how do you get good evaluations?

[Thewonderer]

I agree with the following thread in which clinical grades are very very subjective!

http://forums.studentdoctor.net/showthread.php?t=150061

That being said, there are a couple things that all medical students should do to increase their chances of getting better grades:

1) Do not ask too many questions! In an effort to impress attendings with their knowledge, med students ask too many questions. Honestly, residents and attendings are there to do the work and want to get out ASAP. Med students asking too many questions simply hold up the rounds. I would say that, while presenting a patient, don't ask more than 2 very important questions!!! Asking more will annoy the residents and make you look very very unsure of yourself. We can see when medical students just have absolutely no clue. Well, even if you have no clue, don't show it. Just wait, ask the interns later or find out through the nurses, or call up the lab to get the values that were not paged to you, etc. And in surgery, definitely a big no no to ask questions!!! If they ask you questions, yes, then try to answer. But if they don't ask you, then don't bother to make a sound. Surgeons are concentrating on the surgeries, especially the residents who are still learning the intricacies and have their attention 120% focused on the tasks at hand. Keep your mouth shut. For pt's sake (so they don't clamp the wrong vessels while you distract them with your stupid questions) and resident's own educational sake, don't make a sound. You will end up getting better grades that way.

2) Appear confident. Similarly, if you have no clues, don't sweat it. Attempt to do what is asked of you (such as seeing a pt, writing up an H&P, finding out the lab values after rounds, etc.), and then show what you have done to the residents. THEN they would know what you know and what you don't know, and they can help you. It is so bad to have students just shaking their heads right after you ask them to do something and you have to walk through EVERY single step with them. I mean, half of what is done in medicine is common sense so attempt those first. When you get stuck, then ask appropriate questions. Of course, if it is a procedure you never performed before, then you need guidance from the very beginning.

3) Don't be afraid to say, "I don't know..." It will end the torture of being pimped a heck lot quicker. It is ok to give one best shot at the answer. But if you don't get it right away, then it is time to pull out the "I don't know" phrase. Med students are so afraid of looking stupid that they will keep on answering on and on for....oh....10 minutes. But that's a big waste of time for everyone invovled. But if you say, "I don't know," then residents will think more highly of you. Honestly, most of the answers are really clinical so new 3rd year students who are in the mind set of basic sciences almost have no clue about what the answers are. At that point, pulling out the "I don't know" makes you look like a star in comparison to other students who mumble on and on and hold up everyone from getting the round done and getting to work (attendings and residents are often too nice to interrupt the rambling so be nice to them and end everyone's torture...).

4) Don't ask residents questions while they write or type. This is my major pet-peeve. If you get into the periphery of their visions, they will notice that you have a question to ask. And if they don't turn their heads toward you, it means they are REALLY busy. If necessary, even wait 20 minutes, until they stop typing (on that VA computer) or writing, then fire away your questions. I know that most of the questions require quick answers. But residents cannot do dual tasking. When they are writing, they are planning out the whole H&P and assessment + plan. It sucks that you have to wait for a while and it seems that it is a waste of your time. But I can assure you, it will give you some bonus points when they evaluate you.

5) Stand up for your learning. Grades are subjective but if you stand up for your learning, then at least you can say that you have learned something. However, that still means that if any residents ask you to do something or evaluate some pts, you say, "yes" I keep on hearing horror stories of students sitting on their butts reading and yet refuse the chief resident's request to see a certain pt because "oh, I have seen 2 patients with pancreatitis already...or I have seen 2 CABG's already...." That's a big no no. Just go ahead and see the patients, no questions asked.

During down time on call nights, go ahead and read, but be sure to be close by to be available. Don't be afraid to pull out your book and read while residents are busy. They know WHEN they need you so be patient. But that does not mean you should sneak home and sleep.

6) Go home when you are asked to. You will notice that residents ask you to go home prematurely sometimes. when that happens, they really do mean, "you should damn go home NOW!!!!" Sure, ONE of those times you can try to stick around and show your enthusiasm. But in general, all the other times, don't stick around. And if they ask you go home the second time, then just pack up and leave. The residents are in fact hinting to you that your staying here will make it more work for them, so they rather that you go home NOW. Thereby, they don't feel obligated to teach during that busy day (or that busy night on call). Seriously, if you don't go home, they will get pissed off (of course, if it is the intern who asks you to go home, you should always double check with the upper level residents).

hope this helps! as you can see, more does not mean better. Sometimes, the dumb blonde gets higher grades may be because she keeps her mouth shut, gets "some" work done and appears that she is super confident and is on top of every single detail about her patients, while appearing relaxed and joked around. That definitely beats an enthusiastic student who asks questions non-stop and stick around on calls to annoy residents with more questions! You can be that confident dumb blonde too (just be sure to show up on all rounds and surgeries).

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[VentdependenT]

Work your ass off. Act like an intern, but of course have others sign your orders. Read up on cases. Act like a human being and relate to your "superiors."

There ya go.

 

[phoenixsupra]

All these things you mention are common knowledge. Most schools give you some sort of handbook with these cliches included. Everyone, hears these at some point going into rotations.

But the reason people are always bitching about third year grades is because the grade you get seems to have little to do with these basic principles of workplace conduct. One thing that seems to have most bearing on your grade is whether you're "thinking of going into that specialty or not". Sure it's great when you get a little halo effect for wanting to follow the teams footsteps. But when the shoe is on the other foot it aint so nice.

Almost every team I joined tried to pump me for my future ambitions. Most I was honest with and I often felt an immediate change from there on for the worse. So I moved on to using the usual bs answer - "I don't know, I'm trying to weigh up the pros and cons of ...blah blah. That's as far as I'll go. What many studs do is to tell every team that they want to go into their field. Sickening when you see these peeps talking out of their ass and getting rewarded for it. You'd think they'd see through it. But they don't. It really does work for many.

A psych attending actually told me that I should do this. WTF. He said that when he was a medical student he told every single rotation team that he was going into their field. He proudly boasted that he only got caught out once. Sheesh. What is wrong with these dinguses?

When I'm an attending, I'll pay very little attention to this crap. If anything I'll try to get some idea of how the stud behaves toward patients, nurses and staff when I'm not around. I know that's incredibly difficult but I think I'll try. And if as a surgeon, someone tells me they are going into medicine, or psych or something else I will respect them for it.

Will this be possible or will I just end up going with my gut feeling and get it wrong most of the time, therby perpetuating the same crazy system? Who knows. Not an easy one to answer.

 

[Blake]

When I'm an attending, I'll pay very little attention to this crap. If anything I'll try to get some idea of how the stud behaves toward patients, nurses and staff when I'm not around. I know that's incredibly difficult but I think I'll try. And if as a surgeon, someone tells me they are going into medicine, or psych or something else I will respect them for it.

My exact feelings on this.

 

[Samir Desai]

I just want to comment on something phoenixsupra said, which was:

"All these things you mention are common knowledge. Most schools give you some sort of handbook with these cliches included. Everyone, hears these at some point going into rotations."

I agree with phoenixsupra that a lot of it is common knowledge. But it's one thing to have heard this advice and it's another to go out there and practice it. You can hear something that makes sense but not follow through on the advice. It happens to a lot of students.

 

[maugham]

the original poster makes the point that students shouldn't waste everyone's time by asking lots of questions. The idea seems to be that there is important work to do and lowly medical students just gum up the works by being inquisitive. It may be worth reminding those who share this sentiment that students have invested huge sums of money for the privilege of training in hospitals and questions should not be squelched in what is supposed to be an educational environment. This may be a naive view in the bustling world of the average busy hospital, but I find it disconcerting that even a self-identified faculty member in the previous post seems to be in agreement with this policy of discouraging curisosity and engagement with attendings during rounds as a needless hindrance. In my limited experience on the wards so far, most students seem to be overly cowed into submission by lorldly attendings as it is and barely utter a peep unless prompted to. I actually can't imagine students becoming more submissive than they already are. I actually think students should speak up more not less.

 

[VienneseWaltz]

the original poster makes the point that students shouldn't waste everyone's time by asking lots of questions.

I think the idea is that some questions are more appropriate than others and some times are more appropriate than others, not that students shouldn't ask questions at all.

 

[Hawk22]

I'm sorry, I just don't know what to do about asking questions. I've had 2 rotations where I didn't ask too many questions because everytime I did I felt like I was annoying the attending or the resident. There NEVER seemed to be a good time to ask, no matter how busy we were at that time. I purposefully didn't ask during busy times and only asked pertient, quick questions during rounds. I didn't ask anything I couldn't find the answer to in a book in 2 minutes and did my best not to ask silly questions that would look like I was asking just to be asking something.

So what was my major feedback points from these 2 rotations? (1) I didn't ask enough questions (2) I didn't show enough interest in the material b/c I didn't ask enough questions. What a load of crap! I was pretty mad because it seems like no matter what it was the wrong thing. I still got good reviews overall, so it didn't really matter that much.

I can understand that residents are busy, but part of signing up to do a residency at a teaching hospital is the expectation that you're going to have to teach medical students. That's even more so for attendings because they don't have to be there like residents...they are there willingly and getting paid for it. I'm not saying that all students are justified in their questions (because they are clearly not), but its not all their fault either.

 

[vietcongs]

every day wear low cut blouses, miniskirts, stilletto heels, and spend at least 2 hrs doing your hair and makeup in the morning... guaranteed A+ evals!

 

[IV Doc]

I can understand that residents are busy, but part of signing up to do a residency at a teaching hospital is the expectation that you're going to have to teach medical students. That's even more so for attendings because they don't have to be there like residents...they are there willingly and getting paid for it. I'm not saying that all students are justified in their questions (because they are clearly not), but its not all their fault either.

This sounds good but wait until you are a resident following 10 patients and you desperately need rounds to be over so you can start doing your work. Most residents I have worked with are good people who want to teach the third year students but they just do not have time. So it annoyes the hell out of residents to listen to a third year student ask numerous questions just to hear themselves talk.

 

[supercut]

It is difficult and grading is subjective. Now that I'm a resident, I realize how hard it is to try to evaluate a student as well.

As far as aking questions...I think the type of question is more important than the amount or even timing. Though you should probably hold questions when it is clear the entire team is doing speed rounds to try to get work done, most of the time one or two questions won't hurt. What you want to do is ask question that shows you have some baseline knowlege and are seeking to add to that. Don't ask questions about basics that you should be able to get from reading. And don't pepper the residents with questions. One or two per session should be adequate. I once had a couple of student who would ask many questions on evening rounds (on a very busy surgical service when we often started rounds after 6pm). The questions were also things like "what's going on with this pt" or What is pt x's hct". I felt like they were pimping me with things that they could have looked up easily themselves.

Other things to help you do well..make sure your note is in the chart before any residents note. Know everything about your pts, have all their data handy. And make sure you concentrate on writing good notes.

I can't believe that students would refuse to write H&P on pt just because they have seen a couple of pts with that problem. Any student who said that to me would be at very high risk of getting a failing grade from me. 2 pts with pancratitis does not make you an expert.

Work hard, read as much as you can, ask appropriate, well timed questions (even in surgery), write good notes and you should get a decent grade. Ask both residents and your attendings as you approach the halfway point how you are doing and what they think you need to improve and follow that advice. Be a team player. And realize that you will probably get some unfair evaluations. That's life. It won't kill you. My worst evauation was very unfair, came from my surgery clerkship, and cost me a grade (making surgery my lowest grade for 3rd year). Still, I matched, at a program that was high on my list, and that grade was never mentioned.

 

[MDrugger]

the original poster makes the point that students shouldn't waste everyone's time by asking lots of questions. The idea seems to be that there is important work to do and lowly medical students just gum up the works by being inquisitive. It may be worth reminding those who share this sentiment that students have invested huge sums of money for the privilege of training in hospitals and questions should not be squelched in what is supposed to be an educational environment. This may be a naive view in the bustling world of the average busy hospital, but I find it disconcerting that even a self-identified faculty member in the previous post seems to be in agreement with this policy of discouraging curisosity and engagement with attendings during rounds as a needless hindrance. In my limited experience on the wards so far, most students seem to be overly cowed into submission by lorldly attendings as it is and barely utter a peep unless prompted to. I actually can't imagine students becoming more submissive than they already are. I actually think students should speak up more not less.

As a 3rd year student who tends to if anything talk a little too much, i think it comes down to the student and the situation. I don't think the first poster was implying that students shouldn't talk at all or ask questions when appropriate during rounds. It was more discouraging
(1) asking questions to show how much you know [gunner type]
(2) asking questions that if you thought about you could answer yourself [speaking before thinking].
Unless rounds are running ridiculously long most attendings I have worked with welcome relavent questions (of course i only have experience with medicine and peds--I've been warned i may need to learn to keep my mouth shut a little more in surgery). As students we hope that residents and attendings recognize the talking to show off type students as purely that. If you find yourself being one of those students who is always talking in teaching sessions or rounds (I've been that student). Consider talking to a fellow student or resident you feel comfertable with and see how its being percieved. If you find yourself sitting silently day after day, try to speak up even if its hard or "not your style". Students complain that evaluations are "subjective" and having attendings who never even saw them with a patient grading their clinical ability. The reality is for some what you do or don't say during rounds or teaching sessions may form the majority of your grade.

 

[macman]

Other than the common sense stuff-a few factors I think play a big role:

1) Do they like your personality? If you hit it off with the attending or chief r. you are ok on the eval. not fair but true

2) I agree with above on specialty-I noticed a BIG difference on rotation where I indicated I was consdering that field

3) unfair evals will happen-you will always be pissed about them - you may also dream about egging their house

 

[bigfrank]

3) unfair evals will happen-you will always be pissed about them - you may also dream about egging their house

And sometimes you'll actually do it.

 

[BrooklynDO]

Ive only completed my three months of surg so far, and the one thing i learned, whether on general or on electives :
Even when you do not get along with the team at all... (i had a horribly terse, tense, abused ortho team, and they passed the sentiment along )... if you have a question, ask, or if it comes up during a surgery or while the resident is busy, tell him that youd like to ask a question about the case or patient, and ask when is a good time to sit down and talk about it.
I found that residents were willing to teach, even the "mean" ones, when you asked thought out questions if you were visibly considerate of their time and their schedule.

 

[BrooklynDO]

I just want to comment on something phoenixsupra said, which was:

"All these things you mention are common knowledge. Most schools give you some sort of handbook with these cliches included. Everyone, hears these at some point going into rotations."

I agree with phoenixsupra that a lot of it is common knowledge. But it's one thing to have heard this advice and it's another to go out there and practice it. You can hear something that makes sense but not follow through on the advice. It happens to a lot of students.

another thing that dr desai perhaps didnt mention :
what you think you are doing and how you think you are acting may not be what the team/other students/attendings perceive. You may think you are acting like a good lil med stud and scut monkey extraordinaire, but if the evaluator doesnt notice...it wont matter

 

[Hawk22]

This sounds good but wait until you are a resident following 10 patients and you desperately need rounds to be over so you can start doing your work. Most residents I have worked with are good people who want to teach the third year students but they just do not have time. So it annoyes the hell out of residents to listen to a third year student ask numerous questions just to hear themselves talk.

I understand what you're saying, but those same residents were once medical students too. There's got to be a happy medium that balances student teaching and patient care. I don't expect these folks to sit down and give me a lecture, but I don't think its fair for them to snap at a legitimate question either (especially if its asked at an appropriate time). Good medical students and good residents can find this happy medium, but those are both few and far between.

 

[MasterintuBater]

I got good evals by figuring out ways to make the attending's job and the resident's job easier and not harder. This meant knowing when to contribute in effective and meaningful ways....and when to get out of the way and keep my mouth shut. Learn to read your attendings. Play the game and play it well.

 

[Samir Desai]

It is important for students to ask their residents and attending physicians questions but they need to be asked at the right time. You need to be able to recognize the right and wrong times to ask questions. If you are not sure, simply ask if this is a good time to ask a question. This is an area that requires some emotional intelligence.

You might also consider bringing this up during the first day or two of the rotation when you meet with the resident or attending to discuss expectations, rules, responsibilities of the rotation. Consider asking the resident or attending when they would prefer you ask questions. Maybe the resident doesn't want to be bothered during the morning hours - perhaps that is his time to be efficient and productive. Maybe the attending doesn't want to be asked questions until the end of rounds because he feels that it slows down rounds. I think you get my point.

With the heavy workload that residents and interns have, they are mainly interested in being efficient and productive. And let's face it - too many questions can affect efficiency and productivity. And yes, residents do have a responsibility to teach - it's just that for many residents, as a priority, it's lower on the list. What a lot of residents don't realize is that you don't have to set aside an hour to answer questions. Students often appreciate as little as 10-15 minutes of time - in that amount of time, you can certainly pass along a lot of tips, pearls, etc. Also many residents are under the assumption that in order to teach something, they have to prepare. That's often not the case - you can offer a lot just based on your experience and your existing knowledge, which is considerabe.

 

[bigfrank]

I've found that the most effective strategy is........

PATRONIZE THEM!!!

(i.e., "wow, I can't believe you matched in Plastics -- how'd you do it?" and "could I watch you do that [procedure] again? You did it so well.")

The key is to make them believe that you're impressed with their "skills"! Simple as that!

 

[livewires]

Ya...I've decided to just play the game too and tell them whatever they want to hear. If you're stubborn and are honest and stick to your own goals, while making them public, you'll end up in the sea of mediocrity. Attendings seem to, for the most part, be extremely arrogant in one way or another, particularly in Surgery and they only want to be pampered by us petty little worthless med students. Right? Tell em whatever they want to hear, even if you have to come up with new carreer goals every four weeks. It will pay off when evals come out.

Sad but true.

By the way, thewonderer sounds very annoying to work with and I did not think her post was very pleasant. It makes her look like she is one of those bastardly residents that I just posted a thread about. Read it and you'll see what I mean. All through here thread there are references to how medical students are annoying. Lets face it, residents will complain if we ask questions and they will complain that we are apathetic if we don't. It's the nature of the beast I guess.

 

[phoenixsupra]

Ya...I've decided to just play the game too and tell them whatever they want to hear. If you're stubborn and are honest and stick to your own goals, while making them public, you'll end up in the sea of mediocrity. Attendings seem to, for the most part, be extremely arrogant in one way or another, particularly in Surgery and they only want to be pampered by us petty little worthless med students. Right? Tell em whatever they want to hear, even if you have to come up with new carreer goals every four weeks. It will pay off when evals come out.

Sad but true.

By the way, thewonderer sounds very annoying to work with and I did not think her post was very pleasant. It makes her look like she is one of those bastardly residents that I just posted a thread about. Read it and you'll see what I mean. All through here thread there are references to how medical students are annoying. Lets face it, residents will complain if we ask questions and they will complain that we are apathetic if we don't. It's the nature of the beast I guess.

Totally agree with not being super honest about your goals. That was something that was important to me. I used to call it integrity. Seems it's not compatible with medicine. I've definately been through the mill on that one.
Please don't go the whole hog and start telling the colo-rectal surgeon that you've been dreaming of that field since birth. Just take the safe bland middle road of being confused and totally uncertain about what you want to do. I sympathize man. I've taken so many body punches on that one.

You're probably right about the other poster being like the little napolean resident you had. Medicine is full of harsh people who worship order as an end in itself. They're everywhere. You cannot escape them. I think the only way to cope with that type is to understand them and somehow learn to get along. I blabbered at length about this on your other post. I really do think that my personality is more therapeutic than that of your average tightass. But I am accepting that I have to alter my personality in the clinic when this type of order nazi is on the throne. Hang in there. Good luck.

 

[phoenixsupra]

I've found that the most effective strategy is........

PATRONIZE THEM!!!

(i.e., "wow, I can't believe you matched in Plastics -- how'd you do it?" and "could I watch you do that [procedure] again? You did it so well.")

The key is to make them believe that you're impressed with their "skills"! Simple as that!

Ha ha. LOL You crack me up. That's great.

 

[scootad.]

You guyz crack me up, talk about being overdramatic. Face it, the real world is full of toxic personalities, medicine is not even close to the worst of it. Its like medical students are these robots used to plastering their faces in textbooks, the first time they have to actually interact with the real world and its personalities on a consistent basis they freak out!

Its not that difficult to be a little humble, do what you are told as a student, complete your responsibilities. 99% of the time even the most toxic resident will appreciate that effort.

 

[phoenixsupra]

You guyz crack me up, talk about being overdramatic. Face it, the real world is full of toxic personalities, medicine is not even close to the worst of it. Its like medical students are these robots used to plastering their faces in textbooks, the first time they have to actually interact with the real world and its personalities on a consistent basis they freak out!

Its not that difficult to be a little humble, do what you are told as a student, complete your responsibilities. 99% of the time even the most toxic resident will appreciate that effort.

What you say about med students being study androids is often fairly true. I didn't go straight to medschool and I have plenty of "real world" experience. Sometimes the androids who have been working on getting into medschool since birth resent people who come into the field with real experience cuz let's face it they can run rings around the hothouse flowers in most respects. These androids you speak of seem to be gods in their own minds. Android egos are very large and just as fragile. Given a little power and a world experienced student under them they often go ballistic. I'd be willing to bet that something like that is happening in livewires case. Grade junkies are usually not in control of their emotions or even aware of them. So it takes some skill and patience to deal with them. I think medschools should teach an "emotions for androids" course or something in first year and teach each fresh crop of multi-choice athletes how to be more human. There are TONS of interesting and mellow people in medschool. Unfortunately there is also no shortage of the android type. Medicine is not like bussiness or a regular job. We take care of sick and fragile humans. Being a caring and warm person is essential. It is NOT ok for a doctor to be toxic. Let's not forget that.

 

[Legion560]

Ya...I've decided to just play the game too and tell them whatever they want to hear. If you're stubborn and are honest and stick to your own goals, while making them public, you'll end up in the sea of mediocrity. Attendings seem to, for the most part, be extremely arrogant in one way or another, particularly in Surgery and they only want to be pampered by us petty little worthless med students. Right? Tell em whatever they want to hear, even if you have to come up with new carreer goals every four weeks. It will pay off when evals come out.

Sad but true.

I told myself at the beginning of the year that I would stick to my principles: i.e. working hard, not kissing ass, not trying to out gun the gunners, not talking my mouth off, and being honest etc. You know what that has gotten me so far?

A lot of mediocre evaluations from attendings.

I find it hilarious when they tell us about humanism and values in medicine when our whole teaching system is based on the "game". Im going to find it hard not to bust out laughing when I hear this from an attending. Medicine is the SAME as any other profession in this regard.

Legion