Is the sky no longer the limit? Getting back on track in med school
December 15, 2013 8:48 AM   Subscribe

I had a rough start to medical school academically. People keep telling me that if I "do well" here on out, it "shouldn't matter" in four years when I apply to the next stage in my training (residency). That's easy for them to say, but I need more perspective than that. I'm bothered that it could put a "ceiling" on what I might be able to achieve otherwise. Those who have experience with medical education and academics, please give me your thoughts!

Due to a combination of factors (not being academically talented enough, the difficulty of memorizing insane amounts of information after majoring in the physical sciences, dealing with the acute stress of a sexual assault and abuse from faculty and subsequent judicial process, moving far away from my friends and family to live on my own for the first time, being quiet in class), I failed not one, but two classes my first semester of medical school. It shows on my transcript. I will have to explain it to future interviewers.

On a cognitive level, I know I am not doomed. Preclinical grades matter little compared to other factors, and realistically, nobody is going to actually care in four years. I know I am not the first and won't be the last student to have a rough transition to graduate studies, and that there are people who sometimes fail an entire year and have to repeat.

What bothers me is that I think I could be "limited" in the places I could go later on because of these black marks on my record. In other words, if med school were a video game (and ha, I know it's not), I surely would have rage-quit by now so that I could start out with "full potential" again. The few people I've discussed this with make vague statements like, "Well, you probably won't get into neurosurgery at Mass Gen ... But otherwise you won't be limited! Just do well on your board exams." Somehow, I feel like I'm left hanging every time I hear a response like that.

I get the impression that the general, openly-expressed sentiment in medicine is that you have to really, really, really want to be a doctor to be one. Therefore, since you want to be a doctor so much, you should be willing to train anywhere, and that prestige doesn't matter. I get that, and I'm not super hung-up on prestige in itself. But I want to go into academic medicine, and I want to interact with people who are influential in the field, and in my case that means going to top programs even though I know there are brilliant people to be found at all types of institutions. I was a great student in undergrad-- magna cum laude at an Ivy, recipient of the departmental award, active in school activities and research. I loved learning. I don't want to be mediocre in a field when I know that I'm capable of excellence; I'd almost rather switch fields so that I can interact with top minds in the career I choose.

I know I probably sound really immature and possibly even entitled, as if I've never dealt with failure or hardship before and am falling apart (well, perhaps it isn't that dramatic) at the first hint of failure, but that's not the case. I take responsibility for my failures and I've done everything I can to move forward in a positive way. I realize that even if I didn't have these obstacles in my first semester of medical school, it's possible that I could run into subpar performance later on in my training, be it on the board exams or in third year rotations. I know that all I can do is my best, and that is exactly what I've been doing. I went to therapy. I exercised daily. I ate well and made sure I slept. I got a tutor and worked really hard and didn't miss class, even on bad days. People are noticing that I seem better, and I almost feel like a whole person again; my symptoms of PTSD and depression are subsiding. I'm starting to be curious again, and I'm starting to look into extracurricular and career-building activities again. I'm cautiously optimistic.

Still, it's hard to not let the self-doubt get to me. I feel I have "ruined" things before they've even had a chance to go anywhere; first-year preclinicals are supposed to be easier than the rest and practically nobody at my school fails anything. It's a mental block. Can people who have either been through something similar and bounced back, have experience with how residency programs work, or have some perspective to contribute help me out here? I feel I need to reframe my mindset before I can get over the discouragement and start to work optimally again. I don't want to be too derailed.

Other details that could matter: I don't know what I want to specialize in, but I know it's certainly not ENT, orthopedic surgery, plastic surgery, dermatology, or radiology; I'm more of an internal med-leaning type.
posted by anonymous to Education (17 answers total) 7 users marked this as a favorite
"I'd almost rather switch fields so that I can interact with top minds in the career I choose."

You say you are not concerned with prestige, but you clearly are. I would investigate why you feel this way in therapy. I guarantee this attitude will hold you back more than any shitty first year.

My two cents: Since you can't turn back time and un-fail those courses, your choices are to proceed with your studies with the minuscule chance that your bad first year will keep you from some unforeseeable amazing opportunity, or drop out and guarantee you will have no opportunities at all.

Go back to therapy. Stay in school. You will be fine.
posted by elizeh at 9:40 AM on December 15, 2013 [13 favorites]

If nothing changes between now and the start of spring semester, if you hold the line exactly as you are now, do you think you can not only pass, but do well, in the spring?

I ask because it sounds like external issues, totally understandably, are getting you down, not just hard material or regular first-year stress.

Does the school offer a five-year plan? Would they give you an LOA?

Not that you want to do any of these things. BUT one thing that would SUCK is carrying on with unresolved issues and then, God forbid, failing something in the spring.

Are you a "traditional" student? Just out of college or close to it? Then you have yet to see that there is a huge, huge range of opportunity between Mass General and "mediocrity." I don't mean to sound like a jerk. I really mean it sincerely. I only found this out myself by, well, living.
posted by skbw at 9:58 AM on December 15, 2013

You're young. Your perspective is limited. This idea that it's not worth doing if there's a limit on how high you will reach, I think, is misguided -- and I think you will come to realize that in time. I don't think bad grades early on will limit you in any meaningful way. Things are fluid, and as you go, you will open some new doors and close others. You can't worry about closing doors, because that's a natural and necessary part of career progression.
posted by J. Wilson at 10:00 AM on December 15, 2013 [3 favorites]

The weird thing about growing older is that as you go, opportunities keep closing themselves off. For instance, you probably won't be the next Zuckerberg-style boy millionaire. The fact that you're in med school now means the opportunity to do that has pretty much passed you by. Similarly, you no longer can get your first bachelor's degree in anything other than what you studied. You can do a second one, if you want, but you know that's an unusual choice. As you age, you'll see that the opportunities closed to you get broader and more commonplace. At some point, you'll hit an age where you've either had kids or missed the window.

Maybe the opportunity to be a world famous orthopedic surgeon is no longer on the table for you. Luckily, that wasn't something you actually wanted. Consider this preparation for choosing a specialty. I know a lot of former med students, and all of them agonized so hard over what to pick - for many of them, it was the first time they really felt like they were engaging in a conscious diminishing of opportunities. Of course it wasn't - picking their undergraduate major was that - but since they always knew they wanted to go to med school, it never felt before like they had so many *appealing* options that they had to leave on the table, never to be revisited.
posted by town of cats at 10:11 AM on December 15, 2013 [8 favorites]

I don't have any experience with medicine but I do have a lot of experience with academics.

This stood out to me: What bothers me is that I think I could be "limited" in the places I could go later on because of these black marks on my record. In other words, if med school were a video game (and ha, I know it's not), I surely would have rage-quit by now so that I could start out with "full potential" again. The few people I've discussed this with make vague statements like, "Well, you probably won't get into neurosurgery at Mass Gen ... But otherwise you won't be limited! Just do well on your board exams." Somehow, I feel like I'm left hanging every time I hear a response like that.

I finished a PhD this year and during the celebration afterward I couldn't help feeling disappointed and unhappy. When I dug into why I felt that way, I thought back to all the other graduation ceremonies I'd had. During all of those, what I was celebrating was my stellar accomplishments - being at the top of my class in high school, being Phi Beta Kappa in college, etc. I could look back at all those moments and think, "Yeah, I was amazing. I basically could not have done any better." No wonder it was easy to feel good.

With my PhD, it was different. I didn't do an amazing job. I just scraped through. I wasn't fighting to be the absolute best number one superstar; I was struggling to finish. When I looked back on my time in the program, I could see all the little humiliations and the compromises and the stupid mistakes and embarrassing failures. There was a lot to feel bad about. It is an understatement to say that I did not finish my PhD program feeling full of potential.

But at the same time, I can see, stepping back from it, that my graduation from the PhD program was by far the most meaningful accomplishment, because it was the only graduation that was ever in doubt. Potential is a word that describes the future; it's hinting towards something that might happen, but hasn't yet. And what that thing is, the fulfillment of potential, is not the endless feeling of limitlessness but the brute fact of being brought up against your limits, of pushing yourself harder and harder until all your potential is spent and there is simply the reality of what you can and cannot do.

It would be lovely, surely, to spend one's entire life feeling full of potential, to move from success to success without ever scraping the ugly, ragged bottom of one's abilities. Except a life like that would, basically, be a life wasted. You can preserve that feeling for a long time by doing only things you are sure will come easy to you and where failure is not a real possibility. It's also easy to wish, I guess, that the moment where you hit your edge could be postponed just a little longer: "I want to reach my limit once I'm in the neurosurgery program at Mass General, and not before!" Fair enough, I guess. I wish I'd hit my limit competing for the Nobel Prize in literature, instead of just trying to finish a dissertation! But I didn't, and that is just life. It doesn't mean I can't keep trying for the thing I want; only that I know exactly the tools I'm working with and the limitations I face as I keep stumbling towards it.

So yeah, I guess what I'm saying is that you are limited. You aren't living off potential anymore. And you can either mourn that endlessly and retreat back into a sphere where you aren't truly being tested...or you can recognize that this is exactly the place you belong, here at the far reaches of your abilities, because it is the only place where anything worthwhile ever happens. Potential is for children. It's a valueless currency. Only accomplishments matter, and the accomplishments that matter the most are the ones that weren't guaranteed, and so, by definition, are bordered on the edges by failure.
posted by pretentious illiterate at 10:16 AM on December 15, 2013 [109 favorites]

Look, what do you want to do?

If you had your heart set on neurosurgery at MassGen, and failing a couple classes your first year takes that off the table, sure, rage against the dying of the light or whatever you need to do.

But there are a lot of doctors. And they do a lot of things. There are still a lot of paths you can take that will probably make you happy, and are probably right in line with why you decided to become a doctor.

At a certain point in your life, doors start to close. This is going to happen whether you fail, or just because, well, as you travel along the road, you pass certain paths by and they're no longer available to you. This just is.

Stop getting high on the POTENTIAL of it all. Decide what you actually want to do and either make that happen or ragequit because what you actually failed at the thing you wanted to do. Don't ragequit because a few most likely irrelevant doors are now closed to you.

You didn't go to medical school to Win At Life. You went because you want to be a doctor. Go be a doctor.
posted by Sara C. at 10:25 AM on December 15, 2013 [4 favorites]

Years ago, I dated a medical student. She came very close to flunking out her first year. Like you, she struggled to adapt to the amount of work, to the huge amoungs of memorization, to the competitive climate. Her school had a summer program for first year students who'd struggled, and she had to go through that, and then she was probationary, IIRC, for her next year.

I was really impressed with how she persevered after that. She finished med school and has been practicing now for, oh, probably 25 years, and very happy in her profession.

Your experience isn't unique. And from what I've seen, it's not a reason to give up, either.
posted by not that girl at 10:26 AM on December 15, 2013 [3 favorites]

I totally agree with pretentious illiterate and couldn't have said it any better. I felt the same as I was receiving my (only just made it to the end) PhD. When I was then applying to a profession that was much less prestigious but a much better fit, the following quote helped me get over myself:

"Yes, your brain feels immotral; yes, it whispers that (in the poet Walt Whitman's words) you can contain multitudes; yes, your brain says that you can have it all and do everything. These egotistic inklings are all turned up loud and proud by consumer culture's persistent promises of infinite self-realisation. But in fact no, your brain isn't immortal and you can't have it all. Those are just convictions that your head evolved to persuade your body out of bed on damp mornings. We are human and limited, and we have to live within our lives' realistic limits for them to be sustainable and satisfiable. We can hit personal bests in our time but there will be many others things that we won't ever see, be, own or do. Enoughism requires us to accept that the carrot of infinite promise will always dangle just beyond our noses. Embracing this fact is a path to contentment."
(John Naish, Enough)

We all get to the point where we aren't the best at what we are doing. Learning to deal with that is probably one of the most helpful learning experiences you will ever have, so make the most of it. If you're bright, it just means you never had to learn this lesson earlier on in school where most people were learning it.
posted by kadia_a at 10:31 AM on December 15, 2013 [10 favorites]

I get the impression that the general, openly-expressed sentiment in medicine is that you have to really, really, really want to be a doctor to be one. Therefore, since you want to be a doctor so much, you should be willing to train anywhere, and that prestige doesn't matter. I get that, and I'm not super hung-up on prestige in itself.

I was together with my first wife through medical school, internship, residency and I spent a lot of time around medical students. I also grew up in a medical family and have spent more time in and around hospitals than I wanted. IMHO, I see there are three types of MDs. Those who:

1. Love medicine as a science, don't care so much about patients.

2. Love taking care of people, don't care about prestige, and the interest in science is limited to being able to use it to help people.

3. Love the prestige of being a medical doctor. Don't care much for patients or the science.

It seems you are in the first category which points to those things you don't want to be (surgery, radiology, etc.). I think you have to take a step back and really ask yourself why you want to be an MD. It may just not be for you and that this is your real struggle.
posted by three blind mice at 11:52 AM on December 15, 2013 [1 favorite]

I'm friends with loads of MDs (both in academia and private practice), am married to one, and I understand exactly how residency programs, the match, and being a successful MD works.

The hardest part is already behind you. You got into an American medical school and will graduate as an MD. That means unless you murder someone (and get caught) you will make at least a low 6-figure salary someday, pretty much guaranteed. Even in internal medicine, which is not where the money or the prestige is, but maybe the personal satisfaction for you is.

You are already one of the chosen ones. All is not lost, OP. You CAN still "get into neurosurgery at Mass Gen." You can still become an academician at a top program (little-known fact but the academicians are often the worst surgeons and clinicians, but they are adept at bringing in the money for the institution via NIH grants and fundraising skills). Or better yet, you could make a ton of money and have a great lifestyle in private practice in the non-urban South or the West in an in-demand subspecialty that really engages you. Just do well on your board exams! (Yes, that is precisely what others have told you already and you were possibly irked to hear - because it is absolutely true.)

In fact, you need to ace the fuck out of those board exams, OP.

So let's say you want to "get into neurosurgery at Mass Gen." You need:

* Board scores WELL above the national average, preferably 97th% percentile and up.
* An excellent academic record from here on out - top 1/3 -1/2 of class, AOA membership, honors in surgery (the lower-ranked your med school is, the higher your grades and achievements need to be.) You need to hang with the gunners.
* Do rotations at the institutions you're interested in (that would be Mass Gen in your example here) and form relationships with the Chairman who makes the decisions about match
* Create overwhelming, incontrovertible evidence that you're a team player (never be late! arrive early, stay late, go the extra mile etc.)
* Demonstrate leadership
* Get additional surgical experience such as working as a tech or by extra participation in a surgical anatomy or anatomy 3D course (the best surgeon we all know spent his extra time in med school practicing making beautiful stitches on dead pig parts.)

* The folks who will write your recommendations (and take unsolicited phone calls from residency people and future employers) need to see you as honest, forthright, mature, clear thinking, direct, decisive, ethical, and as someone who works well under stress
* Being able to admit that you are in control of your situation, and that you could have done it better or differently is the most important surgical instinct.

So, that's it. A tall order indeed, but not impossible.
posted by hush at 12:06 PM on December 15, 2013 [4 favorites]

You mention that you were sexually assaulted, and that this affected your ability to complete your courses.

At my undergrad university, a trauma like this would be grounds for retroactively dropping the failed courses from the transcript, so that they would not affect their record. You should find out whether your medical school has any similar policy.
posted by jb at 12:06 PM on December 15, 2013 [4 favorites]

I know that it's hard in the first year because of how much your peers chatter about this prestigious thing and that prestigious thing, because they're crazy gunners who want to keep winning. Try to drown them out. Like Sara C said, med school is about you being a doc, and you'll be fine once you start and get used to taking care if yourself.

I've had a few Really Tough Things happen myself this semester, and sometimes I feel insanely pressured to look like I'm doing great because I don't want to burden anybody. It's been tough. But that's life and I think continuing to move forward without freaking out and quitting is a good plan. You'll be happier later.

Also, you're not the only med student one in the universe or history of time who has ever failed at coursework. I know at least 2, and they graduated, got residencies, and are doing fine.
posted by discopolo at 12:42 PM on December 15, 2013 [1 favorite]

I know what you mean, I think. It would be nice to leave those failures behind and start fresh.

In my opinion, we all eventually get to a point when we have found something (a place, or a career field, or a person, or all three) we want so much that we can't rage-quit, can't run away from our mistakes. We have to live with them, and with the people who have seen us experience them. And maybe they limit our potential in some ways. But hopefully when people see the bigger picture of our strengths and weaknesses, they still find us worthy, and we still find ourselves worthy, of doing what we most want to do.

Living with the knowledge that we've made mistakes and are not perfect requires more courage, in my opinion, than blindly striving for perfection. It is humbling and scary to realize how much all of our lives intersect, and not just when we're at our best -- that we do screw up, and other people see it. (I'm dealing with this right now myself, and it sucks.) When you feel that people really know all your faults but still accept and respect and love you, it is touching and gratitude-inspiring, but the path to get there is nerve wracking and not fun. It seems like you've made it through the worst bits already? And there is a certain wisdom in it all (one prays): that anybody who'd reject you for being rattled by experiencing an assault is not someone you want in your life anyway.

I had a professor once explain another professor's failure to reply to my emails via a very circuitous explanation that I remember as going something like this: "Professors tenured in a department work together for years or even decades. I've seen a lot of young professors, and I was one myself. You start out as a real go-getter. [X] has been a real go-getter. He's very smart. Then at some point, something happens -- for me it was the death of my parents. [Long pause.] After you go through that, you start thinking that your career maybe isn't the most important thing and generally soften up. A department is really just people in a community. So I don't actually know, but I sense is that he is going through some kind of ...difficulties right now." It was his way of telling me not to interpret the lack of email as a comment on my professional merit, nor to judge this professor as unprofessional, but to have compassion and fellow feeling for a guy going through the kind of painful crisis we all do sooner or later.

I am confident and hopeful that you can find a path among people like that professor (and I believe there are a lot of them out there), who will see your overall brilliance and years of hard work, and who understand that life overcomes us all every once in a while.
posted by salvia at 2:20 PM on December 15, 2013 [4 favorites]

We will always run up against a point where we will no longer be the best at something or where something did not yield as easily to our efforts as they did before. At some point, we have to figure out how to deal with that. But ambition isn't always about going from success to success to success. Part of ambition involves the ability to bounce back from those times you stumble and come back again. You've stumbled and stumbled hard. That's ok! The difference between real life and a video game is that real life is so much more unstructured and the paths so unfixed. There's no need to rage-quit, because there are so many different things you can do and opportunities you can take.
posted by deanc at 5:06 PM on December 15, 2013

I am not a doctor, but I have been around them all my life and have been operated on twice by a top surgeon. He went to a well regarded med school at a state university in the Midwest. He did his residency at the university's large and well-known teaching hospital. He did fellowships at clinics that specialized in his specialty and made contacts in a then-emerging area of his specialty. He then came home, did the hard work of building the reputation of his department in this new field, and eventually became chairman of the department, a world class surgeon, and Nobel Prize committee member. I remember one appointment where he had to leave to jet to Sweden and my mom told him to mention me to the queen.

TL,DR: Not getting into a place like Mass Gen is not the end of the world. Where you are at right now is what you make of it.
posted by Fukiyama at 6:07 PM on December 15, 2013 [3 favorites]

Student Doctor Network has people who can give advice on this, but avoid the pre-med and med school forums and ask in the general residency forum where there are several wise attendings.
posted by the young rope-rider at 6:10 AM on December 17, 2013 [1 favorite]

First of all, I’m really, really sorry you went through all of that your first semester of medical school. I also just completed my first semester of med school, so I understand somewhat, at least in regards to memorizing vast amounts of information in a short amount of time. I can’t imagine learning all of that and going though what you did at the same time.

Yes, first year is technically the easiest, perhaps, but lots of people find it to be harder in another sense because of all the adjustments you have to make to become a successful med school student (studying all the time, no really, ALL the time, not seeing your old friends, family, etc).

I’m not an expert, but I truly believe that the sky still can be the limit for you. As long as you continue to take the necessary steps towards greatness, nothing is “ruined” for you.
The Dean’s letter about you for residency applications will have a few paragraphs on your preclinical years and PAGES of evaluations from your clinical years. Knock those out of the park. I’ve been talking with 3rd and 4th year students and residents in specialty interest groups that I am a part of, and their advice has been pretty valuable. During clinical rotations: be likeable, be useful, don’t stare at your phone the whole time, and don’t be too eager to go home at the end of the day (even though we all want to).

If your confidence has been shaken about doing well on the things you need to do well on in the future, talk to people about WHAT you need to do well on and then HOW to do well on them. Utilize your school’s resources. Do you have a mentor or advisor? Talk to them. Are you part of your school’s internal medicine interest group? Get involved.

Get advice but then use it selectively. Some advice givers just love to tell you about how you’re never going to be a neurosurgeon at Mass General now. Some advice givers tell you that you can but you’ll have to work hard – those are the people you should listen to. People were generally pretty negative when I was applying to medical school (“when are you going to have a family?” “you know you’ll be in debt forever, right?”) and I had to practice blowing them off and I’m so glad that I did because I actually fucking love medical school, and medicine, and doctoring.

Follow hush’s advice. Just like you surely did for your med school application, beef up your resume with other things.
Take an extra year to do something fabulous that you are passionate about but that will also make you look good. No one likes cookie-cutter applicants, whether its for med school, residency, or a job in a non-medical field.
I’m an older student and I see a lot of the 22 year olds just rushing full speed to get… somewhere, I don’t know. They are sort of panicky and frantic and they don’t know what they are trying to do, they just think they always need to be getting ahead. I know I’m biased because I’m old but you do not need to be a prodigy to be great. Take your time, do what you like, while also, yes, killing it on the boards.

One more thought after proofreading: while I'm all for greatness, it's always good to take some time to reconsider your definition of greatness and evaluate what you truly want.

Please feel free to Memail me if you want to talk about anything more.
posted by bobobox at 11:46 AM on December 20, 2013 [3 favorites]

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