When you're a resident, how will you grade your students?

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This is directed at people still in medical school and on rotations.

As we've figured out by now on the floors, medical students probably have to be the most annoying breed of (non)human beings ever created. They kiss up, show up early despite being told not to, ask stupid questions, ask good questions, do tasks and look up lab values that residents already know about, read review books during every spare millisecond on the wards, smile when a patient's O2 sat is below 85% (yay learning ), take up space, can't read anyone else's handwriting, have bad breath, take criticism a little too well, are always well-groomed, and say "thank you" 500 times a day. And me? Guilty as charged.

So the question is... how will you evaluate medical students when, say 1-2 years from now, you're on the other side of the fence? Will you have compassion for your students and be nice to them and write them glowing evaluations? Will you put them in their place when they are out of line by writing a frank and honest assessment at how terrible they are? Or will you be a wuss and just give everyone HP?

I'm virtually none of those qualities. ...except for the taking up space part. Plus my breath smells great most of the time.

Originally Posted by Deferoxamine

This is directed at people still in medical school and on rotations.

As we've figured out by now on the floors, medical students probably have to be the most annoying breed of (non)human beings ever created. They kiss up, show up early despite being told not to, ask stupid questions, ask good questions, do tasks and look up lab values that residents already know about, read review books during every spare millisecond on the wards, smile when a patient's O2 sat is below 85% (yay learning ), take up space, can't read anyone else's handwriting, have bad breath, take criticism a little too well, are always well-groomed, and say "thank you" 500 times a day. And me? Guilty as charged.

So the question is... how will you evaluate medical students when, say 1-2 years from now, you're on the other side of the fence? Will you have compassion for your students and be nice to them and write them glowing evaluations? Will you put them in their place when they are out of line by writing a frank and honest assessment at how terrible they are? Or will you be a wuss and just give everyone HP?

Interesting question... I think I'd be one of the more lenient graders overall. However, I would use knowledge and attitude to determine who gets honors. I would be clear enough with students as to what I'm looking for, as being vague, IMHO, is what sets up students for being over bearing pests. For those who still over do it, I'll down grade them and be clear in my comments as to why. The problem is, there is a fine line between being normal (e.g. yawning a few times during a 16 hour shift) and appearing lazy or disinterested. I hope I don't have to evaluate anybody before I am mid-level resident!!

If I like you, then probably honors

If I don't like you, then probably high pass

I would probably use the "give a crap scale"

1 = fail 2 = 70% 3 = 80%, 4 = 90%, 5 = 100%
Any 1s, consistent 2s get called to Deans office. Any 1s or 5s require comment for each section.

1 = majorly screwing up. Coming in late/ not showing up consistently, behaving unprofessionally - being rude to pts, nurses, poor hygeine, txting during rounds, smelling of ETOH, ect. Have to TRY to fail.
2= shows up approx on time most days. Does minimum. May try to skip out early. Don't like student, but have no grounds/ strong reason to fail.
3 = comes on time with few exceptions (and let us know if they were running late), professional, appears to read. Does basic 3rd/ 4th year med student duties. Can easily locate student (I would not trap the student but get their cell/ pager # and let them go "read", but would expect them to answer the phone if I called, and possibly return to work)
4 = 3+ give a crap but is not overly kiss *****/ annoying. Great with patients.
5 = want to work with this student in the future/ functioning on level of resident.

4th year 5 = 3+give a crap after match.

3rd year grading randomness involves being subjected to evaluators that are both too tough and too lenient. so since it's mostly b/s anyway, and the students' careers are at stake, i'm erring on the side of too lenient. everybody gets honors by default, unless they *really* don't care/show up. no penalty for introverted/shy personality.

Originally Posted by Tiger26

If I like you, then probably honors

If I don't like you, then probably high pass

Grade inflation.


Does every student really deserve honors or high pass? Doesn't it cheapen the grade a little bit?

Originally Posted by SLUser11

Grade inflation.


Does every student really deserve honors or high pass? Doesn't it cheapen the grade a little bit?

Sure, but at the same time, how good of an impression can you get in 2-4 weeks?

If I have to grade students next year I think I am going use the everyone gets a high pass unless they show they deserve something else.

So if you show you really put in the extra effort, go the extra mile to be a team player and know your stuff, that HP may get bumped up to an honors. If you show you don't want to be there, don't read and are generally difficult to work with, that HP gets bumped down to a P or a F.

This way, you are not going to totally kill someone's grade. At certain clerkships at my school, if you get almost all H's, just one P can drop you down to a HP overall. However all H's and one HP rarely does that.

Originally Posted by Instatewaiter

Sure, but at the same time, how good of an impression can you get in 2-4 weeks?

If I have to grade students next year I think I am going use the everyone gets a high pass unless they show they deserve something else.

So if you show you really put in the extra effort, go the extra mile to be a team player and know your stuff, that HP may get bumped up to an honors. If you show you don't want to be there, don't read and are generally difficult to work with, that HP gets bumped down to a P or a F.

This way, you are not going to totally kill someone's grade. At certain clerkships at my school, if you get almost all H's, just one P can drop you down to a HP overall. However all H's and one HP rarely does that.

I do something similar when at restaurants. Having waited tables in the past, I can empathize with my server, and I frequently over-tip even if the service was bad. However, I always feel guilty because I feel that I'm reinforcing bad behavior. Maybe bad servers shouldn't get good tips, because they will then stay in the industry and continue to provide bad service.

With grades, I want the students to work hard and earn good marks. How good of an impression do I get in 4 weeks? I'm not grading their self-worth or overall intelligence. I'm grading their performance during those 4 weeks.

I think if we give out automatic high passes to people that we feel are average at best, then we're contributing to grade inflation, and we're not providing that student with an impetus to improve.

I'm not trying to "kill someone's grade." I'm trying to give them the grade they deserve. Despite the practice at a lot of our "top schools," not every student should get all honors and high passes as a MSIII.

Originally Posted by SLUser11

I do something similar when at restaurants. Having waited tables in the past, I can empathize with my server, and I frequently over-tip even if the service was bad. However, I always feel guilty because I feel that I'm reinforcing bad behavior. Maybe bad servers shouldn't get good tips, because they will then stay in the industry and continue to provide bad service.

With grades, I want the students to work hard and earn good marks. How good of an impression do I get in 4 weeks? I'm not grading their self-worth or overall intelligence. I'm grading their performance during those 4 weeks.

I think if we give out automatic high passes to people that we feel are average at best, then we're contributing to grade inflation, and we're not providing that student with an impetus to improve.

I'm not trying to "kill someone's grade." I'm trying to give them the grade they deserve. Despite the practice at a lot of our "top schools," not every student should get all honors and high passes as a MSIII.

The issue is that there is no standardization either between students, or between schools. Clinical evaluations tend to have more to do with personality compatibility and luck. I would say that 100% of the grade in a course should rest on the shelf.

Originally Posted by PathMD2010

I would probably use the "give a crap scale"

1 = fail 2 = 70% 3 = 80%, 4 = 90%, 5 = 100%
Any 1s, consistent 2s get called to Deans office. Any 1s or 5s require comment for each section.

1 = majorly screwing up. Coming in late/ not showing up consistently, behaving unprofessionally - being rude to pts, nurses, poor hygeine, txting during rounds, smelling of ETOH, ect. Have to TRY to fail.
2= shows up approx on time most days. Does minimum. May try to skip out early. Don't like student, but have no grounds/ strong reason to fail.
3 = comes on time with few exceptions (and let us know if they were running late), professional, appears to read. Does basic 3rd/ 4th year med student duties. Can easily locate student (I would not trap the student but get their cell/ pager # and let them go "read", but would expect them to answer the phone if I called, and possibly return to work)
4 = 3+ give a crap but is not overly kiss *****/ annoying. Great with patients.
5 = want to work with this student in the future/ functioning on level of resident.

4th year 5 = 3+give a crap after match.

I like this.

Im gonna grade on attitude. There is just so much you dont know as a 3rd year, especially in your first few rotations. As long as people show up on time, look interested and like they are trying, Im happy. Anyone who mopes or whines a lot is gonna get a worse grade because that brings the whole team down.

Originally Posted by Substance

The issue is that there is no standardization either between students, or between schools. Clinical evaluations tend to have more to do with personality compatibility and luck. I would say that 100% of the grade in a course should rest on the shelf.

I disagree, I worked with some booksmart people that were not very good. One girl in particular I worked with on IM almost failed because she was so bad clinically. She showed up late all the time, randomly disappeared, and many times didnt even have the current lab values for her patients. To say her patient presentations were bad would be an understatement. That had nothing to do with personality and luck, and everything to do with her being someone that thought she could just study for boards and not ever have to worry about the clinical side. I will agree the personality component has some effect, and there is a little luck with attendings that grade really easy, and ones that grade hard, but a lot is the actual student. One of the funnier things I heard from a surgery resident to a guy that was also horrible. "I fail you but I dont want to chance getting you as a student again" so he got a marginal pass.

is it weird that i want no part in evaluating students when i'm a resident? it seems so pretentious and phony. "hi, i was a med student like you only a couple years ago but now i have some pseudo-authority over you so i will get on my high horse and decide if you are worthy of honors based mainly on if i like you."

I'm giving everyone honors unless they do something unprofessional to jeopardize quality of care for patients.

I will talk politics and religion with them. If they are right-wing or religious I will fail them. If I am an attending I will put on a pokerface and offer to write a LOR and make calls to their dream programs (secretly warning any future employer that this individual is bat-**** crazy and doesn't belong in medicine).

Originally Posted by Substance

The issue is that there is no standardization either between students, or between schools. Clinical evaluations tend to have more to do with personality compatibility and luck. I would say that 100% of the grade in a course should rest on the shelf.

It's ridiculous to base the entire grade on the shelf. While we need the shelf as a way to subjectively measure the student's knowledge, it has little reflection on the student's actual performance during the clerkship. There's a lot more to becoming a doctor than memorizing blueprints and pretest.

I agree that it's frustrating that there's no standardization of grades. On the applications, the interviewers can see what percentage of the student's class got honors in every class, but I doubt all the program directors take that into consideration. Having read a lot of these applications for surgery, it's frightening how many places give honors to 50-75% of their students. And, usually this happens at the "upper tier" schools.

At SLU, 15% of the students honored a clerkship. I had to fight for those H's.

Originally Posted by PostCall

is it weird that i want no part in evaluating students when i'm a resident? it seems so pretentious and phony. "hi, i was a med student like you only a couple years ago but now i have some pseudo-authority over you so i will get on my high horse and decide if you are worthy of honors based mainly on if i like you."

Nobody spends more time with the student than the resident. In most places, the majority of the instruction comes from the resident as well, at least in surgery. The resident is often the most qualified to evaluate the student, and is also more likely to give the student a good evaluation. I agree that the process is biased, and some people are just a-holes and abuse their "pseudo-authority," but this is the way medical education works in America. We can blame Halsted for that.

Originally Posted by smiley737

I'm giving everyone honors unless they do something unprofessional to jeopardize quality of care for patients.

Grade inflation. I guess everyone is an honor student these days....at least according to their parents....If I'm going to place blame for this phenomenon, I think I'll lay it on the person who decided that in sports every kid should get a participation trophy.

The way I will grade will be as follows:

1. You better show up on time and work hard
2. Your physical exam skills and note writing should improve based on critiques of your notes and exam skills.
3. Whether or not you know some pimping question will have no effect on your clinical grade because 1. That's what the shelf and in class tests are for and 2. How the hell would I know what you are reading at night.

So if you achieve points 1 and 2 I will give you the best eval ever.

and there is absolutely nothing for students to do, I will send you home; NOT keep you for the sake of keeping you, or make you follow me around to watch me get my work done (ie put in orders or other stuff students can't really do). simply keeping students for the sake of keeping them=freaking waste of time=pisses me off like no other!!!......I found this to be true mostly in IM


sorry this isn't on topic but it's something i've noticed a lot lately...and my 3rd-year-itis + no learning value, complete waste of time = quickly becoming a pet peeve of mine.

Originally Posted by sendwich

and there is absolutely nothing for students to do, I will send you home; NOT keep you for the sake of keeping you, or make you follow me around to watch me get my work done (ie put in orders or other stuff students can't really do). simply keeping students for the sake of keeping them=freaking waste of time=pisses me off like no other!!!......I found this to be true mostly in IM


sorry this isn't on topic but it's something i've noticed a lot lately...and my 3rd-year-itis + no learning value, complete waste of time = quickly becoming a pet peeve of mine.

Just to play devil's advocate, I think a lot can be learned from seeing how your residents spend their day. If you write a progress note in the morning and then disappear for the rest of the day, how much are you learning about clinical medicine? You can teach a monkey to write a progress note. The real meat of clinical medicine is the orders and decision making that gets the patient from point A to point B, and eventually gets them home.

I frequently encourage my students to help me with the floor work. You wouldn't believe how hard it is for students to write orders and scripts without direct prompting. You may think we're doing this just to torture you, but that's pretty nearsighted. I can complete my floor work much faster without walking a student through the process. It probably takes me twice as long to coach them through it.

I also find it sort of ironic that students pay around $200K to experience this, but can't wait to run away from the wards at first opportunity, and complain about any extra time spent there when the student's presence isn't necessary. I can tell you that you are inherently unnecessary. You are doing this as a sort of dress rehearsal for your residency, and to find out what a specialty is really like.

Originally Posted by SLUser11

Just to play devil's advocate, I think a lot can be learned from seeing how your residents spend their day. If you write a progress note in the morning and then disappear for the rest of the day, how much are you learning about clinical medicine? You can teach a monkey to write a progress note. The real meat of clinical medicine is the orders and decision making that gets the patient from point A to point B, and eventually gets them home.

I frequently encourage my students to help me with the floor work. You wouldn't believe how hard it is for students to write orders and scripts without direct prompting. You may think we're doing this just to torture you, but that's pretty nearsighted. I can complete my floor work much faster without walking a student through the process. It probably takes me twice as long to coach them through it.

I also find it sort of ironic that students pay around $200K to experience this, but can't wait to run away from the wards at first opportunity, and complain about any extra time spent there when the student's presence isn't necessary. I can tell you that you are inherently unnecessary. You are doing this as a sort of dress rehearsal for your residency, and to find out what a specialty is really like.

I completely agree with what you're saying, the sort of thing you describe would actually be very helpful.. but I'm griping about times when there is no teaching whatsoever. Like today, I asked an intern why he chose to order a certain test. He brushes me off with "wait, i'm getting distracted, ask me later", or something along those lines. Then he goes on to chat with a fellow intern about something non-work related for 40-some minutes in the hallway. afterwards, he sends me down to the basement to fetch a set of slides for a paper he's publishing (from a patient he had 3 months ago). He seems to think students show up to be used. THis happens a lot with this particular intern, supposedly, and i should speak up, but wth it'll all be over in 2 days and not worth raising dust over.

Originally Posted by Momentum70

I disagree, I worked with some booksmart people that were not very good. One girl in particular I worked with on IM almost failed because she was so bad clinically. She showed up late all the time, randomly disappeared, and many times didnt even have the current lab values for her patients. To say her patient presentations were bad would be an understatement. That had nothing to do with personality and luck, and everything to do with her being someone that thought she could just study for boards and not ever have to worry about the clinical side. I will agree the personality component has some effect, and there is a little luck with attendings that grade really easy, and ones that grade hard, but a lot is the actual student. One of the funnier things I heard from a surgery resident to a guy that was also horrible. "I fail you but I dont want to chance getting you as a student again" so he got a marginal pass.

M1 here.
We keep being told that pre-clinical grades are worth much less than the clinical grades (and step 1) and that even if you barely passed, as long as you rock the boards and do well in the clinicals, you'll be fine. Yet i keep seeing that the clinical grades are extremely subjective and you have to be absolutely horrible to fail. Plus it sounds like it would be easy to get honors if your personality clicked with the rest of the team and some mistakes could be ignored. I'm assuming that residency directors know all this already so can i assume that the only true way to compare applicants is step 1?

If so, then why would someone not just coast through the clinical years just like the first 2 doing just enough to not get into trouble of be noticeably bad if they have a great step 1 score behind them.

Not trying to get flamed or anything but i'm starting to think that regardless of what publiched reports say, the only thing that matters really is step 1. I'm i looking at this the wrong way?

That's pretty accurate. If your school does not teach the first two years for Step 1, which most don't, you should absolutely just coast and do the minimum requirement. Just make sure to not fail anything or get any other sort of red flags on your record. But you're right in that only your Step 1 score matters.

For clinical performance, it's 100% subjective and you just have to get good at playing the game.

It seems like many people are throwing around the word "subjective" as if we have NO control over the grade. Is my school the only one where the shelf accounts for a portion of our grade? Don't other schools have required write ups/reports that also go into the final grade? The clinical evaluation from residents and attendings is significant but most of the time we absolutely have control of what happens. A lot of what goes on in the wards and what we as students can do is common sense! Think about what the residents would want to make their lives easier. Perhaps this means checking the labs, knowing the patient well, talking to our patient but it may also mean getting the bed to speed up transport, calling those consults, doing certain procedures because the nurses or techs are way too busy to do it in the timely matter the resident desires. Medical students DO have the time to do all that silly "scut." If you choose to help speed up the process and contribute meaningfully, residents will like you. If you choose to be more easy going, not so damn sensitive, and have a good sense of humor everything will be much more enjoyable and everyone else will be more willing to teach you or help you out. I can't speak for the posters on SDN but I do know that the students in my school who are known to be tough to work with in third year were the same ones who complained about everything during the first two years (when we were coddled to death). You just couldn't please these people! Please realize everyone is working! No one has the time to sit every single medical student down to talk out the exact role and duties that are expected. So what makes you special? You passed the first two years so you're not a complete idiot, figure it out!

Anyway, my point is, I disagree that third year is completely subjective. There will always be that one resident or attending that makes your life miserable no matter what you do. However, this is NOT the majority. Thus, to get back to the OP, this is how I will judge my students as a resident. The ones that do the minimum, never volunteers, have a snobby sense that things should be handed to them will never do well with me. Students who appear enthusiastic, keep up with the material, are honest (i.e. do the basic common sense things to make everyone's lives easier) will always get the better grade.

As for giving everyone a good grade, this would be very ideal however, how would one distinguish the students who are just ok vs the ones who excelled? My school requires a definite break down of who gets H, HP and P for a reason. It allows that H or HP to actually mean something. Despite all the politically correct propaganda, not everyone is equally as smart and not everyone is equally as hard working so not everyone deserves the same grade. That being said, I do believe that every resident should give students the benefit of the doubt because third year really is one of the most stressful years in our careers.

harshly and unfairly is what I will go for

Originally Posted by SLUser11

Grade inflation.


Does every student really deserve honors or high pass? Doesn't it cheapen the grade a little bit?

You act as if you have the final say on the student's grade. Most attendings don't ask for our feedback. Those who do take what we say with a heavy grain of salt.

Originally Posted by SuperHiro

It seems like many people are throwing around the word "subjective" as if we have NO control over the grade. Is my school the only one where the shelf accounts for a portion of our grade? Don't other schools have required write ups/reports that also go into the final grade? The clinical evaluation from residents and attendings is significant but most of the time we absolutely have control of what happens. A lot of what goes on in the wards and what we as students can do is common sense! Think about what the residents would want to make their lives easier. Perhaps this means checking the labs, knowing the patient well, talking to our patient but it may also mean getting the bed to speed up transport, calling those consults, doing certain procedures because the nurses or techs are way too busy to do it in the timely matter the resident desires. Medical students DO have the time to do all that silly "scut." If you choose to help speed up the process and contribute meaningfully, residents will like you. If you choose to be more easy going, not so damn sensitive, and have a good sense of humor everything will be much more enjoyable and everyone else will be more willing to teach you or help you out. I can't speak for the posters on SDN but I do know that the students in my school who are known to be tough to work with in third year were the same ones who complained about everything during the first two years (when we were coddled to death). You just couldn't please these people! Please realize everyone is working! No one has the time to sit every single medical student down to talk out the exact role and duties that are expected. So what makes you special? You passed the first two years so you're not a complete idiot, figure it out!

Anyway, my point is, I disagree that third year is completely subjective. There will always be that one resident or attending that makes your life miserable no matter what you do. However, this is NOT the majority. Thus, to get back to the OP, this is how I will judge my students as a resident. The ones that do the minimum, never volunteers, have a snobby sense that things should be handed to them will never do well with me. Students who appear enthusiastic, keep up with the material, are honest (i.e. do the basic common sense things to make everyone's lives easier) will always get the better grade.

As for giving everyone a good grade, this would be very ideal however, how would one distinguish the students who are just ok vs the ones who excelled? My school requires a definite break down of who gets H, HP and P for a reason. It allows that H or HP to actually mean something. Despite all the politically correct propaganda, not everyone is equally as smart and not everyone is equally as hard working so not everyone deserves the same grade. That being said, I do believe that every resident should give students the benefit of the doubt because third year really is one of the most stressful years in our careers.

The thing is, medical students aren't working. They're students. They're 100% learners.

I fail to see how moving beds around and doing scut constitutes as learning medicine. I'd actually respect a student more if he refused to do scut. Medical tuition is supremely expensive, and scut is not a worthwhile product of that expense. Students should demand teaching and useful clinical time and not settle for lab fetching and scut. Moreover, students should be evaluated on their medical prowess and not their willingness to do menail tasks for the sake of the "team".

Assistants should be hired to take care of the scut. Medical students should not work for free.

Originally Posted by Substance

The thing is, medical students aren't working. They're students. They're 100% learners.

I fail to see how moving beds around and doing scut constitutes as learning medicine. I'd actually respect a student more if he refused to do scut. Medical tuition is supremely expensive, and scut is not a worthwhile product of that expense. Students should demand teaching and useful clinical time and not settle for lab fetching and scut. Moreover, students should be evaluated on their medical prowess and not their willingness to do menail tasks for the sake of the "team".

Assistants should be hired to take care of the scut. Medical students should not work for free.

Trust me, I agree with most of what you wrote. I think students should be taught and not just used for work. However, I think we all need to keep some perspective on the matter. There is absolutely not way we can control what attendings do on an individual level. They are either going to teach or not. Usually it is up to residents and interns to teach us. But what is their incentive? They have a set salary with a lot of work to accomplish every day. If I was in their shoes, would I care more about finishing what my attending and patients expects of me or teaching the medical student? The answer is obvious. This is the system, I don't like it and I didn't make it this way and I would absolutely encourage ANYONE with ideas on how to change it to speak up. What I do know is how it works and I choose to use that knowledge to my advantage. I choose not to gripe about any lack of teaching when I am on the wards, I choose to help get that bed because transport is taking too damn long, I choose to run labs to pathology to get that tech to give me results, I choose to bring a positive and enthusiastic attitude to my team every day and so on and so on? Sometimes I have to fake the smile and the go-getter attitude but I also consciously choose not to mind because it helps out the team and saves everyone time. From my experience, I have benefited greatly from being this way. My residents have told me how much it helps them when I work hard and in return, we get closer under the common ground of trying to get all that sh*t done as efficiently and quickly as possible. When my residents like me, they are much (MUCH) more willing to give me constructive criticism, trust me to do procedures, pimp me out with relevant questions pertaining to the shelf etc. If attendings notice, they are more likely to be nicer, to be forgiving if I do not know the answer and to explain various facts to me on the wards (i.e. TEACH!). And this also goes for nurses, techs, PAs, NPs and other medical personnel.

Please keep in mind that we as students are disposable. When you go off the wards for exams or lectures, the team is not going to fall apart. Thus, when you are on the floors, you can be more of a nuisance than a help because they now have to explain things to you, watch you during procedures, listen to your slow(er) and probably less informative presentations. There is work to be done and surprise, being a doctor doesn't mean your entire focus is ONLY the medical aspects of the patient. Unfortunately for us, the attending as the head of the team turfs all that other clerical BS to his support staff (residents, nurses, PAs, students).

Anyway, I don't mean to offend anyone. I just wanted to share my perspective on the matter and I felt like it has really helped make my entire third year (so far) in to an extremely enjoyable experience. I've gotten along great with all my residents and I believe I received so much attention from them because I did keep an up-beat attitude. What was that old saying again, you get more bees with honey than vinegar?

Originally Posted by MasterShakeDO

You act as if you have the final say on the student's grade. Most attendings don't ask for our feedback. Those who do take what we say with a heavy grain of salt.

Maybe in your experience, that is the case. However, I think it's hard for you to justify a blanket statement about resident involvement in the grading process. In surgery, the residents spend a lot more time with the students, and the staff can often rely heavily on the resident's opinion, besides the fact that at least where I'm at now and where I trained, the residents submit their own evaluations of the students that are weighted equally.

Originally Posted by Substance

The thing is, medical students aren't working. They're students. They're 100% learners.

I fail to see how moving beds around and doing scut constitutes as learning medicine. I'd actually respect a student more if he refused to do scut. Medical tuition is supremely expensive, and scut is not a worthwhile product of that expense. Students should demand teaching and useful clinical time and not settle for lab fetching and scut. Moreover, students should be evaluated on their medical prowess and not their willingness to do menail tasks for the sake of the "team".

Assistants should be hired to take care of the scut. Medical students should not work for free.

It's tough to draw a line between what's educational and what's scut, because a lot of students call work "scut" when it's something they don't want to do. As far as foleys, lines, etc, it's not scut until it's old hat. Do you really think that as a student you're above these tasks?

You are definitely there to learn, and you are learning how to function as a doctor. It's not just about the contents of textbooks. You are learning the practical application of medicine.

Just as you think medical students "should not work for free," remember that the residents aren't getting paid for their part in your education. They are essentially volunteer teachers. Having you around makes their day longer and harder, but they do it, for free, since they're committed to the process.

yes grading during rotations is largely subjective and anybody who says differently is in denial. you could get assigned to a resident/attending who gives everybody honors or u could end up with one who doesn't give honors no matter how good u are. i remember once i was in the med ed office and an attending barged in like he was in a hurry. i later learned he was post-call and they had paged him to come in to fill out evaluations for a rotation that he had kept putting off. i remember how the students in that rotation had said they still hadn't gotten their evals many months after the rotation. so i guess the admin finally put its foot down and told him it had to be done that day...his post-call day. so this guy barges in, grabs the stack of evals, and just goes down the columns circling "pass" on all categories for everybody. not even caring which student it was or leaving any comments. just quickly circling the same thing for everybody whether they were a slacker or gunner, scribbling his signature at the bottom, shoving the stack of evals back to the secretary, and taking off. two months of those students busting their butt on that rotation and their grade determined in under a minute by a guy who couldn't care less. even if they aced the shelf they couldn't get honors with all passes on their evals.

Originally Posted by PathMD2010

I would probably use the "give a crap scale"

1 = fail 2 = 70% 3 = 80%, 4 = 90%, 5 = 100%
Any 1s, consistent 2s get called to Deans office. Any 1s or 5s require comment for each section.

1 = majorly screwing up. Coming in late/ not showing up consistently, behaving unprofessionally - being rude to pts, nurses, poor hygeine, txting during rounds, smelling of ETOH, ect. Have to TRY to fail.
2= shows up approx on time most days. Does minimum. May try to skip out early. Don't like student, but have no grounds/ strong reason to fail.
3 = comes on time with few exceptions (and let us know if they were running late), professional, appears to read. Does basic 3rd/ 4th year med student duties. Can easily locate student (I would not trap the student but get their cell/ pager # and let them go "read", but would expect them to answer the phone if I called, and possibly return to work)
4 = 3+ give a crap but is not overly kiss *****/ annoying. Great with patients.
5 = want to work with this student in the future/ functioning on level of resident.

4th year 5 = 3+give a crap after match.

Somebody once told me that grades were dependent on keeping your preceptors entertained. With that in mind how anout this 5 point scale:

1= speaks, but consistently rude, whiny, or apathetic
2= does not speak unless specifically prompted to
3= speaks, but generally uninteresting
4= has said a few genuinely funny or intellectually interesting things
5= consistently funny/interesting things coming out this person's mouth

Fairly. If the effort is there and the kid is trying then I will give a good assessment. If they're lazy then I won't. Same way I want to be evaluated today.

Originally Posted by waterhammer

Somebody once told me that grades were dependent on keeping your preceptors entertained. With that in mind how anout this 5 point scale:

1= speaks, but consistently rude, whiny, or apathetic
2= does not speak unless specifically prompted to
3= speaks, but generally uninteresting
4= has said a few genuinely funny or intellectually interesting things
5= consistently funny/interesting things coming out this person's mouth

The higher end of that may be factored in depending on the personality of the person evaluating you. Others may give you a 4 or 5 for not speaking unless spoken to.

Giving someone a failing grade is a somewhat big deal; there are implications for the student, justifications on your side ect. So someone whould probably have to say something rude on a daily basis or to multiple people including staff and patients. Whiny or apathetic - may lower your grade but wouldn't fail you, unless checking your watch while counseling a dying pt/ banging your head against the wall, insert horribly unprofessional behavior here

I never felt I had the burden of "entertaining" my preceptors; I always felt my role was to be receptive to new information/ tasks and available. Of course, getting along with the people grading you on a personal level always helps If you get the attending laughing at your joke, its always a good sign.

And ALWAYS stay vague/neutral with religion/ politics!

Originally Posted by Substance

The thing is, medical students aren't working. They're students. They're 100% learners.

I fail to see how moving beds around and doing scut constitutes as learning medicine. I'd actually respect a student more if he refused to do scut. Medical tuition is supremely expensive, and scut is not a worthwhile product of that expense. Students should demand teaching and useful clinical time and not settle for lab fetching and scut. Moreover, students should be evaluated on their medical prowess and not their willingness to do menail tasks for the sake of the "team".

Assistants should be hired to take care of the scut. Medical students should not work for free.

This was the worst for me on pediatrics which I just recently finished. When doing inpatient, I'd say "hey residents, do you have any work for me to do?" "Nope." Okay, cool, time to bust out Case Files. I get a chapter or two done, then they look over at me reading and say "Why don't you go play with your patient."

I almost lost my damn mind.

If you're a female, I will grade you based on how hot you are. If you are a dude, you've got to find some other way to impress me.

im not going to evaluate students.

anything positive i could say would mean zip.

anything negative i say could ruin someones career. stainsa re hard to remove.

Originally Posted by Chloroform4Life

If you're a female, I will grade you based on how hot you are. If you are a dude, you've got to find some other way to impress me.

Now would this be on the normal hot scale, in which most med school girls would fail, or the med school hot scale. My classmates and I debated the two scales and they are very different.

I will give everyone 4's/5's, except for the gunners- they will get lower grades.

Originally Posted by basupran

I will give everyone 4's/5's, except for the gunners- they will get lower grades.

Agreed!!

Originally Posted by Momentum70

Now would this be on the normal hot scale, in which most med school girls would fail, or the med school hot scale. My classmates and I debated the two scales and they are very different.

This makes me sad with agreement.

Originally Posted by PathMD2010

I would probably use the "give a crap scale"

1 = fail 2 = 70% 3 = 80%, 4 = 90%, 5 = 100%
Any 1s, consistent 2s get called to Deans office. Any 1s or 5s require comment for each section.

1 = majorly screwing up. Coming in late/ not showing up consistently, behaving unprofessionally - being rude to pts, nurses, poor hygeine, txting during rounds, smelling of ETOH, ect. Have to TRY to fail.
2= shows up approx on time most days. Does minimum. May try to skip out early. Don't like student, but have no grounds/ strong reason to fail.
3 = comes on time with few exceptions (and let us know if they were running late), professional, appears to read. Does basic 3rd/ 4th year med student duties. Can easily locate student (I would not trap the student but get their cell/ pager # and let them go "read", but would expect them to answer the phone if I called, and possibly return to work)
4 = 3+ give a crap but is not overly kiss *****/ annoying. Great with patients.
5 = want to work with this student in the future/ functioning on level of resident.

4th year 5 = 3+give a crap after match.

That's reasonable.

I've worked with students who would have justifiably failed rotations if they were graded according to this scale.

Honors would also be achievable based on merit here.

Originally Posted by SLUser11

I frequently encourage my students to help me with the floor work. You wouldn't believe how hard it is for students to write orders and scripts without direct prompting. You may think we're doing this just to torture you, but that's pretty nearsighted. I can complete my floor work much faster without walking a student through the process. It probably takes me twice as long to coach them through it.

I can tell you that you are inherently unnecessary. You are doing this as a sort of dress rehearsal for your residency, and to find out what a specialty is really like.

QFT

I know, because I was an intern last year and saw things from the other side (yet I lacked the authority at the time to be able to give students crappy evaluations meaning I didn't really care much if you were never there to begin with).

Originally Posted by sendwich

I completely agree with what you're saying, the sort of thing you describe would actually be very helpful.. but I'm griping about times when there is no teaching whatsoever. Like today, I asked an intern why he chose to order a certain test. He brushes me off with "wait, i'm getting distracted, ask me later", or something along those lines. Then he goes on to chat with a fellow intern about something non-work related for 40-some minutes in the hallway. afterwards, he sends me down to the basement to fetch a set of slides for a paper he's publishing (from a patient he had 3 months ago). He seems to think students show up to be used. THis happens a lot with this particular intern, supposedly, and i should speak up, but wth it'll all be over in 2 days and not worth raising dust over.

What an awesome guy! Once you live internship yourself, you'll see that students can be pests and at the end and you're the sucker that has to deliver the shift, not the students. If I have the time to teach students for a few minutes and I'm not in a sucky mood, I'm pretty accessible and enjoy explaining stuff and giving them tips to choose a good hospital to have a good internship (stuff you won't learn in school). However, sometimes I'm just really, really, really busy and have just 2 hours to finish 20 floor pendings before the attending or resident show up to make my life miserable if everything isn't picture perfect.

I'd probably be caught chit chatting with the buddy, but I'm not so mean to force you to go fetch stuff unless you really want to lend me a hand.

--

Sadly a lot of students (or most of them) are just too.. chicken to do something they could do if they had the initiative. When I was a student, if a resident asked me to fill out a particular form, once I learned how it had to be filled, I'd be prefilling them the second a new patient shows up to save them time. If work ended and there was nothing else to do, they'd teach me stuff. It was a close to real internship experience that helped me when my time came. I got along really nicely with an intern in my last semester and personally requested him if I and another friend could take the blood samples he needed to save him the time and exhaustion because he was post call and I was fresh like a bird. It was great clinical experience for me and my friend and we even sent the stuff to the lab to help the poor guy who looked pretty messed up that day.

As an intern I found it to be frustrating to ask politely a student if he could lend me a hand with something as simple as a clinical chart (even after I had explained him a few days ago how to make good & quick charts that contain the information we care about) and he didn't do it. I ended up doing it because at the end it's MY JOB to deliver a good shift. If you can lend me a hand, awesome but if not, I'll just do it myself but I won't have the time or the interest to babysit you.

I wasn't a nasty intern to my students. If I saw there was no real work, I'd always tell them to run off and have breakfast while no attending is around to scold them for doing nothing. I did get into a bit of a problem once when I was post call during a really sucky night and hadn't slept or eaten anything and needed to stitch a hand. The cafeteria has specific open hours and time was running out. I let a student suture and she was doing a good job while the other students watched. They even insisted I should go eat something before I fainted and told them I'll be back in 10 minutes tops.

When I came back 10 minutes later after eating some cereal, they did stitch the hand all right and I didn't even expect the girl to have been done so damn fast since I think it was her first time even doing it. The problem came when a nurse told me they accidentally threw a cover for the iodine or whatever that should never be thrown out and the nurses had to bill me for the piece because I was the person responsible for them (which at the end didn't matter when I finished last December because the bill magically disappeared and I never had to pay for it). When I become a resident, I'll be watching them until I know they can do an activity on their own with no problems. The students weren't mean or lazy people, they simply didn't know that and I was in a really sucky situation that day because I had a bad night and needed to eat something pronto). I didn't even scold them or even tell them they had screwed up though I was a bit grumpy that day because I was going to be billed out of my little salary.

I'd probably not care if a student showed up late because I never really know when they are even supposed to show up, but I'd honor those that don't need me to ask them to lend me a hand. If you can tell me "what can I do to help you?", learn fast and have the capacity to do the things you can do solo to make my life easier, and are a nice person and easy to work with, you'll honor or at least HP even if you don't have the best clinical knowledge. If your skills improve during the rotation, that's even more extra awesome points. Be nice and fun but always respectful with patients. I'd rather kick you out for the day instead of you sitting in front of a patient and laugh at them even if their problems are dumb because it's unprofessional. I had a few patients tell me they didn't like the students because they thought the students were laughing at them while they liked me because I could always keep a poker face.

Grade (out of a 100)

[2 X (# of doughnuts they bought for me)] - (number of stupid Qs they ask me because they think it will boost my ego) - (# of times they are late)

*multiply by 1.2 if a hot female

Originally Posted by FutureInternist

Grade (out of a 100)

[2 X (# of doughnuts they bought for me)] - (number of stupid Qs they ask me because they think it will boost my ego) - (# of times they are late)

*multiply by 1.2 if a hot female

That's a LOT of doughnuts

Originally Posted by SLUser11

Grade inflation. I guess everyone is an honor student these days....at least according to their parents....If I'm going to place blame for this phenomenon, I think I'll lay it on the person who decided that in sports every kid should get a participation trophy.

I heard a brief news spot on the radio a couple months ago. These days, kids in college think they deserve a B just for attending class. This is what happens when the kids who get participation trophies grow up. Soon they will expect honors on rotations just for existing.

Originally Posted by notinkansas

I heard a brief news spot on the radio a couple months ago. These days, kids in college think they deserve a B just for attending class. This is what happens when the kids who get participation trophies grow up. Soon they will expect honors on rotations just for existing.

This is all the "feel good" mentality that took hold in the 1960's and took 10+ years to eradicate... yup, it's been creeping back.

To answer the original question posed in my own thread, let me say this: I will be pretty lenient with the clinical evaluation and grade if you show up on time and do what you're supposed to do at least somewhat well. I'm not gonna hold it against you if you sorta mess up when presenting patients early on... I'm more concerned about your improvement throughout the rotation. Basically, what level are you at when this rotation is all said and done? That's how I will evaluate. This will put well over 50% of you in a very strong borderline high pass / honors grade or better. I will reserve the straight H's for the real amazing performances.

I have a major pet peeve - it's flat-out dishonesty when it comes to getting out of something you are supposed to do as a student. For example, if you tell us you have a funeral to attend and will not be there on Thursday, and I find out that you were at a baseball game and wanted the day off, I will fail you. I don't care how well you did on the rotation on the days you did come in. If I have 6 students and they all leave to go to some "lectures" that don't exist and they don't come back, and it's not just some simple misunderstanding or scheduling change, then I fail all 6 of them. This might sound hard-ass, but if there's such a huge blunder of dishonesty on your part, then I no longer have a reason to believe anything else that comes out of your filthy mouth. It's that simple. Tardiness, not knowing basic pharmacology or pathphysiology, dull personality, poor communication -- these can all be somewhat overcome with time, work, and experience. Flat-out dishonesty at age > 22/23, however, is ugly, goes right to the bone, and has little chance of changing over time.

Originally Posted by MasterShakeDO

Those who do take what we say with a heavy grain of salt.

I love that you make that statement. Whenever I try to answer questions for my patients, I usually preface with, "But since I'm just the med student, take this with a handful of salt".

Originally Posted by SuperHiro

Anyway, I don't mean to offend anyone. I just wanted to share my perspective on the matter and I felt like it has really helped make my entire third year (so far) in to an extremely enjoyable experience. I've gotten along great with all my residents and I believe I received so much attention from them because I did keep an up-beat attitude. What was that old saying again, you get more bees with honey than vinegar?

I think the best thing that third years can do is anything that gets the work done faster. I don't care what menial task it is, if it helps finish the work for the day quicker, it is useful. I think this makes the lives of our interns and residents easier, and it either gives us more time for them to teach us or for them to let us leave early to self-teach at home.

I think I will probably be an easier grader overall unless someone really rubs me wrong. I think I'd be utterly uncomfortable in screwing someone's chances into going wherever they wanted for residency because they were unfortunate enough to get stuck with a harda$s grader for a resident while someone who isn't as good as they are got lucky and put on an easy grader's team. Most people are pretty good anyways, I've hardly had any students on a team with me that just sucked and refused to be helpful, so might as well make the residency programs sort it out. Also, gunners will be advised that gunning is unprofessional and get knocked down a letter grade if they continue to do so after their warning.

Originally Posted by SLUser11

Just as you think medical students "should not work for free," remember that the residents aren't getting paid for their part in your education. They are essentially volunteer teachers. Having you around makes their day longer and harder, but they do it, for free, since they're committed to the process.

What a load of bull. Teaching medical students is part of your job as a resident. They tell you that when you interview for residency. You get paid for it because it's part of your job description.

I'm sure the program director would love to know that you consider yourself a "volunteer teacher".

What an arrogant and stupid statement.

Originally Posted by DarknightX

What a load of bull. Teaching medical students is part of your job as a resident. They tell you that when you interview for residency. You get paid for it because it's part of your job description.

I'm sure the program director would love to know that you consider yourself a "volunteer teacher".

What an arrogant and stupid statement.

so do you get paid more for doing your residency at an academic institution versus a community program?

I'd say that the supervision of medical students is something that may be assigned and inflexible, the teaching of medical students is definitely voluntary... I've had residents teach me plenty because they like to teach; conversely, I've had residents who only wanted me around because I could make their job a little easier and they taught me nothing in return.

I really don't have any argument with SLUser11's comment's and I doubt his/her program director would either.

Originally Posted by DarknightX

What a load of bull. Teaching medical students is part of your job as a resident. They tell you that when you interview for residency. You get paid for it because it's part of your job description.

I'm sure the program director would love to know that you consider yourself a "volunteer teacher".

What an arrogant and stupid statement.

I'd be willing to bet you'll be eating your trollish words when you're a resident. I've found that entitled students become entitled residents, and these residents are usually quite horrible to the medical students.

Anyway, don't act like you know anything about what is discussed in residency interviews or resident job descriptions, as it's obvious you have no idea what you're talking about.