Frustrated with surgical rotation review on clerkship...

[Random Anesthesiologist]

I am definitely looking for some relief here, but also very frustrated.

I received my grade for my first rotation in my surgery clerkship, and it came back as "proficient". I'm really disappointed about this, since surgery is something I'm interested in.

I worked my butt off studying for my first 2-week rotation, and I felt like I had a good repor with the physician and his staff. It was a specialty rotation, so I wasn't able to do much, nor did he really let me do much (from the beginning). He instructed a lot and was good about explaining surgical procedure, imaging, treatments, etc, and I asked tons of questions. There were some pimping questions got wrong, but nothing horrible.

So, IDK. I'm just hoping this is rather common and that I'm maybe overreacting a little bit. I did end up with an Outstanding (equiv to honors) from another rotation in my clerkship so far. I've done a total of 3 rotations, on my 4th, and have 2 more to go to round out the 12-week clerkship, and have those 2 grades back.

If this were academic grades, I wouldn't be fretting so much about pass vs. HP or O/H. But this is clerkship time, and I really want to do well in the areas I'm interested it.

Maybe my ego is bruised a little, IDK. I just would like some feedback from some other 3rd/4th years who maybe ended up in surg and had the same thing or similar happen.

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[WiseGuy1]

Wish I could offer you some solid advice, but this is the way of surgery. You could work you ass off during that clerkship (of course, depending on how it is organized at your school) and you still might be left with a grade of "pass" or "proficient". At my school 90% of the time you're working with the intern (who has no say so in your grade). The other 10% of the time you might be in the presence of an upper level or an attending, but more often than not, they probably don't even realize you're there, or at least that's how it seems. Students don't get an opportunity to present (or hell, even speak) on rounds, so you never get a chance to "show off" your knowledge or proficiency. I freaking hated surgery. The residents really depend on the students to complete the list, write the progress notes, post-op patients, and anything else that needs to be done, but the favor was rarely returned in the form of teaching or whatever. Finally, the odds are the more time you spend in the hospital, the less time you'll have to study. And unless you're lucky, no one who evaluates you will notice your hard work. So not only do you not reap the benefits of getting a good eval, your shelf score suffers. Now this is coming from some one who is definitely not going into surgery, but I can certainly empathize with you had I had a similar experience in a field I was interested in.

 

[Random Anesthesiologist]

Thanks for the response. It's a little comforting to know it's not just me, but still disconcerting that I have 4 grades still pending for this rotation (we rotate through 3 general surgeons, 1 anesthesiologist, and 2 specialties).

Looks like I'm just going to have to tough it out and see how it turns out, and then get nervous 😱

 

[OveractiveBrain]

I am definitely looking for some relief here, but also very frustrated.

I received my grade for my first rotation in my surgery clerkship, and it came back as "proficient". I'm really disappointed about this, since surgery is something I'm interested in.

I worked my butt off studying for my first 2-week rotation, and I felt like I had a good repor with the physician and his staff. It was a specialty rotation, so I wasn't able to do much, nor did he really let me do much (from the beginning). He instructed a lot and was good about explaining surgical procedure, imaging, treatments, etc, and I asked tons of questions. There were some pimping questions got wrong, but nothing horrible.

So, IDK. I'm just hoping this is rather common and that I'm maybe overreacting a little bit. I did end up with an Outstanding (equiv to honors) from another rotation in my clerkship so far. I've done a total of 3 rotations, on my 4th, and have 2 more to go to round out the 12-week clerkship, and have those 2 grades back.

If this were academic grades, I wouldn't be fretting so much about pass vs. HP or O/H. But this is clerkship time, and I really want to do well in the areas I'm interested it.

Maybe my ego is bruised a little, IDK. I just would like some feedback from some other 3rd/4th years who maybe ended up in surg and had the same thing or similar happen.

1. Surgery blows
2. It was your first rotation. Many people make that mistake "Ill do what I want to go into FIRST!" walking in without any knowledge or ability (we really don't / didn't on the first rotation no matter our confidence level).
3. You aren't alone. there are now 3 other surgery complaint threads.
4. Surgery blows

 

[Random Anesthesiologist]

1. Surgery blows
2. It was your first rotation. Many people make that mistake "Ill do what I want to go into FIRST!" walking in without any knowledge or ability (we really don't / didn't on the first rotation no matter our confidence level).
3. You aren't alone. there are now 3 other surgery complaint threads.
4. Surgery blows

😳 Thanks for the feedback.

I wish I didn't have to do surgery first, but personal situations were such that I needed to get it done first.

I need to check out the other surg complaint threads. I guess if in the end I get decent reviews I shouldn't be so worried, but this is just the beginning. Ahhhh!

 

[speedyk]

I hear you. At least it was just a sub-specialty rotation and not gen surg or your whole grade. Hopefully you have some indication of what you can do better? What were their comments?

 

[CardiacIntensivist]

1) You can always rock a sub-i or do research in the field if you are truly that concerned

2) you may even end up going into surgery

3) If you're looking into a surgical subspecialty, you may end up taking a year off just because of how competitive they are.

This one grade won't kill you but I would suggest you exam other aspects of why you may not have gotten the grade you deserve. It's easy to mistaken that just because you answer a few pimp questions, did well on the shelf and never got yelled at, you deserve honors. Surgeons are all about the go-getter and getting things done in a timely manner (stat). Did you volunteer to help with scut? Did you get along well with the team? And that means not just being about the joke around and stuff but also that they wanted to talk to you about your goals, count on you to get stuff done, was enthusiastic about having you around? Did you make it known that you are super interested in surgery?

Also, sometimes the bottom line is that not everyone can get H or HP. You are being compared to your peers and sometimes no matter how hard you work, your definition of a "honors" student may differ from whomever is grading you. That's life

 

[Random Anesthesiologist]

1) You can always rock a sub-i or do research in the field if you are truly that concerned

2) you may even end up going into surgery

3) If you're looking into a surgical subspecialty, you may end up taking a year off just because of how competitive they are.

This one grade won't kill you but I would suggest you exam other aspects of why you may not have gotten the grade you deserve. It's easy to mistaken that just because you answer a few pimp questions, did well on the shelf and never got yelled at, you deserve honors. Surgeons are all about the go-getter and getting things done in a timely manner (stat). Did you volunteer to help with scut? Did you get along well with the team? And that means not just being about the joke around and stuff but also that they wanted to talk to you about your goals, count on you to get stuff done, was enthusiastic about having you around? Did you make it known that you are super interested in surgery?

Also, sometimes the bottom line is that not everyone can get H or HP. You are being compared to your peers and sometimes no matter how hard you work, your definition of a "honors" student may differ from whomever is grading you. That's life

Thanks Hiro. Yes, I've been working super hard at it, doing all the things mentioned. I did get nice reviews for my social skills LOL.

I think I was just having a freak-out moment and wondering if this was all normal. I have the feeling that doing all these things is indeed, a "Pass" on the clinical side, because they expect all the scut, rounding, dictation, patient care, etc.

I have 2 weeks left on Gen Surg and I'm just going to have fun with it. I like Gen Surg over the specialties anyway (I know, I know), and I'm already thinking ahead about a sub-i for 4th year. There are a couple other specialty interests I have that I will get to yet. I just like having my options open 🙂

I'm curious as to how different my knowledge will be between now and 4th year!

 

[smq123]

One of my friends had this happen to him. He got a Pass on Surgery for his MS3 rotation.

He's now a general surgery resident. He did well on his sub-Is, his Step 1 scores were good, and he's a good interviewer. A few people did ask him why he got a Pass for his MS3 rotation, but he had an answer ready, and it didn't seem to be a real obstacle.

 

[Random Anesthesiologist]

Just a little follow-up... I ran into said physician after a conversation with a fellow med student and asked politely about my grade and how I thought I got on well with him and the practice. He laughed and said I did do very well, but that he's old-school and just doesn't give out advanced grades on M3 clerkships, or at least he has yet to do so in the decades he's been a preceptor.

That made me feel a little bit better and slow down on questioning my thoughts on whether surg is for me or not Apparently if I do a sub-i with him and do as well, I will have no probs getting a great grade.

So for those out there lurking who may be disappointed like I was, sometimes it really is not a big deal! Live and learn!

 

[MossPoh]

Lots of people have gone into surgery who didn't have honors.

Sometimes it is just the name of the game. Some attendings will never give excellents or whatever your system is. They just don't believe in it. The biggest thing you can do is ask your attending what you can do to improve and get better every week and then actually do it. It is usually looked upon favorably to constantly show you want to improve. Working hard helps a lot, but it only takes one mistake at the wrong time to make you look bad.

I can't really offer much advice on the whole residents/interns thing, since we work one on one with attendings. I've heard, that while they may not grade you, their input and disposition can mean a lot on an evaluation.

 

[Mace1370]

I have no doubt that there are physicians out there who don't give As/Honors/Excellents or whatever to M3s, but that position is absolutely ******ed. It is the school's job to set the grading scale, not the preceptor.

 

[MossPoh]

We said good bye to objective grading after 2nd year. The way of life is now figuring out how to gain favor with the attending. Clinical grades are mostly subjective. Shelf exam is to make sure people have a fund of knowledge in addition to being clinically savvy. One just has to develop the ability to anticipate each attending's demands and expectations and then exceed them. Some set the bar impossibly high. I had one attending write in my evaluation that he thought I'd make an awful surgeon and was inferior to my peers, yet I had the highest shelf exam score and my primary attending give me nearly all excellents. (Our highest ranking)

Everyone has their own opinion and it is understood amongst program directors that grades are subjective. One honors might be a fluke, but it is when someone gets multiples that a trend really begins to emerge.

 

[Morsetlis]

I once did a non-surgical rotation as an MS4 where an attending described me in a faculty meeting as "rude, arrogant, obnoxious, and inappropriate." I still honored the rotation, because another attending told me about it and I made the necessary changes.

Don't let this break your confidence, and don't take it as a reflection on your character or potential. Think of it as a learning experience on how to play the game. Make adjustments, do better with your next group. Things can still turn out just fine for you.

So you were rude, arrogant, obnoxious, and inappropriate, and then changed?

Or what?

 

[Rollo]

So you were rude, arrogant, obnoxious, and inappropriate, and then changed?

Or what?

Of course not.

He just went ahead and slept with that attending after 2 pitchers of long islands.

 

[mrwesticles]

Anything under the whims of other docs is going to be a huge hassle.

I was in my pediatrics clerkship, and I felt like my performance was on par with all of my other clerkships which had gone really well. Time rolls around and I get a passing grade for not knowing the answer to one pimping question.

 

[Random Anesthesiologist]

Lots of people have gone into surgery who didn't have honors.

Sometimes it is just the name of the game. Some attendings will never give excellents or whatever your system is. They just don't believe in it. The biggest thing you can do is ask your attending what you can do to improve and get better every week and then actually do it. It is usually looked upon favorably to constantly show you want to improve. Working hard helps a lot, but it only takes one mistake at the wrong time to make you look bad.

I can't really offer much advice on the whole residents/interns thing, since we work one on one with attendings. I've heard, that while they may not grade you, their input and disposition can mean a lot on an evaluation.

At my program, there is only a FM residency, so no surgical interns/residents. You're with your assigned attending all the time. I had 6 different attendings during my rotation - 3 subspecialty, 2 gen surg, and 1 anesthesia. Which, of course is good and bad. You're first-assisting most of the time, but you ALWAYS have to be "on".

Now that it's over, in hindsight, I may have been a little reactive to my first grade received. Overall, clinically I did pretty well. I'm still waiting on one grade to make its way back, but it should be fine.

I guess the subjectivity threw me off quite a bit. I mean, I read a lot of the clinical threads before the rotation and expected certain things, but real experience is always different from what you expect. In the end it wasn't that bad. Even if I only end up with a "P", I know I would be welcomed for a sub-i and get an honors, and this comes from a frank conversation with the surgical group I was attached to.

So, for anyone who has yet to take their surg rotation and is reading this, it will seem hard, and you will get discouraged. But if you do everything you're supposed to do (and you will know what that is), then you'll do fine 🙂

Don't knee jerk at the beginning like I did