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

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Before starting 3rd year, I heard all the stories about subjective grading and was naive enough to believe that it wouldn't happen to me. I have always done great on both objective and subjective evaluations but 3rd year is a different beast. Although my evaluations have been for the most part excellent, I have not done as well as I did 1st/2nd year (granted I did set the bar very high). The frustrating part is there really is no rhyme/reason to why I didn't do better. It's not like I can look back and say I should have done this/could have done that. I was at the whim of someone checking off a box and while there are strategies you can use to stack the cards in your favor (i.e. play the game), if you aren't dealt the right cards, there is not much that you can do.

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Before starting 3rd year, I heard all the stories about subjective grading and was naive enough to believe that it wouldn't happen to me. I have always done great on both objective and subjective evaluations but 3rd year is a different beast. Although my evaluations have been for the most part excellent, I have not done as well as I did 1st/2nd year (granted I did set the bar very high). The frustrating part is there really is no rhyme/reason to why I didn't do better. It's not like I can look back and say I should have done this/could have done that. I was at the whim of someone checking off a box and while there are strategies you can use to stack the cards in your favor (i.e. play the game), if you aren't dealt the right cards, there is not much that you can do.

Yup. Some residents/attendings are easy graders, some aren't. Some residents remember being an M3, some don't. Some rotations do conference grading in which your biggest proponents -- or detractors -- may or may not be present.

I was told early on to just bust ass for the shelf exam, the one thing that's not subjective, and let everything else fall in place. Best piece of advice I got about M3 grading.
 
My school does clinical and shelf grading separately unfortunately. Guess I should have looked more closely into this before picking a medical school. Hopefully PD's will actually look at my shelf scores...
 
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Yup. Some residents/attendings are easy graders, some aren't. Some residents remember being an M3, some don't. Some rotations do conference grading in which your biggest proponents -- or detractors -- may or may not be present.

I was told early on to just bust ass for the shelf exam, the one thing that's not subjective, and let everything else fall in place. Best piece of advice I got about M3 grading.

This is excellent advice. I still remember my gen surg rotation where I slacked off on the shelf because I thought for sure the attending would just high pass me. He ended up giving me a really high grade, but when my shelf was added in I just high passed. Moral of the story: take care of the things under your control.
 
Everyone gets honors unless they really screw up. Medical students are not annoying or pests. I don't understand why you guys would say such terrible things. You were there not to long ago.
 
I will give everyone honors unless they are complete tools, don't show up on time, or are not willing to work.

I think this whole clinical + shelf = transcript grade is BS.
 
Before starting 3rd year, I heard all the stories about subjective grading and was naive enough to believe that it wouldn't happen to me. I have always done great on both objective and subjective evaluations but 3rd year is a different beast. Although my evaluations have been for the most part excellent, I have not done as well as I did 1st/2nd year (granted I did set the bar very high). The frustrating part is there really is no rhyme/reason to why I didn't do better. It's not like I can look back and say I should have done this/could have done that. I was at the whim of someone checking off a box and while there are strategies you can use to stack the cards in your favor (i.e. play the game), if you aren't dealt the right cards, there is not much that you can do.

Just to play devil's advocate here, since I'm sitting on the other side of the fence:

Is it possible that students are so convinced that they're doing a great job, because of their perceived inherent skills/talent, that they cannot comprehend that their performance was actually average?

In medical school, you're surrounded by people who are just as smart and successful as you are, which for most of us is a first, since we were high school valedictorians and set the curve on all our college tests. We're not used to being in the middle of the pack, but truthfully almost everyone here on SDN is middle of the pack (or lower), since only a small fraction of medical students can really be at the top of the class.

Everyone here, including me, prefers a lot of feedback from those above us, which is sort of a Generation Y/neXt thing. However, hasn't most of this feedback that we've demanded been positive over the years? How often have we gotten negative feedback, and how well have we taken this "constructive criticism?"

Is it possible that what we really want is feedback that specifically reinforces how awesome we think we are? When we receive negative feedback, how often do we think the fault lies with us? How often do we assume that the evaluator is really the one with the problem?

When you receive a positive evaluation, you naturally assume that you deserve it because of your talent and hard work. However, when you receive a negative evaluation, or maybe just a lukewarm or average evaluation, how often do you think it's deserved? Now, look across the board at all your classmates, and decide if some of them deserve negative evaluations....do you think they feel that evaluation is justified, or do they feel just like you do?

Are we sure that our responses to negative evaluations aren't just coping mechanisms for our ego? Haven't our parents been telling us every day since we were little that we were the smartest and most talented person in the world? Aren't we unique little snowflakes, after all? How can SLUser possibly lump us all together? Doesn't he know that this situation doesn't apply to me because of how unique and talented I am?

I got a less-than-stellar evaluation because:
a. I didn't perform well, or perhaps I had an average performance in this field of extremely talented peers. I was in control of the evaluation, and my performance fits the grade. (almost nobody picks A)

b. The evaluator was a jerk (maybe a resident on a power trip whose lost touch, or an attending who never gives good evals).
c. Evaluations are totally random, and I was just unlucky.
d. Some sort of unfair occurrence out of my control led to this evaluation.
e. Evaluators are jealous of my knowledge and talent (this one comes up more often than it should)
f. The other students were total gunners and stabbed me in the back.
g. Multiple other excuses that could go to XYZ.


Like I said, this is just playing devil's advocate. I had some of the same feelings that you guys did when I got a lukewarm evaluation on neurology. I thought I did a great job, and the attending that gave me the average marks barely spent any time with me, and one of the residents was just punishing me because I wanted to do surgery.....this is so unfair!!!!


Food for thought....
 
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I got a less-than-stellar evaluation because:
a. I didn't perform well, or perhaps I had an average performance in this field of extremely talented peers. I was in control of the evaluation, and my performance fits the grade. (almost nobody picks A)

b. The evaluator was a jerk (maybe a resident on a power trip whose lost touch, or an attending who never gives good evals).
c. Evaluations are totally random, and I was just unlucky.
d. Some sort of unfair occurrence out of my control led to this evaluation.
e. Evaluators are jealous of my knowledge and talent (this one comes up more often than it should)
f. The other students were total gunners and stabbed me in the back.
g. Multiple other excuses that could go to XYZ.


Like I said, this is just playing devil's advocate. I had some of the same feelings that you guys did when I got a lukewarm evaluation on neurology. I thought I did a great job, and the attending that gave me the average marks barely spent any time with me, and one of the residents was just punishing me because I wanted to do surgery.....this is so unfair!!!!


Food for thought....

The most important thing in an evaluation happens during the time beforehand. The terms of evaluation have to be set from the beginning. That way, the students have more control over reaching the endpoints, and if someone does not meet these terms, there are no surprises when the final eval is less than stellar.

I've had experiences like yours when throughout all the rotations your evaluations were gold, and then you get to this other one thinking you're doing a good job but get a lukewarm response on the final eval by an attending you've spoken to for 2 minutes max. Even if I was deserving of such an eval, I could not believe it because I had no frame of reference for what I could have improved, nor did I have ongoing feedback, nor were the terms of evaluation stated at the start of the rotation. So the only thing the eval accomplished was to confuse me.

I have also seen residents who were jealous of really good students give critical evals because the students wanted to go into derm or radiology or some other competitive field. It happens, and probably more often than we think since most of the rotations are in the noncompetitive core fields.
 
I hate hate hate over-achievers.

Gunners/suck ups will right away be in my bad books. If they are EXCEPTIONAL with patients, I will give them a high pass.

More relaxed, chill, and friendly people will get the best grade.

Might come off as a douche, but can't stand fake people. Its been a huge pet peeve of mine since high school
 
The most important thing in an evaluation happens during the time beforehand. The terms of evaluation have to be set from the beginning. That way, the students have more control over reaching the endpoints, and if someone does not meet these terms, there are no surprises when the final eval is less than stellar.

I agree 100% that laying out the expectations at the beginning of the rotation is key to being an effective clinical teacher.

I have also seen residents who were jealous of really good students give critical evals because the students wanted to go into derm or radiology or some other competitive field. It happens, and probably more often than we think since most of the rotations are in the noncompetitive core fields.

I seriously doubt that this happens frequently. I'm sure that in the student's mind, this is the only fathomable reason why they would receive a negative evalution, but there's not an army of insecure residents looking to take smarty-pants students down a peg.

The truth is that students are more transparent than they think they are, and residents know when they're not giving 100% effort. Residents also know when they're FOS regarding class/lectures/non-clinical obligations. If they're senior residents, then they've been around long enough to hear all the possible excuses as well.

To the students on SDN, don't you think that when you're a resident, you'll be able to see through any BS the future students throw at you? How come you don't think your current residents can do the same?


This will generate some hate, but I think residents that give out nothing but honors are the worst teachers, and are obstructive to the learning process. They will get awesome evaluations from the students, but they are reinforcing bad behavior, and preventing marginal or average students from improving.

In my opinion, the best resident teachers are the ones that make their expectations clear, give frequent positive and negative feedback, and push the students to do more and work harder (in surgery, that means more scrubbing, more presentations, more writing orders, following more patients, etc). When the rotation is over, these residents give an appropriate grade, which isn't always an A+. In the end, these residents won't be your best friend, and they may not be your favorite, but they will have made the largest contribution to helping you become an effective clinician.

On a side note, this same teaching method can used when teaching residents (as a senior resident or attending), and is met with a similar amount of distaste on that level.
 
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If you see shady behavior use your point in power as an opportunity to teach the student how to behave in a team
You really think that'd work or is even possible? I agree that it's a good idea to call people out if they're doing things that suck, but if you're doing so with the goal of changing that person, you're going to be disappointed.
 
Thus why I'd say there's no reason in being a douche and giving a bad grade. I think if a resident/attending essentially just tells a student up front their expectations (that are not unreasonable and specific) and essentially assures them that Honors/A+ if they try their best......

I don't think "trying your best" should be enough to guarantee an honors grade. Not every student, even in their best form, is an honors student. I've had several students who worked extremely hard, but still possessed below-average clinical skills and knowledge.

I will say, however, that trying your best is the absolutely best way to be a candidate for an honors grade.
 
Everyone gets honors unless they really screw up. Medical students are not annoying or pests. I don't understand why you guys would say such terrible things. You were there not to long ago.

I agree. I dont think I'll be the type that forgets about being a medical student. And be waay more chill :D

Plus, I DO believe that someone simply working hard should get honors, since rotations, all you REALLY need to do, is be nice, work hard, show up on time, and try as learners.

I would roll my eyes at people who would think rotations are a competition, since I don't think anyone should compete against peers, they should work together and be normal. I know currently med students on rotations aren't cutthroat, unless they are abnormal xD
 
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The most important thing in an evaluation happens during the time beforehand. The terms of evaluation have to be set from the beginning. That way, the students have more control over reaching the endpoints, and if someone does not meet these terms, there are no surprises when the final eval is less than stellar.

I've had experiences like yours when throughout all the rotations your evaluations were gold, and then you get to this other one thinking you're doing a good job but get a lukewarm response on the final eval by an attending you've spoken to for 2 minutes max. Even if I was deserving of such an eval, I could not believe it because I had no frame of reference for what I could have improved, nor did I have ongoing feedback, nor were the terms of evaluation stated at the start of the rotation. So the only thing the eval accomplished was to confuse me.

I have also seen residents who were jealous of really good students give critical evals because the students wanted to go into derm or radiology or some other competitive field. It happens, and probably more often than we think since most of the rotations are in the noncompetitive core fields.

I think expectations/rubric need to be more concrete, and agree that doing so makes evaluations more objective. Saying someone is at the "expected level" or "above the expected level" is almost meaningless because everyone has their own definition of what expected is. I have had residents/attendings who apparently have very unrealistic expectations of what the "expected" student is (both incredibly high and incredibly low). By clearly defining these expectations using specific examples (and not using terms such as "good", "excellent", or "outstanding"), a greater level of standardization could be achieved.
 
Just to play devil's advocate here, since I'm sitting on the other side of the fence:

Is it possible that students are so convinced that they're doing a great job, because of their perceived inherent skills/talent, that they cannot comprehend that their performance was actually average?

In medical school, you're surrounded by people who are just as smart and successful as you are, which for most of us is a first, since we were high school valedictorians and set the curve on all our college tests. We're not used to being in the middle of the pack, but truthfully almost everyone here on SDN is middle of the pack (or lower), since only a small fraction of medical students can really be at the top of the class.

Everyone here, including me, prefers a lot of feedback from those above us, which is sort of a Generation Y/neXt thing. However, hasn't most of this feedback that we've demanded been positive over the years? How often have we gotten negative feedback, and how well have we taken this "constructive criticism?"

Is it possible that what we really want is feedback that specifically reinforces how awesome we think we are? When we receive negative feedback, how often do we think the fault lies with us? How often do we assume that the evaluator is really the one with the problem?

When you receive a positive evaluation, you naturally assume that you deserve it because of your talent and hard work. However, when you receive a negative evaluation, or maybe just a lukewarm or average evaluation, how often do you think it's deserved? Now, look across the board at all your classmates, and decide if some of them deserve negative evaluations....do you think they feel that evaluation is justified, or do they feel just like you do?

Are we sure that our responses to negative evaluations aren't just coping mechanisms for our ego? Haven't our parents been telling us every day since we were little that we were the smartest and most talented person in the world? Aren't we unique little snowflakes, after all? How can SLUser possibly lump us all together? Doesn't he know that this situation doesn't apply to me because of how unique and talented I am?

I got a less-than-stellar evaluation because:
a. I didn't perform well, or perhaps I had an average performance in this field of extremely talented peers. I was in control of the evaluation, and my performance fits the grade. (almost nobody picks A)

b. The evaluator was a jerk (maybe a resident on a power trip whose lost touch, or an attending who never gives good evals).
c. Evaluations are totally random, and I was just unlucky.
d. Some sort of unfair occurrence out of my control led to this evaluation.
e. Evaluators are jealous of my knowledge and talent (this one comes up more often than it should)
f. The other students were total gunners and stabbed me in the back.
g. Multiple other excuses that could go to XYZ.


Like I said, this is just playing devil's advocate. I had some of the same feelings that you guys did when I got a lukewarm evaluation on neurology. I thought I did a great job, and the attending that gave me the average marks barely spent any time with me, and one of the residents was just punishing me because I wanted to do surgery.....this is so unfair!!!!


Food for thought....

You make some good points. I would certainly agree that on average, the 220's Step 1 student who had some scattered Honors during pre-clinical probably should not expect consistent Honors during the clinical years. Obviously there are exceptions of people who are "just great clinically" or for whatever reason don't give maximal effort during the pre-clinical years, but that is not the norm. I would think that in general, those who do well on Step 1/pre-clinically also continue to do well in the clinical years. Therefore, this idea of suddenly being good amongst a group of "great" students doesn't necessarily hold.
 
I don't think "trying your best" should be enough to guarantee an honors grade. Not every student, even in their best form, is an honors student. I've had several students who worked extremely hard, but still possessed below-average clinical skills and knowledge.

I will say, however, that trying your best is the absolutely best way to be a candidate for an honors grade.

Agree. But if they get clinical honors, then it's up to them to honor the shelf and then the rotation.

I don't like the idea of clinical grades because they are so subjective and the student is not really in control of them.
 
I would probably give all clinical honors, unless someone was

a. blatantly dishonest (that too, I would probably give a warning and then if it was a repeated thing)
b. blatantly lazy and/or pawning off work on others
c. very obviously trying to be a giant gunner and make others look bad in order to make himself look better. that might butter up some attendings but nobody likes a show-off, least of all someone who's just using others to hold up his imaginary pedestal.

Things I would NEVER mark down for:

a. being interested in another specialty - this pissed me off as a student and I certainly wouldn't do that to someone else. not everyone is gonna want to go into your specialty
b. having trouble with presenting. sometimes people just need help with it.
c. having some knowledge base troubles. people learn at different speeds. if they have a persistent issue i would encourage them to work on it and find time to teach them.

When it comes down to it, as a medical student you are there to help the team and learn. You are not there to do the scutwork and nonsense unless of course it helps make stuff run more smoothly, and there should be PURPOSE to doing the scutwork that helps in patient care. I hated the residents who used us as essentially for finding the charts and flagging orders without teaching us one bit just so they could go spend more time in the OR or get a few extra nap minutes. And I wasn't alone in that sentiment.

At the end of the day, you treat your medical students well, and they will have more respect and liking for you. It is the small gestures and small favors that really make a resident shine and stand out just as much as the big stuff.

That's all I've got for now.
 
I don't think "trying your best" should be enough to guarantee an honors grade. Not every student, even in their best form, is an honors student. I've had several students who worked extremely hard, but still possessed below-average clinical skills and knowledge.

I will say, however, that trying your best is the absolutely best way to be a candidate for an honors grade.

Maybe because you're a fellow and a bit removed from where we are now, I will say that as a medical student the numerical grades are what matter for your MSPE and residency application and therefore I would not mark someone down purely because of that unless there was a SERIOUS error that resulted in the harm of another patient or something that indicated a lack of morality (i.e. dishonesty, being a sociopath towards other patients or your team members, etc).

That's why I would discuss it in the evaluation comments when they need help or need to correct something that's seriously lacking instead of marking them down. My school has a separate section for constructive criticism that does not go on the MSPE on each evaluation. I don't think it's fair to tank their grade based on (in your case) what seems like somewhat unreasonable expectations requiring a very rare combination of things to coincide in a medical student.
 
Also, there is this HUGE false belief that giving someone a low grade makes them want to improve. More like, it makes them sad/upset and ends up being mad at the resident. Since, there's nothing wrong with grade inflation at all. Who cares if everyone in a group gets honors? I would have no problem HP or H'ing the students, since remember, rotations are supposed to be a relaxed environment. It's never, ever meant to be competitive(unless you are a freaky douche) and it's meant to be a learning experience.
 
The thing is, medical students aren't working. They're students. They're 100% learners.

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

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

Old post, but I am waiting for someone and bored so I read the first page(don't ask :rolleyes:)

This I agree 100%. The residents that didn't agree with this on one rotation I tend to roll my eyes at and don't respect those *****s at all.
 
The reality is that even for those of you who will now give every medical student honors because you failed to receive them yourself for various reasons, not every student can be an honors student. Imagine a world where everyone honors. That makes honors meaningless.

Medical students fall on a spectrum regardless of how you slice it. The final grade is typically the product of several evaluators (interns, residents, attendings) and some people still manage to honor EVERY rotation. While arrogance would like to say that you're just as good, the reality is that everyone falls on a spectrum of clinical performance and some perform better than others.

It's ok if you don't honor everything. You can still be a great doctor. You can have a fabulous and bright future. You can take care of patients (or not) and do what a lot of people came into med school to do. Maybe you won't make it into a top 4 residency, but if you think only MGH/BWH/UCSF/Hopkins produces great doctors, you've got another issue to deal with entirely...
 
The reality is that even for those of you who will now give every medical student honors because you failed to receive them yourself for various reasons, not every student can be an honors student. Imagine a world where everyone honors. That makes honors meaningless.

Medical students fall on a spectrum regardless of how you slice it. The final grade is typically the product of several evaluators (interns, residents, attendings) and some people still manage to honor EVERY rotation. While arrogance would like to say that you're just as good, the reality is that everyone falls on a spectrum of clinical performance and some perform better than others.

It's ok if you don't honor everything. You can still be a great doctor. You can have a fabulous and bright future. You can take care of patients (or not) and do what a lot of people came into med school to do. Maybe you won't make it into a top 4 residency, but if you think only MGH/BWH/UCSF/Hopkins produces great doctors, you've got another issue to deal with entirely...

You're missing the point. Of course not everyone should get honors. However, I think the basic criteria is having a good basic fund of knowledge, working hard and being eager to learn, and contributing to the team in a productive manner. Like I said, it would take a lot to make me screw a student over on his evaluation grade, and those are typically cardinal sins. In my opinion the shelf exam is what separates the men from the boys metaphorically speaking.
 
The whole idea of including a grade distribution can also be very misleading if one assumes that the x percent who honors is the top x percent of performing students. In my high school AP World History class, there were 2 teachers. There was a rubric for essay grading 1 to 9 (which corresponded to number grades given by the department- we were given number grades on our transcripts). My teacher would not give above a 7 on the essay (she would write best in the class on my papers). The other professor gave more than half the class 9's. If you would look at the final distribution without looking at who gave the scores, you would think I was an average student. I ended up getting the last laugh and won the award for top World History student. Just shows how looking at un- standardized numbers doesn't really give much info.
 
The reality is that even for those of you who will now give every medical student honors because you failed to receive them yourself for various reasons

I loled. Nope, no honors here :laugh:.

I'm still giving everyone honors. The reason I do it is because I don't believe that there should be grading in medical school. Medicine is a team sport. There shouldn't be competition. There shouldn't be "gunning". Third year grades are incredibly subjective. People focus in on them and do whatever they need to do to honor, which isn't necessarily what they need to do to learn and become the best doctors they can be. At my medical school, to get honors was to step into an incredible pressure cooker that was still mostly based on luck. That's not how we should treat each other. I can't change the world by eliminating medical school grading, but at least I can change my little part of the world.
 
I don't honestly think anyone is pathetic enough to support gunning and cut throat competition as a good thing. At least, if they are, those are the ones I :rolleyes: at for being lame excuses of life.
 
I loled. Nope, no honors here :laugh:.

I'm still giving everyone honors. The reason I do it is because I don't believe that there should be grading in medical school. Medicine is a team sport. There shouldn't be competition. There shouldn't be "gunning". Third year grades are incredibly subjective. People focus in on them and do whatever they need to do to honor, which isn't necessarily what they need to do to learn and become the best doctors they can be. At my medical school, to get honors was to step into an incredible pressure cooker that was still mostly based on luck. That's not how we should treat each other. I can't change the world by eliminating medical school grading, but at least I can change my little part of the world.

+1 :thumbup:
 
Things I would NEVER mark down for:

a. being interested in another specialty - this pissed me off as a student and I certainly wouldn't do that to someone else. not everyone is gonna want to go into your specialty
b. having trouble with presenting. sometimes people just need help with it.
c. having some knowledge base troubles. people learn at different speeds. if they have a persistent issue i would encourage them to work on it and find time to teach them.

.....therefore I would not mark someone down purely because of that unless there was a SERIOUS error that resulted in the harm of another patient or something that indicated a lack of morality (i.e. dishonesty, being a sociopath towards other patients or your team members, etc).


I don't think it's fair to tank their grade based on (in your case) what seems like somewhat unreasonable expectations requiring a very rare combination of things to coincide in a medical student.

So, with your grading system, students should not be marked down for inability to present a patient or having an unsound knowledge base....however, you concede that if a student makes a serious error that results in harm to a patient, and/or they are a sociopath, then maybe it's okay to just give them a high pass?

:eek::scared:

You're missing the point. Of course not everyone should get honors....

Does that mean you believe a certain number of sociopathic students who cause bad outcomes for patients should exist in your school?

I'm a fellow, yes, and I graduated medical school in 2006, but I'm definitely not removed from the process. In addition to my 2 years as a clinical med student, I've spent 6 years involved in the education of students, both on a clinical and administrative level. I've encountered many more students than you have, both good and bad, over the years, and I feel like my ability to grade fairly is intact.

My expectations are not unreasonable, as you've said, and it's not "rare," as you've suggested, that students get honors under my watch. However, I don't give it out for free...that takes the whole point away, and reminds me of the "participation trophy" I got in T-ball as a young child.
 
That's fine. I approve giving high passes for not presenting well and having a low clinical baseline if they are on time, get along well. Cause everyone knows med students don't make REAL decisions. Or if they do, it's just one small little finding.

Sociopaths..well I've never met one IRL, but I know that's not acceptable ever.

Remember, clinicals are NEVER meant to be stressful and encouraging competition. It's a relaxed environment, where you learn about specialties and such. I know plenty of attending tell students that they tend to rag on residents since they are paid to work, while they don't yell at med students for being bad at presenting since they pay to be here. It's a learning process, with nothing to lose.

It's not like 3rd years are needed to the residents unless they suck at efficiency or something. Cause, what would they do? Take pictures of the sick crashing patient, and interview them? :laugh:
 
You're missing the point. Of course not everyone should get honors. However, I think the basic criteria is having a good basic fund of knowledge, working hard and being eager to learn, and contributing to the team in a productive manner. Like I said, it would take a lot to make me screw a student over on his evaluation grade, and those are typically cardinal sins. In my opinion the shelf exam is what separates the men from the boys metaphorically speaking.

I loled. Nope, no honors here :laugh:.

I'm still giving everyone honors. The reason I do it is because I don't believe that there should be grading in medical school. Medicine is a team sport. There shouldn't be competition. There shouldn't be "gunning". Third year grades are incredibly subjective. People focus in on them and do whatever they need to do to honor, which isn't necessarily what they need to do to learn and become the best doctors they can be. At my medical school, to get honors was to step into an incredible pressure cooker that was still mostly based on luck. That's not how we should treat each other. I can't change the world by eliminating medical school grading, but at least I can change my little part of the world.

I think our interpretation of what defines "honors" is very different. I don't think third year students should be competitive with each other, but it seems for a lot of posters here, the definition of "being screwed over" is NOT getting honors. That's simply not true. I do think students should be encouraged to practice/learn how to function in the hospital in a relaxed environment, but that this should constitute a "pass". Honors means something different...that you've gone above and beyond what is expected and excelled in areas that you wouldn't have been expected to excel in. Is it unfair? Do people judge subjectively? By all means, yes! This is the real world where people's stereotypes/biases come into play. There's no avoiding that and this will continue until you retire.
 
Just to play devil's advocate here, since I'm sitting on the other side of the fence:

Is it possible that students are so convinced that they're doing a great job, because of their perceived inherent skills/talent, that they cannot comprehend that their performance was actually average?

... lots of other stuff....

Like I said, this is just playing devil's advocate. I had some of the same feelings that you guys did when I got a lukewarm evaluation on neurology. I thought I did a great job, and the attending that gave me the average marks barely spent any time with me, and one of the residents was just punishing me because I wanted to do surgery.....this is so unfair!!!!


Food for thought....

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The gunners/haters are gonna gun/hate on your comment. But seriously. The entire thing was nearly flawless in my opinion and exactly what I think whenever I am busting my ass with patients the whole time I'm at the hospital. Covering for everyone else. Following around residents and attendings when im all caught up and have no "patient" care to do, just to see if they will drop nuggets of info on me when they round.... and the guy who sees 2 patients a day and then studies all day and avoids being seen til sign out, or the one who gets the same damn question about non-ionic gap metabolic acidosis wrong *every single day* and never takes a second when hes home to actually learn about his damn patients.... they drive be crazy when they have **** fits at evaluation time that they only got Pass or High Pass.
 
That is fair, if they complain after blatantly being lazy, that's one thing. But I know you are probably a normal person and not a freak of nature who wants to gun or compete against them and such, since like it's mentioned, rotations are meant to be a relaxed environment for students, since we are merely paying to get exposure. It's best to work together, and everyone gets good grades! Cause after all, med students are expendable lol, unless the resident is mentally ill, they won't NEED to call a 3rd year for an emergency or rush to get them. The 3rd year would then end up taking pictures and writing notes, getting in the way ;)
 
That is fair, if they complain after blatantly being lazy, that's one thing. But I know you are probably a normal person and not a freak of nature who wants to gun or compete against them and such, since like it's mentioned, rotations are meant to be a relaxed environment for students, since we are merely paying to get exposure. It's best to work together, and everyone gets good grades! Cause after all, med students are expendable lol, unless the resident is mentally ill, they won't NEED to call a 3rd year for an emergency or rush to get them. The 3rd year would then end up taking pictures and writing notes, getting in the way ;)

Well I thik my two people are extreme examples. But I'm more using it to illustrate how completely oblivious people are to the differences in performances witnessed by the residents/attendings. Now I cant say a blessed word about it first hand, since I've never been the evaluator. Simply saying that I think we are all greatly oblivious/in denial of legit reasons we dont get the Honors and it may come down to a bit of the preconceived notions the present generation tends to have. But I'm just guessing. I may be entirely wrong or my n= may be too low for significance.
 
Remember, clinicals are NEVER meant to be stressful and encouraging competition. It's a relaxed environment, where you learn about specialties and such.

It's not like 3rd years are needed to the residents unless they suck at efficiency or something. Cause, what would they do? Take pictures of the sick crashing patient, and interview them? :laugh:

......rotations are meant to be a relaxed environment for students, since we are merely paying to get exposure. It's best to work together, and everyone gets good grades! Cause after all, med students are expendable lol, unless the resident is mentally ill, they won't NEED to call a 3rd year for an emergency or rush to get them. The 3rd year would then end up taking pictures and writing notes, getting in the way ;)

You are absolutely right that you are not needed. Students are not necessary to medicine, and usually their presence does not decrease the resident and attending workload. Instead, their presence usually increases the workload.

However, July 1st goes by, and all of a sudden the MS4 is a PGY-1, and now they are very necessary, and when they don't show up to work, there's a huge gap that needs to be filled. Strong interns contribute to medicine and continue to learn without becoming overwhelmed or putting patients in danger. Weak interns flop around with the new responsibility, make mistakes, miss things, cut corners when trying to catch up, and are generally miserable and dangerous.

The last 2 years of medical school are a dry run/dress rehearsal/whatever you want to call it for your intern year. The more you learn about clinical medicine, hospital mechanics, and "scutwork" as a student, the better prepared you are for intern year. I've watched many students transition into residents, and the students who have a good attitude and work hard are the same ones that turn into strong interns.

There's nothing "relaxing" about residency, and focusing on relaxation and lack of pressure as a student has a good chance of turning you into the weak intern. Trust me, you don't want to be the weak intern. Every residency class has one. I'm sure you've met a few this year, and you've probably talked crap about them behind their back.....foreshadowing....
 
So, with your grading system, students should not be marked down for inability to present a patient or having an unsound knowledge base....however, you concede that if a student makes a serious error that results in harm to a patient, and/or they are a sociopath, then maybe it's okay to just give them a high pass?

:eek::scared:



Does that mean you believe a certain number of sociopathic students who cause bad outcomes for patients should exist in your school?

I'm a fellow, yes, and I graduated medical school in 2006, but I'm definitely not removed from the process. In addition to my 2 years as a clinical med student, I've spent 6 years involved in the education of students, both on a clinical and administrative level. I've encountered many more students than you have, both good and bad, over the years, and I feel like my ability to grade fairly is intact.

My expectations are not unreasonable, as you've said, and it's not "rare," as you've suggested, that students get honors under my watch. However, I don't give it out for free...that takes the whole point away, and reminds me of the "participation trophy" I got in T-ball as a young child.

Do tell, where did I say I would *just* mark them down to a high pass? If someone lied about seeing their patient on a regular basis or did something to harm a patient, that's liable to get failed on their eval. And I don't see how you're getting from my comments that I would let a sociopath slip through the cracks. All I said was that I don't think having some performance anxiety while presenting or being a slow learner should qualify for screwing someone over on their evals. I have a friend who is a very hard working clinician who was very good by the end of his medicine rotation, but because he had trouble with public speaking it took him a while to get used to it. Under your system, he would have been marked down to a "pass".

I'm sure you've graded a lot of students under you, but the way you talk about grading students reeks of arrogance and it's kind of unsettling. I think making the system so cutthroat competitive to obtain a grade is ridiculous anyway as it doesn't do anything to contribute to anyone becoming a good clinician. It's like people who think beating their kids somehow makes them better people.
 
I see that the years of emphasis on self esteem and whatnot has produced some interesting results. To assert that everyone should get honors unless they are lazy, a sociopath, or some other bad thing is absurd. Every medical student should be expected to be on time, available during duty hours (as defined by the rotation), and make an effort to know their patients. If you try your very best but still can't remember the formulas you are not going to get an A on that physics test during undergrad (or have they changed that too), why would you expect that during clinical education?

An honors student will succeed at knowing their patient to include checking on results for tests they know have been ordered (and they are up to date on what has been ordered because they read up on what would typically be ordered), and can answer questions regarding the condition their patient has (because they already knew, or they looked it up) as well as questions regarding other patients on the service (and new patients with common issues for the specialty). They can come up with some ideas for plan of care and anticipate what would be required for that plan (patient doing great and poss d/c home-scripts written and just need signature, or patient with new cough-xray order form obtained/placed in EMR for possible signature , etc). They may be wrong, but they at least put thought into it. For a procedural specialty, they demonstrate good technical skills (they practice knot tying/suturing, they know what is required for a central line or chest tube that they would like to put in). They may make themselves available outside of duty hours (not a must, and can be annoying if they just follow you around but don't actually contribute anything). They demonstrate good examination skills and don't miss examining things (patient has abdominal pain-they check for hernias and do a rectal).

Not everyone will do the above (or is capable of it), but those that do need to have a grade that separates them from those that don't because, let's face it, those that do the above are much more likely to be a strong intern and a good resident. False praise might be ok for really young kids doing t-ball and AYSO soccer (not really sure it is), but at some point you need to put on your big girl/boy pants and face the world, which isn't going to tell you you are great just because you show up.
 
Do tell, where did I say I would *just* mark them down to a high pass?

I was being facetious. You stated that causing harm to patients or being a sociopath were the only things that warranted a less-than-honors evaluation. Now that you say you'd fail these people, you've essentially created an all-or-nothing situation where you either honor or you fail.

I'm sure you've graded a lot of students under you, but the way you talk about grading students reeks of arrogance and it's kind of unsettling. I think making the system so cutthroat competitive to obtain a grade is ridiculous anyway as it doesn't do anything to contribute to anyone becoming a good clinician. It's like people who think beating their kids somehow makes them better people.

Some of my theatrics in this thread are intentional, and meant to stimulate student SDNers to be self-reflective. I will re-read my posts, but I don't think I ever described a "cutthroat" system where only the "rare" student gets honors.

What I described was a system with clear-cut expectations, frequent balanced positive and negative feedback, and a fair grade based on performance.

Students are treated as members of the team. When the team is post-call, the students go home, too. When the team is busy, so are the students (which, as I already mentioned, actually makes the team even busier). When the team stays late, the students stay late. They are addressed directly (instead of ignored), and given tasks to complete.

They are given graduated autonomy and responsibility (procedures, orders, number and complexity of patients). Since they are given clear-cut expectations, they are held accountable for those expectations. I refuse to eliminate accountability from the grading process.
 
You are absolutely right that you are not needed. Students are not necessary to medicine, and usually their presence does not decrease the resident and attending workload. Instead, their presence usually increases the workload.

However, July 1st goes by, and all of a sudden the MS4 is a PGY-1, and now they are very necessary, and when they don't show up to work, there's a huge gap that needs to be filled. Strong interns contribute to medicine and continue to learn without becoming overwhelmed or putting patients in danger. Weak interns flop around with the new responsibility, make mistakes, miss things, cut corners when trying to catch up, and are generally miserable and dangerous.

The last 2 years of medical school are a dry run/dress rehearsal/whatever you want to call it for your intern year. The more you learn about clinical medicine, hospital mechanics, and "scutwork" as a student, the better prepared you are for intern year. I've watched many students transition into residents, and the students who have a good attitude and work hard are the same ones that turn into strong interns.

There's nothing "relaxing" about residency, and focusing on relaxation and lack of pressure as a student has a good chance of turning you into the weak intern. Trust me, you don't want to be the weak intern. Every residency class has one. I'm sure you've met a few this year, and you've probably talked crap about them behind their back.....foreshadowing....

I see that the years of emphasis on self esteem and whatnot has produced some interesting results. To assert that everyone should get honors unless they are lazy, a sociopath, or some other bad thing is absurd. Every medical student should be expected to be on time, available during duty hours (as defined by the rotation), and make an effort to know their patients. If you try your very best but still can't remember the formulas you are not going to get an A on that physics test during undergrad (or have they changed that too), why would you expect that during clinical education?

An honors student will succeed at knowing their patient to include checking on results for tests they know have been ordered (and they are up to date on what has been ordered because they read up on what would typically be ordered), and can answer questions regarding the condition their patient has (because they already knew, or they looked it up) as well as questions regarding other patients on the service (and new patients with common issues for the specialty). They can come up with some ideas for plan of care and anticipate what would be required for that plan (patient doing great and poss d/c home-scripts written and just need signature, or patient with new cough-xray order form obtained/placed in EMR for possible signature , etc). They may be wrong, but they at least put thought into it. For a procedural specialty, they demonstrate good technical skills (they practice knot tying/suturing, they know what is required for a central line or chest tube that they would like to put in). They may make themselves available outside of duty hours (not a must, and can be annoying if they just follow you around but don't actually contribute anything). They demonstrate good examination skills and don't miss examining things (patient has abdominal pain-they check for hernias and do a rectal).

Not everyone will do the above (or is capable of it), but those that do need to have a grade that separates them from those that don't because, let's face it, those that do the above are much more likely to be a strong intern and a good resident. False praise might be ok for really young kids doing t-ball and AYSO soccer (not really sure it is), but at some point you need to put on your big girl/boy pants and face the world, which isn't going to tell you you are great just because you show up.

I was being facetious. You stated that causing harm to patients or being a sociopath were the only things that warranted a less-than-honors evaluation. Now that you say you'd fail these people, you've essentially created an all-or-nothing situation where you either honor or you fail.



Some of my theatrics in this thread are intentional, and meant to stimulate student SDNers to be self-reflective. I will re-read my posts, but I don't think I ever described a "cutthroat" system where only the "rare" student gets honors.

What I described was a system with clear-cut expectations, frequent balanced positive and negative feedback, and a fair grade based on performance.

Students are treated as members of the team. When the team is post-call, the students go home, too. When the team is busy, so are the students (which, as I already mentioned, actually makes the team even busier). When the team stays late, the students stay late. They are addressed directly (instead of ignored), and given tasks to complete.

They are given graduated autonomy and responsibility (procedures, orders, number and complexity of patients). Since they are given clear-cut expectations, they are held accountable for those expectations. I refuse to eliminate accountability from the grading process.
Some of the best posts I've seen written anywhere on SDN! I really hope I have residents like you guys when I hit the clinical years.

If a resident gave everyone honors, why the eff would I care enough to try hard on that rotation? I would just blow it off and put forth the minimal amount of effort required to get the honors. That's it. By letting me off the hook, you're kind of ruining the learning for me and essentially making me a weaker student.

I'm just an M1 (so please take what I say with a grain of salt), but we already had something like this in our year with our biochem professor. He made the exams really easy by essentially telling us what the topic of each question on the exam was going to be a few days before the exam (calling it a "review guide"). So, of course, the majority of us never really studied and waited for the review guide to come out, crammed for a few days, did awesome on the exam, and subsequently dumped everything out of our memory. When we were basically guaranteed a great grade, there was no incentive to really learn and understand the material or to put forth any decent amount of effort in the class. Now, I'm going to have to review biochem in my free time over summer because the professor took away any incentive to actually learn it during the duration of the course. That means I'll be wasting time catching up/learning something I should've learned months ago.

Why would I want something like this to happen again during the clinical years? I want residents like SLU and dpmd who outline their expectations clearly, give feedback along the way (instead of surprising me at the end of the rotation when I can't do anything to improve anymore), and expect that I meet their expectations to earn an honors on the rotation. These are the kind of residents I want, ones who'll drive me to be better and not be lazy, ones that don't hand out honors like candy, ones who actually have expectations similar to what pretty much every other job in the world has. No one deserves anything just for working hard. That certainly wasn't true in any of my previous jobs, both in academia and outside of it. If I'm not good at something and perform poorly, I shouldn't receive a great grade for it. It's that simple.

Edit: Just wanted to clarify that none of what I mentioned (or what SLU/dpmd have mentioned) suggests anything about cutthroat competition or gunning others down. That kind of stuff should absolutely not be tolerated.
 
Completely agree with the last 3 posts.
 
Forgot to mention in my last post, but someone who takes their strengths and uses them to help other students perform better gets higher marks from me than someone who is stellar but never misses a chance to show how their fellow students are not. The term gunner gets thrown around often, and the perceived definition varies. The low performing students are the most likely to call anyone who is just a good student a gunner because their confidence and ability makes them look bad in comparison even if the other person isn't actually trying to do anything bad (if a question is asked in a group and the low performing student can't answer or answers wrong, is the other person a gunner for answering correctly if asked? Does it matter if they are individually called on, or if a "does anybody know the answer" is thrown out?). I have seen several students who by some standards would be considered gunners because they stay late whenever they think they might be needed, ask for extra call, have all kinds of supplies in their pockets, will take on any task if asked with a good attitude about it, and will volunteer to do tasks they think need doing that will help the team or the patient ("hey, do you want me to bring so and so up to the OR since transport isn't here yet"). On the other hand, they split cases evenly, help the other students know where to find things and how we like the notes (we get students who have started clinicals at varying times so some are less experienced than others and they rotate several times through surgery), and don't automatically answer first every time. Those people have gotten honors. Some of it may have to do with enthusiasm about the specialty, but I have also had some really good students who wanted to do something completely unrelated. The fact that they still approached this with an enthusiasm for learning (if not the specialty specifically) made me try to help things relate more to the specialty they wanted (like explaining to the IM wannabe how in private practice XYZ would have been done as an outpatient unless ABC is going on, or showing the ER wannabe how this lac differs from one they should close on their own-or how you can use this technique to hold things until daytime if they are at a place without residents). There is a bit of give and take that is expected. I don't get paid any extra to teach students, and you don't pay any extra to rotate with me versus somewhere else. You pay me with your work and I will pay you with practical education. Otherwise you can sit in the library reading first aid for the surgery shelf all day and figure it out for yourself. Don't expect honors for that though.
 
you realize of course that if you slacked off just because you thought you were going to get honors no matter what, you would get a poor eval and bad comments from everyone on here who has advocated for giving mostly honors. The premise we all generally had was that we wanted students to try hard, be enthusiastic, and learn as much as they can. But if you slack you get a bad eval...

I didn't say I'd slack off. I said I'd do the least amount of work required to still get the honors. There's a difference there. If the performance was worthy of honors, why would there be any negative comments? :confused:

My philosophy is simply, yes, students are all different but if I believe a student has tried hard and learned a lot that student should get honors. If I think the student has slacked off (and especially after a warning) that student will not get honors. I just think a student should be more concerned about learning medicine, learning how the field he/she's rotating in operates, and enjoys the experience. I think a student constantly worrying about what the eval will say every single day (which we all do) is completely counter intuitive to the learning process.

Yes students will differ. The better students get better comments. But students who try and maybe not the best knowledge will still get that "honors" grade from me though I may not be as enthusiastic about comments but I won't be negative - just not as praising unless I really liked the person.

And I agree with this, for the most part. I just don't think that someone who works hard but doesn't improve at something deserves the same grade as someone who does work hard and improves. Does that mean that I think student A will make a poorer physician than student B? No. We all have different strengths and weaknesses. We'll just have to agree to disagree on the grading issue. And, honestly, my clinical years' experiences will probably shape how I'll be as a resident far more than what my current philosophy is. So, a few years from now, I may end up feeling the same way as you do. :shrug:

and you see, kaushik, you say you don't like gunners but you are one. You don't want your classmates to do better than you because they may not try as hard as you plan to or know as much as you. That's a gunner. People like you bug the crap out me. But guess what... if you did try hard and knew your **** I'd give you honors regardless of your gunnerness. Though if you were a douche on the service I'd probably say in the comments section that you need to work on your attitude or something along those lines but I wouldn't dock your grade because we didn't click on a personal level. You simply will not click with every resident you come into contact with. Some will give you a worse grade because of it and then you'll be back on sdn complaining... Now please tell me who would you rather have as a resident...

Yea, that's exactly what I said. That I don't want my classmates to do better than me. If you talk to my classmates though, you'd be proven wrong. Having a different grading philosophy than you doesn't automatically make me a gunner. :rolleyes:

As for the last sentence, I clearly stated that I wanted residents who made their expectations clear and gave feedback along the way. Nowhere did I say anything about preferring a resident who would give a student a bad grade because they didn't click. I don't want residents like that. I want residents who are like SLU and dpmd. I don't think that anything they've said so far has been unreasonable, do you?

Everyone has a different philosophy. Though the above posts are actually really good I still will stick to what I think is best. I'll see how it works anyway and if I need to change it I will. But I don't think that will be necessary.
Agreed.

Anyways, that'll teach me to venture out into the clinical forums...
 
I'm just an M1 (so please take what I say with a grain of salt), but we already had something like this in our year with our biochem professor. He made the exams really easy by essentially telling us what the topic of each question on the exam was going to be a few days before the exam (calling it a "review guide"). So, of course, the majority of us never really studied and waited for the review guide to come out, crammed for a few days, did awesome on the exam, and subsequently dumped everything out of our memory.

You must go to UIC.

It always bothered me that this professor is held up as a model by other students when he is being disingenuous to our education.

I want to learn. I want to learn HOW to learn. Learning responsibility and accountability is part of that process. Spoon-feeding students a course or clinical experience may make the students like you, but it's a crappy way to educate.
 
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I realize that I will incur the wrath of many self-righteous medical students, but after having read the posts in this thread I am taken aback and am motivated to share my perspective.

First, the criteria for grades in the clinical years is actually well-documented at most institutions. Ask to see one of the evaluation forms to get a clear idea of what is being evaluated. Granted, it is not as clear-cut as a multiple choice examination, but here's a little secret.... nothing in real life is.

I notice a recurring theme in posts by medical students that students should be given the highest clinical grade just for "trying their best" regardless of fund of knowledge, or how they actually perform in relation to their peers. This notion is unfortunately a result of years of being told that you are all special snowflakes, and more years probably, of getting trophies and ribbons for 8th place finishes in the swim meet.

Since most students have never had a real job, and had to exist in the real world and see how "unfair" that cold, hard, world can be, they still cling to the notion that they are special and by right deserve a participation medal for just showing up and being their relaxing, laid-back, chill, selves.

For those of you who do not think that medical school should be a competition... I have no idea where you get that idea. Medical school is absolutely a competition. Not everyone gets the same grades, and the smartest, hardest-working, most professional students will get the best grades.

I think SLUser has it right that we all believe that we are perfect little snowflakes, and a non-honors eval simply cannot be deserved. I have given out hundreds of evaluations, and I have had the privilege of teaching some amazing medical students. These guys/girls don't just show up to get their participation medals. They know more than the other students, they work harder to perfect their presentation/rounding skills, are highly organized, do not need to be spoon-fed what to do, and are always with the team when the team stays late. They never complain, and they are always positive. If this sounds like a "gunner douche" to the medical students in this forum, then I suggest you engage in some introspection.

Competition is good. It pushes good people to great heights. One day when I am sick, I do not want a "chill", "laid-back", "non-douchey", "got honors for showing up" doctor taking care of me. I want a smart, extremeley motivated, extremely well-read, highly knowledgable, and highly professional doctor to take care of me. I daresay all patients want this type of doctor, and not someone who was rubber-stamped through the process by evaluators who thought "being chill", and not a "douche" were the main criteria for handing out honors.

I hear the cries, and wails, of entitled medical students already...
 
I realize that I will incur the wrath of many self-righteous medical students, but after having read the posts in this thread I am taken aback and am motivated to share my perspective.

First, the criteria for grades in the clinical years is actually well-documented at most institutions. Ask to see one of the evaluation forms to get a clear idea of what is being evaluated. Granted, it is not as clear-cut as a multiple choice examination, but here's a little secret.... nothing in real life is.

I notice a recurring theme in posts by medical students that students should be given the highest clinical grade just for "trying their best" regardless of fund of knowledge, or how they actually perform in relation to their peers. This notion is unfortunately a result of years of being told that you are all special snowflakes, and more years probably, of getting trophies and ribbons for 8th place finishes in the swim meet.

Since most students have never had a real job, and had to exist in the real world and see how "unfair" that cold, hard, world can be, they still cling to the notion that they are special and by right deserve a participation medal for just showing up and being their relaxing, laid-back, chill, selves.

For those of you who do not think that medical school should be a competition... I have no idea where you get that idea. Medical school is absolutely a competition. Not everyone gets the same grades, and the smartest, hardest-working, most professional students will get the best grades.

I think SLUser has it right that we all believe that we are perfect little snowflakes, and a non-honors eval simply cannot be deserved. I have given out hundreds of evaluations, and I have had the privilege of teaching some amazing medical students. These guys/girls don't just show up to get their participation medals. They know more than the other students, they work harder to perfect their presentation/rounding skills, are highly organized, do not need to be spoon-fed what to do, and are always with the team when the team stays late. They never complain, and they are always positive. If this sounds like a "gunner douche" to the medical students in this forum, then I suggest you engage in some introspection.

Competition is good. It pushes good people to great heights. One day when I am sick, I do not want a "chill", "laid-back", "non-douchey", "got honors for showing up" doctor taking care of me. I want a smart, extremeley motivated, extremely well-read, highly knowledgable, and highly professional doctor to take care of me. I daresay all patients want this type of doctor, and not someone who was rubber-stamped through the process by evaluators who thought "being chill", and not a "douche" were the main criteria for handing out honors.

I hear the cries, and wails, of entitled medical students already...


I think we should eliminate subjective rotations-based evaluation and instead focus on written and oral examinations. We don't do oral exams often enough anymore. It would be a good way to figure out if someone actually has an idea about medicine, rather than just being a suck-up on the wards or being good at MCQs.
 
One day when I am sick, I do not want a "chill", "laid-back", "non-douchey", "got honors for showing up" doctor taking care of me. I want a smart, extremeley motivated, extremely well-read, highly knowledgable, and highly professional doctor to take care of me. I daresay all patients want this type of doctor, and not someone who was rubber-stamped through the process by evaluators who thought "being chill", and not a "douche" were the main criteria for handing out honors.
Unfortunately, I don't think that's the case. People tend to want doctors they get along with and don't seem to care much what their education was like. If you don't have a medical education, it's basically impossible to evaluate how competent your doctor is unless he's just completely botching everything. In other words, yes, everyone wants a doctor who's motivated, smart, AND friendly, but since most patients don't have any way to tell whether you're good at your job or not, they rely mainly on personality.

I think we're setting up a false situation where students who get feedback and graded according to how they meet expectations turn out to be better physicians, grades be damned. You can have situations where you get regular feedback and constructive criticism of your work but are still guaranteed honors. Med students are generally conscientious enough to do their best to live up to expectations, regardless of whether there's a grade at stake or not. (Incidentally, I agree that, while I'll probably go pretty easy on my students, the feedback-->performance-->grade model is probably best for education.)
 
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