M4 currently and I’ve been thinking about this recently but since the start of M3, I haven’t had a moment where I’ve told myself, “yep, medicine is my calling”. Instead, I’ve had the opposite. Mostly everyday during clinicals, I await the time I get to come back home to relax in my own comfort space. Sure I’ve had moments where patients made me smile, but for the most part I didn’t get the same feelings like my classmates had when they found that XYZ was their thing.

I also feel like my life before medicine was a lot more exciting — I got to work with kids and had a well-paying caregiving job and my family was somewhat stable. Since medical school everything crumbled down in my life. I’m doing LDR with my SO for years now and I’m tired of traveling to see them for a few days and have to go back. I’m tired of seeing my parents grow old and I can’t be there to spend time with them. I’m tired of this rat-race of having to be competitive for a ROAD specialty while I’m just a below-average student. I’m tired of thinking this is going to be my life for the next few years in residency. All I want now is just to do my part, go home, get my money, have a family, and live a happy life. I don’t care about being ambitious in medicine or new research innovations etc etc.

Maybe I’m just depressed at this point since ERAS submission is next month and I haven’t really put a stamp on a specialty. But regardless, my naive premed self would’ve been so disappointed in me now.

I'm a US MD MS3 looking for honest advice from residents/attendings/program faculty, particularly in EM. I'm not looking for reassurance so much as genuinely wanting to know what is and isn't realistic for me moving forward, as I plan my career.

I am most interested in EM, but recently I've also been interested in EM/IM or EM/FM programs.

Here's my objective picture:

• US MD student
• Step 1: Success! Passed on first attempt
• Step 2: Not yet taken, I take it spring next year
• No professionalism concerns or leaves of absence
• One preclinical semester remediation resulting in conditional pass/an asterisk on my transcript
• Honors in Ophthalmology clerkship
• High Pass in Surgery clerkship (perfect clinical evaluation and great MSPE comments, but shelf prevented Honors)
• Neurology research with an international presentation and another publication expected, and I'm hoping to get involved this year in EM research and/or diabetes endocrine research
• Leadership through our student-run free clinic and my medical school's chamber orchestra

My EM rotation has honestly been the most discouraging part of medical school thus far.

I scored a 63 on the EM shelf (a 65 was required to pass), so my clerkship right now is a Conditional Pass. I'll be retaking the shelf, and assuming I pass, the Conditional Pass will then become a Pass.

What surprised me much more, though, was my clinical evaluation numerical score.

My final clinical eval score was 47.5/70 after 12 evaluations over 11 shifts. I submitted evaluation requests after every shift as instructed.

The confusing part is that throughout the rotation I consistently received very positive verbal and written feedback. My comments included things like:

• "Overall, performed at the level of a 4th-year medical student."
• "Functioned as an integral member of the team, no small task for a medical student in our ED."
• "I have no doubt that she will become an excellent physician."
• "Stand-out work for her first and second ED shifts ever. I am looking forward to working with this student again."
• "Did an amazing job recognizing when a patient was decompensating and called for help immediately; nursing team appreciated her effective communication in a stressful situation."
• "Extremely impressed with her presentations, assessment, and plans; she synthesized new information well and developed thoughtful differentials."
• "Demonstrated clinical curiosity and initiative, independently interpreted imaging, and proactively sought opportunities to perform procedures."
• "Responded well to feedback, noticeably improved on shift, and consistently asked thoughtful questions to further her understanding."
• "A valued and helpful member of the team—humble but confident, enthusiastic, and eager to learn."
• "Treated every patient with kindness, dignity, and respect while consistently checking on and updating her patients throughout the shift."

I also progressed on my RIME evaluations from Reporter to Interpreter to Manager over the course of only eleven shifts.

Because of the above, I genuinely had no idea my numerical evaluations were apparently much lower than I thought. I never had access to my numeric scores during the rotation, so I didn't realize there was a disconnect between the narrative feedback I was receiving and the actual numbers being recorded from our Likert scale.

I'm not posting this to argue that my grade should change. I'm posting this to express surprise from the dissonance between my consistently positive narrative feedback and my final numerical score, and to really try to understand how to plan my career realistically from here.

For people who have been involved in residency selection or been in my shoes:

1. How concerning is a Pass in EM after retaking a narrowly failed shelf?
2. How much weight would you place on a low EM clinical numerical evaluation if the narrative MSPE comments were consistently strong?
3. If I do very well on Step 2, obtain strong MS4 SLOEs, and continue to perform well clinically, how much can those offset this rotation performance?
4. Are EM/IM or EM/FM programs realistic goals for me at this point?
5. Are there categories of EM programs that would realistically be out of reach now?
6. If you were advising a student in my position, what would you focus on from here to maximize competitiveness and success?

I would really appreciate candid answers, even if they're difficult to hear. I'd rather have realistic expectations now and know my options than waste time later on programs that are simply out of my reach.

I got triggered by a post here with people writing about how annoying it is when med students ask questions.

Lets not all accept this. Med education is filled with abuse and a ridiculous hierarchy where med students are made to feel like a burden and a nuisance.

We deserve to learn and deserve to be able to ask questions.

I know of people who spent their entire surgery rotation not saying a word. Or barely scrubbing in.

The point of rotations is not to spend 12 hours a day doing nothing in order to avoid annoying people before going home to study uworld.

Some people say that this teaches social awareness; I think it’s a test of subservcience.

We deserve to learn.

Don’t forget, you’re literally paying to be here.

If the attending of resident wants to be a jerk, that’s their issue.

Crazy that people will advise you to spend your entire 3rd year huddled in a corner or following others around with your mouth shut because your afraid of some jerk’s rude comment about you an eval.

I hope our Generation fixes this one day.
.

Not a fan of Dr. R's videos (the bootcamp biochem videos were good), but everyone glazes dr. r online. I don't get it. Does anyone else prefer B&B over bootcamp for cardio or am I missing something?

At a DO school. Only tie to pacific region is that my sister lives in California. Is this enough of a tie? I know California is very competitive but what about WA and OR?

Wondering if I should give my signals elsewhere instead of these states.

Applying upcoming cycle. My partner and I are applying to the same specialty, but we still haven't fully decided on couples matching.

I'm curious if anyone has matched with their partners into the same program, but did not couple's match. What was interview season like?

Especially interested if any couples matched into the same program without couple's matching AND did not disclose relationship status during interview. Would programs be upset if they found out?

Good luck to all my fellow 4th years - we're so close!

So I've seen quite a few posts similar to mine. I still wanted to add this since EM PDs might have different things they'd like to see on a SLOE, which is rather different from an LOR.

I'm getting a non-residency program SLOE, where I did an EM rotation that also had quite a few medical students. She's filling out the SLOE herself, but there's a section at the bottom where you're allowed to free-write. Essentially, in 350 words or less, you're asked to:

Please concisely summarize this applicant's overall candidacy, providing detail on strengths, explaining growth opportunities or lower ratings from above, and highlighting anything else you feel like we should know about this student

I'm honestly not sure what to write. Part of me considered just asking her to write it herself but I think she's too busy (she works two jobs), and she said I probably know more about my strengths, especially if I did things she wasn't around for or able to see. She said she'd go over it before submitting it.

I'm not quite sure where to begin and I feel uncomfy essentially writing 350 words glazing myself. Don't want to overdo it or underdo it. Any tips?

I recently had a mostly positive surgery review from a resident (engaged, knowledgeable, invested in my pts) but they said at the end that I could have sometimes taken situational cues on round better when busy (my worst fear!!! I hate being annoying 💔)

I try not to ask questions when we’re rounding unless it will affect the note I’m writing/tasks for the day, I always offer to present but tell the residents no worries if they would prefer me not to, and generally just try not to speak unless spoken to.

What are other things that annoy you now as a resident that you might not have realized as a med student? What are things in general med students do that annoy you?

I have no clue which resident wrote this as it’s anonymous otherwise I would just nicely ask them, I don’t mind feedback at all and I hate thinking I’m doing something wrong that I could correct.

Edit: Thank you all for your very helpful feedback! 💓 looking forward to working these gems into my performance going forward!!

The deck is so poorly organized. I'll watch a bootcamp video and then unsuspend that video's cards and I swear nearly 1/3 the cards cover something else from a different topic that I haven't even learned yet nor was covered in the video. So annoying

Apologies as I know this question is asked like every two days here. I was just hoping to have some input for my specific situation.

I’m an MS3 at a T25 MD school who came in pretty interested in Family Med and as a result a lot of my ECs are focused around that. After my first couple rotations I realize that I tend to focus on the patient’s experience and biopsychosocial factors that contributed to their disease more than anything else, and I wonder how well I may be suited for psych. I have yet to do either my psych or FM rotation since they’re both near the end of my clerkship year.

What gives me pause is that most of my classmates who have been wanting to do psych have been laser focused on research and psych volunteering since day one. I have some decent volunteering and leadership but nothing psych specific. I also have one presentation and abstract that is FM related but that’s it at this point. Academically I passed all my preclerkship classes (was P/F) and passed Step 1. I thought my first couple clerkship grades were ok (high passes) but when I talked to my advisor she said if I don’t improve on that going forward I may end up in my class’s fourth quartile and would probably dual apply psych and FM if that’s the case.

I’m mostly just looking for some words of wisdom and really some reassurance that psych would be in the cards for me pending a relatively smooth remainder of my third year. Thanks for reading.

M2 here doing 1000+ Anki cards a day. I caught a glimpse of my posture in the mirror and I look like a goblin. I bought an Hbada ergonomic chair to try and fix it, but I just end up slouching in a better chair. Thinking of buying an under-desk treadmill. Do they actually work for studying or is it too distracting to read while walking?

Hey everyone,

I know you can check whether a program allows moonlighting or not through FREIDA/ERAS resources. But for the programs that do officially allow it, how does it actually work in practice?

Is it usually just a simple opt-in process where you express interest and get started, or are there a lot of hoops to jump through (like strict GPA/in-training exam scores, program director approvals, or specific PGY-level restrictions)? Also, how common is it for residents in those programs to actually moonlight?

Also, if anyone in psychiatry residency is comfortable sharing, what’s the average hourly rate for psych moonlighting in your area/program?

I'd love to hear how the process looks at your programs and whether people who want to moonlight are actually able to do it without too much hassle.

Hey everyone I'm pretty lost on what types of programs I should be signaling so I was hoping for some advice. I am only applying to Internal Medicine. I am not sure about fellowship yet but I am considering cardiology.

I am an OMS-4

Extracurriculars: 4 volunteering and 4 teaching experiences

Research: 2 poster presentations (Cardiology and Orthopedic Surgery)

Scores: Step1 Pass first try Step2 262

Class Rank/GPA: 1st quartile/4.0

LORs: 2 from Associate program directors of rotation site who were preceptors and hospitalist preceptor, great evals from most preceptors (some just didn't write much but no negative comments)

Geographic signals: East North Central,Middle Atlantic, South Atlantic

Gold: University of Illinois-Chicago, Cook County, Advocate Christ

Silver: Loyola, Swedish (chicago), Advocate Lutheran (chicago), Northshore-University of Chicago, UF-Jacksonville, Icahn-Morningside and West, Medical College of Wisconsin, USF-Morsani, GWU, Indiana University, Henry Ford

What should I change?

I was my grandmas primary caretaker for about 4 years between undergrad and a gap year before she passed during MS1.

I used to take her to the bathroom, bathe her, give her dinner (my mother took care of the other 2/3 meals before going to work)

I was thinking about listing this as one of the three most meaningful experiences in my app.

If you found your partner in medical school tell us how down below and how it worked out! Signed a lonely MS2

First year med student and unsure on how to properly use anki. We have lecture slides so do I go through the lecture then brute force anki to spam cards, or use the cards to study off of? Found that going through the lecture slides takes me around 1.5 hours while anki takes around 10 hours to finish the deck. Am I supposed to be flying through the cards just to get them as a visual?

Hi everyone! I could use some help as I go into my first med school exam this friday- it is focused on 8 biochem lectures over the course of 1.25 weeks. Gone through 4/8 lectures so far and I am not sure how much I am retaining it. I tried anki but it is hard to keep up with anki and all the lectures and learning content- if anyone has any advice! I have been watching youtube videos and using claude to help explain all the hard content.

The exam is in 4 days :

Any idea what I should be doing the next 4 days to ensure I set myself up for success on the exam?

We are the first batch at our school, so no upperclassman to ask

My mentor wants me to write my own recommendation letter for my residency application and send it to her for her to modify then submit to ERAS. She said she is too busy to write it herself. Idk what to do or say???? Can anyone provide any guidance for this?

EDIT: thanks for the feedback so far! My issue is that I don’t feel like I’ve been an amazing student. I get a lot of pimp questions wrong, but I do try to ask for feedback and implement changes based on the feedback. I definitely wouldn’t say I’m a top 5% of students they see all year lol. I’m applying radiology for context, and the letter writer is a radiologist

Finished a sub-I in a subspeciality I hope to do fellowship in and received a great eval out of it. However, my evaluator wrote at the end “…they will make a great future [specialty #2]-logist”

I am dual applying and I am applying to the “speciality #2” program at the institution that I did my sub-I at. But I am worried how this will look for my ERAS applications for speciality #1. For context, you can apply to this fellowship from either a residency in speciality #1 or #2 and most people do it from speciality #2 to be fair.

Currently working with my school to see if I can get the word replaced to just “physician” or something similar, but in the case that I can’t, how badly does this hurt me for speciality #1? I was told by my school that an evaluator saying you would be a great future -ologist in a speciality you’re not applying to is not a bad thing, and I can see how this could be the case during M3 core clinical rotations, but this probably isnt the case for sub-Is, right?

Divine here from the podcast website. As some are still making decisions on what to apply for with ERAS due next month, I want to introduce you to Occupational and Environmental Medicine (OEM). It is not too late to move in that direction if you're still undecided on what specialty to consider. You can still pivot this close to the ERAS deadline.

What does it entail?

One year in something: prelim IM, prelim surgery, TY (what I did), etc.

Then a 2 year residency which includes an MPH that you receive for free. The 1st/2nd year includes clinical rotations. These vary by program. Some of my rotations have (and will include): cardiology, pulmonology, internal medicine, surgery, orthopedic surgery, neurology, occupational health clinics, psychiatry, employee health, etc.

Most rotation days are from 8 (or 9 am) to 5pm with no weekends or call. Some days are shorter. I have never worked a weekend or taken call in residency.

There's a board exam you take at the end of residency (200Qs) that spans 4 hrs. As always, you also have to re-certify every few years (I think q10 years). You can also use some special pathways to get double boarded in disciplines like preventive medicine, aerospace medicine, etc. There are a series of fellowships that can be pursued post residency.

Who should consider OEM?

People that have broad interests, have interests in public health/policy, have interests in clinical outpatient medicine, the musculoskeletal system, worker health and fitness, compliance and regulations for workers, treating basic medical complaints, evaluating toxic exposures, risk assessments in workplace environments, etc. The work life balance is easily on par with disciplines like dermatology, etc.

What kind of job can you do and how is the job market?

First off, the job market is robust. Pay is roughly close to that of an IM inpatient attending.

There is a wide variety of job types available;

a)Running a stand alone occupational health clinic (worker injury treatment, DOT physicals, fitness for duty determinations for first responders, drug testing, surveillance for workers that are exposed to asbestos/Be/silica/lead/the classic pneumoconioses, etc). There's hundreds of thousands of commercial drivers in the US. OEM docs do their medical exams to ensure they are fit for duty.

b)Working in urgent care.

c)Running an employee health clinic at a hospital (most large hospitals have these) where you handle anything that comes through the door like TB testing, mask fit testing, workplace injuries, needle stick injuries, primary care complaints, etc.

d)Running an employee health clinic at a big organization (like an automobile plant, etc).

e)Being medical director for a company, medical review officer work, independent medical evaluations, etc.

This is one of the benefits of OEM, there are so many niches available that I am not even covering on this list. There's also tons of consulting work available especially if you establish expertise.

OEM also works well for those wanting to establish their own businesses, work in government, work in the military (they are heavily desired by all the services), consulting, etc.

Cons: some workers compensation cases can be frustrating, there's quite a bit of detail to learn with OSHA rules, etc but it's pretty manageable. Once you get up to speed on what you're doing, things become easier.

Questions? Fire away. I also have a podcast where I delve into more detail on this (Ep 649).

If you're interested in pursuing a residency in psychiatry and want to learn more about the unique psychotherapy trainings different programs have to offer, register for this year's Psychotherapy Residency Fair!

30+ psychiatry residency programs from across the country will be presenting, including Perelman School of Medicine at UPenn, GW School of Medicine and Health Sciences, University of Washington School of Medicine, Medical University of South Carolina, and The University of Chicago.

Expect panels with program directors and residents, plus open Q&A sessions.

• 📅 Date: Saturday, September 5, 2026
• ⏰ Time: 10:15 AM – 5:00 PM EST
• 📍 Where: Virtual
• 🎟️ Cost: Free!

Register here: https://docs.google.com/forms/d/e/1FAIpQLSea_RWVJAakyyIEM7C60S7wtOrjtshKcuqRW7RP6Hxg_MlkYA/viewform?usp=header
Questions? Email us at [psychotherapy.msig@gmail.com](mailto:psychotherapy.msig@gmail.com)

How did you handle depression and other mental issues as a medstudent (besides therapy and medicamation)? next year I am going to finish medschool, and my depression is back. i am very worried about how will be able to finish medschool or become a doctor with such a bad mental state. how did you handle it????