How to do well in 3rd year?

[Daredevil]

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I'm currently at a loss as to how to get better grades than just passing in our clinical years. I just finished my psych rotation and received my grade. Despite the fact that I did well enough on the final exam to qualify for a High Pass, the clinical evaluation by my preceptor was not good enough to get me that HP. The thing is, I don't agree with some of his evaluations and mostly of what I did for the rotation was NOT observed by the preceptor. SO how exactly was he able to give a fair assessment of by abilities? It's all PURE BS! 😡

 

[rxfudd]

Welcome to third year...

 

[starayamoskva]

Welcome to third year...

What he said!

 

[doc05]

you need to learn how to play the game; when you can relax, when you need to be "on," and who you need to impress. don't brown-nose either, just work hard and be smart.

 

[EctopicFetus]

Also, keep in mind some of the times when you were goofing off or whatever you might have pissed the resident off. My situation was similar except I always looked like I was working hard and always helped everyone I could. My attending told me that the residents had nothing but praise. I am sure this played a large part in getting my A in Medicine.

 

[Boomer]

You could always resort to dragging out the knee pads......

 

[Mumpu]

Avoid the "I'm just a med student" attitude. You are a professional in training, so act like one. Know everything about your patients. Know why every lab is up or down. Know about every disease in the differential and every drug on the med list. If you don't know something, look it up. If your intern/resident doesn't know something, look it up and teach them. Show up on time, get all your work done on time, don't whine, don't look like you are trying too hard. And so on... 🙂

 

[ears]

Lot of cynicism in response to your post. And yeah, some of it is justified; the process is somewhat arbitrary, and sometimes boot-lickers get further ahead than they should. (But it's actually less bad in academic medicine than lots of "real-world" kinds of jobs I know.)

But there is still stuff under your control. Big three tips for medical students:

• Know your patients. When you have patients (or your team has them), make sure you know about them: what's going on with them, what the plan is, what could go wrong. Know about their diagnosis, whatever it is. Try to make yourself a sort of expert on whatever it is. No kidding, it helps. (And you actually learn stuff.) Pretend like you were going to give a little talk on whatever it is. Actually do give a little talk on whatever it is.
• Try to be helpful. You want (or you should want) to get in there and try to do stuff, on every rotation there is. Even scut. Actually, especially scut, but that usually leads to good learning opportunities. You can start by saying, "Is there anything I could do to help?" The next level is seeing someone busy doing something, and asking "Could I be doing that for you?" And then there's the level where you've been observing how things work, and you know what comes next, and you start just doing it yourself.
• Be proactive/confident. You can be useful to your team or your preceptor, just by constantly putting yourself out there. And you can demonstrate what you know by speaking up, answering questions, asking questions, and just generally being interested. Meet the people you're working with more than halfway (or try to). Get in there!

In the hospital, you make your own education. If you're aggressive in doing that (in whatever way you want; and believe me, it's you that decides), then you'll succeed. In terms of getting good grades, but also in actually learning what you want to learn to be the kind of doctor you want to be.

Don't let 'em get you down. Good luck!

 

[Bull's eye]

Another thing is to just do the obvious...... tell the attending that you want honors. SERIOUSLY I received honors on all my third year rotations except one (due to my post test). The first day tell your evaluator that you are shooting for honors, and that if you fall below that standard you want to be told. Then follow up midway through the rotation. Finally, tell them at the end that you really hoped that you met the expectations and would like to discuss your performance. Most attendings don't want to disappoint, and hopefully you get ample time for them to get to know you better. If you make them laugh.... it's over you win you get gleeming honors and an interview invite. DON'T LET THEM INTIMIDATE YOU! I had an attending known as hellfire Helfry. The residents were scared of him. After the case he said, "How long are you here for?" with a smirk on his face. Just be yourself and if you can jab some wit in that's great. In the case of Helfy that is all it took. Making fun of yourself is always a good play. For example on gen surg We were talking about appendicitis. He asked for the signs and I, like a ******, said LLQ pain. He looked up at me with a stare from the OR table I looked back at him and knowing I was wrong and I said, what? the dude might have Kartagener's syndrome, retrocecal colon. then laughed about it afterward. (You had to be there) If you are not a funny or witty person do the same as above and work real hard.

 

[ears]

I totally agree, Bull's eye. That's great advice. I never told anyone that I wanted honors, but it's a good way to go about things. (For one thing, if you've already told the attending you want honors, you're going to bust your a-- so you don't look like a blowhard.)

And definitely, definitely ask for feedback. Specfic feedback, if you can. (Like, "I've been working on my presentations. How have they been going?") Not too often, obviously. But halfway through a rotation is a great time. And when you're going off-service (or someone you've been working with is going off-service) is kind of a natural time.

To the OP: go back and ask your preceptor what the difference between an honors performance and your performance was. Make him get specific, and give you examples. Don't do it as if you want to change your grade; be explicit that you want to get honors in your next rotation, and you don't understand how to do it.

Alternatively, you could decide that only people who really suck up and "drag out the kneepads" get honors, and that it's all arbitrary BS. Your call.

Good luck.

 

[lowbudget]

As far as studying for the shelf, focus on 5 things when you're rounding, taking admissions, whatever...
1) What are the signs and symptoms of a disease?
2) How do you work up a disease? And how do you nail the diagnosis?
3) What is the "next step in management"? Either treatment or diagnostic?
4) What is the differential for a given symptom or lab test?
5) What is normal and what can you do to prevent complications?

When attendings and residents teach, they'll tend to focus on Number 3... You need to remember that as a 3rd and 4th year, you are EXPECTED to learn and know the things that will be on Step 2 (which are basically these 5 things).

Check out USMLE to see what you need to know and let that be your guide to the types of questions you ask during rounds and the things you focus on when an attending is talking.

 

[Ergo]

Wow, thank you for this thread. Im in the process of re-evaluating my behavior.
I am becoming fatigued by "floundering" on the wards.
Doing a good job looks different depending on the observer - or the day of the week -and often they cant tell you what they expect when you ask.

I was getting very positive feedback for the last 3 wks from my attending and resident, then was blindsided by cruel, non-specific non-constructive criticism.
I asked for a small verbal eval - asked him to let me know how I am doing and what he would like me to do differently. I was told (sharply)that I am a "spaz in the O.R." I then told him I wanted to do a good job and asked for specific examples that characterize that behavior (because I am not hyper, dont talk excessively, I ask to assist etc.) He then backtracked and said that "spaz" was the wrong word, but that there were two mistakes I made. Once when injecting lidocaine into a nose the needle detached from the syringe, and on another day I applied traction to a small piece of tissue and it ended up not being helpful. So he wants me to do less, because Im 'overm my head' when assisting with these procedures. Hey, were not talking about microsurgery here, I was just doing a few small injections - which I have done for him dozens of times and made one mistake. He was probably just having a bad day and unloaded on me, but it still created a small sensation of despair.
Im enthusiastic, hard working, I pay attention and am "happy to help." I want to do a good job at anything I try, otherwise why be there at all?
Its just hard to know how each person wants you to 'be' during 3rd year.

No cynicism, just a little slice of despair.

Lot of cynicism in response to your post. And yeah, some of it is justified; the process is somewhat arbitrary, and sometimes boot-lickers get further ahead than they should. (But it's actually less bad in academic medicine than lots of "real-world" kinds of jobs I know.)

But there is still stuff under your control. Big three tips for medical students:

• Know your patients. When you have patients (or your team has them), make sure you know about them: what's going on with them, what the plan is, what could go wrong. Know about their diagnosis, whatever it is. Try to make yourself a sort of expert on whatever it is. No kidding, it helps. (And you actually learn stuff.) Pretend like you were going to give a little talk on whatever it is. Actually do give a little talk on whatever it is.
• Try to be helpful. You want (or you should want) to get in there and try to do stuff, on every rotation there is. Even scut. Actually, especially scut, but that usually leads to good learning opportunities. You can start by saying, "Is there anything I could do to help?" The next level is seeing someone busy doing something, and asking "Could I be doing that for you?" And then there's the level where you've been observing how things work, and you know what comes next, and you start just doing it yourself.
• Be proactive/confident. You can be useful to your team or your preceptor, just by constantly putting yourself out there. And you can demonstrate what you know by speaking up, answering questions, asking questions, and just generally being interested. Meet the people you're working with more than halfway (or try to). Get in there!

In the hospital, you make your own education. If you're aggressive in doing that (in whatever way you want; and believe me, it's you that decides), then you'll succeed. In terms of getting good grades, but also in actually learning what you want to learn to be the kind of doctor you want to be.

Don't let 'em get you down. Good luck!

 

[cbc]

What do you do in those rotations where you switch all the time, like every 2 weeks? Also, I've been working with different people almost everyday. I literally present to 4 different attendings, maybe once-twice a day to each. How are you expected to be evaluated?

Also, isn't it screwed up some schools have F/P/HP/H, whereas some have F/P/H. Even if you are in the HP range, it'll only show up as P. It's either H or bust. What do you think of that?

 

[tom_jones]

I'm currently at a loss as to how to get better grades than just passing in our clinical years. I just finished my psych rotation and received my grade. Despite the fact that I did well enough on the final exam to qualify for a High Pass, the clinical evaluation by my preceptor was not good enough to get me that HP. The thing is, I don't agree with some of his evaluations and mostly of what I did for the rotation was NOT observed by the preceptor. SO how exactly was he able to give a fair assessment of by abilities? It's all PURE BS! 😡

Its all about kissing ace. You'll be amazed at the length some people will go to kiss ace. Ace the USMLE, this is the only objective measure you will have.

 

[ParisHilton]

Get a scouting report from people that went through that rotation. You don't want to spend all your time with a resident who has no impact on your evaluation only to later find out that "you were never around" according to the ones who grade you. Find out who the major players are, who to avoid, when you can leave early etc. You will be amazed at what goes on during your clinical years. I?ve had people on my service that showed up less than half the time and always left after lunch and got a higher grade than me. Unless you?re extremely good or bad, you'll blend in with everyone else and you'll be lucky if they know your name by the end of the rotation. It?s all a game and as the Gambler said, ?If you?re gonna play this game, boy, you gotta learn to play it right.?

 

[ears]

Look, the evaluation business can be very, very arbitrary. I wouldn't deny any of what people are saying. And it certainly can be very demoralizing.

I was getting very positive feedback for the last 3 wks from my attending and resident, then was blindsided by cruel, non-specific non-constructive criticism.
I asked for a small verbal eval - asked him to let me know how I am doing and what he would like me to do differently. I was told (sharply)that I am a "spaz in the O.R." ...

No cynicism, just a little slice of despair.

Sometimes, the resident/attending you're assigned to work with is a terrible, terrible clinical teacher. That sounds like what ran into here. And to a certain extent, there's nothing you can do about what that attending is. But if you have it under your control, try to work with people who are good at teaching you and evaluating you. They're usually not that hard to figure out.

And I hear the despair, and it's certainly justified. But hand in there; if you were getting good feedback, you were probably learning and doing many things right.

What do you do in those rotations where you switch all the time, like every 2 weeks? Also, I've been working with different people almost everyday. I literally present to 4 different attendings, maybe once-twice a day to each. How are you expected to be evaluated?

Two weeks can be plenty of time, depending on what kind of rotation it is. As for presenting to attendings... consider yourself lucky to get to present so often. Make sure you're getting better at your presentations as you go along. Ask them how they think you're doing, if you can. Two weeks, and presenting once-twice a bunch of different attendings sounds like a dream. The really dangerous situation is when you're assigned solely to a real jerk whom you don't get along well with.

And in any event, what can you do? Just control the things you can. Try your best, and remember the idea is that you're making an education for yourself. Figure out what you kind of education you want, and get it.

Also, isn't it screwed up some schools have F/P/HP/H, whereas some have F/P/H. Even if you are in the HP range, it'll only show up as P. It's either H or bust. What do you think of that?

I think that's pretty crummy, actually.

My school has H/HP/P/LP and Fail, and I'll tell you, the presence of "High Pass" makes the "Pass" grade seem like a slap in the face.

What would you think of a ten-point scale? I think that'd actually be kind of cool. Not so much precision that it becomes silly, but don't you think someone could tell the difference between a 9/10 and a 10/10? Hmm...

Get a scouting report from people that went through that rotation.

I think this can be a good idea, but take such "scouting reports" with a grain of salt; they can be more subjective and arbitrary than the grades you're getting!

It?s all a game and as the Gambler said, ?If you?re gonna play this game, boy, you gotta learn to play it right.?

Its all about kissing ace. You'll be amazed at the length some people will go to kiss ace.

Look, even if the grade were all about kissing a--, you have bigger fish to fry: you're there to learn how to be a doctor. (And I think residents and attendings, in general aren't that bad at spotting phonies. Not perfect, but they see more than most medical students think.)

Besides, what a miserable model to try to live by. Do your best; work hard. Be interested and act interested. Ask questions. Ask how you're doing. Think about what kind of doctor, what kind of person you want to be. Plenty of people will notice a genuine, intelligent, eager, motivated student and the grades will mostly follow.

Don't let 'em get you down. Good luck.

 

[Ergo]

Look, the evaluation business can be very, very arbitrary. I wouldn't deny any of what people are saying. And it certainly can be very demoralizing.

Sometimes, the resident/attending you're assigned to work with is a terrible, terrible clinical teacher. That sounds like what ran into here. And to a certain extent, there's nothing you can do about what that attending is. But if you have it under your control, try to work with people who are good at teaching you and evaluating you. They're usually not that hard to figure out.

And I hear the despair, and it's certainly justified. But hand in there; if you were getting good feedback, you were probably learning and doing many things right.

Two weeks can be plenty of time, depending on what kind of rotation it is. As for presenting to attendings... consider yourself lucky to get to present so often. Make sure you're getting better at your presentations as you go along. Ask them how they think you're doing, if you can. Two weeks, and presenting once-twice a bunch of different attendings sounds like a dream. The really dangerous situation is when you're assigned solely to a real jerk whom you don't get along well with.

And in any event, what can you do? Just control the things you can. Try your best, and remember the idea is that you're making an education for yourself. Figure out what you kind of education you want, and get it.

I think that's pretty crummy, actually.

 

[fourthyearmed]

Doing well during third year has nothing to do with book smarts. It's all about being organized, knowing exactly what's going on with your patients, and being where you're supposed to be when you're supposed to be there. Act interested, be willing to help out, be enthusiastic, and it won't matter if you don't know the answer to all of their questions. I was middle of the class first and second years but then I made As on most of my clinical rotations even with average miniboard scores due to my clinical evaluations. As I have posted before, being #1 the first two years doesn't imply you will be good on the wards.

 

[cbc]

How does that work when your shelf exam is like 50-60% of your grade? Even if you ace your eval, which is near impossible considering everyone gets similar evals (i literally worked my tail off compared to my peers last rotation, and received just only BARELY FEW more points in 1 or 2 categories, and I mean BARELY), you still gotta ace your shelf (or am I wrong here?). So in the end, isn't it all about the shelf?

Doing well during third year has nothing to do with book smarts. It's all about being organized, knowing exactly what's going on with your patients, and being where you're supposed to be when you're supposed to be there. Act interested, be willing to help out, be enthusiastic, and it won't matter if you don't know the answer to all of their questions. I was middle of the class first and second years but then I made As on most of my clinical rotations even with average miniboard scores due to my clinical evaluations. As I have posted before, being #1 the first two years doesn't imply you will be good on the wards.

 

[Seaglass]

The shelf is weighted differently at different schools and in different rotations.

 

[cbc]

Even if the shelf is only 20 or 30%, I can't see how the shelf won't be the determining factor of a grade. Like I said, doesn't everybody basically gets extremely similar level of evaluations ("John Smith did a good job."). Even if you get 10/10 in every category, if you don't honor the shelf, there's no way you'll receive honor (or am I wrong here?).

The shelf is weighted differently at different schools and in different rotations.

 

[tega]

Even if the shelf is only 20 or 30%, I can't see how the shelf won't be the determining factor of a grade. Like I said, doesn't everybody basically gets extremely similar level of evaluations ("John Smith did a good job."). Even if you get 10/10 in every category, if you don't honor the shelf, there's no way you'll receive honor (or am I wrong here?).

i sure hope so...cuz evaluations are too subjective to be the primary determinant of such an important grade. you shouldn't have to "play the game" to get a certain grade.
i had 2 teams during the first half of my med rotation...it was like night and day...and i was basically the same person. go figure 😕

 

[fourthyearmed]

How does that work when your shelf exam is like 50-60% of your grade?

Our shelf was usually about 30%. Therefore it was possible to ace your evals and do average on the shelf and still get an A. And everybody doesn't always get the same evals!

 

[Mumpu]

Our shelf is ~20% of the grade but it's kind of separate -- you need 60% to pass, 70% to honor, so excellent evals and a crappy Shelf score will keep you from honoring.

 

[irlandesa]

From reading about the trials of third year on here, I think one thing people don't realize in advance is that 3rd year is a lot like the military. Unconditional respect for the hierarchy and accounting for every bit of your time is the norm. As I said on another thread, if you have to leave early or miss sign-out, attending rounds, etc; be sure to clear it in advance with your resident and attending, if possible, with WRITTEN documentation. even one "incident" can be frowned upon and possibly hurt your grade. Even minor things like going to the bathroom b/c of diarrhea or female issues during rounds can provoke some dirty looks if you disappear without telling your resident. Also, any problems with excessively rude patients, residents, staff, or harrasment from anyone should be reported to the clerkship director immediately before you end up taking the blame and it comes back to bite you in the arse. It sounds paranoid, but CYA is the way to go third year.

 

[Mumpu]

Wow, some people here go to hardcore programs. You can miss just about everything here (within reason -- the system is not to be abused) -- the understanding is that patient care comes first and students are encouraged to be primary providers for their patients. I've missed chief classes because I was admitting patients, morning report because I was in autopsy of my patient, etc.