Residency applicants with red flags on their application

March 21, 2010

QUESTION:

I’m a fourth year medical student at a good school, with excellent grades across all years (mostly Honors). Most of my clinical evaluations are very good, with many of them including stand-out comments about exceptional clinical performance and devotion to patient care.
I will be be applying for residency after I graduate medical school, as I’m taking a year to do research.
However, I was on academic probation for one year (from 3rd-4th) for deficiencies in professionalism that occurred in 2nd and 3rd year, mainly related to issues of attendance and personality conflicts with two attendings. (I have spent a great deal of time working on these issues in order to see where I went wrong and how to avoid it in the future, although I’m sure I’ve made a few more mistakes along the way.)

I’ve been informed that my Dean’s letter and my transcript will note that I was on probation.

Here are my questions:
1. How will this affect my chances at getting into a good residency program? (note, I will not likely be applying to subspecialty programs)

2. How do I answer if/when I’m asked about this on interviews?

No one at my medical school has been able to guide me with this. I would greatly appreciate any advice or suggestions. Please feel free to be critical – realistic answers would be the most helpful as I continue to plan my career.

Thank you so much.

ANSWER:

In evaluating a medical student with a “red flag” on their record, there are four major things I look at/for in the application:

What exactly created the problem / probation? If it’s failing a course, that’s usually straightforward. If it’s a professional issue as you describe, vague answers such as “personal problems”, “health issues”, “family issues” are all major concerns without some detail. Left to my imagination, I will assume the worst.
Does this fit a pattern, or is it an anomaly? Is there a pattern of low board/shelf exam scores? Are there written comments from other rotations raising concerns about your performance?
Have you demonstrated a pattern/track record of improvement? I need to be CERTAIN that this is completely resolved, and will not happen again. You want to demonstrate that, put back in a similar situation, the outcome would be satisfactory.
Do you demonstrate insight into the problem and it’s solution, and do you take full responsibility for your part? Every story has two sides, as I’m sure your’s does. That being said, you need to be clear that you understand the problem, accept your role/responsibility, and have a solution to prevent further similar issues.

If I can answer all four of these questions/issues from the application itself, then a decision regarding an interview is made. So how do you do this?

Dean’s letter — virtually all US medical schools will allow you to review your Dean’s letter for accuracy before they are sent. You are not allowed to change the content of your Dean’s letter, unless you feel it is truly inaccurate. Your first step is to see what details they put into the Dean’s letter. Usually, they will be extremely vague, attempting to protect your privacy. If you think that a more open discussion of your problem would help your application, you should try to get your letter writer to explain the situation in the best possible light. Remember, it’s in your Dean’s office’s best interest to get you into a residency program, so they should be at least somewhat helpful in this regard.
The Personal Statement — For an entire year on probation, I think you will absolutely need to use your PS to address it. Some would argue that you are better off not drawing attention to your deficiencies in your PS. I personally disagree, and in this case (with a big problem on your application) I don’t think you have much of a choice. It is vital that you see your Dean’s letter first, so that your PS and your Dean’s letter descriptions match up. You will discuss in your PS all the issues listed above. (Note: I expect others may disagree with this advice, and suggest you get other opinions)
Applications — Because of this problem, you will need to apply more broadly and perhaps to lower tier programs. Hyper competitive programs (Rad/Derm/Urology/Plastics) are probably out of the question altogether. Gen Surg is also quite competitive. You really don’t know how this is going to affect you. The plan is to get at least 10 interview offers — if you go on 8 interviews you are very likely to match in IM, FP, Peds, etc. You will need to decide if you want to apply to a large number of programs up front, or if you want to start with 10 programs and then expand if you don’t get enough interviews.
Interviews — You will be asked about this, for sure. If not, you need to bring it up yourself. In fact, you might want to think about doing that right at the beginning of the interview yourself, to get it out of the way (“Dr. XXX, before you start asking questions, I’d like to talk for a few minutes about the obvious concern about my academic probation on my record, what I have learned from this process, and how I have addressed this so that it will no longer be a problem”)
The confidential informant — As a real ace-in-the-hole, see if you can find someone involved with your remediation who would be willing to talk to PD’s about your issue off the record. They must be as unbiased as possible, know all the intimate details of the issue, and be willing to talk “off the record”. You have to trust them completely. If you have such a person, during your visit make sure to tell the PD / interviewer that if they have any concerns, they can contact this person for more details.

Exactly how much this will affect your application depends on the details, and how it is addressed by you and your program. A study demonstrated that unprofessional behavior in med school predicts future board disciplinary actions. Many programs may simply see you as too much of a risk. PD’s have all had residents who look great on paper, but have self destructive personalities that erode camaraderie and create discord in the residency. I would rather have an empty slot.

SOURCE: http://forums.studentdoctor.net/showthread.php?t=404764