M&M Rounds: Didn’t Match for an Internship

During M&M rounds, we will examine some fictitious cases and evaluate the facts and consider some solutions to these problems.

Ivey Sprigs is a 27-year-old Caucasian female presenting for not matching into an internship through the VIRMP.  Her eventual professional goal is to do a cardiology residency, so an internship is virtually essential as a first step towards that.

Ivey’s history is that she came to vet school planning to do mixed animal practice and return to the small town where she grew up.  She was an average student through vet school, focusing more on learning the material than grinding for a grade.  Her class rank was 50/130.  She did some research during the summer between freshman and sophomore year but it did not lead to a publication.

During her junior year, she began to think that she might want to specialize after vet school, but wasn’t sure in what.  In her senior year, she did an amazing job on clinics.  She arrived before everyone else and left after everyone else, was enthusiastic, was humble, and applied all that she had learned in her pre-clinical years while her classmates were just focusing on the next test.  She particularly enjoyed her cardiology and internal medicine rotations, and decided that she wanted to be a cardiologist.

When Ivey applied to internships through the VIRMP, she only applied to highly competitive academic internships, since she felt these would be more likely to lead to a cardiology residency.  She had her mentors review her letter of intent and had a letter of recommendation from an internist, a cardiologist, and a pathologist.  Because she did well on clinics, they wrote her strong letters of recommendation.

The treatment for Ivey is both simple and complex.  The simple part is that she now needs to Scramble to get SOME kind of reasonable-quality internship.  While she could enter private practice and try again next year, I think it’s harder to get back into the academic system once you have gotten out.  The complex part is that she needs to make herself a more competitive candidate during her internship year.

Unfortunately, that’s going to be hard to do.  Her class rank is probably adversely affecting her for some institutions, particularly if they have other stellar candidates with a better class rank.  She can’t do anything about that, though, so let’s look elsewhere.  While she has some research experience, she doesn’t have a publication.  Getting a publication during the intern year is hard, but not impossible.  Telling the faculty at the start of the program that doing research and getting a publication is of top importance may be helpful.  But remember, the internship is a year for clinical training.  Very few interns successfully complete a research project or write a case report.

Ivey is probably going to have to do a cardiology specialty internship to be competitive for a residency.  To that end, finding an internship at an institution that has a cardiologist during the Scramble will be key.  Another alternative may be to enter a PhD program in physiology or pharmacology and then finish that program while getting good grades in it.  That is a very long road but, if Ivey can’t get there through the internship/specialty internship route, that may be the only option available to her.

There are a lot of lessons I think are important here.

  1. Sometimes, grades do matter.  However, learning the material matters MORE in my opinion.  Being an RFHB is even more important than that.  Don’t neglect your development as a person or as a clinician just to score good grades.
  2. The competition for high-quality academic internships is fierce.  You would not believe what the applications I read look like.  Multiple peer-reviewed publications, letters of reference with them in the top 1% of candidates, incredibly well-written letters, a wide variety of experience, and letters of recommendation from people in core disciplines.  Ivey could have done a few things differently:
    1. Follow through her research to a publication (or make sure she worked with someone who would enable her to do so).
    2. Applying to less-high-quality positions but rank them lower.
    3. Get a letter from a surgeon rather than a pathologist.
  3. Working hard counts for far more than almost any other variable.  However, your hard work is not remarkable.  It is EXPECTED that any intern applicant will work hard.  So, unfortunately, putting in the hours is the minimum baseline to be considered for an internship.  You have to somehow go above and beyond, like Ivey did- being humble, knowing what is clinically relevant, and being pleasant to work with.

If you don’t match for an internship, it’s not the end of the world.  There’s always the Scramble.  However, this is why I advocate that you apply and rank anywhere you think you COULD be happy, not just the high-quality positions.  Because I think it’s far better to get a mediocre internship than to go into private practice if you’re keen on specializing.

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