Failing a rotation

[Researchie]

Hi,

About a two weeks ago, I finished my first rotation in family med. I haven't seen my whole grade, but I have seen 1 eval, and it was really bad. I was given average on everything, except communications, where I was given significantly below average points. I did so badly, infarct, thAt my preceptor felt the need to phone my school about it--I have yet to find out why. I also was told I made patients and staff feel uncomfortable--again I have no idea how.This came as an absolute shock to me, as when I asked that preceptor for feedback they said nothing about this. My other preceptor told me they were very impressed with me, too.

I understand that not all preceptors give high scores, but the fact she felt that I did so badly that she need to phone my school about it scares me. I know I'm very shy and have few friends, and the eval came from the first days of my rotation, and I was very afraid to speak with patients at that time. I know I come close to being considered avpd, but I did try to engage with nurses, staff and patients. One possible issue is that I read my family med book during breaks and free time- which is what I thought I was supposed to be doing. I did show enthusiasm throughout the rotation, and stayed extra hours as well.
After doing so well in preclinicals, and hoping for a competitive residency, I'm crushed. I almost feel that I should consider leaving med school, as I don't think I'll make it as a doctor with poor inter professional skills. I don't really know where to go from here.

Thanks in advance.

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[neutropeniaboy]

Sorry to hear about this. I'd be crushed too.

I think the next step is to request some sort of inquiry into the evaluation. You need to figure out what you said (if anything), did (if anything) or didn't do that resulted in the evaluation you got.

Another option is to do directly to those responsible for the evaluation and ask for feedback.

Is it possible that there is any discrimination involved?

On another note, clinical rotations can be very frustrating for students because there often are no rigid criteria for performance evaluation. It's not like your biochemical class where the 90% correct gives you the high pass. Evals on rotations are often very subjective, and Family Medicine (as I recall from mine) seems to be more on the touchy feely side of things, especially if you're in a doctor's private practice like I was.

Bottom line: be persistent in your quest to find feedback. For your next rotation, ask for feedback after the first week. More importantly, approach the director/attending/whatever and ask what his/her expectations of you are for the rotation.

 

[Mad Jack]

Hi,

About a two weeks ago, I finished my first rotation in family med. I haven't seen my whole grade, but I have seen 1 eval, and it was really bad. I was given average on everything, except communications, where I was given significantly below average points. I did so badly, infarct, thAt my preceptor felt the need to phone my school about it--I have yet to find out why. I also was told I made patients and staff feel uncomfortable--again I have no idea how.This came as an absolute shock to me, as when I asked that preceptor for feedback they said nothing about this. My other preceptor told me they were very impressed with me, too.

I understand that not all preceptors give high scores, but the fact she felt that I did so badly that she need to phone my school about it scares me. I know I'm very shy and have few friends, and the eval came from the first days of my rotation, and I was very afraid to speak with patients at that time. I know I come close to being considered avpd, but I did try to engage with nurses, staff and patients. One possible issue is that I read my family med book during breaks and free time- which is what I thought I was supposed to be doing. I did show enthusiasm throughout the rotation, and stayed extra hours as well.
After doing so well in preclinicals, and hoping for a competitive residency, I'm crushed. I almost feel that I should consider leaving med school, as I don't think I'll make it as a doctor with poor inter professional skills. I don't really know where to go from here.

Thanks in advance.

Learning to talk to patients and communicate effectively takes time. Just give it a chance. Also, it sounds like you weren't very interested in FM to begin with, is it possible this showed during your rotation? If you're gunning for a competitive specialty and come off as bored or disinterested, it might put off your preceptor. If you aren't particularly good with people, any potential disinterest might be more outwardly visible than you realize. Just some thoughts.

In any case, don't give up and give it some time. You'll probably get the hang of it eventually.

 

[Researchie]

Learning to talk to patients and communicate effectively takes time. Just give it a chance. Also, it sounds like you weren't very interested in FM to begin with, is it possible this showed during your rotation? If you're gunning for a competitive specialty and come off as bored or disinterested, it might put off your preceptor. If you aren't particularly good with people, any potential disinterest might be more outwardly visible than you realize. Just some thoughts.

In any case, don't give up and give it some time. You'll probably get the hang of it eventually.

The only points I got slightly above average on was motivation. I did my utmost to show enthusiasm for everything-asked questions, arrived 30 minutes early, stayed late (2hrs late), and asked to do more, like procedures such as Pap smears-to which my preceptor said no, because of patient comfort, which I can understand.

 

[Psai]

Come 5 minutes early and don't stay late. Get feedback early and often. A lot of docs don't have great interpersonal skills, just have to be nice to folks

 

[Doctor Bob]

and asked to do more, like procedures such as Pap smears

This can very much work against you. Depending on how you ask.

If you stand there, sweating profusely, wringing your hands, and lecherously leering at the patients, then asking to do some Pap smears, you might get a poor evaluation.


But in all seriousness, this is the drawback to evaluations. They're subjective. If you just have a personality conflict with someone it'll mean a bad evaluation. Which is why one bad eval isn't an issue as long as on the balance they're all good.

If on the other hand you have multiple bad evals... well... then that shows a trend and some serious introspection is needed. It can be tough to figure out the problem on your own. You need someone to sit down with you and go through your evals as well as discuss your clinical experience to find out where the problem lies. Some preceptors will do this. Otherwise it's the responsibility of your clerkship director to gather this info and then have the talk with you.

 

[notbobtrustme]

I know I'm very shy and have few friends, and the eval came from the first days of my rotation, and I was very afraid to speak with patients at that time. I know I come close to being considered avpd, but I did try to engage with nurses, staff and patients.

wait what? talking to patients is the easiest part of clinical rotations. get a script going, don't be a robot and do a quick physical. you aren't trying to make friends, you're trying to get information out.

were you just sitting in the patient's room for 5 minutes in silence looking for words and then had nothing to present to your preceptor? i feel like you're leaving out a lot of important details here.

 

[Researchie]

wait what? talking to patients is the easiest part of clinical rotations. get a script going, don't be a robot and do a quick physical. you aren't trying to make friends, you're trying to get information out.

were you just sitting in the patient's room for 5 minutes in silence looking for words and then had nothing to present to your preceptor? i feel like you're leaving out a lot of important details here.

Lol, no, I did speak to the patients and took an HPI, ROS, and PE. I did present the info. The first day, I didn't do this at all ( maybe once), because my preceptor wanted me to just watch her. The second day, I did it a couple of times-based on how much she let me do. I was only with her a day and a half. I spent all of my breAk time, and time in between patients, researching the drugs the patients were taking, the conditions the patients had, and read my case files book. Maybe I came off as aloof because I didn't make chitchat instead? I did make a point of learning the nurses names and speaking with them a little so I didn't come off as a pretentious jerk.

I feel a little upset because when I asked for feedback at the end of the two days, all my preceptor said was I did okay, but was maybe a little shy. Nothing about making patients and staff uncomfortable, which my eval stated. I also only thought the preceptor would complain to the school only if there was something serious, like harassment or endangerment of patients. I feel particularly miffed because this preceptor never once watched me interact with patients, as in, watched me take a H&P.

 

[PaxRoma]

Say good morning with a smile to everyone everyday you're there. On the last day of my rotation, my preceptor took a picture with me because she said she love my smile.

 

[Kaustikos]

So,
You didn't fail a rotation. It's based on all preceptor evals unless you did something horrible like lie, not be there or whatever. Two days with one preceptor means you have other preceptors.

 

[operaman]

While this is reading the tea leaves a bit, my spidey sense tells me that this all likely boils down to a single bad encounter, either with a staff member or patient or the preceptor herself. You don't have to share it, but I would think long and hard about any interaction you had with anyone that could be construed as inappropriate or awkward (esp. in a creepy way). My experience is that single events tend to get multiplied in retelling, so one bad encounter suddenly becomes 'made patients [plural] feel uncomfortable.'

This further tends to color one's overall impression of someone. Since most of us make a generally neutral impression 95% of the time, it's what happens in that other 5% that colors people's perceptions. If those 5% are good experiences, friendly chats, etc., then people look at your 95% including reading and volunteering to do procedures as being interested and engaged. If those 5% were bad/creepy/awkward, then suddenly those same actions are viewed as someone who is aloof and disinterested who would rather study for the shelf than participate and who seems creepily interested in gynecological procedures. Your job is to figure out what 5% went wrong so you don't make that mistake again. Self-reflect and seek out honest feedback until you identify the issue. Unfortunately, feedback in this area is hard to get because nobody wants to tell someone negative things, especially if they don't really know how to fix them. Maybe you're just terribly awkward and come off as creepy; who wants to tell someone that?! Most will just say nothing or say something generic. My guess is you already know what the 5% issue was but are underestimating how much it may have colored your preceptor's overall impression of you.

If after serious investigation you cannot figure out what went wrong, I would say to act on the assumption that your general demeanor comes off differently than you think it does. Best thing to do in that case is press your top lip firmly against your bottom lip and keep it there. Keep everything boring and all business. Always have a pen and paper in hand and when in doubt, look like you're taking notes about something. You may not win congeniality awards that way, but it's pretty hard to offend anyone that way either. The note-taking will keep you from appearing disinterested and also gives you something to do with your hands (it's an old stage director's trick since less experienced actors will tend to fall out of character or look awkward during those moments when their character is just standing there with nothing to do). Beyond that, work hard, work fast, and try and stay positive and remember that 4th year is not that far away.

 

[Researchie]

Thanks for the advice. I'm pretty confident I'm going to have to repeat this rotation, as my shelf was also pretty bad--74. I'm meeting with the clerkship director in two weeks to figure out how to improve.

 

[notbobtrustme]

Thanks for the advice. I'm pretty confident I'm going to have to repeat this rotation, as my shelf was also pretty bad--74. I'm meeting with the clerkship director in two weeks to figure out how to improve.

74 should be fine, chances are that that's the national mean if you're talking NBME.

 

[Kaustikos]

Thanks for the advice. I'm pretty confident I'm going to have to repeat this rotation, as my shelf was also pretty bad--74. I'm meeting with the clerkship director in two weeks to figure out how to improve.

What is wrong with you? A 74 is definitely a pass. And you even said most of that evaluation was average.
Lighten up. You're jumping to incorrect conclusions without anything to support that.

 

[Lefty Doodle]

I got a 74 on my family med test and it was a high pass

 

[cbrons]

my spidey sense tells me that this all likely boils down to a single bad encounter

Really? Because something tells me this might be a little deeper than one incident.

One thing I have noticed from some medical students, including a close friend of mine, is that they have a very low level of social intelligence and often don't even realize how they come off to people. I think it is part of being born into the internet generation, where social conditioning at an early age has been largely replaced by faceless interaction with peers via instant messenger and social media. But setting social theory aside, I would not jump to the conclusion that this boils down to one single misunderstanding because most of the time students in these situations lack the capacity to evaluate their behavior.

One good source for information on this is to ask a friend who you know will be honest. "Do I turn some people off with the way I act?" Some bad friends won't tell you the truth, but good ones will let you know.

 

[Kaustikos]

I got a 74 on my family med test and it was a high pass

You're welcome.

 

[Giic]

wait what? talking to patients is the easiest part of clinical rotations. get a script going, don't be a robot and do a quick physical. you aren't trying to make friends, you're trying to get information out.

were you just sitting in the patient's room for 5 minutes in silence looking for words and then had nothing to present to your preceptor? i feel like you're leaving out a lot of important details here.

Talking to patients may actually be very hard depending on your personality. Did you read the part where he said he may have AVPD? You shouldn't be so judgmental!

 

[dozitgetchahi]

Lol, no, I did speak to the patients and took an HPI, ROS, and PE. I did present the info. The first day, I didn't do this at all ( maybe once), because my preceptor wanted me to just watch her. The second day, I did it a couple of times-based on how much she let me do. I was only with her a day and a half. I spent all of my breAk time, and time in between patients, researching the drugs the patients were taking, the conditions the patients had, and read my case files book. Maybe I came off as aloof because I didn't make chitchat instead? I did make a point of learning the nurses names and speaking with them a little so I didn't come off as a pretentious jerk.

I feel a little upset because when I asked for feedback at the end of the two days, all my preceptor said was I did okay, but was maybe a little shy. Nothing about making patients and staff uncomfortable, which my eval stated. I also only thought the preceptor would complain to the school only if there was something serious, like harassment or endangerment of patients. I feel particularly miffed because this preceptor never once watched me interact with patients, as in, watched me take a H&P.

Wait, you were with this particular preceptor for only a day and a half? Why are they even letting her write an eval? Where I went, a preceptor couldn't write an eval unless at least 4 days had been spent working with the student in question.

I donno, seems crazy. Either there was some sort of interaction that was way out of line or this preceptor went a bit overboard. Sounds like you were doing a lot of the right things socially and that your heart was in the right place. Granted, you could have been really aloof and done something ugly, but usually people doing bad stuff aren't even trying to do the right things.

 

[Gambler 101]

Deleted. Didn't realize this is from August

 

[kakashi1992]

I found this post today, and I want to say this exact same situation happened to me. To a tee. Was failed without notice, no concrete reason given. The aftermath was that I met with the clerkship director, the school dean, and I was strictly prevented on going onto the remainder of my third year rotations. There was no recourse whatsoever for me to get back to doing my rotations. No matter how much I tried to find out the reason, no matter how much I cried and begged. I'm back on 3rd year rotations now, but if this ever happens to me again, I'm quitting med school for good.

 

[NeurologyHopeful2018]

I found this post today, and I want to say this exact same situation happened to me. To a tee. Was failed without notice, no concrete reason given. The aftermath was that I met with the clerkship director, the school dean, and I was strictly prevented on going onto the remainder of my third year rotations. There was no recourse whatsoever for me to get back to doing my rotations. No matter how much I tried to find out the reason, no matter how much I cried and begged. I'm back on 3rd year rotations now, but if this ever happens to me again, I'm quitting med school for good.

Your story don't add up. There is a rule that in order to fail you - they must give you formal feedback and a chance for remediation before failing you. Also why did the school not let you appeal? The administration want you to succeed and it makes no sense to hide the reason why you failed.

 

[Merely]

Your story don't add up. There is a rule that in order to fail you - they must give you formal feedback and a chance for remediation before failing you. Also why did the school not let you appeal? The administration want you to succeed and it makes no sense to hide the reason why you failed.

This is not true, people can fail you for any reason and at anytime. They will always believe an attending vs a student. You have no recourse as a student. Good luck.

 

[Giovanotto]

This is not true, people can fail you for any reason and at anytime. They will always believe an attending vs a student. You have no recourse as a student. Good luck.

What school do you go to that this is true?

 

[kakashi1992]

What school do you go to that this is true?

Yes