Here's an example:
I just finished OB/GYN. I scored an 87th percentile on the shelf. Not too bad, but not outstanding. As you realize, our grades are not solely based on tests any more. I finished the rotation on night float and labor and delivery - two fairly time consuming rotations (eleven 12 hour shifts in twelve days), but I did what I could to make myself useful on the service. I was told by my classmates that I should just disappear and study, but I refused to do that...Apparently a mistake because I got terrible evaluations anyway.
I was called in to defend a couple of the evaluations I received. One was semi-legit Basically, I did something wrong one morning, and a resident called me out on it. I explained myself (in what I thought was a respectful way) and apologized to the resident. She said "Okay," which I assumed meant it's not a problem. I then (which she didn't know) proceeded to apologize to the patient for any distress I may have caused. She said what happened wasn't a problem at all, and she appreciated our care. For the rest of the week, she and the other off service resident treated me like it was my first day - respectful and kind. We were slammed, so they didn't teach me much, but I didn't blame them. They have jobs. Meanwhile, if there was no one around, I would grab triages on my own (a couple of the triages they didn't even have to see because I reported straight to the senior) and helped out nurses with odds and ends...Again, a lot of stuff they didn't even know happened. Anyway, my evaluation read that I was, "unprofessional, lazy, disrespectful, slammed charts on the desk (never happened), and reacted negatively to criticism (the only criticism I received was a tongue lashing for what happened above - to which I didn't react at all)." The other evaluation had a bunch of made up junk that never happened...It basically got thrown in the garbage...However, both evaluations *numerical* score count towards my grade, which basically screws me.
So, to answer your question, "How is it different?" It doesn't matter what your intentions are, or how you actually act that determine your grade. It's how other people are doing that day or how they perceive that you're acting that determine your grade. I made myself available for an extremely time consuming part of the rotation that my other classmates did the opposite for, and ended up getting terrible evaluations for it. The resident I'm talking about is extremely nice, extremely intelligent, and a very good teacher. I must have just done the wrong thing on the wrong day to make her mad. I'm just glad I got a chance to explain what happened to the course coordinator to avoid that nonsense going into my Dean's Letter...That doesn't always happen. If it would have stayed, that's something that would hurt my career more than just a couple of points on my grade.