Can I rant about 3rd year grades for a bit

[general admission]

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This is ridiculous. I don't understand how something that is so inherently subjective and not standardized at all between schools (or even between graders in the same specialty at the same school) can carry so much weight. How can a residency gain anything from looking at one final grade knowing that what it took to earn it could vary by an incredible amount? Secondly, I don't see what a school has to gain by making honors difficult to earn. It's only doing a disservice to the students and nothing else.

Just finished my 1st clerkship. My school has very high standards for honors. Usually, a 90% is required on the shelf, with an honors needed on a majority of evals (with the "honors" criteria being impossible to meet for a student on their first rotation without prior clinical experience). Got high 90s on the shelf - busted my dangus from day one reading.

In clinic, always showed up early, always asked good questions, wrote notes, etc. All the feedback I got was very, very good. (Extremely organized, thorough, great presentations, notes, encyclopedic knowledge base, great patient skills, always offers a detailed and accurate A/P). And those comments were from multiple attendings and consistent throughout the entire clerkship. Whenever I'd ask what I could be doing better I got nothing, they said I was excellent.

Got my first few evals back. One of them: All "pass" with no marks in the "honors" categories at all. No written comments at all, except for the final category in which some mildly positive comments were written, followed by "could work on so and so better", which they had never brought up with me at all. This was from an attending that consistently said I was amazing. All I have to show from my time with them is that lukewarm two sentence eval. Another one gave me very good comments but all "pass" markings, specifically citing the specificity of the "honors" markings as something I'd be fulfilling later on in my rotations. I'm now locked out of an "Honors" no matter what.

Meanwhile, friends get an attending that has given 70% of every student they've ever worked with "honors", and residents that take time to write amazing, detailed feedback that make them out to be a worldbeater. So even if I am a much stronger student, they make it out with an H (or at the very least HP and much better comments), while I get a P or HP with very little comments for my dean's letter. I think my same exact performance would have easily earned an honors at other schools. But all residencies will see is the "H" and my "HP" or "P" and that will be that. Even with the class histogram in the dean's letter; all of the intricacies of subjectivity, ie what % of students get an H from that attending, my specific shelf score, etc, will be essentially lost.

 

[IonClaws]

Not on rotations yet, but to me, these evaluations always seemed like getting tips as a waiter. You can bust your balls and not get anything and alternatively not do that much and get honors.

 

[Elisabeth Kate]

All you can do is deal with it. I feel you. I really do. At least your attendings get to make the choice. At some schools, regardless of what the attendings say, the school has final say and there is no standardization even in the school. A friend of mine said that at her school, you had to score in the top 1/3 of the class for the shelf exam (with no actual percentage set) and that if you did, you might get honors. The school decides based on the WRITTEN notes on the eval form, not from whether or not they checked "honors". So if the attending thought you honored and they didn't write anything on the eval, you were shut out.

Are you hoping for a competitive specialty?

 

[SoundofSilver]

Third year clerkship grades are one of the most frustrating aspects about the entire medical school experience. Just try your best on each rotation and hope you land with a team that gives out good evals more liberally next time.

There are people out there who have scored 99 on a shelf exam yet did not honor the rotation - simply because an attending or resident may not have liked the student.

 

[anbuitachi]

same 3rd yr grades is very frustrating. it's very subjective and grading varies a lot from school to school

 

[tantacles]

This is ridiculous. I don't understand how something that is so inherently subjective and not standardized at all between schools (or even between graders in the same specialty at the same school) can carry so much weight. How can a residency gain anything from looking at one final grade knowing that what it took to earn it could vary by an incredible amount? Secondly, I don't see what a school has to gain by making honors difficult to earn. It's only doing a disservice to the students and nothing else.

Just finished my 1st clerkship. My school has very high standards for honors. Usually, a 90% is required on the shelf, with an honors needed on a majority of evals (with the "honors" criteria being impossible to meet for a student on their first rotation without prior clinical experience). Got high 90s on the shelf - busted my dangus from day one reading.

In clinic, always showed up early, always asked good questions, wrote notes, etc. All the feedback I got was very, very good. (Extremely organized, thorough, great presentations, notes, encyclopedic knowledge base, great patient skills, always offers a detailed and accurate A/P). And those comments were from multiple attendings and consistent throughout the entire clerkship. Whenever I'd ask what I could be doing better I got nothing, they said I was excellent.

Got my first few evals back. One of them: All "pass" with no marks in the "honors" categories at all. No written comments at all, except for the final category in which some mildly positive comments were written, followed by "could work on so and so better", which they had never brought up with me at all. This was from an attending that consistently said I was amazing. All I have to show from my time with them is that lukewarm two sentence eval. Another one gave me very good comments but all "pass" markings, specifically citing the specificity of the "honors" markings as something I'd be fulfilling later on in my rotations. I'm now locked out of an "Honors" no matter what.

Meanwhile, friends get an attending that has given 70% of every student they've ever worked with "honors", and residents that take time to write amazing, detailed feedback that make them out to be a worldbeater. So even if I am a much stronger student, they make it out with an H (or at the very least HP and much better comments), while I get a P or HP with very little comments for my dean's letter. I think my same exact performance would have easily earned an honors at other schools. But all residencies will see is the "H" and my "HP" or "P" and that will be that. Even with the class histogram in the dean's letter; all of the intricacies of subjectivity, ie what % of students get an H from that attending, my specific shelf score, etc, will be essentially lost.

Do you want to know what frustrating is?

My site director for the first rotation specifically told the residents not to give us all evaluations in the "exceeds expectations" category because it was our first rotation, which led to every single student (except one, who is an absolute genius and all-around awesome at everything clinical person - she deserves it) at this particular site being locked out of an A. Realistically, your rotation order shouldn't dictate the grade you get, but at this site? Not so.

 

[giantswing]

Welcome to third year. It sucks. I got a pass eval while doing dictations, seeing patients, and my clasmate who would fall asleep while patients were talking got honors... Feom the same attending.
But overall, if you do strong work throughout the year you will be rewarded.
Man I hated third year.

 

[DermViser]

Welcome to the real world, where your performance is not based on a multiple choice test.

 

[PL198]

How has this system not been changed? Like I understand it's not possible to standardize it nationwide, but I don't get how the system hasn't been overhauled to reduce the significance of someone just liking or not liking you.

 

[alpinism]

Lol welcome to 3rd year.

If you're getting this worked up already over 1 passing grade its going to be a long hard year.

All you can do is show up, work hard, and pretend to be excited.

Start accepting the fact that you'll likely end up with a mix of H, HP, and P like most other students.

 

[DermViser]

How has this system not been changed? Like I understand it's not possible to standardize it nationwide, but I don't get how the system hasn't been overhauled to reduce the significance of someone just liking or not liking you.

There is a standardization measure - it's called the NBME shelf exam. MS-3 and residency are based on subjective evaluations. Up until now, as a premed and med student you've been sheltered from this reality. Your non-med school friends have dealt with this fact of life since the end of college.

 

[operaman]

Honors in 3rd year is purely a function of how much people liked you. Period.

Obviously working hard, being well read, solid knowledge base, decent clinical skills, working hard to learn, etc., are important because they largely determine how much you are liked, but the real key is being incredibly likeable on top of all that. I wish I could articulate clearly how to do this, but it's something most people either have or don't have. It can be learned but it's very difficult.

My advice to the OP and others is to make appointments to talk with these attendings and find out how you are being perceived and why they graded you as they did. Sometimes people will change grades, but VERY rarely. I would always ask my attendings on each rotation if they were familiar with how their evals were translated into our course grades; most knew, but some didn't and thought they were given better evals than they were (my school has an odd system). Also, when asking for feedback from residents and attendings (and you SHOULD be asking for verbal feedback 1x per week), tell them you are hoping to improve and perform at an honors level and ask what you can do differently to get to that point. Ask the difference between you and a student who earns honors.

Of the many students I worked with last year/this year, many who didn't honor and thought they should have were people who genuinely didn't know how they were really perceived (and by extension, how well liked they were). Maybe a simple way to think about it is this: if everyone around you could hear your inner monologue, would they perceive you differently? The truth is, they can hear/see more of it than you realize, just as you can easily tell what others are thinking.

 

[Wordead]

How has this system not been changed? Like I understand it's not possible to standardize it nationwide, but I don't get how the system hasn't been overhauled to reduce the significance of someone just liking or not liking you.

Because it's basically how you will be evaluated for the rest of your life. You think attendings are evaluated based on how well they do on MOC stuff? Residents based on inservice test performance?

 

[DermViser]

Because it's basically how you will be evaluated for the rest of your life. You think attendings are evaluated based on how well they do on MOC stuff? Residents based on inservice test performance?

You mean residents aren't evaluated only on how well they can fill in multiple choice bubbles? Color me shocked.

 

[tdram]

Yeah, it sucks big time. I've already mentioned a few examples on here of how unfair 3rd year grades can be. For example, I got great evals from every attending on one rotation except for one, who gave me a bad eval, and the clerkship director decided to weight that eval more because she "trusted" that attending more than the others. In another clerkship, they sent me to a far, remote site where I didn't even want to go (I'd ranked it last). The attending there was very happy with my performance and gave me all honors and an excellent, detailed writeup. But the clerkship has a policy of flatly "downgrading" people who go to the remote site because they think the attendings there are too lenient. This is an absurd policy for many reasons, especially because my attending was new to the site and I was only the second student from our school he had ever precepted.

 

[SoundofSilver]

Honors in 3rd year is purely a function of how much people liked you. Period.

This.

 

[DermViser]

Yeah, it sucks big time. I've already mentioned a few examples on here of how unfair 3rd year grades can be. For example, I got great evals from every attending on one rotation except for one, who gave me a bad eval, and the clerkship director decided to weight that eval more because she "trusted" that attending more than the others. In another clerkship, they sent me to a far, remote site where I didn't even want to go (I'd ranked it last). The attending there was very happy with my performance and gave me all honors and an excellent, detailed writeup. But the clerkship has a policy of flatly "downgrading" people who go to the remote site because they think the attendings there are too lenient. This is an absurd policy for many reasons, especially because my attending was new to the site and I was only the second student from our school he had ever precepted.

Your school is quite weird (don't know if it's a DO school). At any other place it would be labeled as "capricious grading".

 

[tdram]

This.

In my experience, it's a function of how much the clerkship director likes you, regardless of how much the attendings love you.

 

[tdram]

Your school is quite weird (don't know if it's a DO school). At any other place it would be labeled as "capricious grading".

No we are an MD that has been around for > 100 years.

Since we talked about this last, I actually did complain to the dean, but no one cares.

 

[DermViser]

No we are an MD that has been around for > 100 years.

Wow, that's very unusual then. I've never heard of changing grade distribution based on clerkship site. At our med school all rotations were on site. So for Peds, everyone did their rotation at the affiliated children's hospital, for example.

 

[tdram]

Wow, that's very unusual then. I've never heard of changing grade distribution based on clerkship site. At our med school all rotations were on site. So for Peds, everyone did their rotation at the affiliated children's hospital, for example.

Yeah, changing the distribution based on the site really makes no sense at all. I tried to explain this to the dean, but he doesn't really care, and the clerkship director basically brushed me off. In my case, everyone does their rotation on site, except they have this one site they have a "partnership" with purely for public relations reasons, and they have to send a student there once in a while. It's in a place no one wants to be. Unfortunately I got picked, and to add insult to injury, I got my grade reduced for going there, even though it wasn't even my choice!

In the end I actually had a great experience at the site - the attending really went above and beyond teaching me, and everyone was super nice and helpful to me - so it turned out fine except for the grade... Guess I should be happy about that.

 

[DermViser]

Yeah, changing the distribution based on the site really makes no sense at all. I tried to explain this to the dean, but he doesn't really care, and the clerkship director basically brushed me off. In my case, everyone does their rotation on site, except they have this one site they have a "partnership" with purely for public relations reasons, and they have to send a student there once in a while. It's in a place no one wants to be. Unfortunately I got picked, and to add insult to injury, I got my grade reduced for going there, even though it wasn't even my choice!

In the end I actually had a great experience at the site - the attending really went above and beyond teaching me, and everyone was super nice and helpful to me - so it turned out fine except for the grade... Guess I should be happy about that.

And now you know why medical students, as a whole, don't give back in alumni donations to their medical school.

 

[PL198]

And now you know why medical students, as a whole, don't give back in alumni donations to their medical school.

Dude if there was a magical opportunity for me to negatively donate, or like pull a citizen's arrest and say "you owe me 50k" I'd do that in a heartbeat. After I'm done, the first time they call me for donations, I will specifically say to never call again.

 

[DermViser]

Dude if there was a magical opportunity for me to negatively donate, or like pull a citizen's arrest and say "you owe me 50k" I'd do that in a heartbeat. After I'm done, the first time they call me for donations, I will specifically say to never call again.

Medical students always remember the people who treated them like **** in medical school: Attendings, Deans, Deans of Student Affairs, PhD professors, etc. Alumni aren't stupid and they remember. Stanford has a great alumni base for a reason.

 

[NontradCA]

Can any attendings in academia comment on why the grading seems so sporadic to med students?

@IlDestriero @gyngyn

 

[DermViser]

Can any attendings in academia comment on why the grading seems so sporadic to med students?

What's sporadic about the grading system? The criteria for getting Honors is pretty clear at most schools.

 

[NontradCA]

What's sporadic about the grading system? The criteria for getting Honors is pretty clear at most schools.

So why do I always see 3rd years saying how great of an investment they put in for little return?

 

[tiedyeddog]

Welcome to the real world, where your performance is not based on a multiple choice test.

Where instead it is based on if you got lucky enough to have a nice attending or an easy service so you could study in your free time.

Third year grading blows, terribly subjective. Just do your best and keep smiling.

 

[tdram]

What's sporadic about the grading system? The criteria for getting Honors is pretty clear at most schools.

The criteria often leave a lot of room for interpretation.

 

[tiedyeddog]

The criteria often leave a lot of room for interpretation.

This is exactly the problem. I had some attendings say "I NEVER give out 5/5 grades because no one is perfect" when you literally almost need a 5/5 in some rotations to get honors. However, other people on the rotation will get put with an attending who thinks everyone walks on water and that everyone gets a 5/5 just for showing up. It's incredibly subjective.

 

[DermViser]

So why do I always see 3rd years saying how great of an investment they put in for little return?

Just bc you invest a lot into something, doesn't mean you'll get what you want at the end. That's life. Hardly a sporadic grading system by definition. Grades aren't 100% subjective evals either.

 

[DermViser]

This is exactly the problem. I had some attendings say "I NEVER give out 5/5 grades because no one is perfect" when you literally almost need a 5/5 in some rotations to get honors. However, other people on the rotation will get put with an attending who thinks everyone walks on water and that everyone gets a 5/5 just for showing up. It's incredibly subjective.

Hence why one clerkship grade isn't looked at. It's the trend.

 

[general admission]

This is exactly the problem. I had some attendings say "I NEVER give out 5/5 grades because no one is perfect" when you literally almost need a 5/5 in some rotations to get honors. However, other people on the rotation will get put with an attending who thinks everyone walks on water and that everyone gets a 5/5 just for showing up. It's incredibly subjective.

100% this.

My friend pulled a 99 on the shelf exam, and is one of the top students in our class. Got paired with one attending, who's eval made up 50% of their written eval grade that rotation. She literally told him, the 1st day, "Just so you know, I never give anybody honors on this rotation. Well, I did once, but it was to somebody who had it as their 5th or 6th rotation." Given that we need 50% of written evals as "Honors" to honor, he was pretty much locked out of honors for that rotation. Meanwhile, other students got attendings who give a majority of their students honors, meaning that they automatically got honors for that rotation in the written eval section.

That's ****ing complete ********, and not fair at all.

Standardized tests at the end don't mean ****. Nobody will ever know my shelf score and all the hard work I put in to it. They'll only see the "P" or "HP".

 

[Ismet]

So why do I always see 3rd years saying how great of an investment they put in for little return?

Because when a large portion of the grade is subjective (evals), there's going to be a variety of results. 60% of my grade for the rotation I'm on is evals and 10% is professionalism, so essentially 70% of the grade is subjective (although the professionalism grade is a gimme unless you do something blatantly unprofessional). And that's not even the worst one, on IM I think evals are worth 80% of our grade. Several classmates honored the shelf exam but only passed the rotation because of evals.

Like DermViser said, the criteria for grades is usually outlined, but you have different attendings who grade differently.

 

[general admission]

What's sporadic about the grading system? The criteria for getting Honors is pretty clear at most schools.

The problem is it's not enforced for ****.

Criteria for "honors" are as follows: (paraphrased examples)

-Always comes up with an impeccable assessment and plan that is completely accurate
-Presents history and physical, every time, in an extremely clear, thorough and methodical manner, leaving no doubt as to the patient's conditions
-Extensively cites the latest resources in their answers to questions and patient plans (the satisfactory one is "nearly always", lol)
-Impeccable physical exam skills that always show regard to the patient and are always accurate

Given those criteria, it is literally impossible for any medical student to perform at that level at their first clinical rotation. Some attendings follow these criteria; so you can't blame them for not giving you honors, given those criteria (the fact that the criteria are that stringent for a 1st rotation is unreasonable, but that's a different story). But other attendings do not give a **** and give honors like candy. It should be pretty easy from a school's standpoint to see the distribution of honors being given from each evaluator.

 

[DermViser]

The problem is it's not enforced for ****.

Criteria for "honors" are as follows:

-Always comes up with an impeccable assessment and plan that is completely accurate
-Presents history and physical, every time, in an extremely clear, thorough and methodical manner, leaving no doubt as to the patient's conditions
-Extensively cites the latest resources in their answers to questions and patient plans (the satisfactory one is "nearly always", lol)
-Impeccable physical exam skills that always show regard to the patient and are always accurate

Given those criteria, it is literally impossible for any medical student to perform at that level at their first clinical rotation. Some attendings follow these criteria; so you can't blame them for not giving you honors, given those criteria (the fact that the criteria are that stringent for a 1st rotation is unreasonable, but that's a different story). But other attendings do not give a **** and give honors like candy. It should be pretty easy from a school's standpoint to see the distribution of honors being given from each evaluator.

And yet every year there are people who make Honors on a rotation. You just don't like that it's not you (at the moment). Your grade isn't 100% dependent on subjective evals. There are TONS of books written on how to do well on clerkships. Too bad you haven't picked them up. Not your schools fault if you're not proactive.

 

[general admission]

And yet every year there are people who make Honors on a rotation. You just don't like that it's not you (at the moment). Your grade isn't 100% dependent on subjective evals. There are TONS of books written on how to do well on clerkships. Too bad you haven't picked them up. Not your schools fault if you're not proactive.

Yeah, the ones who are good students and have reasonable attendings, or go to schools with easier criteria.

Of course I'm upset that it's not me. I did my part for sure and owned the shelf. I also read Desai's "Success on the Wards" before clinicals started. But when you get the attending that says they give no honors no matter what, your hands are tied, and no amount of proactiveness will help you. Whether you're matched with them is essentially luck and that's extremely frustrating.

 

[DermViser]

Yeah, the ones who are good students and have reasonable attendings, or go to schools with easier criteria.

Of course I'm upset that it's not me. I did my part for sure and owned the shelf. I also read Desai's "Success on the Wards" before clinicals started. But when you get the attending that says they give no honors no matter what, your hands are tied, and no amount of proactiveness will help you. Whether you're matched with them is essentially luck and that's extremely frustrating.

I agree. No one said it wasn't frustrating. That being said, you won't have that type of attending on EVERY clerkship.

 

[operaman]

I would hesitate to believe attendings who say they don't give out honors, and you can ask your clerkship director if it's really true. Often what people say and what they do are very different things. Some old school attendings say stuff like that just to see who will step up and try to be the exception. I had my very first attending on my first clerkship say that he almost never gives out honors and especially doesn't do it early in the year -- maybe 1 or 2 per year, if that. I politely told him that I intended to be the exception and would work as hard as I could to make it happen. Busted my tail. Not only honored, but got some of the best comments of the year from him.

Lesson: don't let anything derail your attitude and your willingness to work hard.

There was one guy at my school who was rumored always to give terrible evals, so I asked the clerkship director who confirmed it and said he stopped counting his evals years ago and finally just quit sending him any evals at all. In reality, evaluators should aim to give out a percentage of honors that is in line with whatever percentage the department or school is aiming for. Clerkship directors care about this kind of thing and should be taking corrective action if there's a problem. Don't suffer in silence, but don't be surprised if Dr. NoHonors actually doles out a few of them each year.

 

[Siggy]

Welcome to the real world, where your performance is not based on a multiple choice test.

I don't think that's quite fair. I know my med school clerkship experience was, "Go to community hospital with low volume, low acuity and get an honors, or go to big county hospital, see 5x the number of patients, who any one of them can be seriously sick, and you'll take your pass and enjoy it." Yes, performance isn't a multiple guess exam, but clerkship grades often have little to do with actual performance, espeically when comparing between multiple attendings, or even multiple core sites.

 

[DermViser]

I don't think that's quite fair. I know my med school clerkship experience was, "Go to community hospital with low volume, low acuity and get an honors, or go to big county hospital, see 5x the number of patients, who any one of them can be seriously sick, and you'll take your pass and enjoy it." Yes, performance isn't a multiple guess exam, but clerkship grades often have little to do with actual performance, espeically when comparing between multiple attendings, or even multiple core sites.

Guess what life is like that too. Your friends (who don't work in medicine) know that different companies have different cultures, different bosses. Different residencies even in the same specialty have different faculty, different cultures. That's life. You're not just going to be handed Honors, and even if you (think) you're working the hardest, that doesn't guarantee you an Honors. You don't get an "A for effort" at this stage of the game or in residency.

 

[Siggy]

Guess what life is like that too. Your friends (who don't work in medicine) know that different companies have different cultures, different bosses. Different residencies even in the same specialty have different faculty, different cultures. That's life. You're not just going to be handed Honors, and even if you (think) you're working the hardest, that doesn't guarantee you an Honors. You don't get an "A for effort" at this stage of the game or in residency.

No, As shouldn't be given out for effort, but there needs to be a way to adjust for difficulty. It's like comparing a baseball player hitting in batting practice to another player's performance who's hitting during a real game. Sure, the batting practice player SHOULD be hitting a lot more home runs, but the comparison for his home runs to the player being thrown 100 mph fastballs and 80 mph curve balls is flawed at best. ...but hey, you don't get an A for effort and batting practice player has more home runs, therefore there's no problem at all giving him an A and the guy hitting in a real game a C, right?

 

[DermViser]

No, As shouldn't be given out for effort, but there needs to be a way to adjust for difficulty. It's like comparing a baseball player hitting in batting practice to another player's performance who's hitting during a real game. Sure, the batting practice player SHOULD be hitting a lot more home runs, but the comparison for his home runs to the player being thrown 100 mph fastballs and 80 mph curve balls is flawed at best. ...but hey, you don't get an A for effort and batting practice player has more home runs, therefore there's no problem at all giving him an A and the guy hitting in a real game a C, right?

The problem is that it's subjective. That's the point. There is no objective metric to grade medical students, residents, or even attendings. It's an overall gestalt. Even in residency, you will be at different locations. Are you going to tell your program director that your evaluations should be different if you're at the VA vs. the university academic medical center bc one place is easier? Do you hear baseball players complain bc each player doesn't get the same ball, at the same velocity, in the same direction which affects their batting averages?

I don't understand what you think is a "fair" way to adjust grades based on attending or location. Should a certain percentage of people be given Honors no matter what their performance? Hopefully that's not what you're advocating.

 

[Siggy]

The problem is that it's subjective. That's the point. There is no objective metric to grade medical students, residents, or even attendings. It's an overall gestalt. Even in residency, you will be at different locations. Are you going to tell your program director that your evaluations should be different if you're at the VA vs. the university academic medical center bc one place is easier? Do you hear baseball players complain bc each player doesn't get the same ball, at the same velocity, in the same direction?

I don't understand what you think is a "fair" way to adjust grades based on attending or location. Should a certain percentage of people be given Honors no matter what their performance? Hopefully that's not what you're advocating.

Are you suggesting that the impact of residency evaluations (especially on residents not looking for fellowships) is the same as clerkship evaluations on the near 100% of medical students looking for a residency?

Are you suggesting that shrugging off one bad eval during residency of at least 2.25 years (assuming applying for fellowship, which means post fellowship match evals aren't relevant. Add more years as needed for specific specialties) is the same as shrugging off one bad eval from 1.25 years of clerkships?

Am I suggesting that X% gets honors? No.
Are you suggesting that, if these were med school applicants, that grades from Harvard and Podunk Community College should have the same weight? After all, O-Chem is O-Chem.

 

[DermViser]

Are you suggesting that the impact of residency evaluations (especially on residents not looking for fellowships) is the same as clerkship evaluations on the near 100% of medical students looking for a residency?

Am I suggesting that X% gets honors? No.
Are you suggesting that, if these were med school applicants, that grades from Harvard and Podunk Community College should have the same weight? After all, O-Chem is O-Chem.

In residency, you are evaluated the same way for fellowships, by overall gestalt, not some micromanaged (for fairness) objective metric. Evaluations by their very nature are subjective, hence why even many PDs consider clerkship grades to be useless bc many people get grades they shouldn't. http://well.blogs.nytimes.com/2013/...et-failing-grades/?_php=true&_type=blogs&_r=0

Your medical school also plays a factor into the residency match as well. An "Honors" in IM at Vanderbilt will mean more than an "Honors" in IM at Meharry.

 

[KnuxNole]

Lol welcome to 3rd year.

If you're getting this worked up already over 1 passing grade its going to be a long hard year.

All you can do is show up, work hard, and pretend to be excited.

Start accepting the fact that you'll likely end up with a mix of H, HP, and P like most other students.

True with the last statement. Remember, very, very few people will end up with All Honors, or All honors w/ 1-2 HP. If you needed all honors to get to residency, 80% of medical students would have no jobs 😛

 

[Kahreek]

This is ridiculous. I don't understand how something that is so inherently subjective and not standardized at all between schools (or even between graders in the same specialty at the same school) can carry so much weight. How can a residency gain anything from looking at one final grade knowing that what it took to earn it could vary by an incredible amount? Secondly, I don't see what a school has to gain by making honors difficult to earn. It's only doing a disservice to the students and nothing else.

Just finished my 1st clerkship. My school has very high standards for honors. Usually, a 90% is required on the shelf, with an honors needed on a majority of evals (with the "honors" criteria being impossible to meet for a student on their first rotation without prior clinical experience). Got high 90s on the shelf - busted my dangus from day one reading.

In clinic, always showed up early, always asked good questions, wrote notes, etc. All the feedback I got was very, very good. (Extremely organized, thorough, great presentations, notes, encyclopedic knowledge base, great patient skills, always offers a detailed and accurate A/P). And those comments were from multiple attendings and consistent throughout the entire clerkship. Whenever I'd ask what I could be doing better I got nothing, they said I was excellent.

Got my first few evals back. One of them: All "pass" with no marks in the "honors" categories at all. No written comments at all, except for the final category in which some mildly positive comments were written, followed by "could work on so and so better", which they had never brought up with me at all. This was from an attending that consistently said I was amazing. All I have to show from my time with them is that lukewarm two sentence eval. Another one gave me very good comments but all "pass" markings, specifically citing the specificity of the "honors" markings as something I'd be fulfilling later on in my rotations. I'm now locked out of an "Honors" no matter what.

Meanwhile, friends get an attending that has given 70% of every student they've ever worked with "honors", and residents that take time to write amazing, detailed feedback that make them out to be a worldbeater. So even if I am a much stronger student, they make it out with an H (or at the very least HP and much better comments), while I get a P or HP with very little comments for my dean's letter. I think my same exact performance would have easily earned an honors at other schools. But all residencies will see is the "H" and my "HP" or "P" and that will be that. Even with the class histogram in the dean's letter; all of the intricacies of subjectivity, ie what % of students get an H from that attending, my specific shelf score, etc, will be essentially lost.

all you said is true, i feel the same, but dont get jaded, life is unfair, make the best out of it. Stay strong brother

 

[VisionaryTics]

I would hesitate to believe attendings who say they don't give out honors, and you can ask your clerkship director if it's really true. Often what people say and what they do are very different things. Some old school attendings say stuff like that just to see who will step up and try to be the exception. I had my very first attending on my first clerkship say that he almost never gives out honors and especially doesn't do it early in the year -- maybe 1 or 2 per year, if that. I politely told him that I intended to be the exception and would work as hard as I could to make it happen. Busted my tail. Not only honored, but got some of the best comments of the year from him.

Lesson: don't let anything derail your attitude and your willingness to work hard.

There was one guy at my school who was rumored always to give terrible evals, so I asked the clerkship director who confirmed it and said he stopped counting his evals years ago and finally just quit sending him any evals at all. In reality, evaluators should aim to give out a percentage of honors that is in line with whatever percentage the department or school is aiming for. Clerkship directors care about this kind of thing and should be taking corrective action if there's a problem. Don't suffer in silence, but don't be surprised if Dr. NoHonors actually doles out a few of them each year.

Very true.

My surgery rotation was at a huge urban hospital with one of the busiest trauma programs in the country. It was also a community hospital with zero fellows, and the university residents were spread really thin. As a result, it was supposed to be the best site for people interested in surgery because your case load was 2-3x of other locations, you took q5 30-hour call, and you had a good amount of autonomy.

However, the place was plagued by rumors that the attending "only gives out 1 honor per year". People bitched constantly about being placed there.

When I did my rotation, I think 3/6 ended up getting clinical honors. We all worked our butts off, but the residents and attendings noticed. Just like they noticed when students in previous rotations wouldn't come back after lecture and would take post-call days off after not showing up for call. Literally, students who complained about the tough grading told me they did this stuff and got away with it without anyone knowing so it shouldn't have affected their grades. Then I would hear the attendings and residents mention how they knew the students were doing this stuff.

I also had a rotation where the attending told me face-to-face "I don't believe in giving out honors because it means you don't have room to improve". The clerkship director knows that, and if they don't, you should let your clerkship directors know.

tl;dr Work your butt off all the time, even if you think no one is paying attention. If you hear comments from your attending/site director (not just rumors), let your clerkship director know. Don't tattle, just say "FYI, this is what he said his grading policies are."

tl;dr, part 2: Electric Boogaloo: The harder you work, the luckier you get.

 

[DermViser]

Because when a large portion of the grade is subjective (evals), there's going to be a variety of results. 60% of my grade for the rotation I'm on is evals and 10% is professionalism, so essentially 70% of the grade is subjective (although the professionalism grade is a gimme unless you do something blatantly unprofessional). And that's not even the worst one, on IM I think evals are worth 80% of our grade. Several classmates honored the shelf exam but only passed the rotation because of evals.

Like DermViser said, the criteria for grades is usually outlined, but you have different attendings who grade differently.

Funny, Professionalism was never a certain percentage of our grade. It was an expecation you either met or didn't meet. You fail professionalism, you fail the rotation. Period.

 

[Ismet]

Funny, Professionalism was never a certain percentage of our grade. It was an expecation you either met or didn't meet. You fail professionalism, you fail the rotation. Period.

It seems like it's an actual, outlined part of the grade in some rotations and not in others. I'm sure evals incorporate professionalism.