MSPE comments bad?

[hopefulscribe2]

Hi there,

I am wondering if these are coded MSPE comments that suggest I didn't do a good job on the clerkship. Any thoughts? Thank you!

Student passed his surgery rotation. He was prompt, polite and professional. He was engaged and enthusiastic. He is able to take a focused history and perform an appropriate physical examination. He is able to give a reasonable patient presentation for a beginning third year medical student. He reads about his patients and is always available to help. He needs to progress with differential diagnosis as well as management plans during the remainder of his third year. One faculty commented, “engaged, asked for feedback, made progress on notes throughout rotation, can give basic differential diagnosis. Continue reading, work on documentation including assessment statements” Overall, student is performing appropriately for a third year medical student. He will surely continue to progress with medical knowledge, differential diagnosis and clinical skills throughout his fourth year.

Student passed the Pediatric Clerkship. He was engaged, eager to learn, and showed great listening skills evident in his attentiveness to patients’ and their families’ needs. He was able to perform the required clinical skills with notable improvement in history taking and commendable notes and patient communication. He demonstrated professionalism and respect to the providers and staff he worked with making him a valuable team member. He is expected to continue evolving his critical thinking towards becoming an entrustable learner.

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[ChymeofPassion]

???

 

[GoSpursGo]

Seems formulaic, which is most of the MSPE.

 

[mrbreakfast]

Depends on your med school culture, but I would say these are "pass" evaluations (which is fine, ideally what most students should get).

As a medical student I also tried to read into evaluation comments. Now as someone who has to fill them out, I have realized that most medical students perform at a level roughly indistinguishable from one another. Comments like "prompt, polite and professional...engaged and enthusiastic" find their way into most of my evaluations, but I expect every student to be prompt, polite, and professional, etc.

 

[Dral]

Usually if there is a negative, it will be stated as such. I don't perceive 'coded' language in MSPE's. Maybe it happens.

LoRs are where one can perceive coded language. In general, LoRs should be fairly glowing.

Student Bee did a spectacular job and we hope to match them at our home program. I have absolutely no reservations with recommending them and expect them to become a cream of the crop surgdoctorologist.

vs

Student Cee fulfilled their duties well. While they had some communication issues at the beginning, these improved over time.

The first example is an expected glowing letter. The second example would give me worry that the person may have some underlying traits that make them possibly a bit difficult to work with (but the writing does not for example say outright "I think student Cee has a type B personality disorder. Avoid them").

 

[Goro]

Reads far better than "works well under supervision".

 

[Angus Avagadro]

Sounds like a pretty positive eval for a 3rd yr med student. There are some gaps with respect to differential diagnosis, documentation, and clinical skills that are typical for a 3rd yr student . Nice comments, engaged, professional, etc.. This evaluation basically tells me as a clinical instructor " I can teach this person" . I wouldn't worry.

 

[cj_cregg]

This all looks pretty standard and would not worry me in any way.

 

[Redpancreas]

Hi there,

I am wondering if these are coded MSPE comments that suggest I didn't do a good job on the clerkship. Any thoughts? Thank you!

Student passed his surgery rotation. He was prompt, polite and professional. He was engaged and enthusiastic. He is able to take a focused history and perform an appropriate physical examination. He is able to give a reasonable patient presentation for a beginning third year medical student. He reads about his patients and is always available to help. He needs to progress with differential diagnosis as well as management plans during the remainder of his third year. One faculty commented, “engaged, asked for feedback, made progress on notes throughout rotation, can give basic differential diagnosis. Continue reading, work on documentation including assessment statements” Overall, student is performing appropriately for a third year medical student. He will surely continue to progress with medical knowledge, differential diagnosis and clinical skills throughout his fourth year.

Student passed the Pediatric Clerkship. He was engaged, eager to learn, and showed great listening skills evident in his attentiveness to patients’ and their families’ needs. He was able to perform the required clinical skills with notable improvement in history taking and commendable notes and patient communication. He demonstrated professionalism and respect to the providers and staff he worked with making him a valuable team member. He is expected to continue evolving his critical thinking towards becoming an entrustable learner.

My take's a little different than above.

I don't want to promote more neuroticism than there already is on SDN but these seem like below average evals. These are indications you might be a bit behind your class. The tendency is usually to commend students and say things like "they're doing an excellent job, exceeded expectations, pleasure to work with". No need to panic, you're clearly doing what's expected and are not in any trouble by any means but remain complacent and the gap will widen with each clerkship. It's not fair but as much as 25% of your class either has a first degree physician relative and have already learnt medicine-speak or they come from a clinical background and have an edge in clinical reasoning. If you don't have this, find someone a few years ahead of you in residency/fellowship/attending-hood and tell them your clinical skills are weak. Run through mock cases or scenarios for them. Make them grill you.

The other way to learn quickly is to truly commit to autonomy. It's scary to do because you're being judged for what you say but most MS3s especially read our notes and present off them because they really lack a big picture. Start trying to form your own impression and big picture and practice doing it. Ask yourself why the patient is in the hospital and if that issue is getting better. If not, what are the 1-3 things we can do differently. You have to gauge your environment though. I wouldn't do this in a competitive surgical rotation environment where you get kicked out of the OR for not knowing the patient's potassium on the first day of third year (true story).

 

[operaman]

Agree these sound pretty average. The surgery one even notes it’s your first rotation and that you made good progress. Truth is that’s pretty accurate feedback for any third year student, even the superstars. Nothing to suggest you did anything truly bad, just that you’re learning. An honors eval would probably say more things like you’re ahead of the game, strong foundation, beginning to function more like a resident by the end of the rotation, etc.

I would expect this to be coupled with M4 and sub-I comments to reflect improvement and say things like you’re ready to be an intern and starting to function at that level. Coupled with solid letters and nothing in these MSPE comments would make be not interview someone.

It’s frustrating that there’s so much score creep in evals and I admit I’m guilty of it too. Essentially we have to pretend that a student is functioning like a seasoned attending for them to get honors.

 

[collegestud2013]

I suspect these commends sound like average or slightly below average student (but still passing). When someone does well on a rotation, most schools would learn towards highlighting strong performance with stronger language. If your school also gives a numerical score and compares you to the class that may be more reflective. Not a red flag here unless you were going for a surgical specialty.

 

[psyspy]

Don't expect all honors evals. Don't read into them too much. Shelf ultimately will differentiate scores among classmates the most

 

[GoSpursGo]

My take's a little different than above.

I don't want to promote more neuroticism than there already is on SDN but these seem like below average evals. These are indications you might be a bit behind your class. The tendency is usually to commend students and say things like "they're doing an excellent job, exceeded expectations, pleasure to work with". No need to panic, you're clearly doing what's expected and are not in any trouble by any means but remain complacent and the gap will widen with each clerkship. It's not fair but as much as 25% of your class either has a first degree physician relative and have already learnt medicine-speak or they come from a clinical background and have an edge in clinical reasoning. If you don't have this, find someone a few years ahead of you in residency/fellowship/attending-hood and tell them your clinical skills are weak. Run through mock cases or scenarios for them. Make them grill you.

The other way to learn quickly is to truly commit to autonomy. It's scary to do because you're being judged for what you say but most MS3s especially read our notes and present off them because they really lack a big picture. Start trying to form your own impression and big picture and practice doing it. Ask yourself why the patient is in the hospital and if that issue is getting better. If not, what are the 1-3 things we can do differently. You have to gauge your environment though. I wouldn't do this in a competitive surgical rotation environment where you get kicked out of the OR for not knowing the patient's potassium on the first day of third year (true story).

Meh. I think it is possible to interpret it that way, but it just depends on the school. Some schools just copy/paste all of the attending comments into the MSPE, and those would be kind of generic points for improvement that any attending might say just to give *something* for the student to work on.

Agree it's probably not an honors eval, could be slightly above or below average. Ultimately the advice you're giving makes sense. I just don't think there's a ton of sense in trying to divine where you stand based on comments unless they are obviously glowing or obviously problematic.

 

[Angus Avagadro]

Remember, this a 3rd yr medical student. Unless they were a PA or RN in another life, these are normal and expected deficiencies. We all had them. No early 3rd yr student Honors surgery. After 4 yrs of undergrad, advanced degrees, and 2 yrs of medical school, we discovered on our first 3rd yr rotation, we were pretty much useless.

Rule XI,..Show me a medical student that only triples my work and I'll kiss their feet...The Fat Man.

 

[GoSpursGo]

Rule XI,..Show me a medical student that only triples my work and I'll kiss their feet...The Fat Man.

Recently had a weekend where the residents were off for some sort of retreat, so it was just me and the fellow rounding. We had, by far, the fastest and most efficient rounds I've ever gotten to run.

 

[Redpancreas]

Meh. I think it is possible to interpret it that way, but it just depends on the school. Some schools just copy/paste all of the attending comments into the MSPE, and those would be kind of generic points for improvement that any attending might say just to give *something* for the student to work on.

Agree it's probably not an honors eval, could be slightly above or below average. Ultimately the advice you're giving makes sense. I just don't think there's a ton of sense in trying to divine where you stand based on comments unless they are obviously glowing or obviously problematic.

I think we both have good points. Ultimately I hope OP sees useful points in both takes. All I hope to impress on OP is to be very proactive about any feedback he or she gets. In my experience, I perceived little constructive feedback until residency so any feedback delivered earlier would be welcome.

At the same time, OP should not get discouraged. Medicine does have definitely wrong answers, but more than one right answers. Don’t fret if you and an attending always don’t see eye to eye. Here I do see a pattern of mixed evaluations.

 

[Lawpy]

It’s frustrating that there’s so much score creep in evals and I admit I’m guilty of it too. Essentially we have to pretend that a student is functioning like a seasoned attending for them to get honors.

That’s why it’s a terrible idea to grade MS3s at the level of attendings. Honors should mean MS3s really did outstanding work as a student, not as if they’re functioning like an attending. And there are fundamental differences between student performances within each class that attendings can easily spot.

 

[cj_cregg]

I think we both have good points. Ultimately I hope OP sees useful points in both takes. All I hope to impress on OP is to be very proactive about any feedback he or she gets. In my experience, I perceived little constructive feedback until residency so any feedback delivered earlier would be welcome.

At the same time, OP should not get discouraged. Medicine does have definitely wrong answers, but more than one right answers. Don’t fret if you and an attending always don’t see eye to eye. Here I do see a pattern of mixed evaluations.

There is certainly constructive feedback present, but in my mind it is the constructive feedback that I would expect a third year to need - read more, develop your differential and assessment/plan, etc. The whole point of third year is to learn those things and so I see those types of comments in many MSPEs and do not consider it a red flag or concerning at all. It is really pretty average/standard from the apps I've seen. I'd be worried if the constructive criticism was related to professionalism, communication skills, etc. but that's not the case for OP.

Take the feedback into account, work on those areas, try to improve - absolutely. But this isn't anything that I would stress about for residency applications I think is the point that I'm making.

 

[supsup321]

Reads far better than "works well under supervision".

we aint midlevels here buddy

 

[Angus Avagadro]

we aint midlevels here buddy

True. But if I had a nickel for whenever a medical student may not have had the correct answer to a question, but were never in doubt about the answer they gave me, I could have retired years ago. Unlike midlevels, physicians get paid to know. Students who make the best residents are the ones who know what they don't know, and are teachable. Of course, I will always have a need for the doctor to take care of my mother in law.

 

[jstwannagraduaaate!!!]

I browse this site occasionally, and its posts/responses like these make me wanna sign off for good. You passed one of the hardest rotations with run-of-the-mill standard evals and no red flags. Unless you want neurosurgery etc you're fine.

 

[Goro]

True. But if I had a nickel for whenever a medical student may not have had the correct answer to a question, but were never in doubt about the answer they gave me, I could have retired years ago. Unlike midlevels, physicians get paid to know. Students who make the best residents are the ones who know what they don't know, and are teachable. Of course, I will always have a need for the doctor to take care of my mother in law.

Humor doesn't travel well over the internet, wise colleague. I believe that supsup was joking

 

[FlowRate]

I agree with everyone that all of the comments sound exceptionally appropriate for a beginning third year med student.

And I can say that the culture of my medical school was such that these would be below-average comments if kept in the "summative" section of the eval.

We had "formative" and "summative" sections. Formative = actual feedback, more likely to be critical, does not show up on MSPE. Summative = more coded comments and reflects your grade on the rotation.

Summative comments along the lines of what OP posted would indicate a student who, for at least part of the rotation, was judged to have significant deficiencies in comparison to other peers. Student might have improved significantly by the end of the rotation but that would still leave you behind vs the students who started and finished stronger.

But that's just the culture of my med school. Having read many MSPE's while on residency selection committee, I'd say I mostly skimmed the MSPE and stopped caring about most rotation comments unless something really stuck out. Doesn't seem out of the ordinary for what I might have seen in any random applicant's file.