I second everything agger said. In fact, I'd go so far to say that it is the superstars that really (and obviously) stand out. Those are they students for whom residents and attendings go out of their way to help. Those are the students who residents rave about when programs consider taking SubI's or students from their own school.
It's the excellent students, that one-tier step-off, that tends to find themselves washed in among the average. Most ENT applicants are excellent students, but not all excel as a SubI. That's why I say in other posts it's more likely for a SubI to hurt you than help you, because like Agger's experience I'd say we had maybe 2-3 superstars as well the during my residency of the 15 or so SubI's that rotated through our program while I was there.
Our residents really went to work promoting those superstars. When we were asked about the excellent students, the responses were more average. "Yeah, he/she's good, but. . ."
Let me tell you about the worst SubI we ever had. A Canadian medical student.
Week #1 - on rounds with our rhinologist. He's seeing a patient with allergic fungal sinusitis that he wants about 10 more days of medical treatment on before taking to the OR. The SubI, in the room and in front of the patient, says, "Isn't AFS best treated with aggressive debridement followed by medical therapy rather than vice versa." Obviously, questioning the attending in front of the pt is not the smartest move. The attending, with the patience of Job, then explains his rationale for this particular case. Again, the SubI challenges him with "But that's not what Dr. Marple does and he's one of the leaders in this disease." Our attending was good friends with Dr. Marple and tells the SubI to get out of the room, apologizes to the patient, goes outside, and rips the kid to shreds.
But he didn't back down.
Week #2 - rotates with me at the Children's Hospital because the University Team was ready to kill him. I'm the chief. That's our busiest rotation. Day started at 5AM and ended at 7Pm on good days. 80 hour work weeks were not yet in effect. I've got a wife and 2 kids and all I want to do is get home to see them before they go to bed. SubI guy makes comments throughout the day that he didn't rent a car and isn't sure how to get back to his cousin's house with whom he's staying for the month. He follows me out to my car and stands at my car assuming I'm going to give him a ride even home even though he never asked. He never called his cousin for a ride even though it's 8PM. He pulls this tactic 3 nights in a row until I tell him to take off.
Keeps telling me the whole week how he's put in over 8 sets of tubes and really is ready to do some here. Attending allows him the opportunity and proceeds to make a myringotomy 50% of the length of the TM in a radial direction--exactly opposite of everything the attending was telling him. Then tells the attending, "Well, that's how we do it at my school." Attending beats the crap out of him.
Week #3 - debates (uninvited) with an attending about radiation vs primary surgical intervention for a tonsillar cancer in front of the patient
Week #4 - ostracized from every resident and most services, he is relegated to following the medical allergist around.
He continually just makes stuff up when asked a question he doesn't know the answer to.
He was simply stunning.
Don't be that guy. Worst part, I saw him in Toronto at the Academy meeting this year with a badge on that said "resident." So he got in somewhere. Scary.
