EM Away freak out

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Murgencee

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I'm half-way through an away rotation and things have been going really well so far, I've had great feedback and evaluations and my mid-term meeting was really positive. Today I had a shift (in a low-acutuity part of the ED) where I was trying SO hard to be on top of things, help out, jump into cases, be proactive, and at the end of the shift the attending pretty much told me I was horrible. I was shocked, and freaked out, and I've completely lost my mojo. I'm terrified this one shift might destroy me, not only for this rotation, but because I need this away rotation for a SLOE. (I was told I should smile more to seem more interested--that I wasn't "sufficiently acting like a cheerleader" and to "tighten" my presentations, even though every time I tried to see a new patient and asked to present them, the attending or resident would say "Nah, I'm going to see them anyway")

I was really shocked by the feedback today because it was SO different from the positive feedback I've received on every shift so far, and don't know what to do to salvage this. Do I ignore it (half of my evaluators don't turn in evals anyway), do I go to the program director and tell them I had a shift that was a bit off and received some feedback that I wasn't expecting...I probably won't work with this person again, it seems like I'm with someone new every shift (which makes it hard to really adjust because everyone is different).

I feel totally defeated right now, like all of my effort and enthusiasm, and time spend genuinely trying to do my best was a total waste and that my life is ruined and I've destroyed the entire away rotation because of one day. I know that seems like an exaggeration, but when an attending tells you as a visiting student that they are unimpressed and disappointed with you, you kind of want to die.

Ugh- what do I do now?

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I'm half-way through an away rotation and things have been going really well so far, I've had great feedback and evaluations and my mid-term meeting was really positive. Today I had a shift (in a low-acutuity part of the ED) where I was trying SO hard to be on top of things, help out, jump into cases, be proactive, and at the end of the shift the attending pretty much told me I was horrible. I was shocked, and freaked out, and I've completely lost my mojo. I'm terrified this one shift might destroy me, not only for this rotation, but because I need this away rotation for a SLOE. (I was told I should smile more to seem more interested--that I wasn't "sufficiently acting like a cheerleader" and to "tighten" my presentations, even though every time I tried to see a new patient and asked to present them, the attending or resident would say "Nah, I'm going to see them anyway")

I was really shocked by the feedback today because it was SO different from the positive feedback I've received on every shift so far, and don't know what to do to salvage this. Do I ignore it (half of my evaluators don't turn in evals anyway), do I go to the program director and tell them I had a shift that was a bit off and received some feedback that I wasn't expecting...I probably won't work with this person again, it seems like I'm with someone new every shift (which makes it hard to really adjust because everyone is different).

I feel totally defeated right now, like all of my effort and enthusiasm, and time spend genuinely trying to do my best was a total waste and that my life is ruined and I've destroyed the entire away rotation because of one day. I know that seems like an exaggeration, but when an attending tells you as a visiting student that they are unimpressed and disappointed with you, you kind of want to die.

Ugh- what do I do now?

If all the rest of your shifts have been good and you've been getting positive feedback, shrug this one off. Everyone is allowed to have a ****ty shift. If all of your shifts are looking like this, then yeah, I'd start worrying at that point.
 
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I'm half-way through an away rotation and things have been going really well so far, I've had great feedback and evaluations and my mid-term meeting was really positive. Today I had a shift (in a low-acutuity part of the ED) where I was trying SO hard to be on top of things, help out, jump into cases, be proactive, and at the end of the shift the attending pretty much told me I was horrible. I was shocked, and freaked out, and I've completely lost my mojo. I'm terrified this one shift might destroy me, not only for this rotation, but because I need this away rotation for a SLOE. (I was told I should smile more to seem more interested--that I wasn't "sufficiently acting like a cheerleader" and to "tighten" my presentations, even though every time I tried to see a new patient and asked to present them, the attending or resident would say "Nah, I'm going to see them anyway")

I was really shocked by the feedback today because it was SO different from the positive feedback I've received on every shift so far, and don't know what to do to salvage this. Do I ignore it (half of my evaluators don't turn in evals anyway), do I go to the program director and tell them I had a shift that was a bit off and received some feedback that I wasn't expecting...I probably won't work with this person again, it seems like I'm with someone new every shift (which makes it hard to really adjust because everyone is different).

I feel totally defeated right now, like all of my effort and enthusiasm, and time spend genuinely trying to do my best was a total waste and that my life is ruined and I've destroyed the entire away rotation because of one day. I know that seems like an exaggeration, but when an attending tells you as a visiting student that they are unimpressed and disappointed with you, you kind of want to die.

Ugh- what do I do now?

Just relax and try to make something positive about their feedback. There are always outliers on either end of the attending spectrum - both the kind of cranky and the excessively effusive - maybe this one was on one end. It can't all be perfect all the time and it sounds like they had some useful input in terms of how other people perceive you. If you have the "opportunity" to work with this person again, ask them exactly what they mean by "tighten." Politely ask for actionable feedback on how you can improve and if they can't offer anything, smile, say thanks, and realize maybe they are just a douche.
 
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Not everyone is going to like you. This is particularly true with the challenges of an away rotation. If it makes you feel better I had a disastrous shift with a physician well known to everyone reading this sentence. Moral of the story: everyone else liked me and I have moved on with my life ¯\_(ツ)_/¯
 
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Thanks guys- I'm gutted but trying to find a way to put on my best cheerleader face so I can smile my way through the next shift. My confidence has taken a huge hit but I guess my best bet is to just try to smile and fake it till I get back some game. On the plus side, I guess if everything goes tits up, I'll just move to Thailand and be a scuba instructor ;)
 
At one of my aways, I had a particularly nasty attending.

Needless to say, I strove to staff with other attendings after that whenever given the chance. Once was enough.

You will overcome this, no biggie.
 
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On my first away last year, my attending on my first shift gave me a rather painful evaluation. I switched out of the only other shift I was scheduled to work with him, and I magically didn't get any more bad evals on that rotation. While it may have been me that shift, and it may have been you on your shift, sometimes it's somebody else's problem. I fully understand the devastated feeling, though. I am really happy to no longer be playing the med student game. But next shift's a brand new shift working with somebody else. Take some deep breaths, get some rest, and keep working hard.
 
I'm gutted but trying to find a way to put on my best cheerleader face so I can smile my way through the next shift.
Bruh... chill. It's a bad eval not your mom dying.
 
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I'm half-way through an away rotation and things have been going really well so far, I've had great feedback and evaluations and my mid-term meeting was really positive. Today I had a shift (in a low-acutuity part of the ED) where I was trying SO hard to be on top of things, help out, jump into cases, be proactive, and at the end of the shift the attending pretty much told me I was horrible. I was shocked, and freaked out, and I've completely lost my mojo. I'm terrified this one shift might destroy me, not only for this rotation, but because I need this away rotation for a SLOE. (I was told I should smile more to seem more interested--that I wasn't "sufficiently acting like a cheerleader" and to "tighten" my presentations, even though every time I tried to see a new patient and asked to present them, the attending or resident would say "Nah, I'm going to see them anyway")

I was really shocked by the feedback today because it was SO different from the positive feedback I've received on every shift so far, and don't know what to do to salvage this. Do I ignore it (half of my evaluators don't turn in evals anyway), do I go to the program director and tell them I had a shift that was a bit off and received some feedback that I wasn't expecting...I probably won't work with this person again, it seems like I'm with someone new every shift (which makes it hard to really adjust because everyone is different).

I feel totally defeated right now, like all of my effort and enthusiasm, and time spend genuinely trying to do my best was a total waste and that my life is ruined and I've destroyed the entire away rotation because of one day. I know that seems like an exaggeration, but when an attending tells you as a visiting student that they are unimpressed and disappointed with you, you kind of want to die.

Ugh- what do I do now?

Can't win em all dude
I've had some attendings tell me that I'm awesome and that they wish I was going into EM while others won't listen to a thing I say and treat me like dirt. Just how it is.
 
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Bruh... chill. It's a bad eval not your mom dying.
apparently you have not been through this. Your comment is very insensitive. His residency application may depend on this "one bad eval". The system is horse**** but its what we have. Its extremely stressful. OP youll do fine, there is always some truth to negative evaluations, try to take something constructive out of it.


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If the attending is a notorious ass hole, then the evaluation will be looked at with that in mind, especially in a sea of otherwise good evaluations.

Try to do some shifts with the PD/aPD if possible. Their opinions will matter the most.

Also despite what the attending thinks, the resident opinion of you can carry a lot of weight as well. If I think I've been with a particularly outstanding student, I'll contact the PDs and chief residents and tell them so directly (though that does not happen often)
 
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apparently you have not been through this. Your comment is very insensitive. His residency application may depend on this "one bad eval". The system is horse**** but its what we have. Its extremely stressful. OP youll do fine, there is always some truth to negative evaluations, try to take something constructive out of it.


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Apparently you didn't read my post above.
 
Been there, done that... fortunately, the PD was awesome, wrote me a beautiful SLOE and everyone knew that particular attending was crazy anyway. I even heard said attending talking about me to nursing staff and then a loud "shushhhh" when I rounded the corner . I ended up ranking that program further down my list due to that person (like nearly last). Have no regrets and glad I didn't end up there to suffer with that person for 4 years (especially now that the PD I really liked is leaving the program!). Just keep truckin', you'll be alright!
 
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This sucks. I saw a fellow med student be chewed up for not being "enthusiastic" enough during a presentation. Even if your gut tells you to want to punch this person for being rude and crushing your dream, try to save it. ASK specifically what could you do to improve on presentation, overall work or communication. Every attending is different, do NOT take things personal. Say that you wish you get a chance to work with him in the future and that you are thankful for the feedback. I know you don't feel like doing these things, but we gotta keep it together, and professional, and rise above it. Next shifts, with him or anyone else, ask them to give you some feedback after a couple presentations. People appreciate that you put some thought into knowing how you come across and how you could improve. Good luck.
 
You will get bad evals.
People will not like you.

This happens.
Not much you can do about it.

Many, if not most, students are not any good.
The reason, they have no experience.

Some attendings have totally forgotten what it is like to be in that position.
Usually these docs give everyone a hard time and bad evals.

The other faculty know who these people are and usually take this into account.

But still listen to the feedback and use it to improve if possible.
 
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Now I can't get the image of med students as cheerleaders out of my head. "Kayexalate who do you appreciate!!" "Bring the noise, DKA!"
 
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The system is engineered to work against you.

How can a visiting Sub-I (or even someone on their home sub-I) manage to:
a) learn the EMR
b) learn the culture
c) appear smart
d) appear enthusiastic
e) not piss off people whom you are essentially creating more work for by virtue of you being there?

Honestly, who am I to stand in a medical student's way of achieving their desired career? Certainly not me, and certainly not any other sort of subjective evaluation. You have enough to worry about with USMLEs, etc. Objective evaluations and interviews will take care of the selection process.

I evaluate students on 3 criteria:
1) You showed up and weren't late. If you didn't show up, I wouldn't have known.
2) You displayed some kind of interest. Low bar here. Like I asked you to see a patient or to repair a lac and you complied.
3) You didn't say/do anything overtly unprofessional / racist / sexist / classist / etc.

I just filled out 3 Sub - I evaluations. I gave them all whatever the top grade is. "Consistently and amazingly performed history and physical examination".....blah blah blah yada yada yada. Who cares? Not me. Let's start bringing people up instead of knocking them down.
 
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The system is engineered to work against you.

How can a visiting Sub-I (or even someone on their home sub-I) manage to:
a) learn the EMR
b) learn the culture
c) appear smart
d) appear enthusiastic
e) not piss off people whom you are essentially creating more work for by virtue of you being there?

Honestly, who am I to stand in a medical student's way of achieving their desired career? Certainly not me, and certainly not any other sort of subjective evaluation. You have enough to worry about with USMLEs, etc. Objective evaluations and interviews will take care of the selection process.

I evaluate students on 3 criteria:
1) You showed up and weren't late. If you didn't show up, I wouldn't have known.
2) You displayed some kind of interest. Low bar here. Like I asked you to see a patient or to repair a lac and you complied.
3) You didn't say/do anything overtly unprofessional / racist / sexist / classist / etc.

I just filled out 3 Sub - I evaluations. I gave them all whatever the top grade is. "Consistently and amazingly performed history and physical examination".....blah blah blah yada yada yada. Who cares? Not me. Let's start bringing people up instead of knocking them down.

Honestly, I think you are doing yourself, your program, your students, and the specialty a disservice. I do not think that it is that difficult for almost anyone to do a through e on your list. We should expect more of our future colleagues.

I agree that things likes Steps and interviews play important roles in the selection process, but how is an interview less subjective than an 8 - 12 hour rotation, repeated multiple times over the course of a month? I think rotations/auditions give the students a chance to move beyond a short 15min assessment where there is certainly a power imbalance to a scenario where they have a lot more ability to positively (or negatively) influence how others perceive them.

By giving everyone the same grade, you are essentially lowering the bar. You are taking away from the most talented and motivated students to benefit those at the very bottom. Are those really the types of people you want in your program and your specialty? I think it is important that we don't harm the futures of rotating students, but I think it is also important that we help all students find the right spot for them.
 
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Honestly, I think you are doing yourself, your program, your students, and the specialty a disservice. I do not think that it is that difficult for almost anyone to do a through e on your list. We should expect more of our future colleagues.

I agree that things likes Steps and interviews play important roles in the selection process, but how is an interview less subjective than an 8 - 12 hour rotation, repeated multiple times over the course of a month? I think rotations/auditions give the students a chance to move beyond a short 15min assessment where there is certainly a power imbalance to a scenario where they have a lot more ability to positively (or negatively) influence how others perceive them.

By giving everyone the same grade, you are essentially lowering the bar. You are taking away from the most talented and motivated students to benefit those at the very bottom. Are those really the types of people you want in your program and your specialty? I think it is important that we don't harm the futures of rotating students, but I think it is also important that we help all students find the right spot for them.

I see your point for sure, and it's a good one. However, it's hard for medical students to show up on day one and just be "on." Maybe this rotation is their first away rotation (btw, it seemed like all our sub-Is this year were being counseled to do not 1 but 2 away rotations! Times have changed...) or maybe they haven't even had a chance to do their home rotation due to do scheduling issues, etc. Why should X student be favored over Y student simply because this is their 3rd rotation compared to the other's 1st. I've seen too many instances where students were judged to be "AMAZING" when I thought they were "fine" and "AWFUL" when I thought they were "fine" just because of the whim of whatever attending was evaluating them. In my opinion, most people likely regress towards the mean and 1-2 shifts with me isn't going to allow me to truly discern what they will be like as a resident - and ya know what, if we accept what turns out to be a "poor" resident, if they work hard they will regress towards the mean as well. Granted, if I think someone is truly amazing (like they show up with PGY2 skills) or truly awful (literally have ZERO idea of what's going on, disinterested, aloof) I will report back on that.
 
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Or, you know, we could actually let students act like interns instead of evaluating them based on how good they are at M3-style "hang out and kiss my ass"
 
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Or, you know, we could actually let students act like interns instead of evaluating them based on how good they are at M3-style "hang out and kiss my ass"
This is what I do, and I make it very clear that I'm doing so.

Be useful & interested, and try to act like a doctor. Make decisions - I want them to commit to a course of action, even if wrong. I can get an H&P faster myself & with more relevance... it's the MDM & follow through I'm more interested in.

Just don't piss off my nurses. d=)

Semper Brunneis Pallium
 
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I see your point for sure, and it's a good one. However, it's hard for medical students to show up on day one and just be "on." Maybe this rotation is their first away rotation (btw, it seemed like all our sub-Is this year were being counseled to do not 1 but 2 away rotations! Times have changed...) or maybe they haven't even had a chance to do their home rotation due to do scheduling issues, etc. Why should X student be favored over Y student simply because this is their 3rd rotation compared to the other's 1st. I've seen too many instances where students were judged to be "AMAZING" when I thought they were "fine" and "AWFUL" when I thought they were "fine" just because of the whim of whatever attending was evaluating them. In my opinion, most people likely regress towards the mean and 1-2 shifts with me isn't going to allow me to truly discern what they will be like as a resident - and ya know what, if we accept what turns out to be a "poor" resident, if they work hard they will regress towards the mean as well. Granted, if I think someone is truly amazing (like they show up with PGY2 skills) or truly awful (literally have ZERO idea of what's going on, disinterested, aloof) I will report back on that.

It is true that a student with more rotations will likely feel more comfortable than one that has never been in the ED. That is why I always ask (as my attendings did for me) if they have rotated through the ED before and scale my expectations accordingly. I think what is more important is their attitude, not what they already know from other rotations (or their prior career if they were a former nurse, PA, paramedic, etc). I think that the traits @Daiphon hit on are more important than being particularly intelligent.

Even single evals are important - they show something about someone in a slice of time - perhaps they were having a bad day so they'll have one eval where they weren't particularly impressive; alternatively, they could be consistent and reliable so every eval of them, regardless of who is writing it, says the same thing - that is important information and tells a lot about someone. I think it is important to be as honest as possible; just because your experience isn't the same as others doesn't mean the whole process is worthless.
 
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scale expectations? lmao. more doublespeak for "fake" subinternships

1) let students manage patients (i.e. put in orders without having to listen to ressies bitch about signing them)
2) cut the chit chat, have actual substantive conversations about medicine
3) mandatory eval at end of shift = how close was this person to being ready to roll as an intern?

EZ. I just fixed SLOEs. You're welcome.
 
scale expectations? lmao. more doublespeak for "fake" subinternships

1) let students manage patients (i.e. put in orders without having to listen to ressies bitch about signing them)
2) cut the chit chat, have actual substantive conversations about medicine
3) mandatory eval at end of shift = how close was this person to being ready to roll as an intern?

EZ. I just fixed SLOEs. You're welcome.

I'm not sure how you're able to judge how I interact over the webs, but congrats on being bitter.

I don't think there is a problem with SLOEs. I think there is a problem with whiny people. At my program, we expect our students to act as interns (granted, we do have some systems issues about student EMR access which we solve on the ground, but nowhere is perfect) and most of us try to offer end of shift feedback.

FWIW, chit-chat is important, because that is what normal people do at work with their colleagues.
 
The problem with SLOEs are attendings who eval everyone the exact same. Or the attendings who can't give me feedback at the end of shift when I ask, but have no problem giving me (and every other medical student) straight 3s on the online eval.

Then there are the attendings that don't fill out a shift eval at all, that's a whole other problem though.
 
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The problem with SLOEs are attendings who eval everyone the exact same. Or the attendings who can't give me feedback at the end of shift when I ask, but have no problem giving me (and every other medical student) straight 3s on the online eval.

Then there are the attendings that don't fill out a shift eval at all, that's a whole other problem though.

I totally agree, which was supposed to be my point in post #19. I just hope that all of you frustrated medical students remember this when it is your turn to write evals as residents and attendings - the process will always be imperfect, but is is only as good as the effort we put into it. You guys deserve to have fair and thoughtful assessments of your performance, although it doesn't always mean that the assessment will be positive.
 
I totally agree, which was supposed to be my point in post #19. I just hope that all of you frustrated medical students remember this when it is your turn to write evals as residents and attendings - the process will always be imperfect, but is is only as good as the effort we put into it. You guys deserve to have fair and thoughtful assessments of your performance, although it doesn't always mean that the assessment will be positive.
Yeah, I'm all for a fair assessment. I want to be better. A poor assessment with no comments is one of the most frustrating things about rotations, it's something that I will never do to the future students that I'm evaluating.
 
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I had a similar situation last year. Got wonderful feedback on all my shifts, and then bang, a negative eval in the middle of the month by one attending. It ruined my confidence. "Plans were incomplete, presentations were too short", etc.

I'm now a resident at said program. I've worked with the same attending multiple times since and he is one of my favorites. In fact, everybody loves him. Looking back, he was 100% correct. I was overconfident and I shortened my presentations because I thought I "earned" it. The truth is I didn't "earn" anything. I was still a visiting med student and I had to work for respect every shift. He called me out on it. No hard feelings.

It sounds like some of the criticism might be over the top (acting like a "cheerleader"), but maybe some of it is valid (Tighten your presentations)? Did you really bring your A game today? Were all of your presentations perfect? Were you as proactive as you could have been? Did you perform at the level of a Resident? You're allowed to have a bad day, it doesn't make you a bad student, and I highly doubt it will have any impact on your SLOE.

The point is; reevaluate, stay humble, and then brush it off as necessary. Have a cold beer, get a good nights sleep, and use it for motivation. Best of luck!
 
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I'd honestly be interested in figuring out ways to be better at teaching the med students during ER shifts. I find it easier on medicine blocks because I work with the same med students for several weeks and have time to work on things like presentation skills and discuss specific topics.

It's a lot harder in the ED to do that. At our place, the med student reports to (the usually single) resident in the pod. So I'm trying to keep up with my patients, I give the student patients to see, and I try to throw in teaching points when I'm able to, but when it comes to needing to completely refine presentations, or explaining why the 84 yo with htn, hld, DM, ESRD is going to get admitted for their left shoulder pain, I don't feel like I have the full time to devote to it. Sometimes I'd rather get my charting done
 
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