Evaluating your medical students...

[Ypo.]

I have a few questions about how residents go about evaluating students. I know that filling out those evaluations must be a pain (it is for us students and we are 1/5 as busy as you are). Which is why I really appreciate your honest input, and I know the answers will be different for everyone.



1. Does the clerkship director tell you "students need to get ______ out of ________ on their evaluations in order to honor the rotation."? The reason I ask this is my institution uses this really crappy evaluation form which uses three possible choices; "consistently", "usually", and "seldom". We have to get 75% "consistently" on all of our evaluations in order to meet criteria to honor (in addition to a high shelf score).

Sometimes I get the feeling that each of these terms are not viewed equally by everyone. I personally think that "usually" is actually really good; unfortunately if you get more than 25% of them, you have no chance of honoring. "Consistently" on the other hand can be interpreted different ways; for example as "perfect" or "always." Anyways, my assumption is that oftentimes people won't pick the highest score because it's ridiculous to say that a medical student does anything "perfectly" in the hospital, really.

2. What do you think are reasonable expectations (by your standards in your specialty) for a student to honor?


I just finished a rotation in which I showed up early everyday, stayed late everyday, took on more patients than I was required to, followed them more closely than anyone on the team, and got along really well with all of the residents and attendings. On the weekends after rounding, when I could have gone home with the other medical students at 9am, I always stayed into the afternoon. One time when we got slammed on a Sunda the residents asked if I could stay a little longer and do some more admissions (which I did gladly) and I ended up getting out of there at 9pm. My notes were always on time; I presented all my own patients to the attendings. I followed through on every patient. I really tried to think like an intern... So I was surprised when the resident who had seen me do all this gave me mostly "usually" and a few "consistently." The thing is; I know he really liked me and was impressed with me because he told me so, and everytime I see him he gives me a big friendly smile. He's a really sweet guy. So the only thing I can think is that "consistently" means something different to him than it does to others, or...that he's not the type to tell a medical student they do anything "consistently" well (or perhaps he's just like me and he thinks that "usually" is actually "really good".)

It's just frustrating because most students I know try really hard, but then we have to try to analyze an evaluation which (I feel) is ambiguous. And I don't know (because I haven't bothered to ask yet😳) whether a resident knows they are "screwing" us by giving us mostly "usually". Actually I suspect the residents who went to my school DO know (because they tend to give great evals) whereas the FMGs/out of state docs tend not to.

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[Ypo.]

1. H & P - Provides a thorough and appropriate H & P (Question 1 of 34 - Mandatory)
H & P Grading Criteria
N/A Seldom Usually Consistently
0 1 2 3
2. H & P - Comments (Question 2 of 34)
3. Case Presentations - Is organized and succinct in case presentation (Question 3 of 34 - Mandatory)
Case Presentations Grading Criteria
N/A Seldom Usually Consistently
0 1 2 3
4. Case Presentations - Comments (Question 4 of 34)
5. Assessments & Diagnoses - Is able to synthesize data & generate assessments and differential
diagnoses (Question 5 of 34 - Mandatory)
Assessments & Diagnoses Grading Criteria
N/A Seldom Usually Consistently
0 1 2 3
6. Assessments & Diagnoses - Comments (Question 6 of 34)
7. Incorporates Assessments - Incorporates patient assessments into verbal and written work (Question 7 of 34
- Mandatory)
Incorporates Assessments Grading Criteria
N/A Seldom Usually Consistently
0 1 2 3
8. Incorporates Assessments - Comments (Question 8 of 34)
9. Chart Notes - Writes appropriate chart notes in a timely fashion (Question 9 of 34 - Mandatory)
Chart Notes Grading Criteria
N/A Seldom Usually Consistently
0 1 2 3
10. Chart Notes - Comments (Question 10 of 34)
11. Therapeutic Plans - Monitors therapeutic plans (Question 11 of 34 - Mandatory)
Therapeutic Plans Grading Criteria
N/A Seldom Usually Consistently
0 1 2 3
12. Therapeutic Plans - Comments (Question 12 of 34)
13. Medical Knowledge - Is able to apply medical knowledge in a clinical setting (Question 13 of 34 - Mandatory)
Medical Knowledge Grading Criteria
N/A Seldom Usually Consistently
0 1 2 3
14. Medical Knowledge - Comments (Question 14 of 34)
15. Technical Skills - Exhibits facility with technical skills (Question 15 of 34 - Mandatory)
Technical Skills Grading Criteria
N/A Seldom Usually Consistently
0 1 2 3
16.`Technical Skills - Comments (Question 16 of 34)
17. Communication - Exhibits appropriate communication skills with patients (Question 17 of 34 - Mandatory)
Communication Grading Criteria
N/A Seldom Usually Consistently
0 1 2 3
18. Communication - Comments (Question 18 of 34)

Please comment on student's overall clinical performace:

 

[Faebinder]

Two comments:

1) Many people out there are d**ks and feel that if everyone didnt work as hard they did then they are s**t and thus give bad evaluations. You are better off asking the chief or senior resident for an evaluation over asking the intern cause to the intern... life sucks and so will your grade.

2) One of the things that I wish I knew when I was in med school is how much communication can help make things simple. You come on to a rotation and bust your ass and in the end they give you a B/Satisfactory. The way around this is to communicate your objectives Minute ONE. "Hi my name is Ypo, I will be your student for a week." Some more talk happens then you break the conversation and say "I want to go into XXX, I would really like to ACE this rotation and get a great evaluation from you. What do you think I should do?" Do this with each resident and follow their instructions. This establishes your objectives day one and they will pay attention to your work. Later on, half way down the rotation, ask about your status and what you can do to improve. Do this with all the residents (cause they communicate when you are not around).

Finally, you can't win them all... just remember not to be like them when you are the big bad ass attending/senior resident.

 

[Ypo.]

Two comments:

1) Many people out there are d**ks and feel that if everyone didnt work as hard they did then they are s**t and thus give bad evaluations. You are better off asking the chief or senior resident for an evaluation over asking the intern cause to the intern... life sucks and so will your grade.

2) One of the things that I wish I knew when I was in med school is how much communication can help make things simple. You come on to a rotation and bust your ass and in the end they give you a B/Satisfactory. The way around this is to communicate your objectives Minute ONE. "Hi my name is Ypo, I will be your student for a week." Some more talk happens then you break the conversation and say "I want to go into XXX, I would really like to ACE this rotation and get a great evaluation from you. What do you think I should do?" Do this with each resident and follow their instructions. This establishes your objectives day one and they will pay attention to your work. Later on, half way down the rotation, ask about your status and what you can do to improve. Do this with all the residents (cause they communicate when you are not around).

Finally, you can't win them all... just remember not to be like them when you are the big bad ass attending/senior resident.

Thanks, Fae.

I wish we got to choose who would evaluate us, but the truth is that we don't have a choice. We get assigned residents, and they get sent evaluations.

But the other advice is great, thanks.

 

[mlw03]

MS3 is the most subjective grading I have ever been subjected to. It's wholly unfair at times, and I wish I had a more satisfying answer for you, but that's just the way it is. Residents are inconsistent with each other, and often even within themselves. You're probably right on the money about non-homegrown residents not knowing how the eval system works. I would suggest talking to the department's chief resident and asking him/her to explain to the residents one day at morning report/M&M/whatever how the grading scheme works. Most importantly, the residents need to know what is considered "average" and what it takes to earn an Honors. It'd take 10 minutes of their time and really help out your fellow med students by at least providing some consistency in grading.

 

[smq123]

1. Does the clerkship director tell you "students need to get ______ out of ________ on their evaluations in order to honor the rotation."? The reason I ask this is my institution uses this really crappy evaluation form which uses three possible choices; "consistently", "usually", and "seldom". We have to get 75% "consistently" on all of our evaluations in order to meet criteria to honor (in addition to a high shelf score).

If your school is anything like my school - then, no, the residents are clueless about how the grading scale works. Either they heard it at one point, but totally forgot (which is understandable, given how busy they are), or they have to rely on med students to tell them.

I figured this out after a heart-stopping conversation with a resident.

Resident: You did a great job. I would have given you honors, but I decided not to. I wanted to give you the opportunity to do the oral exam, and showoff your knowledge and skills in front of the attendings. You know, so you can get an LOR out of it.
Me: 😱😱😱 ORAL EXAM?!?!? What oral exam????
Resident: You know. The oral exam that they give to people who are borderline between honors and excellent?
Me: WHAT?

Apparently, a few years ago, the school used to give an oral exam to people who were borderline between honors and excellent, and give them a chance to boost their grade up. It evidently didn't work well, because they certainly didn't do it this year or last year.

Sometimes I get the feeling that each of these terms are not viewed equally by everyone. I personally think that "usually" is actually really good; unfortunately if you get more than 25% of them, you have no chance of honoring. "Consistently" on the other hand can be interpreted different ways; for example as "perfect" or "always." Anyways, my assumption is that oftentimes people won't pick the highest score because it's ridiculous to say that a medical student does anything "perfectly" in the hospital, really.

I agree - the ambiguity is really annoying. If it really seems like it's not clear, maybe you could ask that your school put definitions on the evaluation sheet. Maybe? The evaluation sheet sample that you posted isn't very clear, and maybe it would help if it specified that "consistently = always; usually = > 90% of the time; etc.

I think everyone knows someone who was told "Wow, you were great! You practically functioned at the level of a 2nd year resident! That's why I'm going to give you an excellent!" Uh....😕

 

[Smurfette]

If your school is anything like my school - then, no, the residents are clueless about how the grading scale works. Either they heard it at one point, but totally forgot (which is understandable, given how busy they are), or they have to rely on med students to tell them.

I think everyone knows someone who was told "Wow, you were great! You practically functioned at the level of a 2nd year resident! That's why I'm going to give you an excellent!" Uh....😕

Um...no, I've never heard that one.

As a resident, I've never been told how the grading forms correlate with final grades. Only chiefs/seniors can grade students, but the interns can give input if a student is particular obnoxious or outstanding.

It's been rare that I think a student has deserved honors (let's be honest, where I am, the students leave a bit to be desired for both motivation and appropriate behavior (i.e. don't whine and complain to residents about everything under the sun!)). I think this is school dependent; rotating students from other institutions have almost always been outstanding. But it doesn't take a genius to know how to fill out the form so that they get honors.

The thing that sucks about 3rd year of med school is how subjective the grading is as well as WHO is chosen to fill out your forms.

 

[johankriek]

I have a few questions about how residents go about evaluating students. I know that filling out those evaluations must be a pain (it is for us students and we are 1/5 as busy as you are). Which is why I really appreciate your honest input, and I know the answers will be different for everyone.



1. Does the clerkship director tell you "students need to get ______ out of ________ on their evaluations in order to honor the rotation."? The reason I ask this is my institution uses this really crappy evaluation form which uses three possible choices; "consistently", "usually", and "seldom". We have to get 75% "consistently" on all of our evaluations in order to meet criteria to honor (in addition to a high shelf score).

Sometimes I get the feeling that each of these terms are not viewed equally by everyone. I personally think that "usually" is actually really good; unfortunately if you get more than 25% of them, you have no chance of honoring. "Consistently" on the other hand can be interpreted different ways; for example as "perfect" or "always." Anyways, my assumption is that oftentimes people won't pick the highest score because it's ridiculous to say that a medical student does anything "perfectly" in the hospital, really.

2. What do you think are reasonable expectations (by your standards in your specialty) for a student to honor?


I just finished a rotation in which I showed up early everyday, stayed late everyday, took on more patients than I was required to, followed them more closely than anyone on the team, and got along really well with all of the residents and attendings. On the weekends after rounding, when I could have gone home with the other medical students at 9am, I always stayed into the afternoon. One time when we got slammed on a Sunda the residents asked if I could stay a little longer and do some more admissions (which I did gladly) and I ended up getting out of there at 9pm. My notes were always on time; I presented all my own patients to the attendings. I followed through on every patient. I really tried to think like an intern... So I was surprised when the resident who had seen me do all this gave me mostly "usually" and a few "consistently." The thing is; I know he really liked me and was impressed with me because he told me so, and everytime I see him he gives me a big friendly smile. He's a really sweet guy. So the only thing I can think is that "consistently" means something different to him than it does to others, or...that he's not the type to tell a medical student they do anything "consistently" well (or perhaps he's just like me and he thinks that "usually" is actually "really good".)

It's just frustrating because most students I know try really hard, but then we have to try to analyze an evaluation which (I feel) is ambiguous. And I don't know (because I haven't bothered to ask yet😳) whether a resident knows they are "screwing" us by giving us mostly "usually". Actually I suspect the residents who went to my school DO know (because they tend to give great evals) whereas the FMGs/out of state docs tend not to.

i feel ya

stop wasting precious time writing about this.. DId you pass? if yes, move on... go have a drink do something you like.. go let a guy take advantage of you.... trust me it wont make a lick of difference in 5 years even in 1 year even in a few months.. it really wont.. WHo cares what he wrote about you? did you do all those things because you wanted a good eval or because you truly wanted to. AND if you knew he would write that would you have stayed and showed your diligence? CMON.. take it easy girl.. I had some of the nastiest things written about me on those evaluations to the point where it was personal.. " I barely know why he wants to be a doctor and neither does he" " He is the worst human being on the face of the earth" This is after I felt i was doing ok on the rotation and nobody ever re directed me and i never had problems.. these comments appeared in my deans letter.. Mind you.. i am board certified physician now.. never had any problems with my step exams and never had problems geting board certified Let it go.. DOnt even waste your time questioning it.. all my best.. johan

 

[exPCM]

When I was a resident, the program director never gave us any protected time to just sit down and fill out med student evaluations. My philosophy was that if you want me to take a task seriously, then give me some time to work on the task. Since they didn't give me the time, I would just rate all the students excellent down the line and not fill in any comments. Med students never complain about getting excellent evaluations so I was never asked to explain any of my evaluations. Other residents I know would be called to justify and/or explain when they gave poor evaluations to students.

Plus, why do residents need to evaluate the clinical performance of students anymore? After all, they are NOW CERTIFIED AND BLESSED by the USMLE as competent physicians based on the Step 2 Clinical Skills Exam which thankfully did not exist when I was a med student. Surely, the attending evaluators at the Clinical Skills exam are better able to judge a med student in one day than a resident can over the course of one month.

 

[Winged Scapula]

I was never told what the qualifications were for P/HP/H or anything like that when evaluating students as a resident or fellow. We were given a form with a Likert type scale and a space for written comments on how the student (or junior resident, as the forms were similar) could improve, what they did really well, and any general comments.

If I'd known that the student needed "75% consistentlys" to Honor I would have made a concerted effort to complete the form that way. I am sort of the type that feels no one is going to get a "5" (the top score) on every category because that would mean there is no room for improvement (and there always is) but I would try and complete the form in a fashion that would give the grade the student deserved, if I'd known what contribution the evals had in grading.

 

[Ypo.]

Resident: You did a great job. I would have given you honors, but I decided not to. I wanted to give you the opportunity to do the oral exam, and showoff your knowledge and skills in front of the attendings. You know, so you can get an LOR out of it.
Me: 😱😱😱 ORAL EXAM?!?!? What oral exam????
Resident: You know. The oral exam that they give to people who are borderline between honors and excellent?
Me: WHAT?

That really sucks. (and funny in retrospect). So what; was he saying you were a ‘borderline' student? Or did he just honestly want to give you a chance to get pimped and shine on an oral exam…

I agree - the ambiguity is really annoying. If it really seems like it's not clear, maybe you could ask that your school put definitions on the evaluation sheet. Maybe? The evaluation sheet sample that you posted isn't very clear, and maybe it would help if it specified that "consistently = always; usually = > 90% of the time; etc.

That is a really good idea. If I can't get my school to change it to a 1-5 scale, I'll at least go for a definition (or both). What would be really great is if they would just put the requirements for honoring at the top of the evaluation; that way the residents would be able to take that into consideration.

It's been rare that I think a student has deserved honors (let's be honest, where I am, the students leave a bit to be desired for both motivation and appropriate behavior (i.e. don't whine and complain to residents about everything under the sun!)). I think this is school dependent; rotating students from other institutions have almost always been outstanding. :

But is the reason you think most of them don't deserve to honor simply because they whine? (I agree the last thing a resident wants to hear is a medical student whining). Or does it have to do with something else?

Most importantly, the residents need to know what is considered "average" and what it takes to earn an Honors.
:

I really have been wondering it it's just too hard for residents to remember what's appropriate for a 3rd yr student to know/be capable of. I've been noticing that I almost learn by osmosis (mainly because I don't have time to really ‘study' the way I did in 1st and 2nd yr), which in a way makes it hard to really notice when I assimilate things, which in the future (I assume) would make it hard to be cognizant of when I learned something. I think as students we've all had that experience with the crazy community physician who's been out of medical school for 30 yrs tell us to go in, examine the patient, do a pap and pelvic unsupervised, and then write whatever prescriptions are necessary. (!)

In general, I think the only reason clerkship directors know what level medical students should function at is because it's their job to know, and they interact with us everyday, they read the national standard requirements, etc…and they have to put a deal of thought into organizing the rotation.

Perhaps residents need a reminder? FWIW, half the time I swear I don't even know what level I'm supposed to be functioning at.

If I'd known that the student needed "75% consistentlys" to Honor I would have made a concerted effort to complete the form that way. I am sort of the type that feels no one is going to get a "5" (the top score) on every category because that would mean there is no room for improvement (and there always is) but I would try and complete the form in a fashion that would give the grade the student deserved, if I'd known what contribution the evals had in grading.

I feel exactly the same. I'd rather get an evaluation with all 4's than all 5's (because there is no way I'm a ‘perfect' anything), with comments on what I was good at and how to improve. But having to choose between 2 & 3 (when 3's are required to honor) really bites!
I actually think converting the scale to a 1-5 would be a really good idea.

 

[Blade28]

I was never told what the qualifications were for P/HP/H or anything like that when evaluating students as a resident or fellow. We were given a form with a Likert type scale and a space for written comments on how the student (or junior resident, as the forms were similar) could improve, what they did really well, and any general comments.

We have a similar system here.

I agree that you can't give the top grade in every single category, as it implies the med student is perfect. 🙂 A few token 4s scattered among all the other 5s works, though, if the student was truly phenomenal.

I'll also separately talk to the students in whom I see some potential, if they're at all considering surgery.

 

[Smurfette]

But is the reason you think most of them don’t deserve to honor simply because they whine? (I agree the last thing a resident wants to hear is a medical student whining). Or does it have to do with something else?

No, it doesn't have to do with whining. It has to do with the fact that most seem to have an attitude of only doing enough to "get by" or simply not trying to do well. Most do not follow patients actively or want to learn to do procedures (I've had a few say "I'd rather study" or ask how long it would take since they were hoping to get sent home). But I've ranted about my med students in other threads before. Like I said, most of the rotating students I've seen are awesome and totally deserve honors.

 

[Faebinder]

No, it doesn't have to do with whining. It has to do with the fact that most seem to have an attitude of only doing enough to "get by" or simply not trying to do well. Most do not follow patients actively or want to learn to do procedures (I've had a few say "I'd rather study" or ask how long it would take since they were hoping to get sent home). But I've ranted about my med students in other threads before. Like I said, most of the rotating students I've seen are awesome and totally deserve honors.

Wow, way on the other spectrum for me. I actually understand that they need to read cause on the floor you don't see everything or even nearly enough. Worse, now a days if you dont score high on the USMLEs then your career is toast. So yeah, go home, study and score high, get the residency you want.

 

[Tired]

When I fill out evals, and on the few occassions I've discussed it with the upper-level residents, there is one simple thought operating: Nobody cares.

We just scribble out the eval, unless the student has really made an effort to make a good impression. I agree with the above post about telling the residents that you want a really good eval for whatever reason. If you don't, you're just going to get a reflection of the mood they're in at the moment, rather than a true evaluation of how you did.

 

[DOCTORSAIB]

Here's my objectives when I started 3rd year:

1) Honor Medicine and Surgery AT ALL COSTS. The advice of telling the resident up front that you want to Honor is dead-on. I used it and it worked well for me.
2) Expect to get Passes on the eval's in everything else. If I got Honors it was always a pleasant surprise. Remember, these things are VERY subjectives as the above posters have pointed out. No need in losing too much sleep over it.
3) Read my ass off and nail the rotation exams. That coupled with a Pass on the eval would land me a semi-sexy High Pass plus I'd know my material well for Step II.

Using this approach kept me sane and happy all of 3rd year. Hope that helps.

 

[PeepshowJohnny]

I'm a med student, but I know for a fact residents and even some new attendings (or those not used to having students) have no idea how our evaluation system works.

I don't want to brag, but myself and other students had an evaluator come up to me near the end of their time together with their evaluation form and say "I want you to get Honors, how do I make sure you get them?" I'm assuming they don't want to just fill straight "5/5, 10/10" down the line because that looks suspicious, but they don't want to go risk costing a student something because they circled too many 8 out of 10's.