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

[45408]

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.

Not seeing (or buying) it.

You'll change. I know because you'll do everything you can. You'll do all the stuff the guy said above but still get a high pass. You see, residents say they do the stuff above about giving feedback but not one single resident ever approached me to give feedback and when I asked and got some it was generic - "oh you're doing great, no problems at all", "just continue to read", and other bullsh*t.

I don't do it for everyone, because it depends on how much I actually have interacted with them, but I've pulled at least a few students aside and given very pointed feedback.

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[45408]

The reason why I mentioned that last sentence in my last post is cause I've noticed that out of my rotations, surgery seems to be the only one that is a bit harder on the students and has a more "hardass" mentality compared to the rest. None of the other rotations cared that students go for breakfast/coffee before rounds(or in OB/surg, a case) and take an hour for lunch or leave for lectures without getting asked a bunch of defensive questions. There are probably tons of exceptions, but from anecdotal evidence, it seems they tend to be harder to please and not tolerating "chill" or "less douchey" students and labeling them incompetent.

An hour for lunch? For what? Cocktails? Good Lord...

 

[Gastrapathy]

I'm not surprised that you found your way into a forum to bash on surgery, since you've done it before. Socialist probably shouldn't have singled out your beloved specialty, but you're no better when you lash out in response. Saying, "I want you guys as far away from my patients as possible" is extremely insulting, and probably inaccurate.

Any consultant, as part of the nature of their practice, can produce several anecdotal stories that make another specialty look inept. I know that I can produce multiple stories about dumb gastroenterologists, but I don't do it because I know that there's idiots in every specialty, and there's great doctors in every specialty.

As I finish my colon and rectal surgery fellowship, I would love to hear why you think I shouldn't be doing colonoscopies.....fire away.

So, you are extremely insulted and still manage to find the popcorn emoticon? Funny that you didn't feel the need to correct the surgical resident for bashing an entire specialty but when someone responds, its time to lecture on courtesy and conduct.

Ask your residents if they know what a serrated adenoma is or why SIM in a hiatal hernia isn't Barrett's before you dismiss that list as pure anecdote.

And the comment you found offensive was not inaccurate. The most dangerous person in the hospital is a surgical resident. They have a license to kill thats unlike any other trainee. Its the price of the responsibility that comes with being a staff surgeon later. I don't want them involved in a case unless there is an urgent surgical problem and I definitely don't want my patients sitting on a surgical service unless they need an operation.

Oh and to answer your question: You shouldn't be doing colonoscopies because you should be doing surgery. Its the same reason I think its odd that some surgeons do ERCP. But, if you can't generate a referral base from your local GIs to keep you busy, then scope away. None of the 3 to whom I refer regularly (academic IBD surgeon and 2 community colorectal surgeons) scope much, but then, they are talented surgeons and businesspeople and buy me tasty treats.

 

[Gastrapathy]

These evaluations, however, are for the most part not subjectively putting a number on your performance, a single number that could determine the rest of your career. Also, a "meets expectations" (rather than going well beyond) in everywhere other than 3rd year evaluations is certainly not something to be upset about.

One local HMO gives significant weight to nurse and patient reviews at the transition from associate to partner (really) and for determining bonuses.

Grade inflation exists on so many levels. I put a 4 instead of a 5 (out of 5) on endoscopy skills for a colleague and it resulted in a call from the head of the medical staff.

 

[Gastrapathy]

Employees get paid. Students pay to learn. Big difference.

This is 100% true but will get you nowhere. You aren't paying the people who are teaching you. Most of your key teachers will be other trainees who are getting paid poorly to work very hard. You'll be better off if you abandon this notion and view your tuition as an entry fee and your MS3 year as your first year of apprenticeship. You are being taught by more senior apprentices and occasionally an actual blacksmith.

 

[KnuxNole]

An hour for lunch? For what? Cocktails? Good Lord...

uh....no, just regular food xD
It's not that it takes us an hour to actually finish, but that's usually the alloted time we "break" for lunch, which makes a lot of sense, since we pay to be there so if they didn't give students obligatory lunch time, that'd be pretty ****** up. Especially on surgery, where they round insanely early, so around noon, hunger creeps up real fast!

Sure if it's SUPER busy, it might be cut short, but thankfully I've never been on a rotation(crosses fingers) where they would crash if a 3rd year wasn't present because they are busy on their lunch hour and also with the given lectures that students break for too. So unless someone has loose screws, it seems reasonable

 

[45408]

And the comment you found offensive was not inaccurate. The most dangerous person in the hospital is a surgical resident. They have a license to kill thats unlike any other trainee. Its the price of the responsibility that comes with being a staff surgeon later.

That's just not true, at all. We can tell our staff that we believe someone needs an operation, but the staff surgeon has to be convinced as well. We're not spiriting away patients for fun, although we could if we wanted to. Lord know that the hospitalists and medicine teaching services try to pawn off patients to us on a daily basis.

 

[igap]

The most dangerous person in the hospital is a surgical resident. They have a license to kill thats unlike any other trainee.

I put a 4 instead of a 5 (out of 5) on endoscopy skills for a colleague and it resulted in a call from the head of the medical staff.

"How to win friends and influence people." By Gastrapathy.

I am sure that you feel that as a gastroenterologist, armed with your mighty endoscope, you are the most important piece of the healthcare puzzle. You are entitled to your opinion. But making a blanket accusation that a surgery resident is the most dangerous person in the hospital is ridiculous.

In the Unite States, a surgical resident is supervised by a fully-trained attending surgeon. The notion that surgical residents are killing patients willy nilly with unnecessary operations done for their own amusement is patently false, and is a bizarre belief.

 

[SLUser11]

So, you are extremely insulted and still manage to find the popcorn emoticon? Funny that you didn't feel the need to correct the surgical resident for bashing an entire specialty but when someone responds, its time to lecture on courtesy and conduct.

Socialist is allowed to his opinion, just like you are...I simply said that you're no better than him with your response...plus he made a one-sentence remark about a situation that you agree is inappropriate (calling surgery for non-urgent bleeding), and you responded with a more dramatic/grandiose disrespect for surgical residency in general.

I wasn't personally "extremely insulted" by your post because it's sort of ridiculous. I find the whole thing entertaining, hence the popcorn emoticon.

Ask your residents if they know what a serrated adenoma is or why SIM in a hiatal hernia isn't Barrett's before you dismiss that list as pure anecdote.

Ask your fellows why GI bleeds are only surgical emergencies when they occur in the middle of the night. Also, please quit bringing up endoscopy pathology like it's a legitimate reason to disallow surgeons to do scopes. Most residents can interpret these things, but others can't....however, the attendings know about serrated adenomas, etc, and make the final call on the proper plan of care. Maybe we should start quizzing all the GI fellows on the multiple abbreviations you provided, and make sure they get them all right.

.....and I definitely don't want my patients sitting on a surgical service unless they need an operation.

I agree with that.

Oh and to answer your question: You shouldn't be doing colonoscopies because you should be doing surgery.

While I agree that endoscopy and surgery are two different skill sets, I happen to possess both. When I start my practice in 3 months, I plan on doing plenty of procedures (office based, outpatient centers, endo suites) that aren't "surgery" but are integral to a well-rounded colorectal practice. Your threats just sound like turf-war bullcrap. If a GI doc tries to punish his colorectal surgeons by denying referrals, he's really just punishing the patient. Since you're familiar with the literature, you know what I'm talking about.

Now, a more difficult question is whether or not general surgeons should be doing endoscopy, or FPs for that matter. I think this is variable, and is based on the endoscopist's volume and level of experience, which is why we have quality measures like adenoma detection rate, scope withdrawal times, etc. If an endoscopist does not meet quality measures, they shouldn't be scoping, regardless of specialty (surgery and GI included). The literature says you need to do 150 colonoscopies to be proficient, but I think we'd both agree the number is higher.

In my experience, most places were FPs or general surgeons are doing a lot of scopes are rural areas, and they do these procedures because there's a need for them (i.e. underserved area), so it's sort of a difficult subject.

I know the minimum requirement for GI fellowship is 150 colonoscopies, but what is the average number of EGDs and colonoscopies performed by a fellow during the fellowship? What would be considered high and low on that spectrum?

You are entitled to your opinion. But making a blanket accusation that a surgery resident is the most dangerous person in the hospital is ridiculous.

In the Unite States, a surgical resident is supervised by a fully-trained attending surgeon. The notion that surgical residents are killing patients willy nilly with unnecessary operations done for their own amusement is patently false, and is a bizarre belief.

Agree 100%.

 

[Gastrapathy]

At both places I work with surgical residents, they have so much autonomy that the staff often meet the pt in preop or the OR. Sometimes that means a bad resident has sold a case to the staff that he/she believed was justifiable (I don't think they are evil, just trainees that want to operate and are human). Some longtime academic attendings don't ask tough questions (and don't like to operate). Those residents will also sometimes seek out the attendings they can slip stuff by. Other residents will simply ignore patients on their service that they know aren't bound for the OR, although I think ownership is a universal problem in the work-hours era. This stuff doesn't happen much with younger attendings in my experience (how much insight do you have on whats happening on other people's services?).

Either way, I stand by the view that surgical housestaff have more autonomy and are in a position to make errors that are more significant than any other trainee. I just think you all are so used to that situation that you don't see how different it is than the way non-surgical housestaff function. So, when housestaff are involved, I'd rather my patients were on an IM service. They are more likely to do what I ask and less likely to get bored and either intervene or discharge my patient.

I know you were critical of anecdote earlier so I'll save the examples.

The current #s per the ASGE are 140 colons and 130 EGDs. Higher #s for ercp and eus. These are numbers for fellows though and we start from having done almost no procedures before fellowship. I train surgical residents in endoscopy and I think they are generally faster at picking it up unless they get their start with someone who does the "you push, I'll drive" technique. I did 2000+ procedures in fellowship and i think that's typical. I felt colos got easier around #80 and way easier around #200. ERCP and EUS both clicked for me a little late (in the 300s somewhere).

As for the turf war stuff, I'm not sure what literature you mean. I can't do surgery so any patient that needs surgery would have a bad outcome in my hands. As for the data on the various ways to manage superficial rectal lesions (I'm guessing here), EMR holds up well in the right setting. Our colorectal surgeons hardly scope because they are busy operating but I have no problem with anyone scoping who is good enough.

 

[SLUser11]

At both places I work with surgical residents, they have so much autonomy that the staff often meet the pt in preop or the OR.

This still goes on in certain areas of academia, but it's going away. Surgical attendings recognize that residents should be allowed appropriate autonomy and appropriate supervision. Like anyone, residents don't like it. I do agree with you that some of these Wild-wild-west type places have the blind leading the blind (i.e. senior surgical residents with crappy technique and judgment responsible for teaching said crappy technique and judgment to junior residents).

Anecdotal stories of bad residents tend to be concentrated in these institutions, but I still don't think it's fair to accuse surgery residents in general of being dangerous cowboys with bad judgment. Remember how the surgical attendings that you now respect got to where they are today.

Either way, I stand by the view that surgical housestaff have more autonomy and are in a position to make errors that are more significant than any other trainee. I just think you all are so used to that situation that you don't see how different it is than the way non-surgical housestaff function. So, when housestaff are involved, I'd rather my patients were on an IM service. They are more likely to do what I ask and less likely to get bored and either intervene or discharge my patient.

I highlighted the most important part of your paragraph. If they're your patients, and you want to be the one making their medical decisions, then you should admit them to your service.

The current #s per the ASGE are 140 colons and 130 EGDs. Higher #s for ercp and eus. These are numbers for fellows though and we start from having done almost no procedures before fellowship. I train surgical residents in endoscopy and I think they are generally faster at picking it up unless they get their start with someone who does the "you push, I'll drive" technique. I did 2000+ procedures in fellowship and i think that's typical. I felt colos got easier around #80 and way easier around #200. ERCP and EUS both clicked for me a little late (in the 300s somewhere).

There are not too many surgeons trying to do ERCPs and EUS. You teach surgery residents, so you know there's a disparity of talent and interest in endoscopy.

During my general surgery residency, I did over 50 bronchs, 100-150 EGDs, 30 PEGs, and 200+ colonoscopies. Not all residents go into CRS, but many do go into rural environments, and I feel that with those numbers they are well prepared to perform endoscopy. I will admit that after doing another 250+ colonoscopies as a fellow, I feel more comfortable.

As for the turf war stuff, I'm not sure what literature you mean......but I have no problem with anyone scoping who is good enough.

That's what I was waiting to hear. The truth is that volume and scope of practice usually dictate quality, regardless of specialty. As long as surgeons (and even ::gasp:: FP docs) meet the quality measures we've mentioned, I think it's appropriate for them to do endoscopy, especially if they are in an underserved area where there aren't a bunch of gastroenterologists available.

I was referring to the literature that shows that subspecialty training in colorectal surgery leads to better patient outcomes. Patients undergoing elective or emergency surgery on the colon or rectum, whether for benign or malignant disease, do better with a CR surgeon (morbidy, mortality, DFS)...this is more significant with the rectum than the colon. Some of this literature is inherently flawed, but it accentuates my point that volume and scope of practice dictate quality.

However, despite my beliefs that I do a better colectomy or LAR/APR than a run-of-the-mill general surgeon, I would never be so bold as to say that general surgeons shouldn't operate on the colon. It's just not practical, as plenty of general surgeons are more-than-qualified to do these surgeries, and colorectal surgeons couldn't possibly cover the volume of colectomies that occur in the US. Now, substitute "colonoscopy" for "colectomy," and you can see how I think this situation applies to you.

Anyway, I don't think we disagree as much as you think we do, and I'm also prone to histrionics when my specialty is attacked, so I call for a truce. We've hijacked this thread enough, and I'm sure the snowflakes want to go back to complaining about unfair evaluations.

 

[KnuxNole]

But it does make sense that residents can't have a lot of autonomy. Why don't residents like it? It makes good sense to me.

And lolsnowflakes. Fine I'll bring it on on-topic with a little piece, Gosh

I think evaluations are a frickin joke, that's why I would give people honors. Since a lot of residents don't give feedback, and just put pass or honors or whatever equivalent down the middle on evals and no comments. The residents HERE seem vocal about performance, but is it the majority? I know a few residents seem to think med students are a waste of space or prefer they scram than stay in the hospital.

Since I got honors on one rotation, and I don't think some residents have seen me do a physical, or ever pimped me or know my "professionalism". On one rotation, they refrained medical students from presenting :| So, it's a huuuuuuge crapshoot...

 

[Psai]

So for the people who are residents now, how do you actually grade medical students?

 

[thepoopologist]

So for the people who are residents now, how do you actually grade medical students?

The line between pass and fail in a psych rotation under me is effort. If you're lazy you will fail, and then you will be one of the small group of people in your class to have failed a psych rotation and get to have me again.

 

[McGillGrad]

It is extremely difficult to fail as a student rotating with me. As long as you show up, show interest, take the rotation seriously and treat the patients and nurses with a modicum of respect, you get an easy pass. If you want special mention then focused effort is required.

 

[VisionaryTics]

So for the people who are residents now, how do you actually grade medical students?

With a steel fist.

Seriously though, very interesting on the other side. When I was a med student, I looked at my classmates and thought we were all pretty similar in terms of being HP quality with maybe 10% being an outlier either way. I don't know whether it's my new institution or the God-like powers of insight that my MD has given me, but there's a large swath of students who simply don't give a **** at all, and don't make any pretense about hiding it (or they aren't nearly as good at hiding it as they think they are).

As an intern in a surgical subspecialty, I don't do a ton of grading (a handful so far) but I was pretty active in discussing the away rotators (the interns have probably more contact with them than anyone). I can think of one that was outstanding and probably moved themselves near the top of the rank list, and the rest evenly split between being pretty good and being below average (either from knowledge base, work ethic, personality, etc). I can also think of one that was horrific as an away rotator. For comparison to the gen surg clerkship students, the horrific away rotator who was told in no uncertain terms to never apply to this program and to avoid applying to ENT altogether was more knowledgeable and active than 90% of the gen surg clerkship students.

So far my pattern is: awful/aggressively lazy, I pass them on my eval (since that is essentially a C or D in med school). Regular lazy, shows up to OR, asks some questions = high pass. Not lazy, shows a good knowledge base, active in OR and floors = honors.

 

[Neuronix]

I don't believe in medical school grading. Everyone will get honors as long as they show up.

Still feel the same way.

 

[KnuxNole]

With a steel fist.

Seriously though, very interesting on the other side. When I was a med student, I looked at my classmates and thought we were all pretty similar in terms of being HP quality with maybe 10% being an outlier either way. I don't know whether it's my new institution or the God-like powers of insight that my MD has given me, but there's a large swath of students who simply don't give a **** at all, and don't make any pretense about hiding it (or they aren't nearly as good at hiding it as they think they are).

As an intern in a surgical subspecialty, I don't do a ton of grading (a handful so far) but I was pretty active in discussing the away rotators (the interns have probably more contact with them than anyone). I can think of one that was outstanding and probably moved themselves near the top of the rank list, and the rest evenly split between being pretty good and being below average (either from knowledge base, work ethic, personality, etc). I can also think of one that was horrific as an away rotator. For comparison to the gen surg clerkship students, the horrific away rotator who was told in no uncertain terms to never apply to this program and to avoid applying to ENT altogether was more knowledgeable and active than 90% of the gen surg clerkship students.

So far my pattern is: awful/aggressively lazy, I pass them on my eval (since that is essentially a C or D in med school). Regular lazy, shows up to OR, asks some questions = high pass. Not lazy, shows a good knowledge base, active in OR and floors = honors.

I've noticed this in med school, there's usually 1-2 in the group who is more active and wants to get the most out of the rotation and the others want to get by with the bare minimum. I see the similar notion as a resident, and it's just as easy to sniff it miles away....which is fine, they can do whatever they want. But, if they are with me, and want me to put a good word if needed, they actually have to put a teeny effort.

I would also be lenient in filling out an eval for someone I worked with minimally...if they are having a hard time finding people, since as a student, I understood how annoying that can be.

 

[ThoracicGuy]

A+ thread. I just spent my morning coffee break re-reading this whole thing.

I don't technically get to "grade" students. I submit my evaluation to the faculty preceptor who then compiles that into the final grade (along with the evals of my co-residents and the other attendings on each service).

But I would echo some of what has already been said - once you've worked with a few dozens to hundreds of students, you do actually see a pretty wide spectrum of performance.

I go back and forth on this issue of grade inflation and what the "default" grade should be (it's HP at my institution and only a small percent get honors and an even lower percent pass) and can appreciate all sides of it, particularly the impact of grades on residency interviews/matching.

So I take filling out the evaluations seriously. If in doubt or I didn't work with the student enough, I don't fill out an eval. If I have worked with them enough to feel like I have a reliable impression of them - then I fill out the evaluation and I try to be as fair as I can. Fair doesn't mean everyone gets an honors, however.

The one thing I am extremely hesitant to do though, is give a truly negative evaluation. I did this once, for a student who I felt deserved to fail the clerkship. It was such an outlier in all of my interactions with students (not showing up in the morning multiple times, skipping assigned clinics/ORs without explanation, not following up on tasks they'd said they would do) that I felt strongly enough to voice my concerns. The end result of this was multiple painful emails and meetings and the school ended up giving the person a marginal pass anyways. So yeah, I'm not likely to put myself through that hassle again when I know the school is going to skirt them through anyways and all I do is create pain for myself.

I had one student that was just so bad that we ended up as residents giving him a failing grade. Our attending gave him a marginal pass. There were a bunch of emails back and forth as well with him. I wouldn't have failed the kid except that he got worse as the rotation went on. He got to where he didn't even show up and would hide. And this kid wanted to go into Ortho... Ultimately, the school did fail his rotation and he had to repeat it as a fourth year. If the kid had just tried a minimal improvement over the rotation, I would have given him a pass, but when you go backwards, that is a bad bad sign...

 

[KnuxNole]

I think Evals, if done right, are meaningful. I said before I thought it was a joke....

I think the number system is still a joke. A 4/5 or a 3/5 or an 8/10 or 5/7, etc does very little to explain anything or have substance. However, I will say the meat of Evals are comments. Real comments. When I evaluate, I write a paragraph with clear, specific examples. That way, the person being evaluated knows without question, and the person reading it can gain a good grasp.

 

[Apoplexy__]

I think I'll grade with a negative points system. My default grade will be honors, then I'll deduct points for any of the following:
-Not improving or responding to feedback over the rotation (My most important category -- I assume you'll suck, but how you deal with that is what's important)
-Having an awful knowledge base (just know the basics, don't be utterly terrible)
-Being lazy, uninterested, complaining, not trying, being unprofessional, etc. etc.

My default comments will be lukewarm ("Mr/Ms. X is a good student, who is capable and professional. He/She met expectations and overall did well on this rotation"). I'll have a low threshold for positive comments, trying when possible to include examples/memories, with a very high threshold for negative comments.

 

[zany_brainy]

I'll grade in such a way that everyone will start off with a HP and then I'll more than likely bump the grade up to honors way more often than pass. I won't fail anyone unless the student absolutely deserves it. I also won't specifically grade anyone based on their knowledge base or their personality. As in, I won't give them negative points if their knowledge is lacking, provided I see some improvement by the end of the rotation. I also won't hold it against anyone if they're more quiet/reserved than talkative. I'm a quiet person by nature and it sucks when I get a lower grade based on not talking enough even though I asked questions when I truly didn't understand something, I interact with staff and patients respectfully and my knowledge level for the rotation is above average. I had an attending tell me that I had the knowledge level of someone in residency in a rotation I did a few months ago, yet I ended up getting a low-ish grade because I didn't talk as much as some of the other students on the rotation.

 

[dozitgetchahi]

With a steel fist.
Seriously though, very interesting on the other side. When I was a med student, I looked at my classmates and thought we were all pretty similar in terms of being HP quality with maybe 10% being an outlier either way. I don't know whether it's my new institution or the God-like powers of insight that my MD has given me, but there's a large swath of students who simply don't give a **** at all, and don't make any pretense about hiding it (or they aren't nearly as good at hiding it as they think they are).

Yeah, I noticed this too. I've been on ward teams were the students were really good - helpful, energetic, trying to learn things, giving good management suggestions, etc. Then I've been on teams where the students just seem like slugs - they don't want to do anything, aren't motivated, etc.

I'll still be reluctant to give these students overtly bad evaluations, but there will definitely be a spectrum.

The other thing is that I'm not a nazi when it comes to making sure the students go to their educational sessions/work every single day (even the day before block exams)/etc. This is for three reasons: 1) I simply don't have time to keep up with all this on the wards, and I don't actually care much either; 2) I assume you are mature and able to make the best use of your time - if you really need a break or a nap rather than going to listen to some terrible lecturer drone on endlessly about something you won't remember anything about anyway, that's ok (we do this as residents too); 3) I remember how stressful and ****ty it was as a medical student on wards when it came to finding study time, and if it's the day before exams I'm liable to simply tell you to go the hell home.

 

[da8s0859q]

I'm easy. Everyone gets a solid evaluation that plays to their strengths by default. Same thing I told myself I would do when I was an M3.

Serious concerns? As in, serious to the point where even I, the least uptight about these things, feel concerned? I talk to them. It stays off their record. The whole game is hard enough without dropping bombs in their evaluations, regardless of whether one resident's comment makes it to the MSPE.

It's not that I'm a pushover. It's just that I know how I learned the most and was the happiest as a med student, an intern, and even now -- which is to say, little from flat out criticism, and a lot from people who are positive, supportive, and offer friendly ways to expand on what I know/do. Medicine is a harsh enough culture as it is.

One friendly local neighborhood EM upper level resident's opinion.

 

[gujuDoc]

I think I'd have expectations but I'd lay it out on the first day to my assigned student or students. I'd make it clear that even if the hospital doesn't allow them to write notes I expect them to start learning to write notes, go to uptodate or clinical key or even back to year 2 material if they've forgotten something about a disease. Know everything about their patient (meds, allergies, hx, that when we say get to know the patient we mean take a thorough history of their condition until you've exhausted everything you can bc sometimes more trained docs miss things since we have higher patient loads and are in a rush). I'd expect that they show up on time, accept criticism well and learn to grow from it and build themselves up to a level of an intern.

I'd explain RIME criteria to them in other words and make it clear that I would not fail them but I would not honor them unless they work at the level of honors.

 

[gujuDoc]

I'm easy. Everyone gets a solid evaluation that plays to their strengths by default. Same thing I told myself I would do when I was an M3.

Serious concerns? As in, serious to the point where even I, the least uptight about these things, feel concerned? I talk to them. It stays off their record. The whole game is hard enough without dropping bombs in their evaluations, regardless of whether one resident's comment makes it to the MSPE.

It's not that I'm a pushover. It's just that I know how I learned the most and was the happiest as a med student, an intern, and even now -- which is to say, little from flat out criticism, and a lot from people who are positive, supportive, and offer friendly ways to expand on what I know/do. Medicine is a harsh enough culture as it is.

One friendly local neighborhood EM upper level resident's opinion.

I will agree though that I'd make it clear to students that if they misbehave or act unprofessionally it could go in their evals so if I give them criticism or something for them to take it seriously before it hits the eval.

 

[dpmd]

I will agree though that I'd make it clear to students that if they misbehave or act unprofessionally it could go in their evals so if I give them criticism or something for them to take it seriously before it hits the eval.

Do you really think that is something that has to be explicitly stated to students? That should be their expectation.

 

[KnuxNole]

Do you really think that is something that has to be explicitly stated to students? That should be their expectation.

Some students will think they can slide by and get a slap on the wrist.

 

[da8s0859q]

Do you really think that is something that has to be explicitly stated to students? That should be their expectation.

"Okay, guys, let's talk about this rotation here in the ER with us. Or ED. Whichever. We're easygoing, but you do still have to act with a little decorum. Don't call in strippers and do lines of cocaine with them while in the internal medicine resident's call room. That happened a couple months ago. Didn't end well. Also, we were asked to ask you all to stop punching drug seekers in the face. Because, God forbid, if you actually have enough strength to cause a meaningful fracture or they fall and smack their head, they may have a reason for pain meds."

 

[Kaustikos]

"Okay, guys, let's talk about this rotation here in the ER with us. Or ED. Whichever. We're easygoing, but you do still have to act with a little decorum. Don't call in strippers and do lines of cocaine with them while in the internal medicine resident's call room. That happened a couple months ago. Didn't end well. Also, we were asked to ask you all to stop punching drug seekers in the face. Because, God forbid, if you actually have enough strength to cause a meaningful fracture or they fall and smack their head, they may have a reason for pain meds."

...I wouldn't know how to respond to that. Ship them to law school/investment banking?

My points is directly correlated to number of cups of coffee brought to me. JK - everyone gets honors as long as they don't kill a patient.
Kidding. But seriously... lines of cocaine and strippers?

 

[alpinism]

The grading rubric will be determined entirely by retraction skill. Nothing more.

This makes sense since during your 12 hour day you will be spending at least 8 hours retracting.

This will be clearly explained to students at the beginning of the rotation. Because I care about your education.

Also, who would you rather have as your doctor: Someone who can't even retract or someone who is an amazing retractor?

Everyone starts out as a Failure. You have to earn a Passing grade.

I have no tolerance for lazy med students and I can spot them from a mile away.

It's a privilege, not a right to retract for me in my OR.

 

[MedicineMan99]

I'm a new attending. But, when I was a med student, I made it my personal goal to be an easy grader- so long as students showed and up and did what they were told. I followed through because some attendings think an excellent student should get a 90/100 while other attentings think the same student should get a 100/100. So, some students are screwed just because of the attending. For that reason, I always give excellent students perfect scores.

 

[DrShazam]

I am a third year med student, and this is what I plan to do as an attending and resident:
- As an attending, makes rounds efficient. No point in lugging med students and residents just for the hell of it. We had a stroke resident who looked up all the patients beforehand/ formulated an appropriate plan/ met with the patient. Then he did table rounds where he pimped the resident to ensure he/she got all the teaching points/ wasn't being lazy/ didn't miss anything, then did a 10-20 minute teaching session/ took the resident and student along if it was an interesting PE finding, and then let the students and resident write their notes. Rounds were pure bliss
- As a grader, my plan is to be very transparent. None of this crap where the studen doesn't know their grade or final comments till the evals are already in. I would tell the med student exactly what constitutes an excellent student in my eyes, and emphasize that staying extra hours where the student has nothing to do is not going to impress me. Be an initiative taker, care about your patients, show me you are reading, and get along with the team/ make yourself useful without being annoying, and that's your ticket to impress me.

 

[ketosisevangelist]

The grading rubric will be determined entirely by retraction skill. Nothing more.

This makes sense since during your 12 hour day you will be spending at least 8 hours retracting.

This will be clearly explained to students at the beginning of the rotation. Because I care about your education.

Also, who would you rather have as your doctor: Someone who can't even retract or someone who is an amazing retractor?

Everyone starts out as a Failure. You have to earn a Passing grade.

I have no tolerance for lazy med students and I can spot them from a mile away.

It's a privilege, not a right to retract for me in my OR.

I had retracting skill. My attending is now my best friend.

 

[Psai]

Here's a fun thought exercise for the students:

How do you "grade" your residents and attendings in your evaluations of them?

Do you hold them to these same standards?

Do you "pull punches" so to speak?

I give everyone a perfect score unless they sucked at which point I give them a terrible score. I write nice things for almost all of them but don't embellish or make things up. It takes a really bad person to make me say what I really think about them. I figure no one reads them and it's a waste of my time. My school is always sending me emails to grade some crappy lecture with a 1-5 point scale and I just click 5s through because what really changes? It's annoying that I have to fill those things out in the first place

 

[Wordead]

Here's a fun thought exercise for the students:

How do you "grade" your residents and attendings in your evaluations of them?

Do you hold them to these same standards?

Do you "pull punches" so to speak?

Same as Psai - full marks unless they were truly ****ty in all aspects. Because I think it's ridiculous that I would have any affect on someone else's future. Just like I think it's pretty ridiculous that most residents and even attendings grade me.

 

[Kaustikos]

Evaluations for faculty and residents actually matter a lot if there is anything negative - especially if the dreaded Professionalism is cited...I've seen residents get in big trouble with their PDs and have heard of negative evals getting brought up when an attending is up for tenure

It's like Terror Alert when that ****'s brought up.

I also would like to add that students able to make great jokes/make the time more enjoyable get auto-honors. Bonus points if they're able to get the okay to pick items up without fear from the Scrub Tech. Extra bonus points if the staff remembers their name.

 

[Psai]

Professionalism is the dumbest concept I've ever heard of

 

[metopic]

Here's a fun thought exercise for the students:

How do you "grade" your residents and attendings in your evaluations of them?

Do you hold them to these same standards?

Do you "pull punches" so to speak?

Yeah, I think I've given everyone a perfect eval. I pull punches. I know their first responsibility isn't teaching med students, so I'm just glad make an effort to teach.

 

[chasm-e-baddoor]

smile when a patient's O2 sat is below 85%

LMAO

 

[chasm-e-baddoor]

I just spent my morning coffee break re-reading this whole thing.

surgeons get coffee breaks?

 

[Psai]

He's a chief. It's good to be the king

 

[TallScrubs]

As a student 'grading' residents: they all get good remarks; they get great remarks if we really get along. If i'm not learning on a rotation, I save that for 'rotation survey'. I'm not lampooning a busy resident like that, but at the same time, I think someone should know if the rotation isn't up to snuff.

As a resident: I think evaulations are important tools and will try to treat them as such. No free honors pass from me, but I won't be the guy who says 'in my 35 years, 3 students have received honors pass'

 

[Dave89]

Here's a fun thought exercise for the students:

How do you "grade" your residents and attendings in your evaluations of them?

Do you hold them to these same standards?

Do you "pull punches" so to speak?

Same thing that I've done for professors since the beginning of college: give 5/5 for everything unless I thought they were thoughtless jerks.

 

[Porfirio]

As a medical student for residents and attendings, all 5/5; reasoning (fill in the blank) - Perfect; ways to improve - None. [They just have to be good people.] It is uncommon that I will take the time to write a review of a resident or attending. When I take the time I say things like, "one of the best residents/attendings during my medical education for X,Y,Z reasons," and "We need to have more residents/attendings like this one attached to our medical school."

If the resident or attending is bad, I write them a bashing review with multiple examples of how they are bad. I give detailed examples. Whenever they act unprofessionally or mistreat, I write it down that night when I get home and just copy/paste it into the online review. I have only written 2 of these reviews (1 during IM, and one during Peds). I did not write a bad review of these 2 people for teaching, but I did for professionalism and conduct.

 

[Kaustikos]

If the resident or attending is bad, I write them a bashing review with multiple examples of how they are bad. I give detailed examples. Whenever they act unprofessionally or mistreat, I write it down that night when I get home and just copy/paste it into the online review. I have only written 2 of these reviews (1 during IM, and one during Peds). I did not write a bad review of these 2 people for teaching, but I did for professionalism and conduct.

OMG. I have never laughed so hard reading something on sdn. I just... Tears are coming from my eyes and flooding the floors.
I'm picturing this kid furiously typing on this online peer review site with passion. Cackling. Lightning in the background. "Vengeance will be MINE!"


Serious note: if someone is doing something that bad, you should probably bring it up earlier.

 

[BDUS]

If the student did a great job on most days they get honors/high pass. Once a student was so horrible I declined to write his eval..my evaluation would have hurt him in his career if it went into his file. Everyone has bad ..several weeks... I guess. He had come so far so he must have potential in him. He can take it as a wake up call change his ways and ask someone else to evaluate him.

 

[Porfirio]

OMG. I have never laughed so hard reading something on sdn. I just... Tears are coming from my eyes and flooding the floors.
I'm picturing this kid furiously typing on this online peer review site with passion. Cackling. Lightning in the background. "Vengeance will be MINE!"


Serious note: if someone is doing something that bad, you should probably bring it up earlier.

You have quite the imagination... Reality is so different.

 

[Kaustikos]

If the student did a great job on most days they get honors/high pass. Once a student was so horrible I declined to write his eval..my evaluation would have hurt him in his career if it went into his file. Everyone has bad ..several weeks... I guess. He had come so far so he must have potential in him. He can take it as a wake up call change his ways and ask someone else to evaluate him.

I'd rather no comment than bad comments. I've had bad days and would hate to think someone would take that as a way to ruin my career in the short amount of time I have on that service. I remember a week on IM wherein everything went to **** for me outside of that rotation and I tried to keep it together. I kept quiet and just did the bare minimum. The attending met with me and asked what was up and I told him. He said he understood and wouldn't hold it against me... but not before saying the obvious; life happens and you can't let it get to you.

You have quite the imagination... Reality is so different.

Better:

 

[Psai]

I'd rather no comment than bad comments. I've had bad days and would hate to think someone would take that as a way to ruin my career in the short amount of time I have on that service. I remember a week on IM wherein everything went to **** for me outside of that rotation and I tried to keep it together. I kept quiet and just did the bare minimum. The attending met with me and asked what was up and I told him. He said he understood and wouldn't hold it against me... but not before saying the obvious; life happens and you can't let it get to you.

Damn I feel you bro. I had a similar thing with personal issues during IM and if it wasn't on thanksgiving week with the opportunity to go home for a few days, I would have just fallen apart.

As a medical student for residents and attendings, all 5/5; reasoning (fill in the blank) - Perfect; ways to improve - None. [They just have to be good people.] It is uncommon that I will take the time to write a review of a resident or attending. When I take the time I say things like, "one of the best residents/attendings during my medical education for X,Y,Z reasons," and "We need to have more residents/attendings like this one attached to our medical school."

If the resident or attending is bad, I write them a bashing review with multiple examples of how they are bad. I give detailed examples. Whenever they act unprofessionally or mistreat, I write it down that night when I get home and just copy/paste it into the online review. I have only written 2 of these reviews (1 during IM, and one during Peds). I did not write a bad review of these 2 people for teaching, but I did for professionalism and conduct.

dude this sounds kinda lame