Grading Policy for M3/M4 Years

[Dedikated2liftn]

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It's pretty straightforward how medical students are evaluated during the preclinical years (majority of one's grade is derived from written tests); however, what it the standard system of grading while one's on the wards? Is it an evaluation by an attending (or even resident) at the end of the rotation? Are there written tests throughout the rotation that one must pass? Are there practical exams (i.e. something similiar to Step 2 CS) throughout each rotation? Additionally, if the majority of your grade is coming from a superior's evaluation, it seems to me that the means of assesment transitions into the realm of the subjective. Consequently, are there barriers in the system to prevent someone getting screwed just because he didn't have an ideal relationship with his superior?

 

[ZagDoc]

Additionally, if the majority of your grade is coming from a superior's evaluation, it seems to me that the means of assesment transitions into the realm of the subjective.

Yup. But really, that is the way your performance will be evaluated through residency and for the rest of your career. The general consensus is that success can be found by working your ass off, bringing a good attitude, and offering to do whatever possible to make the residents' lives a little bit easier. But even when you do that, you're may still run into residents and attendings who you just don't get along with. Such is life.

 

[soeagerun2or]

Consequently, are there barriers in the system to prevent someone getting screwed just because he didn't have an ideal relationships with his superior?

No. One attending can take you down and there is nothing you can do about it except roll over and take it.

 

[smq123]

however, what it the standard system of grading while one's on the wards? Is it an evaluation by an attending (or even resident) at the end of the rotation? Are there written tests throughout the rotation that one must pass?

Generally - yes, it is mostly the attending/resident evaluation that will decide (at least part of) your grade.

At my school, the clinical evals and the shelf exam scores are totally separate. So your rotation grade depends almost entirely on the attending's evaluation.

At other schools, it is a mixture - for instance, 70% of the grade will come from the subjective evaluation, while the other 30% is your shelf exam.

Depending on the school you go to, you will take an exam at the end of the rotation. A lot of allopathic schools use the NBME shelf exams; I've noticed that many osteopathic schools write their own exams. It will vary, but count on an exam of some sort.

Are there practical exams (i.e. something similiar to Step 2 CS) throughout each rotation?

Depends on the school and on the rotation. At my school, we have practical exams after the OB/gyn and surgery clerkships.

Additionally, if the majority of your grade is coming from a superior's evaluation, it seems to me that the means of assesment transitions into the realm of the subjective. Consequently, are there barriers in the system to prevent someone getting screwed just because he didn't have an ideal relationship with his superior?

Welcome to the VERY frustrating part of third year. 🙁

No. One attending can take you down and there is nothing you can do about it except bend over and take it.

Fixed.

 

[vtucci]

Working hard, having a good attitude will take you far in third year. You still need an adequate knowledgebase to honor usually so read when you can.

For evaluations, yes they are subjective but you can ask for feedback on how you are doing throughout the rotation and not just at the end (mistake many students make).

Shelf exams are also frequently factored into grades and/or national percentiles need to be obtained to be eligible for a certain grade as is the case at my med school.

 

[Droopy Snoopy]

A typical 3rd year rotation grade might go like this:
1) exams 45% -- 15% in-house tests and quizzes; 30% national shelf exam.
2) evaluations 50% -- by residents and/or attendings.
3) 5% miscellaneous (maybe a required presentation, graded H&P, completing on-line case files, something like that).

Class rank (if you really care about that kind of thing at this point) is still really differentiated based on the written exams. Also important are the actual eval comments. Pretty much everybody at some point gets a negative or blah eval because there's no way you can shine all the time particularly on rotations you hate. Subjective? Sure, but your dean's letter will throw out the outliers and hopefully resolve this into an accurate picture for your potential future employers.

Basically if you show up on time and are professional, work hard and appear interested, read when you get the chance, and get along well with others you've got nothing to worry about for the 18 months between Step I to Match. I wouldn't worry too much about 4th year grades.

 

[PeepshowJohnny]

Consequently, are there barriers in the system to prevent someone getting screwed just because he didn't have an ideal relationship with his superior?

In my school, we're pretty lucky. I've had a couple people who had a completely outlier evaluation dropped just because it was an outlier. Usually this takes the support of the course director, but they tend to be very student friendly and receptive to student concerns with only one rotation asthe exception. They've had like 4 course directors in 5 years an no one wants the job. I won't say it's name but it starts with an "O" and ends with a "BGYN".

 

[NPR]

For evaluations, yes they are subjective but you can ask for feedback on how you are doing throughout the rotation and not just at the end (mistake many students make).

Oh I love this one. This is stressed repeatedly at my school and like a good little student, of course I do it.

Every single time, I hear stuff like "You're doing great! Just keep doing what you're doing! You can always read more and flesh out your knowledge base but you're doing just fine!"

And then I turn around and receive a pass on the final evaluation. There were multiple times in 3rd year I felt like grabbing the attending/resident by the neck, repeatedly slamming their heads into a desk, and pleading "Why? Why? Why can't you just tell me what I did wrong at the mid-rotation evaluation session?"

Welcome. To. 3rd. Year.

😡

 

[Ashers]

Oh I love this one. This is stressed repeatedly at my school and like a good little student, of course I do it.

Every single time, I hear stuff like "You're doing great! Just keep doing what you're doing! You can always read more and flesh out your knowledge base but you're doing just fine!"

And then I turn around and receive a pass on the final evaluation. There were multiple times in 3rd year I felt like grabbing the attending/resident by the neck, repeatedly slamming their heads into a desk, and pleading "Why? Why? Why can't you just tell me what I did wrong at the mid-rotation evaluation session?"

Welcome. To. 3rd. Year.

😡

Most of our clerkships have mandatory midterm evals that we have to have filled out with a resident and receive feedback -- it also sets the minimum grade you can get from that person (numerical score + comments in multiple areas). For OB/gyn, I was ranked as Average numerically because I was told that's what the chief does, and I was told I was doing well, and just read the text more and review books less (I was still reading 3 hours a day -- beginning of 3rd year I still cared). Then on my eval, I got the minimum score they could give me, because the chief resident didn't like it that I didn't read the actual text in its entirety, with a comment saying, "She's obviously very smart based on her shelf exam." Bite me.

Psych: my attending was so out there that even though I brought in articles every day for the first two weeks, he never had time to discuss them with me, so I got a comment saying I needed to bring in more articles for the team.

However, like PeepshowJohnny said, sometimes outliers can be assessed. Surgery has some notorious fellows and residents, so if their comments clash with what everyone else said, they're not put on the grade sheet.

For the record, I hate OSCEs, and I like shelf exams much more than departmental exams.

 

[Law2Doc]

It's pretty straightforward how medical students are evaluated during the preclinical years (majority of one's grade is derived from written tests); however, what it the standard system of grading while one's on the wards? Is it an evaluation by an attending (or even resident) at the end of the rotation? Are there written tests throughout the rotation that one must pass? Are there practical exams (i.e. something similiar to Step 2 CS) throughout each rotation? Additionally, if the majority of your grade is coming from a superior's evaluation, it seems to me that the means of assesment transitions into the realm of the subjective. Consequently, are there barriers in the system to prevent someone getting screwed just because he didn't have an ideal relationship with his superior?

As others have said, your grade will generally be determined 60-80% by subjective evaluations. Which means an attending's view of you can make or break you. Some are more generous than others. Some take huge imput from residents. Some have higher expectations than others. Some are jerks (everybody gets at least one). All you can do is work hard, show up on time, be diligent, be affable, do your scut with a smile, stay organized, try to know your stuff and look up what you didn't know, and seem interested and enthusiastic. The rest is going to be out of your control. Most of the remainder of your grade is usually going to be based on a shelf exam, which more often than not is a test where you have inadequate time and are tested on things not generally seen or discussed day to day on rotation, meaning you have to study for it in your "spare" time. But since the percentage of your grade on the shelf is fairly low, the impact is not that great, so this usually just serves to separate the folks with similar evals into honors/not, letter grades etc.

It's a totally new world, and the less you focus on the grades (and more about treating the rotation like your job), the better your life will be, because frankly there isn't all that much you can do about them during this stage.

 

[vtucci]

Oh I love this one. This is stressed repeatedly at my school and like a good little student, of course I do it.

Every single time, I hear stuff like "You're doing great! Just keep doing what you're doing! You can always read more and flesh out your knowledge base but you're doing just fine!"

And then I turn around and receive a pass on the final evaluation. There were multiple times in 3rd year I felt like grabbing the attending/resident by the neck, repeatedly slamming their heads into a desk, and pleading "Why? Why? Why can't you just tell me what I did wrong at the mid-rotation evaluation session?"

Welcome. To. 3rd. Year.

😡

There is a difference between asking how am I doing in a general sense and giving them a copy of what will be the final evaluation form and have them fill it out at the midterm. You can then ask if you get passes- what do I need to do to move to high pass/honors. It may be that the professors don't give honors-- I have seen this happen.

 

[persia]

I would agree with NPR that this is the madness of subjective evals. It seems often, that who they like is the most important part of the eval. You can have a weak knowledge base, show up close to rounds, not have much interest in patients but get along well with shooting the BS with residents and end up with honors.

Sometimes this is overt, and sometimes you can't tell. Like being told for one month 'you are going and excellent job!' by everyone on the team. Ask for what you can do to be improving on and they say 'nothing, you are really doing great!' Be told that you did a good job, when you pass in the eval form. Be told that they liked you and they will write good comments for you. And then, after you leave your eval (written by someone else) says that you are bone average and your comments are very weak.

In medicine you are not really allowed to challenge a grade - for fear of making people angry. It doesn't seem like this is a good system for really training people, and for helping them on to the next step since your whole grade can come from someone's incomprehensible comments and eval. And, from whether they 'liked' you or not. That is very different from whether you are clinically sound and progressing well.

I genuine do not understand why a student would be told you are doing an excellent job! nothing to improve and then barely pass the rotation and receive very weak comments. That to me seems very hostile and passive aggressive. The subjectiveness of clinical grades can make you dizzy, but it also seems very unfair sometimes.

In the end, you can chose how you want to behave during these years. Be yourself and work hard, smile and have a good attitude and hope for the best, or try the resident schmooze - which may or may not work for you. These are hard years, and I don't know that I have the answers.

 

[NPR]

There is a difference between asking how am I doing in a general sense and giving them a copy of what will be the final evaluation form and have them fill it out at the midterm. You can then ask if you get passes- what do I need to do to move to high pass/honors. It may be that the professors don't give honors-- I have seen this happen.

I've seen both. I've had professors tell me they don't hand out honors at all. (I hate these people)

Our midterm evals are identical copies of our final evals. I've actually seen some of my final evals with the highest numerical scores circled. The course director just opted not to give me the grade indicated by my numerical scores.

I cannot figure it out. I just can't.