Spotlight Interview: a family medicine resident who failed step 1

Emily Chan is a Ross University graduate who successfully matched into her top choice residency program. However, it wasn’t an easy route to residency. As a Canadian citizen she could only apply to programs that would sponsor her visa. Oh and she also failed USMLE step 1. Here’s her story.

As a close friend, I know you pretty well. Can you tell my followers a little bit about yourself? Who are you professionally? Who are you outside of the hospital?

I’m from the beautiful area of Niagara Falls, Canada. True to stereotype, I am polite, love maple syrup, and say “eh” often. I received my Bachelor’s in biomedical sciences at the University of Montréal – in French.

Professionally, I am a hard worker and a team player. I show up to the office or the hospital with a smile and do my best. People have described me as a problem solver because I will come up with quick solutions for anything.

Outside of the hospital, I indulge in my hobby of cooking and baking. Nothing makes me happier than sharing good homemade food with friends. I also attempt, with varying degrees of success, to justify my paid gym membership even though I hate working out.

You matched into your top choice family medicine program. That’s an amazing accomplishment. Why did you choose to apply to family medicine?

Thank you! It is the most amazing feeling. I knew since I was 12 years old that I wanted to be a family doc. I’ve always loved talking to people and listening to stories about themselves, their families, and their lives. I believe that every personality fits in a certain branch of medicine. How will you know? Trust me, you’ll just feel it, you’ll know. Family medicine was my perfect fit.

Where are you from originally? Did you want to match in the US or Canada? Did you experience any extra hardships trying to match in American programs as a Canadian?

As a Canadian, I knew the odds were not in my favour across the board. Many factors influenced my choice to not pursue a Canadian residency. Canada made it very difficult for me to apply (poor matching stats, inconvenient availability of mandatory tests, and difficulty to obtain Canadian electives). I felt that if my own country made it so challenging for me to come back, then I wasn’t going to put up a fight. Instead, I concentrated all my energy to match in the US. I am very glad my strategic gamble paid off. Yes, you face discrimination because as a resident you will require a visa. I was ineligible to apply to many programs because they did not want to deal with the headache of visas. Disappointing, sure, but I don’t blame them.

Speaking of hardships, I remember the day that we all received our step one scores. You and I, along with three close friends of ours, were living together in Florida. I remember the moment when you came downstairs from your room and told us what every medical student dreads to even think of. That you failed step one. What happened? Why do you think you failed? Were you doing poorly in school? Did it come as a shock to you?

Oh that dreadful day… It was awful! I was so glad to be surrounded by friends like you when I found out I failed. You all rallied around me in a big group hug and reassured me that everything was going to be ok.

Failing Step 1 was a huge blow and I did not expect it at all. Granted, I’m not the strongest student so by no means did I expect to have a stellar score. I just expected to pass. So when I learned I was a few points shy of passing, I was crushed. I had done fine in school up to that point. I never failed any tests on the island, never repeated a semester, and I even passed the comp on the first try. Everything suggested that I’d be fine.

In hindsight, I realized what I thought was enough preparation for the test ended up being insufficient. To tackle Step 1 a second time around, I had to prepare more than ever before.

What was step 2 CK like for you? What steps did you take to make sure you didn’t make the same mistakes again?

Step 2 CK was definitely better than Step 1. I will say, all the self-doubting and insecurities resurfaced when I was prepping for Step 2. I spent 6 months studying and even delayed my test till October – meaning I applied to match without a CK score. As anyone and everyone will tell you, it’s best to apply to match with a full and complete application but mine lacked the CK. It was a risk I was willing to take. I absolutely could not afford to fail a second USMLE exam. Aside from doubling the time I dedicated to study, I got weekly tutor help to go over questions on UWorld that I got wrong. I also made sure that I took plenty of practice tests.

How many programs did you end up applying to? How many categorical? How many preliminary? How many interviews did you end up going on?

I applied to every single FM program in the US for which I was qualified. All categorical, no prelim. I spent a little over $3,100 on my 140+ applications. In the end, I only had 2 interviews. Yes, you read that right, two interviews. One interview was where I did all my core rotations in 3rd year. I got the other interview because I clicked well with residents from that program while attending the AAFP National Conference. I knew from the get go that on paper I was less than stellar so I worked hard on networking. I attended family medicine residency fairs like it was going out of style. In 12 months, I attended 3 residency conferences.

What was match day like for you?

Every medical student will tell you that match day is a nerve-wracking day, and for me, it was no different. I was hoping to match but I also mentally prepared myself that there was a good chance I would not match. When I learned that I successfully matched, I cried tears of joy and relief. Knowing that I beat the odds was the most incredible feeling. It validated all the people along the way who believed in me and said I would make it. I now had proof that outside people (not just family and friends) believed I was worthy of pursuing this profession.

I know we’ve talked a lot about a major weakness in your application but what do you think were your greatest strengths about your application? What set you apart from the other applicants?

Academia has never been my forte. I knew clinical years were my time to shine. It’s what I do best; it’s where I feel most comfortable. I worked diligently and was rewarded with A’s in all my core and elective rotations, except surgery. I genuinely connected with my attendings and they wrote me beautiful letters of recommendation. My strong LORs were undoubtedly a key component to my match success. I’ve always been a people person so interviews came naturally to me. When applying to medical schools, I had 4 interviews and was accepted to all 4. I knew I had strong interview skills. I harnessed that same energy and left my 2 residency interviews feeling confident.

The fact that you failed step one, the proverbial kiss of death to any applicant’s dream of obtaining a residency, but still managed to match into your top choice family medicine program is quite an accomplishment. In closing, what advice would you give to a medical student who failed or didn’t do well on step one?

I want people reading this to say to themselves, if she can match her top choice in her dream specialty with a 203 Step 1 score, a 215 Step 2 score, and only 2 interviews, I can do it too. One failure does not define you. You will encounter people along the road who will encourage you to quit medicine (one of my Ross professors counseled me to pursue non medical careers) or take time off (I was strongly encouraged to delay my graduation date and my match by a year) or give up all together. Take all that advice as fuel to prove them wrong.

Thank you Emily for bravely sharing your inspirational story. You are proof that it is possible to fail USMLE step 1 and still earn a residency. I’m sure it was an emotionally tumultuous path and taught you a lot about yourself along the way.

UPDATE: Unfortunately due to the high volume of requests to speak with Dr. Chan I can no longer forward her private email. If you have questions for her please comment below. After sufficient questions have been posted we plan to release an updated blog post with the most frequently asked questions. Thank you for your understanding.

Study Tools During Clinical Years

Your two years of classroom basic sciences are drastically different than your clinical years. Studying in your first two years is somewhat easier because your primary responsibilities are all geared towards taking tests, culminating in the USMLE or COMLEX. Third year sucks because you are still studying for step 2 but fourth year hits that sweet spot between ‘done studying for tests’ mentality and ‘almost got a job’ swagger. These were my favorite resources that I used outside of my step studying.

 

 

Maxwell Quick Medical Reference

Super small and lightweight. This is great for beginners on the wards. It comes with a pocket eye chart which is probably the only place you will find eye charts in hospitals. Also comes with good on the go guides for shorthand notes and labs.

 

 

Pocket Medicine

The purple book is an intern’s favorite friend and mighty helpful too for med students. I don’t know when the new version is coming out but I didn’t feel like waiting for it. If nothing else, it’s a quick reference guide to everything you will see in the hospital. Differential diagnoses, work-up, treatments, etc. Pocket guides are also available for surgery, OB/GYN, peds, and such. I am going into internal medicine so I chose not to get any other pocket guides but google away if you want them.

 

 

Journal Club App 

Just buy it. It is the best $5.99 I spent in med school. This app provides concise and easy to journals that changed patient standard of care. You can also check them out for free online at Wiki Journal Club. Cardiology Trials is also a good site specifically aimed at cardio stuff.

 

 

UpToDate

It’s like Google for doctors! Okay, I’m starting to be redundant but its a great site that I’m sure you use already.

 

 

Moleskin Classic Notebook

 

 

Did I miss anything? What apps or resources have you used s/p step 2?

The Day To Day Schedule of a Third Year

An incoming first year medical student asked me, “what is the day to day schedule like in medical school?” To begin with, I want to differentiate the two halves of your medical school education. The first half is spent in the classroom and the second half is spent in clinical rotations. In this post I will be discussing the day to day schedule during your clinical years, specifically your third year (because fourth year is basically like senior year of college).  Now before you scroll down to see the day to day hourly schedule of a third year medical student I have a few caveats about your third year clinical rotations to reveal.

Everyone’s experience is different. 

During the first two years of medical school, regardless of what school you attend, everyone basically learns the same stuff. The information that you are eventually are tested on during your United States Licensing Exams (USMLE) is standardized regardless if you went to an Ivy League school or a Caribbean one like me. So the first two years of didactic lectures are pretty similar in every medical school. This standardized experience of your first two years of medical school is grossly different compared the second half of your schooling. You can be from the same school and be in the same rotation and have completely different experiences during your rotations, and there’s a number of reasons why. You works with different residents, different fellows, and different attending physicians and each one of them will share with you something unique. Not to mention that you end up seeing entirely different pateints. There is simply no way for everyone to have the same experience. Ultimately, although you might have the same schedule as your colleagues, your experience can be considerably different.

Each respective rotation is different

My third year core rotations consisted of the following: 6 weeks of pediatrics, OB/GYN, psychiatry, and family medicine, and 12 weeks of internal medicine and surgery and each rotation’s schedule was completely unique. Just think about how different the day to day life of a surgeon is compared to a psychiatrist. The same is true when it comes to your schedule. More so, each hospital’s respective rotation experience can vary widely between the hours you work, number of patients you see, balance between autonomy and supervision, and how much the residents and attending physicians are willing to teach. So take the following daily schedule with a grain of salt because it is mainly applicable to my internal medicine rotation that I completed in Brooklyn, New York.

Here’s my daily internal medicine schedule

  • 7:00am. Handoff from the night team. Pick up a new patient.
  • 7:00-9:00. See patient(s). Write note. Talk to the cute nurse. Look up how to treat my patient. Talk to my patient’s actual nurse. Present and discuss my patient with my resident. Prepare presentation for rounds.
  • 9:00-10:30. Round with my team. Present my patient. Discuss assessment and plan with the attending. Make updates to my patient’s treatment plan.
  • 10:30-10:35. Find that piece of paper that you wrote everything down on and then subseqently lost.
  • 10:35-10:40. Find your team that you lost while you were trying to find the piece of paper that you just found.
  • 10:40-11:30. Play it cool. They wouldn’t have noticed if you left altogether. Update my patient’s note. Call consults and check if lab-work results are back and interpret them if you can.
  • 11:15-12:00. Lunch. Attempt to resist drinking second cup of coffee.
  • 12:00-1:00. Lecture of some sort.
  • 1:00-1:15. Go get that second cup of coffee. Remind myself to stop trying to stop drinking coffee.
  • 1:15-4:00. Go say hello to my patient. Make sure labwork, radiology, and procedures were ordered. Call people to make sure it gets done. Eventually ask my resident, ‘if there is anything else I can help with’ and hope that they don’t need something faxed. God I hate fax machines. Seriously, why do they still exist?? I think its punishment for all the years of attitude I gave my parents when I wouldn’t help them find the ‘TV/VIDEO button’. Side note, when are TV/VIDEO buttons going to be a thing of the past?
  • 3:00-3:05. Complain about my research project.
  • 3:05-3:30. Work on my research project.
  • 3:30-4:00. Find someone to procrastinate with. Find someone to annoy if they won’t procrastinate with you.
  • 4:00-6:00. UWorld.
  • 6:00-7:30. Home, relax, gym, shower, eat.
  • 7:30-8:30. Review UWorld or watch Kaplan videos (Thank you Conrad Fischer and Online MedEd)
  • 8:30midnight. Beer, Netflix, Xbox, read something non-medical, and lament over how little I got done today. Repeat tomorrow.

OB/GYN: What To Expect

“I’m starting my third year with OB/GYN. Do you have any tips or tricks for that particular rotation? Anything I should expect working with those attendings? Or anything the attending like or expect from us? Just anything that could help before starting.”

Short answer: Expect vaginas, babies, long hours, and lots of vaginas.

Long answer: During my obstetrics and gynecology rotation I rotated through each aspect of the specialty. Obstetrics, gynecology, gynecological oncology, a week with a preceptor, a week in the outpatient clinic, one week on days, and one week on nights. Days and nights are the worst because they are literally twelve hour shifts. My surgery rotation wasn’t even this bad. In surgery you can at least steal away to the library to study. In OB/GYN, you are constantly doing something. It’s a lot of work and in my opinion the toughest third year rotation. Not to mention all of the vaginas.

For me, one of the most difficult aspects of pediatrics and OB/GYN is the fact that it feels like I’m studying a complete different species. For the most part, in internal medicine, family medicine, emergency medicine, surgery, and psychiatry you study the medicine involved with the adult human being. Pediatrics and OB/GYN are completely different entities. The steep learning curve in OB/GYN is a tough one to tackle. So grab a review book and start reading and, like every rotation, be present! Learn as much hands on medicine as you can. The OB/GYN residents I worked with went above and beyond to teach. They get a bad rap in my hospital for being…high-strung. Yes, let’s say high-strung. All joking aside, they are hard-working, intelligent, and willing to teach but you have to be willing to work. Just don’t get stuck doing SCUT work all day. Yes you are there to help but first and foremost you are there to learn. So be a part of the team, be willing to help out, ask questions, and learn! Of course, pick and choose your time to ask questions. There is a delicate balance between inquisitive med student and OMG STFU med student.

OB/GYN also sends you into the surgical realm. So learn how to scrub in properly and be nice to the scrub nurses. Also be warned- there are certain scrub nurses who will be rude, curt, and straight up nasty to you in surgery. Don’t take it personally and just roll with the punches. Introduce yourself when you enter an operating room and state your purpose. My friend got into the habit of literally walking in and saying “Hi my name is John Smith. I’m a medical student” because when you walk into an OR everyone will look to see who you are and it’s kind of awkward if you just scoot in without saying anything.

As for the attendings, I stopped trying to guess what they are thinking and what will make them happy. Just show up on time, work hard, study your medicine, be professional, be kind to your patients, and you will be fine.

Let me know if you have any follow up questions. And as always, happy studying!

Premeds: How To Shadow Like a Boss

July 1st marks the beginning of intern year for residents but they aren’t the only new faces in the hospital. The summer months are also the perfect time for premed undergrad students to get into the hospital for summer shadowing experiences. Shadowing experience gives premed students valuable clinical experience. Not to mention it’s essential to any medical school application. You probably have heard this before, or at least I hope you have, but in case you haven’t here’s how you can get the most out of your shadowing experience in the hospital.

Pursue what interests you, be curious, and ask questions
There’s nothing more refreshing than a young mind excited to learn. Your vigor makes it fun to work with you and a positive attitude makes me want to teach you more. You need to help me help you learn by actively asking questions so that we can direct your learning experience. It also further shows that you are actually interested in the field of medicine. So screw the cat- be curious and ask questions.

Put away your phone
Like it or not, people assume you are texting when you are on your phone. I’ve been victim to nurse technicians and attending physicians reprimanding me for ‘being on my phone’ even though I was actually researching information pertinent to our patient. Many people don’t mind when you quickly Google pertinent topics but rather play it safe than sorry. As a guideline keep your phone in your pocket and instead carry a small pen and pad with you in the hospital. Write down what you don’t know and Google it when you go home.

Don’t fall asleep
It happens by accident more often than you think. You finally get to sit down on a comfy couch after a long day on your feet in a comfortably warm room. Someone starts lecturing and their voice soothes you into slumber (Its like they want you to fall asleep!). Fight the urge and stay awake.

Look the part
You don’t need to wear a suit and tie but you should look presentable. When in doubt always overdress than underdress. You can always loosen a tie or take off a jacket but it’s hard to cover up your sneakers. In general, don’t look like you just woke up. At least put a comb through your hair before you show up. These are common sense things but it seems that common sense isn’t so common.

Be respectful
Medicine is an intimate art. People discuss things about themselves that they don’t tell anyone else or things that most people just straight up don’t want to know. So remember to treat your patient with respect and dignity regardless if you’re talking about their bowel movements or their cancer regiment.

Find a mentor
Much of what I just mentioned is about how you are perceived by your patients and the doctor you are shadowing. Instead of trying to conform to how others want you to act you should set your own standard that you hold yourself against. The best way to do this is to find a mentor who you want to be like when you’re a doctor. I’ve found several. I look up to an ICU/trauma surgeon who is able to apply mechanistic knowledge of disease processes to treat his patients, a cardiologist able to diagnose diseases with the use of his hands and stethoscope alone, and countless other individuals whose personal attributes I have grown to value. These attributes, like having a vast knowledge of medicine and the ability to apply that knowledge, won’t last unless you want them to. They are life long personality traits that you have to start developing now. So find someone who motivates you to be a better you and start the process towards becoming a physician today.