something I did whenever I work with her, because she always comments about what I’m doing wrong or what I should be doing better. I talked to one of the interns who told me that she’s notoriously not good with students, usually yelling at them or publicly humiliating them until they have to excuse themselves because they start crying. He told me that if the only thing she’s done to me is give me criticism, then it might mean I’m not doing as bad as I think. Yeah, we’ll see about that. I still have two weeks of my audition left and will mostly likely work with her at least one more time, so I’m trying to really take to heart what she’s told me so that I can show her I’m capable of improvement.

In regards to working with residents, I’ve been trying to anticipate their needs beforehand and be helpful as much as possible.

“NB, I need you to see the patient in Room 1 and write the admit note. Then tell me your orders so we can review them”

“I already wrote the note and I just finished the orders for your review”

“NB, I need you to get the patient to release medical records and add them into the chart”

“I already had the patient sign the release and the records are being faxed to us right now”

I feel proud of myself for being proactive and getting things done before I’m asked, but this is really all just common sense, and all the other M4s who are auditioning have been doing the same thing- it doesn’t really set me apart.

One thing that is putting me at a disadvantage though is auditioning at a hospital I’ve never been to. Some of the M4s I’m with have rotated here as M3s, and they know how everything runs and where to find what they need. Meanwhile, my co-sub intern (who also has not rotated at this hospital before) and I feel like we were being thrown into the rotation, especially during the first week. I think the hardest part was that everyone expects a lot from us since we are fourth years; they just don’t know that we’ve never been here before and that it’s all new to us. It’s almost like we are M3s all over again.

We’ve also found that there has been little to no guidance on how to do things. We were not given a on-service orientation. During the first week when a resident would tell me to do something, I would enthusiastically reply, “Absolutely, I’ll do that right now” while simultaneously thinking, “Okay I guess I’m going to wing this too”. I really depend on the nurses, axillary staff, and more experienced M4s to help me out. There is definitely a steep learning curve, I think even bigger than the learning curve between M2 and M3 year. It makes me wonder if my core rotation site provided adequate training to my past M3 self, or if this is just an incredibly high-volume, high-stress, figure-it-out-as-you-go type of hospital. I’m thinking more of the latter. It is a county hospital after all.

Something else I did was re-introduce myself to the Program Director. My interaction with him this month is pretty limited, so I’m thinking of scheduling some kind of meeting with him. I am interested in going to this program, so I hope it goes well. It could also backfire, or have absolutely no effect on my chances of matching here.

Anyway, deep breaths. We’re halfway done.

 

-NB

Boards And Audition Rotation Woes

They say that every medical student will have at least one moment of self-doubt, one moment where they wonder if this is all going to pan out. I recently had one of these moments a couple days ago.

I had to push my board exam back, putting me at a disadvantage when it comes to my applications since now programs will not get my scores until after October 1st. To make matters even worse, I’ve essentially gotten rejected from my top choice program-one that I’m going to be auditioning at. I got in contact with the program and pleaded with them to reconsider. However the person I talked to told me that since they’re the only program for that specialty in the whole state, they get an extremely high volume of applicants and because of that they have to essentially pre-rank applicants based on COMLEX level I and level II (which I don’t have) alone. I get that it’s competitive but to not even give me a chance when I haven’t auditioned yet seems a little unfair. Plus, this ‘requirement’ is stated nowhere on their website or in any email correspondence I’ve had with them.

Now it’s too late to cancel and pull another audition rotation out of my ass, so I’m pretty much just stuck. I still need a Letter of Recommendation from that institution, so I do still need to work hard. But it’s extremely discouraging to be getting bad news so early in the cycle.

I used to wonder if some of my classmates had slipped through the cracks of the medical student selection process. How did some of these people get through the interview? But nowadays I find myself wondering if I am the one who doesn’t belong here. Lately I’ve been feeling like a fraud.

I really, really, really hope this all works out in the end.

 

-NB

Clerkship Advice

Now that the M3s are about to start their rotations, I thought I’d put together some advice about clerkships and doing well on the floor. Personally, I did well on rotations and got great evals and comments. This wasn’t because I was some kind of magical social butterfly either; it was because I just wasn’t a freaking weirdo. And yes, you will encounter lots of weirdos this year (patients, other medical students, doctors, etc.). Below is a compilation of advice based on my experience from this year. As always, take everything I say with a grain of salt.

  1. Third year is one big game. Everything is subjective. Your evals will be based off how much work the evaluator thinks you did or how hard he/she thinks you worked. This is why it’s important to be cognizant of what you’re doing at all times. If you think you’re slacking, chances are your evaluator thinks so too. Also, and this is huge, be smart about who you give your evaluation to.
  2. Don’t take anything personally. You’ll learn to develop thick skin during rotations. Embrace any criticism that you’re given and learn from your mistakes. I advise against trying to talk back for the sake of ‘making a point’ or to prove that you’re ‘right’. Just take it, say thank you, and move on.
  3. Be a good communicator and listener. Reply to your resident/attending/intern’s texts and answer their calls. If you’re going to be late or can’t make it to work, then let someone on your team know. It’s much better to at least let someone know then have people wondering where you are, even if you’re gone for a legitimate reason. In addition, pay attention and actively listen. People can tell if you’re not tuned in and sometimes they like to surprise pimp you. Nod, ask questions, whatever it is that you do to show people that you’re actually listening and paying attention to what is going on.
  4. If someone tells you to do something, do it. It helps to keep a running checklist of things that you need to get done for people. As you finish each task, check it off. Even if it’s scut work, you should do it. Every little thing helps the team out!
  5. Don’t lie. This is especially true on the physical exam. It always amazes me how many people falsify the PE findings. If you didn’t do it, don’t add it into the note! Just say that you didn’t do it. I’ve never seen people get yelled at for forgetting to do an exam, but I have seen people get yelled at for adding findings that they didn’t actually do.
  6. Help others. Not just the residents you work with, but your fellow medical students as well. You never know who will have your back when you need it. Be nice to everyone, and help everyone out. Never ever ever put someone down or make someone look bad. That’s the quickest way to make everyone hate you.
  7. Always be doing something. Don’t just stand around. If you’re in the OR, then help prep for the case. If your resident is typing a note, read about whatever the patient has. If there’s actual down time, then you should be studying for the shelf. You get the idea.
  8. You’re only a third year. There’s only so much that you can do. If someone tells you to go home, then go home. It is not a trick. Same with if someone tells you to go eat.
  9. Be prepared. Read about your patients, read about cases you want to scrub in on, bring your stethoscope or purple book or whatever other thing you need.
  10. Don’t take crap from people. This includes residents, other medical students, PA students, nursing students, nurses, and other staff. This is still your rotation and you’re here to learn. If your intern is giving you problems, then talk to your resident. If your resident is giving you problems, talk to your attending. If your attending is giving you problems, then tell the school. If there are students who are being rude, inconsiderate, or are hogging cases/patients, then it helps to just talk to them about the issue first before going to a resident. I’ve only had a problem with students a couple of times, and each time it was resolved after I talked to them.
  11. Every rotation has its own curriculum. It will take a couple days to get settled into each rotation and figure out what you’re supposed to be doing on a day-to-day basis. It helps a lot if there is another M3 or M4 on the rotation who can show you what you’re supposed to do and how to do it. It’s usually a good idea to ask an upperclassman or a classmate who has had the rotation before so they can give you tips and advice.

Anyway I think those are the basics, I hope it helps. Again, most of this is common sense. Good luck to all the soon-to-be M3s! You’ll do great.

-NB