Objective Measurement 3rd year?

[LoveandHate]

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So I am a first year. I have discovered that the trick to doing well on an evaluation is to be liked by the evaluator (this is regardless of my actual performance). Is 3rd year any better? Worse? How important are objective measures of performance (shelf exams)?

 

[stimuluspackage]

So I am a first year. I have discovered that the trick to doing well on an evaluation is to be liked by the evaluator (this is regardless of my actual performance). Is 3rd year any better? Worse? How important are objective measures of performance (shelf exams)?

For evaluations, generally it is about how much you are liked by the evaluator, especially with interns and residents who are closer to your age. Some of the more experienced attendings are more objective probably. However, if they don't like your "vibe," this is probably the difference between a good and great eval. My preceptor on medicine told me she thought I was really smart and had good thorough presentations and notes, but said I seemed not engaged on rounds sometimes which reflected in my evals. I didn't really feel that was true, but that was the "vibe" i gave off, such is life.

As far as shelf exam importance, totally school dependent. At my school, they don't matter unless you fail and grade is totally off evals. At other schools, they count for like half the grad

 

[sirenomelia]

Clerkship evals are far more subjective than pre-clinical grades

-Work tirelessly
-Care about and know every detail about your specific patients and their problems
-Do whatever your asked with a great attitude
-Show interest in that specialty even if you have no plans to do it
-Don't complain, show off, or undermine anyone else
-Be really nice to the nurses and support staff and make them your allies
-NEVER lie or feed bad data to your team- If you don't know something or forgot to check a value then just say you dont know but you will find out

 

[Law2Doc]

So I am a first year. I have discovered that the trick to doing well on an evaluation is to be liked by the evaluator (this is regardless of my actual performance). Is 3rd year any better? Worse? How important are objective measures of performance (shelf exams)?

The shelf exam weights will vary by school, and even by rotation within each school. In general, they are worth a lot less than the subjective evaluation by the attending(s) and senior residents. Being liked helps, but in third year there are other factors at play -- you have to be a useful member of the team (residents will generally weigh in), and you often have to outshine other med students who are on the rotation with you. I've seen cases where the attending clearly liked a med student, but then based the grade largely on what the senior resident said about him. I've seen cases where the attendings and residents clearly liked both med students who were on a rotation at the same time, but liked one better and the difference was reflected in the final grade, despite the fact that the less impressive of the two probably would have gotten a higher grade if he had been on rotation with a different classmate. Then there's situations here attendings or senior residents change over mid rotation and suddenly all the goodwill you have built up goes out the window because the folks who end up grading you missed your brightest hours. Welcome to subjective evaluation. It's how the world works out of school, not just in medicine.

 

[Siverhideo1985]

Clerkship evals are far more subjective than pre-clinical grades

-Work tirelessly
-Care about and know every detail about your specific patients and their problems
-Do whatever your asked with a great attitude
-Show interest in that specialty even if you have no plans to do it
-Don't complain, show off, or undermine anyone else
-Be really nice to the nurses and support staff and make them your allies
-NEVER lie or feed bad data to your team- If you don't know something or forgot to check a value then just say you dont know but you will find out

I'd say this approach is true in 50% of cases. The other 50% is just being able to play the game with your evaluator. The things above are all valid and for your own sake you should do them regardless of the benefit to your evals, but oh so often have I gotten good evals because I was able to relate to the attending in one way or another. From my personal (and therefore purely anecdotal) experience it is very much about how much the people writing your evals like you...there are different ways to go about being liked.

 

[da8s0859q]

-Do whatever your asked with a great attitude

Not trying to pick a fight, but do you think that med students should maintain that great, ooh-I'm-so-happy attitude when being blatantly scutted out beyond the point of just doing little things to help your interns/residents, and paying a whole lot of money to be there while learning nothing?

Of course it's good for evaluations, but then there's the matter of (a) just how badly is a low-mid B going to hurt you anyway, and (b) dignity.

 

[Law2Doc]

Not trying to pick a fight, but do you think that med students should maintain that great, ooh-I'm-so-happy attitude when being blatantly scutted out beyond the point of just doing little things to help your interns/residents, and paying a whole lot of money to be there while learning nothing?

Of course it's good for evaluations, but then there's the matter of (a) just how badly is a low-mid B going to hurt you anyway, and (b) dignity.

Dignity doesn't come into play. You are the bottom of the totem pole. If you learn how to happily endure working with idiots, that is a far more useful skill for your career than any medical "black pearl" some resident is going to try to teach you. You show up with a good attitude and work hard at whatever gets thrown your way, and you get lauded. You gripe about not being taught enough and being scutted out and you will get regarded negatively. It's a lesson many people learn the hard way. And stop focusing on "paying money to be there". The attendings and residents who will work with you see none of that money, and so your anger is misplaced. You are paying tuition for both a degree and some level of preparation for intern year, where you will actually START to learn medicine. All this other stuff is foundation, but your real training lies ahead. If you are scutted out for menial tasks, it's likely because you aren't really able to add value anywhere else. Such is life.

 

[Rollo]

Dignity doesn't come into play. You are the bottom of the totem pole. If you learn how to happily endure working with idiots, that is a far more useful skill for your career than any medical "black pearl" some resident is going to try to teach you. You show up with a good attitude and work hard at whatever gets thrown your way, and you get lauded. You gripe about not being taught enough and being scutted out and you will get regarded negatively. It's a lesson many people learn the hard way. And stop focusing on "paying money to be there". The attendings and residents who will work with you see none of that money, and so your anger is misplaced. You are paying tuition for both a degree and some level of preparation for intern year, where you will actually START to learn medicine. All this other stuff is foundation, but your real training lies ahead. If you are scutted out for menial tasks, it's likely because you aren't really able to add value anywhere else. Such is life.

Harsh words but I agree to certain extent as far as learning to not let others' attitudes rule your emotional state of mind.

But why not just send the student home early? Some of us will care enough to actually go home and study if we aren't spending 10 hours doing secretarial work or shadowing you.

 

[astrocreep96]

Dignity doesn't come into play. You are the bottom of the totem pole. If you learn how to happily endure working with idiots, that is a far more useful skill for your career than any medical "black pearl" some resident is going to try to teach you. You show up with a good attitude and work hard at whatever gets thrown your way, and you get lauded. You gripe about not being taught enough and being scutted out and you will get regarded negatively. It's a lesson many people learn the hard way. And stop focusing on "paying money to be there". The attendings and residents who will work with you see none of that money, and so your anger is misplaced. You are paying tuition for both a degree and some level of preparation for intern year, where you will actually START to learn medicine. All this other stuff is foundation, but your real training lies ahead. If you are scutted out for menial tasks, it's likely because you aren't really able to add value anywhere else. Such is life.

+1 to the bolded part. I swallowed my pride at the beginning of 3rd year and did what was required. It's stupid, but it is also only temporary and everyone has been there.

I disagree regarding the "paying money to be there." I've entered into a contract with the school and I expect to get my money's worth. I have no problem going from eval to dean with detailed complaints if someone burns me out of my expensive education. Just because I'm in a school setting doesn't mean my money is worthless. I don't particularly care if the resident or attending doesn't see a penny of it - they're at a teaching hospital and I pay my fees so the administration can keep people in check, if nothing else.

 

[Orbo]

Dignity doesn't come into play. You are the bottom of the totem pole. If you learn how to happily endure working with idiots, that is a far more useful skill for your career than any medical "black pearl" some resident is going to try to teach you. You show up with a good attitude and work hard at whatever gets thrown your way, and you get lauded. You gripe about not being taught enough and being scutted out and you will get regarded negatively. It's a lesson many people learn the hard way. And stop focusing on "paying money to be there". The attendings and residents who will work with you see none of that money, and so your anger is misplaced. You are paying tuition for both a degree and some level of preparation for intern year, where you will actually START to learn medicine. All this other stuff is foundation, but your real training lies ahead. If you are scutted out for menial tasks, it's likely because you aren't really able to add value anywhere else. Such is life.

+1 to the bolded part. I swallowed my pride at the beginning of 3rd year and did what was required. It's stupid, but it is also only temporary and everyone has been there.

I disagree regarding the "paying money to be there." I've entered into a contract with the school and I expect to get my money's worth. I have no problem going from eval to dean with detailed complaints if someone burns me out of my expensive education. Just because I'm in a school setting doesn't mean my money is worthless. I don't particularly care if the resident or attending doesn't see a penny of it - they're at a teaching hospital and I pay my fees so the administration can keep people in check, if nothing else.

Agree with the disagreement. It's like saying college students have no right to complain about bad professors because "professors never see a penny of their tuition." Actually they do. Same with MDs in teaching institutions. Part of their job description is to teach, and their salaries come from the institution which does receive funds from tuition (even if it's a minute portion overall).

So yeah, while some degree of scut is to be expected and put up with, if a student is, despite putting in genuinely good effort, not receiving any education from his attendings and senior residents, he has every reason to be upset. To excuse bad attendings who never teach within the setting of a teaching hospital continues the negative precedent that makes medical education, at times, such a stinking s-hole.

 

[Law2Doc]

...
But why not just send the student home early? Some of us will care enough to actually go home and study if we aren't spending 10 hours doing secretarial work or shadowing you.

simple. When you are in residency you are going to try to send the med students home early and shortly afterwards something cool is going to walk in the door. The attending will come in and say "where are my med students?", and then tear you a new one because you sent them home early. So you quickly learn it's just not worth it. I've had this happen several times in intern year alone. And residents are stuck with these attendings for years, while the med student is gone in a month, so it's not really a good place to pick your battle as a resident. Bring a book and if there's down time study on the wards.

 

[Law2Doc]

...
I disagree regarding the "paying money to be there." I've entered into a contract with the school and I expect to get my money's worth. I have no problem going from eval to dean with detailed complaints if someone burns me out of my expensive education. Just because I'm in a school setting doesn't mean my money is worthless. I don't particularly care if the resident or attending doesn't see a penny of it - they're at a teaching hospital and I pay my fees so the administration can keep people in check, if nothing else.

conceptually this is true, but in real life it's futile. All you succeed in doing is create a bad reputation for yourself. The administration may come down hard on attendings, who might be better about teaching for a day or a week, but resent you for complaining for a month. As for residents, since the attendings really only care about their own patients being taken care of, they may tell residents "you need to teach the students more", but it's always a very watered down mixed message, because you are only supposed to teach when there's time after you take care of their patients, which can be a never ending task list. Most residents try to impart what they know when they can simply because they remember being a med student themselves, but with changes in duty hour, there's often simply not the time to stop and really explain things without leaving too much of your work for the next shift. To some extent resident time to spend working with med students is a casualty of shortened duty hours.

 

[turkeyjerky]

simple. When you are in residency you are going to try to send the med students home early and shortly afterwards something cool is going to walk in the door. The attending will come in and say "where are my med students?", and then tear you a new one because you sent them home early. So you quickly learn it's just not worth it. I've had this happen several times in intern year alone. And residents are stuck with these attendings for years, while the med student is gone in a month, so it's not really a good place to pick your battle as a resident. Bring a book and if there's down time study on the wards.

Calling BS on the claim that you ever sent a student home early. No f'ing way.

 

[ScubaStarved]

x

 

[Guillemot]

The objective part of 3rd year grades are shelf exams. Resident and attending assessments are by nature subjective.

The subjective assessments by residents and attendings are without exception going to be unfair. For even if an individual receives an accurate assessment, there will be other people graded by different residents and attendings. These other people may or may not be assessed accurately. The individual grades may or may not be accurate and will therefore not be comparable.

 

[KnuxNole]

The shelf exam weights will vary by school, and even by rotation within each school. In general, they are worth a lot less than the subjective evaluation by the attending(s) and senior residents. Being liked helps, but in third year there are other factors at play -- you have to be a useful member of the team (residents will generally weigh in), and you often have to outshine other med students who are on the rotation with you. I've seen cases where the attending clearly liked a med student, but then based the grade largely on what the senior resident said about him. I've seen cases where the attendings and residents clearly liked both med students who were on a rotation at the same time, but liked one better and the difference was reflected in the final grade, despite the fact that the less impressive of the two probably would have gotten a higher grade if he had been on rotation with a different classmate. Then there's situations here attendings or senior residents change over mid rotation and suddenly all the goodwill you have built up goes out the window because the folks who end up grading you missed your brightest hours. Welcome to subjective evaluation. It's how the world works out of school, not just in medicine.

I've never experienced a situation where residents/attending would base grades by comparing other med students. But I have been on rotations where every med student was hard working and good, and everyone received Honors, even if there were 1 or 2 that were "outshining" the others.

But I guess it depends on the rotation.