Appealing M4 pass in specialty of interest

[Medshpep2021]

Hi, applying anesthesia this coming cycle and my school grades M4 rotations on H/P/LP/F scale and I recently received a pass on my 4 week anesthesia sub-I. For reference, I performed above average on Step 2, honored most of my M3 core rotations including Medicine (~top 35% of the class at my school honors a given M3 core) so was shocked to see a pass on a M4 rotation that I tried hard on (in contrast, most M4 grades are honors). Upon reading the feedback (non-MSPE), my clerkship director said I had excellent interpersonal and teamwork skills but ok to below average knowledge base (only one sentence of feedback). I came onto the rotation with barely any anesthesia knowledge and only worked with my clerkship director on week 1 of the rotation, when I barely knew anything about OR physiology, got many pimp questions wrong, and was still learning procedural skills. I did not get assigned with my clerkship director week 2 and thought ok, I can build up more knowledge in the meantime and try to request to work with them my last two weeks.

Little did I know, my clerkship director disappeared without notice beginning of week 3 for the remainder of the rotation and though I sent out 2 - 3 emails asking for a feedback session and for OR assignments, never got a reply. I still showed up daily early in the morning and worked whichever attending would take me on weeks 3 and 4. I also did a ton of reading after going home to improve my knowledge base. Several attendings later told me I had "excellent" knowledge for an MS4 and was acing the procedural skills at the level of a resident. I asked 2 - 3 of them to send feedback and they agreed, but I just received my grade back and it is a "pass" with the only MSPE comments "good student, communicates well" (outside the non-MSPE feedback above). I reviewed the criteria for M4 honors and it is literally "outstanding performance and clinical knowledge well beyond expectations, functions at the level of a housestaff" which would evidently not be me from my clerkship director's perspective (given I answered so many pimp questions wrong those two times working with them week 1) but somehow most M4 grades are still honors.

How should I navigate appealing this? I've been told that anything less than honors for your specialty of interest could be a red flag, especially for anesthesia, which is getting more and more competitive and I am worried that this "pass" will make me be screened out for programs. My school does allow for appeals, but it would have to go through the clerkship director and if they deny the appeal, the decision is final... I have a feeling that my clerkship director may also not be familiar with MS4 grades as they did not go to med school in the US and only 3 students rotate through the hospital where I was at each year.

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[Tenk]

So anesthesia was your specialty of interest but you went in “with barely any anesthesia knowledge.” This was a self fulfilling prophecy. You even said you knew that anesthesia is a competitive specialty.

Clerkship grades suck, they are subjective and lame. You can try to appeal but it sounds like you just didn’t like the grade you got so I doubt it will work. Probably better to just move on, dig down, and work harder the rest of the year on networking so you can match. Good luck.

 

[Medshpep2021]

So anesthesia was your specialty of interest but you went in “with barely any anesthesia knowledge.” This was a self fulfilling prophecy. You even said you knew that anesthesia is a competitive specialty.

Clerkship grades suck, they are subjective and lame. You can try to appeal but it sounds like you just didn’t like the grade you got so I doubt it will work. Probably better to just move on, dig down, and work harder the rest of the year on networking so you can match. Good luck.

Sure, I had limited knowledge but did also get some questions correct and this was days 2 and 3 of week 1 for me in the OR. On most of the rotations I got honors as an MS3 with having close to 0 knowledge also on week 1, but was able to demonstrate improvement by the end of the rotation and so got honors.

This rotation was different in that I never got to demonstrate improvement (even though I did reading and got questions from other attendings correct) after the first 2 days given my clerkship director just disappeared. Having just 2 days for a grade that could determine which program I match into (or if match at all) seems extreme.

 

[ACSurgeon]

Sure, I had limited knowledge but did also get some questions correct and this was days 2 and 3 of week 1 for me in the OR. On most of the rotations I got honors as an MS3 with having close to 0 knowledge also on week 1, but was able to demonstrate improvement by the end of the rotation and so got honors.

This rotation was different in that I never got to demonstrate improvement (even though I did reading and got questions from other attendings correct) after the first 2 days given my clerkship director just disappeared. Having just 2 days for a grade that could determine which program I match into (or if match at all) seems extreme.

If the clerkship director only worked with you for two days, there’s a good chance he asked other attendings for feedback to formulate your grade/eval. There’s always a chance the clerkship director is forced into this role and doesn’t care about student education and just filled out whatever eval.

If you’re going to appeal: make sure you use language that is NOT entitled. Seem humble and hopeful. Make your case about how excited you are about anesthesia and address your concern about matching with less than honors. Make your case about improving but only after using the feedback as a “truth” that you made progress from.

If you go in swinging and seem to demand honors OR blame the clerkship director or the rotation setup, it won’t end well.

 

[Medshpep2021]

If the clerkship director only worked with you for two days, there’s a good chance he asked other attendings for feedback to formulate your grade/eval. There’s always a chance the clerkship director is forced into this role and doesn’t care about student education and just filled out whatever eval.

If you’re going to appeal: make sure you use language that is NOT entitled. Seem humble and hopeful. Make your case about how excited you are about anesthesia and address your concern about matching with less than honors. Make your case about improving but only after using the feedback as a “truth” that you made progress from.

If you go in swinging and seem to demand honors OR blame the clerkship director or the rotation setup, it won’t end well.

Yeah, I acknowledge I may have come off as a little entitled in my post and reply and will definitely try to appear humble and hopeful in my appeal. Still, would indicating that I am concerned with my grade due to concern about matching be seen as "guilt trapping"?

I did ask another attending who I worked with while my CD was gone if they ever get evaluations for medical students, and apparently they do not so I asked them to send word about me directly. Whether my clerkship director incorporated that feedback or that feedback was completely positive, I don't know since I got 1 sentence of feedback on my eval.

 

[NotAProgDirector]

I think there's a big difference in expectations between a 3rd year clerkship and a SubI. For a clerkship, you're expected to know nothing on day 1. On a SubI, you are often expected to know the basics and hit the ground running. Usually a SubI is your second rotation in a field. This can be complicated for Anesthesia if there isn't an experience in the 3rd year.

 

[ACSurgeon]

Yeah, I acknowledge I may have come off as a little entitled in my post and reply and will definitely try to appear humble and hopeful in my appeal. Still, would indicating that I am concerned with my grade due to concern about matching be seen as "guilt trapping"?

I did ask another attending who I worked with while my CD was gone if they ever get evaluations for medical students, and apparently they do not so I asked them to send word about me directly. Whether my clerkship director incorporated that feedback or that feedback was completely positive, I don't know since I got 1 sentence of feedback on my eval.

Your post didn’t sound entitled you were just explaining what happened. In a formal appeal I’d be extra careful to plead my case while highlighting strengths while acknowledging some of the potential weakness and ultimately asking the clerkship to reconsider the grade rather than saying you deserve a better grade.

I’ve never done this, so take my opinion for what it’s worth!

 

[Medshpep2021]

Thanks for the advice - appealed to honors!

 

[Redpancreas]

Great job advocating for yourself.