Clinical Evaluations and Residency Evaluations

[Lem0nz]

Thought this was an interesting discussion from the other thread but didn't want to derail her from getting advice on finding a peds residency.

- How do you guys think clinical grading should be done for medical students, and why? What is 'fair'?

- Separate question but similar vein, what is the utility of residency evaluations and how do you think they should be conducted and utilized?

To frame the questions can start with examples from the other thread: a medical school where 60% are pass, 20% are high pass, 20% are honors with the goal of deliberately comparing students against each other to actually make the grades meaningful. For residency, residents are graded on a 1-5 scale where 1 is basic intern skills and 5 is independent attending.

My personal opinion is that the entire grading scheme is absolutely worthless for both. Its probably MORE worthless for residency than it is for medical students. The only real utility of either seems to be in catching people that need to remediate. Specifically for residency, the feedback comments tend to be given by upper year residents or attendings with little (and sometimes no) faculty development on meaningful grading and feedback, and they are almost entirely irrelevant for fellowship applications or job applications upon completion because your fellowship is going to have letters of rec which the resident picks who writes, your in service exams, and your research. Your board certification and your interviewers are never going to see any of it. I stopped looking at them after PGY2 year because they were so poorly written and often were either not helpful 'amazing resident' or cruel if someone had an issue with you where they'd use your eval to take out their rage on you. My PD certainly did not use it to construct his letter for my fellowship app, he used our relationship over 5 years and his personal experience with me and it reflected in the letter. On the medical student side, if we want them to be meaningful then truthfully 60% of people getting a pass seems accurate and fair. But medical students getting those passes absolutely are not going to feel that way and our first advice to a student who gets a pass is always "go talk to them and see if you can get it changed" which... is odd. Reality says most people are in fact average because bell curve when you take a sample of them.

Interested to hear thoughts. How could this be better or useful? What are other's experience?

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[Lawpy]

Grading med students relative to their peers and not to experienced attendings is the most important step

 

[Matthew9Thirtyfive]

Grading med students relative to their peers and not to experienced attendings is the most important step

Or even to residents. Like a 4/4 or 5/5 should be someone performing at an intern+ level. Someone performing at the level expected of a med student shouldn’t be getting a 2/4 or 3/5. At my school, a 2/4 is supposed to be someone who isn’t failing but isn’t quite up to par for their level.

 

[operaman]

Full disclosure: I made it through all of Med school and residency and fellowship without even so much as opening an evaluation. I always felt that any meaningful feedback would have been given face to face so I never cared about what people said later.

For students I do think there is some value in clinical grades but the grading systems are nuts. The milestone thing is a great idea in theory except that grading accurately only works if literally every faculty member buys in. If they don’t, then if I say an MS3 functioned like an intern instead of like a veteran attending, they’ll get bumped down from honors. So we all just keep pretending that all the children are above average.

Ive often thought about simplifying grades to a handful of metrics and simply have faculty pick what their grade (f/lp/p/hp/h) should be. Then just average those. Maybe that would at least ensure faculty were giving the grade they thought was fair based on their interaction rather than some arbitrary confusing scale that gets converted to a grade later.

It should also be said that clinical grades say nothing about your clinical skill; they only show how much people like you. Mostly honors says you probably get along well with everyone. Noting more.

 

[Lawpy]

For students I do think there is some value in clinical grades but the grading systems are nuts. The milestone thing is a great idea in theory except that grading accurately only works if literally every faculty member buys in. If they don’t, then if I say an MS3 functioned like an intern instead of like a veteran attending, they’ll get bumped down from honors. So we all just keep pretending that all the children are above average.

See the bolded makes no sense to me at all. Like is it too much to ask for attendings to be reasonable?

 

[Lawpy]

@Med Ed would like to know your thoughts as well, because i'm struggling to understand why anyone would make 5/5 = performs at a level of an attending and why praising an MS3 for being intern level kicks them out of honors

 

[Angus Avagadro]

I don't think I like the 60% pass thing. All the students cannot rotate through the service as many are sent to other institutions for the same rotation, let's say surgery. So one service will only see a small segment of that class on rotations. Let's say the have 30 students rotate on service and they are mostly the top students in the class. To be fair, if they perform as expected , limiting Homors to only 6 , 20%, of these superior students would be unfair IMO, as they are not a homogeneous representation of the class.

 

[operaman]

See the bolded makes no sense to me at all. Like is it too much to ask for attendings to be reasonable?

Well in practice it seems that you have to give students the highest possible marks to make them honors eligible. If you read the descriptions of those particular milestones, they’re describing an experienced attending and I’m not sure if I even cut the mustard half the time.

If I give a student an objectively good grade by saying they are functioning well beyond their level yet not quite like a veteran attending, the rubric will often ding them and give them a pass. This is largely because enough other docs are giving the good students the top marks. So we have to get everyone on the same page or it all falls apart.

 

[Lem0nz]

I don't think I like the 60% pass thing. All the students cannot rotate through the service as many are sent to other institutions for the same rotation, let's say surgery. So one service will only see a small segment of that class on rotations. Let's say the have 30 students rotate on service and they are mostly the top students in the class. To be fair, if they perform as expected , limiting Homors to only 6 , 20%, of these superior students would be unfair IMO, as they are not a homogeneous representation of the class.

I don't particularly like it either. I also don't know/understand the role of residents evaluating medical students. We did it all the time and as far as I can tell those evaluations made up HUGE parts of the final med student eval for the rotation because the attendings just had much less face time. Residents got absolutely *zero* instruction on med student evals. My system started out really strict, then by the end I defaulted everyone to HP and any effort at all above breathing and being on time was honors and showing up late was pass because I didn't want to be responsible for destroying someone's grade and future.

 

[Lawpy]

Well in practice it seems that you have to give students the highest possible marks to make them honors eligible. If you read the descriptions of those particular milestones, they’re describing an experienced attending and I’m not sure if I even cut the mustard half the time.

If I give a student an objectively good grade by saying they are functioning well beyond their level yet not quite like a veteran attending, the rubric will often ding them and give them a pass. This is largely because enough other docs are giving the good students the top marks. So we have to get everyone on the same page or it all falls apart.

Then why not change the rubric so that the highest marks = intern level?

 

[operaman]

Then why not change the rubric so that the highest marks = intern level?

Well the big idea between lcme and acgme was that we would all start using milestones that would apply across all phases of training and students would progress through them over a number of years. Ideally graduating residents would finally be hitting the higher levels of mastery and be ready for board certification and solo practice.

 

[Ho0v-man]

Make them all p/f for med students. Keep the comments.

 

[Lawpy]

I don't particularly like it either. I also don't know/understand the role of residents evaluating medical students. We did it all the time and as far as I can tell those evaluations made up HUGE parts of the final med student eval for the rotation because the attendings just had much less face time. Residents got absolutely *zero* instruction on med student evals. My system started out really strict, then by the end I defaulted everyone to HP and any effort at all above breathing and being on time was honors and showing up late was pass because I didn't want to be responsible for destroying someone's grade and future.

At least you care about med students. A lot of residents are heavily drunk on power that they'll turn into dictators and viciously torment MS3s to satisfy their fragile egos

 

[Matthew9Thirtyfive]

I guess I don’t understand why the number of honors has to be limited. My school makes it so everyone could get honors. You just have to perform at would be considered an honors level for that rotation. It shouldn’t change your level of performance just because you happen to rotate with a great group of students. That makes no sense.

 

[Lawpy]

Well the big idea between lcme and acgme was that we would all start using milestones that would apply across all phases of training and students would progress through them over a number of years. Ideally graduating residents would finally be hitting the higher levels of mastery and be ready for board certification and solo practice.

Why would the milestones be the same for an MS3 and a graduating resident rather than gradually evolving the rubrics for each year?

 

[Lem0nz]

Why would the milestones be the same for an MS3 and a graduating resident rather than gradually evolving the rubrics for each year?

He's saying you get nine years worth of milestones (ish) and that in medical school you should not be getting above a 4, even if you're a freaking rockstar, because an independent practicing physician is a 9 or a 10 and an intern is a 5 at best.

 

[Matthew9Thirtyfive]

Why would the milestones be the same for an MS3 and a graduating resident rather than gradually evolving the rubrics for each year?

For real. What a stupid idea.

 

[Matthew9Thirtyfive]

He's saying you get nine years worth of milestones (ish) and that in medical school you should not be getting above a 4, even if you're a freaking rockstar, because an independent practicing physician is a 9 or a 10 and an intern is a 5 at best.

And that’s the stupidest idea I’ve ever heard, because psychologically someone who gets a 4/10 is going to look bad to us even if the rubric says that’s good for a med student.

 

[Lawpy]

He's saying you get nine years worth of milestones (ish) and that in medical school you should not be getting above a 4, even if you're a freaking rockstar, because an independent practicing physician is a 9 or a 10 and an intern is a 5 at best.

Yes that's my point. It's using the same rubric to assess all trainees based on how far they progressed, which is deranged and completely idiotic. The rubric itself must evolve at each stage in training. What a highest score means for an MS3 must be different than what it means for a resident

 

[Lawpy]

Also FFS why is getting Honors dependent on getting all 10 milestones as an MS3?

 

[Lawpy]

And that’s the stupidest idea I’ve ever heard, because psychologically someone who gets a 4/10 is going to look bad to us even if the rubric says that’s good for a med student.

I really don't believe med education leaders are this idiotic and incompetent, so i'm thinking whether something else is in play

 

[Lem0nz]

And that’s the stupidest idea I’ve ever heard, because psychologically someone who gets a 4/10 is going to look bad to us even if the rubric says that’s good for a med student.

Well get ready to feel like **** then because general surgery has been graded 1 to 5 or 1 to 10 everywhere I've ever been and it takes years before they'll give you above a 3 on the 1-5. One (of many) reasons I stopped looking at evals altogether and tuned out in the conversation for semi-annuals. I didn't want to hear it or know because it did nothing but make me feel like crap.

Was that way in fellowship too. A board certified general surgeon getting a 2 out of 5 on my first semi-annual in fellowship... smh. By the 2nd semi-annual they flat out told me "you're ready to graduate and would be safe doing these operations alone in the world, but for the ACGME we're going to keep marking it as 3 then 4 then 5 right before you graduate".

 

[Lawpy]

Well get ready to feel like **** then because general surgery has been graded 1 to 5 or 1 to 10 everywhere I've ever been and it takes years before they'll give you above a 3 on the 1-5. One (of many) reasons I stopped looking at evals altogether and tuned out in the conversation for semi-annuals. I didn't want to hear it or know because it did nothing but make me feel like crap.

Was that way in fellowship too. A board certified general surgeon getting a 2 out of 5 on my first semi-annual in fellowship... smh. By the 2nd semi-annual they flat out told me "you're ready to graduate and would be safe doing these operations alone in the world, but for the ACGME we're going to keep marking it as 3 then 4 then 5 right before you graduate".

... i can't even

Holy crap the ACGME is led by idiots

 

[Lawpy]

Why can't we just have a grading rubric specific for each milestone?

 

[Matthew9Thirtyfive]

Well get ready to feel like **** then because general surgery has been graded 1 to 5 or 1 to 10 everywhere I've ever been and it takes years before they'll give you above a 3 on the 1-5. One (of many) reasons I stopped looking at evals altogether and tuned out in the conversation for semi-annuals. I didn't want to hear it or know because it did nothing but make me feel like crap.

Was that way in fellowship too. A board certified general surgeon getting a 2 out of 5 on my first semi-annual in fellowship... smh. By the 2nd semi-annual they flat out told me "you're ready to graduate and would be safe doing these operations alone in the world, but for the ACGME we're going to keep marking it as 3 then 4 then 5 right before you graduate".

Yeah I mean it’s different once you’re already in residency. Med school is totally different because the grades on your rotation for the specialty you want actually can hurt you. And when people see a 4/10, it will just look awful. My school uses a 4 point grading scale and it is based solely on med student performance at, above, or below what is expected for someone AT THE STUDENT’S LEVEL.

And the whole “we’re going to keep you at a 3 because you’re supposed to be at a 3 right now and we want you to progress as you go” is also present in military fitreps and might be the dumbest way possible to evaluate someone, second only to having a single grading rubric be applied to students, residents, and fellows alike.

 

[Lawpy]

We need a rubric for each milestone, not a rubric with scores ranging from 1st to last milestones. I can't believe this needs to be spelled out in the profession filled with the brightest minds

 

[Lawpy]

This is all the more reason why we need to throw the Flexner Report in the garbage and do a thorough reevaluation and revamp of medical education.

 

[Angus Avagadro]

I don't particularly like it either. I also don't know/understand the role of residents evaluating medical students. We did it all the time and as far as I can tell those evaluations made up HUGE parts of the final med student eval for the rotation because the attendings just had much less face time. Residents got absolutely *zero* instruction on med student evals. My system started out really strict, then by the end I defaulted everyone to HP and any effort at all above breathing and being on time was honors and showing up late was pass because I didn't want to be responsible for destroying someone's grade and future.

Agreed. Residents see this as more busy work and probably don't give it the necessary attention as they have other busy work to attend to.

 

[operaman]

Looks like it was addressed pretty well already. I agree the whole milestones thing is a good idea gone horribly wrong. I’m always amazed at how MedEd can take good ideas and just beat the life out of them.

Milestones and more objective metrics are a great idea for learners to track their improvement if used well. They are a crappy way to grade/evaluate people because nobody really pays attention to what it actually says. All of them are poor substitutes for in the moment face to face feedback.

I think it’s also worth mentioning the temporal error involved in evaluating trainees. I had a junior resident ask me the other day how they compare to their peers and whether they are operating at an appropriate level. Totally fair question, but I had a hard time giving an accurate answer because while this resident was more advanced than their peers who rotated on service at the start of the year, they also have nearly a whole extra year of training by now so it’s not a fair comparison. Even their peers are more advanced than I recall when I work with them on call and that’s exactly how it should be.

Fundamentally we need to examine why we give any kind of feedback at all. Do we honestly think that our learners simply lack the knowledge of what they’re doing wrong? That if only we tell them where they fall short they can correct it? Written out it sounds absurd, but it’s definitely the ethos that belies our system of evaluation.

The best teachers are able to provide guidance and feedback that makes people perform better. They are the ones who helped me develop my strengths more than they pointed out my faults. Finding that balance that corrects errors while simultaneously building up strengths is the essence of great teaching.

 

[NickNaylor]

I supervise medical students on our service and deal with the difficulty of grading students. We're provided with fairly well-described criteria for how to grade students on a variety of aspects of their performance. The issue I run into is the expectation of students. On a 5-point scale, the average student is going to perform at a 3/5. This is how things should work, and in practice this generally tends to be true. For my field, the criteria to score 5/5 essentially describe what I would expect of a well-performing PGY-1, not a medical student completing a clerkship. That doesn't seem unreasonable to me - an exceptional grade should be consistent with exceptional performance - but many students don't see it this way. The expectation seems to be that if you simply show up, "try," and aren't a complete dunce, you should receive a 4/5. If you put in "extra effort," then you deserve a 5/5. When those are the expectations, getting 3/5 and 4/5 on most components of the evaluation obviously comes as a disappointment. I find this puzzling as I sit down with students for 30-45 minutes at the start of their clerkship, try to describe very clearly to them what I expect of them and how to do well, provide feedback throughout the clerkship, and generally try to be very clear with what they need to do in order to perform well. Some students take this in and do end up doing well. Some seem to have no capacity to incorporate my feedback/suggestions and then give me a Pikachu face when they receive their final evaluations. Some have a non-reality-based self-appraisal of their skills and seemed shocked that they are "just average."

I sit down and go over a student's evaluation with them before the end of their rotation and have them read my comments and grades before I submit them so that we can discuss them. Rarely do students actually provide any legitimate disagreement with how I grade them. Instead, they're often disappointed in their grade - which I understand - but generally don't disagree with the evaluation that I've provided when they see the criteria that I'm given.

When reviewing residency applicants, I do think there's some value in seeing where an individual student performed relative to his/her peers in the class. But, really, the narrative comments from the supervising attendings are the most helpful.

 

[Thesimplelifeofamyloid]

I supervise medical students on our service and deal with the difficulty of grading students. We're provided with fairly well-described criteria for how to grade students on a variety of aspects of their performance. The issue I run into is the expectation of students. On a 5-point scale, the average student is going to perform at a 3/5. This is how things should work, and in practice this generally tends to be true. For my field, the criteria to score 5/5 essentially describe what I would expect of a well-performing PGY-1, not a medical student completing a clerkship. That doesn't seem unreasonable to me - an exceptional grade should be consistent with exceptional performance - but many students don't see it this way. The expectation seems to be that if you simply show up, "try," and aren't a complete dunce, you should receive a 4/5. If you put in "extra effort," then you deserve a 5/5. When those are the expectations, getting 3/5 and 4/5 on most components of the evaluation obviously comes as a disappointment. I find this puzzling as I sit down with students for 30-45 minutes at the start of their clerkship, try to describe very clearly to them what I expect of them and how to do well, provide feedback throughout the clerkship, and generally try to be very clear with what they need to do in order to perform well. Some students take this in and do end up doing well. Some seem to have no capacity to incorporate my feedback/suggestions and then give me a Pikachu face when they receive their final evaluations. Some have a non-reality-based self-appraisal of their skills and seemed shocked that they are "just average."

I sit down and go over a student's evaluation with them before the end of their rotation and have them read my comments and grades before I submit them so that we can discuss them. Rarely do students actually provide any legitimate disagreement with how I grade them. Instead, they're often disappointed in their grade - which I understand - but generally don't disagree with the evaluation that I've provided when they see the criteria that I'm given.

When reviewing residency applicants, I do think there's some value in seeing where an individual student performed relative to his/her peers in the class. But, really, the narrative comments from the supervising attendings are the most helpful.

I strongly disagree with this type of system. When I'm an attending, this is what I do
<3 = antagonistic, rude etc,
3 = you show up
4 = you show up, you put in good effort, your knowledge base is comparable to others med student
5 = you show up, put in good effort, you have a great knowledge base compared to other students


This whole "comparing yourself to an intern" is not very good because most of the time, you're not given the opportunity to excel and show how much you know relative to your peers. One of my rotations we would sit there for 8 hours a day waiting to see one patient, only to get entirely shut down but the attending because they wanted to move quickly

With all do respect, systems like what you have encourage people to try and leave early and go study for the shelf, b/c actually trying on rotations ends up being futile

 

[IMG69]

How come you guys even have this? Everyone in my school either writes their own feedback or gets 'performs well above expected' none of the consultants/attendings care. Same goes for all our DOPS or CEX's they just ask where do I sign.

Do you guys not have OSCE's where you formally get assessed on Clinical skills/procedures etc?

 

[Med Ed]

@Med Ed would like to know your thoughts as well, because i'm struggling to understand why anyone would make 5/5 = performs at a level of an attending and why praising an MS3 for being intern level kicks them out of honors

I don't even know WTF this thread is about.

 

[NickNaylor]

I strongly disagree with this type of system. When I'm an attending, this is what I do
<3 = antagonistic, rude etc,
3 = you show up
4 = you show up, you put in good effort, your knowledge base is comparable to others med student
5 = you show up, put in good effort, you have a great knowledge base compared to other students


This whole "comparing yourself to an intern" is not very good because most of the time, you're not given the opportunity to excel and show how much you know relative to your peers. One of my rotations we would sit there for 8 hours a day waiting to see one patient, only to get entirely shut down but the attending because they wanted to move quickly

With all do respect, systems like what you have encourage people to try and leave early and go study for the shelf, b/c actually trying on rotations ends up being futile

I don’t disagree with the notion that expecting students to perform at the level of a resident is unreasonable. That said, I interpreted your description as a 4/5 basically being average, 5/5 being any degree of above average, 3/5 being a warm body that doesn’t actively hamper the team’s effort, and 1-2/5 actively contributing to a negative experience for everyone involved.

That seems a bit goofy to me.

 

[Matthew9Thirtyfive]

I supervise medical students on our service and deal with the difficulty of grading students. We're provided with fairly well-described criteria for how to grade students on a variety of aspects of their performance. The issue I run into is the expectation of students. On a 5-point scale, the average student is going to perform at a 3/5. This is how things should work, and in practice this generally tends to be true. For my field, the criteria to score 5/5 essentially describe what I would expect of a well-performing PGY-1, not a medical student completing a clerkship. That doesn't seem unreasonable to me - an exceptional grade should be consistent with exceptional performance - but many students don't see it this way. The expectation seems to be that if you simply show up, "try," and aren't a complete dunce, you should receive a 4/5. If you put in "extra effort," then you deserve a 5/5. When those are the expectations, getting 3/5 and 4/5 on most components of the evaluation obviously comes as a disappointment. I find this puzzling as I sit down with students for 30-45 minutes at the start of their clerkship, try to describe very clearly to them what I expect of them and how to do well, provide feedback throughout the clerkship, and generally try to be very clear with what they need to do in order to perform well. Some students take this in and do end up doing well. Some seem to have no capacity to incorporate my feedback/suggestions and then give me a Pikachu face when they receive their final evaluations. Some have a non-reality-based self-appraisal of their skills and seemed shocked that they are "just average."

I sit down and go over a student's evaluation with them before the end of their rotation and have them read my comments and grades before I submit them so that we can discuss them. Rarely do students actually provide any legitimate disagreement with how I grade them. Instead, they're often disappointed in their grade - which I understand - but generally don't disagree with the evaluation that I've provided when they see the criteria that I'm given.

When reviewing residency applicants, I do think there's some value in seeing where an individual student performed relative to his/her peers in the class. But, really, the narrative comments from the supervising attendings are the most helpful.

This is essentially how it should be. The problem is that some/many attendings will just 3/5 everyone regardless. When you’re being told during the rotation that you’re performing at the level of a resident and then get a 3/5 on your eval, something is wrong.

 

[Lem0nz]

I don’t disagree with the notion that expecting students to perform at the level of a resident is unreasonable. That said, I interpreted your description as a 4/5 basically being average, 5/5 being any degree of above average, 3/5 being a warm body that doesn’t actively hamper the team’s effort, and 1-2/5 actively contributing to a negative experience for everyone involved.

That seems a bit goofy to me.

This is correct. This was my grading method in a nut shell. I agree with you that's its goofy as hell and not OK.

But like myloid said, the problem is that the vast majority of medical students are not given the opportunity to perform at the level of an intern or resident even if they wanted to and put in the effort. Setting aside that there are great medical schools where students are heavily involved, I believe (personal experience and what has been described to me by most others) that the majority of medical students are largely shadowing. They don't get to put in orders. They probably get to write notes that get heavily edited and/or ignored and blindly cosigned by an attending which ignores "agree with above" and "modifies below" which is the actual part of the note. Some teaching definitely occurs but outside of writing some H&Ps and progress notes, medical students are rarely putting in orders, doing bedside procedures, communicating with nursing or other medical staff semi-independently without a resident literally standing next to them, etc. When they do any of that (not consistently, I mean when they do any of that at all) that is probably the exception.

The norm is the resident is already struggling with their work load and duty hours and needs to just get all of that stuff done and may take time out of their day once a week to do some of those things with a medical student and the other times the medical student is shadowing. My take on the "average medical student experience" is to go in and independently interview a patient for a history/physical, report said interview with some vague plan of diagnostics and treatment plan, and then a resident or attending does all of the things.

If that is all most medical students are allowed to do (if even that) shouldn't we be grading in the context of the fact that due to time constraints, liability fears, or just poor instruction that they are not given the opportunity to shine? Should they be punished for that?

I don't say that to put down the faculty and teachers we have who are excellent and consistently carve out time and have some form of teaching structure to let students do those things. I say it to highlight all of the other attendings that are faculty which can be anywhere from 25% of them to 80% of them at a given institution who view med student teaching as 'exposure to my specialty' shadowing with some token teaching moments. I have to imagine at least 50% of medical students are dealing with the later group of attendings more often than the former good teacher types and if so its cruel to me to grade them to your standard (which is an excellent standard) when they aren't given the opportunity to function as a resident ever.

 

[Lem0nz]

This is essentially how it should be. The problem is that some/many attendings will just 3/5 everyone regardless. When you’re being told during the rotation that you’re performing at the level of a resident and then get a 3/5 on your eval, something is wrong.

I think this thread (and the other) has made me a believer that clinical grades should just go to pass/fail and comments. Residency grading should 1000% also do that.

Edit: Though, thinking about that line of reasoning, then all applications will really start to bleed together with a PF step 1 and PF clinical grades. Would make the arms race even worse I think if all of the objective metrics continue to erode.

 

[Matthew9Thirtyfive]

I think this thread (and the other) has made me a believer that clinical grades should just go to pass/fail and comments. Residency grading should 1000% also do that.

Edit: Though, thinking about that line of reasoning, then all applications will really start to bleed together with a PF step 1 and PF clinical grades. Would make the arms race even worse I think if all of the objective metrics continue to erode.

Right, but clinical grading is obviously not objective. It should just be pass fail and keep the comments.

 

[Lawpy]

What's the point of residency grades? Fellowship match?

 

[Lawpy]

I think this thread (and the other) has made me a believer that clinical grades should just go to pass/fail and comments. Residency grading should 1000% also do that.

Edit: Though, thinking about that line of reasoning, then all applications will really start to bleed together with a PF step 1 and PF clinical grades. Would make the arms race even worse I think if all of the objective metrics continue to erode.

In the P/F world, school name is king.

 

[deleted1064759]

I think making preceptor evaluations P/F and leaving shelf exams to discern H/HP/P/F might be more objective. Here's a thread with some discussion about it.

 

[NicMouse64]

3rd year grading is such a joke. It's a game at my school to get the best preceptors who give all 5s and not get the ones who get straight 3s. your grade has nothing to do with clinical skill or effort just who you get. I know some really clinically strong people who got passes and some absolute idiots who got honors on the same rotation because they got lucky.

 

[Lawpy]

3rd year grading is such a joke. It's a game at my school to get the best preceptors who give all 5s and not get the ones who get straight 3s. your grade has nothing to do with clinical skill or effort just who you get. I know some really clinically strong people who got passes and some absolute idiots who got honors on the same rotation because they got lucky.

Unfortunately this helps the idiots for residency match a lot more than the clinically strong students

 

[Lawpy]

Do you guys think PDs care about crappy clinical grading and instead just count how many honors they see?

 

[Steve_Zissou]

Make them all p/f for med students. Keep the comments.

While I agree with this for the most part, man did I work my ass off in some rotations and get mediocre comments because the preceptors had no interest. Specifically, OB is where I worked the hardest and all I got was “strong student.” Other rotations, I just showed up and got 5 paragraphs of praise. Medical education is wild.

 

[NicMouse64]

While I agree with this for the most part, man did I work my ass off in some rotations and get mediocre comments because the preceptors had no interest. Specifically, OB is where I worked the hardest and all I got was “strong student.” Other rotations, I just showed up and got 5 paragraphs of praise. Medical education is wild.

There needs to be some class or lecture that is given if you are grading residents/med students. I have gotten some brutally honest feedback at the beginning of a rotation then improved throughout and I became a better student throughout that rotation. They gave me High passes or honors but said I started at a fail/pass level. These are the types of attendings that truly help in making excellent doctors. But these attendings are VERY rare. I've been lucky to have 2-3.

 

[Welshman]

At my med school our clinical grades are functionally entirely determined by our shelf score. Either you make the honors cutoff based at 75th percentile, high Pass 10 points below that or just pass after that.

Unless you really don’t care, clerkship Evals don’t matter a hill of beans, enough people evaluate you that you’ve average rating usually floats to the top of the scale. Comments are the most frustrating part, 90% of preceptors can’t be bothered to write more than 3 fragments. If you’re lucky you get the extrovert pediatrician or psychiatrist who loves to type flowery compliments but most of us get the old surgeon who thinks a good eval is a silent nod. The saving grace when it comes to clerkship comments are the coordinators who combine the fragments into a cohesive, albeit template-esque, paragraph for our deans letter.

I feel like a lot of students idealize entirely objective grades like this but unfortunately, the overall effect of this grading scheme is exactly what you would predict. Everyone lives to get out of clinic ASAP so they can study for the shelf and get honors. This was a pretty lame realization from in my opinion because the point of third year is to be in the clinic and seeing patients. For us it felt more like clinic was a chain holding us back from getting honors, especially if you had a busy preceptor/site.

 

[Lawpy]

At my med school our clinical grades are functionally entirely determined by our shelf score. Either you make the honors cutoff based at 75th percentile, high Pass 10 points below that or just pass after that.

Unless you really don’t care, clerkship Evals don’t matter a hill of beans, enough people evaluate you that you’ve average rating usually floats to the top of the scale. Comments are the most frustrating part, 90% of preceptors can’t be bothered to write more than 3 fragments. If you’re lucky you get the extrovert pediatrician or psychiatrist who loves to type flowery compliments but most of us get the old surgeon who thinks a good eval is a silent nod. The saving grace when it comes to clerkship comments are the coordinators who combine the fragments into a cohesive, albeit template-esque, paragraph for our deans letter.

I feel like a lot of students idealize entirely objective grades like this but unfortunately, the overall effect of this grading scheme is exactly what you would predict. Everyone lives to get out of clinic ASAP so they can study for the shelf and get honors. This was a pretty lame realization from in my opinion because the point of third year is to be in the clinic and seeing patients. For us it felt more like clinic was a chain holding us back from getting honors, especially if you had a busy preceptor/site.

I mean i'm resigned to the idea that true learning only begins in residency so i'm indifferent

 

[Welshman]

Trying to turn subjective scales into numerical grades is always going to be a major challenge, especially when there could be hundreds of preceptors evaluating students. The fairest method I can think of would be to have a blind committee review collective comments and shelf scores for a rotation and recommend honors based on that. This would at least standardize the relative standing of students within a rotation. However it still relies on getting enough valuable feedback from the doctors we work with which seems like a pretty difficult task

 

[Captain_Falcon]

Trying to turn subjective scales into numerical grades is always going to be a major challenge, especially when there could be hundreds of preceptors evaluating students. The fairest method I can think of would be to have a blind committee review collective comments and shelf scores for a rotation and recommend honors based on that. This would at least standardize the relative standing of students within a rotation. However it still relies on getting enough valuable feedback from the doctors we work with which seems like a pretty difficult task

My school does this ^