Getting Clinical Honors

[wondertwinkle]

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So I've done several rotations now and I get a High Pass in each of them clinically. I am happy with my grades. But I was wondering, what separates someone from a high pass to an honors clinically from what you've seen? I don't mind HP in all my courses, if I can get an honors in medicine which is what I'm interested in.

Is it about having articles or studies printed out? Something about how confident you make yourself out to be? About coming in earlier than others and staying later?

Thanks!

 

[Droopy Snoopy]

So I've done several rotations now and I get a High Pass in each of them clinically. I am happy with my grades. But I was wondering, what separates someone from a high pass to an honors clinically from what you've seen? I don't mind HP in all my courses, if I can get an honors in medicine which is what I'm interested in.

Is it about having articles or studies printed out? Something about how confident you make yourself out to be? About coming in earlier than others and staying later?

Thanks!

Personally, I give honors to an M3 who functions at the level of an intern. You can take a patient and illicit more subtle history and physical exam points, interpret them as well as your lab/rads data into an accurate and complete problem list, form a 5+ item differential diagnosis for your CC, independently formulate a reasonable treatment plan, then succinctly present the patient on rounds (and your note) and aid the team on daily management and discharge. Educating the team about the specific disease process is a bonus in my mind, but often attendings do expect this because they don't see your daily work ethic whereas the residents do.

 

[Superfrost]

Getting honors is 1/3 luck 1/3 kissing up 1/3 effort.

 

[lakersbaby]

Getting honors is 1/3 luck 1/3 kissing up 1/3 effort.

agreed its complete bs

 

[juiceman311]

Disagreed totally. Kissing up is not in the equation. The equation is very simple. It is a pure blend of hard work + reading early and often. That is all.You can work hard, but if you can't answer questions your fund of knowledge will get a ding and make you look not as smart to the attending whose main interaction with you is rounds and never sees your hard work. You can read a lot and leave early to study, but then you look lazy/uninterested. Luck plays has nothing to do with it.

 

[Davey Havok]

Disagreed totally. Kissing up is not in the equation. The equation is very simple. It is a pure blend of hard work + reading early and often. That is all.You can work hard, but if you can't answer questions your fund of knowledge will get a ding and make you look not as smart to the attending whose main interaction with you is rounds and never sees your hard work. You can read a lot and leave early to study, but then you look lazy/uninterested. Luck plays has nothing to do with it.

I mostly agree, except don't discount the luck factor. You might work with a hard-ass attending, or your reading might not be on quite the right thing. What if you get pimped on inpatient DVT management on Day 2, while you've busted your ass reading on CHF and Diabetes management for those first two days? Well, now you've made a sub-optimal impression on that attending, which will probably carry through. So the "luck" of getting topics you can wow someone on is definitely a factor, and attending personalities, which will be quite different, are a major variable that is nothing but scheduling/luck.

 

[rachmoninov3]

While there is always luck involved, here are my tips for a honors:

1. Nail your reporting on AM rounds. Clear, confident and quick.
2. Understand what your results mean. Talk to your intern before hand if there are any questions.
3. Start formulating a managment plan. Only do this if you have the first two down cold. The difference between a HP and Honors at my school is if you start to manage. However, don't skip the first two and go straight to trying to manage your patient just for the grade.

 

[Deferoxamine]

Getting honors is 1/3 luck

👍

Which students you get teamed up with for X number of weeks

Which residents are assigned to the same service you are

What particular pathology walks through the door, and how much you know about it from months/years ago when the attending grills you on it on the spot

What mood the resident is in when you give him/her your evaluation


1/3 luck, hmmm... sounds familiar. I think it's called the "real world", being an adult, and adapting and adjusting to the expectations to still deliver the best possible product with the resources at hand, no matter the challenge, no matter the interpersonal differences... That said, over time, the true superstars will probably find a way to shine through.

 

[Noeljan]

getting clinical honors has been more or less easy with hard work (at least in my case, don't want to judge anyone with an unlucky situation)...Seem enthusiatic, know your patients, don't slack off, have good knowledge.

now here is where the LUCK comes in IMO...how much time you have to study for the shelf exams. At some sites you will do every single call (like my surgery rotation being Q2 or Q3 with no precall), where some more laxed places students could get some significant studying done. Same on medicine or anywhere else. If you have residents that don't think it is important for you to be up all night every call, let you read, or easy hours, you have LUCKED out. You are unlucky if you are at a place with zero time to shelf study (no matter how awesome you are clinically in some courses the shelf exams will decide more than that). That my friends is where I think luck comes in which is why I think shelf exams should be pass/fail (it is a standardized test without standardization of amount of study time).

 

[ucsfstudents]

I agree with the above. I would also add discussing expectations early on and asking for constructive feedback several times during the rotation. Good luck!

 

[Substance]

Being a medical student sucks. Residency is way better.

It's kind of funny...when I did internal medicine, I was completely average. Of course, my team had 5 other students on it and between us we had very few patients to follow. Not only that, most of my admissions were social admits. Old failure-to-copes. AND there were five different attendings heading my team throughout the four weeks of medicine, so it was like the three-little-bears: one would want to manage a patient one way, and then a new attending would come on and change the management completely because they thought it wasn't suitable. etc.

I came in early, read around things, tried to answer obtuse questions, and even pressed on for a very important test nobody wanted to do when we hit a roadblock. Turns out the test was the right one to do and gave us our answer, but I didn't get any credit for it. The resident did, and didn't speak up for me. I should have said something but I didn't.

The main problem with being a medical student is that you have no true autonomy. Even if you know what to do, you have to filter everything through residents and attendings. Your ability to filter is based half on your knowledge and the other half on your prosody. My prosody wasn't that great, so I got dinged and was rated pretty average.

Fast forward to residency: I did internal medicine again. Same thing, except I was the resident and didn't have to filter anything through anyone. I was the guy in charge. I was given the highest evaluation one could possibly achieve, between five separate attending physicians over my time on the wards. I rocked out.

Medical school sucks. Evaluations are a pile of crap.

 

[kdburton]

This is a long post so bear with me. Thinking about this helps me evaluate myself as I go through the end of my 3rd year as well. Assuming you mean the evaluation portion of the grade rather than the shelf exam portion... Your clinical grade is going to mostly depend on three things - knowledge, work ethic, likability (not in any particular order). Theres some other things that go into this equation, but these are big ones in my opinion.

1) Knowledge: You don't have to be the smartest person in your class to be evaluated well in this category and you don't have to know everything - the key is to know the answers to questions at the right time (i.e. whenever a resident or attending is asking them). Read about the patients you're following so that on rounds the next day you can answer questions about general concepts of conditions they have. I personally liked to either read this information in my review books that I was using to study for the shelf (which may be a little slim on the info somtimes though) because you're killing two birds with one stone. If your school/hospital has access to uptodate.com then that is an excellent resource in my opinion too. Make sure you know what kinds of tests have been ordered for your patients (esp what has come back within the last 24 hours) and be ready to interpret all of this data on rounds or any other time someone might ask you. i.e. If a patient had cultures drawn have an idea of when that type of culture comes back and be there to report it ASAP. You should also have a general idea of oother patients on the service (even ones you're not following) because you may have the "opportunity" to answer questions about these patients as well. If you're on a surgery rotation then read about the surgery before you go scrub so you can answer questions in the OR yadda yadda yadda. The bottom line is to know the right information at the right time ALWAYS and you will be evaluated as having honors-level knowledge.

2) Work ethic - Show up on time (NEVER be late). Always give yourself enough time to pre-round and write notes if that is what you do on that particular service. Keep your residents updated on any new labs or findings that you think they might not be privy to (even if they actually already knew it) because if you save their @ss on rounds when they know something because you told them about it they are going to love you. Look a what the interns are doing and try to emulate it. If they grab the charts and scribble down orders that the senior resident is spouting off during rounds then (if its within your bounds) you should start doing that. Its one less thing they have to do and, hey, you get to learn how to write orders. The interns and seniors will take note of this and be happy about it. If they always write post-op notes on patients, you could probably start doing it to (obv just gotta make sure someone co-signs anyhting you do). If you know a patient in the ER is going to be admitted to your service then take the 5 minutes to write the admit orders. If it turns out you're wrong and they're not getting admitted or you wrote some wrong orders then no sweat - at least you got to practice and maybe had someone look it over for you to tell you where you screwed up. Any opportunity you have to go above and beyond the call of duty is an opportunity to show people that you have a great work ethic. I'm not saying you should volunteer to do all the scutwork, but the residents are busy and if you help them out with some stuff it may give them some extra time to interact with you when they don't have a million other things to do. Just don't step on anyones toes or harm any patients in the process. If you get a LOR out of a clerkship where they say "We would definitely recruit this student to our program" based on your work ethic then you are fricken' golden. Make every rotation a rotation where someone would OFFER to write a letter that says that.

3) Likability - I'll try to expand on this a bit because over the course of 3rd year so far I've seem some social ******s. Some of these are exceptions to the rules stated above.

Never throw your classmates under the bus. As I stated earlier you should have a general idea about all patients on your service (even ones you arent following) so you can answer questions about them if the opportunity comes up. If a question is asked about a patient on the service that your fellow medical student is following and they don't know the answer you could make them look bad depending on how you answer. Use discretion here because you may look like the lifeiline that is saving your classmate or you may look like the deuchbag that is trying to impresss people at the expense of others (the latter group is sadly mistaken usually). On the opposite end of the spectrum if your classmate points out a heart murmur to you before rounds because they weren't sure about whether it was systolic or diastolic or something you can mention on rounds when that patient is being discussed "Yeah so-and-so picked up on that this morning and gave me the opportunity to listen to it." Pumping up your team member in this way makes them look good and really makes you look like a team player. Try not to make it look to obvious though, just slip it into the conversation if the opportunity allows.

Don't disagree with or question your superiors. If something they are doing is about to endanger a patient's life it is a different story but in general they probably know a lot more than you and have a lot more experience. You must realize that sometimes (actually many times) the textbook answer is not the only answer when everything else is taken into consideration. Use this as an opportunity to ask questions and learn something new. As long as you're not being annoying the residents may actually like the idea that you're asking intellectual questions about why they may be doing something different than you learned it out of a 1999 edition of First Aid for Pediatrics.

Don't try to spout off a bunch of medical nonsense every time you have the podium just to show everyone how much you know. Even if you could recite Harrison's word-for-word you could get a bad clinical evaluation simply because you're always perceived as showing off and stepping on the feet of others. Know your place and answer questions when you're asked them. Attendings and residents have been around the block and they know who is a total toolbox. Don't be that guy/girl

Without being annoying make sure people know your name. If you're on a surgery clerkship and your scrubbing with 5 different surgeons throughout the course of a month they may not remember who the hell you are when its time to evaluate you because they certainly aren't paying much attention to you in the OR. When its appropriate, introduce yourself and make conversation to get some face-time. The key here is "when its appropriate." You'll have to use your discretion again, just don't be annoying about it.

Engage in casual discourse with your residents as appropriate. I found this particularly easy on surgery because I am a guy and I want to do surgery (sorry if that sounds sexist). You're not assigned to a service so that you can make new friends, but if the opportunity allows for you to get dinner with the residents on yoru team and talk about stuff outside of your clinical duties then by all means do it. We're all human. However if this isn't going to happen because your personalities just don't mesh, then don't force it. People may have positive memories about you that have nothing to do with medicine. That is a good thing when its time for them to evaluate you but it is not necessary. For example I didn't really have much in common with people on my pediatrics rotation, but I still got honors without really doing anything besides showing up on time and working hard.

Don't be a grade-grubber. You can do everything I've said in this post without making it obvious that at least some part of it is in order to get honors. DON'T ASK ATTENDINGS AND RESIDENTS WHAT YOU CAN DO TO GET HONORS. You can ask people in classes above you what they think might get you honors and you can ask your attendings and residents what you can do "to be a better member of the team" or "to get the most out of the rotation" or somethign like that without sounding like you're only out to get the big H. Nobody likes to hear about this including your fellow classmates that you're rotating with.

There is a lot mroe to this category, but the bottom line is that the more people like you the more likely they will be to evaluate you highly on ANY PART OF YOUR EVALUATION whether you deserve it or not. This is psychology people.


Going overboard in any of the above categories may end up making you look like a suckup or something along those lines. You can be the best student ever on the rotation however and still make it not look like you're sucking up at all, you just have to re-evaluate what you're doing to make sure that its not going to be perceived in the wrong way. So all in all if you maximize the above 3 components I will gurantee that you get clinical honors. Now you just gotta ace the shelf 🙂

 

[dantt]

Educating the team about the specific disease process is a bonus in my mind, but often attendings do expect this because they don't see your daily work ethic whereas the residents do.

Strange that so many people say this. I've never been on a rotation where the residents either appreciated or cared about medical students educating them about a disease process. They thought students should read for themselves, never to present to the team. I also have heard of some students making hand outs for their residents about something...I've never met a resident who cared for that *shrug*

 

[Droopy Snoopy]

Strange that so many people say this. I've never been on a rotation where the residents either appreciated or cared about medical students educating them about a disease process. They thought students should read for themselves, never to present to the team. I also have heard of some students making hand outs for their residents about something...I've never met a resident who cared for that *shrug*

Unless it directly helps me take better care of a patient, I agree with you and couldn't care less about med student 'lectures' of this sort. The point was that attendings care about you answering pimp questions on rounds and doing the whole "tomorrow give us all five minutes on sickle cell" thing, whereas the residents care primarily about your work ethic and helping us all get home to our families. 'Educating the team' usually takes time away from getting work done, but I've never known a resident to penalize you for it. So maybe substitute 'bonus' for some other word that better fits that long-winded explanation.

I also agree with most everything that's been said above. It is a crapshoot in many regards. What happens though is that everyone is playing on the same field. You might have a huge b*tch of an OB resident and think it's unfair because your buddy had the most chill team ever, but it'll even out later in the year when your IM attending is a benign little old lady geriatrician and your buddy gets the cards staff who has no greater pleasure in life than roasting medstuds for not knowing the difference between AVRT and AVNRT. You just have to work hard, expand your knowledge base for the shelf, treat people with respect, and in general do the best you can. Don't worry about the rest, it's out of your control.

 

[Cirrus83]

Oh there's certainly quite a bit of luck involved or everyone wouldn't try to get the same attendings during rotations where you can pick who to rotate with (sometimes with a lottery system). Not so surprising to see that by the time you get to the end of the lottery system it's the attendings known for being hard graders who are left.
I have to say that 3rd year definitely sucks for people who tend to be shy when interacting with their superiors. And sucking up does work, but you have to remember that you may only be able to handle so much sucking up before you want to slap yourself, so while the attending that you managed to suck up to will write a great evaluations your sense of soulessness afterwards will get you horrible evaluations from everyone else. (kidding, kidding, sorta)
Unfortunately it seems that I haven't been selling myself all that well this year...2 rotations now I've gotten top scores on the shelf to no avail-for one of them I had already been told by several people that the attending pretty much only gave sat's, so I went well out of my way to do extra things and stayed late to see more patients...and got probably the nicest comments I've ever seen on an evaluation...but got a satisfactory anyway. If luck isn't part of this then it's just a mighty weird coincidence that everyone with high lottery numbers picked off the attendings with "easy grading" reputations lol.

 

[Flank Pain]

In my experience, getting honor's has more to do with going the extra mile to be pleasant, making the residents life easier and finding ways to advertise what you have done or what you have read/learned. I think I learned more on the rotations where I focused on reading and taking care of my patients. I think maximizing your learning and trying to get honors are mutually exclusive goals, you've got to pick your battles to get what you want out of each rotation.

 

[cpants]

Getting honors is all about studying for the shelf. You can work your ass off and be a great asset to your team, and your clinical grade probably won't be much different than the other students. At our school at least, people generally get in the high HP to the low H on clinical grades no matter what you do. As long as you are generally a good person, do your notes and presentations reasonably, are always on time, you should be fine with your clinical grade. Trying to go the extra mile usually just detracts from your study time, and the shelf grade is what usually differentiates the HP's from the H's.

 

[Noeljan]

Getting honors is all about studying for the shelf. You can work your ass off and be a great asset to your team, and your clinical grade probably won't be much different than the other students. At our school at least, people generally get in the high HP to the low H on clinical grades no matter what you do. As long as you are generally a good person, do your notes and presentations reasonably, are always on time, you should be fine with your clinical grade. Trying to go the extra mile usually just detracts from your study time, and the shelf grade is what usually differentiates the HP's from the H's.

👍👍

soooooooo true. Im suprised more people don't know about this really. I have seen some people in our IM course get S and HS for clinical then get above the grade for honors on the shelf and honor, then I have seen people get H for inpatient and outpatient score a few points below the honor shelf grade and get HS. I can't believe how little clinical performance actually counts in some of these courses and how much the shelf does (seeing how they throw down your throat its all about clinically, go the extra mile blah blah). I also cannot believe achievement over 8-10 weeks means less than one day (which if you had more time to study for obv you will do better not that the tests are more difficult) Another place you are right, going the extra mile often gets you that clinical H but it is meaningless. The person who hid out in the library all day ends up with a better grade at the end of the day.

 

[CardiacIntensivist]

Without being annoying make sure people know your name. If you're on a surgery clerkship and your scrubbing with 5 different surgeons throughout the course of a month they may not remember who the hell you are when its time to evaluate you because they certainly aren't paying much attention to you in the OR. When its appropriate, introduce yourself and make conversation to get some face-time. The key here is "when its appropriate." You'll have to use your discretion again, just don't be annoying about it.

Engage in casual discourse with your residents as appropriate. I found this particularly easy on surgery because I am a guy and I want to do surgery (sorry if that sounds sexist). You're not assigned to a service so that you can make new friends, but if the opportunity allows for you to get dinner with the residents on yoru team and talk about stuff outside of your clinical duties then by all means do it. We're all human. However if this isn't going to happen because your personalities just don't mesh, then don't force it. People may have positive memories about you that have nothing to do with medicine. That is a good thing when its time for them to evaluate you but it is not necessary. For example I didn't really have much in common with people on my pediatrics rotation, but I still got honors without really doing anything besides showing up on time and working hard.

There is a lot mroe to this category, but the bottom line is that the more people like you the more likely they will be to evaluate you highly on ANY PART OF YOUR EVALUATION whether you deserve it or not. This is psychology people.

100% agree with everything said but especially what I chose to quote. People forget that it is so much easier to grade down or care less about someone if they are anonymous or harder to get along with. Think about all the insults and arguments that occur in forums, it's the same concept that occurs on the wards. Of course you can be the most hardworking person there, but if people don't want to work with you or you do not have the common sense to realize your place as a medical student, you will not get the grade you want. I'm definitely not the smartest person in third year and I've made quite a few mistakes but as I read through all my resident evaluations (and the accompanying high marks) most of the comments were about how great it was to work with me and how much of a team player I am. Those mistakes (including arriving three hours late to the floor, missing the fact that my pt's J-tube turned feculant, forgetting to check the ostomy during prerounds when it was swelling and becoming necrotic, letting suction fall out of swollen bowel and having feces splatter over the field) were never mentioned. [side note: Don't worry, those misses sound horrible but were quickly caught by the resident so the patients were ok.]

This seems to be a good rule of thumb I followed: if your residents can playfully tease you, you are viewed well by the team. If they remain completely 100% professional and PC at all times, they are either really anal and hard to work with and/or you'll be in trouble during evals.

 

[netminder]

. . . This seems to be a good rule of thumb I followed: if your residents can playfully tease you, you are viewed well by the team. If they remain completely 100% professional and PC at all times, they are either really anal and hard to work with and/or you'll be in trouble during evals.

Wow; I bet it's hard to tell the difference sometimes. I wonder if this is going to make me paranoid.

 

[fyfanatic]

I came in early, read around things, tried to answer obtuse questions, and even pressed on for a very important test nobody wanted to do when we hit a roadblock. Turns out the test was the right one to do and gave us our answer, but I didn't get any credit for it. The resident did, and didn't speak up for me. I should have said something but I didn't.

This happened on my surgery rotation, not to me but to another student I was with. He basically diagnosed a PE when he was checking in on his pt. and noticed that the pt. was tachypnic and just didn't look well. He brought it to the attention of the resident that the pt. might be having a PE but the resident just thought it was fluid overload and gave the pt. Lasix. After the lasix didn't work, only then did the resident decide to get an ABG and then a CT angio which showed b/l PEs.
During rounds with the attendings, the resident made no mention of the fact that it was the student who noticed the pt.'s deterioration and so the student got no credit for it...

 

[Rollo]

This happened on my surgery rotation, not to me but to another student I was with. He basically diagnosed a PE when he was checking in on his pt. and noticed that the pt. was tachypnic and just didn't look well. He brought it to the attention of the resident that the pt. might be having a PE but the resident just thought it was fluid overload and gave the pt. Lasix. After the lasix didn't work, only then did the resident decide to get an ABG and then a CT angio which showed b/l PEs.
During rounds with the attendings, the resident made no mention of the fact that it was the student who noticed the pt.'s deterioration and so the student got no credit for it...

In this situation, I realize that as a student, trying to tell the resident in front of the entire team that, "You're welcome for that diagnosis by the way!" is probably a bad idea.

But couldn't the student talk to the resident in private later and mention something like, "Wow that was a lucky guess on my part huh?"...trying to keep it light-hearted so as not to embarrass the resident anymore.

 

[fyfanatic]

In this situation, I realize that as a student, trying to tell the resident in front of the entire team that, "You're welcome for that diagnosis by the way!" is probably a bad idea.

But couldn't the student talk to the resident in private later and mention something like, "Wow that was a lucky guess on my part huh?"...trying to keep it light-hearted so as not to embarrass the resident anymore.

He didn't mention anything, I guess because he felt there was no point. But after that we joked around all the time about how it was time to go on "PE rounds" when there was nothing else to do =)

 

[dienekes88]

In this situation, I realize that as a student, trying to tell the resident in front of the entire team that, "You're welcome for that diagnosis by the way!" is probably a bad idea.

But couldn't the student talk to the resident in private later and mention something like, "Wow that was a lucky guess on my part huh?"...trying to keep it light-hearted so as not to embarrass the resident anymore.

He didn't mention anything, I guess because he felt there was no point. But after that we joked around all the time about how it was time to go on "PE rounds" when there was nothing else to do =)

It's best not to mention anything. Hopefully, it will show up on your eval even if you don't get a parade in your honor during the rotation. It happened to me a couple times and definitely made it onto the evals.

You don't want to come across as a jerk.