I'm f^&king tired of getting screwed so I just don't care anymore. I do my best and I say f*^k it.
This happened to me about halfway through my 3rd year. I stopped worrying about grades and trying to impress everyone, and instead focused on learning what I needed to know for both the shelf and for medical practice in real life. I also lightened up and started having more fun both at and outside of work - I started going out again on weekends and the occasional weeknight (even at the expense of a full night's sleep). Oddly enough, I ended up doing significantly better in the second half of my 3rd year, probably because I was less stressed out and wasn't trying so hard and thus putting undue pressure on myself.
The back half of my year was comprised of surgery, OB, and pediatrics, so it wasn't that I had the cushier rotations during this period. But I made the most out of my time at the hospital, volunteered to do anything and everything that sounded fun or interesting, studied for shelf exams during downtime (e.g. between OR cases, on L&D when nobody was being admitted/delivering), and when I went home, what little free time I had was completely my own.
3rd year grades are probably one of the most important parts of your residency application, in addition to USMLE scores and letters. So, it's natural to feel concerned when you're not performing at the "honors" level in every rotation. We have been bred since kindergarten to settle for nothing less than being #1. However, I don't think anyone has yet figured out the algorithm for success. In my own personal experience, a couple of the students that excelled in 3rd year were also some of the laziest, most unmotivated and unreliable students I've ever met, who happened to be exceptionally (almost unfairly) bright and also uncannily astute at brown-nosing and being in the right place at the right time, so that they would be observed doing the job that they otherwise would be shirking. Others were clinical superstars who put in extra hours and deserved every "H" on their transcript. Some were lucky, while others used less-than-honorable tactics to gain higher favor than their fellow 3rd years. Then again, there are many who worked their rear ends off, only to be demolished in the end by the shelf exam or by one mediocre evaluation out of 10 otherwise stellar reviews. And there's always the idiopathic "fluke" that can't be explained by any rational means.
3rd year grading is extremely subjective and makes absolutely no sense. Many of our final grades and evaluations were submitted by attendings we had never met or interacted with. This will probably be your experience as well. It's extremely frustrating, especially if you are one of the unfortunate students who performs well, but just *not well enough.* That said, 3rd year is not the time for grade-grubbing. Keep focused on what's important - learn what you need to learn in the hospital/clinic, study for your shelf exams, smile and be nice to people, help out your team, and try to be fun to be around, and the rest will follow. Most importantly, stay interested. A lack of interest will be reflected upon negatively in your evaluation. If you find that you really hate a particular rotation, find at least one thing that really turns you on and ask to do all of them (e.g. if you hate OB and want to go into rads or EM, ask to do all the prenatal and admission ultrasounds. If you hate being in the OR, get really proficient at vac/dressing changes and postop progress notes, and volunteer to assist with floor work).
A note of encouragement - 4th year is a huge ego-boost. It's essentially impossible not to get honors in your electives (as long as you show up and do the work), and you will honor your Sub-Is if you show your strong desire and interest in that particular field. It's not difficult to work extra-hard on your Sub-I if it's a field that you really enjoy and take pleasure in. So, don't sweat 3rd year so bad - most of us were/are in the exact same boat.
