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lluvia2rain

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so,
I am just finishing third year. It has been a huge struggle for me. I have been mostly humiliated and embarrassed. During OB I was told I was rude in an evaluation.

I am actually a very sensitive and quite person. I know that I have never been rude to anyone. All my school osce's have been good.

On my more recent rotations I have almost stopped caring because it seems that no matter what I do there is something bad to be said about me. To my amazement my evals went up when I stopped caring. However, today I got all of our clinical grades from the entire year and learned that in an earlier rotation someone said they were concerned about my "interviewing style". I thought this was interesting since I know in that rotation I was never observed actually interview a pt. Today was just another reminder of my past and possibly present incompetence. I am feeling sad =(((

I am hoping to hear what other people think and if they have any stories.
 
You have no idea why you got the bad evals? I find it hard to believe that a preceptor would call someone who claims to be a "very sensitive and quite person" rude... You sure there isn't more to the story?
 
That rotation was a year ago, but at that time I asked the dept secretary her thoughts. She said to me.... You are a "misunderstood person". But she said that she did not think I was ever mean or rude to anyone. I should add that my attendings never said anything bad. It has always been a resident.
 
Sometimes attendings mix people up. I know this because I've gotten credit for things I didn't do.

Of course I gave my fellow students credit by notifying the attending.
 
Patients will say stuff, too. I've been doing outpatient stuff and when I go back in the room with the attending after doing the H&P alone, the patients will often say something to the attending about what a nice young lady I am or some such. Probably what happened to you was one patient didn't like you (are you Indian by chance? I've had two patients so far tell me how happy they are to see an American in training, because they hate foreigners... they don't know I'm secretly a Canadian spy, ha ha ha) and the patient said something to your resident/attending. Or like Jeebus said, maybe it wasn't even you. How cheering.
 
lluvia2rain said:
so,
I am just finishing third year. It has been a huge struggle for me. I have been mostly humiliated and embarrassed. During OB I was told I was rude in an evaluation.

I am actually a very sensitive and quite person. I know that I have never been rude to anyone. All my school osce's have been good.

On my more recent rotations I have almost stopped caring because it seems that no matter what I do there is something bad to be said about me. To my amazement my evals went up when I stopped caring. However, today I got all of our clinical grades from the entire year and learned that in an earlier rotation someone said they were concerned about my "interviewing style". I thought this was interesting since I know in that rotation I was never observed actually interview a pt. Today was just another reminder of my past and possibly present incompetence. I am feeling sad =(((

I am hoping to hear what other people think and if they have any stories.
Click to expand...

There is the phenomenae of "normalization to the mean" in undergraduate medical education, which is slang, i.e. doesn't refer to any actual mathematical principle. Basically, a medical school class starts out as a varied group of individuals, i.e. different backgrounds, different values, different thoughts about what is good bedside manner. At graduation, everyone is more or less the same, i.e. you aculturate to the level of attention to patient care and bedside manner at your schools core hospitals.

Example A: A student like yourself who feels it is important to be empathetic with patients and takes time to be sensitive.
Acculturation: You are told in various ways that this shouldn't be done, i.e. that you are inefficient or have bad interviewing skills. Sometimes residents and attendings will project their own failings, i.e. "rudeness" on the student, this is an actual psychologic defense mechanism.
Result: You feel bad, don't empathize with patients as much and become more like the team, i.e. not so sensitive. When older you (i.e. you as an attending) see an empathetic young med student, you feel upset unconciously as this is how you were, and you attack, i.e. give bad eval to this student. In this way, the bad bedside manner of physicians in general is perpetuated.

Example B: A student with no empathy for patients may get excellent clinical evaluations, but learn from others who are empathetic role models, i.e. attendings and residents who have at least SOME empathy for patients.
Result: A student with no empathy for patients will become more empathetic, but still only around average for attendings and residents at their school, which may be low to begin with.

Grand Total End Result is that most medical students become less optimistic and humanistic after medical school.

Don't feel bad, outstanding and very poor medical student, resident and attendings are attacked by colleges because they stand out. Bottom line is don't stand out!
 
lluvia2rain said:
so,
During OB I was told I was rude in an evaluation.
Click to expand...
Well, it's pretty easy to offend someone even if you're not trying to be rude when it comes to genital related issues. Plus I could see some attending being overprotective of their patients in that kind of setting and interpreting something benign as rude.

Something that was suggested to me was to ask about mid-way through the rotation how you're doing and how you can improve. Then you might have a chance to rectify things before eval time. Good luck with the rest of third year!
 
are you shy? sometimes being shy comes off as being rude or standoffish. i know this because i find that i get alot of negative treatment from nurses when i feel intimidated/shy and i think its because they think i'm being rude
 
hey guys. i find it interesting that so many people on here say that the minute they stopped caring was when their evals went up.

do you think attendings/residents etc can 'sense' when we care too much, and than this encourages them to attack us? kind of a bleak thought, but a valid one, I think.

moral of the story....just go and do your job, be professional, use your brain, and that's about all you can do.

because at the end of the day, I believe there is always going to be some jackass you are just not going to gel with.....and really, there is no way to control that.

trying to make everyone like you will just make you want to jump off a bridge in the end.
 
while i was never told that i was rude, i have had comments where preceptors said i was 'not sensitive' ,'didn't show empathy', 'no concern for social aspects of medicine',,,i would also describe myself as reserved, but polite, i never deliberately did something to hurt someone as far as i know, how this came across i dont know? i think you have a quiet personality you will get punished, especially on these evaluations, the ones who get 'rewarded' with points that is, are the outgoing, go-getter, exuberant types. if this doesnt fit you and you want those points, then i suggest you adapt fast.

and btw, i am indian, and i do notice that ppl tend to remember me, i dont know why, b'c like i said im not very outgoing, but somehow ppl do remember me, and that goes for when ppl make comments to, i think certain pt types are more quick to criticize whenever they dont deal with their ideal customer service type medical professional: tall,white guy,blond,blue eyes,well groomed(man, maybe im describing a nazi!). when they dont see that, they tend to be more quick to make nasty comments, of which ive had swallow many,just the other day i went to see a pt in the er, and was talking to the family and writing info down and looking at the chart when suddenly the pt's daughter snapped and said ,'i think its rude that you are writing and not looking at me when im speaking to you'. she can get away with that b'c again she belongs to the pt group that is quik to criticize. if i were the 'ideal' health care provider,and did the exact same thing, this woman would have said nothing,

now as far as the rude comment grows, i think ppl may mistake your reserved attitude for disinterest, so speak up more and that will prevent these comments in the future

hope this helps,
greenbean
 
A lot of unfairness takes place during third year (understatement of the century). I'm quite outgoing, good with pts, etc. but I've gotten dinged before for random crap (with two attendings contradicting each other, to boot). Sometimes you just run across that attending or resident you don't get along with...or have some misunderstanding crop up...or you just don't gel well with someone for some reason. Just believe in your strengths and good qualities, and don't let someone else's misguided impression of you affect how you think about yourself. Attendings who interact with you one-on-one for, at most, 10-30 minutes over the course of a week or a month aren't capable of truly judging your performance, so a lot of it is random chance. Some people are lucky and play the politics well; sometimes luck isn't in your favor. The sad part is that even if patients love you it may not matter (I've had patients tell me "I wish you were my doctor" several times on rotations where I received a few less than stellar comments.) God knows I'd be living out of a cardboard box if I let myself truly believe the things my ob/gyn residents/attendings told me about myself.

Chin up, you'll end up in the place that's right for you.
 
Having been through several rotations now, I can wholeheartedly agree with what has been said. The more you act "like a doctor" the more you are rewarded. Since medicine is very much a social endeavor, the system punishes those who are sensitive, shy and introverted.

The best advice I have gotten is to "learn to be comfortable with being uncomfortable". I think what people mean by "not caring" really translates to "appearing relaxed and confident". I find when I worry less about what others think, I appear more relaxed and am able to act more "naturally".

Subjective evaluations are one of the most inherently unfair methods for judging performance. My program assigns point values to different aspects such as "history taking" and "relationship with team" (on 1-4 scale). Basically, to get honors you need to get mostly 4's. You can imagine how poor the inter-rater reliability is for these evaluations. Couple this with the fact that for a given rotation, one may only receive 4-6 evals, and here you have a recipe for unfairness since one outlier can significantly skew the mean.

For example, I received evaluations for a particular clerkship that if you just read the comments, you would think is clearly worthy of an "honors" grade. Unfortunately, I was just under the point cut-off--so I was SOL.
 
Everyone gets an occasional ding, deserved or not. It won't matter either way since your Dean's letter most likely won't include it. However, if you keep getting negative feedback about the same issue, it is probably something you need to address. You CAN just chalk it up to the unfair and random system and ignore it, but it just might bite you in the ass later.
 
You were told you were rude, but didn't ask for an example or further clarification? Odd.

Honestly, I suspect you are kind of brusque or curt, and hence some take that as rude. The "rude" label is pretty strong, and I have only heard of it being used occassionally, usually due to a specific incident. I was called rude once, and in all honesty I probably deserved it. You should look at your behavior and make adjustments.

Insisting that you aren't doing anything wrong, after two seperate evaluators said you have issues, means you are probably in denial.
 
how does a quiet person become more outgoing? i need good evals and i feel that not being outgoing is hurting me. i'm not super quiet or anything, but how do i get the extra edge? have any of you "quiet" ppl changed your ways for the better or are we quiet ppl doomed to mediocre evals??
 
goodies said:
how does a quiet person become more outgoing? i need good evals and i feel that not being outgoing is hurting me. i'm not super quiet or anything, but how do i get the extra edge? have any of you "quiet" ppl changed your ways for the better or are we quiet ppl doomed to mediocre evals??
Click to expand...

Ask more questions. Make up questions to ask even if you don't have any. Make it a point to do this several times a day.

I'm a quiet person, and not really a question-asker (aka I NEVER raised my hand in lecture), but I try to make it a point to do this so I seem more interested (b/c, based on feedback from attendings, not asking questions doesn't mean you understand, it apparently means you are not interested). Anyway, it's a pretty simple way to "participate" on the team. Just feel it out first before asking 100,000 questions on surgery; I think a lot of times in surgery you're supposed to keep your mouth shut until they say something to you.
 
To the OP: As you know evals are subjective. If something someone said about you bothers you, find/email that person, express your regret, and sincerely ask them why they gave you that evaluation. If their explanation makes sense, then you can use that to improve in the future.
 
have any of you ever been evaluated by a nurse? how do you feel about nurses giving you (un-asked for) feedback?
 
Never been evaluated formally by a nurse, but get lots of often unasked for feedback. And feedback I asked for. The way I deal with unasked for feedback is to listen to what they are saying. Sometimes my first reaction is anger, because it will be inane feedback along the lines of "You can't put the bottom rails on the bed up without a restraint order" in an incredibly condescending or demeaning tone after I've been awake for 36 hours busting my rear. But you still have to listen to it, and even if it was coming from a bad place, hear what they're getting at. Sometimes there really is nothing to learn, but often there is. Other times, the feedback is just wrong. I listen to them, make that evaluation, and depending on the relationship either discuss the issue or nod my head and ignore what they just said. There are several nurses who I respect deeply and ask for feedback (e.g., what could I have done better explaining that to the patient, is there a right way to do this thing that I'm not doing very elegantly, etc.).


Anka
 
goodies said:
have any of you ever been evaluated by a nurse? how do you feel about nurses giving you (un-asked for) feedback?
Click to expand...

I feel like it depends on the nature of the feedback.

Sometimes I'll get comments about my medical decision-making. This usually amounts to "I've seen most doctors do X". In those cases, it's nice to use it to get a feel for how the docs in that department practice. Sometimes it's a little more curt, along the lines of "You never should have given X, you should have given Y." That's usually based, again, on what they've seen other docs do. If they're right, I say so, and thank them. If they're wrong, I cite studies and offer them papers, and that usually prevents further criticism.

When it comes to how I interact with patients, I actually taking nursing feedback very seriously. Docs are notoriously poor at interacting with patients. Given that nursing education puts much more emphasis on this, and they practice it far more, I take them as something of experts. I've gotten pretty good advice on dealing with difficult patients from nurses.
 
lluvia2rain said:
so,
I am just finishing third year. It has been a huge struggle for me. I have been mostly humiliated and embarrassed. During OB I was told I was rude in an evaluation.

I am actually a very sensitive and quite person. I know that I have never been rude to anyone. All my school osce's have been good.

On my more recent rotations I have almost stopped caring because it seems that no matter what I do there is something bad to be said about me. To my amazement my evals went up when I stopped caring. However, today I got all of our clinical grades from the entire year and learned that in an earlier rotation someone said they were concerned about my "interviewing style". I thought this was interesting since I know in that rotation I was never observed actually interview a pt. Today was just another reminder of my past and possibly present incompetence. I am feeling sad =(((

I am hoping to hear what other people think and if they have any stories.
Click to expand...

I was told that I was rude and too forward in my last rotation. It actually didn't bother me. That particular residency program had a group of very conservative, uptight people. I knew I wanted a more laid-back group, so it made it easy for me to withdraw my application.
 
AlternateSome1 said:
Everyone gets an occasional ding, deserved or not. It won't matter either way since your Dean's letter most likely won't include it. However, if you keep getting negative feedback about the same issue, it is probably something you need to address. You CAN just chalk it up to the unfair and random system and ignore it, but it just might bite you in the ass later.
Click to expand...

.
 
Last edited:
The key to medical student evals is that while some people are douchebags who are trying to show power, a lot of times criticisms harbor very important opportunities for improvement.

When I was a medical student and someone wrote something critical about me, it was their fault and I did nothing wrong of course.

Now that I am more mature and in residency, I take every criticism and really think about it to see if there is an opportunity for me to improve, or is the person criticising just to be a DB. In time you will find that the majority of people just want to make you better based on what they have experienced and what they know will make you a success.

It is all about attitude.
 
I 100% support the original poster. She wasn't being rude. Third year is EVIL.
 
I think most of the time, it's how the advice is given. People don't have to be so damn condescending. That's what third year is for, to learn, because you're not a licensed physician yet. I understand expectations can be high, and that's fine, but I don't get why people have to be DB's about how they give the advice.
 
Obviously the OP is gone, but for all MS3's and younger, you should not just read these evaluations and walk away wondering what went wrong. Especially if it is negative feedback. You need to talk to the person who wrote the evaluation and ask for more feedback.

Something like 'rude' on your evals can be very damaging, especially if it is written in the section to be included in your MSPE. Therefore, you need to request that this situation be clarified or rectified. Approach the course director and state that you feel this was an unfair evaluation. Likely they have a process for arbitrating evaluation disputes. For someone to write 'rude' on your evaluation, they better have some specific examples of how your behavior was rude, and quiet/introverted isn't going to cut it. If the examples are there, then you keep the grade and learn from the experience. If not, you are entitled to a new evaluation.
 
cpants said:
Obviously the OP is gone, but for all MS3's and younger, you should not just read these evaluations and walk away wondering what went wrong. Especially if it is negative feedback. You need to talk to the person who wrote the evaluation and ask for more feedback.

Something like 'rude' on your evals can be very damaging, especially if it is written in the section to be included in your MSPE. Therefore, you need to request that this situation be clarified or rectified. Approach the course director and state that you feel this was an unfair evaluation. Likely they have a process for arbitrating evaluation disputes. For someone to write 'rude' on your evaluation, they better have some specific examples of how your behavior was rude, and quiet/introverted isn't going to cut it. If the examples are there, then you keep the grade and learn from the experience. If not, you are entitled to a new evaluation.
Click to expand...

Definitely agree with this. The third year is so important for residency you owe it to yourself to at least get suggestions for improvement or to clarify a grade. I haven't personally tried but I do know of a friend who has diplomatically argued a grade up without brown-nosing or whining.
 
SuperHiro said:
Definitely agree with this. The third year is so important for residency you owe it to yourself to at least get suggestions for improvement or to clarify a grade. I haven't personally tried but I do know of a friend who has diplomatically argued a grade up without brown-nosing or whining.
Click to expand...


This is dangerous. I have a friend who had his tennative grade reduced by being aggressive in confronting the stupidity of the whole subjective grading process.

It's fair to ask for an explanation and suggestions for improvement, but
don't expect them to alter your grades. In real life fighting the power only gets you burned.
 
SGuttenberg said:
This is dangerous. I have a friend who had his tennative grade reduced by being aggressive in confronting the stupidity of the whole subjective grading process.

It's fair to ask for an explanation and suggestions for improvement, but
don't expect them to alter your grades. In real life fighting the power only gets you burned.
Click to expand...

Key word - aggressive. Obviously it takes some finesse and common sense to argue a grade up, which that friend had. Not everyone can do that and I certainly did not recommend that.
 
Our school checks social networks such as this, so I won't directly quote my last evaluation, but I will paraphrase how I interpreted what was written:

.g squared 23 is kind of a creepy d-bag. He doesn't talk much, and I get the impression that he is very shy, lacking basic clinical knowledge, and is insecure about his many deficiencies. May God have mercy on the director who is duped into selecting him as a resident.
.
 
Last edited:
g squared 23 said:
Our school checks social networks such as this, so I won't directly quote my last evaluation, but I will paraphrase how I interpreted what was written:

.g squared 23 is kind of a creepy d-bag. He doesn’t talk much, and I get the impression that he is very shy, lacking basic clinical knowledge, and is insecure about his many deficiencies. May God have mercy on the director who is duped into selecting him as a resident. .
Click to expand...

Here was my last eval:

Steve Guttenberg is a completely apathetic and unmotivated "human" being whose level of sloth and indolence was truely monumental. He lacked the slightest shred of interest in the learning process. To make matters worse he exuded arrogance to his superiors and was cold and uncaring with patients. Any residency program director who would even dare to consider him should be examined for incompetence by a medical professional.

I think what they meant to write for both of us was probably something along the lines of "X is sort of shy, but he seems to know enough to be a physician of some sort". This year can't be over soon enough...
 
SGuttenberg said:
Here was my last eval:

Steve Guttenberg is a completely apathetic and unmotivated "human" being whose level of sloth and indolence was truely monumental. He lacked the slightest shred of interest in the learning process. To make matters worse he exuded arrogance to his superiors and was cold and uncaring with patients. Any residency program director who would even dare to consider him should be examined for incompetence by a medical professional.

I think what they meant to write for both of us was probably something along the lines of "X is sort of shy, but he seems to know enough to be a physician of some sort". This year can't be over soon enough...
Click to expand...

On my next rotation, I'm going try being the loud, obnoxious kid, instead of the quiet kid and see if the eval is any different. Introversion is apparently not one of the qualities they are looking for in a resident, or a person in general.
 
Under the category of Patient Advocacy (read: knowing the political ins and outs of the healthcare world), I received this little gem of a comment:

"WanderingDave has obviously done no outside reading on the subject, and shows minimal interest in the issues facing the world of medicine today."

This came from an attending who is ascending a lofty administrative position in the AOA, and is pretty preoccupied with political and economic reform in the world of medicine and expects all his students to be just as into this as he is!

Sorry, but I'm a bit busy learning the science and the basic praxis of medicine to have much of an opinion on the politics of healthcare reform. I listened intently whenever this jerk of an attending spoke on these issues, but just didn't have much of an opinion or any questions to ask on the subject.

I really hope that comment doesn't make it into my dean's letter.
 
lil pook said:
do you think attendings/residents etc can 'sense' when we care too much, and than this encourages them to attack us?
Click to expand...

Absolutely, yes. I think maybe my biggest problem third year was asking for too much feedback and just looking like I was trying too hard. Also I really didn't enjoy any inpatient rotations and I have a hard time hiding when I don't like something (not for lack of trying, though).
 
SuperHiro said:
The third year is so important for residency you owe it to yourself to at least get suggestions for improvement or to clarify a grade. I haven't personally tried but I do know of a friend who has diplomatically argued a grade up without brown-nosing or whining.
Click to expand...

On the other hand, going to the person who criticized you to ask for clarification can MAJORLY backfire. You can look defensive, insecure, and whiny, or, worse, you can look like an arrogant person who cannot take feedback gracefully. Be careful when when taking the above advice from the other posters. Maybe ask your deans office first whether they think they are going to put the criticism in your dean's letter -- most comments from third year don't make it into the letter. Then ask your dean of students for advice. It may be, very often, that the best policy is to ignore it.
 
DrBosse said:
On the other hand, going to the person who criticized you to ask for clarification can MAJORLY backfire. You can look defensive, insecure, and whiny, or, worse, you can look like an arrogant person who cannot take feedback gracefully. Be careful when when taking the above advice from the other posters. Maybe ask your deans office first whether they think they are going to put the criticism in your dean's letter -- most comments from third year don't make it into the letter. Then ask your dean of students for advice. It may be, very often, that the best policy is to ignore it.
Click to expand...

You have to pick your battles, obviously. But if someone writes 'rude' on your feedback, that is just not acceptable. They have already given you a horrible evaluation, what do you care if they think you are insecure, whiny or arrogant now? The damage is done. Time to do damage control. Talking to the dean is a good idea.
 
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