Possible bad comment on MSPE and matching surgery

[voxveritatisetlucis]

So I just got an EM rotation eval back and it said “student rigid, empathy and compassion in patient interview lacking.” If this shows up on my MSPE how bad will it look?

My comments for surgery were very good and I got honors on the shelf and clinical grade (which only 15% of my class gets) but now I’m very worried about how this will look. The strange thing is that the other eval said “very compassionate in patient encounters”

So far my grades are

FM: P OB: H Surgery: H don’t know the others yet but probably can’t be AOA anymore

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[GoSpursGo]

Does this actually sound like this would be accurate based on your interactions with your preceptor? Is there a chance this was intended for someone else?

 

[voxveritatisetlucis]

I think the problem is that I am pretty shy/introverted and somewhat monotone. perhaps in some of the encounters that he observed me, I got straight to the point. I feel as though this may come across as a lack of empathy on rotations at times but I feel like that isn’t really the correct word that should be used on MSPE.

 

[Nontrad_FL_LGBT]

If your evaluator didn't give you feedback to this effect and give you a chance to improve their perception of you, this was extremely scummy of them to write on your eval. Idk why this seems to be so common in medicine, it doesn't fly in any other professional environment.

See if you can get those comments removed from your MSPE given that others wrote that you were compassionate, otherwise I would think they would be pretty bad for your chances tbh.

 

[voxveritatisetlucis]

It hasn’t been entered yet so hopefully it’s more of a formative thing I’m hoping. It just kind of sucks because all of my other evals on this rotation have been 5/5s and now I’ll probably be stuck at pass rather than honors

 

[Dral]

Have you gotten other bad comments on other rotations? At my school, we were allowed to pick one thing to be 'stricken from the record' on our MSPE.

I'd wait and see what the final eval shows and go from there.

 

[voxveritatisetlucis]

Have you gotten other bad comments on other rotations? At my school, we were allowed to pick one thing to be 'stricken from the record' on our MSPE.

I'd wait and see what the final eval shows and go from there.

All positive feedback besides that so far. Family med pass was because of the shelf but I got honors clinically

 

[Redpancreas]

So I just got an EM rotation eval back and it said “student rigid, empathy and compassion in patient interview lacking.” If this shows up on my MSPE how bad will it look?

My comments for surgery were very good and I got honors on the shelf and clinical grade (which only 15% of my class gets) but now I’m very worried about how this will look. The strange thing is that the other eval said “very compassionate in patient encounters”

So far my grades are

FM: P OB: H Surgery: H don’t know the others yet but probably can’t be AOA anymore

Yikes. Sounds like this particular evaluator lacks empathy if you ask me. This feedback isn’t particularly actionable/helpful without examples. I’m not sure what you’re supposed to do or feel about it by reading it other than feeling like a terrible person. I would ask for clarification from the course director. Worst case, you get examples on what exactly they meant. Best case, your comment is removed.

 

[Med Ed]

Yikes. Sounds like this particular evaluator lacks empathy if you ask me. This feedback isn’t particularly actionable/helpful without examples. I’m not sure what you’re supposed to do or feel about it by reading it other than feeling like a terrible person. I would ask for clarification from the course director. Worst case, you get examples on what exactly they meant. Best case, your comment is removed.

The feedback is quite actionable without examples. It's much better than "5/5 keep reading."

Rigid = work on developing a more relaxed demeanor.
Empathy and compassion lacking = here are seven tips that took me seven seconds to find.

This stuff is covered in clinical skills courses. Many students ignore it until they're in clinical settings and forget how to talk to people.

 

[Med Ed]

I think the problem is that I am pretty shy/introverted and somewhat monotone. perhaps in some of the encounters that he observed me, I got straight to the point. I feel as though this may come across as a lack of empathy on rotations at times but I feel like that isn’t really the correct word that should be used on MSPE.

We judge others by their actions, but ourselves by our intentions. Can't claim credit for that sentiment, but it's true.

If someone said you acted like a robot then perhaps you should take it to heart, regardless of what was going on in your head at the time. Most of the positive feedback provided to medical students is just recycled fluff designed to not cause any waves. The rare individual who decides to actually call people out is trying to do them a service.

 

[Med Ed]

When I read "rigid", my perception was that OP wasn't allowing for deviation from what they were asking the patient. I didn't at all interpret it as OP not having a relaxed demeanor.

Relaxed people have an easier time deviating from the script as appropriate.

The fact that two separate people can perceive that comment very differently is exactly why specific examples are extremely important. What's the point of shoving SMART feedback down our throats during preclinicals if it will not be utilized in our evaluations?

Also worth noting that OP said the other eval (I'm assuming also in EM) said they were very compassionate in patient encounters. OP also says they've gotten great feedback from other electives too. They seem to be performing very well clinically. It's entirely possible the the evaluator is the problem, not OP.

That is of course possible. But consider and alternate scenario: the traditional clerkship model in an RVU world does not lend itself to the types of interactions between faculty and students that are necessary to give meaningful feedback. Moreover, faculty are increasingly attuned to the fact that giving someone negative feedback can result in time-consuming blowback. Hence, there is diminishing incentive to do anything other than tell every student they are good and doing great. So most of the positive clinical reviews students are given are worth nothing.

 

[Redpancreas]

We judge others by their actions, but ourselves by our intentions. Can't claim credit for that sentiment, but it's true.

If someone said you acted like a robot then perhaps you should take it to heart, regardless of what was going on in your head at the time. Most of the positive feedback provided to medical students is just recycled fluff designed to not cause any waves. The rare individual who decides to actually call people out is trying to do them a service.

I really like this post. I would still maintain that if you’re going to use that feedback, it’s better to give concrete examples and probably give it to the student in person too. I agree wholeheartedly that most feedback is a gift.

 

[Hollow Knight]

Moreover, faculty are increasingly attuned to the fact that giving someone negative feedback can result in time-consuming blowback

This is a huge issue honestly. And probably the reason the attendings on my surgery rotation basically didn’t speak to me….

I worked with two attendings this week. All my classmates told me they were jerks. But I had an excellent experience. They didn’t praise me (quite frankly, I sucked), but they pointed out flaws constantly and told me to read up on things that would help me in my intended specialty. And they weren’t rude about it, they would just say “Nah, that’s wrong. Go read up on this, you want to do FM, these things should be instant knowledge for you.” I didn’t get an ego boost, but I actually learned stuff.

Sorry to derail the thread though and I do think it sucks that OP is getting flamed when most med students are equally bad anyway.

 

[operaman]

Hopefully this comment gets stricken. It really isn’t appropriate as is, and course evals aren’t the place for giving feedback. We have a box for comments that are formative but not a summative eval and this would be ok in that context, but not as a final evaluation. Every new M3 is a bit stiff and awkward in interviews because you’re learning a new skill while lacking the underlying medical knowledge to know what you need to ask and how you want to guide the encounter.

An appropriate final eval for a student truly not displaying empathy in patient interviews would also include language about how the student was given feedback to this effect and failed to improve despite repeated coaching. If I ever make a negative written comment, it always includes detail about how I attempted to correct the issue repeatedly over time. My personal opinion of a one-off encounter just isn’t that meaningful.

Your comment needs to either be removed or more detail added to better characterize your overall performance on the rotation. My guess is that line doesn’t make it into your final eval that goes to mspe unless multiple docs said the same thing.

 

[mistafab]

Honestly, this is good feedback. You can work on it and it can make you a better doctor.

For general surgery this won't bar you. I know med students wring their hands about comments but one specific negative comment is not going to sink your whole app unless its VERY negative or you're applying for Neurosurg/derm or other perfection-required specialties.

Most schools are not going to blast you on your MSPE unless multiple people are seeing the same thing. Worry about the MSPE later and focus on the improvement now. Once the rotation is over you can always reach out to your rotation director and discuss your concerns - but again, focus here on improving and don't worry about the MSPE until you're at that stage.

Most med students are focused on the perception of being good, rather than actually becoming better. If you're the latter, every future interaction will be easier, and you're more likely to succeed anyway. It's a breath of fresh air in residency interviews when you can tell people just want to work hard and improve. When I, for example, catch a whiff of an excuse in an interview - it's over.

 

[LucidSplash]

I have to question if this evaluator meant the OP was rigid in their expressed perception of others and situations. Contextually this would fit with the other descriptors used. I am asking this based on post history here. Rigid suggests you were given feedback and did not adjust based on the feedback.

OP can you earnestly evaluate these comments and think of the specific situation or situations that occurred that might be the source of these comments?

 

[voxveritatisetlucis]

I have to question if this evaluator meant the OP was rigid in their expressed perception of others and situations. Contextually this would fit with the other descriptors used. I am asking this based on post history here. Rigid suggests you were given feedback and did not adjust based on the feedback.

OP can you earnestly evaluate these comments and think of the specific situation or situations that occurred that might be the source of these comments?

No he meant rigid as in shy and mildly autistic/not showing much emotion. I’ve been told I’m pretty monotone before

 

[LucidSplash]

No he meant rigid as in shy and mildly autistic/not showing much emotion. I’ve been told I’m pretty monotone before

So you did get direct feedback from the person who wrote this then?

 

[Med Ed]

No he meant rigid as in shy and mildly autistic/not showing much emotion. I’ve been told I’m pretty monotone before

Have you at least figured out if this is formative feedback?

 

[MoldToPenicillin]

I really like this post. I would still maintain that if you’re going to use that feedback, it’s better to give concrete examples and probably give it to the student in person too. I agree wholeheartedly that most feedback is a gift.

Rigid I can understand.

But I agree that "lacks empathy and compassion" needs more specific examples to the student for it to be fair. Perhaps they are compassionate but need to work more on expressing it in ways like sitting down when speaking to pt / asking pt at the end if there is anything else they can address / do to make them feel comfortable...etc.

I'll give this student the benefit of the doubt and say they have good intentions; perhaps they simply need to be more expressive; otherwise, I don't think they would have received good comments in FM.

Jumping to the conclusion that they do lack compassion is funny.

But I'm only a lowly MS1.

 

[amoxicillin_resistant]

Rigid I can understand.

But I agree that "lacks empathy and compassion" needs more specific examples to the student for it to be fair. Perhaps they are compassionate but need to work more on expressing it in ways like sitting down when speaking to pt / asking pt at the end if there is anything else they can address / do to make them feel comfortable...etc.

I'll give this student the benefit of the doubt and say they have good intentions; perhaps they simply need to be more expressive; otherwise, I don't think they would have received good comments in FM.

Jumping to the conclusion that they do lack compassion is funny.

But I'm only a lowly MS1.

ditto

nice username btw

 

[LucidSplash]

Rigid I can understand.

But I agree that "lacks empathy and compassion" needs more specific examples to the student for it to be fair. Perhaps they are compassionate but need to work more on expressing it in ways like sitting down when speaking to pt / asking pt at the end if there is anything else they can address / do to make them feel comfortable...etc.

I'll give this student the benefit of the doubt and say they have good intentions; perhaps they simply need to be more expressive; otherwise, I don't think they would have received good comments in FM.

Jumping to the conclusion that they do lack compassion is funny.

But I'm only a lowly MS1.

They did specify. In a patient interview. The feedback wasn’t that the student lacked empathy and compassion overall, it was that they were not able to adequately convey empathy and compassion during a patient interview. These are two different things. The student can work on the latter.

 

[MoldToPenicillin]

They did specify. In a patient interview. The feedback wasn’t that the student lacked empathy and compassion overall, it was that they were not able to adequately convey empathy and compassion during a patient interview. These are two different things. The student can work on the latter.

The student had good comments in FM and OB. What aspect/s of the interview lacked compassion? The tone? was it rushed?

Telling a student they did not convey empathy and compassion adequately, without at least mentioning an area for the student to work on can leave them frustrated. And it does not explain another important point - what nuances the evaluator found to be lacking in OP to back up that statement. It also begs the question, if they really are that monotone/lacking in empathy while interviewing pts; would they go through FM and OB without a single comment on that?

I still take OPs side here. It's clear from their history and prior evals that they do care about their patients.

 

[LucidSplash]

The student had good comments in FM and OB. What aspect/s of the interview lacked compassion? The tone? was it rushed?

Telling a student they did not convey empathy and compassion adequately, without at least mentioning an area for the student to work on can leave them frustrated. And it does not explain another important point - what nuances the evaluator found to be lacking in OP to back up that statement. It also begs the question, if they really are that monotone/lacking in empathy while interviewing pts; would they go through FM and OB without a single comment on that?

I still take OPs side here. It's clear from their history and prior evals that they do care about their patients.

I think we don’t have all the information, on that we agree. But from the OPs comments where he clarifies that he knows “rigid” refers to physical and not mental attributes, it is clear he did get some in person feedback. He just isn’t sharing it here. The rotation feedback as written is only so long because it is meant to be a summary, not an extensive recitation of everything that occurred during the rotation. Different facets of one’s personalities and abilities come out on different rotations. So feedback on different rotations may pick up something different. And no one has suggested that the OP doesn’t have good intentions. And OP may actually care about their patients. But the feedback was that it didn’t come through during patient interviews in their EM rotation. EM patients can and frequently are a much different patient population than encountered on other rotations, and it can be more difficult for some people to lead with empathy and compassion, depending on the patient and their presentation.

EM also tends to have a bit more freedom for students to interact with patients than OB or FM.

Additionally, review of the OPs extensive post history reveals some perspectives and ways of communicating here that could be seen to correlate with this kind of feedback.

I don’t know that OP asked anyone to take a “side.” Saying that the OP obtained actionable feedback isn’t “against” the OP. In fact I’d say that the “ignore the feedback entirely because it doesn’t match what was said on FM and OB and it also isn’t positive” is much more “against” the OP than telling them that this is something they can address and they should seek additional feedback.

 

[MoldToPenicillin]

I think we don’t have all the information, on that we agree. But from the OPs comments where he clarifies that he knows “rigid” refers to physical and not mental attributes, it is clear he did get some in person feedback. He just isn’t sharing it here. The rotation feedback as written is only so long because it is meant to be a summary, not an extensive recitation of everything that occurred during the rotation.

Classic mindset that always puts the blame on the student. No one is asking for an extensive recitation of everything that happened during a rotation or hell even the times OP was observed; but if an attending will write "student rigid, empathy and compassion in patient interview lacking." the least they could do is add 1 specific example of why they think so. Thats not much now, is it?

Different facets of one’s personalities and abilities come out on different rotations. So feedback on different rotations may pick up something different.

I agree. I think that's a really good point actually. On FM and OBGYN the student would have had more time to chat with patients and interact with them; wouldn't their awkward/rigid communication skills according to you show up here more? Even if they got attendings that didn't care; I find it hard that they went without any feedback on that.

I don’t know that OP asked anyone to take a “side.” Saying that the OP obtained actionable feedback isn’t “against” the OP.

I'll address that.

In fact I’d say that the “ignore the feedback entirely because it doesn’t match what was said on FM and OB and it also isn’t positive” is much more “against” the OP than telling them that this is something they can address and they should seek additional feedback.

I haven't said once to ignore the feedback. I also am not basing my argument entirely around their earlier evals. Basically, what I am trying to point out are two things. 1)- that there is a chance OP might had genuine intent to be compassionate and caring throughout their pt interviews; and they simply need help to work on their social skills. This is important because if someone needs help on this; a very general statement will do more harm than good. 2)- since you seem to be inclined that OP is hiding stuff - which hey - it could be true; I think they deserve the benefit of doubt.

it is clear he did get some in person feedback. He just isn’t sharing it here.

Confident, are we? Don't be so demure now @LucidSplash you should have just said how brilliant you are at analyzing online forums and message histories!! My sincerest apologies. Out with it now OP! what are you hiding!


Students with poor social skills will not improve with broad feedback (specifically this for intricacies in communication). It might have the opposite effect of hurting, frustrating, and isolating them even more. You can't tell a "rigid" student they are rigid and expect them to improve.

 

[LucidSplash]

Classic mindset that always puts the blame on the student. No one is asking for an extensive recitation of everything that happened during a rotation or hell even the times OP was observed; but if an attending will write "student rigid, empathy and compassion in patient interview lacking." the least they could do is add 1 specific example of why they think so. Thats not much now, is it?

I agree. I think that's a really good point actually. On FM and OBGYN the student would have had more time to chat with patients and interact with them; wouldn't their awkward/rigid communication skills according to you show up here more? Even if they got attendings that didn't care; I find it hard that they went without any feedback on that.

I'll address that.

I haven't said once to ignore the feedback. I also am not basing my argument entirely around their earlier evals. Basically, what I am trying to point out are two things. 1)- that there is a chance OP might had genuine intent to be compassionate and caring throughout their pt interviews; and they simply need help to work on their social skills. This is important because if someone needs help on this; a very general statement will do more harm than good. 2)- since you seem to be inclined that OP is hiding stuff - which hey - it could be true; I think they deserve the benefit of doubt.

Confident, are we? Don't be so demure now @LucidSplash you should have just said how brilliant you are at analyzing online forums and message histories!! My sincerest apologies. Out with it now OP! what are you hiding!


Students with poor social skills will not improve with broad feedback (specifically this for intricacies in communication). It might have the opposite effect of hurting, frustrating, and isolating them even more. You can't tell a "rigid" student they are rigid and expect them to improve.

Wow. That was… a lot.

I never said the OP was hiding anything? Just that from their follow-up comments where they clarified that the attending was specifying rigidity of affect rather than of mindset or thinking, that it was clear they had received more detailed feedback. I’m not sure how else OP would know that was the meaning of the comments. Saying they hadn’t shared the rest of the information isn’t accusing them of hiding anything, just pointing out we don’t have all the information and are forced to extrapolate based on what information we do have.

And again, feedback is not “blame.” Feedback is feedback. Specific examples are not usually given in rotation end written comments. I agree that if this was the only time the OP ever heard about this, on the written eval, that is bad form on the part of the evaluator. But that doesn’t seem to be the case in this context based on the sum total of the OPs comments in this thread.

My own experience on OB and FM were such that I actually had more face-to-face but less overtly attending or resident structured time with patients on EM than on FM or OB. Often I was sent to see a patient myself first, whereas in FM and OB it was typically more structured and simultaneous with the attending. But every school/rotation does that differently. So maybe the OP had more time with patients on those rotations, I don’t know. But it isn’t unreasonable to extrapolate based on our own experiences as those the OP has shared here in other posts.

You seem to think I’m attacking the OP and you feel the need to defend them. But, especially once you get to your clinical years, I want to encourage you to see feedback as an opportunity to improve. If you only ever receive positive feedback, you miss out on vital opportunities to grow as a physician. Feedback isn’t meant to denigrate. It helps you see your weaknesses so you can work on them.

I think this exchange is hijacking the thread so I’m going to bow out from this point on, as I don’t want to detract from others who may have valuable input to help the OP or other students. Which is all any of us attendings who still hang around this forum try to do. Pointing out that this is useful feedback to the OP to consider in future patient encounters is intended in that vein.

 

[MoldToPenicillin]

I think this exchange is hijacking the thread so I’m going to bow out from this point on, as I don’t want to detract from others who may have valuable input to help the OP or other students. Which is all any of us attendings who still hang around this forum try to do. Pointing out that this is useful feedback to the OP to consider in future patient encounters is intended in that vein.

I apologize for the sarcasm in my reply. It was not out of a place of disrespect or aggressiveness - just trying to stand behind my perspective (that feedback on communication at a minimum should carry with it an example of what the student did wrong). Thank you for the advice and also your perspective on the matter.

 

[mistafab]

When I was a student (and now as an evaluator), the goal is always to find something actionable regardless of the quality of feedback.

In this setting, the faculty member provided a specific area (patient interview) where the student can focus on making sure to display their empathy and compassion. This is a common area for students to work on, since they are often focused on getting XYZ pertinent patient information, they forget to make the patient comfortable or feel heard. Taking feedback as actionable - lets think about it through that lens.

When someone says rigid, lacking empathy and compassion in patient interview. It tends to mean checklist interrogation of questions and never checking in with the patient about how they are doing, when there are obvious signs they are not comfortable. An example could be doing a thorough data gathering on someone in the ED with a broken arm for 10 minutes, and never asking if they needed pain medicine - despite the patient obviously wincing in pain. It can sometimes be observed that the medical student will continue to barrel through more questions (even asking for data we already know).

When the student approaches the feedback as actionable, they tend to come off as more mature and tend to perform better. Additionally, the more open they get to feedback, the better their feedback becomes, and the more feedback they get. We all know those students who fight against all feedback, or act as if every coaching point is traumatizing - I remember classmates who routinely focused on criticizing feedback, and low and behold, their feedback became more and more sparse and often negative. As a student, I specifically worked on obtaining feedback, as often and as specific as possible. And it became obvious that getting feedback is also a skill. As a student, it also feels less demoralizing when approaching feedback as always actionable. This stance tends to lead towards better performance and as a result, better grades.

 

[voxveritatisetlucis]

The final evals were all good and I should be able to honor if I do wells on the shelf. If I honor the final 3 rotations then I’ll be eligible for AOA and from my understanding would then be nearly impossible to not match general surgery. Just need to finish strong

 

[Med Ed]

The final evals were all good and I should be able to honor if I do wells on the shelf. If I honor the final 3 rotations then I’ll be eligible for AOA and from my understanding would then be nearly impossible to not match general surgery. Just need to finish strong

So in summary, this was formative feedback that would not end up in your MSPE, and everything is just fine.

 

[voxveritatisetlucis]

Update: I honored the shelf so only 3 more for AOA. I feel like I’ve hit my stride so the next 3 should be obtainable to get honors

It’s very humbling, from four years ago getting multiple acceptances rescinded from top 25 schools to still be in a position today to become a surgeon. Most people never get a second chance in life so I’m extremely grateful for the few schools that were willing to take a chance on me