Clerkship evaluation frustration

[premed1234567891011]

How does everyone deal with the inevitable agonizing frustration whenever a resident or intern rates you low in a ridiculous category like HIPAA compliance when you never had any issues with it? I know these evals are done in a hurry by super busy people but it’s not okay for this to affect such a large portion of your grade and be due to luck.

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[differentiating]

At some point you just accept that third year grades have little to no relationship to your performance or your potential in the future. Fourth year is much better, thankfully.

 

[afib123]

Ya it is hard at first but you either learn to adapt or get stuck with mediocre Evals. I still get mediocre Evals time to time but mostly figured out how to do well.

 

[mrbreakfast]

You will get random "bad" grades here and there because preceptors don't care. Nothing you can do about it. It happens to literally every student.

Though, "bad" grades = average marks (like 3 out of 5). If you are getting below average grades (like, 2s out of 5), I would take the criticism seriously.

I'm saying that because it's match week and clinical grades do matter. I personally know 3 people (so far) who are scrambling, and the unifying factor is all had good scores but below average clinical grades.

 

[DrSnips]

How does everyone deal with the inevitable agonizing frustration whenever a resident or intern rates you low in a ridiculous category like HIPAA compliance when you never had any issues with it? I know these evals are done in a hurry by super busy people but it’s not okay for this to affect such a large portion of your grade and be due to luck.

I understand the frustration. But if you think about it, most of your career comes down to luck. The circumstances of your birth and your intrinsic level of intelligence are factors that were beyond your control and led to your acceptance to med school. You won the lottery already. Don't be discouraged by a few mediocre evals. They won't matter in the grand scheme of things.

 

[nimbus]

I understand the frustration. But if you think about it, most of your career comes down to luck. The circumstances of your birth and your intrinsic level of intelligence are factors that were beyond your control and led to your acceptance to med school. You won the lottery already. Don't be discouraged by a few mediocre evals. They won't matter in the grand scheme of things.

Funny you mention that.

 

[MerYangBey]

Ya it is hard at first but you either learn to adapt or get stuck with mediocre Evals. I still get mediocre Evals time to time but mostly figured out how to do well.

Lol how did you figure out how to do well? I’m just curious. I feel like some people will give every student 4/5 if they showed up and were generally normal. And some people will give 3/5 no matter how much of a superstar you are. So what did you figure out? It’s way easier to make a decent impression when your personalities click and that has nothing to do with actual clinical performance.

 

[IMreshopeful]

Lol how did you figure out how to do well? I’m just curious. I feel like some people will give every student 4/5 if they showed up and were generally normal. And some people will give 3/5 no matter how much of a superstar you are. So what did you figure out? It’s way easier to make a decent impression when your personalities click and that has nothing to do with actual clinical performance.

It’s a combination of luck and chance and knowing how to act on your rotations

I typically give my students 4/5 and give 5/5 if they’re good, hardworking, read, and try. They don’t have to be perfect. They get a 3/5 if they don’t put in effort or and I usually make it clear in my evaluation why I marked them down and give tips for improvement. 2/5 or lower is for if they are rude to staff, harmful to patients, or intentionally sabotage another student.

I get that there are these gunners who try to whine and cry for every extra point because they’re trying to match derm or whatever. I don’t usually fall for a sob story, and will usually keep that grade unless someone else tells me otherwise to corroborate. I firmly believe that there is a value to having fair but objective evaluations without being harsh.

And yes there are some attendings who no matter what you do will always grade you low. I had a neurology attending like that in medical school who was known for his mediocre evals. Thankfully our school recognized the degree of subjectivity and weighted our shelf exams higher.

 

[Melanogaster]

It's been said before, but the most important thing on rotation aren't your knowledge (you have very little), but the "3 As":

Affable

Available

Able (last)

 

[differentiating]

It's also going to vary from school to school. At my school, the shelf exam is weighted very lowly, so your grade is pretty much determined by subjective evals - so you just hope for honors and brace for passing. Oftentimes comments will be positive, but you'll still get 3/5 because 3/5 is identified as being good at each of the different aspects (with 4 & 5 being "better than good" and "better than better than good" respectively). Your best way of getting honors is if you're a popular extrovert or interested in a competitive specialty, neither of which has anything to do with your actual rotation.

Other schools it sounds like there's a bit more control over your grade, whether in your actual performance or through shelf scores.

I'm saying that because it's match week and clinical grades do matter. I personally know 3 people (so far) who are scrambling, and the unifying factor is all had good scores but below average clinical grades.

To some extent. If you fail a rotation, yeah, you're in trouble - but I know a few of my classmates who had straight passes in core clerkships, and all of whom I've spoken which have matched. Clinical grades are of some importance, but passing is fine unless you're gunning for something competitive. Your sub-Is are where you can and should shine.

 

[MerYangBey]

It’s a combination of luck and chance and knowing how to act on your rotations

I typically give my students 4/5 and give 5/5 if they’re good, hardworking, read, and try. They don’t have to be perfect. They get a 3/5 if they don’t put in effort or and I usually make it clear in my evaluation why I marked them down and give tips for improvement. 2/5 or lower is for if they are rude to staff, harmful to patients, or intentionally sabotage another student.

I get that there are these gunners who try to whine and cry for every extra point because they’re trying to match derm or whatever. I don’t usually fall for a sob story, and will usually keep that grade unless someone else tells me otherwise to corroborate. I firmly believe that there is a value to having fair but objective evaluations without being harsh.

And yes there are some attendings who no matter what you do will always grade you low. I had a neurology attending like that in medical school who was known for his mediocre evals. Thankfully our school recognized the degree of subjectivity and weighted our shelf exams higher.

Yeah I understand..... I’m just over this year. Every school is a bit different, the grading is different, the rotations are different. So it makes this whole thing subjective. And it’s kinda silly that these grades even matter.

 

[19pieces19]

It's also going to vary from school to school. At my school, the shelf exam is weighted very lowly, so your grade is pretty much determined by subjective evals - so you just hope for honors and brace for passing. Oftentimes comments will be positive, but you'll still get 3/5 because 3/5 is identified as being good at each of the different aspects (with 4 & 5 being "better than good" and "better than better than good" respectively). Your best way of getting honors is if you're a popular extrovert or interested in a competitive specialty, neither of which has anything to do with your actual rotation.

Other schools it sounds like there's a bit more control over your grade, whether in your actual performance or through shelf scores.



To some extent. If you fail a rotation, yeah, you're in trouble - but I know a few of my classmates who had straight passes in core clerkships, and all of whom I've spoken which have matched. Clinical grades are of some importance, but passing is fine unless you're gunning for something competitive. Your sub-Is are where you can and should shine.

So you're saying that if you told your team you want to do derm or neurosurg they're more likely to give you honors?

 

[differentiating]

Yeah I understand..... I’m just over this year. Every school is a bit different, the grading is different, the rotations are different. So it makes this whole thing subjective. And it’s kinda silly that these grades even matter.

I know this doesn't help when you're stuck in it, but fourth year is better, at least. My roommate and I were laughing the other day about how we're putting in 50% the effort as post-interview MS4s and getting way better evals than in MS3, and how ridiculous the whole thing is. We both hated third year and were absolutely miserable then.

So you're saying that if you told your team you want to do derm or neurosurg they're more likely to give you honors?

People who were interested in more competitive specialties were more likely to get honors/AOA. That theoretically could also be due to better performance, but having actually worked alongside some of them in clerkships, they weren't any better of third years than anyone else I worked with. Our school is actually getting rid of core clerkship grades because they found that there were biases in the system, so at least things will be better going forward.

 

[mrbreakfast]

From the M4 perspective (worked with ~30 M3s on my AIs) I would say that while everyone knows you should "act like you're interested and want to be there" surprisingly few M3s seem to actually do this.

 

[afib123]

Lol how did you figure out how to do well? I’m just curious. I feel like some people will give every student 4/5 if they showed up and were generally normal. And some people will give 3/5 no matter how much of a superstar you are. So what did you figure out? It’s way easier to make a decent impression when your personalities click and that has nothing to do with actual clinical performance.

Yes there are personalities that you won't click with that will give you average grades no matter how good you are, but for most you can pretty definitely get above average which is 8/9 for us.

Main thing is your presentations in rounding. That is probably the single most important factor in determining your grade. If you prepare your presentation the night before for overnight H and Ps (look in the EMR the night before) or patients you admitted after rounds and deliver your everyday soap notes perfectly with an excellent assessment and plan and your resident doesn't have to add anything to it, that is most likely an 8/9 performance. Bonus to be on the safe side ask 2-3 excellent questions per day on your patients or other people's patients (high level questions after you read up on the basics related to areas of controversy or something not intuitive that you come across on UptoDate). Read on UptoDate regarding all your patients. It pretty much has all pimp questions and high level stuff needed to know for the disease.

If I am not sure how my performance is going, I write a really detailed history and physical note with references from studies and ask them to give me feedback on it (takes 1-2 hours but solidifies your grade)

This pretty much guarantees me a 8/9 regardless of whether they like me or not because those things are definitely an above-average performance anywhere in the country. There are some people that just will not like you and I could care less about those evals because majority of the evals will overshadow those (well except in Family where I did get screwed by a average eval because of only 1 attending).

Those tips are for rotations such as internal medicine, pediatrics, neurology, psychiatry which are rounding heavy.

For surgery, I have no clue. I am on it right now and I think I will get average evals, because I am still figuring out what surgeons like and don't like but my shelf, etc should take me to honors because that's what I will concentrate on.

 

[NITRAS]

I understand the frustration. But if you think about it, most of your career comes down to luck. The circumstances of your birth and your intrinsic level of intelligence are factors that were beyond your control and led to your acceptance to med school. You won the lottery already. Don't be discouraged by a few mediocre evals. They won't matter in the grand scheme of things.

I bet you'd find that the vast majority of physicians are just average to just above average. Everyone knows that many clerkship grades can be random at times. Your MCAT, Shelf exams, STEP 1 score, research, undergrad gpa, and networking are all within your control. The whole victimization of everyone is one of the worse things to happen to people in America.

 

[MerYangBey]

Yes there are personalities that you won't click with that will give you average grades no matter how good you are, but for most you can pretty definitely get above average which is 8/9 for us.

Main thing is your presentations in rounding. That is probably the single most important factor in determining your grade. If you prepare your presentation the night before for overnight H and Ps and deliver your everyday soap notes perfectly with an excellent assessment and plan and your resident doesn't have to add anything to it, that is most likely an 8/9 performance. Bonus to be on the safe side ask 2-3 excellent questions per day on your patients or other people's patients (high level questions after you read up on the basics related to areas of controversy or something not intuitive that you come across on UptoDate). Read on UptoDate regarding all your patients. It pretty much has all pimp questions and high level stuff needed to know for the disease.

If I am not sure how my performance is going, I write a really detailed history and physical note with references from studies and ask them to give me feedback on it (takes 1-2 hours but solidifies your grade)

This pretty much guarantees me a 8/9 regardless of whether they like me or not because those things are definitely an above-average performance anywhere in the country. There are some people that just will not like you and I could care less about those evals because majority of the evals will overshadow those (well except in Family where I did get screwed by a average eval because of only 1 attending).

Those tips are for rotations such as internal medicine, pediatrics, neurology, psychiatry which are rounding heavy.

For surgery, I have no clue. I am on it right now and I think I will get average evals, because I am still figuring out what surgeons like and don't like but my shelf, etc should take me to honors because that's what I will concentrate on.

Lol yes those are good tips for people that still care.

 

[afib123]

Lol yes those are good tips for people that still care.

I guess and also it is important for introverted people like me to do those things or people won't even notice we exist. I think lot of the charismatic, extroverts can get good evals by doing far less but I am not in that category.

 

[MerYangBey]

I guess and also it is important for introverted people like me to do those things or people won't even notice we exist. I think lot of the charismatic, extroverts can get good evals by doing far less but I am not in that category.

So you write a random note with references? A note that’s not in the patients chart? I’m confused by that part. What’s the purpose of that?

 

[afib123]

So you write a random note with references? A note that’s not in the patients chart? I’m confused by that part. What’s the purpose of that?

So you write a random note with references? A note that’s not in the patients chart? I’m confused by that part. What’s the purpose of that?

I mean I don't believe most attendings or residents really read your notes that you write in the EMR unless you ask them to give you feedback on a particular note. This is something I only started doing recently, but I take a patient who I admitted and write a detailed history and physical with a long assessment and plan including possible differentials and treatment plans and throw in a few references there to show that I am reading (Example, so and so review article shows the most common cause of lower GI bleeding is ______. So and so review article shows the first line treatment for lower GI bleeding is _____. So and so review article shows long term treatment plan for this disease is ____. Pretty simple, just be thorough. Some people might say it's too long (obviously that's why I ask them to read it but most of them comment positively about your attention to detail and thoroughness)

Then I print that out and ask the attending to give me feedback on that 1 particular note. It is just a way to show you are reading and being above-average.

You can also just point them to look at that particular note in the EMR, but I find the EMR interface clunky, so I type up this particular note in a word document but you don't have to. You can just ask them to look in the EMR.

By no means, am I an expert in sucking up and getting good evals but these are just the ways that worked for me in getting good evals. With just having surgery and sub-i's left, hopefully they work for me till ERAS apps are in. I could care less after that

 

[MerYangBey]

I mean I don't believe most attendings or residents really read your notes that you write in the EMR unless you ask them to give you feedback on a particular note. This is something I only started doing recently, but I take a patient who I admitted and write a detailed history and physical with a long assessment and plan including possible differentials and treatment plans and throw in a few references there to show that I am reading (Example, so and so review article shows the most common cause of lower GI bleeding is ______. So and so review article shows the first line treatment for lower GI bleeding is _____. So and so review article shows long term treatment plan for this disease is ____. Pretty simple, just be thorough. Some people might say it's too long (obviously that's why I ask them to read it but most of them comment positively about your attention to detail and thoroughness)

Then I print that out and ask the attending to give me feedback on that 1 particular note. It is just a way to show you are reading and being above-average.

You can also just point them to look at that particular note in the EMR, but I find the EMR interface clunky, so I type up this particular note in a word document but you don't have to. You can just ask them to look in the EMR.

By no means, am I an expert in sucking up and getting good evals but these are just the ways that worked for me in getting good evals. With just having surgery and sub-i's left, hopefully they work for me till ERAS apps are in. I could care less after that

It’s probably good practice for you. Although some might argue it’s a bit extra.
And I totally feel ya. Best of luck!

 

[Newyawk]

I mean I don't believe most attendings or residents really read your notes that you write in the EMR unless you ask them to give you feedback on a particular note. This is something I only started doing recently, but I take a patient who I admitted and write a detailed history and physical with a long assessment and plan including possible differentials and treatment plans and throw in a few references there to show that I am reading (Example, so and so review article shows the most common cause of lower GI bleeding is ______. So and so review article shows the first line treatment for lower GI bleeding is _____. So and so review article shows long term treatment plan for this disease is ____. Pretty simple, just be thorough. Some people might say it's too long (obviously that's why I ask them to read it but most of them comment positively about your attention to detail and thoroughness)

Then I print that out and ask the attending to give me feedback on that 1 particular note. It is just a way to show you are reading and being above-average.

You can also just point them to look at that particular note in the EMR, but I find the EMR interface clunky, so I type up this particular note in a word document but you don't have to. You can just ask them to look in the EMR.

By no means, am I an expert in sucking up and getting good evals but these are just the ways that worked for me in getting good evals. With just having surgery and sub-i's left, hopefully they work for me till ERAS apps are in. I could care less after that

This will definitely work. While they might think youre a dweeb and would probably not want you as a co-resident, they would be left with no choice but to leave you incredible comments for going the extra 50 miles. This is of course assuming theyre reasonable people.

 

[afib123]

This will definitely work. While they might think youre a dweeb and would probably not want you as a co-resident, they would be left with no choice but to leave you incredible comments for going the extra 50 miles. This is of course assuming theyre reasonable people.

Not arguing about that. I think it's extra too, but you do what you have to do to get honors when you are aiming for competitive specialities.

I also think it's not the right approach to a sub-internship where it's more about gelling with people and showing you at least have average intelligence. But for core clerkships, if you could care less about what they think of you other than that you are a hard worker and are above-average, it has worked for most people.

 

[nimbus]

Don’t lose the forest for the trees. It requires a greater depth of understanding to write a short, succinct note that cuts to the chase. Nobody likes long-winded notes.

 

[Newyawk]

Don’t lose the forest for the trees. It requires more understanding to write a short, succinct note that cuts to the chase. Nobody likes long-winded notes.

No doubt. However, not only are med students not expected to be able to write short notes, they arent trusted to do so and furthermore doing so would make them look very lazy and/or trying to practice beyond their level.

 

[NITRAS]

Look, if a med student was able to write a note that had all the important things and nothing else.....he’d look like a demi god among men.

The vast majority of students just have no idea what’s important.

 

[afib123]

Before people start debating on how long a note should be, most of my notes are pretty short and to the point. These slightly longer detailed notes that I refer to are only for practice and to show an attending my thought process on how I thought through the patient's admission, how I plan to treat the patient, and document my history taking and physical examination skills relevant to that disease.

I make it pretty clear to the attending that I give my note to the reason why I wrote the note the way I did.
Obviously, every note won't be that detailed because I don't have the time to write every note like that.

 

[Giovanotto]

From the M4 perspective (worked with ~30 M3s on my AIs) I would say that while everyone knows you should "act like you're interested and want to be there" surprisingly few M3s seem to actually do this.

This is me. I know I should act interested, but really, I'm bored half to death most of the time, tired, annoyed, and occasionally angry.

 

[Lawpy]

Look, if a med student was able to write a note that had all the important things and nothing else.....he’d look like a demi god among men.

The vast majority of students just have no idea what’s important.

How do you distinguish between the Honors-level student vs average student?

 

[ciestar]

This is me. I know I should act interested, but really, I'm bored half to death most of the time, tired, annoyed, and occasionally angry.

Same. I really try though and I am struggling badly on surgery. I avoid the OR whenever I can.

 

[ndafife]

I think my best grades/comments came from an attending who I subbed for his injured men's league golf partner for a few weeks during the rotation

AKA its all BS

 

[curbsideconsult]

An attending said to my face, "this is the most fun I've had with a med student," and I still didn't get full marks. Another attending barely said two sentences to me and gave me 100% and said I did well. Still another attending is basically like one of my best buddies in medical school and gave me less than 100%. I think I deserved all these grades in each of these cases. By the same token, it still sucks because the grading is so all over the place. I've been told that what's more important than the numbers are the comments left by the faculty. I hope that's true because that's the only thing that keeps me sane when I get my evals.