Huge rant about clerkship grades

stormjen · Sep 16, 2004

Hi, my name is Stormjen, and I have had all the life beaten out of me by the complete lack of sense of clerkship grades. I am an MS4 and today finally received the last of my MS3 grades.

And I am at a complete loss.

Let me explain.

When I first started my third year, I thought, like most innocent and naive students, that clerkship grades would be based on how hard I worked and how well I did.

Not.

No, my friends, this is not the case. No, clerkship grades are based on how much you are liked; in essence, it's a popularity contest. They are based on rumors that might be spread about you, and on how the evaluators are feeling that day.

As someone who tends to do her work quietly without drawing attention to herself, I basically got screwed. There are all sorts of little rules and tips I was not aware of, so I did not know how to play the game. Shall I give some examples?

Pediatrics
One of the head attendings obviously thought a great deal of me. So, while I worked hard, I made a special point to impress him because I knew that at the end, we could choose who would write our evaluations. At the end of the rotation, I personally handed this attending one of my evaluation forms. But alas, he never bothered to turn it in. So all that effort I had put into impressing him was wasted. My final grade was based on evaluations from a handful of other people who were not quite so impressed by me.

Surgery
Don't even get me started. There were three incidents during this rotation that knocked me down a few pegs. Incident one was quite similar to my peds rotation - an attending thought very highly of me, made it clear he thought I was an outstanding student, then he never bothered to evaluate me. Argh! Incident two: I went into the hospital early one Saturday morning to help out a resident, even though I didn't have to come in. I was, in essence, doing him a favor. I was going to leave after pre-rounds, as I had some other things I had to do that day. The attending working that day came in and told me he wanted me to present a couple patients on rounds. I was like, umm, okay. So we start doing rounds, but then the attending sits down at one of the nurses stations and starts having a big discussion with some people about malpractice insurance. I wait and wait and wait, but finally I'm like, I need to leave, so I ask my resident if it's okay. He says sure. In hindsight, I should have directly asked the attending, but I didn't want to interrupt his discussion. So fast forward to another day, and I am in surgery with this particular attending, and he asks me to close the patients surgical wound. So as I start suturing, the attending takes a step back and is like "so, stormjen, what happened to you on Saturday? I told you to present those patients, so it was really bad that you left". Since I was trying to suture this patients wound, and since I couldn't talk and suture at the same time, I mumbled something about how the resident said I could go. I thought that was it, but when I got my evaluations at the end of the rotation, that attending had failed me! He never gave me any indication at all that he was going to fail me, but instead it was basically a malicious attempt to screw me over. Thank god, the course director thought highly of me so threw that evaluation out. Incident three: the other student on the rotation with me was nowhere near as good as I was at seeing patients, assisting in surgeries, nothing. In fact, she was often studying when I was running around like crazy taking care of patients and in surgery. She even paged me for help because she didn't know how to do the most basic of things. Yet the attendings all loved her because she was bubbly, so she ended up honoring the rotation, and I didn't.

Ob/Gyn
This was the grade I got today. I worked so unbelievably hard during this rotation. I thought there was a chance I might go into it, so I knew I really had to impress them. I was enthousiastic, out-going, and I basically acted as an intern, seeing patients by myself and everything. The attendings encouraged me to go into ob/gyn and told me I was an outstanding student. One of them even wrote me a recommendation letter. I KNEW that I was going to get at least a high pass, if not an outstanding. So I finally got my grade in the mail today. PASS!!!!! What the F***?! So I'm thinking to myself, what the heck happened? The only thing I could think of was at my final meeting with the course director, she said that the residents mentioned I had missed rounds a couple times. Well, no, I didn't. I had a doctor's appointment one afternoon so missed sign-out at the end of the day, but with the chief resident's permission. On one other day, I was post-call and let before sign out because I was exhausted and forgot (my one screw up the entire rotation), but I didn't have any patients to present, so I wouldn't have done anything anyway. But could this possibly have been enough to erase all the hard work I had done.

I am completely and utterly flabbergasted. I really want to just cry at how ridiculous the grading system is. How hard I worked was completely unrelated to the grades I got. Attendings didn't follow through on their compliments to make sure you got a good grade. Attendings were malicious. It's so unbelievable that residency programs look at these grades as if they represent what kind of student you are. I am so frustrated, and tired.

I would be interested to hear other students' stories. Surely I'm not the only one.

Good luck to everyone.

-Stormjen

Carb Addict · Sep 16, 2004

Well, I'm only an M3 with a few rotations behind me, but I agree with you. Clinical grading is extremely arbitrary. My school has H/NH/P/F from first year on. I find it reasonable during the first two years to give some impetus for achievement. But in the clinical years, how can you be given numbers or grades based on things like: attendings' opinions of your interaction with patients [that they've never seen, btw], evaluations by people you work with for 2 days, and with a huge variety of opinions on how anally evaluations ought to be completed (people who generally give all high scores cuz they see it's all really ridiculous or people who generally think everyone is average).

Now, I'm not one to just play the game and be Mr. Smiley-Face. Some may think I'm just being a fool because the only way to make it is to play the damn game. And I generally do, I suppose. Let's admit it, though, sometimes it's hard to know exactly how to play the game because you're always playing for different people with different expectations. Yeah, you can ask everybody you meet if you're doing what's expected of you, but that isn't always a luxury when time is short (days vs. weeks with a resident/attending). Oh well, I've resigned myself to just be a nice guy and generally happy. I doubt I will fail anything and I can be super happy if I get honors.

Blade28 · Sep 16, 2004

Man, that does suck. I agree that, unfortunately, attendings' (and residents') evaluations of you can be very arbitrary, and based off very little personal contact. I've also seen classmates who would do ANYTHING to get a good eval, including backstabbing other students, etc.

FionaS · Sep 16, 2004

This is why I like my school's system. We have gradings from our consultants, but they don't count for anything unless you fail. We are told to aim for a C grade overall (things are different here! A C grade is good), anything above is nice to have, but doesn't actually mean anything.

However, if you get a D or E grade, you acquire penalty points and are required to see the course supervisor. This is your chance to explain that you were ill/never saw the consultant because they were never there etc etc. Accumulate enough penalty points and you fail the year - but you have to be consistently D or E graded throughout the year to do that.

Incidentally, backstabbing other students would be an automatic black mark over here - consltants generally aren't stupid...

trex92499 · Sep 16, 2004

Amen to all that has been said. Third year grades are the biggest load of crap ever.....

My surgery grade story: While I didn't fail, my general surgery eval was bad enough to knock my total grade down to a C. This is horrible, because Iam planning on going to into a very very competitive surgical subspecialty. Why was the eval so bad? Well, it was a few days before our shelf exam and on that day one of the surgeons was running her endoscopy clinic while the other was in the or. I was sent AS A MESSENGER to find out if anyone needed to go to the clinic. When I got there, the doctor said "no, I don't need anyone, why don't you just go and read." I said "are you sure? Someone can come" and she said no, your shelf is coming up and you should take the time to study. Well, come evaluation time and what is on my eval is "student showed no interest in surgery and made decisions to go off and read when she was supposed to be attending a clinic."
I was like WTF! I was the MESSENGER!!!! I had said i would go ask as a courtesy to my other students. I tried to contact the surgeon who wrote the eval, the course director, and the dean, and they all said the same thing....All evals were final. The dean said that even though it was a misunderstanding, nothing could be changed because that would open the door for everyone to complain about their grade. Hence, my C in surgery.

Also, my other peeve with third year grades is the shelf exams. They count for a decent amount of our grade, but they are scaled so that you need to score in the 95% percentile (a shelf score of 85 or above ) to even have a shot at an A. And the point value dropped the lower your score went, for medicine, if you scored the mean on the shelf, you would get 50% of the points available. WTF is up with that? That is a major blow to your grade.

So, to reiterate my points. Third year grades are bull. Your classmates will stab you in the back. Trust no one. NO ONE, even if you have known them since the day they were born. They will turn on you and eat your young for Honors.

BTW, I did honors in FP and Psych. FP because my attending was so ditzy that she had no clue about anything and Psych because it was my last rotation and I had finally caught on to the hot medical student showing cleavage to male attending thing. In essence, I sold out

IV Doc · Sep 16, 2004

After reading these stories I remember the parts about third year which sucked. However now that I am a 4th year I see all the things which make residents/attendings think medical students suck.

Optimistic · Sep 16, 2004

IV Doc said:
After reading these stories I remember the parts about third year which sucked. However now that I am a 4th year I see all the things which make residents/attendings think medical students suck.

Like what??

nuclearrabbit77 · Sep 16, 2004

IV Doc said:
After reading these stories I remember the parts about third year which sucked. However now that I am a 4th year I see all the things which make residents/attendings think medical students suck.

so since you are still a med student, you can see how bad you suck? 4th year sounds insightful indeed!

tom_jones · Sep 16, 2004

trex92499 said:
Amen to all that has been said. Third year grades are the biggest load of crap ever.....

My surgery grade story: While I didn't fail, my general surgery eval was bad enough to knock my total grade down to a C. This is horrible, because Iam planning on going to into a very very competitive surgical subspecialty. Why was the eval so bad? Well, it was a few days before our shelf exam and on that day one of the surgeons was running her endoscopy clinic while the other was in the or. I was sent AS A MESSENGER to find out if anyone needed to go to the clinic. When I got there, the doctor said "no, I don't need anyone, why don't you just go and read." I said "are you sure? Someone can come" and she said no, your shelf is coming up and you should take the time to study. Well, come evaluation time and what is on my eval is "student showed no interest in surgery and made decisions to go off and read when she was supposed to be attending a clinic."
I was like WTF! I was the MESSENGER!!!! I had said i would go ask as a courtesy to my other students. I tried to contact the surgeon who wrote the eval, the course director, and the dean, and they all said the same thing....All evals were final. The dean said that even though it was a misunderstanding, nothing could be changed because that would open the door for everyone to complain about their grade. Hence, my C in surgery.

Also, my other peeve with third year grades is the shelf exams. They count for a decent amount of our grade, but they are scaled so that you need to score in the 95% percentile (a shelf score of 85 or above ) to even have a shot at an A. And the point value dropped the lower your score went, for medicine, if you scored the mean on the shelf, you would get 50% of the points available. WTF is up with that? That is a major blow to your grade.

Third year sucks ace. I had this OB/Gyn male attending that rolled his eyes after my presentation of the sexual hx of a 72 y/o lady. He wanted me to ask this lady, who was in for unrelated complaints, if she was having anal sex. He wanted me to ask every pt if they were having anal sex. And he evaluated me to say that my histories were inaccurate and incomplete b/c of this. Also the people who gave comments in ob/gyn at my school were too cowardly to put their names by the evals, you just got unmarked comments. I hate ob/gyn

maugham · Sep 16, 2004

I remember all during the first two years of medical school constantly hearing that the only grades that really mattered were for year three clerkships. Now it sounds as if these grades, on average, are extremely subjective and not especially reliable indicators of student achievement. But if this is so endemic, which monitoring this site makes me believe, wouldn't residency directors in a position to evaluate applicants be onto this as well? What intelligent person would put much stock in these evaluations anyway, which I suspect are most often just blandly and generically complimentary. The whole evaluation process for year three seems really pointless to me.

Seaglass · Sep 17, 2004

Some schools are perhaps worse than others. From my third year class I know of maybe 1 or 2 students who got better grades than they deserved but overall they seemed pretty fair to me.

ears · Sep 17, 2004

maugham said:
I remember all during the first two years of medical school constantly hearing that the only grades that really mattered were for year three clerkships. Now it sounds as if these grades, on average, are extremely subjective and not especially reliable indicators of student achievement. But if this is so endemic, which monitoring this site makes me believe...

Don't believe it.

First, I don't think it's as bad as that. I know at my school, the grading was tough, but good performances mostly got good grades and mediocre performances mostly got mediocre grades. (Believe me, there are some exceptions to this that still make me grind my teeth.)

Second, even if it were that bad, you have to try to act as if it weren't. Just do your best, work as hard as you can, learn as much as you can, and act as professionally as you can. Med students who sulk around the hospital are advancing neither their grade nor their education.

(Note to stormjen and trex and others: please don't think I'm criticizing you... you're definitely entitled to be upset and to gripe about it here.)

kornphan · Sep 17, 2004

This SUCKS ! for everyone... I am completly lost on how the damn Med School that we pay BIG BUCKS for and have worked extremely hard to get in have the right to treat us this way. You work your ass off the first two years only to be treated like scum the 3rd year by your peer ..... this is really bad.. they should give us more respect on where we came from and treat us as part of the team and not scum bags .... but I guess as they say in the Corporate world " It's not what you know, it's who you b**w ".... ....

Is it frustrating ?... you bet ya !.... and there is NOTHING that any of us can do !.. as there are thousands of new throw away meat waiting in line and the damn school knows it !...

Maybe all MS3's should gang up and go on strike !.. ;-)

Seaglass · Sep 17, 2004

they should give us more respect on where we came from

Heads up dude, they all came from there too and put up with just as much poo. Like I said before, I personally have not seen this as as big a problem as it is made out to be here.

Usually, in my experience, the people who complain about this sort of thing the most are the smart people who are a little lacking in the people skills dept. Sorry to be the one to have to tell you, but medicine is a people skills type of job. You convince people to do what is healthy not by being smart, but by being convincing.

kornphan · Sep 17, 2004

Seaglass said:
Usually, in my experience, the people who complain about this sort of thing the most are the smart people who are a little lacking in the people skills dept.

Like I said " It's not what you know, it's who you b**w" .. and some people apparently do it better then others ;-) ..

kornphan · Sep 17, 2004

"Teachers should treat students as they wish students to treat patients."

Quoting from a JAMA article "Membership has its Costs," "To gain entrance and acceptance within the guild [of medicine] one has to go through a series of hidden, punitive rituals.... The use of humiliation, rejection, and alienation in these punitive hazing rituals is readily observed by... [medical students] during training." From the Journal of General Internal Medicine: "Psychological abuse, gender discrimination, sexual harassment, physical abuse, homophobia, and racial discrimination are prevalent problems during... training."

Nature is cruel; therefore we are also entitled to be cruel - Himmler

An Association of American Medical Colleges panel called medical education, "a brutal academic experience." Quoting from Mother Jones, "Men and women becoming doctors experience eight to ten years of relative social isolation, receiving almost no feedback from the nonmedical world. Conservative male faculty members dominate most medical schools, many of them emotionally brutalized by the same profession they are teaching."

New England Journal of Medicine: "Too often our top leaders in academic medicine, the deans and the department chairs, manage through fear and intimidation." Where else could people get away with this? What other professional context would sanction this behavior? Writes one physician, "Before embarking on medical study, I had a career in college teaching. If, as a professor, I had treated students the way I was treated as an MD student, I would have been quickly summoned before my department chair or dean to account for myself."

Cutting Edge
Not surprisingly, studies find that the frequency of abuse was greatest during the surgical rotation. In one study, eight percent of students were threatened with bodily harm, assault, or assault with a weapon. Perpetrators were most often surgeons.

From the trade journal Medical Economics:

For the most spectacular tantrums, it's hard to match the lords of the operating room. While most surgeons mind their manners, a minority go absolutely bonkers - flinging scalpels, threatening to throw scrub nurses against the wall, kicking equipment, fistfighting with anesthesiologists... 'The throwing of scalpels goes on, but not as much as it used to,' says... a former medical director. 'Maybe one guy out of 30 does it now. It used to be one out of 10.

In a pilot study, ten percent of students report actually being physically abused (slapped, kicked, or hit) by residents or faculty. Examples were given:

In the OR I was being taught to suture. When I held the forceps improperly I was hit on the knuckles with another instrument by my chief. When I inadvertently did it again I was hit in the same place. After the operation, my knuckles were bleeding and I now have a scar on the back of my right hand.

One student reported he had been kicked in the testicular region by an attending physician and required medical attention for his injury.

Medical student testimonials: "'The abuse felt like someone shoved a vacuum cleaner hose down my throat and sucked everything out of me.' As far as I'm concerned it's been three years of constant abuse and humiliation, and I view it as a time to forget - a sacrifice of 4 years of my life." "My third year experience so completely soured my ideals of medicine that I am now considering becoming a malpractice consultant." Me too damn it. Maybe I'll just get a law degree and sue doctors. Watch them untouchably squirm on the stand.

And on and on and on it continues..................................... ;-(

ears · Sep 17, 2004

kornphan said:
Like I said " It's not what you know, it's who you b**w" .. and some people apparently do it better then others ;-) ..

Three quick responses.

You missed the point; people skills that matter in the clinic aren't sucking up to your superiors, but rather getting along well with the team that takes care of every patient now. (You can spot a suck-up; so can most of the people being sucked up to.) It also matters that you can effectively communicate with your patients.
Even if your vulgar "witticism" were true, believing it would a miserable way to live and would make it more difficult to become a good doctor. You should try not to believe it, and if you do believe it, you should try to act like you don't.
You don't want to sound like this. The whole "they should give us more respect on where we came from" and "it's not what you know..." attitude is really stale in the hospital, and you will get slammed for copping it.

kornphan · Sep 17, 2004

Thanks .. see my post above and thats from a 'respected organization' and I didn't make it up nor is it my point of view..

ears · Sep 17, 2004

I've seen them before. And there are definitely abusive people in medical education; I've met some of them. And there's a lot about clinical medical education that should be improved. (It's a topic I think about a lot, acutally.) And many, many people are miserable while they pursue their training, especially as MS-III's or interns. I deny none of that. And it's one of the reasons people should think carefully before they pursue medical training.

But if you're going to choose to pursue that training, your best defense against all of the s--t is being secure in your own professionalism and identity. Be confident in who you're trying to become, and work as hard as you can to become that. It will both discourage abuse and help protect you from it.

And "people skills" is an important part of that professionalism. Not "sucking up", but rather being able to be part of a team taking care of a patient, communicating well with the patient, dealing with difficult people (colleagues and patients), being able to give helpful feedback to colleagues and receive feedback from them (even if they don't put it very well).

Why throw up your hands in disgust at it? Why not say, "This is what I'm doing, and I'm going to do it as well as I can"?

kornphan · Sep 17, 2004

I agree.. Thanks for lending an ear ... ears

..

md2bny · Sep 17, 2004

irlandesa · Sep 17, 2004

I have a few words that may be comforting, though granted it is hard to take comfort in some of the 3rd year BS that goes on..

1)There is nothing horrible or shameful in getting a HP. Hey, I would bet that even the "SDN superstars" like Seaglass, avendesora, Hercules, etc. got one or two

Much as many people would have you believe otherwise on here, the majority of people are not getting Honors. For me, to perform in the middle of the class, even during the clinical years, is nothing to scoff at considering I am in a class of very talented individuals and didn't come out of the most prestigious background. Now if you end up with nearly all Passes, you may have something to worry about regarding people skills or test-taking, but no need to flagellate yourself for not being AOA.

2)Grades do NOT necessarily correlate with where you will match and in what specialty. 2 people who got AOA this year in the previous class did not match beyond Surgery prelim, 1 matched at an IM program that didn't fill, and yet another 2 matched at relatively low-prestige FP programs. Matches among those who were not AOA included:
Anesthesia: BIDMC, NYUx2
ER: Michigan, UCSD, BIDMC
Internal Medicine: Beth Isreal Deaconess x3, NYP-Columbiax2, NYP-Cornell, Northwestern, U Chicago, UCLA, Cedars-Sinai X2
Med-Peds:UCLA
OB/Gyn: NYP-Columbia, Cedars-Sinai
Optho: NYP-Cornell, 5 other non-AOA matches
Ortho: Einstein-Montefiore, 4 other matches at university-based programs
Pathology: Duke
Pediatrics: Boston Children's, Children's National
Radiation Oncology: JHU, Emory

3) Most of the people complaining are going to get bitched out on here for being whiners with bad interpersonal skills; so if you want to save yourself the trouble of getting into an argument with someone who doesn't even know you, probably best to close this thread.

While everyone should definitely work hard and cover your @$$ whenever you leave to go anywhere (except the bathroom, and even there), it is also true that once you get through 3rd year (unless your performance was exceptionally awful or you have a LP/F on your permanent transcript), the door is open from there. AND don't let certain people on here get you down; it is NOT a tragedy if you don't match at BWH, MGH, etc; especially in certain specialties.

ears · Sep 17, 2004

Irlandesa: I hope my posts here didn't come across as slapping anyone down for being whiners; I didn't mean anything like that.

Your post provides some important perspective: not only is it not all about grades, but you're absolutely right to point out that grades aren't the be-all end-all that many med students make them out to be. Even in the residency application process, they're just one part of the puzzle. There's lots more to you than your medicine grade.

The grading can be frustratingly arbitrary, and this is a perfect kind of place to complain about it. But we can't can't let it get us so down that we lose sight of the big picture, the important question: "Am I making myself into the kind of doctor I want to be?"

njbmd · Sep 17, 2004

ears said:
Irlandesa: I hope my posts here didn't come across as slapping anyone down for being whiners; I didn't mean anything like that.

Your post provides some important perspective: not only is it not all about grades, but you're absolutely right to point out that grades aren't the be-all end-all that many med students make them out to be. Even in the residency application process, they're just one part of the puzzle. There's lots more to you than your medicine grade.

The grading can be frustratingly arbitrary, and this is a perfect kind of place to complain about it. But we can't can't let it get us so down that we lose sight of the big picture, the important question: "Am I making myself into the kind of doctor I want to be?"

Hi there,
As one of those "terrible" general surgery residents who is charged with grading medical students, I will list some of my criteria for how I designate a grade for a medical student.

1. If this is your first rotation third year, I take that into consideration. You should know how to do a history and physical exam but I don't care if you can't present patients in rounds. You will quickly acquire this skill as you move on. If you make steady progress, I take that into consideration and it is reflected in your grade. You are in school to learn after all.

2. I hate, repeat HATE, people who try to "suck up" to me or attending physicians. Both myself and the attending can see through you. You should have some interest in your rotation but I don't expect you to lie and say you are interested in surgery if you are not. If you are undecided as to a specialty, say so and we leave it at that. I have curriculum and grading guidelines that I have to follow regardless of your interest in surgery. If you do well, you get Honors.

3. On the other hand, if you are not interested in surgery or are interested in surgery, I still expect you to do your work to a minimum standard. If you work well, have a good fund of basic care the surgical patient and give good patient care, I have no problem giving you Honors in Surgery. You don't have to be going into General Surgery to earn Honors in Surgery. You do have to master the points of General Surgery that will make you a good "whatever".

4. When you rotate on surgery, you are part of the team. This means that you help your fellow students, you get your work done, you help the intern and you play your role without complaining all of the time. All medicine is hard at the learning level. The hours are long and there are many things to master. Try to get the best learning experience that you can. Again, I do not penalize medical students who are having a bad day or even a bad week. I try very hard to look at your overall progress.

5. Finally, clerkship grades are subjective. I hate this system but it is the only system that we have. Sometimes, I have had medical students that were terrible people but good medical students. My not liking you has nothing to do with your grade as long as you conducted yourself well professionally and put the patient first. Again, if you performed up to standard, helped the team and were able to put your newly acquired knowledge into practice, I have no problem grading you highly. There is no set number of honor, pass, fail. I had some rotation groups where everyone in the group got Honors because they worked well.

Generally, if a student is not performing up to standard, I pull them aside early in the rotation and give them some pointers. (I know that you didn't pay tuition to fail rotations) Using this system, I have yet to fail anyone who made improvements. In the case of a couple of students, who were in danger of failing early on, they went on to get Honors because the corrected their deficiencies. Get feedback from your residents and attendings early and make changes where necessary.

I went through this system and I strive to improve it where I can. I have little respect for my resident colleagues who want to torture medical students. I can honestly say that I have failed very few students. The ones that have failed didn't show up or performed so poorly that they needed a second shot at the rotation anyway. Sometimes things just do not click no matter how hard you try. Also, I can't control what the attending physician writes about you. I can only add my opinion. Sometimes this has made the difference between a student passing and failing. In almost every case, my grade has been higher than the grade that the attending wanted to give.

Good luck!
njbmd

zoolander · Sep 17, 2004

Some top annoying clerkship moments:

- That one guy who always claims a passion to go into exactly the field you're rotating on at given time (surg, medicine, then psychiatry) and gets showered with attention and mentorship, but doesn't mention the two years of obscure retinal surgery research he's been logging for his future career in ophtho.

- Getting an evaluation for a clerkship you never did- "Good effort... Could work on presentation skills" (had already dropped it)- nice.

- Selective memory of the bad bits- "seemed distracted" with car in the shop- omitting "got sample for bizarre disease shipped out to Johns Hopkins."

- Getting an extensive eval meant for another person "oh, you look so much alike... you're both tall."

Any others? Brutal.

Mirror Form · Sep 21, 2004

stormjen said:
On one other day, I was post-call and let before sign out because I was exhausted and forgot (my one screw up the entire rotation), but I didn't have any patients to present, so I wouldn't have done anything anyway. But could this possibly have been enough to erase all the hard work I had done.

woah, although I do agree that you got screwed, missing rounds is a sure fire way to provoke the wrath of unhappy and bitter ob-gyn biatches (or any unhappy residents).

On one of my trauma surgery rotations that I worked my f'ing a$$ off in, I showed up for rounds about 10 minutes late once when I was post call, b/c my pda alarm took a long time to wake me up for some reason (probably b/c I had only been asleep for one hour). Sure enough, that erased all the hard work I had done. My eval mentioned that I needed to be more motivated, even though I had worked much much harder then the other two med students on the rotation with me (who didn't get anything good or bad said about them).

Rocky888 · Sep 21, 2004

My illustration of bizarre clerkship grading...

"Excellent student. Took an active role in her learning. Very good fund of knowledge." Grade: 4.8/5.0

This was the written comments I received for my CT surgery elective. Happy? Certainly! Fair? Um...no.

You see, I actually didn't go to a single day of the CT surgery elective (2 weeks out of my 8 week surgery block) due to a family death. The ironic thing is that I did far worse on the rest of the clerkship (my other 2 week elective, and my 4 weeks of general surgery) where my comments said that I should "read more."

The lesson that I learned? I do far better when I don't go into my clerkships. When I go in (and "mess up") I do worse. Hence, I have adopted this strategy of not going in on frequent subsequent occasions. And it works!

irlandesa · Sep 21, 2004

Rocky888 said:
My illustration of bizarre clerkship grading...

"Excellent student. Took an active role in her learning. Very good fund of knowledge." Grade: 4.8/5.0

This was the written comments I received for my CT surgery elective. Happy? Certainly! Fair? Um...no.

You see, I actually didn't go to a single day of the CT surgery elective (2 weeks out of my 8 week surgery block) due to a family death. The ironic thing is that I did far worse on the rest of the clerkship (my other 2 week elective, and my 4 weeks of general surgery) where my comments said that I should "read more."

The lesson that I learned? I do far better when I don't go into my clerkships. When I go in (and "mess up") I do worse. Hence, I have adopted this strategy of not going in on frequent subsequent occasions. And it works!

dear lord, I hope this story is a joke..
no reference to you intended ears, you seem to have a good head on your shoulders and no one can fault that.. njbmd, thanks for sharing your insight as a resident; it would be nice if anyone in our surgery dept. put that kind of effort into our grades.. If I may offer a suggestion, I think being sure to give ALL students feedback about how they are doing is important so that people can improve themselves and so there are no unpleasant surprises at the end of the rotation. And at many institutions, the Surgery exam usually swings the grade one way or the other; those in the H/HP territory will be bumped up if they do well (or down if not), those in mid-HP or P/HP territory will drop to a Pass if they do not do well, and a few fortunate souls will stay put in the H or HP range. Most of us scored within a few points of eachother (safely in the HP range) on the clinical grade, oral exams, and oral presentation (all 3=75% of grade), but my friend got the big H due to his strong exam score, while I royally screwed up the exam and slid down to a P.

oh I can't emphasize CYA enough, even if you get to the ridiculous point of having to tell your resident every time you need to use the toilet, better safe than sorry.

femme_fatal · Sep 22, 2004

My medicine eval (nokidding!)
I haven't really worked with Ms..., I met with her once and she looked kind of distracted and sleepy (i just did not wear make up post call) on rounds. I read her note, which looked very organized, even though Ms... did not appear organized and on top of things. So, i cannot really judge Ms, but I think she needs extensive couseling and more time to adjust to the culture of medicine.
HELLO!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

femme_fatal · Sep 22, 2004

My bottom line:
there is a lot of injustice in the world. You will get a lot of injusts evals. Use whatever talents you have to your advantage. Because for every undeservingly bad eval, you might as well get an undeservingly good one. Evens out at the end...
One rule, however, is whatever you do, dont screw your colleagues and don't endanger patients.Play it safe and dont take yourself too seriously. Remember, 10 years from now, you won't even remember what med school you went to (joke of course), much less that bitchy ob/gyn old maid that made your life hell for 2 weeks.
1) if you are a pretty woman--USE it. (for non-malicious purposes, like flirting with lab techs to get results faster, etc). do NOT get involved with anybody on your team while you are there. It is a kiss of death.
PS same for prretty guys
2) If you are into research, pull up articles for residents, they will love you for it!
3) If you have a great sense of humor, use it! (with caution and appropriately of course). Gotta have personality!

Mumpu · Sep 22, 2004

Top-notch advice Femme.

I got stellar evals from my first two months of medicine. A little worried about the third -- the hospital I was in allowed a lot less freedom for med students so I wasn't as actively involved in patient care and the attending never let me finish my presentations and then told me my written H&Ps were much better than my oral presentations (yeah, because I was never allowed to actually present my A/P!). Thankfully we had two attendings that month and I'm sure my first one will give me a great rec even if the second one is only OK.

My attitude is to show up, take ownership of my patients, offer to help (a simple "Is there anything I can do for you?" works just fine), be thorough, and get the job done. Basically, if you don't make your team's job more difficult you will do well. If you make it easier, you'll be a star.

TicDouloureux · Sep 22, 2004

femme_fatal said:
2) If you are into research, pull up articles for residents, they will love you for it!

I have not yet figured out how to do this without feeling like a total suck-up and always worry that the other med students on the rotation are thinking that I'm a gunner trying to show them up. Am I just being too self-conscious, or is there a proper way to do this without looking like a tool?

Mumpu · Sep 22, 2004

The proper way is to look things up when it's relevant. E.g. you are discussing some aspect of managing your patient's illness. Your intern says "I'm not sure what's the best way." You say, "I'll look it up." Come back in two hours and report what you've found. I did this on an almost daily basis because the unknowns pop up all the time.

The improper way is "I was walking to the kitchen for a sandwich and accidentally fell onto my keyboard and this NEJM article came out."

gwyn779 · Sep 25, 2004

Unfortunately grades are subjective so everyone has at least one story about how they got screwed. During my last rotation, I got screwed because about 4 out of a total of 12-15 residents and attendings I worked with actually turned in evals. And of course, the ones who were more likely to actually fill out the stupid forms were the ones who had bad things to say. Then there's the annoying fact that we're graded on a certain number of criteria, all rated on a 5 point scale. Well, at the university hospital, everyone pretty much knows that the average is a 4 and giving someone a 3 means they were well below average. Now, on the actual forms, it says that a 3 is supposed to be average for a student from our school. So the people from the community hosp. where I did my main medicine rotation actually took that as face value and even said to my face that I was better than all their other students, but that's what they would expect from my school, so I got mostly 3's. Then there was the comment from later on about not seeming like part of the team and not being prepared for rounds "despite adequate teaching." During that rotation I had an average of 5 hours of lecture/conference every day which meant that I missed nearly all of the team's discussion and management decisions which weren't always documented or relayed to me the next morning when I asked because they assumed I knew since it had been discussed with the "team." And of course, all the residents that said "I give every student a good eval" never turned anything in.

So, grades for rotations aren't fair, but there's not much to do about it.

novacek88 · Sep 26, 2004

I'm glad this post was written because finally the "real world" enters medicine. Most of you have never worked in a full time job outside of college and thus you don't know how the real world works.

The real world is a popularity contest. The person who gets the promotion is the one who is liked the best not the one who works the harders. The one who gets the job is the one who interviews well and makes a great impression and not where he or she went to school.

It is sad and I empathize with many of you who are learning this for the first time. You have been stuck in college and medical school and you assume that things work on the basis of a meritocracy but it's not like that at all. Your ability to network and get along with people mean more than your academic skills and pedigree.

It is unfair but a reality of life. Learn from this now. Remember when you get hired on at your first job out of residency, it is a popularity contest. Play nice, smooze, get along with others, don't rock the boat and you will do just fine.

You should always suck up to whoever is evaluating you. The key is to not make your sucking up look obvious. Also, you should never complain about anything and always volunteer to do more than you are asked but make certain the attending observes you requesting additional work. And finally, act like you own the hospital. That's right, just take control and learn while you go. Don't act scared! That is the difference between someone who gets Honors vs. High Pass.

QuothTheRaven · Sep 26, 2004

Not to add fuel to the flame, but there is a very big luck of the draw component to these clinical rotations as well. Some physicians give great evaluations, others take more of a hard line. It's completely random.

Another piece of advice, I like it when my fellow classmates copy and past stuff from eMedicine and/or UpToDate, and then make handouts the next day for the team and act like they spent five hours last night putting it together, whn it actuality they put in 5 minutes.

QuothTheRaven · Sep 26, 2004

novacek88 said:
I'm glad this post was written because finally the "real world" enters medicine. Most of you have never worked in a full time job outside of college and thus you don't know how the real world works.

The real world is a popularity contest. The person who gets the promotion is the one who is liked the best not the one who works the harders. The one who gets the job is the one who interviews well and makes a great impression and not where he or she went to school.

It is sad and I empathize with many of you who are learning this for the first time. You have been stuck in college and medical school and you assume that things work on the basis of a meritocracy but it's not like that at all. Your ability to network and get along with people mean more than your academic skills and pedigree.

It is unfair but a reality of life. Learn from this now. Remember when you get hired on at your first job out of residency, it is a popularity contest. Play nice, smooze, get along with others, don't rock the boat and you will do just fine.

You should always suck up to whoever is evaluating you. The key is to not make your sucking up look obvious. Also, you should never complain about anything and always volunteer to do more than you are asked but make certain the attending observes you requesting additional work. And finally, act like you own the hospital. That's right, just take control and learn while you go. Don't act scared! That is the difference between someone who gets Honors vs. High Pass.

I agree. Kissing ass helps. It pays to be slow as well and know less. That way you'll spend more time in the hospital and at home putting together handouts becuase you didn't or don't know what the hell was going on. It makes it look like you're working harder.

scootad. · Sep 26, 2004

Also this may seem counterintuitive, but the slower you are, the fewer patients you take on, the better you are likely to do, as you will know every little thing about your patients and there will be less of an opportunity for you to screw up and make an idiot of yourself on rounds.

Think of 3rd year as an acting performance, not a job. Hard work is not necessarily rewarded, its doing or saying the right thing at the right time in front of the right person.

QuothTheRaven · Sep 26, 2004

scootad. said:
Also this may seem counterintuitive, but the slower you are, the fewer patients you take on, the better you are likely to do, as you will know every little thing about your patients and there will be less of an opportunity for you to screw up and make an idiot of yourself on rounds.

Think of 3rd year as an acting performance, not a job. Hard work is not necessarily rewarded, its doing or saying the right thing at the right time in front of the right person.

exactly, I worked on a one intern rather than a two intern team and I was required to follow more patients and stay longer on call nights, as was my fellow classmate on my team. others would pick up one patient per call night and follow two or three patients total. yeah, it's really tough to prepare ONE patient the morning after call. But it doesn't matter, they'll still critique your presentations the same no matter your work load.

MD'05 · Sep 26, 2004

scootad. said:
Think of 3rd year as an acting performance, not a job. Hard work is not necessarily rewarded, its doing or saying the right thing at the right time in front of the right person.

I have to agree. What would benefit medical students most is 1 year of acting classes prior to starting medical school. You must look and act the role of a doctor 24x7 to honor a rotation. Bottom line.

scootad. · Sep 26, 2004

mind you this isn't true only of med school as alluded to earlier. Success in all facets of life and all occupations is achieved with some solid acting skills.

debvz · Sep 26, 2004

During my 3rd yr surgery clerkship, evaluations by faculty and residents carried equal weight. The other 3rd yr student and I on the team received all 2's (on a 1-5 scale, a 2 is barely passing) and a token 3 from a particular resident who we'd never worked with personally. We'd only rounded with that resident in the SICU, but s/he'd never seen us do the H&P's, physical exams, procedures, etc that s/he'd supposedly observed us doing (as evidenced by the cr@ppy evals) on our floor patients. IMHO, if you don't work with a student, just don't evaluate them - don't try to flunk them!

Mumpu · Sep 26, 2004

I disagree with taking as few patients as possible. That's the "I'm just a dumb medical student" attitude. You will look like you are not trying and not challenging yourself. Day 1 of my third year, my intern told me "you are the patient's doctor." Go in with that attitude and act accordingly. Take on as many patients as you can handle (I was up to 4 by the end of medicine) and do everything.

I got stellar evals and NEVER had to kiss ass. Hard work speaks way louder than words. To boot, I bet I learned more from my 4 complex patients than you would from 1 easy one.

Hawk22 · Sep 26, 2004

That's great Mumpu, but not everyone has a resident that will let you do things like that. My resident wouldn't even trust my list of medications that I would give him after going through the medication bag. Now I'll admit I'm not the smartest guy in medical school, but I am pretty sure I can read the medication name, dosage and frequency and COPY it down. I was actually smart enought to get into medical school after all. He would give me a looke like "you dumby", go through it anyway and say he had to do it to be complete.

So its great that you have that kind of experience, but if my resident wouldn't let me do something so simple then would he let me be the patient's acting doctor? I asked and asked for more responsibility, but never got it.... so your'e lucky you had someone to work with you.

Mumpu · Sep 27, 2004

Wow Hawk, that's really unfortunate.

Supervision is important in medical training but some people are total control freaks. I hope you have a better experience in the future.

aa82 · Oct 7, 2004

tell me about it! the grades we receive are totally unfair, i mean a saw how a well-known professor in a very famous hopital how he wrote a very great evaluation( gave her 20 out ot 20) for a visiting student who he has not worked with her at all, but just beacause she smiles most of the time, and pretty beautiful young student, she got what he want

fourthyear · Oct 7, 2004

I'm another of thsoe mean residents who grades you.

I am so tired of students who just don't seem to take any initiative to be part of the team. Some students are great, and I tell them so...but the lazy ones I just tend to ignore.
So now I have a student doing sub-par work and I had a talk with him about it...instead of taking my advice, appreciating it and using it to improve, he had the nerve to argue with me about every point I made. I guess he was tryign to defend himself but it was very frustrating b/c here I am taking my time to give helpful advice early in a rotation in time to let the student make improvements and the student doesn't want to listen.

I suspect you are all smart kids who aren't used to anyone telling you that you are less than the best. So here when you decide (as the first poster did) that it is unreasonable to hang around to complete morning rounds with an attending on saturday and instead just leave, and then are shocked that it reflected poorly on you...I can only assume you think you can do no wrong and instead of taking responsibility for your poor judgement, you blame the person grading you. It's unbeleivable how you can't accept the fact that maybe you could have some room for improvement.

doc05 · Oct 7, 2004

I am one of those fourth year students who isn't too disappointed with clerkship grades.

It's pretty easy to do well 3rd year...all you have to do is work hard (i.e. don't be lazy); get along well with your resident (i.e. don't be the typical stupid annoying medical student); and lose that chip on your shoulder.

doc05 · Oct 8, 2004

scootad. said:
Think of 3rd year as an acting performance, not a job. Hard work is not necessarily rewarded, its doing or saying the right thing at the right time in front of the right person.

perhaps you should spend a couple days in the real world. this is true of every job; in fact it's true of most things in life.

phoenixsupra · Oct 8, 2004

As far as I see third years are sort of graded on a 'chip off the old block' scale. If the attending can see himself in you, you get a good grade. Nerdy attendings tend to downgrade students with personality. Any sort of significant difference and your screwed. Really, it seems like the more grading catagories that they add the more arbitrary the grade.

I worked with a Sweedish student in the ticu. Apparantly, over there they dont grade students on their rotations. He seemed confused by the whole idea. He said "but I don't see how grading everyone all the time could possibly lead to an atmosphere of mutual trust and collegiality". Eh, guess what? It doesn't.

Huge rant about clerkship grades

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