Struggling with subjective clinical grades. Impact on competitive specialty?

[ccuc2020]

I recently received high pass on my first three rotations, despite doing well on shelfs (which count for <10% of the grade, so pretty useless), and getting nothing but positive comments during rotations and on evals. I consistently solicited feedback during rotations, and I always got the "you're doing great, keep up the good work", but then some how still end up with 3/4 for most categories. I consider myself a pretty easy going person. I get along with the residents, I show engagement/ask questions when appropriate, and I try my best to be an asset to the team. I don't know what more I can be doing.

I'm having somewhat of career crisis, since my plan was to apply into ENT, but that is looking less likely with my grades. For background, I attend a T10 school. Roughly 30% honor any given rotation, with the rest receiving high pass. My research is solid (couple of pubs with more to come), and I know a couple of attendings in my home department. I'm going to study my butt off for step 2 given p/f step 1, and I hope that can make up for my poor clinical grades.

I'm very concerned that this trend continues and that I end up with all high passes. I'm not really sure what to do career-wise if that happens. Some people have said dual apply with general surgery as a backup, which is definitely an option, but I just don't know if I'd be happy if that were the case. Would getting all high-passes be a death sentence for ENT, even if I apply broadly and do aways at less well-known programs?

Regarding clinical grades, what else can I do to maximize my chances of honoring my remaining rotations? I've heard from classmates that some residents give out 4s to everyone, whereas some never give 4s. Is my future really up to random luck based on who evaluates me? This year has been nothing but frustrating, and I'd greatly appreciate any advice.

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[GoSpursGo]

HP is not "poor." I know everything matters when it comes to a highly competitive specialty, but especially coming from a T10 I would not worry about a few HPs. Your step 2 score and your research/letters do become that much more important though.

It's asinine that they are having the residents directly grade you rather than the attendings. There's not a ton you can do about it, but keep doing what you're doing, and if anyone asks how the evals translate into grades don't hesitate to let them know that you basically need 4s to get honors. That isn't how anyone should design a grading system, but if it's the truth then so be it.

 

[Dral]

I'd say just keep doing your best and don't get any negative comments. While clerkship grades matter, we all understand that different schools do it differently. When I'm reviewing apps (competitive specialty) I mainly am looking for a standout red flag. If I don't see any, then I'm pretty satisfied that the person has solid clinical abilities. While all honors will certainly make someone stand out, it's rare to see that.

I got a bunch of interviews back in the day with a mix of grades on clerkships. Granted, the step I change could affect things a bit, but again, just do your best.

You may want to pay special attention to surgery, IM, and your specialty field rotation for honors. Most of the time, competitive specialty fields have 'gotten the memo' about honors so to speak. If you tell them that is the field you are interested in, they'll typically honor anyone as long as they are appropriately engaged and don't mess up during the rotation.

 

[throwaway123342]

You are coming from a T10. Your main concern is whether your home program supports you. If so, you will go far. Oh, and step 2.

 

[ccuc2020]

I'd say just keep doing your best and don't get any negative comments. While clerkship grades matter, we all understand that different schools do it differently. When I'm reviewing apps (competitive specialty) I mainly am looking for a standout red flag. If I don't see any, then I'm pretty satisfied that the person has solid clinical abilities. While all honors will certainly make someone stand out, it's rare to see that.

I got a bunch of interviews back in the day with a mix of grades on clerkships. Granted, the step I change could affect things a bit, but again, just do your best.

You may want to pay special attention to surgery, IM, and your specialty field rotation for honors. Most of the time, competitive specialty fields have 'gotten the memo' about honors so to speak. If you tell them that is the field you are interested in, they'll typically honor anyone as long as they are appropriately engaged and don't mess up during the rotation.

Thanks for your response. ENT isn't one of the core graded rotations, but are you saying that when I'm on surgery, I tell them that I'm interested in surgery so that they give me honors? I guess I'm still unsure what to tell residents/attendings when they ask what I'm interested in. For example, if I'm on psych and the resident asks, should I say that I'm open minded, or be honest and say I'm interested in ENT.

You are coming from a T10. Your main concern is whether your home program supports you. If so, you will go far. Oh, and step 2.

Hopefully. I've been trying my best to network within the department and meet people through projects. Just worried that even my home program won't want me with no honors.

 

[Redpancreas]

I recently received high pass on my first three rotations, despite doing well on shelfs (which count for <10% of the grade, so pretty useless), and getting nothing but positive comments during rotations and on evals. I consistently solicited feedback during rotations, and I always got the "you're doing great, keep up the good work", but then some how still end up with 3/4 for most categories. I consider myself a pretty easy going person. I get along with the residents, I show engagement/ask questions when appropriate, and I try my best to be an asset to the team. I don't know what more I can be doing.

I'm having somewhat of career crisis, since my plan was to apply into ENT, but that is looking less likely with my grades. For background, I attend a T10 school. Roughly 30% honor any given rotation, with the rest receiving high pass. My research is solid (couple of pubs with more to come), and I know a couple of attendings in my home department. I'm going to study my butt off for step 2 given p/f step 1, and I hope that can make up for my poor clinical grades.

I'm very concerned that this trend continues and that I end up with all high passes. I'm not really sure what to do career-wise if that happens. Some people have said dual apply with general surgery as a backup, which is definitely an option, but I just don't know if I'd be happy if that were the case. Would getting all high-passes be a death sentence for ENT, even if I apply broadly and do aways at less well-known programs?

Regarding clinical grades, what else can I do to maximize my chances of honoring my remaining rotations? I've heard from classmates that some residents give out 4s to everyone, whereas some never give 4s. Is my future really up to random luck based on who evaluates me? This year has been nothing but frustrating, and I'd greatly appreciate any advice.

There are people out there getting 4s, who knows how they do it. Maybe they have prior clinical experience, maybe they are sitting there memorizing Harrison's, who knows. You seem to have hit a ceiling out of your control. Things within your control include Step 2, research, and away performance. Maximize those! Stay Calm and Carry On.

 

[Browns99]

You are coming from a T10. Your main concern is whether your home program supports you. If so, you will go far. Oh, and step 2.

Not true, with the competitiveness of otolaryngology, op needs to continue with research, continue giving their best on their clinical, secure excellent letters from well-known physicians in the field and do well on step 2.

I agree that coming from a T10 will help, but it will not guarantee anything. Of course you need a letter from your programs chair, so yes, it is important that they support you.

To the OP, best of luck....take a deep breath, continue working hard and you will be fine. Try and see what the comments were that determined a HP vs H. Like the poster above said, a few HP from a T10 school is not going to hurt you, but, if there is something you were consistently doing wrong that you did not realize and it shows in the comments across the three rotations that you received HPs in , then you can make the necessary adjustments moving forward.

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[Dral]

Thanks for your response. ENT isn't one of the core graded rotations, but are you saying that when I'm on surgery, I tell them that I'm interested in surgery so that they give me honors? I guess I'm still unsure what to tell residents/attendings when they ask what I'm interested in. For example, if I'm on psych and the resident asks, should I say that I'm open minded, or be honest and say I'm interested in ENT.

Nah. On your core rotations, just be honest. Psych residents know that not everyone wants to do psych. Just say something like "I'm interested in ENT, but not totally decided yet". Residents ask you as small talk, not to judge you (as least the normal ones). It's like a freshman asking another freshman at college what their major is and where they are from.

During your core, just do the same thing. Be honest. For surgery core rotation, don't expect honors just because you told them you are interested in a surgical field.

I was referring specifically to the specialty itself (ENT) in terms of the honors part:

In general, when people do their Derm rotation, if the student says they are going into derm (and again, do a good job and don't mess anything up), the program will a lot of times give that student honors because they know that's how the game is played (programs you apply to for residency want to see honors in the rotation you're interested in pursuing).

So for that part, I was specifically referring to an ENT rotation. I'm not sure if they work the same was as Derm, but as a competitive field as well, we might assume they do, meaning that if you tell them you are applying ENT, do a good job, don't mess anything up, and are likable...I would think there would be a relatively high chance of getting honors for that rotation...whereas on your surgical core, the same level of performance might just net you high pass...or maybe honors, it depends.

 

[operaman]

Yes the all HP is a slight ding but not insurmountable. I think the only rotation where not getting honors is a death sentence would be your ENT sub-i.

Hard to say what your issue is in not getting honors. There’s some randomness to clinical grades but at this point there’s something you’re doing consistently to miss out on the H. It’s hard to get truly good feedback but do try and find someone who knows you and could tell you honestly what’s happening. It’s obviously nothing egregious but it would be nice to know before your sub-I.

ENT competition is getting insane. Not sure if it’s going to continue like this or if we will see a correction like we did a few years ago when we went from 70% match rate to more slots than applicants in 2 cycles. And now here we are back to 61% match rate this last cycle. Even some research positions for unmatched applicants are requiring a minimum step 1 of 250! So yeah, everything matters even if you’re coming from a top program.

I’ll tell you one thing I did that may have helped me get all honors: I would specifically ask people for it. When asking for feedback I would say that I wanted to earn honors on the rotation and ask how can I improve my performance so I’m hitting that level. What’s the difference between me and a student who gets honors. Things like that. I also expressed interest in every rotation and Put in the work and am generally an easy person to get along with. I do think putting the honors bug in peoples ear may have helped make a difference when people were deciding whether to give me a 3 vs a 4.