Beware my rant

[jeff2005]

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OK, so I just found out that my class rank has declined precipitously since the beginning of third year. I'm not going to use this thread to pick on people who kicked ass 3rd year because most of them deserved their honors grades. My beef is with the system. At my school clerkship exams count for very little. And somehow, even though I always did extremely well on these exams, my clinical evals all said that my knowledge base was really something I could work on. How is this possible? Part of the problem is that on a rotation I only opened my mouth when I had something productive to add, and I only brought in articles if they would be truly helpful to the team. I knew it was going to hurt me but behaving any other way was contrary to my personality. I could go on about 3rd year but i will spare you. I thought I was "over" third year but I guess I'm not.

 

[b&ierstiefel]

Jeff, I feel your pain man. I've kinda ranted on this issue in one of the other threads. And I could still go on and on and on about this. Perhaps when I stumble back to my place tonight, my emotions will be revved up even more. Then I can truly add to this in the appropriate tone and spirit that this topic deserves.

 

[stormjen]

I completely agree that the clerkship grading system is wack (see my thread about this very subject in the clinical forum). If and when I am an attending sitting on a pile of applications, I plan to place very little weight, if any, on 3rd year grades.

Side note: Andy, I was reading some old posts and saw that you are Asian. That completely blew my mind. Just though you should know. Perhaps your avatar threw me off a little?

 

[b&ierstiefel]

I completely agree that the clerkship grading system is wack (see my thread about this very subject in the clinical forum). If and when I am an attending sitting on a pile of applications, I plan to place very little weight, if any, on 3rd year grades.

Side note: Andy, I was reading some old posts and saw that you are Asian. That completely blew my mind. Just though you should know. Perhaps your avatar threw me off a little?

I thought the grading system at Michigan was wack. But I see from some of posts on the forums that the clerkship grading system is pretty much wack everywhere. Personally, there is the theory running around at Michigan now that grade deflation is a scheme to keep Michigan students at Michigan for residency. That's totally fine for the significant fraction of us who have family, loved ones, etc in Michigan and Midwest. But for the remainder, it is a source of much frustration. Michigan has this attitude that a grade of Pass (which is what 50-60% of students end up getting on any given rotation) is an achievement to be very proud of. My response? and monkeys are flying out of my arse.

Anyways, I've posted about this in detail and with much more fervor also in one of the other threads (I think it had to do with match lists or something...don't remember cuz it was a while ago).

And yes, I am Asian; however, other Asians call me a Twinkie or Banana...that's my best explanation for my avatars I guess...

 

[DrDre']

Andy, you guys are better off than us. We have a rigidly enforced rule that only 30% of the class or people on rotation can get near honors or honors (usually 20 and 10% respectively). It is very hard to honor classes in the first 3 years.

 

[b&ierstiefel]

Andy, you guys are better off than us. We have a rigidly enforced rule that only 30% of the class or people on rotation can get near honors or honors (usually 20 and 10% respectively). It is very hard to honor classes in the first 3 years.

That's pretty tight (in a bad way). In our rotations, around 10-15% of students get honors but yes, about 30-35% students get a high pass. I didn't mean to imply that we had it the worst; I just wanted to add to the sentiment on this thread that the clinical grading system is kinda wack.

 

[yaah]

Yeah, my school was doing that, "pass" (or, "expected" as they called it there) was an excellent grade. The problem was that the range of performance you had to put in to get an expected was way too wide. If you barely showed up, were rude to people, passed all your tests but barely, handed in your projects late and they were sloppy, and showed no enthusiasm on the wards you got an expected. In order to get above that it was mostly political.

They say it's not political, but it totally is. Anyone who does pediatrics and does a few things: 1) Smiles at all the kids; 2) Brings in articles (doesn't matter if you read them or understand anything); 3) asks for more responsibility in situations when you know they are not going to give you any more; and 4) bring a "milestone" chart with you everywhere; gets a better grade. Knowledge? What's that? Did you bring in an article? Do you want to look in that brat's ear? My comment on my pediatrics grade: "Would have been nice if he showed more interest in pediatrics." Well, ****sticks, it would have been nice if you all showed more interest in pathology other than "is the biopsy back yet? Is the biopsy back yet?"

And yes, I feel your pain in not having the test grades count for anything. The surgery clerkship it did count for about 25%, which is reasonable. In the others it counted for 10%, which when you have a 3 tier grading system is basically crap. And plus, they "average" things out. On family, for example, my grade on the clinical part was "expected." Grade on the few papers we had to pass in: "Above expected." Grade on the final exam: "Above expected." Final grade: Expected. Whatever happened to rounding up? Oh wait, I get it. They only round up for people who say, "I want to go into" field x.

I tried not to have in my evaluations of my clerkships until after I received my grade, so I could properly make some choice comments. Like on the pediatrics eval I was able to write, "My problem with this clerkship was that intelligence and knowledge were deemphasized in favor of other characteristics."

 

[b&ierstiefel]

Only a few months into M3 year, I lost all faith in the grading system. My former classmates who matched in 2002 had warned me about this. But I was a grad student at that time and didn't heed their warnings much as I thought of it as more pressing issues were of significance at that time. But man, your family medicine story brings back memories of some wacky grading:

Infernal medicine: clinical grade = high pass, few honors; shelf = average --> PASS (wtf)
Pediatrics: clinical grade = high pass; shelf = just on the fence of high pass/honors --> PASS (maybe because I did this rotation at Jokewood hospital and not at U of Michigan...bastards)
Anesthesiology: dunno anything about my grades; went in at 6-7 am, left at 9-10 am everyday. --> HIGH PASS

This whole grading is ass backward!
I'm really curious as to what my grade in the SubI's were considering that my evals were all honors but again, both of my SubI's were at Jokewood. I'll probably end up with a Pass

 

[DrDre']

Hey Andy,

I didn't post my school's "rules" to devalue your's at all! I was merely doing the same as you. It is so unfortunate that 3rd year is like this. I actually miss the grading of the 1st 2 years now. It is easier to pass now. But doing well is depressingly subjective.



Good luck to all you guys.

 

[jeff2005]

I completely agree that the clerkship grading system is wack (see my thread about this very subject in the clinical forum). If and when I am an attending sitting on a pile of applications, I plan to place very little weight, if any, on 3rd year grades.

Side note: Andy, I was reading some old posts and saw that you are Asian. That completely blew my mind. Just though you should know. Perhaps your avatar threw me off a little?

I went back and read your thread. YOU DO FEEL MY PAIN! Thanks guys for commiserating. 👍

 

[DrDre']

Hey Andy,

I didn't post my school's "rules" to devalue your's at all! I was merely doing the same as you. It is so unfortunate that 3rd year is like this. I actually miss the grading of the 1st 2 years now. It is easier to pass now. But doing well is depressingly subjective.



Good luck to all you guys.

 

[b&ierstiefel]

Hey Andy,

I didn't post my school's "rules" to devalue your's at all! I was merely doing the same as you. It is so unfortunate that 3rd year is like this. I actually miss the grading of the 1st 2 years now. It is easier to pass now. But doing well is depressingly subjective.

Good luck to all you guys.

It's all good...we're in the same boat. And the boat stinks of SHENANIGANS!

 

[DrDre']

***** alert. Sorry for the repeat post. I guess I really wanted to wish you all well.


Stormjen, I feel the same way as you!

 

[b&ierstiefel]

Holy crap batman! This thread exploded! 😀

 

[yaah]

Holy crap batman! This thread exploded! 😀

Oh oh. You're a 1000+ person now.

Andy I had the same experience during 4th year. I got all outstandings except for ID where I got an above expected.

 

[b&ierstiefel]

OK all this talk about clinical crap is getting me fired up.

Drinky time to quench the fire.

 

[deschutes]

U of C is a Pass/Fail school. It is also a 3-year program.

Wackily enough, this means that my transcript sent into ERAS only has my 1st and 2nd year grades (which show something like "Completed All Requirements" across all fields). It is not worth the paper it was printed on.

Therefore all eyes turn to the Dean's Letter.

Based on the Pass/Fail ideology, I don't know what my number grades for the clerkship exams are - I know I at least passed every one of them.

Clinical performance, however, is graded on a spectrum of:
Unsatisfactory - Below Average - Average - Above Average - Outstanding.

The final mark for the rotation is one of Pass/Performance Deficiencies/Fail.

The system, which I was very recently made painfully aware of, values a pass more than it does stellar performance - right along the lines of what DrDre' was saying.

Peds: Clinical = average, exam = pass, final grade = satisfactory.
Psych: Clinical = above average, exam = pass, final grade = satisfactory.
IM: (an elephant in process - and here is where things get confusing)

Clinicals -
ID: average
Rheum: above average
Teams: below average
First 2 weeks of Nephro: outstanding

I passed the IM mid-term, and based on my track record I know I will at least pass the IM final.

One would think that the two 'above average' grades would counter the one 'below average' grade. But nooooo... the Teams experience tests a unique set of skills which cannot be found anywhere else in medical education, bugger it all that I chose to do my month at a regional referral centre and that my grade was 'below average' and not 'unsatisfactory'. Apparently I am a danger to patients if I do not at least perform satisfactorily.

Will the IM clerkship committee choose to Pass, Fail or Remediate me to satisfaction? I have to wait a month to find out.

Because of timing, a "Performance Deficiencies" may yet end up on my Dean's Letter.

 

[deeq]

you know deschutes, i'm in a similar boat as you. my school unfortunately requires us to do a month of geriatrics. due to what i can only describe as hullabaloo, my grade was unfairly less than satisfactory. i'm currently in a grades appeal process but like it's gonna matter or even help. i've already sent in my ERAS and now programs are gonna totally notice what appears to be a glaring lack of ability to care for those poor elderly folk.....never mind the remainder of my clinicals show above average knowledge base..... 😡
i'm gonna take a deep breath now, otherwise i get progressively pissed!

 

[deschutes]

What pissed me off was the Teams attending bringing my choice of career into the picture at the exit interview. As if!

She was as small as me. At any other time I probably would have been charged with assault. But at that time I had been up for 30 hours on Day 20 of straight service. I was a blithering idiot.

Never mind that I chose to suck it up, grin and bear it.
Never mind that I didn't wake up, phone in sick and *koff koff* in those 20 days.
In retrospect, I should have.
As I said, I'm a blithering idiot.

~
What never ceases to amaze me (and provides me with no small measure of comfort) is that no matter how brilliant people are - and there are obviously some brilliant people on this forum - everyone gets bitter and vehement about the M3/M4 years.

Horrors. It's a rite of passage, but horrors nonetheless.

 

[yaah]

I feel your pain.

The problem, deschutes, is that they have this grade of "below average" but I would be willing to bet that they don't give it out to 40% of the class. Technically, 49% of the class would be below average, right?

Oh, there are individuals who claim not to be completely annoyed by M3 year, but these people are generally the chronic suckups that can't let down their guard at any point for the fear that their comment of "shows terrific enthusiasm" is downgraded to "shows enthusiasm."

I love coming in at 4am to round on the vasculopaths!
Does anyone need a rectal exam?
Would you like me to write your notes for you?

 

[deeq]

I love coming in at 4am to round on the vasculopaths!
Does anyone need a rectal exam?
Would you like me to write your notes for you?

oh how i know sooooo many of these suck-ups......and i'm sooooo totally NOT one of them!!!!!!
i'd rather risk walking through a cowpasture barefoot than perform a rectal on a demented 92 yo with jello stuck to her upper lip......

that was mean wasn't it.....

 

[b&ierstiefel]

Oh damn, you GOTS to get me started on the kissasses. OK OK, I can NOT stand the people who during every rotation say, "Oh this is what I've wanted to do since the age of five...I'm living my dream on this rotation". For the last almost 1 year, my answer to the question, "What do you wanna be?" has always been "Pathologist." And I love...LOOOOVE seeing their reactions to it.

These brown-nosing automatons do this during every rotation! And when you ask them, so what are you going into, they're like, "Oh I dunno...I love everything...this year is the best year of my life!" And the whole time I'm thinking, "Close your legs...the monkeys flying out of your ass are hittin me in the face!" And these folks can't take part in any honest conversation or any non-medical conversation in fact because they don't wanna "let their guard down." Now, you ask them the same question, they answer, "I'm going into Dermatology." I KNEW IT!

How sad it is that in a time where Dermatology has gotten so competitive that dermatology-wannabe-people must lose all sense of self-pride while going through clinical rotations. In any case, I'm glad more medical students are going into some of these lifestyle fields. At Michigan, which is a school who is trying to pump out more primary care docs, applicants to Anesthesiology, Derm, Rads are at an all time high. I think that's beautiful.

 

[deschutes]

Technically, 49% of the class would be below average, right?

Precisement! And yet some evaluators have said to me without any sense of irony, "Most students fall under Average or Above Average." I don't see how a left-shifted bell curve works in my favour though!

The individuals who claim to not be completely annoyed by M3? Outside of this forum where insanity in medicine prevails! Probably the same people who want to do a combined Internal Med/Peds program.

I cannot imagine 5 years in a world more hellish.
God my stomach just lurched again.
Peds Teams + IM Teams.... AAAAAaaaaaHHHHHHH!!!!!

Haven't had much of a family med experience. That's coming up two Mondays from now. I'm going to a town of about 5,000 people for a month - and they will pay for food and accommodation. Schweet!! Planning on doing lots of Emerg.

After this month I will be fully qualified to say to any internist who tells me I am personable, "I'd really rather do Family Med".

 

[b&ierstiefel]

Haven't had much of a family med experience. That's coming up two Mondays from now. I'm going to a town of about 5,000 people for a month - and they will pay for food and accommodation.

A town without internet. You won't be able to check ADTS...what a tragedy. 😀

 

[deschutes]

A town without internet. You won't be able to check ADTS...what a tragedy. 😀

Have phoneline will check! 😛 You know me - I was never a fan of ADTS.

And I will be in virtual society on SDNPath, while in my physical isolation.

 

[Stinger86]

My biggest complaint about the third year eval system here is that attendings get to evaluate you on "interactions with patients", "work effort", and "history and physical exam skills", when all they ever see you do is present for an hour a day and maybe answer a few ******ed pimp questions.

Attendings should only evaluate you on your information base and your presentation skills, period. Your residents/interns should be the ones to evaluate your interaction with patients and housestaff, your write-ups, and work effort since they spend more time with you.

And of course 30% of our grade comes from the people who spend the least time with us, and 20% of our grade comes from the people who spend the most. Go figure.

I can't wait until Christmas when Medicine, Peds, and Surgery will all be behind me.. 🙂

 

[b&ierstiefel]

You know what bothers me more Stinger? The fact that the far majority of these evals are filled out in less than a minute.

 

[Smitty]

My biggest complaint about the third year eval system here is that attendings get to evaluate you on "interactions with patients", "work effort", and "history and physical exam skills", when all they ever see you do is present for an hour a day and maybe answer a few ******ed pimp questions.

Hallelujah!! You are preaching to the Choir on that one! 3rd year is pure bull****!
(But I'm not bitter). As a 4th year I've gotten to the point where showing fake enthusiasm is comletely impossible! (Not that it ever really was possible). The other day my ICU attending asked me why I am doing an ICU rotation if I'm going into path and I said, "Because we are required to do an ICU month". I'm not a rude or lazy guy, I just get tired of all the crap.

Me at interviews: "Don't pay no attention to that 3rd year rank! Watch me tappidy-tap-tap!!!" as I fling myself on the PD's desk and grind that Dean's Letter into oblivion with a few choice dance grooves!

 

[yaah]

Me at interviews: "Don't pay no attention to that 3rd year rank! Watch me tappidy-tap-tap!!!" as I fling myself on the PD's desk and grind that Dean's Letter into oblivion with a few choice dance grooves!

Smitty if you find a program where this is an effective strategy be sure to let us know. 😉

Either that or you could try the old switcheroo and ask to see your transcript when you interview, because there were some mistakes and you wanted to see if they were corrected in time. Then, using sleight of hand, switch the bad transcript for your own updated version which says you are a god and can do no wrong.

 

[b&ierstiefel]

The other day my ICU attending asked me why I am doing an ICU rotation if I'm going into path and I said, "Because we are required to do an ICU month".

Dude, that was SO me 3 months ago! What I really wanted to say was, "I chose to do my CCU rotation at Jokewood because I heard it was a joke." Cmon...Q7, Saturdays off, Sunday half-days...that sure beats U of Michigan's Q4 bullsh*t. Doing my ICU at jokewood was totally worth the 30 minute commute.

 

[Stinger86]

You know what bothers me more Stinger? The fact that the far majority of these evals are filled out in less than a minute.

I had this resident two months ago who I seemed to really impress with my knowledge and clinical skills yabbity yabb (there wasn't a question he could ask that I couldn't answer), yet when I received his evaluation from the clerkship director, it was a near-failing score with absolutely NO comments provided. ****ing ****head.

So I do probably the best work of my three months of clinical medicine so far, and I get the crappiest evaluation score. Man, like I need something else to turn me off to this crapshoot aspect of medicine.

 

[jeff2005]

I had this resident two months ago who I seemed to really impress with my knowledge and clinical skills yabbity yabb (there wasn't a question he could ask that I couldn't answer), yet when I received his evaluation from the clerkship director, it was a near-failing score with absolutely NO comments provided. ****ing ****head.

So I do probably the best work of my three months of clinical medicine so far, and I get the crappiest evaluation score. Man, like I need something else to turn me off to this crapshoot aspect of medicine.

The same thing happened to me. Maybe we're just dense. 🙁

 

[b&ierstiefel]

The same thing happened to me. Maybe we're just dense. 🙁

Me three. Same thing happened (but it was Surgery). I answered this one attending's pimp questions all correct. He gave me 5/9 on the evals with the sole comment being, "Sufficient fund of knowledge; needs to read more." But ironically, I ended up with a HP on that rotation (even though I got average on that shelf too). Surgery here at Michigan is much more lenient and nice than IM though. Whereas 50-60% students get a Pass in IM, 50-60% students get a HP in Surgery (no complaint's here).

 

[cytoborg]

Ah yes, the insanity of clerkship evals.

Worked my tail off on OB, was up all night every single call night delivering babies, checking cervixes, writing notes, didn't slink away to sleep (like I should have), a sub-i couldn't have done it better. I happened to think delivering babies was really cool (anticipated it was the last time I would ever get to do it) and really gave it my all. Every resident said, "Strong work. Excellent job. Thank you for your excellent help." On rounds, gave excellent presentations and was told so by the attending.

Evaluation (by an attending I had never even heard of): "Cytoborg performed adequately." WTF??? 😡

Luckily, wild horses couldn't drag me into a career in OB/GYN.

 

[deschutes]

And then... AND THEN... you run into the attending in the hallway.

Smile!

 

[b&ierstiefel]

And then... AND THEN... you run into the attending in the hallway.

Smile!

Hell no. I keep it real by looking the other way and not even acknowledging the attending.

 

[deschutes]

It's all coming back to me now - Top 5 reasons NOT to do a residency at the home school...

 

[b&ierstiefel]

It's all coming back to me now - Top 5 reasons NOT to do a residency at the home school...

Hmm...home school residency. Sounds interesting.

As Cartman says, "Home school is so sweeeeeeeet ya guyssssss."

 

[deschutes]

The other day my ICU attending asked me why I am doing an ICU rotation if I'm going into path and I said, "Because we are required to do an ICU month". I'm not a rude or lazy guy, I just get tired of all the crap.

I predict that at the end of the rotation he will say, "Are you really sure you don't want to be an internist/intensivist? I'll write you a letter!"

 

[deschutes]

Hmm...home school residency. Sounds interesting.

As Cartman says, "Home school is so sweeeeeeeet ya guyssssss."

Though both are unlikely, I imagine home school med school would be more likely than home school residency.

Heck, most of my 1st two years of med school were spent hunched over books - I don't think it mattered if it were at home or at school.

Oh you mean you go to school at UMMS? Well then of COURSE you have to apply! 😉

 

[b&ierstiefel]

Though both are unlikely, I imagine home school med school would be more likely than home school residency.

Heck, most of my 1st two years of med school were spent hunched over books - I don't think it mattered if it were at home or at school.

Oh you mean you go to school at UMMS? Well then of COURSE you have to apply! 😉

Well, an interview at the home institution is an interview that cost nothing. It's like saying, "Well OK I guess I'll just walk down the hall in my suit and..."

Start interview. Seriously though, I'm still not sure where Michigan will end up on my rank list if they interview me.