How fatal is low-passing a clerkship (surgery)?

[BigSkyMontana45]

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I recently found out I low-passed my surgery clerkship. NBME Shelf score was fine (low 70s), but got hammered on a rotation evaluation worth 40% of my grade. The attending left no comments, but gave me almost all 1s on a 0-4 scale. I appealed, but was unsuccessful - my final grade is "low-pass".

I have no interest in Surgery - I want to do Neuro/IM/Psych/Family Medicine/Anesthesiology. How screwed am I? I am freaking out!

I am a US -MD. My step 1 score is 220s - hoping for 230s on Step 2CK. All other grades are Pass (80%), and High Pass (20%).

Thank you!!

 

[Doctor Strange]

You're fine... But, jeez, what did you do to piss that attending off...

 

[BigSkyMontana45]

I have no idea - he basically ignored me the whole time and behaved like I was always in his way. I had to produce the burden of proof that his eval was unfair in the appeal process - and couldn't do so.

 

[Seroquel]

I had a similar issue with a surgery attending; by far the rotation with the most malignant personalities. I totally believe your story too. At my school we had several attendings who just hated life and everyone in general and were terrible to be around. It won't really matter in the long run, especially as you aren't going into anything surgical. Congrats on being done with surgery.

 

[WingedOx]

Two things:

1. Was there any sort of mid-rotation feedback documented that you were doing poorly? The LCME is pretty explicit that schools need to offer remediation opportunity during a rotation if a student's performance isn't up to par. (LCME Functions and Structure 9.7) If not, your school essentially made a no-no according to the eyes of the accreditation body.

2. They LCME appears less explicit about narrative comments in an evaluation, but I'd be surprised if they didn't go back and ask the surgeon to justify his answers in writing.

Now of course, what you do with this information is up to you. School admins are lazy a f-ck when it it comes to confronting faculty about insufficient supervision and evaluation and generally won't budge without any pressure. Applying that pressure could blow up in your face, but at the same time a low-pass is still kind of an ugly red flag. We had a case like this in my med school class and things got ugly...

 

[BigSkyMontana45]

I had a similar issue with a surgery attending; by far the rotation with the most malignant personalities. I totally believe your story too. At my school we had several attendings who just hated life and everyone in general and were terrible to be around. It won't really matter in the long run, especially as you aren't going into anything surgical. Congrats on being done with surgery.

Some of my peers said the same thing - its not a failure, and low-pass in Surgery won't affect me applying to non-surgical specialties. HOWEVER, I was also told IM and Surgery clerkship are the 2 most important clerkships looked at by everyone. Any other insight into this?

 

[BigSkyMontana45]

Two things:

1. Was there any sort of mid-rotation feedback documented that you were doing poorly? The LCME is pretty explicit that schools need to offer remediation opportunity during a rotation if a student's performance isn't up to par. (LCME Functions and Structure 9.7) If not, your school essentially made a no-no according to the eyes of the accreditation body.

2. They LCME appears less explicit about narrative comments in an evaluation, but I'd be surprised if they didn't go back and ask the surgeon to justify his answers in writing.

Now of course, what you do with this information is up to you. School admins are lazy a f-ck when it it comes to confronting faculty about insufficient supervision and evaluation and generally won't budge without any pressure. Applying that pressure could blow up in your face, but at the same time a low-pass is still kind of an ugly red flag. We had a case like this in my med school class and things got ugly...

My mid-term evaluation was PERFECT. I did bring that up in the appeal, but was still denied.

 

[AcademicNeurosurgery]

My mid-term evaluation was PERFECT. I did bring that up in the appeal, but was still denied.

What were your scores on the 0-4 scale for the mid-term evaluation?

If they were perfect as you state, I think dropping to almost all 1s is significant. I'd talk to an advisor, clerkship director, or directly contact the surgeon to get some constructive feedback. Of course, you'd want to word it in a non-confrontational way - ask how you can improve on future rotations, etc. If you still do not get a concrete response, I'd put some heat on your administrators to find out what exactly happened. Your performance and any relevant feedback from evaluations aren't supposed to be a secret.

 

[BigSkyMontana45]

What were your scores on the 0-4 scale for the mid-term evaluation?

If they were perfect as you state, I think dropping to almost all 1s is significant. I'd talk to an advisor, clerkship director, or directly contact the surgeon to get some constructive feedback. Of course, you'd want to word it in a non-confrontational way - ask how you can improve on future rotations, etc. If you still do not get a concrete response, I'd put some heat on your administrators to find out what exactly happened. Your performance and any relevant feedback from evaluations aren't supposed to be a secret.

There was no score - just 3 boxes (At/above level of training, needs improvement, and unsatisfactory). Mine was checked At or above level of training. My appeal has already been denied - I am worried about the consequences of this low-pass now. Am I screwed for even non-surgical residencies?

 

[Womb Raider]

I would at least ask the faculty if they could tell you what went wrong so that you can improve on your behavior. Accept the bad grade but since you genuinely don't know what went wrong it might be worth asking. I would. Don't want to make the same mistake twice.

 

[BigSkyMontana45]

I would at least ask the faculty if they could tell you what went wrong so that you can improve on your behavior. Accept the bad grade but since you genuinely don't know what went wrong it might be worth asking. I would. Don't want to make the same mistake twice.

There was no behavior issue. I was checked "professional" in the professionalism category.

I got across the board 1s in sections like "Clinical Competence" "H&P skills" "Procedural Skills" and "Knowledge Base".

 

[Redpancreas]

What were your scores on the 0-4 scale for the mid-term evaluation?

If they were perfect as you state, I think dropping to almost all 1s is significant. I'd talk to an advisor, clerkship director, or directly contact the surgeon to get some constructive feedback. Of course, you'd want to word it in a non-confrontational way - ask how you can improve on future rotations, etc. If you still do not get a concrete response, I'd put some heat on your administrators to find out what exactly happened. Your performance and any relevant feedback from evaluations aren't supposed to be a secret.

Just a warning, at my school contacting the evaluator automatically disqualifies you from making an appeal. I know that an appeal was already made OP, but I think you need to pursue this further if deep down you really feel this came out of nowhere because that's just flat out scary. Also, looking at your history this looks like a double post.

 

[sovereign0]

This is the crap that terrifies me about clinical grades. No matter how good you are or how hard you work, your grades may not necessarily reflect it.

 

[Seroquel]

Some of my peers said the same thing - its not a failure, and low-pass in Surgery won't affect me applying to non-surgical specialties. HOWEVER, I was also told IM and Surgery clerkship are the 2 most important clerkships looked at by everyone. Any other insight into this?

Since surgery is typically a longer rotation like medicine, it will factor more into your third year grades and possibly for your application depending on what you apply for and how competitive the program. A "Pass" in surgery really isn't a deal breaker/red flag in your case. It's unlikely anyone at your school will do anything to help you. It's very frustrating how little we can do as medical students in terms of our education and yet we pay a ridiculous amount of money every year. Anyway, rest assured that this probably won't be a big deal provided you don't apply for a surgical specialty. A few of my friends who matched into psychiatry and medicine had passes in surgery and did perfectly fine. Finish the year strong and good luck!

 

[BigSkyMontana45]

Since surgery is typically a longer rotation like medicine, it will factor more into your third year grades and possibly for your application depending on what you apply for and how competitive the program. A "Pass" in surgery really isn't a deal breaker/red flag in your case. It's unlikely anyone at your school will do anything to help you. It's very frustrating how little we can do as medical students in terms of our education and yet we pay a ridiculous amount of money every year. Anyway, rest assured that this probably won't be a big deal provided you don't apply for a surgical specialty. A few of my friends who matched into psychiatry and medicine had passes in surgery and did perfectly fine. Finish the year strong and good luck!

This is a LOW-PASS. A level below pass.

 

[WingedOx]

Since surgery is typically a longer rotation like medicine, it will factor more into your third year grades and possibly for your application depending on what you apply for and how competitive the program. A "Pass" in surgery really isn't a deal breaker/red flag in your case. It's unlikely anyone at your school will do anything to help you. It's very frustrating how little we can do as medical students in terms of our education and yet we pay a ridiculous amount of money every year. Anyway, rest assured that this probably won't be a big deal provided you don't apply for a surgical specialty. A few of my friends who matched into psychiatry and medicine had passes in surgery and did perfectly fine. Finish the year strong and good luck!

assuming it's the same way as it was at my school, he got something equivalent to a "marginal", which is below the standard pass, and also puts you on automatic academic probation. Not really a great situation.

Honestly if the appeal is indeed "complete" then I highly doubt that the school is going to reverse this. It wounds the egos of academic admin types when you tell them their process was flawed, even if it is a clear violation of the rights of a student to a fair evaluation.

It may be too late, but the best advice I can give for students in this situation, needing to appeal a rotation, is to find a faculty member who is outside of the appeal and advancement process who can advocate on your behalf. Your student affairs deans won't want to make any noise. Also, know your rights throughout the appeal process. The school will tell you that you have none and that their word is all that matters. That's only half true. Rotations MUST provide narrative feedback, and MUST give feedback and time for remediation if the rotation is 4 weeks or longer. How that's actually enforced is up in the air though...

The situation I knew of from my school sounded exactly like yours, OP. Student won the appeal but it was really really ugly. The school insisted that nothing was wrong the whole time, the evaluator did nothing wrong, the process had nothing wrong with it, etc. First and foremost the school with protect the faculty.

 

[Seroquel]

This is a LOW-PASS. A level below pass.

Oh I see, my bad. Thought it was a pass, we don't have marginal passes at my school. Definitely in that case try to figure out what happened. I'm really sorry you have to deal with this 🙁

 

[Seroquel]

assuming it's the same way as it was at my school, he got something equivalent to a "marginal", which is below the standard pass, and also puts you on automatic academic probation. Not really a great situation.

Honestly if the appeal is indeed "complete" then I highly doubt that the school is going to reverse this. It wounds the egos of academic admin types when you tell them their process was flawed, even if it is a clear violation of the rights of a student to a fair evaluation.

It may be too late, but the best advice I can give for students in this situation, needing to appeal a rotation, is to find a faculty member who is outside of the appeal and advancement process who can advocate on your behalf. Your student affairs deans won't want to make any noise. Also, know your rights throughout the appeal process. The school will tell you that you have none and that their word is all that matters. That's only half true. Rotations MUST provide narrative feedback, and MUST give feedback and time for remediation if the rotation is 4 weeks or longer. How that's actually enforced is up in the air though...

The situation I knew of from my school sounded exactly like yours, OP. Student won the appeal but it was really really ugly. The school insisted that nothing was wrong the whole time, the evaluator did nothing wrong, the process had nothing wrong with it, etc. First and foremost the school with protect the faculty.

Great advice.

 

[MrChance2]

Enjoy being done with surgery. Nobody will care about this unless it becomes a pattern or you want to go into surgery.

 

[sliceofbread136]

Classic surgery clerkship stuff right here

 

[Syndicate]

Highly doubt it will matter in the long run unless you are gunning for top 20 IM programs, in which case they might care just because it's so competitive at that point and they need to split hairs


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[sazerac]

Getting a Low Pass in surgery could be seen as a positive if you apply to psych. 😉

 

[BigSkyMontana45]

Bump - any other opinions on the impact of this on my future?

I spoke to the Dean today - and he says I can have one more level of appeal to go through at the institution level. He advised me to obtain notes I have written on patients, any electronic correspondences - to show the burden of proof.

 

[WingedOx]

Bump - any other opinions on the impact of this on my future?

I spoke to the Dean today - and he says I can have one more level of appeal to go through at the institution level. He advised me to obtain notes I have written on patients, any electronic correspondences - to show the burden of proof.

of course, they're surgery notes...

 

[Pathman1000]

A lot of people understand surgeons have emotional issues. You passed, I wouldn't sweat it.

 

[BigSkyMontana45]

A lot of people understand surgeons have emotional issues. You passed, I wouldn't sweat it.

This is a low-pass/marginal - a level below passing.

 

[Pathman1000]

This is a low-pass/marginal - a level below passing.

Im sorry you have to go through this. It's abuse and it's not your fault they made the mistake of choosing surgery for a career.

 

[Syndicate]

Bump - any other opinions on the impact of this on my future?

I spoke to the Dean today - and he says I can have one more level of appeal to go through at the institution level. He advised me to obtain notes I have written on patients, any electronic correspondences - to show the burden of proof.

If you do well in your non-surgery clerkships, I'm sure a marginal pass in surgery can be overlooked.