For the third years and beyond, What determines if you get a strong LOR from clerkship directors?

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EMDO2018

EMDO2018

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What determines if you get strong letters from 3rd year clerkship directors? How important is greasing palms. getting face time, and going above and beyond, vs. just letting your academic work speak for itself?
 
What does this even mean, like you might as well just do everything in your power within reason. I highly doubt a clerkship director cares that much if you butter them up , and so long as you're on time, work hard and not ignorant of social norms, you're probably not going to ever get a bad LOR
 
Why you are worrying about this as an MS-1 is beyond me. #2 - you ask for an LOR from the attending your worked with who evaluated your performance, not the clerkship director which is more a medical school designation in terms of responsibility for turning in grades to the registrar.
 
southernIM said:
Most of your letters won't come from the clerkship directors, but rather the actual attendings you work with clinically.
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At most, I've heard of a Chairman's letter being asked for, not the clerkship director which changes every so often, bc the faculty member gets tired of more administrative rigmarole.
 
southernIM said:
For internal medicine at my school, the clerkship director wrote the "Chairman's letter" for a lot of students b/c there were too many students for the chair to meet with and write letters for them all so they split the workload.
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Yeah, I've never really understood why certain programs ask for Chairman's letters in the first place (yup, IM, don't know if General Surgery does it), when the Chairman 9 times out of 10 doesn't even know who you are and has never worked with you.
 
EMDO2018 said:
What determines if you get strong letters from 3rd year clerkship directors? How important is greasing palms. getting face time, and going above and beyond, vs. just letting your academic work speak for itself?
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I'm not sure what you mean by "academic work." You mean performance on the shelf exam? So much less important than your clinical performance, how you work with patients and colleagues, your knowledge base when answering questions or coming up with ddx, your H&P skills, presentation skills, etc. A strong letter will come from an attending who sees you going above and beyond what is normally expected from a 3rd year medical student, aka doing high pass or honors level work. 3rd year is no longer the time to be complacent with a pass.
 
Ismet said:
I'm not sure what you mean by "academic work." You mean performance on the shelf exam? So much less important than your clinical performance, how you work with patients and colleagues, your knowledge base when answering questions or coming up with ddx, your H&P skills, presentation skills, etc. A strong letter will come from an attending who sees you going above and beyond what is normally expected from a 3rd year medical student, aka doing high pass or honors level work. 3rd year is no longer the time to be complacent with a pass.
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I think it varies by school how much the shelf is worth. At most schools the shelf exam is a standardization measure used to more distinguish between an HP and a P - I think med students commonly mistake it as the metric to be shooting for, as if it will make up for poor clinical performance -- and yes, there are people on the wards who do have poor clinical performance, but bc of med school policies, they have to be given a "Pass".
 
Ismet said:
I'm not sure what you mean by "academic work." You mean performance on the shelf exam? So much less important than your clinical performance, how you work with patients and colleagues, your knowledge base when answering questions or coming up with ddx, your H&P skills, presentation skills, etc. A strong letter will come from an attending who sees you going above and beyond what is normally expected from a 3rd year medical student, aka doing high pass or honors level work. 3rd year is no longer the time to be complacent with a pass.
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So when attending's throw out pimp questions, they use that to evaluate your knowledge base, what if they ask about the one thing you didn't study?
 
EMDO2018 said:
So when attending's throw out pimp questions, they use that to evaluate your knowledge base, what if they ask about the one thing you didn't study?
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They're not study questions. Pimp questions are not coming out of a premade professor course pack. They're more testing if you know what you're doing and you understand the process that's going on in your patient that you're writing your note on.
 
DermViser said:
I think it varies by school how much the shelf is worth. At most schools the shelf exam is a standardization measure used to more distinguish between an HP and a P - I think med students commonly mistake it as the metric to be shooting for, as if it will make up for poor clinical performance -- and yes, there are people on the wards who do have poor clinical performance, but bc of med school policies, they have to be given a "Pass".
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Right but if you're asking your attending for a letter (assuming OP mistakenly asked or didn't know any better about the clerkship director thing), do they even have your shelf score? I would think that to the person writing your letter, clinical performance and everything else on the typical eval would be more important than a shelf score. At least I hope... 😛 My shelf scores have been average thus far but I've been HP/H on the clinical side.
 
EMDO2018 said:
What determines if you get strong letters from 3rd year clerkship directors? How important is greasing palms. getting face time, and going above and beyond, vs. just letting your academic work speak for itself?
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I love how getting face time and going above and beyond are lumped in with greasing palms and dichotomized into some unspeakable category of behaviors that are beyond the pale.
 
EMDO2018 said:
So when attending's throw out pimp questions, they use that to evaluate your knowledge base, what if they ask about the one thing you didn't study?
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You're not expected to have an answer for everything. It's perfectly fine to say "I don't know" or venture an educated guess. That just cannot be your answer for everything or the majority of the things. One of my first attendings told me that she expected a 3rd year medical student to answer 50% of her questions correctly. If you answer more than 50% of her questions correctly, she considers you above average (HP range) for clinical knowledge. Obviously the expectation is higher for 4th years, even higher for interns, etc.

If you find yourself not knowing the answer to most of what you're "pimped," you need to hit the books harder.
 
Ismet said:
Right but if you're asking your attending for a letter (assuming OP mistakenly asked or didn't know any better about the clerkship director thing), do they even have your shelf score? I would think that to the person writing your letter, clinical performance and everything else on the typical eval would be more important than a shelf score. At least I hope... 😛 My shelf scores have been average thus far but I've been HP/H on the clinical side.
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Depends on the letter writer I think. Most of the time, if you didn't do as well on the shelf and got an overall HP, then they won't even mention it and talk about how great you are. If you obviously did well on the shelf which tipped you to the H, then it's just one more gold star which they'll mention in the letter. As far as going out of his way to inquire from the med school on your shelf score, I think it depends on how "academic" (annoying) he is.
 
Pons Asinorum said:
I love how getting face time and going above and beyond are lumped in with greasing palms and dichotomized into some unspeakable category of behaviors that are beyond the pale.
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Yup, on SDN anyone who gets an "H" on a rotation either kissed ass to the residents, bought snacks for the team, brownosed the attending, got an easy attending, etc. It's never bc the person went above and beyond expectations or had good clinical knowledge etc.
 
sigh, our program just switched our grading for clerkships. Now 100% of our grade is the shelf.
 
pathologyDO said:
sigh, our program just switched our grading for clerkships. Now 100% of our grade is the shelf.
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That doesn't make sense. So none of your grade is determined by a clinical evaluation? So it doesn't even matter?
 
DermViser said:
That doesn't make sense. So none of your grade is determined by a clinical evaluation? So it doesn't even matter?
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Well, apparently, they decided that the subjective grading will only go into our Deans letter, but will not affect our clerkship grades.
 
pathologyDO said:
sigh, our program just switched our grading for clerkships. Now 100% of our grade is the shelf.
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That is shockingly absurd, on many, obvious levels. I'm sure that the faculty will be keen to write the comments that will make up your dean's letter knowing that the administration considers their opinions of your clinical performance worthless.
 
Ismet said:
You're not expected to have an answer for everything. It's perfectly fine to say "I don't know" or venture an educated guess. That just cannot be your answer for everything or the majority of the things. One of my first attendings told me that she expected a 3rd year medical student to answer 50% of her questions correctly. If you answer more than 50% of her questions correctly, she considers you above average (HP range) for clinical knowledge. Obviously the expectation is higher for 4th years, even higher for interns, etc.

If you find yourself not knowing the answer to most of what you're "pimped," you need to hit the books harder.
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Did they make the questions harder if you did well ? I remember reading a few talking about it where an aspect of pimping was essentially making you realize how little you actually knew and that even if you knew all the book info they would make it hyper obscure so you wouldn't feel like you knew all the answers .
 
PL198 said:
Did they make the questions harder if you did well ? I remember reading a few talking about it where an aspect of pimping was essentially making you realize how little you actually knew and that even if you knew all the book info they would make it hyper obscure so you wouldn't feel like you knew all the answers .
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Hence the acronym -- PIMP -- Put in My Place.

The more accurate term is the Socratic method. It's pretty much up to the attending of what they want to ask you, some will be easy, some will be hard, some will be in between. If it's really that hyperobscure it won't matter.
 
PL198 said:
Did they make the questions harder if you did well ? I remember reading a few talking about it where an aspect of pimping was essentially making you realize how little you actually knew and that even if you knew all the book info they would make it hyper obscure so you wouldn't feel like you knew all the answers .
Click to expand...

Some do, some don't. Often they just have one or two questions usually related to pathophys or pharm for a patient, and then it's time to move on. Then there was the attending (same one who told me about the 50% thing) who had me go through every cause of anemia and the pertinent lab findings for each...we stood there on rounds for at least 10 minutes between me answering and her/the fellow and residents adding, correcting, and teaching relating back to the patient we were discussing. I was probably visibly getting flustered near the end when I was at the limit of my memory, which was why she told me later about the 50% thing (and apparently I knew more than 50%! thank you Pathoma).

I think it also varies by specialty and by the doctor's personality. "Pimping" was generally less intimidating on peds, FM, and EM so far for me. I haven't done my inpatient adult rotation yet, but worked with primary care IM docs during my outpatient rotation and the Socratic method was in full force there. I've also heard similar things for surgery.

Or just watch this video, it's quite accurate
 
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Ismet said:
Or just watch this video, it's quite accurate
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Not to derail this thread, but when it comes to singing ability that video and this one are really great. Some of the others need work (lol). Definitely reminds me of the experience on starting on the wards.


Ok back to our regularly scheduled thread topic.
 
DermViser said:
Hence the acronym -- PIMP -- Put in My Place.

The more accurate term is the Socratic method. It's pretty much up to the attending of what they want to ask you, some will be easy, some will be hard, some will be in between. If it's really that hyperobscure it won't matter.
Click to expand...

LOL I had no idea thats how it came to be called pimping. I never understood why it was called that before
 
Ismet said:
You're not expected to have an answer for everything. It's perfectly fine to say "I don't know" or venture an educated guess. That just cannot be your answer for everything or the majority of the things. One of my first attendings told me that she expected a 3rd year medical student to answer 50% of her questions correctly. If you answer more than 50% of her questions correctly, she considers you above average (HP range) for clinical knowledge. Obviously the expectation is higher for 4th years, even higher for interns, etc.

If you find yourself not knowing the answer to most of what you're "pimped," you need to hit the books harder.
Click to expand...

You know, there are a lot of my classmates who would rather die than admit they were wrong with anything when it comes to arguing with peers, will this type of arrogance and "show no weakness" attitude be a huge hindrance 3rd year? I can imagine with nurses you have to stick to your guns and show confidence.
 
EMDO2018 said:
You know, there are a lot of my classmates who would rather die than admit they were wrong with anything when it comes to arguing with peers, will this type of arrogance and "show no weakness" attitude be a huge hindrance 3rd year? I can imagine with nurses you have to stick to your guns and show confidence.
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Wow, you're like 0 for 1000 at this point.
 
But seriously though, do 3rd years and residents even have time to talk to nurses? Nurses have stuff to do, just like doctors have stuff to do.
 
EMDO2018 said:
But seriously though, do 3rd years and residents even have time to talk to nurses? Nurses have stuff to do, just like doctors have stuff to do.
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It's like this:


In this scenario - blue blazers = nurses, white coats = physicians.
 
DermViser said:
It's like this:


In this scenario - blue blazers = nurses, white coats = physicians.
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Oh, god this is familiar. Our school has a separate dining hall for faculty and residents and its so nice, the nurses and janitors have to sit on the cold dim lit side of the cafeteria, med students usually sit in the middle and no one ever challenges the status quo. I may just go to the faculty dining room tomorrow to see what happens.
 
EMDO2018 said:
But seriously though, do 3rd years and residents even have time to talk to nurses? Nurses have stuff to do, just like doctors have stuff to do.
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Yes, you do talk to nurses, and the overwhelmingly vast majority of the time, they know more than you. Maybe they don't know the gene that causes a predisposition to a certain disease, but they know how to manage patients and provide patient care better than you, which is more important on the wards.

Nurses often provide valuable information about the patients. I just finished a shift in the ED and a nurse saved my butt on a patient, an unaccompanied 95 y/o delirious woman and an overall poor historian, but the nurse had gotten a good history from the patient's son on intake, so she told me what was going on.

You should always be confident in yourself, but it is not a medical student's place to contradict or challenge a nurse. Nurses aren't people you "have to deal with," they are vital members of the care team and will be a great asset to you as a medical student.
 
Ismet said:
Yes, you do talk to nurses, and the overwhelmingly vast majority of the time, they know more than you. Maybe they don't know the gene that causes a predisposition to a certain disease, but they know how to manage patients and provide patient care better than you, which is more important on the wards.

Nurses often provide valuable information about the patients. I just finished a shift in the ED and a nurse saved my butt on a patient, an unaccompanied 95 y/o delirious woman and an overall poor historian, but the nurse had gotten a good history from the patient's son on intake, so she told me what was going on.

You should always be confident in yourself, but it is not a medical student's place to contradict or challenge a nurse. Nurses aren't people you "have to deal with," they are vital members of the care team and will be a great asset to you as a medical student.
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But what if the nurses aim is to make your life a living hell just because?
 
EMDO2018 said:
But what if the nurses aim is to make your life a living hell just because?
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Not a third year yet, but come on man. Yeah, there might be the occasional wacko who thinks this way, but for the most part, nobody cares about you.

You aren't the center of that nurses universe, you're probably not even a named exoplanet. You're just some stupid blip with a short coat who occasionally gets in the way. Unless you're exceptionally annoying, I doubt they'll spend more than 10 minutes in their entire lives thinking about you.

I know it's difficult for socially anxious/awkward people, but seriously, get over yourself. I'm not saying that to be harsh, I'm just saying you aren't that important to them.
 
EMDO2018 said:
Some nurses here are known to be that way
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Some medical students are known to make other people's lives hell as well, but that doesn't mean all medical students should be approached as the enemy. Learn to play nice with everyone and you'll at least get the moral high ground in any interaction that goes to hell, if nothing else. The nurses have nearly always been nice, professional people in my experience, as long as you treat them like a colleague worthy of equal respect.
 
EMDO2018 said:
Some nurses here are known to be that way
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How exactly do they make med students' lives hell? I'm willing to bet whatever stories you've heard are just gross exaggerations or socially awkward people who misunderstand social interactions.

Nurses do sometimes get annoyed at med students, interns, residents, doctors. Sometimes they gossip/talk about us (said students, residents, etc) behind our backs. I've been scolded by scrub nurses and pushed by circulating nurses in the OR when I'm in the way or doing something/standing wrong. All those things are normal and no big deal. But I've never experienced or heard of a nurse making someone's life hell. Their priority is the patients, not annoying the med students.
 
redpanda said:
Some medical students are known to make other people's lives hell as well, but that doesn't mean all medical students should be approached as the enemy. Learn to play nice with everyone and you'll at least get the moral high ground in any interaction that goes to hell, if nothing else. The nurses have nearly always been nice, professional people in my experience, as long as you treat them like a colleague worthy of equal respect.
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THIS. Treat them as the colleagues they are and you will not have problems with the vast majority of your interactions. If you act like you're better than them, you can quickly be put in your place.
 
Ismet said:
THIS. Treat them as the colleagues they are and you will not have problems with the vast majority of your interactions. If you act like you're better than them, you can quickly be put in your place.
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But what defines "acting better than them". I'm nice and respectful to people but I am naturally sort of standoffish, I don't like small talk and kissing people butts.
 
EMDO2018 said:
But what defines "acting better than them". I'm nice and respectful to people but I am naturally sort of standoffish, I don't like small talk and kissing people butts.
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come on you know what it means, like you're above them.
 
EMDO2018 said:
But what defines "acting better than them". I'm nice and respectful to people but I am naturally sort of standoffish, I don't like small talk and kissing people butts.
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Just because you don't like social niceties doesn't get you out of the need to use them because it smooths out your interactions. Figure out how to play nice and be respectful.
 
Introverts will suffer on the wards 🙁
 
EMDO2018 said:
Introverts will suffer on the wards 🙁
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No they won't. I am an introvert. Super far to the I side of the I-->E spectrum. Introversion doesn't mean you can't interact with people. It means you draw your energy from yourself. After a long hard day I would prefer to go home, get in my pjs with a cup of tea and watch tv or read a book, not go to the bar with friends. That doesn't mean I don't like interacting with people or act awkward in social situations.

If you don't know the difference between engaging in small talk and kissing people's butts, you have a problem with social interaction that is not related to intro/extraversion.
 
Ismet said:
How exactly do they make med students' lives hell? I'm willing to bet whatever stories you've heard are just gross exaggerations or socially awkward people who misunderstand social interactions.

Nurses do sometimes get annoyed at med students, interns, residents, doctors. Sometimes they gossip/talk about us (said students, residents, etc) behind our backs. I've been scolded by scrub nurses and pushed by circulating nurses in the OR when I'm in the way or doing something/standing wrong. All those things are normal and no big deal. But I've never experienced or heard of a nurse making someone's life hell. Their priority is the patients, not annoying the med students.
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I've had some fun conversations with nurses about some of the things they've done to med students or residents (usually residents) who act like jerks. There are two sides to every story, but some of the behavior they described having to put up with from med students and residents actually made my jaw drop. EMDO, don't be a dick to people, and you won't have to worry. That might mean learning how to censor yourself.
 
redpanda said:
No, idiots will suffer on the wards. Part of learning how to be a good professional is figuring out how to play the game within the culture. Refusing to play at all is not going to help you.
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I wish there were more men in nursing, not to sound sexist but men usually don't get into playing stupid little mind games.
 
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