might suddenly be failing 4th year days before graduate (already matched). Feeling numb

[Nahom]

I cannot imagine a more hellish situation. My clerkship director called me today and said I failed my preceptor evaluations for my final (and required) rotation of medical school. Did great on exam, osce, etc.

Heres the thing: I sat down and got feeback from the 3 preceptors I worked with at the end of each week and they all literally said (or wrote in the formative feedback form) that I was doing well and "at expectations" for an MS4. My director told me that the *written* portion of my preceptor evaluations were really positive, and the only "negative" thing was "was a little disorganized with presentations on rounds but quickly improved after feedback."

I asked my rotation director how this contradiction could happen, stellar written evals and face-to-face feedback throughout the month, but the NUMERICAL evaluation (where they fill in bubbles for various questions etc) was a FAIL. He said this happens 4-5 times a year and its because you happen to get multiple attendings that dont understand the way the eval surveys worked (and he admitted that they are confusing). He contacted one of my attendings that I worked with for a week and evaluated me and ALSO happens to be over all of the students for this rotation at this specific hospital and she said

"thats so odd this happend. *He should pass this course*"

They are having a meeting in a few days (literally days before graduation) to decide my fate. I tried my VERY hardest on this rotation, as I do with all of them all 4 years and have NEVER gotten close to failing anything in medical school. This is so strange. The program director thinks its much more likely than not that he will pass me, but I can't stop worrying about this. Would my school seriously destroy my path literally days before graduation so I graduate a year late and have my residency match void?? I just cant believe this, especially since the attendings over my grades all told me I was doing well both during and after the rotation, and the "boss" attending over all the students said "I should pass" after hearing this weird situation I'm in.

What do you guys think?

Thanks. I just feel like I am burning in hell right now.

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[differentiating]

My clerkship director called me today and said I failed my preceptor evaluations for my final (and required).

I'm assuming you mean your last rotation based on the rest of your post? It's a little confusing overall, though I fully understand why given how distraught you currently are.

It's certainly not the most awful situation I can imagine, but it's a pretty stressful one. That being said, assuming this isn't a "tip of the iceberg"-type SDN post, I imagine you'll be fine. The clerkship director (I assume) said he'll probably pass you, attendings who evaluated you said you should pass, your written evals directly contradict the numerical score, and the rotation director says he's seen this issue happen before.

Now, if you'd actually done something warranting failure, it'd be within the school's rights to fail you on this rotation regardless of what it meant for graduation/residency plans. But from what you've written here, that's not the case, and I doubt they'd want to penalize you for what sounds like an error in the grading system.

 

[WalSlave]

Sounds like someone misunderstood the scale. User error happens on these evals more than you‘d think. Your rotation director is having a meeting with the attending who already said he meant to pass you? I’d say you’re as good as “passed” at this point. Try not to let yourself get too distraught while you wait out this meeting with all the catastrophic thinking. You’re good to go.

 

[Nahom]

I'm assuming you mean your last rotation based on the rest of your post? It's a little confusing overall, though I fully understand why given how distraught you currently are.

It's certainly not the most awful situation I can imagine, but it's a pretty stressful one. That being said, assuming this isn't a "tip of the iceberg"-type SDN post, I imagine you'll be fine. The clerkship director (I assume) said he'll probably pass you, attendings who evaluated you said you should pass, your written evals directly contradict the numerical score, and the rotation director says he's seen this issue happen before.

Now, if you'd actually done something warranting failure, it'd be within the school's rights to fail you on this rotation regardless of what it meant for graduation/residency plans. But from what you've written here, that's not the case, and I doubt they'd want to penalize you for what sounds like an error in the grading system.

Oops! Yes, i meant final rotation of med school. Corrected. And no, this isnt a “tip of the iceberg” post. I literally have no red flags, am well liked and got into a top 20 residency program.

 

[candbgirl]

And someone needs to provide training in completing the bubble sheets or get rid of them.

 

[GoSpursGo]

If everyone says that you should pass, then this is almost certainly a blip in the grading scale. I’m sure it’s stressful to sit thorough but you’ll probably be fine.

 

[Raryn]

And someone needs to provide training in completing the bubble sheets or get rid of them.

They're often surprisingly confusingly implemented in this context. At one point, my medical school had a 9-point scale based on the ACGME evaluation for residents. I don't know if you've actually read the descriptors on those evaluations, but they're... aggressive.

For history-taking, a 5/9 would be "Consistently acquires accurate and relevant histories from patients". An 8-9 requires "Obtains relevant historical subtleties, including sensitive information that informs the differential diagnosis".

It goes down the line like that. An 8-9 out of 9 for being able to integrate information had the verbiage "Role models and teaches the effective use of history and physical examination skills to minimize the need for further diagnostic testing" while a 4-6 had "Uses collected data to define a patient’s central clinical problem(s)".

If you were an honest evaluator looking at a *medical student*, there are probably zero people who should *ever* get above a 7 on those scales. They are meant for residents, where interns start off at 4-5 and a minority of graduating seniors are 9 (and many aren't 8).

So we had two groups of people who filled out the evals for the medical students - those who would ignore all the text and be like "yeah, it's a good medical student, maybe even above average, 8/9 is a B, right?", and those who would read the actual text and be like "hey, he's well above average, 6/9!". Your grade hugely depended on which preceptor/site you got. I have no idea if those rotations have updated their expectations or trained their preceptors better at this point (it's been 6 years), but it was ****.

 

[differentiating]

Oops! Yes, i meant final rotation of med school. Corrected. And no, this isnt a “tip of the iceberg” post. I literally have no red flags, am well liked and got into a top 20 residency program.

Then you'll almost certainly be fine. Like I said - I can't imagine the school being willing to fail you for this alone, especially since everyone involved thinks you should pass.

They're often surprisingly confusingly implemented in this context. At one point, my medical school had a 9-point scale based on the ACGME evaluation for residents. I don't know if you've actually read the descriptors on those evaluations, but they're... aggressive.

For history-taking, a 5/9 would be "Consistently acquires accurate and relevant histories from patients". An 8-9 requires "Obtains relevant historical subtleties, including sensitive information that informs the differential diagnosis".

It goes down the line like that. An 8-9 out of 9 for being able to integrate information had the verbiage "Role models and teaches the effective use of history and physical examination skills to minimize the need for further diagnostic testing" while a 4-6 had "Uses collected data to define a patient’s central clinical problem(s)".

If you were an honest evaluator looking at a *medical student*, there are probably zero people who should *ever* get above a 7 on those scales. They are meant for residents, where interns start off at 4-5 and a minority of graduating seniors are 9 (and many aren't 8).

So we had two groups of people who filled out the evals for the medical students - those who would ignore all the text and be like "yeah, it's a good medical student, maybe even above average, 8/9 is a B, right?", and those who would read the actual text and be like "hey, he's well above average, 6/9!". Your grade hugely depended on which preceptor/site you got. I have no idea if those rotations have updated their expectations or trained their preceptors better at this point (it's been 6 years), but it was ****.

Yeah, my school pulls this kind of thing too, except our descriptors are on the opposite side of the scale. Our scale was 1-5, but 3 (minimum to pass) is something like "takes good histories and elicits all necessary details" and a 5 (honors) would be "takes great histories and elicits all details". A joke is that it's common for evaluators to write "X functioned as an intern" and give straight 3s because they sound really positive if they don't understand how our grading system really works. Our school says that they investigate these kind of discrepancies between comments and numerical score, but I personally haven't seen a numerical pass bumped up to an honors due to glowing comments.

 

[Nahom]

Thanks for the support guys. Feeling more calm today but still pretty bad. I have a wonderful wife, family, and amazing friends that also really help. The meeting is tomorrow, will keep everyone posted.

 

[Merely]

You’re good bro it’s just a clerical error enjoy your time off before residency starts, you earned it

 

[Nahom]

Passed the course

 

[candbgirl]

Yay!

 

[group_theory]

Passed the course

Congrats very-soon-to-be Dr Nahom

 

[thumbz]

As someone who fills these out regularly, I've been tripped up before when school A goes from 1-5 left to right, and school B goes from 5-1 left to right. So all of a sudden I've inadvertently given someone a 1 or a 2 when I meant to give a 4 or 5... it kinda sounds like that is what happened here. (Yes, I often have multiple students from 3 affiliated schools, so I get a stack of evals and don't always look that closely when I go from one to the next if I know the student is going to get a good eval)

 

[Piebaldi]

As someone who fills these out regularly, I've been tripped up before when school A goes from 1-5 left to right, and school B goes from 5-1 left to right. So all of a sudden I've inadvertently given someone a 1 or a 2 when I meant to give a 4 or 5... it kinda sounds like that is what happened here. (Yes, I often have multiple students from 3 affiliated schools, so I get a stack of evals and don't always look that closely when I go from one to the next if I know the student is going to get a good eval)

Yep exactly. That's why it's easier when it's 1-10. Clearly someone who gets a 1 is bad but someone who gets a 9 or 10 is pretty good, no confusion there. But you are absolutely right those scales can get confusing and not everyone reads the description of how to use it.

 

[mvenus929]

Yep exactly. That's why it's easier when it's 1-10. Clearly someone who gets a 1 is bad but someone who gets a 9 or 10 is pretty good, no confusion there. But you are absolutely right those scales can get confusing and not everyone reads the description of how to use it.

A ten point system may have the same issue that thumbs was referring to... the number 1 could be on the left or the right, but could mean the same thing on two different evals.

 

[Bernardo_11]

Perhaps something like this would prevent further mistakes; same concept just minor changes in wording maybe replace "Hurt(s)" with "Suck(s)":

 

[emergentmd]

I don't really get what happened. It has been years since I have been out of med school but once you matched, the rest of the months were just a formality unless you go out an robbed a bank.

I don't know of anyone who matched, then failed a rotation, and had to repeat the year.

if this happens, it would royally screw up residencies who are expecting an intern in July only to find out they failed a May rotation????

Really really unusual I would think

 

[evilbooyaa]

I don't really get what happened. It has been years since I have been out of med school but once you matched, the rest of the months were just a formality unless you go out an robbed a bank.

I don't know of anyone who matched, then failed a rotation, and had to repeat the year.

if this happens, it would royally screw up residencies who are expecting an intern in July only to find out they failed a May rotation????

Really really unusual I would think

Rare but happens, usually when people schedule real rotations (for some dumb reason, or due to limited availability) and then completely blow it off.

After match day either do no rotation, do something chill that is OK with you flaking, or do something that you will actually show up to. I've seen some MS4s take it too far, where they no-show for a whole week of the rotation without telling anybody.... or the one I actually saw in the news was a MS4 forged signatures saying he attending his ED rotation at the tail end of his MS4 year.

Regardless - this is all for naught as OP essentially was dealing with a clerical error from an attending/school that is not double-checking it's work.

 

[SLC]

My school had a screwed up eval system. We were graded on a 0-4 scale, 10 questions they asked attendings to rate us on. you needed a near perfect score from the attending to have a chance at honors or high pass. If you got less than 4 on more than 2 areas, you were probably going to get a “pass” at best.

But they wouldn’t tell the attendings what score was necessary. On my sub-I evaluation the PD comments said “he earns honors by our standards” but the numbers still added up to a pass.

 

[tellme_areyoufree]

Oh man. I once had an attending fill out two evals for me. We were rated on a scale of 1-6, and he filled out one eval with all 1s and another with all 6s, and in the comments said "use whichever is better."

These eval systems are dumb, and they seem to be dumb everywhere.

re: your situation. The fact that multiple people are advocating for you is good. Are you allowed to attend this meeting? I would if I were you. Be calm, engaged, and advocate for yourself without being demanding. Talk about the good experience of the rotation and your efforts to improve and succeed, reflected by comments and other scores. Ask them to provide you definitive documentation of the pass once they agree to it.

re: evals in general. These eval systems should be drastically simplified... at least every one that I've seen. "Recommend pass," "recommend remediation," or "recommend honors." Simple. Keep it simple. Remember this crap if you're an attending in the future with an opportunity to advocate for changes.

I'm sorry you have to go through this, but it sounds like you'll make it through.

 

[Piebaldi]

Oh man. I once had an attending fill out two evals for me. We were rated on a scale of 1-6, and he filled out one eval with all 1s and another with all 6s, and in the comments said "use whichever is better."

These eval systems are dumb, and they seem to be dumb everywhere.

re: your situation. The fact that multiple people are advocating for you is good. Are you allowed to attend this meeting? I would if I were you. Be calm, engaged, and advocate for yourself without being demanding. Talk about the good experience of the rotation and your efforts to improve and succeed, reflected by comments and other scores. Ask them to provide you definitive documentation of the pass once they agree to it.

re: evals in general. These eval systems should be drastically simplified... at least every one that I've seen. "Recommend pass," "recommend remediation," or "recommend honors." Simple. Keep it simple. Remember this crap if you're an attending in the future with an opportunity to advocate for changes.

I'm sorry you have to go through this, but it sounds like you'll make it through.

I think OP already got this situation taken care of, it was a confusion of rating scale.
And your situation is hilarious btw - I know which eval I would use!

But that's one of the problems with evals in residency in particular - if you are well liked and what not, you can get good evals. Even if you are a good resident, if not well liked, it's completely subjective and that can tank your evals. That was notorious at my program - until the GME and dean finally got rid of the toxic attendings.