Question about a negative comment on MSPE

[scoobydoo1027]

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Hi all,

Just wanted to ask about a specific comment on my MSPE, and wondering how worried about it should I be?

The comment has to do with my experience on a psychiatry rotation. I was on a consult service and I had a pretty mean attending who would continuously police my behavior and do nothing to teach me on the rotation. A lot of students in our school have similar complaints about this attending. One of the thing he complained about was that sometimes my hand would touch the edge of the patient's bed. I had been on my clinical rotations for several months and no one has ever complained about this. The attending in question himself would do this himself. I would sometimes touch the patient's bed because I have severe scoliosis and sometimes I instinctively reach out to support my body. None of the patient's complained, it was only the attending. I tried to explain this to him but he gave me a pretty tone deaf response. My experience on this rotation was miserable and at the end he wrote a pretty mean eval. I ended up appealing it, and was grateful to get most of it out. Only the following remains that will go in my MSPE:

On the consult service, he was noted to be a "bright man who is academically curious and motivated to learn." Areas for improvement included interviewing skills and establishing rapport, particularly maintaining appropriate interpersonal distance when interviewing. His risk assessments and his communication with medical teams were other areas in which he was noted to need improvement.

Everything else on my psych eval is positive and my comments on the rest of my clerkships have been more or less glowing. My grades have all been really good and my step 1 score is also really good. I just feel really unnerved by this because I feel like so much of this was out of my control and felt terrible for being singled out because I have a physical impediment. I know this has probably been asked many times, but was wondering how worried should I be in being able to match into a good program. I am applying into either IM or Neurology.

And sorry if this is repetitive. Thank you all.

 

[calivianya]

You don't need to worry at all. They took literally everything bad out. Work ons, or improves, are not bad things to be identified per se. Nobody is going to be perfect at everything.

I had a nasty attending, too - they took 99% of the bad comment out but they left 1% that is still very questionable (needs to work on motivation and interest in all areas of medicine). And all my other evals disagreed and called me a motivated, independent, enthusiastic learner, so I think they just drowned out the one negative comment. I'm definitely getting interviews right now, even for a competitive specialty.

 

[scoobydoo1027]

Thank you so much. It meant a lot to hear that.

 

[Maximus2020]

Sorry to hear about this bozo attending. Believe me - many, many people, including me, have dealt with at least 1 horrible attending we'd like to see get fired and shipped to Antarctica. As such, those who interview you expect this, laugh it off, and move on to the bulk of your materials showing you are stellar. No big deal.

 

[Redpancreas]

Hi all,

Just wanted to ask about a specific comment on my MSPE, and wondering how worried about it should I be?

The comment has to do with my experience on a psychiatry rotation. I was on a consult service and I had a pretty mean attending who would continuously police my behavior and do nothing to teach me on the rotation. A lot of students in our school have similar complaints about this attending. One of the thing he complained about was that sometimes my hand would touch the edge of the patient's bed. I had been on my clinical rotations for several months and no one has ever complained about this. The attending in question himself would do this himself. I would sometimes touch the patient's bed because I have severe scoliosis and sometimes I instinctively reach out to support my body. None of the patient's complained, it was only the attending. I tried to explain this to him but he gave me a pretty tone deaf response. My experience on this rotation was miserable and at the end he wrote a pretty mean eval. I ended up appealing it, and was grateful to get most of it out. Only the following remains that will go in my MSPE:

On the consult service, he was noted to be a "bright man who is academically curious and motivated to learn." Areas for improvement included interviewing skills and establishing rapport, particularly maintaining appropriate interpersonal distance when interviewing. His risk assessments and his communication with medical teams were other areas in which he was noted to need improvement.

Everything else on my psych eval is positive and my comments on the rest of my clerkships have been more or less glowing. My grades have all been really good and my step 1 score is also really good. I just feel really unnerved by this because I feel like so much of this was out of my control and felt terrible for being singled out because I have a physical impediment. I know this has probably been asked many times, but was wondering how worried should I be in being able to match into a good program. I am applying into either IM or Neurology.

And sorry if this is repetitive. Thank you all.

I mean...to whoever said all of it is removed, that's actually a pretty problematic couple sentences in a dean's letter which are usually squeaky clean.

LOL, if asked about it I would say share this particular encounter with this attending, mention specifically what the issue was and that was what was meant about the "interpersonal distance" and acknowledge that maybe there were areas you could have communicated better with this individual but that there were no other rotations where you felt this was a concern.

 

[longhaul3]

Maybe it's different in psych but I find my patients respond better to me being closer to the bedside, hand on the railing, etc. rather than austere, hands behind the back on the other side of the room. People who are critically ill or facing frightening diagnoses like to feel cared for.

 

[ACSurgeon]

OP- talk to your student services. If this can be striked, great. If not, you can hope that the numerous other positive comments will drown this one out.

For what it’s worth, your original post comes across as refusing to take feedback and blaming it all on the attending. Maybe the attending is a real jerk. Maybe you actually have a problem that they tried to point out and you were the “tone deaf” person in that exchange so they put it on your MSPE to get you to reflect. A lot of students these days are very sensitive to any feedback and automatically think that anyone who doesn’t think they’re perfect is a mean jerk. Keep this in mind moving forward, because you really don’t want another interaction as a fourth year that makes it’s way to the MSPE.

 

[scoobydoo1027]

They were tone deaf because the attending told me that you should have found a chair for yourself, which is extremely difficult to do on a consult service and if there was ever a chair, he would take it. This experience was terrible, because this attending did not let me do a single psych interview for 3 straight weeks, and when I complained he said, I "should have earned it". I came from a child psych service before where I was leading 45min interviews but this attending was interested in policing my posture than teaching me. I am sorry I have no patience for this kind of behavior from an attending. It was not meant to be constructive in any way.

And yes, after this interaction, my radar has always been on.

As far as leaving everything out. the attending wrote like an essay on me in the MSPE, and they took all of it out and instead framed it in the form of an improvement. I am aware MSPE's are squeaky clean but if a program really holds this against me and overlooks literally the thousands of glowing comments I have gotten then that's really unfortunate.

 

[Matthew9Thirtyfive]

Maybe it's different in psych but I find my patients respond better to me being closer to the bedside, hand on the railing, etc. rather than austere, hands behind the back on the other side of the room. People who are critically ill or facing frightening diagnoses like to feel cared for.

It’s not just psych. I very frequently sit on the bed or crouch down near the bed when I’m on inpatient. Patients appreciate it a lot. It makes them feel like you actually care

 

[ACSurgeon]

They were tone deaf because the attending told me that you should have found a chair for yourself, which is extremely difficult to do on a consult service and if there was ever a chair, he would take it. This experience was terrible, because this attending did not let me do a single psych interview for 3 straight weeks, and when I complained he said, I "should have earned it". I came from a child psych service before where I was leading 45min interviews but this attending was interested in policing my posture than teaching me. I am sorry I have no patience for this kind of behavior from an attending. It was not meant to be constructive in any way.

And yes, after this interaction, my radar has always been on.

As far as leaving everything out. the attending wrote like an essay on me in the MSPE, and they took all of it out and instead framed it in the form of an improvement. I am aware MSPE's are squeaky clean but if a program really holds this against me and overlooks literally the thousands of glowing comments I have gotten then that's really unfortunate.

There’s an element of “playing the game” to get in and through medical school and beyond. You don’t have to believe the attending is in the right. You have to make them believe you’re listening and taking their feedback. They have nothing to lose, but you do.

Every other residency eval I got called out on being a jerk to the nursing staff. I didn’t think so, but you better believe I said the right things and never argued when being given that feedback. I’m not perfect but I’m also not intentionally a jerk.

When you get feedback you don’t agree with try to show introspection and maybe frame something as a misunderstanding and pretend you learned something from it. Higher ups get really worked up when someone in training refuses to take feedback, as they see that as a dangerous trait.

 

[NickNaylor]

Certainly not ideal to have those kinds of comments in your MSPE, but what can you do at this point? Frankly, it's such a small part of your application that as long as you otherwise did well on the clerkship - which it sounds like you did - I doubt it will have much of an impact... unless you're planning to apply into psychiatry.

 

[FutureInternist]

It’s not just psych. I very frequently sit on the bed or crouch down near the bed when I’m on inpatient. Patients appreciate it a lot. It makes them feel like you actually care

The nurses who have to run to turn off the bed alarms must hate you… 😏

 

[Matthew9Thirtyfive]

The nurses who have to run to turn off the bed alarms must hate you… 😏

That only happened once lol.

 

[Prehealth1011]

Your school will take it out

 

[scoobydoo1027]

There’s an element of “playing the game” to get in and through medical school and beyond. You don’t have to believe the attending is in the right. You have to make them believe you’re listening and taking their feedback. They have nothing to lose, but you do.

Every other residency eval I got called out on being a jerk to the nursing staff. I didn’t think so, but you better believe I said the right things and never argued when being given that feedback. I’m not perfect but I’m also not intentionally a jerk.

When you get feedback you don’t agree with try to show introspection and maybe frame something as a misunderstanding and pretend you learned something from it. Higher ups get really worked up when someone in training refuses to take feedback, as they see that as a dangerous trait.

I actually did. I tried to be as humble as possible with the attending and whenever they pointed something out, I told them I will try my best to listen to them. In the end when they made all these complaints, and I expressed my concerns about the rotation and how the attending was treating me, I was in fact told that I should have complained earlier. So it was actually the opposite problem. Had I not "played the game" and simply told them or the admin that this rotation was problematic I might have avoided this ordeal in the first place.

Anyways, I just want to say. I am very grateful for everyone's feedback. I have felt much better now. This was a challenging experience because I am a pretty type A person and I have never been a situation before where I performed below expectations. I am taking it as a valuable life experience and I'd rather have something like this now than later on in residency and beyond when the stakes might be much higher.

All the best everyone.

 

[deleted1022040]

It’s not just psych. I very frequently sit on the bed or crouch down near the bed when I’m on inpatient. Patients appreciate it a lot. It makes them feel like you actually care

That is something they preach in training before getting into clinical work too. Try to get to eye level with the patient as comfortably and naturally as possible.

 

[guytakingboards]

In a vacuum (which it sounds like it is because the other more negative comments were removed), what's left doesn't sound all that bad. Sounds like stuff that could apply to 90% of 3rd year medical students on a psych rotation. If anything it's spun pretty well. Bright and motivated with [insert stuff that doesn't seem overwhelmingly difficult to improve on over the course of residency] as areas of improvement seem like a fair critique. If that same feedback was given of a 3rd year medical resident that would be red flags galore, but not of a 3rd year medical student.

I personally don't find those comments that bad but probably someone could try to overanalyze it. But likely not every top program you are applying to will find issue with that particular section of your MSPE.