3rd year grading question...

[daveshnave]

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Quick question...

Who plays a bigger part in giving grades for third year students? Is is purely the attendings? Is it the residents? Do the attendings actually give the grades after input from the residents? About to start third year in a couple months and was curious...

 

[Brewster]

It depends on the medical school, and even the rotation. At my school, attendings and residents could all submit evaluations. I imagine the attendings' opinions counted more on an individual basis, but there tended to be more resident evals per student. Each rotation also had an exam (shelf, multiple choice, essay, and/or oral) that was counted in the final grade.

I suggest talking to current third years at your school to find out how it is done where you are.

 

[daveshnave]

Thanks Brewster for the feedback.... I knew about the shelf exams, but I guess I should just ask some friends of mine out here at school...

 

[Samir Desai]

As Brewster mentioned, the individuals who evaluate students vary depending upon your medical school and rotation. As a general rule, evaluations are turned in by attendings and residents. Interns may also be responsible for evaluating you as well.

I advise my students to never leave a clinical clerkship orientation without knowing the individuals (as well as the weight their evaluation carries into the determination of the final grade) who will be evaluating them. Many clerkship directors make this known to students on day # 1 of the clerkship but others do not. If you find yourself in the latter situation, it's in your best interests to obtain this information from the clerkship director. After all, in order to secure the best possible evaluation, you need to know exactly who will be evaluating you.

Do attendings seek input from residents and interns before completing their evaluation? Although it varies from attending to attending, many attendings do ask residents and interns about the performance of medical students on their team. It's best to assume that the attending will talk to the housestaff about how well you did during the rotation. That's one of the reasons why you should strive to impress all team members.

Samir Desai, MD
Assistant Professor of Medicine
Baylor College of Medicine

 

[Rads Resident]

I ran the orientation for the incoming 3rd years at my med school one year and everyone has the same question about grades. Of course it varies for each rotation, but I think the following guidelines hold true:

If you want a B, show up on time and do everything that's asked of you.

If you want a C, don't.

If you want an A, anticipate what needs to be done and do it before you're asked.

And don't try to "outsmart" your upperlevels or ask clever questions that are thinly veiled attempts to show you know a particular fact. Don't kiss ass, but go to the staff and/or chief and tell them on day one that you want to do well and you'd appreciate their advice on how to get the most out of the rotation. Work hard and read.

 

[LoneSEAL]

Originally posted by Rads Resident

If you want an A, anticipate what needs to be done and do it before you're asked.

Can you share any examples of what you mean? For some reason, I have the image of the student bringing in donuts for the staff in the mornings, but I'm sure you're talking about a clinical context, right?

 

[Rads Resident]

Think of the 1 or 2 most important issues of the day on each of your patients and seek out the answer. Follow up, follow up, follow up. If, for example, you ordered a chest film on a patient after morning rounds, make sure you're the first to know what it showed. Don't assume it even got done without you checking. Don't wait around for the report the next day. Because, believe me, if it shows something important, the radiologist will call your staff, your staff will ask you what you think about and you won't know what he's talking about. It doesn't exactly make you look good.

A perfect example I learned by watching a fellow student learn this the hard way. He had a post op patient whom we we're waiting to pull the NG tube and feed. Only, of course, the patient needed to pass gas first (to confirm his post op ileus had resolved). When the chief came out of the O.R. each day he only wanted to know thing about this patient: did he pass gas? All the student had to do was take 20 seconds at some point in the afternoon and find out, but he never did. So the chief had to wait for the student find out thus the chief went home later and thus the student (in his eyes) sucked. Fair or unfair.

I'm not sure if I'm making sense, but as you learn more about the management of patients you recognize a pattern of events that needs to occur in a certain order with each one's management. Usually you'll find that you're waiting on one thing before you can go on to the next. Your job is to know what that one thing is for each of your patients and get it done. If you have to do somebody else's job (such as run specimens to the lab) to get it done, do it. And never assume that just because your order is on the chart that it actually was performed.

Not sure if that helps.

 

[gatorAKM]

Rads Resident -

Thanks for the very insightful post. I think most MS2s know that you are supposed to work hard to do well as a MS3, but I dont think everyone knows what that means always.

I think your advice is excellent and believe it applies universally to very rotation.

 

[Celiac Plexus]

I agree with Rads Resident completely regarding anticipating what you need to do.

Some examples from my surgery rotations. Always post-op your patients without waiting for the residents to ask you to. Know when to remove staples, change dressings, pull Foleys, check ABG, draw blood for lab values, etc and just do these things (or write the orders for them). This will save the team a lot of work, you will get valuable experience, and you will learn a lot more by participating than by observing.

I got to the point where I would decide if a patient needed an NG, and if yes, I would go ahead and put it in. One time I put in an NG when one was not indicated, and though I got a mini-talk on the indications for an NG, the chief told me that he liked my initiative and enthusiasm. Bottom line is, you won't get penalized for doing too much, but you will get a bad rep if you consistently wait to be told to do something. If you really don't feel comfortable with doing something, but you think it should be done then at least write the order for it. That will demonstrate your understanding of the treatment of a patient.