Passed shelf, failed rotation...need advice on how to approach evaluators?

[Robin234]

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Hi,
I'm really confused about my evaluation for my OB/GYN rotation. This was my first rotation, and I also started later than everybody else due to delaying my Step 1 exam. I passed my shelf exam, worked hard during the rotation and did everything I was asked to do. On my evaluation, the overall commentary was that I was lost and needed guidance but once I knew what I was doing, I was able to do it well. They said I improved in my H&Ps but still had gaps. I was told by one of my residents that I was doing a good job with my history taking. So much of this is really bothering me. I was even marked down on my interpersonal/communication skills. I didn't do so hot on my departmental midterm exam, but that was my fault because I wasn't studying the right material (it was worth 10% of our grade). I'm meeting with the director and a few of the residents this week.

I heard that if you do what you are told and make an effort to learn and improve, you should be able to at least pass your rotation. I can't understand why they failed me. They mainly were saying I was weak in my medical knowledge. But I was able to answer many of the resident's questions (although not always everything), and learn from those questions that I missed. And did I mention I passed my shelf?

Do you think this is because I started late? Could I have a chance of turning this fail into a pass if I speak to them about it?

 

[justaregularmed]

Hi,
I'm really confused about my evaluation for my OB/GYN rotation. This was my first rotation, and I also started later than everybody else due to delaying my Step 1 exam. I passed my shelf exam, worked hard during the rotation and did everything I was asked to do. On my evaluation, the overall commentary was that I was lost and needed guidance but once I knew what I was doing, I was able to do it well. They said I improved in my H&Ps but still had gaps. I was told by one of my residents that I was doing a good job with my history taking. So much of this is really bothering me. I was even marked down on my interpersonal/communication skills. I didn't do so hot on my departmental midterm exam, but that was my fault because I wasn't studying the right material (it was worth 10% of our grade). I'm meeting with the director and a few of the residents this week.

I heard that if you do what you are told and make an effort to learn and improve, you should be able to at least pass your rotation. I can't understand why they failed me. They mainly were saying I was weak in my medical knowledge. But I was able to answer many of the resident's questions (although not always everything), and learn from those questions that I missed. And did I mention I passed my shelf?

Do you think this is because I started late? Could I have a chance of turning this fail into a pass if I speak to them about it?

These sort of stories (although once in a blue moon) almost never add up.

Failing is never easy, and I really wish you the best of luck, but honestly for whatever reason you rubbed people the wrong way. Figure out what you did or how you acted and fix it.

While I will admit it is possible that you got failed purely on a lack of medical knowledge you had to have been pretty bad at this stage of the game for this to be a factor, generally this becomes more critical later in your learning.

Bottom line is learn from your mistake or we'll be hearing from you again.

 

[Rollo]

There's always two sides to any story.

Do these residents/attendings have a history of giving out bad grades, or even worse, failures? Talk to some upperclassmen and find out.

The poster above me is right. It doesn't make sense that they'd fail you for your lack of medical knowledge since this is your first rotation as a 3rd year, and the amount of information we are expected to know at this point is almost minimal. Yeah, we're expected to know lot of quick one-liners about diseases and drugs but nothing in detail.

And it also doesn't make sense that they'd fail you if, in fact, you were improving with your H&P skills, medical knowledge, etc.

In the end though, this situation definitely sucks. I hope for your sake, you don't go into OB. But regardless, try to talk to the residents/attendings again and attempt to get the grade changed. If not, then move on and learn from your failure.

 

[Robin234]

I was suspecting that there was something else going on, but I just wanted to make sure that I really was doing the right thing and it wasn't some of the things I was experiencing in my rotation. My friends who are farther along in classes were surprised with my story too.

There is a guy who was supposed to show up with me every week for clinic, but he always would switch out with someone else. I would wonder why, and I realized later that our attending did have a reputation for being tough. I foolishly took that as a challenge, but look where that got me 🙄

Plus it doesn't help that I got mistaken for being the cleaning lady (ppl always mistake me for being latina in this town, and someone told the residents to watch me closely because I shouldn't be going into the student lounge). There were other remarks that I've observed from the residents (not so nice remarks that were obvious in their racial undertones) that I was not happy with. I was really miserable about that during my rotation, and I'm really hoping there isn't something about that coming to play in my evaluations!

I guess I'll keep stressing to them at this meeting that I met every one of their requirements on the rubric, that it was my first rotation, and that I have specific examples for how I'm competent and do as I'm told. Even make small runs to get the residents drinks from the gas station (is this normal?). Yeah, I'm a little bitter and nervous because all of this is so out of my control. I was planning to incorporate OB/GYN into my practice in the future, but I'm pretty sure it's not going to be my career.

Thanks for your helpful advice!

 

[KSDeacon]

I was suspecting that there was something else going on, but I just wanted to make sure that I really was doing the right thing and it wasn't some of the things I was experiencing in my rotation. My friends who are farther along in classes were surprised with my story too.

There is a guy who was supposed to show up with me every week for clinic, but he always would switch out with someone else. I would wonder why, and I realized later that our attending did have a reputation for being tough. I foolishly took that as a challenge, but look where that got me 🙄

Plus it doesn't help that I got mistaken for being the cleaning lady (ppl always mistake me for being latina in this town, and someone told the residents to watch me closely because I shouldn't be going into the student lounge). There were other remarks that I've observed from the residents (not so nice remarks that were obvious in their racial undertones) that I was not happy with. I was really miserable about that during my rotation, and I'm really hoping there isn't something about that coming to play in my evaluations!

I guess I'll keep stressing to them at this meeting that I met every one of their requirements on the rubric, that it was my first rotation, and that I have specific examples for how I'm competent and do as I'm told. Even make small runs to get the residents drinks from the gas station (is this normal?). Yeah, I'm a little bitter and nervous because all of this is so out of my control. I was planning to incorporate OB/GYN into my practice in the future, but I'm pretty sure it's not going to be my career.

Thanks for your helpful advice!

I'm sorry, but F that. On one of my rotations earlier this year, our attending (in her second month as staff) asked me and another student to leave the hospital, drive about 15 minutes to pick up cakes for a baby shower for some of the physicians and then come back. Meanwhile, she and the 2 residents on the team were rounding on the patients.
Because i'm either a) spineless or b) terrified to tell an attending No (i prefer option B), the other student and I complied.
Ended up bringing it up to the clerkship director who said it was absolutely inappropriate and unprofessional for the attending to ask that.
I think your residents asking you to go to an outside place to get them drinks is an abuse of power and pretty unprofessional.
I sincerely hope your situation is rectified and that you are able to at least get a Pass on this rotation

 

[officedepot]

.

 

[Robin234]

They are not letting me pass.

The director launched into saying that compared to the other students, I was at the lower end of the bell curve. He had looked up my Step 1 score and was telling me that I'm "barely skating by" when it comes to my medical knowledge. When I told him that this was my first rotation, he was taken aback, and so were the other two residents in the room with me. He then said that perhaps the residents shouldn't have graded me too harshly and he was sorry that I wasn't given any negative feedback. Throughout the course of the discussion, the director had asked two more times, "So this was your first rotation?" and I kept replying yes, that the other students had already gone through three rotations before me. I think for some reason he wasn't believing this was my first rotation. He asked me what was I doing before I started this one and I told him I took a personal leave of abscence. When I pressed the issue about my improvement during the rotation, one of the residents said that yes, I was doing a good job by the end of it. The director then cuts in and narrates a story of another med student who had to do his rotation over (this person didn't pass his exam though) and that he did so much better the second time around and that basically I'll still get into a residency and that I'll still be able to finish somewhere.

By this time, it wasn't making sense. I tried rephrasing the question, "So if I am compared to other students who were also taking this rotation for the first time, would I still be receiving the same results?" and he started to get short with me at this point and replied "Yes." I went on and asked him, "So for future reference, what about the comments about me not knowing my role in the team?" and he was getting even more agitated at this point and replied, "Well, it is coming down to your medical knowledge, and I'm sure you'll do better next time."

Sooo...how bad is this going to look in terms of my future? I'm now planning to redo this stupid thing at a different site. I can't stand the reasoning by this director. Can I still attempt to get an incomplete or something? I'm going to have to talk to someone in my school about this, that's kind of ridiculous to mess with a person's future and to assume that I'll "eventually get a residency somewhere" when during the course of the conversation he admitted that I wasn't supposed to be graded so hard. And also admitting that all the other ridiculous comments really weren't an issue, but it was his opinion of my medical knowledge that failed me. When he also clearly said that "I wasn't there to observe you personally but received feedback from the residents". Who didn't know this was my first time. And admitted I wasn't supposed to be graded so hard in comparison.

What if I want to get a good residency at a nice decent spot? What the hell. He just kept contradicting himself in the evals and then during the discussion. Do you think I have any alternative options that might get this off my record or make it look better?

 

[lexrageorge]

Some advice:

1.) On your next rotation(s), work twice as hard and study twice as much as you did on this past rotation. Really and truly. Bear down and pull out all the stops. Ask for advice from friends, colleagues, faculty, residents, etc. Solicit feedback where and when appropriate. Then work hard to act on any less than positive feedback. Don't complain, don't cry "foul", don't even talk about your last rotation; it's over anyway.

The first step to mitigating a black mark such as failing grade is to respond with good grades in the subsequent rotations. Don't aim to "just pass", but instead aim to do as best as you ever imagined yourself doing.

2.) However, whatever you do, don't allow yourself to be abused. Noone should tell you to go out and get drinks for the residents. Or tell you constantly that you look like the "cleaning lady". If that starts happening again, notify your clerkship director in real time. OTOH, nothing wrong with offering to pick up a soda if you're heading out to get one for yourself. But don't feel you need to do that hourly just to get a good grade.

3.) Talk to your academic advisor to understand your options. There may not be anything that can be done about removing the grade, but earning good grades and reviews on subsequent rotations will go along way to helping your cause in the long term. Advisors and administrators tend to be more sympathetic once you show you're willing to take charge and work your way through difficulties. But it's your responsibility to show them your initiative first.

Your advisor may also help you in terms of positioning this grade in your residency applications. I wouldn't necessarily count on getting an OB/GYN residency at a top-tier academic center. But it's a lot easier to explain a failure on your first rotation when you follow that up with solid credentials elsewhere.

It's not the end of the world, and the silliness of the academic world will eventually be behind you. But right now the ball's in your court to take charge of the situation, as well as your education.

 

[PTPoeny]

When I told him that this was my first rotation, he was taken aback, and so were the other two residents in the room with me.

When he also clearly said that "I wasn't there to observe you personally but received feedback from the residents". Who didn't know this was my first time.

So you started rotations out of sync with everyone else, didn't let the director of your rotation or your residents know and expected to be graded compared to students doing their first rotation instead of their fourth?

I have no idea if you can change the fact that you failed this rotation.

However, in the future you need to communicate with people and let them know if you are expecting something out of the ordinary. You wont get nearly as much slack on your second rotation, but you should definitely let your rotation director and your residents know. The trick is to communicate the information without sounding like you are asking for special consideration or using it as an excuse to do poorly.

On a completely separate note, definitely let someone at your school know about the racist remarks!

 

[Rollo]

It sounds like your Step 1 is poor and the residents got the feeling that you were "barely skating by on medical knowledge".

This is a major red flag. You need to go back to FA Step 1 and brush up on your fundamentals. Yeah on our first rotation, we aren't expected to know anything clinical. Hell, even halfway through 3rd year, I'm not expected to know any clinical stuff like management algorithms and medication dosages.

But I am definitely expected to know the pathophys, mechanism of action, indications/contraindications, "big picture" management of a certain pathology, etc. Things that can be found in a textbook, I'm supposed to have an outline knowledge meaning for disease X, this is the etiology, this is the treatment, and this is how the treatment is supposed to work. The grey area in what I may or may not be expected to know is when to treat, in what order to treat, how to treat, how to monitor treatment, and any complications associated with the treatment.

 

[Robin234]

Thank you lexrageorge for your advice. I was definitely planning to do what you have said. I really have no interest in OB/Gyn at this point. Not necessarily because of my experience during this rotation, but more because I didn't want to be doing just women's health for my practice. I'm really into the broader scope of things at this point.

Mdpdgirl, I think I should have been more aggressive with telling the residents that this was my first rotation. I did tell a few, but it seems that after saying it they didn't seem to care or I just felt like I was coming off as asking for special consideration. And also I was getting positive feedback, so I didn't feel that I needed to keep telling them, but clearly some forgot or I just didn't tell them. But that's a really stupid way to think, and so lesson learned. I'm definitely going to be more aggressive with explaining that next time.

Rollo, thanks for the advice, by the end of the rotation I started to get that idea. That's why I was able to improve so much and pass my shelf exam (73%). I really hate though that the director even brought up my Step 1 because that shouldn't factor into my grade for that rotation.

I talked to someone at the school and they said they don't give out that information to the directors, so he went out of his way to find that out. Honestly, he was looking for a reason to fail me it seems like, and I just don't know why. I'm only looking for a pass on this, that's all.

I'm also appealing one more time (at the advice of the person I talked to at the school) and filing a complaint against the unprofessionalism that I've seen, especially the backtalking about the patients. Maybe this failure happened for a reason. KSDeacon, you are not spineless and I really pretty much did the same thing you did. I'm just not going to take this down though without at least having a little justice.

 

[otterpop]

I am surprised by some of the "tough luck" comments I see in this thread.

Robin234, a failing grade is a serious matter, and I encourage you to meet with your dean to see if it's possible to change your grade. Of course, we are seeing one side of the story, but if what you have described is correct, it sounds like if you were graded unfairly. Passing the shelf exam suggests you have a working fund of knowledge, and the fact that your clerkship director did not know this was your first rotation may have influenced his evaluation of you, based on what you have said. It is uncommon for medical students to fail a clerkship, and when it happens it is usually due to unprofessionalism. I agree with everyone else in that you can put this behind you and move forward -- but not before you do what you can to change the grade, given that it may not reflect your actual performance. I wish you the best of luck in doing so.

 

[ayushman80]

I completely agree. Passing the shelf shows that you have a working knowledge of OB/GYN. Failing you on basis of lack of knowledge is BS if you have a documented passing grade from NBME. That is by definition minimum LOK. Would your school be able to give you an oral board to evaluate you for P/F?

 

[Robin234]

I completely agree. Passing the shelf shows that you have a working knowledge of OB/GYN. Failing you on basis of lack of knowledge is BS if you have a documented passing grade from NBME. That is by definition minimum LOK. Would your school be able to give you an oral board to evaluate you for P/F?

I'm not sure if at this stage they would be considering it. I'm appealing right now to the chairman as soon as I get an appointment with him, and hopefully he will understand. I talked to my dean and he said it's rarely ever overturned unless I felt I have faced some sort of discrimination. I'm still crossing my fingers that at least my shelf score shows any proof to them that I have a working level of knowledge.

It's funny, the only thing I did "passable" in the rubric was professionalism.

 

[VenusinFurs]

I can hardly believe that having to remediate one rotation is going to keep you out of residency.

OP, will your school have you remediate the rotation?

 

[Top Gun]

I'm not sure if at this stage they would be considering it. I'm appealing right now to the chairman as soon as I get an appointment with him, and hopefully he will understand. I talked to my dean and he said it's rarely ever overturned unless I felt I have faced some sort of discrimination. I'm still crossing my fingers that at least my shelf score shows any proof to them that I have a working level of knowledge.

It's funny, the only thing I did "passable" in the rubric was professionalism.

Is there any chance you could get an incomplete? That way, when you repeat the rotation, you won't have the black mark on your transcript. You can even do the rotation at a different hospital, in order to have a chance of being evaluated more fairly. In my opinion, failing you on the basis of your Step 1 score is pure BS. It looks like your clerkship director focused on that, and that biased their evals of your clinical knowledge. If this was your first rotation, there should have been some consideration of that. No one seemed to have a clue that this was your first rotation.

Oh, and mistaking you for the cleaning lady is definitely discrimination. But next time something like that happens, bring it up to the chairman or clerkship director immediately after it happens. I wouldn't bring it up now. If you do it after the fact, it might look like you're trying to make an excuse for the poor evaluation.