Help with clinical grades

[HereWeGo21]

Hey guys,
Despite my efforts, my clinical grades have been fairly middling (50th-60th percentiles). For those who have gotten very good clinical grades, can you offer any advice?

I haven't particularly not gotten along with anyone, except for very rare cases. Rather, I just seem to have a hard time breaking out. I got a very high step 1 score, but I'm rarely asked about physiology and stuff, or anything for that matter. Pimping is honestly a blessing for me. But in the absence of it, what am I supposed to do? I'm not an introvert either. But to what degree am I supposed to be obsequious to my superiors? Really, it seems to me like a battle to get their attention. Thoughts?

BTW my shelf scores have been excellent.

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[DocWinter]

If you're getting excellent shelf exams, I assume you're getting poor grades from your preceptors.

What is the feedback they give you on your evaluation?

IMO clinical grades from preceptors are largely centered on how well they like you, find you teachable and your ability to get along with the staff. I honestly believe they're not terribly impressed with grades, knowledge or pimping responses.

 

[operaman]

Clinical grades in medical school simply tell how much you were liked, nothing more, nothing less. Sounds like you're doing a decent job on that front - at least better than half your class is doing. Stepping it up further is a multi-factorial process. Things to consider:

1) Come early, stay late. This is the sine qua non of being a good student and even a good intern and junior resident. Seems like most students have a habit of disappearing until late in the day when you get a text asking if they can help with anything. Find ways to help the team -- usually those ways come early in the morning.
2) You will be known by your presentations. Maybe this should be number 1. Nobody will ever remember how you did with pimping; they will remember the quality of your presentations. What is considered "good" will vary widely between rotations -- give a 20 second surgery presentation on medicine rounds and you'll likely suffer the same fate as you would giving a 5-10 minute medicine presentation on surgery rounds. Figure out what is important and what isn't for the particular service you're on. Be thorough in gathering information and concise in relating it. Always end your presentations by clearly stating your plan. Most students seem to skip this part or at least hem and haw and equivocate for fear of being wrong. Just make a plan and state it; nobody expects you to be right all the time.
3) Don't ever lie. It amazes me how frequently people fudge the truth and how easy it is to sniff it out. If you didn't ask something or don't know something, just say so.
4) Watch your body language. Most students trail behind the herd; try and plant yourself in the circle at all times. Write down everything about every patient just like the interns are doing. If the chief or attending is talking, your pen should be moving, even if it isn't your patient. Not only is this a subtle and non-annoying way to appear more engaged, but it will also leave you with a sense of what needs doing for the day. Then, rather than asking if there's anything you can help with, you can be specific and ask if you can go pull that drain or that line or fetch that imaging or call for those outside records.

It's interesting being on the other side now and perhaps even harder to say what makes a great student. What I've noticed more than anything else is how when a student is really good, I start relying on him or her as though they were another resident. There isn't any conscious thought about it, I simply have a gut sense that I can trust them a little more and rely on them. My guess is that this gestalt is derived from dozens of subtle things, any one of which would seem laughably inconsequential, but taken as a whole make the difference between someone who is simply shadowing and someone who is actively involved and helping the team.

 

[Psai]

Clinical grades in medical school simply tell how much you were liked, nothing more, nothing less. Sounds like you're doing a decent job on that front - at least better than half your class is doing. Stepping it up further is a multi-factorial process. Things to consider:

1) Come early, stay late. This is the sine qua non of being a good student and even a good intern and junior resident. Seems like most students have a habit of disappearing until late in the day when you get a text asking if they can help with anything. Find ways to help the team -- usually those ways come early in the morning.
2) You will be known by your presentations. Maybe this should be number 1. Nobody will ever remember how you did with pimping; they will remember the quality of your presentations. What is considered "good" will vary widely between rotations -- give a 20 second surgery presentation on medicine rounds and you'll likely suffer the same fate as you would giving a 5-10 minute medicine presentation on surgery rounds. Figure out what is important and what isn't for the particular service you're on. Be thorough in gathering information and concise in relating it. Always end your presentations by clearly stating your plan. Most students seem to skip this part or at least hem and haw and equivocate for fear of being wrong. Just make a plan and state it; nobody expects you to be right all the time.
3) Don't ever lie. It amazes me how frequently people fudge the truth and how easy it is to sniff it out. If you didn't ask something or don't know something, just say so.
4) Watch your body language. Most students trail behind the herd; try and plant yourself in the circle at all times. Write down everything about every patient just like the interns are doing. If the chief or attending is talking, your pen should be moving, even if it isn't your patient. Not only is this a subtle and non-annoying way to appear more engaged, but it will also leave you with a sense of what needs doing for the day. Then, rather than asking if there's anything you can help with, you can be specific and ask if you can go pull that drain or that line or fetch that imaging or call for those outside records.

It's interesting being on the other side now and perhaps even harder to say what makes a great student. What I've noticed more than anything else is how when a student is really good, I start relying on him or her as though they were another resident. There isn't any conscious thought about it, I simply have a gut sense that I can trust them a little more and rely on them. My guess is that this gestalt is derived from dozens of subtle things, any one of which would seem laughably inconsequential, but taken as a whole make the difference between someone who is simply shadowing and someone who is actively involved and helping the team.

Yeah this is so true, most students are meh but I had one person who was really great, knew exactly what to do and was basically like another intern. The other students basically wrote notes and that was it but this person called consults, did the work, made my life easier. I didn't have to ask them to do anything, they just knew. The notes were way better too, I barely had to change anything. I'm not sure what made the difference but I just trusted them instinctively. Felt really bad when there was a procedure coming my way and I wanted them to get to do it but was too selfish

 

[Andeve33]

Clinical grades in medical school simply tell how much you were liked, nothing more, nothing less.

About this... kinda agree... although it is not always like that but I think that it is in most cases.

 

[NWwildcat2013]

Hey guys,
Despite my efforts, my clinical grades have been fairly middling (50th-60th percentiles). For those who have gotten very good clinical grades, can you offer any advice?

I haven't particularly not gotten along with anyone, except for very rare cases. Rather, I just seem to have a hard time breaking out. I got a very high step 1 score, but I'm rarely asked about physiology and stuff, or anything for that matter. Pimping is honestly a blessing for me. But in the absence of it, what am I supposed to do? I'm not an introvert either. But to what degree am I supposed to be obsequious to my superiors? Really, it seems to me like a battle to get their attention. Thoughts?

BTW my shelf scores have been excellent.

Its a different formula at every school, but I guess Ill tell you what I have done on rotations I honored. For us the shelf is usually the majority (usually 60%) but this varies from rotation to rotation. Since its always the most important thing I treat it as such. The shelf is an objective and beatable way to solidify your way to a good grade.

For the rest you need to just not be weird. You know, I don't ever prepare for of care about pimping. I don't think attendings really care if you get it right but if you get it wrong I think they care whether you are interested in the answer. I carry a notebook and am writing stuff down on rounds that seem to be points I could use in the future. Just be engaged and likeable. Go to lunch with the team and make small talk. I try not to talk about "What do you like about [insert specialty]?" If my team starts talking about the NBA finals or one resident talks about their upcoming trip then I roll with it. Those conversations are normal and residents probably get sick of every med student asking "Why did you choose [insert specialty]?" Basically know when to be academically engaged and when to switch to just chilling. The fact that you are thinking about how to "get their attention" tells me you might be trying too hard. If they don't pimp you then show up, work hard, know your patients and participate in small talk and social activities when it happens.