Being a quiet/softspoken person and rotations

[plainolerichie]

Hello folks,

I'm a third year and in the middle of my third rotation. Anyways, I'm pretty frustrated with my grades in the first two rotations and I just want to know what you all think I can do to improve my grades from future rotations and if you have had this problem. We have an honors, high pass, pass, fail system here, with about 5-10% getting pass. The first two years, which are pass fail, I had done very well (always above average except 1 gross test).

I have received "Pass" on the first two rotations, Ob/Gyn and Peds. Now with ObGyn, it sucked, but I did horrible on the shelf, that's a third of our grade (I got a 63, about 10 points lower than our schools average) so I could live with and understand it. I actually got really good clinical evals from the residents and at the clinic sites but the clerkship directors, based on these two mentorship sessions of 1 hr where we present a patient and topic for 10 minutes, gave me the lowest eval of our class of 75%, with the only summary negative comment being "Plainolerichie could work on being less reserved and more outgoing" and they actually both said I did great presentations in the evals.

But my main frustration is with Pediatrics grade that I just received, where I got another "pass." The worst part about that, it's one of my top choices for residency. This time, I got a 78% on the shelf, which I believe is 5 or 6 points above my school's average, but I don't know the actual average yet. I haven't been able to talk to the director about the specific breakdown of my clinical evals. The thing is, again the summary criticism was about me being too quiet and softspoken, needing to improve communication skills and delivery, and saying I need "prompting" to get involved.

Yes, I am a softspoken person and I speak fairly slowly BUT I am sure as hell not all that shy and I am very active in participation with the groups and I don't need prompting to get involved. In our mentorship/attending rounding sessions, I'd ask and would answer the questions they asked us as much or more than most the other students. Sure, I answered in my normal softspoken slow talking self, but that's just me. I feel that because of that, I come across as not talking much to the graders. And I have no idea how I am supposed to apparently change my character and how I talk if I am to get a grade that's at least average for our school.

For peds, the positive comment summary talked about me writing exceptionally good H&P's, reading up on patients and showing it, being thorough and diligent, and being very enthusiastic even with patients I was not following. These are things that I feel I should do to AT LEAST get me the average grade of my school.

Any advice on what to do improve my clinical evals since they center around me being softspoken and not seeming confident? I'm just trying to get the average for my school and I actually do work hard. Or any advice on getting good clinical grades in general?

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[soulofmpatel]

Hey plainolerichie.

The problem you are having with clinical grading is very common. For better or for worse, personality has a tremendous influence on clinical grading...even more than knowledge and work ethic in many cases. As an MSI on my first preceptorship, I was told directly that "the only problem with you is your personality." I later received a poor evaluation compared to my classmates. My problem then is that I was anxious and unconfident around patients.

The fact of the matter is that in life in general, people judge you not by your intrinsic characteristics but by how you make them feel. Think about dating: would you favor a lover who "looks good on paper" or one who makes you feel vibrant, sexy, and fun. Your preceptors are not going to sit down for 15 minutes and deliberate how effective you will be as a pediatrics resident. They don't have time for that. They make snap intuitive judgments based on how much they like you as a person. Are you always smiling? Do you have a strut in your step? Are you professional and confident? Do you tell funny jokes or talk about sports and pop culture? These are the kinds of things that help mediocre students make honors grades.

People secretly believe that their style-their manner of speaking and thinking and working-is superior to all others. A masculine meathead-frat boy type orthopod will always looks down upon a dainty ditzy little feminine medical student...even if her clinical knowledge and procedural skills are excellent. You might find yourself favored by soft-spoken doctors...but that is by far the minority.

My advice: You can't change who you are completely. It would come off as obviously contrived, and you would be dying inside. However, you can make minor adjustments. Try to be a little bit more confident and dynamic. Speak louder. Try to develop personal relationships with residents and attendings. If you are a cute girl, flirt a little bit. Always get as much sleep as possible, exercise, and eat right so that you can show up bright eyed/bushy tailed.

 

[H_Caulfield]

I've dealt with the same problem, and I'd have to say that it's absolutely wrong for you to be getting poor grades on account of your personality. I don't believe that a normal variant of personality should be treated as inferior, but during rotations it is. The worst is when you get someone who's too impatient to give adequate attention, and if you're not really outgoing and interruptive you quite literally run the risk of failing the rotation. Unfortunately, in spite of how discriminatory and inappropriate it is to punish someone for being naturally softspoken, it ends up happening. It's easy for others to say to "just speak up," but as someone who's a bit shy and not particularly socially gifted, I know personally that it feels like trying to go through a brick wall and is just much easier said than done.

What I've resorted to doing is to study my ass off for the shelves. Arrive earliest and leave latest. Bring in journal articles and see more patients than you necessarily need to. These are things that aren't so dependent on your personality.

Luckily for you, pediatrics isn't competitive. It may end up keeping you from the top programs, which isn't fair, but as I'm learning all too quickly neither is life.

 

[LuckyBambooGirl]

It may feel "like trying to go through a brick wall" to speak up louder and appear more confident, but I know from experience you just have to do it. The first year I applied to med school, I interviewed but did not get in, and the dean of admissions told me that it was because I was too shy. This made me absolutely furious!! I spent the next year working on my communication skills and was accepted. Now I am in fourth year, have mostly overcome my shyness, can talk to anyone about anything, regularly speak up in class and on rounds and have not had any negative comments like those you describe on my clinical evaluations. I would suggest that you "fake it til you make it" and just try to appear confident in everything that you do. Especially, try to sound more assertive when speaking. You need to think about what image you are projecting to patients when you act reserved and answer slowly and quietly. They may think that you don't know what you are talking about and won't trust you as their physician. Also, I study really hard so I can get high grades on any tests, especially boards, because I figure that little extra boost can't hurt when it comes to residency applications! By doing these things, I don't think you are completely changing your personality, by being more social you are just letting the real you shine more clearly through your reserved exterior. Good luck!

 

[vtucci]

Keep in mind that third year (like life) is a bit of a crapshoot. You will encounter attendings who will prefer your reserved personality and some of your more outgoing classmates may run into problems with those attendings who think them brash or too aggressive. I think the difficulty with being perceived as quiet is that some may mistake your reserve for disinterest and you need to go above and beyond to prove that is not the case. Ask questions (only relevant, interesting ones) on rounds that demonstrate you are paying attention.

I would suggest to all students regardless of personality to ask frequently what you can do to improve. Take your final evaluation and let them fill it out on a weekly or every other week basis. Show you are committed to doing your best. Bring in journal articles, offer to present on a topic to the team, offer to assist the residents with morning report presentations. Research your team and attendings (do they have a particular research interest, personal interest). Try to engage them on a professional and personal level.

Always ask what else you can do for the team (esp if you are going to leave early).

Ob/GYN tends to be one of more aggressive specialties (so is surgery) and they expect a more direct, outgoing approach, more proactive approach.

 

[plainolerichie]

Thanks for the replies, but much of your advice on working harder highlights my frustration, especially with peds (vent warning!). I remember in Peds inpatients, pleading with the senior if I could pick up and follow extra patients. She eventually let me. Also, we only had to stay late in the 3 days when we were on call to admit patients but I did that 2 days extra to try to get more admissions/ patients to follow. Then I worked insanely hard on my H&P’s when I did admit, one time an attending even stopped the middle of rounds to give me a shout out about a great H&P!

Then, in the mid-rotation evals, the senior was SO positive about my work. The senior (who I believe gave me the final eval) had given me the highest marks in the mid-rotation eval checkpoint, except in the oral presentation part. There she did say “you are really softspoken and could work on your oral presentations, but honestly, I think the ones you did today were very good and well presented and you should keep up the good work,” which I modeled for the rest of the rotation presentations… But I still got a ****ty grade….

Anywho, pardon my tangent, in future rotations, I think I’ll try to really stress that I want to do well in the rotations to my residents/ attendings so that they really know I care. And I’ll ask them how I’m doing and what I need to do to do well more blatantly (really, I should spell it out and not get the usual run around). I’ll try talking louder to residents/attendings though that may be hard, and maybe even be somewhat what I feel is “pushy” about being more active on the wards.

And, I now know that even when attendings or clerkship directors claim something like “this is a relaxed environment” that is “student centered/friendly” and where you are “not graded;” if they are someone who and does grade you, well it’s graded…

About Peds for residency. I really meant I just really liked peds after the rotation and it's really my second choice... but my first is surgery, which really ain't happening (my personality vs the field, the lifestyle, now maybe grades, etc.) so I have no idea what I want to do.

Any other advice?

 

[QofQuimica]

Third year is really an interesting mix of personalities, isn't it? I kind of tend to have the opposite problem; sometimes I have to pull back and make sure not to dominate discussions too much. But the benefit of being a little louder is that people take note of you, and most of the time it's seen as a positive. The strengths of quiet people like you are often underestimated by the powers that be, which is a real shame. I agree that you can't change your personality. However, you can definitely modify your style somewhat. Here are a few specific suggestions:

1) Be mindful of your body language. Look at people in the eye when you are speaking to them. Give a firm handshake when you're meeting someone (not where you're breaking their fingers, but not limp either). Jump in and participate when your team is discussing a differential or a patient. Say what you are thinking (especially when asked) and don't worry about getting it wrong. They don't expect you to be good at differentials and treatment plans as a third year; you wouldn't have to go to med school if you could already function on the level of an MD or DO. If you give your two cents, what they'll remember afterward is that you participated and tried to be a part of the team, not that half the stuff you spouted was wrong.

2) Be mindful of other people's body language. This is an important skill to have regardless of whether you're talking to patients, attendings, residents, or friends. Watch your team's faces while you're presenting. If you're losing your audience, you need to change your style. Rehearse presenting your H & P a few times before rounds so that you can use it as a memory prompt and you don't have to read it word for word. Take cues from the other person and follow their lead. If someone jokes with you, participate in the joke (obviously in an appropriate and professional way). If your attending is in a hurry (common on surgery), give him or her just the facts, ma'am.

3) Watch what successful students do to get honors. You won't be able to follow what other people do tit for tat, but you can learn a lot from other people's successes. Every attending is different, and they will all have different expectations. Some people adapt more quickly to the constant state of flux that is third year. Those are the ones you want to emulate.

4) Use your intern (or sub-I, if you have one on your team). Interns are seriously the best resource on many rotations (assuming you don't get one that's a total jerk). They are often familiar with what the senior and attending want from both of you. They can help you polish up your H & Ps and presentations. You can bounce ideas off them for differentials or treatment plans. As with successful students, you can also watch what your interns do well during rounds and pick up pointers for improving your own presentation style.

Like someone else already said, part of the problem with being soft-spoken is that some people misinterpret that as disinterest or standoffishness. They may also tend to see you as being weak or a pushover, particularly in certain fields like surgery or OB/gyn where assertiveness (dare I say even aggressiveness!) is rewarded. You don't have to change who you are as a person to counteract these impressions. Just be aware of this issue as a potential problem and pay attention to what others do to succeed so that you can learn from them and succeed too. Hope these ideas help--best of luck to you.

 

[Law2Doc]

You will encounter attendings who will prefer your reserved personality and some of your more outgoing classmates may run into problems with those attendings who think them brash or too aggressive.

Nah, I agree with the prior poster who suggested that attendings are going to prefer the outspoken types 99.9% of the time. Even the quiet attendings seem to prefer the brash and aggressive types. So OP needs to go outside his/her comfort zone as much as possible. Remember the Seinfeld episode where George improves his life by doing the exact opposite of what his natural tendencies are? That needs to be you. Sure it's hard to remodel your personality at the drop of a hat. But these are the rules of this game.

 

[bananamed]

I say this tongue-in-cheek (maybe): the key to success is being an @$$h0!e. Be loud, be annoying, be the guy/gal they tell you not to be.

(My wise/poor advice is tainted by my own personal experience. Obviously your mileage will vary)

Like yourself, I too am quiet/softspoken and got railroaded 3rd year despite an outstanding Years 1 and 2.

And since starting 4th year, the good grades are pouring in again.

I did not get lobotomized before Year 3. Nothing changed.

If I had to do it again, I would take my own advice. If that's what they're looking for, it's what I'll give em.

 

[Old_Mil]

A lot of things go into subjective evaluations.

One of my rotations consisted of myself and two other medical students. It just so happened that all three of us were interested in the same specialty, and planned on applying to some of the same programs. One of the medical students was the daughter of the friend of the preceptor. She received honors and glowing commentary. We passed, and the kind chap made sure he said "Student A (and Student B) have an average knowledge of the field" in his comments.

Like I said, a lot of things go into subjective evaluations.

 

[Doctor Bagel]

Not really getting at your main point, but I would definitely talk to your clerkship director about your grade to see what's up. If you really feel like it's not merited (and it sounds like it isn't) and based on how your school works, it might be something to contest.

And for the statement that 99.9% of residents and attendings prefer brash outgoing types, I call total BS. The quiet people graduate, too, and loud, overly arrogant types annoy us.

 

[plainolerichie]

Don't get me wrong though. I completely understand why it's important for doctors to be confident, such as when they are attendings/seniors and have many people looking up to them for answers with difficult questions. But I just find it frustrating that they would stress it so much in my first two rotations that it's the major hindrance to an average grade. I could still understand how it could stop me from honoring. I really would just think that confidence is supposed to come with time and experience and actual knowledge, not just bsing.

Anyways, thanks for the replies. I'll try talking with the director about it as soon as I can.

 

[edmadison]

I have to agree with those who say that the outgoing med student is going to get the better grade. I would disagree, however, that one needs to be arrogant. You are going into a profession that is filled with type A people. Being confident and assertive are key skills for physicians. Further, you will always do better on evaluations when people like you. The residents may judge you based on the sum of your work and knowledge, but those who really matter are the attendings. Their impression of you is much more superficial. I have very little doubt that my personality and interesting background played a great part in my good grades in clinical rotations. Attendings liked talking to me because being a non-trad I was different than the majority of those who were rotating through.

You also need to learn how to "play the game" with the attendings. Always show interest in their field, even if you have no intention of going into it. You don't need to lie (except in surgery), but you're working with someone who has spent his or her life in this field. If you don't show enthusiasm, it will be seen as an insult. Worse yet, they may "save the grades" for those they THINK are going into their field. BTW, many of your colleagues will lie and tell the attendings they are going into their field. If you are interested in the field, even remotely, ask them for career advice. Ask them about their our career (people love to talk about themselves). This puts them in a mentor role which will also make them like you.

Engage the attendings. Ask questions (at appropriate times). But ask questions that show you have some knowledge base. Draw them into teaching and interacting with you. Many are afraid to ask questions because they think it will make them look stupid. Of course the better your are prepared the easier this will be.

Always look busy even if you aren't. You can work 20 hours per day, but if they see you resting, that's what they remember. Always be professional. Don't give a nurse or a resident any chance to bad mouth you, you will lose every time. Always be seen as a team player. It only takes one comment from a nurse to your attending and your honors is toast. Look professional.

Those are just a few of my thoughts.

Ed

 

[Law2Doc]

The quiet people graduate, too, and loud, overly arrogant types annoy us.

We aren't talking about "graduating", we are talking about getting honors, doing well, or at least not being penalized. Pretty much every attending I have come across has rewarded the outspoken folks and penalized the more reserved folks. You don't have to be "arrogant" or obnoxious to be outspoken -- I don't think anyone suggested that was preferred. ("brash and aggressive" was the wording used previously, which doesn't connote arrogance so much as just putting yourself out there, being "forward"). From what I've observed, you absolutely do have to make yourself noticed regularly on rounds. You can do this with more or less tact, but either way, if the attending knows you due to your regular participation and obvious vocal interest, you are going to tend to do better than someone who seems shy and quiet although gets his/her work done. It's unfair, but that's the way subjective grading works. The highly opinionated, always putting in two cents types in fact do get rewarded under this system.

As a fellow med student, it doesn't really matter who annoys you, the attendings do the grading, and their exposure to med students is so limited that someone who makes a lot of noise regularly for the couple of weeks exposure to them tends to stand out positively.

 

[mjl1717]

Nah, I agree with the prior poster who suggested that attendings are going to prefer the outspoken types 99.9% of the time. Even the quiet attendings seem to prefer the brash and aggressive types. So OP needs to go outside his/her comfort zone as much as possible. Remember the Seinfeld episode where George improves his life by doing the exact opposite of what his natural tendencies are? That needs to be you. Sure it's hard to remodel your personality at the drop of a hat. But these are the rules of this game.

So true..(Although its often discounted on this forum).. I still say at least 50% of this medical saga is about how well you communicate..

Because, it takes time tested know how, experience, good insight and intuition, a fund of knowledge, (if advanced humor and presenting a case in a story form)..[you do not want to put people to sleep] The main thing is to be able to do it -especially when you dont feel like communicating and concisely at the right time..
Also I find part of being a good communicator is knowing when not to communicate

I find that if someone says this is easy they probably dont know how to communicate...

Good communication is work. No doubt about it!! (some may misinterpet and misconstrue what you say)

 

[Doctor Bagel]

We aren't talking about "graduating", we are talking about getting honors, doing well, or at least not being penalized. Pretty much every attending I have come across has rewarded the outspoken folks and penalized the more reserved folks. You don't have to be "arrogant" or obnoxious to be outspoken -- I don't think anyone suggested that was preferred. ("brash and aggressive" was the wording used previously, which doesn't connote arrogance so much as just putting yourself out there, being "forward"). From what I've observed, you absolutely do have to make yourself noticed regularly on rounds. You can do this with more or less tact, but either way, if the attending knows you due to your regular participation and obvious vocal interest, you are going to tend to do better than someone who seems shy and quiet although gets his/her work done. It's unfair, but that's the way subjective grading works. The highly opinionated, always putting in two cents types in fact do get rewarded under this system.

As a fellow med student, it doesn't really matter who annoys you, the attendings do the grading, and their exposure to med students is so limited that someone who makes a lot of noise regularly for the couple of weeks exposure to them tends to stand out positively.

What I meant by graduate is that the quiet types will also be attendings/residents who have the power to grade you.

 

[Blade28]

Remember that when you think you're being "polite" and "not rude" and "introspective," it's perceived by residents and attendings as "disinterested" and "unenthusiastic" and "not a team player."

Just think about that for a second.

 

[mjl1717]

True, also do not be someone who often says "you-know what um sayin", "do you know what Im saying"..
Because if I hear that too much.. I think or say.. I dont know what you are saying because you cant communicate...

main point: there is a fine art to communicating properly! [even when many will say they can to it!]

 

[bigdan]

An attending once told me "Clinical rotations are like a 'play-by-play' in sports: you can tell who the stars are by how many times their names are being called"...it's a terse translation, but if you were being watched by a sportscaster during a routine day on a rotation, would your name be said a lot or not?

dc

 

[Law2Doc]

What I meant by graduate is that the quiet types will also be attendings/residents who have the power to grade you.

As I mentioned above, in my experience even the quieter attendings also seem to prefer the outgoing med students over the ones that you'd think they'd see as younger versions of themselves. I can't explain it, but I've seen it multiple times over now. The world cuts pretty universally one way on this issue.

 

[Law2Doc]

Remember that when you think you're being "polite" and "not rude" and "introspective," it's perceived by residents and attendings as "disinterested" and "unenthusiastic" and "not a team player."

Just think about that for a second.

Exactly.

 

[QofQuimica]

And for the statement that 99.9% of residents and attendings prefer brash outgoing types, I call total BS. The quiet people graduate, too, and loud, overly arrogant types annoy us.

Being assertive or forward doesn't necessarily equate with being arrogant or obnoxious, although sometimes even those are useful traits to have. There are certain personalities who only respect you if you shove them back when they shove you. This can especially be an issue if you're a smaller female, which I am. I had one resident who liked to interrupt the students on rounds during their presentations to the attending. Most students would stop talking and let him talk, so they got sidelined and didn't get to finish their presentations. But I didn't stop talking when he did this to me; instead, I moved closer to the attending, turned my back 3/4 toward the resident, and continued presenting in a louder voice right over him. Not only did he not try to talk over me again, but he gave me a very good eval, and so did the attending. Any objective person would almost certainly say that my behavior crossed the line into being obnoxious, but it was necessary in that context. Fortunately, none of my other residents has been like that!

On a tangent, this strategy of turning toward or away from someone can also be helpful when you have a quiet patient accompanied by an obnoxious family member. If you position your chair so that you are mostly facing the patient and have your back 3/4 turned toward the interrupting family member, it subtlely excludes them from the conversation, and they don't interrupt as much.

I have to agree with those who say that the outgoing med student is going to get the better grade. I would disagree, however, that one needs to be arrogant. You are going into a profession that is filled with type A people. Being confident and assertive are key skills for physicians. Further, you will always do better on evaluations when people like you. The residents may judge you based on the sum of your work and knowledge, but those who really matter are the attendings. Their impression of you is much more superficial. I have very little doubt that my personality and interesting background played a great part in my good grades in clinical rotations. Attendings liked talking to me because being a non-trad I was different than the majority of those who were rotating through.

I agree with this.

 

[Doctor Bagel]

You know, we're not really going to get anywhere here because all of our experiences in clinical rotations are relatively unique to the physicians we work with and the culture at our institutions. I still disagree with the assertion that quiet students are universally screwed or that being overly assertive is always the way to go. I've got to say I also find it interesting that the participants here who are arguing that this is always true are people who are all surgical types, and we all know that's a field where a certain personality type seems to dominate.

Anyway, plainolerichie, good luck in your meeting! I would also try to ask for more specific feedback on what you can work on in your communication style. Try to get away from vague terms like quiet and soft-spoken and find more specifics about what you can actually address.

 

[Law2Doc]

I've got to say I also find it interesting that the participants here who are arguing that this is always true are people who are all surgical types, and we all know that's a field where a certain personality type seems to dominate.

I'm not particularly a surgical type and I still take the "life favors the outgoing" viewpoint. I'd also actually say that being outgoing probably rewards folks at least as much in the rounding oriented fields, where discussion of patients/cases is more frequent. The surgery/ortho form of outgoingness is a bit different -- a bit more boy'sclub/jockish/slap each other on the back kind of outgoingness. In the rounding fields, it's more of a "make yourself heard at the meeting" kind of thing that gets rewarded.

Hey, if your school is different, and allows the meek to inherit the earth, so to speak, then that's great -- I think it probably rewards the right kind of thing, but I have to say I think it's probably a minority experience, based on my own experience and that of peers at a number of schools, not to mention the handful of folks in this thread.

 

[Substance]

I had this same problem during the first few rotations that I took part in.

Granted, these were "team medicine" rotations. I was on a large team with three medicine residents, three other clerks, and the attending-of-the-week.

I'm generally an honorable person, and stick to my personal code of conduct unflinchingly. Thus, when the attending asked a question specifically to another member of the team, I did not interrupt. Also, since I liked everyone on my team, I would not chime in with an answer(most of which I knew) if the person who was asked the question didn't know it: I did not want to show them up, because I thought it was kind of gunnerish to do so. I ended up getting a "fund of knowledge below that of his peers" at the end of the rotation. I refused to sign the evaluation. I'm not a showoff, and I fail to see the correlation between adequate knowledge and blurting out answers when you're something as vestigial to patient care as a medical student. All of my exams were at least 1sd, and many times 2sd above the class mean.

The remainder of my rotations were more one-on-one: derm, emerg, surg, psych, even peds. There I did not feel like I was showing anyone up, so when a question was asked by my supervisor, I answered it. I managed to snag some very high evals on the rest of my rotations as a result.

I find the oneupmanship culture to be extreme on team medicine. Everyone is trying to impress the miserable attendings so that they can get the LOR/eval they need to get into "insert fellowship here". It's ridiculous. This is why I hate doing team medicine - I'd rather not do medicine at all if I had to do team medicine.

 

[Doctor Bagel]

I'm generally an honorable person, and stick to my personal code of conduct unflinchingly. Thus, when the attending asked a question specifically to another member of the team, I did not interrupt. Also, since I liked everyone on my team, I would not chime in with an answer(most of which I knew) if the person who was asked the question didn't know it: I did not want to show them up, because I thought it was kind of gunnerish to do so. I ended up getting a "fund of knowledge below that of his peers" at the end of the rotation. I refused to sign the evaluation. I'm not a showoff, and I fail to see the correlation between adequate knowledge and blurting out answers when you're something as vestigial to patient care as a medical student. All of my exams were at least 1sd, and many times 2sd above the class mean.

This is really a tough one. I basically had the understanding that you don't want to piss the residents off, and a pretty good way to do that is to try to show them up. From my experience (and I haven't done medicine or surgery yet so take it for what it's worth), getting in the residents' good graces is the best way to have a non-miserable rotation and to get a decent evaluation. Also, trying to show up your fellow students is just a straight up crappy thing to do.

 

[Law2Doc]

This is really a tough one. I basically had the understanding that you don't want to piss the residents off, and a pretty good way to do that is to try to show them up. From my experience (and I haven't done medicine or surgery yet so take it for what it's worth), getting in the residents' good graces is the best way to have a non-miserable rotation and to get a decent evaluation. Also, trying to show up your fellow students is just a straight up crappy thing to do.

Yeah, I would say showing people up is not really what we are talking about here. There's a difference between being an active participant -- asking good questions, volunteering things, bringing articles to the attention of the team and not only responding when spoken to versus what you are describing which is jumping in and making residents/fellow students look bad when they are being pimped. You want to be vocal/forward but not show people up -- particularly not people who have a say in your grade. So no, you'd never correct a resident in front of an attending, or jump in and answer a question they missed -- that's bad form. But you certainly can put yourself out there in other ways.

 

[QofQuimica]

You know, we're not really going to get anywhere here because all of our experiences in clinical rotations are relatively unique to the physicians we work with and the culture at our institutions. I still disagree with the assertion that quiet students are universally screwed or that being overly assertive is always the way to go. I've got to say I also find it interesting that the participants here who are arguing that this is always true are people who are all surgical types, and we all know that's a field where a certain personality type seems to dominate.

I think you're kind of setting up a straw man here. No one is saying that "quiet students are universally screwed" or that the only way to be successful is to get up into people's faces. But being assertive (not "overly assertive") is often necessary to get you a good grade. Part of the art of doing well in clinics is reading people and knowing when you need to be more assertive so that people know you're not just trying to get by. Of course it's essential to put forth the effort to learn and do a good job behind the scenes. But you're not going to get an honors if the attending doesn't know that you're working very hard, and in fact mistakenly concludes that you aren't doing as much as the other students. This *does* unfortunately happen to some quiet students.

I also wouldn't really describe myself as a stereotypical surgical personality. I did enjoy surgery, but it's mainly because I was always doing something and not sitting around with my thumb up my rear spending half of every day on rounds. There was also less scut expected of me on surgery, and a lot less call. The residents I had when I was on call were all cool and let me sleep for several hours each call night unless there was something really good going on. Plus, I had an attending and team who let me do a lot in the OR and really went out of the way to make sure I had a good experience. That being said, although I did well in the rotation and had a good experience, I have no desire to enter a surgical field. The rigidity of that kind of schedule and lifestyle is really not for me. Nor do I much like missing so many meals or being unable to use the facilities when nature is calling.

Yeah, I would say showing people up is not really what we are talking about here. There's a difference between being an active participant -- asking good questions, volunteering things, bringing articles to the attention of the team and not only responding when spoken to versus what you are describing which is jumping in and making residents/fellow students look bad when they are being pimped. You want to be vocal/forward but not show people up -- particularly not people who have a say in your grade. So no, you'd never correct a resident in front of an attending, or jump in and answer a question they missed -- that's bad form. But you certainly can put yourself out there in other ways.

Agree. When on a team, it's best to only answer the questions that are directly asked of you, and only answer some of the questions asked of the team in general. You should not ever answer questions that are directly asked of other people, unless they are directly asked of you afterward. This was one of the examples I was talking about earlier when I said that sometimes I have to consciously pull back, especially if I am with other students who are quieter than I am. My favorite teams are the ones where everyone is outgoing and will just shout out answers to questions. It can get a little painful to be constantly having to measure in my head, "ok, I answered the last two questions....I'd better stay quiet for a few minutes now so that someone else can answer an equal number of questions before I jump back in."

 

[plainolerichie]

One thing that I think could be a factor is my appearance. I'm a big, "husky" guy (I've been told I look like a football linebacker/lineman with a face like Kenan Thompson). And I felt that my Ob/Gyn and Peds preceptors did not think I was interested in their fields at all, but a total orthopod/surgeon.

When they asked, "what are your interests" I would say surgery, ER, and possibly Peds because I really liked working with kids (though I have no idea which field I'll go into, but I liked Peds a lot after the rotation). But I think after I'd say "surgery" everything else was ignored. There were several times the preceptors or residents would tell me "you're going into surgery right" when I had only said it was one of my possible interests. For example, the Ob/Gyn director told me after I talked to him about my grade, that he thought I wanted to go into Ortho! I know I never told him that and it's not true!

That and I almost feel that they'd expect a big guy like me to be louder and more assertive than I am so if I am "average" they would perceive it as me being relatively "less" assertive and interested. Anyone think that have some merit?

 

[Mariah246]

the key to success is being an @$$h0!e

I have been a dismal failure since 2nd year ended thanks to my quiet nature.

It's not the easiest thing in the world to change (obviously, or I would have done it) but my advice to any incoming 3rd years is: change. And the quote above isn't such a bad idea.

If I had to redo it (and of I could redo it), I would have genuinely pushed myself to be more jerk than "team player".

 

[Doctor Bagel]

I think you're kind of setting up a straw man here. No one is saying that "quiet students are universally screwed" or that the only way to be successful is to get up into people's faces. But being assertive (not "overly assertive") is often necessary to get you a good grade. Part of the art of doing well in clinics is reading people and knowing when you need to be more assertive so that people know you're not just trying to get by. Of course it's essential to put forth the effort to learn and do a good job behind the scenes. But you're not going to get an honors if the attending doesn't know that you're working very hard, and in fact mistakenly concludes that you aren't doing as much as the other students. This *does* unfortunately happen to some quiet students.

Yeah, you're right. You can be assertive without being obnoxious, and I guess I'm a bit sensitive on this issue because we live in a world where introverts and quiet types are generally devalued. However, I still disagree with the assertion that being quiet is always bad. If that is how you are, you just have to find ways to make that work for you instead of trying to change your basic personality. Overall, I think being quiet is a great asset in dealing with patients -- good listening comes with the whole quiet thing -- and we're observant and in tune to what others are feeling.

 

[Doctor Bagel]

One thing that I think could be a factor is my appearance. I'm a big, "husky" guy (I've been told I look like a football linebacker/lineman with a face like Kenan Thompson). And I felt that my Ob/Gyn and Peds preceptors did not think I was interested in their fields at all, but a total orthopod/surgeon.

When they asked, "what are your interests" I would say surgery, ER, and possibly Peds because I really liked working with kids (though I have no idea which field I'll go into, but I liked Peds a lot after the rotation). But I think after I'd say "surgery" everything else was ignored. There were several times the preceptors or residents would tell me "you're going into surgery right" when I had only said it was one of my possible interests. For example, the Ob/Gyn director told me after I talked to him about my grade, that he thought I wanted to go into Ortho! I know I never told him that and it's not true!

That and I almost feel that they'd expect a big guy like me to be louder and more assertive than I am so if I am "average" they would perceive it as me being relatively "less" assertive and interested. Anyone think that have some merit?

Interesting, and I think you might really be on to something. One thing I've realized is that residents in the non-stud fields are a little sensitive about their areas, and I can see where they're more likely to ding people who they conceive of as thinking they're too good to go into their field. I'm predicting that you'll have less of these issues when you do your surgery rotation. My one suggestion would be to drop the mention of surgery on other rotations (well, except surgery) because you're feeding into their preconceived notions about you based solely on your appearance.

 

[Tiger26]

One thing that I think could be a factor is my appearance. I'm a big, "husky" guy (I've been told I look like a football linebacker/lineman with a face like Kenan Thompson). And I felt that my Ob/Gyn and Peds preceptors did not think I was interested in their fields at all, but a total orthopod/surgeon.

When they asked, "what are your interests" I would say surgery, ER, and possibly Peds because I really liked working with kids (though I have no idea which field I'll go into, but I liked Peds a lot after the rotation). But I think after I'd say "surgery" everything else was ignored. There were several times the preceptors or residents would tell me "you're going into surgery right" when I had only said it was one of my possible interests. For example, the Ob/Gyn director told me after I talked to him about my grade, that he thought I wanted to go into Ortho! I know I never told him that and it's not true!

That and I almost feel that they'd expect a big guy like me to be louder and more assertive than I am so if I am "average" they would perceive it as me being relatively "less" assertive and interested. Anyone think that have some merit?

Same thing here almost exactly--I definitely got the "you're going into ortho right?" comment a few times (I'm not btw) and on my eval they said I frequently appeared "disinterested"

 

[Law2Doc]

Overall, I think being quiet is a great asset in dealing with patients -- good listening comes with the whole quiet thing -- and we're observant and in tune to what others are feeling.

Sure, but the patients don't grade you. I don't think anyone is saying being a quiet, reserved person is a bad trait to have in the abstract, just one that won't serve you well in terms of impressing attendings.

 

[vtucci]

Patients can view being quiet just like attendings- uninterested. You want to have a good rapport with patients and that requires the ability to converse and (at least) appear interested.

Do not piss off the team members be they students, residents or the grand poobah attending. No one likes an a-hole (even the few who manage to rise to the top are often despised by their underlings). You do not need to be a jerk to succeed in third year.

 

[RxnMan]

...I would suggest to all students regardless of personality to ask frequently what you can do to improve...

This is something I've learned from this board. About halfway through all of my rotations I've asked the team (one-to-one, not all at once ) what I could do to improve. I ask explicitly for both positive and negative feedback.

...Show you are committed to doing your best. Bring in journal articles, offer to present on a topic to the team, offer to assist the residents with morning report presentations...

On outpatient, I always see the patient first and present my findings to the attending.

On inpatient, I always present during rounds. Usually I cover two patients, one I've been following, one new to me. I try to understand and flesh out the treatment plan before rounds - ask the intern why we chose this test, why we won't order this one, could they have condition X, etc.

Articles really only come into play when you have a real oddball patient. Usually students are given standard, "meat and potatoes" patients. If anything, I'll look up a patient's condition and talk about it (diagnosis, treatment, prognosis) on a more in-depth level than usual during rounds the next day.

I try to offer to present something every rotation. Sometimes it doesn't work out because of scheduling. Sometimes it's given to me by the attending - "Find out about (insert random drug here) and report to us tomorrow" - and I give a quick 3-minute talk on it. If not assigned something, I'll ask to do a presentation. I've done 10-minute sit-down presentations with .ppts and everything. It never hurts to ask.

On a related note, don't get caught in BS arguments like "why should we take up the resident's time" or "how can we, the students, lecture to the experts (residents)?" No service is too busy to hear a 10 minute presentation on a relevant subject - we're all here to learn, right? And as students we have more time to read about something than residents, so yes, we can prepare an informed lecture on a small topic.

Case in point: The only time I've ever been asked not to do a presentation was by (seriously) lazy classmates.

...Try to engage them on a professional and personal level...

This really comes from being yourself. Once you get past the standard stressful week of adjustment to the new rotation, you know where stuff is and how things flow, and you can relax a little. That's when you have the ability to learn more, talk to your residents and interns. This is also when you can let them learn more about you as a person.

...Always ask what else you can do for the team (esp if you are going to leave early)...

This is a no-brainer. Always ask for work. Usually there is some job that students usually have on a rotation - organizing charts for rounds, updating med lists, etc. Ask what the jobs are (if your friends haven't told you) and do them. Then ask them again before you leave.

 

[RxnMan]

Yeah, you're right. You can be assertive without being obnoxious, and I guess I'm a bit sensitive on this issue because we live in a world where introverts and quiet types are generally devalued. However, I still disagree with the assertion that being quiet is always bad. If that is how you are, you just have to find ways to make that work for you instead of trying to change your basic personality. Overall, I think being quiet is a great asset in dealing with patients -- good listening comes with the whole quiet thing -- and we're observant and in tune to what others are feeling.

I completely agree with the bolded statement. I don't think anyone is advocating that quiet is anything negative, but it is something that one will have to work past in certain situations.

My father, generally a quieter man, is in a business where he has to be on the phone, in meetings, and directing people. He realized his natural tendencies won't get him where he wanted to go (i.e. successful business owner), so he developed his communication skills and cultivated the ability to step outside of his usual mode when needed. No personality change required. Just another skill set, like tying knots one-handed or riding a bike.

 

[QofQuimica]

That and I almost feel that they'd expect a big guy like me to be louder and more assertive than I am so if I am "average" they would perceive it as me being relatively "less" assertive and interested. Anyone think that have some merit?

Maybe. Personally, I think residents and attendings make up their minds about you pretty quickly and there's not much you can say later on that will change their minds. It would be interesting to do a little experiment if you're up to it, especially since it doesn't really matter in the long run (in the sense that you're not likely to see most of these people again).

I started out third year telling people I didn't know what I wanted to do. During surgery I said not medicine, and during medicine I said not surgery. After several months of getting asked this question over and over again, I got tired of it and started telling people that I plan to go directly into research, no residency in anything. (I really am considering doing this, but not 100% set on it.) It hasn't made a bit of difference in how people treat or regard me at all, as far as I can tell. I did have one attending ask me why I was there if I just wanted to do research, and I replied that they wouldn't give me an MD otherwise. No repercussions for that, either. The senior explained that I was an MD/PhD student, and the attending started waxing eloquently about some other MD/PhD student who had been on the team earlier that year. I still got a great eval. Shrug.

This is my long-winded way of saying that I don't think it really matters that much what you tell people. They have their own preconceived notions about you anyway, and they'll hear what they want to hear. But what the heck, try telling the next team that you want to do peds, and see what happens. Maybe I'll start telling people that I want to do ortho. They'll probably say I'm not big enough.

Edit: I was just re-reading this post and thinking, yeah, I am (just a little!) burned out. Christmas can't come soon enough....

 

[Doctor Bagel]

Patients can view being quiet just like attendings- uninterested. You want to have a good rapport with patients and that requires the ability to converse and (at least) appear interested.

I've got to say this statement seems like the usual biased stuff we quiet types get. I'm quiet and still have pretty good communication with patients. I've never gotten any substantive negative feedback from an attending, resident or patient concerning my style of patient interaction. In fact, all the feedback I as a quiet person have gotten in that area has been really quite good. My understanding is that patients complain more about physicians not listening than anything else.

 

[RxnMan]

...This is my long-winded way of saying that I don't think it really matters that much what you tell people. They have their own preconceived notions about you anyway, and they'll hear what they want to hear...

To feed the debate, I have used the "I don't know what I want to go into" line many times, and I definitely get the impression that interns and residents would treat me differently if they knew what I wanted to go into!

On a related note: From my discussions with my school's admin, folks who say things like "I'm going into specialty X, which doesn't have anything to do with this current rotation Y, so I don't need to participate/be a team player/pay attention" get NAILED on their evals. My stance: If you're on a rotation completely unrelated to what you want to do, then remember that it's the last time you'll be doing that type of medicine. So catch that baby or learn how to close, because as an internist, you won't be doing that again.

...Edit: I was just re-reading this post and thinking, yeah, I am (just a little!) burned out. Christmas can't come soon enough....

You were posting something similar in another thread. I know the feeling. Drop me a PM if you want.

 

[DwyaneWade]

You do not have to be loud or obnoxious to be a star on clerkships. You do, however, have to:

1) Read independently on your patients and cases
2) Get involved in every aspect of the team. For example, if you are rounding and then the intern comes up and tells the chief "There's a consult in the ER, BRBPR" suggest a diagnosis off-hand and try to get involved in the thinking process of your superiors. Sense when you need to be quiet and when chiming in is appropriate.
3) Get to know your teammates by asking about their lives away from the hospital; it makes the day go faster if you have something to talk about and in addition to developing a good team dynamic you might make permanent friends.
4) Do not brown-nose to attendings, but answer questions addressed to you, independently start talking about the patients on the floor when you run into them, and ask intelligent questions which you have actual interest in.

EDIT: I agree with Q about being burnt out. Surg plus Med was draining...

 

[vtucci]

I've got to say this statement seems like the usual biased stuff we quiet types get. I'm quiet and still have pretty good communication with patients. I've never gotten any substantive negative feedback from an attending, resident or patient concerning my style of patient interaction. In fact, all the feedback I as a quiet person have gotten in that area has been really quite good. My understanding is that patients complain more about physicians not listening than anything else.

I said they can view it as uninterested not that they will view it as such. Just like they can view someone who is naturally outgoing as in their face, loud, not listening. Everything is a balance and it is about reading people.

You are also assuming that someone who is quiet will more likely listen to what a patient has to say. That is not always the case. Quiet does not by definition equal interested, empathetic, observant, fill-in the blank adjective. Nor does outgoing. There are also some of us whacky outgoing introverts and some whacky quiet extroverts. The introvert/extrovert classification is more about how you derive energy (from being around others or by withdrawing into yourself).

Also, if you feel your evaluations do not adequately reflect what you deserve, sit down with the attending/resident. Try to get them to be more specific about what it is with your more reserved nature that warrants not getting the honors grade. Maybe it is something in your demeanor that you are unaware of- maybe you seem hesitant in offering an assessment and plan and they take this to mean your knowledgebase is not as strong as it really is. I still think the best defense is a good offense and by asking for weekly evals, you can improve your final performance grade (and ask what you can do to move up from a 4 to a 5 on a likert scale- can they give an example)

Have faith-- things often work out in the end.

 

[Blade28]

Good advice above.

I should add that quiet, introverted (or introspective) students don't always get dinged on their evals. What's key is knowing when to pipe up and participate, whether it be on rounds, in the OR, down in the ER, during office visits in clinic, wherever. Being assertive doesn't mean you necessarily have to be brash and terse and obnoxious - you don't want to wander into the realm of "annoying" or "arrogant" or "cocky." It just means you stand up for yourself, have faith and confidence in what you're saying and be able to defend your opinions. You can do this in a respectful, humble, soft-spoken manner.

 

[lil pook]

so there's 2 ways i think of this..

1) screw everyone. be yourself. study hard, ace the shelf, and you should do fine...maybe not honors always, but fine still. Besides, acing shelves is higher yield for the end of the year when you gotta do step 2. what some douchebag thinks of your "personality" means absolutely nothing if you don't know your a@@ from a hole in the wall come the end of 3rd year on that wretched test. if you come from a school that heavily emphasizes clinical evals, then you are SOL and your school really sucks cuz everyone and their damn mother knows 3rd year is the biggest bunch of bull**** ever.

2) you are an actor...3rd year is the scene...douchebag attendings and residents are your audience. trick 'em...wow 'em...be fake and GUSH confindence...who cares? it's all an ACT!!! ya get it? like a poster above said..give em all what they want. you are NOT a student during these rotations....OK? YOU ARE AN ACTOR.

Now go be fake.

 

[lil pook]

let me also add that as a fourth year currently interviewing, i have yet...let me repeat...I HAVE YET to hear an interviewer say to me..."gosh, your 3rd year evals were oustanding"

rather it's like...."wow, what was your secret to getting 99% TWICE on steps 1 and 2?"

as long as nobody bad mouths you on an eval, you will be fine. and being "quiet" is not what i am talking about. "so and so is a lazy ***** who is not a team player, is self absorbed, and has no personality or communication skills"...THAT, my friend, would be a bad eval.

stop worrying about what people think and learn the damn material you are paying the bastards to teach you. that's not to encourage being a douchebad like the examples you will see daily on the wards, but rather I believe success in this situation greatly depends on LEARNING and DOING WELL on the shelves.

3rd year evals are probably important only when it comes to the evals not sucking in regards to the field you want to go into...that, and try not to have any glaringly negative remarks..

 

[Law2Doc]

2) you are an actor...3rd year is the scene...douchebag attendings and residents are your audience. trick 'em...wow 'em...be fake and GUSH confindence...who cares? it's all an ACT!!! ya get it? like a poster above said..give em all what they want. you are NOT a student during these rotations....OK? YOU ARE AN ACTOR.

Now go be fake.

As sad as this sounds, I'm not sure it's as off the mark as the above poster is trying to make it sound. You are playing a part -- of 3rd year clerk. You are expected to play the part to the satisfaction of the higher ups, and if they buy your performance, they give you a good eval -- but if you are too over the top (i.e arrogant/obnoxious), or too quiet, you aren't going to get rave reviews.

 

[153445]

I wish I had approached the clinical years as I would approach having a corporate job ... in the corporate world, being aggressive and proactive will land you promotions. On the wards, the same traits that would allow you to thrive in any career will land you an honors eval.

 

[carrigallen]

I am a medicine resident, and I have done maybe 16 student evals. I look for people who are pleasant, and very involved in management of their patient. The same traits you might look for in a babysitter, parent, whatever.. someone who really looks after their patients. Giving the impression you don't care will make it unlikely to get honors.
Someone who is too entertaining or too garulous can be a turn-off and will annoy people. I will admit someone who smoozes a bit will probably do better that someone who doesn't, if only because people like to be liked. And I couldn't care less what your long-term interests are. I will say, make sure you stay on residents/attendings about filling out your evals. Sending a reminder can be helpful.