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A Practical Guide of Navigating Academic Failures for Residency Success

Updated: Apr 30, 2023


Hey guys! I’m Chalyse Christensen and my husband, Joe, is a 4th year student at RVU this year. He recently matched into Family Medicine. We will be continuing our medical journey in Daytona Beach, FL this summer! In the spirit of helping others, I wanted to share some valuable information that I wish had been communicated more effectively during our own journey. Have you ever been curious about what happens when a medical student fails a test, course, shelf, or board? And how this will affect their ability to apply to residencies? As the spouse of a medical student who faced many of these challenges, I want to share our experience to help those who may be going through similar difficulties. Despite struggling through these obstacles, my husband is now nearly graduated and has matched into his top choice residency program, bringing a sense of relief and hope.

Testing was my student's Achilles heel, which meant that he had to dedicate more time to studying than most of my friends' spouses. While others were celebrating on Friday after completing their tests, I knew that our weekends would be spent catching up on other classes or getting ahead for the next course. The first two years were quite challenging, especially during our OMS II when COVID disrupted everything and my student had to study in our walk-in closet on a card table.

Disclaimer: Every year things change. The school and the medical community can change what is required or no longer required. Your student will be informed of what they need to do. Everything in this blog is accurate for the Class of 2023. As the years go on, things may change. Your student should always be up to date on what is required for their class.

So, what happens when a medical student fails a test?

If a student fails a test early in the course, they still have time to correct it by doing well on other quizzes and tests. Almost every medical student knows what they need to get on any given test to pass the course. However, if a student fails a test and realizes that there is no possible way to recover from the low score, they fail the course.

What happens when a medical student fails a course?

If a student fails a course, the course director will contact them via email after the grades are due. They will inform the student that they have not met the requirements to pass and will need to remediate the course, even if the student is less than 1% off. My student failed three courses, one each semester except for his first semester, and each by less than 1%. Remediation means that the student will need to take a 100-question cumulative exam for that course. These questions are taken from a pool of all the questions from the original tests of the failed course. This test is taken during a break, whether it is during winter or summer break. However, if a student fails more than one course in a year, they are required to meet with RVU’s Student Performance Committee. In this meeting, the student presents to the committee information important to the evaluation of his or her performance. This committee then gives feedback to the Dean, who then determines whether or not the student will be allowed to remediate, if they will need to take a leave of absence and repeat the year or, in rare cases, be dismissed from medical school.

Disclaimer: This is accurate for the Class of 2023, the school has since adjusted how remediation works time wise and retaking. Currently, as of 2023, students can only fail 2 courses in a year and do remediation. Once they fail their 3rd course in a year, they will meet with RVU’s Student Performance Committee and have to repeat the whole year.

What happens when a medical student fails remediation?

If a student fails a remediation exam, they most often have to repeat the year.

What happens when a medical student fails a shelf (OMS III)?

If a student fails a shelf, they get a chance to retake it, but they can only take it once they have a month without a shelf. In the case of my student, he remediated his family medicine test during the first block of internal medicine. Retaking a shelf does not show up on the transcript.

What happens when a medical student fails a board exam?

If a student fails a board exam, they must retake it. RVU requires its students to take USMLE (MD test) Step 1 and the COMLEX (DO test) Level 1. COMLEX Level 2 & 3 are also required. If a student is going into a competitive specialty, they should plan on taking the USMLE Step 2 & 3 as well. My student barely passed USMLE Step 1 so he opted not to include the USMLE in his residency application. He also did not take Step 2. Keep in mind that some residency programs may not accept applicants that had to take boards more than once.

Disclaimer: This is accurate for the Class of 2023. As of 2022, all students are only required to take the COMLEX (DO test), but the USMLE (MD test) is HIGHLY encouraged.

Final Thoughts

When my husband finished medical school, his class rank was 110/128, and it stung when we first saw it. Despite failing three courses, a shelf, and getting "ok" scores on boards (Step 1: 198, Level 1: 491, Level 2: 547), he achieved his goal of matching into a very specific kind of family medicine program. He applied to 36 programs and received 15 interviews. Thanks to his excellent letters of recommendation, extra time spent on his personal statement and MSPE letter, and completing four sub-Is he was able to overcome his transcript flaws. His last sub-I was at the program he matched at, and he was told it made the difference. So do not lose hope if your student’s journey through medical school does not go as planned. Remember, your student is more than just their grades, and there are always ways to overcome these challenges and strengthen your application in other ways. Everyone has at least one flaw on their application! If your student has not performed well on standardized tests there is no need not be disheartened as specialties such as Family Medicine, Internal Medicine, and Pediatrics evaluate their applicants more comprehensively. A holistic evaluation takes into account the student's soft skills, including the ability to listen, empathize, connect with patients, work in a team, and overcome challenges. Therefore, it is essential for students to highlight their strengths in these areas during their sub-internships and obtain letters of recommendation that reflect their capabilities. If your student has not performed well on boards or had course failures, it is recommended to address the issue directly, as honesty and resilience are admirable qualities in a physician. For example, my student scored below average on COMLEX Level 1 and turned it into a positive by sharing how he changed his study methods and eventually improved his score significantly on Level 2.

It is also important to understand that failing a course or board may disqualify your student from competitive specialties such as Plastics, Orthopedics, Urology, etc. These specialties can be particularly challenging for DO students, as they face additional hurdles even if their application is otherwise outstanding. Therefore, it is smart to have a realistic backup plan in place and explore other specialties that align with the student's strengths and interests. By leveraging their unique talents and abilities, your student can achieve their professional goals and become an outstanding physician! This website is a good resource and does a great job laying out what factors are important to each specialty.

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