Frustrated with evals

[unsung]

So it's early on in the year, but my evals are depressing.

I'm told to my face I present well. That my notes are good. One person even told me they thought I did a great job on the rotation, and that I'll know more than many interns by the end of the year.

...But when the evaluation comes back, I get a meets expectations, which is actually below average, as only a minority of students fall in that category. I really don't see how these things match up at all. Especially when I'm getting rated below average in the fund of knowledge category.

I've gotten the comment that I seem "distracted" or something to the effect of seems uninterested. They're attributing that to personal issues (they know I have some external stuff going on). But actually, they're wrong. If I seem distracted AT the hospital, it's because I'm stressed. And I'm stressed mainly because I'm getting evaluated constantly. (I've asked interns about how I come off. And they say they don't get any sense I seem uninterested, or ever want to leave early, etc. Then again... my work directly helps them out. Whereas what I do makes no difference to the attending in terms of saving them work.)

The only marks I'm consistently getting above average on relate to patient care. I think that's because people can tell I'm a honest person who cares about the patient.

What I think is my problem-- a couple things: 1) I don't seem happy. (I've even gotten as feedback once when I asked what I can do to improve-- "smile more". Yes, seriously). I'm not happy 'cuz I'm on my toes all the time, worrying about evals. 2) Being an introverted person. 3) Not really good at buttering up anyone.

I'm a hard-worker, will stay late/come early. I'm kind of just quiet and will do my work well & efficiently. I can answer a great majority of their pimping Qs (hence the "you seem intelligent" comments).

Yet I'm getting lower marks than people who pretend to work hard in front of the attending, leave early, answer many Qs wrong-- but make up for it with flattery and small-talk. People being people... they're going to remember the compliments and forget/forgive the lack of knowledge.

The most unfair part that I can't get over is that I'm getting lower marks in fund of knowledge than people who clearly don't know what they're talking about. But they just spend more time socializing and flattering and being loud... and somehow that translates into better marks in all categories. Which is like... fine. Give them higher scores for teamwork or something. But to rank me below average in knowledge (after all kinds of feedback to the effect of you seem smart)... It just kills me.

Yes, I've b!tched about this before. But now I'm scared. At the rate things are going, I have no idea how to turn this year around.

It's kind of a catch-22. I'm supposed to seem happy & enthusiastic, but the more feedback I get, the harder it is for me to actually be happy & enthusiastic. I'm kind of an analytical person (in case you couldn't tell... ha). So when negative feedback comes my way, I'm just constantly trying to figure out how I can act or what I can do to change that.

But what that does is result in making me look "distracted", when basically I'm just stressed and trying to figure it out. It's like, actually I know what I'm supposed to do to get a good eval. But I just can't do it. 'Cuz I don't have that personality. I can work hard & I can know stuff, but 3rd yr is just not about that.

SDN, you have been great to me over the years. Everything from getting me into med school to getting through the first 2 yrs to getting a non-disappointing Step 1 score.

But 3rd yr is a whole other beast. How do I get through this? I fear I'm going to end up with a whole bunch of passes.

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[meowdoc]

So it's early on in the year, but my evals are depressing.

I'm told to my face I present well. That my notes are good. One person even told me they thought I did a great job on the rotation, and that I'll know more than many interns by the end of the year.

...But when the evaluation comes back, I get a meets expectations, which is actually below average, as only a minority of students fall in that category. I really don't see how these things match up at all. Especially when I'm getting rated below average in the fund of knowledge category.

I've gotten the comment that I seem "distracted" or something to the effect of seems uninterested. They're attributing that to personal issues (they know I have some external stuff going on). But actually, they're wrong. If I seem distracted AT the hospital, it's because I'm stressed. And I'm stressed mainly because I'm getting evaluated constantly. (I've asked interns about how I come off. And they say they don't get any sense I seem uninterested, or ever want to leave early, etc. Then again... my work directly helps them out. Whereas what I do makes no difference to the attending in terms of saving them work.)

The only marks I'm consistently getting above average on relate to patient care. I think that's because people can tell I'm a honest person who cares about the patient.

What I think is my problem-- a couple things: 1) I don't seem happy. (I've even gotten as feedback once when I asked what I can do to improve-- "smile more". Yes, seriously). I'm not happy 'cuz I'm on my toes all the time, worrying about evals. 2) Being an introverted person. 3) Not really good at buttering up anyone.

I'm a hard-worker, will stay late/come early. I'm kind of just quiet and will do my work well & efficiently. I can answer a great majority of their pimping Qs (hence the "you seem intelligent" comments).

Yet I'm getting lower marks than people who pretend to work hard in front of the attending, leave early, answer many Qs wrong-- but make up for it with flattery and small-talk. People being people... they're going to remember the compliments and forget/forgive the lack of knowledge.

The most unfair part that I can't get over is that I'm getting lower marks in fund of knowledge than people who clearly don't know what they're talking about. But they just spend more time socializing and flattering and being loud... and somehow that translates into better marks in all categories. Which is like... fine. Give them higher scores for teamwork or something. But to rank me below average in knowledge (after all kinds of feedback to the effect of you seem smart)... It just kills me.

Yes, I've b!tched about this before. But now I'm scared. At the rate things are going, I have no idea how to turn this year around.

It's kind of a catch-22. I'm supposed to seem happy & enthusiastic, but the more feedback I get, the harder it is for me to actually be happy & enthusiastic. I'm kind of an analytical person (in case you couldn't tell... ha). So when negative feedback comes my way, I'm just constantly trying to figure out how I can act or what I can do to change that.

But what that does is result in making me look "distracted", when basically I'm just stressed and trying to figure it out. It's like, actually I know what I'm supposed to do to get a good eval. But I just can't do it. 'Cuz I don't have that personality. I can work hard & I can know stuff, but 3rd yr is just not about that.

SDN, you have been great to me over the years. Everything from getting me into med school to getting through the first 2 yrs to getting a non-disappointing Step 1 score.

But 3rd yr is a whole other beast. How do I get through this? I fear I'm going to end up with a whole bunch of passes.

I'm not going to go into too much detail here. But the bottom line of third year evaluations is that they are a half-load of ****. The quietly competent person such as yourself typically gets shunted to the side. Suck it up and ace your tests. I had one rotation that I had average/above average marks on but a really low knowledge mark, but then I got a 99 on that shelf exam.. can't tell you how satisfying that was. Anyway, I got an honors on that rotation.

The only piece of advice I can give you is to make everyone around you happy. I'm not saying suck up. I'm saying be a kind and friendly person. Be pleasant to work with. When they're doing your evaluations, people will have a better feeling about you.

My personal experience and opinion is that, especially on surgery/OBGyn, my attendings didn't like me always knowing the answers to their pimping questions.. I think part of the problem was that I couldn't answer them in a humble way and came across as a smart ass. Usually they're trying to teach you something with those questions and maybe you should at least act like you always have something to learn from them?? Just my 2cents there..

You'll make it through just fine. People always end up where they belong.

 

[thepoopologist]

There is nothing you can do but adjust and mimic some of the traits of your classmates.

I'd also try to relax a little so that you are enjoying yourself more on the floor.

 

[dozitgetchahi]

I largely agree with this. Unfortunately, too many attendings approach evaluations from a "how much do I like student X" perspective - which is why you see some schmoozers getting better ratings than you on things like "medical knowledge". It's silly.

That said, learning how to engage people in small talk/conversation (and "schmooze", to an extent) isn't a bad idea. I knew coming into my first rotation that I wasn't really good at this stuff, so I consciously tried throughout the rotation to do it as effectively as possible and was pleasantly surprised when my attending seemed to praise my ability to "bond" with the staff, students and other attendings. A little bit of effort towards this seems to pay big dividends, even if it means stepping outside your comfort zone somewhat.

Also note that "schmoozing" doesn't equal "ass-kissing" - I generally despise that, never really engaged in much of it, and didn't see how it would've helped either (although I'm sure there are insecure attendings out there who thrive on students kissing ass all day long.)

 

[thepoopologist]

I'm continually struggling with the issue myself, with varying degrees of success. It's just the way of the world and it's no secret that the competent but socially-skilled person almost always triumphs over the hard-driving, smarter introvert.

 

[CardiacIntensivist]

OP, I think you fail to see that being an engaging human being is part of the "job." Surprise, being a medical student isn't just about working hard and answering all those questions. People have to want to be around you, to teach you, to interact with you etc. It is no different from ANY OTHER JOB that requires human interaction. Plenty of students fail to see that fact because they are have the expectations that they will be graded like they were in the basic science years.

I wouldn't even know HOW to give you advice. You know exactly what you're doing wrong but you can't see to change it. Sometimes you have to fake it. Thing about it in more personal terms. When you are at a party, are you going to gravitate towards people who are more outgoing, happy and enthusiastic or will you go to the people who are weird, quiet, not very interesting and/or makes bland jokes? It seems like one of these simplest things you can do is to...SMILE MORE. It's not as hard as you're making it out to be. Residents are overworked and they aren't your BFFs. Save the sad face for your friends; when you are working, you leave your emotions at home.

Also, I agree with the previous poster who mentioned that "schmoozing" isn't necessarily "sucking up." Residents and attendings are people too. They'll enjoy a good conversation or joke one in a while. Sure, some medical students brown nose, but I'm willing to bet most students accused of 'sucking up' are actually just being human. Just like you learned how to do a history and physical, I suggest you observe and learn from the students who know how to know how to be social.

I'm not saying this to be harsh. I used to be extremely introverted and shy until I realized it was not a feasible option in third year and in life. I get what you are going through but from my experience you can absolutely change with time and effort. I think the first thing to do though is to lose the attitude of the grading process being unfair. It just sets up this idea of helplessness. Fair or not, that's the way it is. Accept it, move on, change.

 

[235009]

all good advice...i have a couple of things to add
1. sorry to tell you but this is how you're going to be evaluated for the rest of your life so you should try to get better at it now
2. why on earth do your attendings/residents know about your personal issues?! from now on you shouldn't tell anyone about "external issues" ...as someone said earlier, these people aren't your friends and you shouldn't confide in them as if they are. That's not to say you shouldn't be friendly ....if people are joking around, laugh, tell a joke, smile, joke/laugh with a patient when it is appropriate....you just sound stiff and miserable and it obviously shows.

 

[dozitgetchahi]

all good advice...i have a couple of things to add
1. sorry to tell you but this is how you're going to be evaluated for the rest of your life so you should try to get better at it now
2. why on earth do your attendings/residents know about your personal issues?! from now on you shouldn't tell anyone about "external issues" ...as someone said earlier, these people aren't your friends and you shouldn't confide in them as if they are. That's not to say you shouldn't be friendly ....if people are joking around, laugh, tell a joke, smile, joke/laugh with a patient when it is appropriate....you just sound stiff and miserable and it obviously shows.

Another excellent point. When you loosen up and make your rotations into more of a social/interpersonal endeavor, THEY BECOME FUN!

The other thing I noticed about the OP's post is this...the notion that you're being "evaluated constantly" on a rotation isn't quite correct. It's more like you get evaluated randomly (and repeatedly) for short, intermittent periods during the rotation. For instance...an attending pimps you on some things and you answer most of his/her qs correctly. That was an eval "session", but between sessions like this you may largely drop off the attending's radar provided you don't do something grossly stupid. Thus, some of the anxiety and stress you feel regarding the fact that "oh god, they're looking at me and evaluating me constantly" may be overstated/misplaced. If you dress and behave professionally, answer questions correctly and don't do anything grossly stupid, you're likely doing as well as anyone else on the rotation is with regards to "fund of knowledge", "professionalism" and other categories on the eval. So shift some of your energy away from worrying about this stuff constantly (since you're likely doing well with it) and focus on improving your interpersonal skills.

Believe me, it wasn't easy for me first either...but if I was able to become way more social over the course of a 12 week rotation, anyone likely can.

 

[Deepa100]

all good advice...i have a couple of things to add
1. sorry to tell you but this is how you're going to be evaluated for the rest of your life so you should try to get better at it now
2. why on earth do your attendings/residents know about your personal issues?! from now on you shouldn't tell anyone about "external issues" ...as someone said earlier, these people aren't your friends and you shouldn't confide in them as if they are. That's not to say you shouldn't be friendly ....if people are joking around, laugh, tell a joke, smile, joke/laugh with a patient when it is appropriate....you just sound stiff and miserable and it obviously shows.

I get goose bumps everytime I see this level of maturity in a med student. great advice! This is what real life is like. Not everyone will like you but that's not the end of the world.

 

[officedepot]

you're lucky that you aren't on my current rotation where the attending asks me to repeat crap he just said to see if I was paying attention (and I have missed his questions on this twice!). He pretty much told me that he is going to try and stress me out... can't wait for his eval.

look a resident told me straight up that she doesn't care about evals and doesn't put much if any thought into them. I think that is the way with most residents and attendings. Directors should know who they are and they'll adjust your scores so don't worry about it (and if they don't just go and ask because they may just give every student they work with "meets expectations"). Kinda sucks because this is the stuff what goes in our Dean's letter.

Also every attending/resident has different expectations. I got rated as giving excellent presentions and knowing more than most M4s on my main medicine rotation but then later on my PSYCH rotation was told my presentations are not good! on psych. haha. What residency cares about your psych grade?

Moral of story is just do what you do and don't worry about evals. Change what is necessary (like if they tell you to do something specifically then do it). Otherwise they're complete crap for the most part. Can't tell you how many evals I got where everything was checked off as "competent" even when I did tons of crap.

Grades during clinical years are very subjective. Getting all honors is extremely difficult. PLENTY of people from previous classes at my school have matched into things like derm with a pass in medicine and family medicine. So go figure.

 

[MossPoh]

I'm very introverted too. I even had a similar evaluation from an attending like you. He sat down with me and talked it over and gave me mostly excellents and then when I got the evaluation back, it was completely different with comments that my fund of knowledge was appalling and that I had no business being interested in surgery. (I got a 96 on the surgery shelf and glowing evals from the clerkship director and my main attending)

I know you are stressed about constantly being evaluated, but that is life. You have to force that obnoxious smile and feign interest in crap you don't care about. I've noticed that attendings seem to enjoy when you try to learn about them as well, but also know how to stay on target and keep moving. Be everywhere at once, but not noticeable. Show up with that freshly ironed white coat, joke around with nurses but then make sure people SEE you working hard. Oftentimes that involves not actually working hard. Sadly, if you aren't in view they assume you are playing words with friends or getting food while everyone else works.

Subjective grading sucks, so it really is a matter of playing the game...and having some luck in who evaluates you.

 

[deleted263296]

Man, how do you guys get such high scores on the shelf exams? I thought they were pretty difficult and didn't have nearly enough time to study for them. Anyways, I'm also an introverted person and got reamed multiple times for being too quiet and appearing uninterested. It was just my personality and despite my best efforts, I could never really change enough to satisfy these people. The best advice is just to do as best you can on your shelf.

 

[unsung]

Oh trust me... I can tell the difference between a naturally sociable person and a "brown-noser". What is brown-nosing? Being nice to the patient for the sake of the grade. But not thinking about them when the attending isn't looking. It's basically being fake. Feigning caring, feigning team-work, feigning intellectual curiosity. Doing things for the sake of appearance.

There are plenty of naturally social, nice students who do well on their evals, and I begrudge them nothing. Don't we all like people who genuinely care about patients and other people?

Some of you guys are making me out to be the smart, socially-awkward/ignorant stereotype lost on rounds 3rd year. And that's not really the case. One, I'm not *that* smart. (SDN standards lol). Two, I have decent interpersonal skills. Yeah, I'm introverted. But I'm not a stiff robot. Otherwise, I would suck with patients, and I don't.

The thing is... patients care more about your real level of knowledge and your work ethic than the people doing the evaluating. As long as you care about the patient and can help the patient, the patient will like you. I'm relaxed around the patient & enjoy chatting with them 'cuz I know this.

Otoh, BSing and chatting with the patient for 5 min, but forgetting about what their problem is 10 min later? Doesn't work with the patient. Might work with an attending, if s/he doesn't get to see the student that much. Actually, that crap doesn't even work with residents. 'Cuz the resident sees your actual daily work ethic. The resident does care that you work hard, stay late, help out with actual work.

The thing that I can't do is brown-nose the attending. But the attending is the one grading.

And actually it takes MORE energy to pretend to work hard than to actually work hard. It's harder to pretend to make a bunch of calls right when the attending is around. Then informing the attending after finishing every little task. Then stop working as soon as no one's looking. This is harder than actually doing work.

I guess some of you guys want me to just copy what the brown-noser does. But that **** is mentally draining.

ALSO, I'm finding my actual "learning" is suffering the more I worry about this other stuff about "performing". I feel like the more energy I put into trying to get an excellent eval from the attending, the less I actually learn and retain.

But... I feel like putting in the energy to do well on the shelf is what will actually stay with me and help me as a physician. I mean, at SOME point down the line, being knowledgeable will actually count for something. Workin' it to get a good eval is a handy skill to have in dealing with superiors in any job... but it's not gonna help you diagnose the patient correctly.

The more energy I put into trying to show off how hard I'm working, etc, the less energy I have to actually work and actually study.

Pretty stupid, eh?

---------------------------------

Anyway, I think some of you guys gave good advice. Making everyone happy is different from brown-nosing. And I do agree chatting and being sociable is just a part of being a team. A little harder when the brown-noser is aggressively taking over the conversation.

So I sorta feel like I have to be aggressive too and cut in to the conversation. One time I was having a great conversation with an attending about this article I read. He was really excited & interested in it. Then it got derailed by the brown-noser and the attending ended up totally forgetting about it.

See? See? And I'm supposed to be happy & enjoying 3rd yr?

Maybe I'll have better luck on the next rotation.

 

[officedepot]

And I'm supposed to be happy & enjoying 3rd yr?

that's impossible. Maybe on your outpatient family medicine rotation where you get all weekends off and your attending is super cool and laid back will you enjoy your 3rd year. Otherwise it will suck pretty much the entire time even in something you think you might be interested in.

why? because you are being evaluated for a grade, have to work crazy hours, learn a new system every rotation, study for nbme shelf exams, and try to find time to decompress. This all coupled with you pretty much having to do what you are told and having no freedom to do rotations you may want to do (e.g. a person really interested in pathology still has to do his outpatient family medicine rotation no matter what; person interested in rads MUST do psych).

So yes 3rd year sucks for all but maybe 2 months. my advice is just to take it for what it is. Evals are unfair. This is nothing new unfortunately.

 

[2012mdc]

that's impossible. Maybe on your outpatient family medicine rotation where you get all weekends off and your attending is super cool and laid back will you enjoy your 3rd year. Otherwise it will suck pretty much the entire time even in something you think you might be interested in.

why? because you are being evaluated for a grade, have to work crazy hours, learn a new system every rotation, study for nbme shelf exams, and try to find time to decompress. This all coupled with you pretty much having to do what you are told and having no freedom to do rotations you may want to do (e.g. a person really interested in pathology still has to do his outpatient family medicine rotation no matter what; person interested in rads MUST do psych).

So yes 3rd year sucks for all but maybe 2 months. my advice is just to take it for what it is. Evals are unfair. This is nothing new unfortunately.

I disagree here. I enjoyed 3rd year more than 2nd year and I decided on rads pretty early. The only rotation I strongly disliked was OB. Enjoyed aspects of Surgery and Medicine even though the hours sucked and enjoyed all the free time in psych, FM, and peds. I was happy for more than half the year. Shelf exams every 8 weeks were a welcome departure from 5-6 exams in 1 week every 4-5 weeks.

 

[DrBowtie]

Most people overrate how good they are as a 3rd year and overrate how much they contribute to patient care. If your intern is happy, the team will be happy. Do scut for your intern and I promise your evals will improve.

 

[speedyk]

Through 2 rotations- my avg resident eval = 3.0/5 (all 5 gave me a 3), attending eval 4.5/5 (a 5 and a 4).

I know I have a low sample size but this confuses and frustrates me. How can one person give me a 3 and another a 5 (with a positively glowing written eval) for the same job performance? Are attendings usually more generous than residents?

 

[Jolie South]

Most people overrate how good they are as a 3rd year and overrate how much they contribute to patient care. If your intern is happy, the team will be happy. Do scut for your intern and I promise your evals will improve.

This ^ and don't be socially awkward with your residents.

 

[PokerDoc]

If evals are consistent, it lends more weight to them. If it's a single or maybe even two isolated poor evals, they don't hold as much weight.

Have you considered asking the attendings who wrote your evals for a moment of their time, so you can ask for them to offer advice on how you can improve your performance in the future? It's one thing to put them on the spot and justify their eval of you, but I think it's an entirely different thing, and appropriate at that, to ask them how they think you can do better in the future, since it wasn't your intention to appear the way they perceived you and you don't feel like you're that kind of student.

 

[fizzle]

Most people overrate how good they are as a 3rd year and overrate how much they contribute to patient care. If your intern is happy, the team will be happy. Do scut for your intern and I promise your evals will improve.

Does that mean if I think I'm doing bad as a 3rd year, I'm really doing horrendously (like burning patient charts while trying to write a discharge order)?

 

[unsung]

I'm not going to go into too much detail here. But the bottom line of third year evaluations is that they are a half-load of ****. The quietly competent person such as yourself typically gets shunted to the side. Suck it up and ace your tests. I had one rotation that I had average/above average marks on but a really low knowledge mark, but then I got a 99 on that shelf exam.. can't tell you how satisfying that was. Anyway, I got an honors on that rotation.

The only piece of advice I can give you is to make everyone around you happy. I'm not saying suck up. I'm saying be a kind and friendly person. Be pleasant to work with. When they're doing your evaluations, people will have a better feeling about you.

My personal experience and opinion is that, especially on surgery/OBGyn, my attendings didn't like me always knowing the answers to their pimping questions.. I think part of the problem was that I couldn't answer them in a humble way and came across as a smart ass. Usually they're trying to teach you something with those questions and maybe you should at least act like you always have something to learn from them?? Just my 2cents there..

You'll make it through just fine. People always end up where they belong.

Yeah. I have this problem too. So I think I actually started over-compensating. I.e. when I know the answer to something, I'll stop myself from just confidently giving out the answer right away. And be like "I think it's (this)". But now I'm getting feedback I'm deficient in knowledge or not confident or something. Oy.

It's so stupid. How do you guys handle this? Not just with knowing answers to pimping Qs. But sometimes I'll have have a good idea but I'm afraid if I just throw it out there, I'll come off as I think I know more than the person above me.

I've seen other students get around it by offering up their suggestions with a lot of stuff like "maaaaybe this could work" 'Cuz honestly a lot of times, ppl seem to want you to know answers to "basic" pimping Qs. But the minute you think of something they hadn't thought of, they get kind of defensive and it's not actually good for you.

Similar problem-- what do you do when someone pimps you with a Q... but get the answer wrong themselves? Tell me I'm not the only one who has ever run into this situation. It's kinda awkward. So far what I've done is just nothing... let it slide, 'cuz there's no point in correcting them. But I can imagine a situation where the answer might actually affect patient care in some way. And I just suck at handling it. (And before y'all jump down my throat. The answer IS actually wrong-- for ex, Janeway vs Osler, painless vs painful... just a hypothetical ex, but you get what I mean.)

I've seen other students "correct" the res or attending in a nice way, and it seems to work. But I guess I'm incapable of doing it without coming across in a bad way.

I think my problem is, I am actually very confident WHEN I know something. The stuff I don't know I'm completely insecure about. But topics I feel I know well, I'm just confident in myself in. Not the type of person to shout out answers or show off what I know AT ALL. (I hate that type.) But stuff I know, I just tend to feel naturally confident in... and I think it can come across as "of course that's the answer". Unfortunately, coming across as really confident in answering pimping Qs isn't always appreciated. What it gets me is more & more pimping Qs until they hit one I can't answer. Also I SWEAR, I actually kinda get punished for it with scut work sometimes by res... people like competent ppl over incompetent ppl. But ppl also like to "put ppl in their place" if they're too competent. Especially if this person (me) isn't great at brown-nosing and making'em feel sweet about themselves.

Knowing stuff & being intellectually curious seems to land me in trouble more than it seems to help me out on rotations. As in, sometimes I have a genuine curiosity about the pathophys of something, and ask the Q before thinking it over. Then that person doesn't know the answer, and gets defensive- almost acting like I'm trying to pimp'em. And I totally wasn't... was just curious. Also, I absolutely have learned not to ask Qs like that basically ever lol! So don't tell me I'm stupid for asking stuff I can look up on my own. It's too bad, 'cuz a lot of the stuff I'm curious about is stuff like that... not necessarily answers to pimping-type of Qs or practical Qs about dosing, etc. "Why" is almost kind of a dirty word. So I basically never ask anymore.

I haz 0 skills for handling these situations.

I either come across as know too much or know too little. And the good grade goes to the competent (but not too much so as to be intimidating) person with the sweet social skillz. I know a person who made AOA (derm-bound) who I'm just like wth... must have aced their rotations, I guess.

 

[DrBowtie]

Having re read this thread, you have a fixation on pimp questions and knowledge.

In reality, I'd say that has little to no relation to how you are graded.
Things you should reflect on:

Your presentations. Are they clear and succint? Does the intern/resident always have to pipe in to add stuff you forgot? Did you discuss your patient with your intern/resident so that you know and can present the management plan? Are you holding everyone's interest with your presentation or are you monotone, reading off a sheet? I'd say on most services, that is the #1 way attendings grade you. Getting obscure pimp questions correct isn't going to get you an A if they wouldn't want you as an intern working under them.

Your attitude/work ethic/trust worthiness. Are you a team player? Do you help things more faster or are you a hinderance? Are you that annoying question person? The attending, resident, intern wants to get all the work done as fast as possible. Are there ways rounds can move faster? (Can you make sure to have all of the charts ready to go and carry them during rounds? Can you obtain all the vital signs and other objective data for your residents so their notes are quicker to write?). Do they trust you enough to send you on tasks without having to check to make sure you did it (Removing suture, central lines, NG tubes)? Are you a generally pleasant person? Do you carry the necessary stuff in your pockets so they don't have to go hunt it down? This is what I've found that most residents grade you on and if you aren't directly graded by residents, then this is the input they tell the attending.

Other intangibles: How do you dress? Is it professional? Are you always texting on your phone?

3rd year isn't about being the smartest bookworm anymore, its about being the best worker. Someone they would want to work with everyday. The other problem is that most people avoid confrontation and won't tell you if you suck to your face. See if you can find another student you rotated with to be honest with you.

I was by no means a 3rd year superstar myself, but these are things that the people who thrive in clerkships all seem to have in common.

 

[ArcGurren]

I found that one thing which helped is just keeping your mouth shut when the resident is saying something to the attending which you KNOW to be wrong... just wait till afterwards and then tell the resident. I saw someone get crucified on his eval for this.

Unfortunately, a lot of medicine relies on peoples' egos being flattered. It's annoying, stupid, and counterproductive, but guess what kind of people med school selects for... surprise.

 

[Jolie South]

Having re read this thread, you have a fixation on pimp questions and knowledge.

In reality, I'd say that has little to no relation to how you are graded.
Things you should reflect on:

Your presentations. Are they clear and succint? Does the intern/resident always have to pipe in to add stuff you forgot? Did you discuss your patient with your intern/resident so that you know and can present the management plan? Are you holding everyone's interest with your presentation or are you monotone, reading off a sheet? I'd say on most services, that is the #1 way attendings grade you. Getting obscure pimp questions correct isn't going to get you an A if they wouldn't want you as an intern working under them.

Your attitude/work ethic/trust worthiness. Are you a team player? Do you help things more faster or are you a hinderance? Are you that annoying question person? The attending, resident, intern wants to get all the work done as fast as possible. Are there ways rounds can move faster? (Can you make sure to have all of the charts ready to go and carry them during rounds? Can you obtain all the vital signs and other objective data for your residents so their notes are quicker to write?). Do they trust you enough to send you on tasks without having to check to make sure you did it (Removing suture, central lines, NG tubes)? Are you a generally pleasant person? Do you carry the necessary stuff in your pockets so they don't have to go hunt it down? This is what I've found that most residents grade you on and if you aren't directly graded by residents, then this is the input they tell the attending.

Other intangibles: How do you dress? Is it professional? Are you always texting on your phone?

3rd year isn't about being the smartest bookworm anymore, its about being the best worker. Someone they would want to work with everyday. The other problem is that most people avoid confrontation and won't tell you if you suck to your face. See if you can find another student you rotated with to be honest with you.

I was by no means a 3rd year superstar myself, but these are things that the people who thrive in clerkships all seem to have in common.

Spot on.

I would also add "are you teachable?"

Do you pick up on things that aren't going well and fix them? Like a resident commenting "I wish we had X while we were rounding" without directly asking you to do it. This actually translates to "STUDENT DO THIS."

Also, if you miss things on day 1 of the rotation, that's ok. That's why you're there. Just remember to ask/check on the next patient or the next day. If you continually miss the same things over and over, that is bad.

It's not rocket science. You can easily pick up on facial expressions and subtle comments that residents put out there day to day without directly saying "how am I doing?"

 

[unsung]

Having re read this thread, you have a fixation on pimp questions and knowledge.

In reality, I'd say that has little to no relation to how you are graded.
Things you should reflect on:

Your presentations. Are they clear and succint? Does the intern/resident always have to pipe in to add stuff you forgot? Did you discuss your patient with your intern/resident so that you know and can present the management plan? Are you holding everyone's interest with your presentation or are you monotone, reading off a sheet? I'd say on most services, that is the #1 way attendings grade you. Getting obscure pimp questions correct isn't going to get you an A if they wouldn't want you as an intern working under them.

This is fair. I can definitely improve here. I think I'm only average in my presentations. But the thing is, I'm getting way BELOW avg marks on it, because of the other stuff I'd already talked about (being sorta quiet, not brown-nosing, etc.). (So if I were giving really great presentations, I'd probably still get only avg marks for presentations on the eval. Kwim?)

One other thing-- what do you do if your plan differs from the intern/resident's plan? A majority of time, this doesn't happen... but I've had moments where I had a good idea, but was made to present something that wasn't my idea... and then the attending slams me for offering up a stupid idea. When my original idea was actually decent! Then the only one who looks stupid is me, 'cuz I'm the one presenting the idea. Which wasn't even mine. I'd much rather present my own ideas & get shot down... that doesn't bother me at all, and I learn from it.

I think that actually is part of my problem-- that hierarchy. When stuff like the above happens, I'm not good at hiding my annoyance. Stuff like that typically doesn't happen when the intern/resident is good. But not everyone is good. I can't imagine I'm the only one experiencing **** like this.

My intuition says that certain residents probably pick up on my wanting to present my own ideas... and respond by not letting me do anything (even scut like taking out sutures, which I'm very happy to do!), and giving me harsh evals.

Your attitude/work ethic/trust worthiness. Are you a team player? Do you help things more faster or are you a hinderance? Are you that annoying question person? The attending, resident, intern wants to get all the work done as fast as possible. Are there ways rounds can move faster? (Can you make sure to have all of the charts ready to go and carry them during rounds? Can you obtain all the vital signs and other objective data for your residents so their notes are quicker to write?). Do they trust you enough to send you on tasks without having to check to make sure you did it (Removing suture, central lines, NG tubes)? Are you a generally pleasant person? Do you carry the necessary stuff in your pockets so they don't have to go hunt it down? This is what I've found that most residents grade you on and if you aren't directly graded by residents, then this is the input they tell the attending.

Again, good point. No, I'm not that annoying Q person. I learned to bite my tongue long ago.

Also, the work ethic thing seems to work more for rotations like surgery. Actually I like that about surgery. A lot more seems to depend on hard work, anticipating what ppl need to get things done, etc. This is definitely rotation-dependent. Some rotations will actually dock you for trying to do intern-type work, instead of staying in role of student.

-----------------------------------

I'm a hard worker. But again, I guess ppl have to want to let you do the work in the 1st place. I'm not sure exactly how it happened, but sometimes I'd offer to do a bunch of stuff, and the resident actively doesn't let me do it. No, it's NOT because I'm incompetent or can't be trusted to do it.

It's more or less 'cuz they'd rather let the sweet-talker who makes'em feel good about themselves do it. I think I come across as too "independent".

Before I make myself out to be the biggest social idiot on the planet ... I should note that it's not every resident. I've had a few who really let me do a lot, even stood up for me in front of other lower down ppl. They were the ones who were pretty confident in themselves and also the ones I respected.

It's just that there are some NOT so competent ppl out there. And I have hard time not having an opinion. AND, there are some competent yet really insecure ppl out there too. Residents who are pretty knowledgeable, yet feel threatened for no reason & scut me out for no reason.

Outgoing competent ppl can kind of disarm ppl's insecurity... "yeah, he's smart, but he's my buddy, so I like him & I'll let him do cool stuff & give him a good eval".

Introverted, competent ppl scare other ppl. I'm just saying. A quiet incompetent person can be thought of as "nice, shy, wallflower"... but quiet competent person gets labeled as "stuck up", "uninterested", (insert negative adjective). It's 'cuz ppl feel threatened.

And, what's even worse for me is that "independent" streak. I always do what I'm told, but sometimes have a hard time hiding how I feel if I'm doing something I don't believe in.

Wow, my personality sucks for med school. Why can't I conform ?! I'm pretty good with patients... but it's a long haul from here to there, when I'll be able to just focus on taking care of patients.

Anyway, if any of you guys have suggestions, please keep the ideas coming. It's driving me nuts not knowing how I can improve my current situation.

 

[45408]

This ^ and don't be socially awkward with your residents.

I just had a brief but very socially awkward interaction with a med student on a different service. Just someone out there in La-La Land, and the student's resident strongly confirmed my observations.

 

[ZagDoc]

I just had a brief but very socially awkward interaction with a med student on a different service. Just someone out there in La-La Land, and the student's resident strongly confirmed my observations.

We've had an interesting crop this month. Have one sub-i which sits right next to me in the work room, leeeeeans in, and watches me do notes. If I can smell what you had for breakfast, you're too close, dude.

 

[footcloud]

Meh what's wrong with just trying to fit in? Like you don't have to suck up majorly, but if you feel "really independent" then just try to make some small talk with people, etc. Yeah, not the easiest if the people are pricks or whatever, but I just try to get by these days sometimes. And people do have a hard time being mean to someone who is nice to them. Or if you say sorry for things, generally people will back down and not be mean. Or if you start sentences with "Sorry to bug you, but I was wondering"...etc. We all do things we don't like to get by. This is one of them, it's not about not having a backbone, not having a personality. There's plenty of opportunities/time for that in the future and socially, but in this system, don't be the odd one out and just try to get things done through the least resistance possible.

 

[smq123]

This is fair. I can definitely improve here. I think I'm only average in my presentations. But the thing is, I'm getting way BELOW avg marks on it, because of the other stuff I'd already talked about (being sorta quiet, not brown-nosing, etc.).

I can tell you that if you, as an MS3, think that you're "average" in your presentations, you're almost certainly well below average.

My experience has been that many med students are nowhere near as good as they think that they are. The ones that truly were great, when asked, usually said that they thought that they were "ok, but had a lot of room to improve." The ones that we've had who thought that they were "average" or even "good"? Were almost uniformly all terrible.

So stop blaming it on the fact that you're quiet and not a brown-noser. I'm very quiet, and was even quieter as a med student. I can't brown nose, I can't schmooze, I don't make small talk. However, my evals were very good - all HP and Honors. I'm sure that I'm not an exception.

And, what's even worse for me is that "independent" streak. I always do what I'm told, but sometimes have a hard time hiding how I feel if I'm doing something I don't believe in.

Dude, I don't know how to break this to you, but if you can't fix this, residency is going to be a tortuous few years for you. Especially if you do something like OB or surgery, where hierarchy can be very important.

Having to please the person immediately above you? Yeah, it doesn't stop with med school.

 

[Telencephalon]

And I have hard time not having an opinion.

I think this is probably the biggest thing you could change. I don't want to be too mean, but as a third year medical student, especially in the first half of the year, you aren't really entitled to an opinion. Heck, in my experiences interns aren't entitled to an opinion.

If you are really as competent as you say I would be surprised. My advice would be to chuck the idea that you are too quiet or introverted to get good evals. I got only average to slightly above average evals my first two rotations as a third year and I took it as an opportunity to learn and grow. Then I honored everything else including surgery and medicine. My evals continued to say "quiet" and "unassuming" but they were tempered with things like "great team player"

My final bit of advice has pretty much been said already but I think it bears repeating: Learning to give clear, accurate concise presentations is the best thing you can do for yourself. Its the only time you have everyone's attention and you can show your skills off even better than in pimping. If you need to practice in front of a mirror or a friend go for it. Remember, even the best plan in the world can sound stupid when its mumbled while looking at your notes.

Good luck, relax, it gets easier

 

[mrwesticles]

Once you have a little more experience, try to make everyone else's job easier. If you constantly volunteer for additional work or anything else that the interns or residents around you need done, it'll reflect well on you.

Alternatively, you could become the biggest suck-up in the universe.

 

[Jack is Back]

So it's early on in the year, but my evals are depressing.

I'm told to my face I present well. That my notes are good. One person even told me they thought I did a great job on the rotation, and that I'll know more than many interns by the end of the year.

...But when the evaluation comes back, I get a meets expectations, which is actually below average, as only a minority of students fall in that category. I really don't see how these things match up at all. Especially when I'm getting rated below average in the fund of knowledge category.

I've gotten the comment that I seem "distracted" or something to the effect of seems uninterested. They're attributing that to personal issues (they know I have some external stuff going on). But actually, they're wrong. If I seem distracted AT the hospital, it's because I'm stressed. And I'm stressed mainly because I'm getting evaluated constantly. (I've asked interns about how I come off. And they say they don't get any sense I seem uninterested, or ever want to leave early, etc. Then again... my work directly helps them out. Whereas what I do makes no difference to the attending in terms of saving them work.)

The only marks I'm consistently getting above average on relate to patient care. I think that's because people can tell I'm a honest person who cares about the patient.

What I think is my problem-- a couple things: 1) I don't seem happy. (I've even gotten as feedback once when I asked what I can do to improve-- "smile more". Yes, seriously). I'm not happy 'cuz I'm on my toes all the time, worrying about evals. 2) Being an introverted person. 3) Not really good at buttering up anyone.

I'm a hard-worker, will stay late/come early. I'm kind of just quiet and will do my work well & efficiently. I can answer a great majority of their pimping Qs (hence the "you seem intelligent" comments).

Yet I'm getting lower marks than people who pretend to work hard in front of the attending, leave early, answer many Qs wrong-- but make up for it with flattery and small-talk. People being people... they're going to remember the compliments and forget/forgive the lack of knowledge.

The most unfair part that I can't get over is that I'm getting lower marks in fund of knowledge than people who clearly don't know what they're talking about. But they just spend more time socializing and flattering and being loud... and somehow that translates into better marks in all categories. Which is like... fine. Give them higher scores for teamwork or something. But to rank me below average in knowledge (after all kinds of feedback to the effect of you seem smart)... It just kills me.

Yes, I've b!tched about this before. But now I'm scared. At the rate things are going, I have no idea how to turn this year around.

It's kind of a catch-22. I'm supposed to seem happy & enthusiastic, but the more feedback I get, the harder it is for me to actually be happy & enthusiastic. I'm kind of an analytical person (in case you couldn't tell... ha). So when negative feedback comes my way, I'm just constantly trying to figure out how I can act or what I can do to change that.

But what that does is result in making me look "distracted", when basically I'm just stressed and trying to figure it out. It's like, actually I know what I'm supposed to do to get a good eval. But I just can't do it. 'Cuz I don't have that personality. I can work hard & I can know stuff, but 3rd yr is just not about that.

SDN, you have been great to me over the years. Everything from getting me into med school to getting through the first 2 yrs to getting a non-disappointing Step 1 score.

But 3rd yr is a whole other beast. How do I get through this? I fear I'm going to end up with a whole bunch of passes.

Sounds like social skills stuff.

People like positive energy and being around positive people, as long as it is genuine.

People like when you take interest in them and talk to them about what they think is important.

The trick is, if you do these two things correct, then others PERCEIVE you as more intelligent. They will think your answers you do know are better, the answers you didn't know were no big deal, and that you are great.

Human beings are emotional, subjective analysis of an individual will most certainly hinge upon how much they like you or like being around you. This is just how life is and complaining about it or ignoring it, doesn't change it.

Be enthusiastic and grateful to be there and you will do great. You don't have to talk a whole lot, just have positive energy and attempt to make others feel very important.

 

[Random Anesthesiologist]

Much of what I would say has been covered.

The thing I want to add is that at this point, you know no one is going to fail you, and the worse grade (consistently) you've had is "meets expectations".

At this point, I think it's worth starting to relax a little, in that you know it won't get worse and can only get better. Maybe just try for one day with the credo that since your grade can't get any worse, you'll just try to have fun being an MS3. Just for one day, because one day won't make or break you. See how it goes, and maybe try it for a 2nd day, and so on.

It sounds like you are your biggest obstacle, so start there Good luck.

 

[MsKrispyKreme]

Wow, all of your posts are always so neurotic.

 

[Lolscan]

Don't give up and don't let this experience put you down. People will be haters and they aren't objective.

I guess part of life is accepting it but not letting it keep you down. I mean you balk at the statistic that asians do worse in OB and pediatrics in their 3rd year. But that doesn't mean you should give up in those clerkships.

 

[quepatho]

I would be curious to know what your idea of a brown-noser is. I get the feeling you'd think *I* was one because I do ask questions and appear interested in the answers.

But actually that's usually cause I am interested.

FWIW, I've gotten really amazing evals, way better than I ever thought I would (especially compared with my abysmal shelf scores).

*shrug*

EDIT: Also, it's way more important to appear "interested" than it is to appear "happy" per se.

 

[rad0nc]

Ace your shelf exams and it won't be a problem. I remember basically not studying at all for my surgery shelf because I thought my evals would be bad. They ended up being really good and I missed honoring by a point because I figured studying didn't matter. Lesson learned.

 

[SlickNickMD]

Ace your shelf exams and it won't be a problem. I remember basically not studying at all for my surgery shelf because I thought my evals would be bad. They ended up being really good and I missed honoring by a point because I figured studying didn't matter. Lesson learned.

This is why I don't take the shelf exams lightly

 

[Acherona]

Personally, I find super perky med students who constantly ask questions and pretend to be interested to be incredibly annoying. I'm sure I'm in the minority though. You might not want to hear this, but amongst residents/attendings there usually is a consensus as to which students are good and which ones suck, and the conclusion is usually arrived at independently, and usually based on skills like history taking, note writing, reliability, ability to carry out tasks, teachability. Most students have pretty poor insight into how good they are (I did too).

 

[officedepot]

Personally, I find super perky med students who constantly ask questions and pretend to be interested to be incredibly annoying. I'm sure I'm in the minority though. You might not want to hear this, but amongst residents/attendings there usually is a consensus as to which students are good and which ones suck, and the conclusion is usually arrived at independently, and usually based on skills like history taking, note writing, reliability, ability to carry out tasks, teachability. Most students have pretty poor insight into how good they are (I did too).

lol I second this. Those med students drive me crazy! I have not ever acted super perky but always somewhat interested (teachability) and have not ever really gotten poor evals (occ average one but usually above average). For example, on obgyn I have heard that you should lie and say you want to go into that field or the residents will hate you. Well I told them from the beginning that I want to do radiology and they actually go out of their way sometimes to relate stuff to that field.

my advice for you gunner, perky, annoying students from your fellow student: just be honest and interested to a respectable point but don't ask stupid questions no one cares about, especially ones not related to patient care, ones you could easily look up, or ones you already know the answers to. I know you say you are interested in those answers but I don't believe you and no one else does either. And I'm sure I'm not the only one annoyed.

 

[Valadi]

Ah the constant subjective eval discussion. I thought third year was an exciting challenge in trying to figure out how to come off well without being "that guy"... and I would never repeat it again, even if you paid me.

Most of the above posters are spot on.

I think the above few are correct in differentiating with a superbly annoying brown-noser or know-it-all. There is a chasm of difference between that, and just being a chill, normal person, who asks questions here and there to improve their knowledge. Some of it you may be able to change immediately in yourself; for the rest, there is just a certain X factor that makes someone come off like a giant dou(he. If you have said X factor, you can work on it. I would enlist many friends to help you with it if you've ever at all in your life been told you're annoying, creepy, awkward, shy, wear too much black, or have a tendency to loom over people.

Think of this as a nice year-long interview to prepare you for the real interviews next year.

Besides the social skills stuff, I do have some practical advice for third year in general.

1. Everyone should be able to take an H&P and come up with some sort of plan. If you're just doing that, you're doing the minimum. Go an extra step and teach something to your team. Spend 10 minutes on pubmed and pull an article.
2. Residents don't want you to slow them down. If you can make their day go by more smoothly, they will love you. If this means you finding half an hour to put in all the patients vitals on the sheet, Do It. Carrying every piece of medical equipment? Have It. Knowing the PHONE NUMBERS FOR SOCIAL WORK? Speed Dial that ish. Patient came in but doesn't know her meds? Call the pharmacy to get a med list on your own. The quicker you make stuff go for them, the more they'll teach you, and the better your reviews will be.
3. If you suck at small talk, turn on NPR on the way to work and remember one 15 second news clip they read. Insert your "did you guys hear that..?" comment somewhere in the day.
4. Bathe. Smelly people get lower marks. Period.
5. Don't condemn, criticize, or complain. Ever.
6. Ask for feedback. Don't ask "How do I come off?" or anything that is leading. A simple, "Hey, I was hoping you could give me some feedback so that I know what to keep working on?" is the catchphrase.
7. Butter up the mid-level providers, janitors, everyone. It all gets around.
8. You said it yourself, SMILE. Only serial killers and... serial killers... don't smile.
9. People who already come off great can get away with saying they don't want to do X specialty. Don't give them that lee-way to knock you if you're not already a rockstar in their books. Just say you're still deciding. Debate the ethics of this after you have your Honors grades. Is it ethical that people would knock your grade down simply because you want to practice in a different field?
10. Re-lax. Some people want to see how far they can push you just to see how you react, some don't even notice you there. You can't figure everyone out, so don't worry so much about it! I've had attendings tell me I was on the verge of failing, that I wasn't allowed to sit down, I didn't count because I was just a med student, I couldn't scrub in and had to be pimped for a 3 hour case to test my knowledge, and every sort of weird ethical question imaginable, and it always ended up being that they just wanted to test my character and I got stellar reviews for doing nothing other than saying, "Yes, of course, doctor" and smiling at them as they shoveled it on (obviously, I had proved competence as well). It's a lot like the military; I think they really just want to make sure people are leaving their egos at the door and won't buckle under pressure.

You will do GREAT this year and are finally getting to do what you have probably dreamed of doing for a long time. Enjoy it as much as you can.

 

[werd]

Ah the constant subjective eval discussion. I thought third year was an exciting challenge in trying to figure out how to come off well without being "that guy"... and I would never repeat it again, even if you paid me.

Most of the above posters are spot on.

I think the above few are correct in differentiating with a superbly annoying brown-noser or know-it-all. There is a chasm of difference between that, and just being a chill, normal person, who asks questions here and there to improve their knowledge. Some of it you may be able to change immediately in yourself; for the rest, there is just a certain X factor that makes someone come off like a giant dou(he. If you have said X factor, you can work on it. I would enlist many friends to help you with it if you've ever at all in your life been told you're annoying, creepy, awkward, shy, wear too much black, or have a tendency to loom over people.

Think of this as a nice year-long interview to prepare you for the real interviews next year.

Besides the social skills stuff, I do have some practical advice for third year in general.

1. Everyone should be able to take an H&P and come up with some sort of plan. If you're just doing that, you're doing the minimum. Go an extra step and teach something to your team. Spend 10 minutes on pubmed and pull an article.
2. Residents don't want you to slow them down. If you can make their day go by more smoothly, they will love you. If this means you finding half an hour to put in all the patients vitals on the sheet, Do It. Carrying every piece of medical equipment? Have It. Knowing the PHONE NUMBERS FOR SOCIAL WORK? Speed Dial that ish. Patient came in but doesn't know her meds? Call the pharmacy to get a med list on your own. The quicker you make stuff go for them, the more they'll teach you, and the better your reviews will be.
3. If you suck at small talk, turn on NPR on the way to work and remember one 15 second news clip they read. Insert your "did you guys hear that..?" comment somewhere in the day.
4. Bathe. Smelly people get lower marks. Period.
5. Don't condemn, criticize, or complain. Ever.
6. Ask for feedback. Don't ask "How do I come off?" or anything that is leading. A simple, "Hey, I was hoping you could give me some feedback so that I know what to keep working on?" is the catchphrase.
7. Butter up the mid-level providers, janitors, everyone. It all gets around.
8. You said it yourself, SMILE. Only serial killers and... serial killers... don't smile.
9. People who already come off great can get away with saying they don't want to do X specialty. Don't give them that lee-way to knock you if you're not already a rockstar in their books. Just say you're still deciding. Debate the ethics of this after you have your Honors grades. Is it ethical that people would knock your grade down simply because you want to practice in a different field?
10. Re-lax. Some people want to see how far they can push you just to see how you react, some don't even notice you there. You can't figure everyone out, so don't worry so much about it! I've had attendings tell me I was on the verge of failing, that I wasn't allowed to sit down, I didn't count because I was just a med student, I couldn't scrub in and had to be pimped for a 3 hour case to test my knowledge, and every sort of weird ethical question imaginable, and it always ended up being that they just wanted to test my character and I got stellar reviews for doing nothing other than saying, "Yes, of course, doctor" and smiling at them as they shoveled it on (obviously, I had proved competence as well). It's a lot like the military; I think they really just want to make sure people are leaving their egos at the door and won't buckle under pressure.

You will do GREAT this year and are finally getting to do what you have probably dreamed of doing for a long time. Enjoy it as much as you can.

yeah, i agree with most of this. when i was an ms3, a surgery resident once told me, "if you make my life easier, i'll make you look good to the attending and you'll get good evals. it's pretty simple." for the most part this is true or at least partially true. personally, when i have a student that's really good, i'll mention how good they are to the attending, and make an extra effort to make sure they understand the plan and know what questions to expect.