Can you be a hotshot clinical student after being a sh*tty basic sciences student?

[YouDontKnowJack]

really...

can you go from bottom of the barrel basic sciences student to a hot shot 3-4th year clinicals student? or is it uncommon?

You've got holes in your knowledge, and if an attending pimped you at bedside, I would think you'd have a hard time answering the questions... no?

What's your opinion? or maybe you're exactly an example of what I'm talking about.

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[Telemachus]

I haven't seen my barrel-bottom classmates shoot up to the cream level, to mix metaphors mildly. But I have seen a lot of mobility between the middle and the top, and between the middle and the bottom.

 

[njbmd]

Hi there,
You DO get something of a "second chance" when you start the clinical years. You can work on making sure that your basic science as it applies to whatever clinical rotation you are on, is up to par. For example, if you are scrubbing a chest case in surgery, make sure that you have reviewed your thoracic anatomy. This will help you answer those "pimp" questions from attendings and chief residents. In addition to this, you can make sure that you are an ace at getting the ward work done while studying very hard for your shelf exams.

A strong third-year can greatly help you. The pre-clinical stuff is behind you so keep up with your patients i.e. read everything that you can about your patient's condition and do good patient care. A string of honors in your required clerkships will look pretty good to residency program directors when you are applying for residency.

As opposed to being a "hot shot" you can be a very competent clinician, which can take you pretty far. Will this erase two very poor years? No, but you can even things up a bit. AOA will probably be out of your reach but good solid clinical skills are what you will need for the rest of your career.

njbmd

 

[pillowhead]

I think the answer depends on WHY the student didn't perform well during the first two years. If it was because said student was lazy and just didn't work as hard as they could have, I think it's doubtful that they will become a stellar clinical student because being a stellar clinical student is all about effort.

However, if this student didn't do so well for the first two years because they had been out of school for a while and had a hard time re-adjusting to the classroom or because of some specific family or health issue that has since resolved, then they can definitely become a stellar clinical student.


Unfortunately, I think many not-so-good pre-clinical students tend to fall into the first rather than the second category. I think some people have this amazing fantasy that while they barely passed the first two years, they will all of a sudden become some amazing clinical student because they think they have amazing people skills or something and that's all they need. IMHO, there is absolutely no correlation between good people skills and good basic science knowledge skills. I've seen plenty of classmates who have both, neither, or just one.

 

[fantasty]

It's hard to say, because I tried not to talk too much about grades with people. But, there were definitely some friends of mine who I perceived were much much better students in the clinical years. I know they didn't get all honors during basic science, but they were so jazzed to see patients, and such good team players and motivated folks, that they were definitely getting good recs (and probably good grades) - and some matched into top programs and competitive specialties.

 

[YouDontKnowJack]

but you can't just talk the talk with people skills.

people skills arent gonna save a patient from illness or death.

there's just so much clinical stuff taught during 2nd year- you know, some path, pharm, micro, and integrating it all. And i'm guessing that if you don't remember it all, you'll get stepped on during 3rd year.

Or do you guys just hit up Harrison's every time you have a patient?

 

[Law2Doc]

However, if this student didn't do so well for the first two years because they had been out of school for a while and had a hard time re-adjusting to the classroom ..., then they can definitely become a stellar clinical student.

Med school interviewers readilly tell nontraditional applicants that this happens quite frequently - I was certainly advised by adcoms that they expected us "old timers" to really shine starting third year, but that we might find the first two to be a bit more of a challenge. The nontrad with a spouse, family or other obligations who cannot immerse him/herself into studies as completely and effortlessly as the unattached 20 year old will often have a harder time competing with the young gunners in the academic test setting, but may do quite well when people skills and life experience can be brought to bear. At least I hope that's the case.

 

[Law2Doc]

but you can't just talk the talk with people skills.

people skills arent gonna save a patient from illness or death.

there's just so much clinical stuff taught during 2nd year- you know, some path, pharm, micro, and integrating it all. And i'm guessing that if you don't remember it all, you'll get stepped on during 3rd year.

Or do you guys just hit up Harrison's every time you have a patient?

I think you are equating not getting Honors with not knowing enough of the material, and I'm not sure that's true. Someone who has the basics and is smart, won't necessarilly have gotten stellar marks in the academic years, but can certainly talk the talk with a certain amount of review reading.

 

[Lesion Of Doom]

I can tell you this from personal experience: During the first two years of med school, I barely did OK. I honored a couple of classes but failed pathobiology and passed pathophysiology, have low step 1 scores, and failed a couple of shelf exams.


Despite all of this, I am very well motivated to be an outstanding physician and I work extremely hard so when I was on the wards during third year, I shined because I love taking care of patients and reading up on their conditions therefore I knew a lot about my patients by time rounds were under way. I could answer most pimp questions and manage my patients just as well as any other student because I was very committed . I didn't quite honor my clerkships because I am not an outstanding test-taker.

Believe it or not, I still got interviews from my top three choice of residency programs and they have all told me that they hope I will choose their program. One program even read some of the great comments that were in my letters of recommendations- Anonymously of course. They were some of the best comments I could have hoped for in my letters. My Dean's Letter is filled with very positive feedback from all of my attendings.

So I believe that you can still be an outstanding 3rd and 4th year student despite not being God's gift to test taking. You just have to be very motivated to learn and love your patients and really dedicated to helping them. The sincere and extreme devotion to them can make you shine and push you to learn and develop what you need to learn and develop in order to help them.

Will you outshine the honor students? Maybe, maybe not. It is a very difficult thing to do especially if those honor students love taking care of patients just as much as you but I would be more concerned with delivering great healthcare and knowing every thing about my patient and I think everything else will fall in place. There is no reason two or three stars cannot shine in the same sky (it is called "a great group of students").

To put it briefly, I agree with most of what is said here , especially NJbmd's post.

 

[RonaldColeman]

I think you can possibly be a hotshot student in the eyes of your attending, but you still won't get honors in your rotations. Many schools have shelf exam minimums for honors. At my school, for example, you must be in the 90th percentile nationally to even be considered for honors. If you weren't strong academically the first 2 years, it is unlikely that you will suddenly change 3rd year.
Also, it is not easy to shine clinically 3rd year. Unless the attending is really interested in differentiating among students (and most aren't), it will be hard for you to stand out. Most of the attendings at my school, for example, didn't even know our names DURING the rotation! Also, most students get good evaluations anyway. On family medicine at my school, for example, if an attending rated you as "top 1/3 of the class" on your evaluation (the only rating higher was "top 10%"), you were actually only in the 16th percentile!! Almost every student kisses the attending's ass, volunteers to stay after, feigns interest in every clerkship, knows everything about their patients. In the end, your ability to perform on written examinations will, at many schools, be the deciding factor for clerkship grades.

 

[TruTrooper]

Almost every student kisses the attending's ass, volunteers to stay after, feigns interest in every clerkship, knows everything about their patients. In the end, your ability to perform on written examinations will, at many schools, be the deciding factor for clerkship grades.

Yes, it's good you threw that "at many schools" in there because I know at my school that I have worked with enough students who clearly don't give a damn what the Attending thinks of them and just do their work and go home as soon as the bell rings. It wasn't hard to stand out next to these students at all. Some students just care about high scores and lack personality and people skills.

In my opinion, motivation is a strong factor in shining in 3rd year. Some people simply just can't muster up enough motivation to shine during 3rd year no matter how hard they try just like some people can't muster up enough motivation and energy to study for 8 hours or longer a day. Fortunately, I can study all day if I need to while I know some extremely sharp students who can study for only about 4 hours a day. Although these guys may be more talented than I am, I believe that I am able to bridge the gap between us by putting in long hours. In the end, I believe that I will get the residency spot of my choice just as they probably will.

If you think you won't be able to shine, you won't shine. Just put in the effort to do it.What is the worst that can happen? You will still pass and learn a lot. If you get nothing out of it, at least 4 years from now you can be at your crappy residency spot but be able to tell yourself that you tried your best.

 

[cytoborg]

Well, I can't speak for other people, but I did not so hot in my classroom coursework, and very well on the wards. I'm not big on multiple choice tests, which comprised the vast majority of my basic science exams. *shrug* I felt a lot more at home on the wards in terms of the types of thinking, learning, and performing that was required. I don't think my performance in either forum had much to do with my actual knowledge base, it had more to do with how well I did at demonstrating it.

But then again I didn't go from the absolute bottom to the absolute top. That seems like it would be pretty unusual.

 

[SLUser11]

I remember hearing this generalization during my first year:

The Top third of the class makes the best teachers.
The middle third of the class makes the best clinicians.
The bottom third of the class makes the most money.

 

[RonaldColeman]

Yes, it's good you threw that "at many schools" in there because I know at my school that I have worked with enough students who clearly don't give a damn what the Attending thinks of them and just do their work and go home as soon as the bell rings. It wasn't hard to stand out next to these students at all. Some students just care about high scores and lack personality and people skills.
QUOTE]

Well, I should have been more specific. That is how things worked at my school. I did work with a few students like those you mentioned; the problem is that many attendings didn't give a rat's ass about getting to know us, so they didn't know what time we were leaving, how much scutwork we did, etc.
I guess the point of my post was that written exams are the only truly controllable measure of achievement in medical school. If you study, you can do well. You should do your best to maximize your score on these because you may or may not control your destiny when it comes to your clinical grade--it just depends on the school and the attendings .

 

[Adcadet]

Well, since the shelf exam counts for a significant portion of your grade (20-30% in most of the rotations at my school, IIRC), and almost everybody is judged to perform pretty well clinically, most of the variation in clerkship grades come from the shelf exam. So if you're a bad standarized test taker who struggled with Step 1 and exams in years 1-2, you're at a major disadvantage. I've also noted on my peds shelf that a fair number of questions required knowing something from year 2, or at least you were helped out a lot if you did. So again, doing well in years 1-2 and on Step 1 translates into doing better on your shelf exams which translates into better clerkship grades.

 

[fantasty]

Our school only uses the shelf exams for 2 rotations, but true - we do have exams in all clerkships.

But, I guess I also interpreted the OP's point as "getting all passes". At my school, only 30% of students get honors or near-honors for preclinical grades. So 70% of us just get passes. Some of us hover around the mean on a lot of classes, and some see no honors grades during the first 2 years. But, even those at the 30-40th percentile learn what we need to learn and do fine on the boards, and I'm just making the point that some of those folks can really become stellar clinical students. (yes, even with a marginal pass in biochem, anatomy, or neuro )