Rant but also seeking advice to keep in mind moving forward.

[Mr_Plinkett]

Rant, but also looking for advice.

Me: MS-4, away rotation, FM
Had end of rotation feedback, felt everything was pretty good during.
Evaluator had monitor with comments somewhat faced towards me.
He turns away for a minute, addresses MA's problem.
I take opportunity, lean in to see feedback on monitor.
Most feedback was “Beyond Satisfactory” and “Great.”
One was “Unsatisfactory” Comment: “Lacks basic scie-” Preceptor: ObGyn
I remember this day vividly: Saw the preceptor for less than 1 hour. Other time was with residents.
Was asked 4 “pimp” questions: Got 3 right.
Question I got “wrong”: “How does aspirin work?”
Me: “Irreversibly blocks COX-1”
Her: “What enzyme is affected?”
Me: “COX-1”
Her: “... the enzyme is cyclooxygenase. Different pathway”
Me: “Isn’t that COX-1 cyclo-oxygenase?”
Her: “Different pathway”
It should feel like a small thing, but I got a “below average” rating from her because I didn’t say the full name of an enzyme, and she was too far removed from med school to even recognize the enzyme by its shortened name. I could’ve corrected her, but she probably would’ve doubled down further.
It's frustrating because she’s apparently well-respected and everyone loves her, so her words probably hold weight in my eval and chances of a good LOR.
I’m just frustrated that my f-----g future might be in the hands of someone like this.
Feels like there are things you just cannot win no matter what you do. You can go in early, put in the work, show your happy face, show eagerness, show enthusiasm, hide the pain, don’t talk back, don’t be confrontational, and take initiative... only to potentially have their impression of you sullied by one person who can’t take 2 seconds to think “wait, maybe it’s ME who is wrong.”
I cannot refute this comment and rating with my evaluator because then it’d seem like I peeked when I shouldn’t have.

To those in residency and beyond, seriously, wtf can I learn from this so that it happens less often, if at all? And any advice that is basically “just move on” isn’t helpful; you’re making it easier for this thing to repeat itself.

And to all the PDs out there: how many of you actually want applicants rotating through your program to be non-confrontational to a fault? If I’m >99% certain that I’m right (especially on something this basic) why is it so bad for me to correct, even politely, my preceptor? Because that seems to be the mindset with all students doing an away or a Sub-I. Why should I just take the hit to my chin, get back up with broken teeth, only to be spat it in the face with a “you’re incompetent” loogie because I’m not allowed to defend my answer against theirs?

I just hope to God that whoever writes my LOR omits that part.

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[LucidSplash]

So from someone who interviews for both residency and fellowship candidates nowadays, you need to know that most of us look at the application as a whole. If the majority of the application and comments are outstanding and there’s a small blip like this I typically take it as: applicant is human not a robot, this comment is an outlier without correlation in the rest of the application, and/or if you already knew everything then there’s no reason for you to do a residency. That’s my perspective when looking at the application. Not a comment on your correctness when answering this question.

This is likely to happen again in training and beyond. Sometimes the answers are clear cut like this and sometimes you will have a difference of opinion on a treatment plan and there is more than one right answer (or sometimes NO right answer). I’m not going to tell you to Let It Go. I’m going to tell you to pick your battles. Ideally you’ll get to know attendings and later on colleagues (who are also humans and not robots) and learn which ones you can engage with on something like this, and how to do it gracefully, and which ones that it is better to let it go because of the bigger picture. Because there is a spectrum of personalities in medicine and this a spectrum of ways that you need to interact with people. Bigger picture could mean with regard to patient care, with regard to your career, or any number of other things. Sometimes it is important to stick to your guns and speak up. And other times it isn’t. I would argue that this particular time it probably isn’t. If the feedback session implied favorable letter, that’s what you need. Never have I ever seen an LOR that said “great student overall with incredible work ethic and attitude, above average fund of knowledge, except didn’t know the 7th step in the Kreb’s cycle once.”

 

[ThoracicGuy]

So from someone who interviews for both residency and fellowship candidates nowadays, you need to know that most of us look at the application as a whole. If the majority of the application and comments are outstanding and there’s a small blip like this I typically take it as: applicant is human not a robot, this comment is an outlier without correlation in the rest of the application, and/or if you already knew everything then there’s no reason for you to do a residency. That’s my perspective when looking at the application. Not a comment on your correctness when answering this question.

This is likely to happen again in training and beyond. Sometimes the answers are clear cut like this and sometimes you will have a difference of opinion on a treatment plan and there is more than one right answer (or sometimes NO right answer). I’m not going to tell you to Let It Go. I’m going to tell you to pick your battles. Ideally you’ll get to know attendings and later on colleagues (who are also humans and not robots) and learn which ones you can engage with on something like this, and how to do it gracefully, and which ones that it is better to let it go because of the bigger picture. Because there is a spectrum of personalities in medicine and this a spectrum of ways that you need to interact with people. Bigger picture could mean with regard to patient care, with regard to your career, or any number of other things. Sometimes it is important to stick to your guns and speak up. And other times it isn’t. I would argue that this particular time it probably isn’t. If the feedback session implied favorable letter, that’s what you need. Never have I ever seen an LOR that said “great student overall with incredible work ethic and attitude, above average fund of knowledge, except didn’t know the 7th step in the Kreb’s cycle once.”

The Karen cycle fit as well.

 

[LucidSplash]

The Karen cycle fit as well.

Haha you saw it before the edit. Damn autocorrect 😂

 

[guytakingboards]

To those in residency and beyond, seriously, wtf can I learn from this so that it happens less often, if at all? And any advice that is basically “just move on” isn’t helpful; you’re making it easier for this thing to repeat itself.

Honestly, there's not a ton you can do to make stuff like this happen less often. It's random. It's the "human element" of training/life you just can't control. People are irrational, biased, mean, lazy, stupid, etc...

Just continue to do good work, expect a few hiccups to occur every now and then, and hope that your record speaks for itself otherwise. And as LucidSplash said, pick your battles.

 

[Dral]

Happens all the time. Vent and then forget about it.

I got a bad review comment from a nurse on surgery rotation because she told me I should be squirting water on skin as I removed some duoderm. She was bent because I didn't listen to her (spoiler: The duoderm came off fine). As an aside: Fast forward to intern year. If the ICU nurses told me to run around the room and honk like a goose before I took off the duoderm, I would do it. lol

I can think of a few other rando things off the top of my head that resulted in bad reviews. You're going to be caught on bad days but you'll also catch other people on bad days. And sometimes it's neither and you just have to play the game.

Don't most med schools let you remove one negative thing from your Dean's letter? Just remove hers, rant in private a few times about the incident, then move on.

 

[Mass Effect]

Don't most med schools let you remove one negative thing from your Dean's letter?

No? Be thankful if yours did.

 

[Matthew9Thirtyfive]

Maybe this is a stupid question, but why couldn’t you appeal that? Something similar happened to me with an attending I barely worked with who wrote that my clinical knowledge was lacking despite not asking me anything except for one resident level question. I went to my rotation’s site director and told them why I thought that was bull**** and they had it changed.

 

[hallowmann]

Maybe this is a stupid question, but why couldn’t you appeal that? Something similar happened to me with an attending I barely worked with who wrote that my clinical knowledge was lacking despite not asking me anything except for one resident level question. I went to my rotation’s site director and told them why I thought that was bull**** and they had it changed.

Not worth it at an away. It would likely be viewed as worse than the comment itself. Runs the risk of looking petty and like you can't take criticism. Best to leave it where it is.

There are going to some attendings that don't like you for literally zero reason or reasons outside of your control. Maybe it's a personality clash, maybe they don't like anyone, maybe they had a bad day the day they met you, or maybe they're racist. The less time and power you afford to these people mentally, the happier you'll be.

 

[flasheroonie]

You're a human, not a robot. You'll be okay in the eyes of residency programs.

 

[Dral]

No? Be thankful if yours did.

I thought I read on here in the past that some schools do. Maybe not most. Mine (UVA) didn't.

 

[Iamnew2]

Rant, but also looking for advice.

Me: MS-4, away rotation, FM
Had end of rotation feedback, felt everything was pretty good during.
Evaluator had monitor with comments somewhat faced towards me.
He turns away for a minute, addresses MA's problem.
I take opportunity, lean in to see feedback on monitor.
Most feedback was “Beyond Satisfactory” and “Great.”
One was “Unsatisfactory” Comment: “Lacks basic scie-” Preceptor: ObGyn
I remember this day vividly: Saw the preceptor for less than 1 hour. Other time was with residents.
Was asked 4 “pimp” questions: Got 3 right.
Question I got “wrong”: “How does aspirin work?”
Me: “Irreversibly blocks COX-1”
Her: “What enzyme is affected?”
Me: “COX-1”
Her: “... the enzyme is cyclooxygenase. Different pathway”
Me: “Isn’t that COX-1 cyclo-oxygenase?”
Her: “Different pathway”
It should feel like a small thing, but I got a “below average” rating from her because I didn’t say the full name of an enzyme, and she was too far removed from med school to even recognize the enzyme by its shortened name. I could’ve corrected her, but she probably would’ve doubled down further.
It's frustrating because she’s apparently well-respected and everyone loves her, so her words probably hold weight in my eval and chances of a good LOR.
I’m just frustrated that my f-----g future might be in the hands of someone like this.
Feels like there are things you just cannot win no matter what you do. You can go in early, put in the work, show your happy face, show eagerness, show enthusiasm, hide the pain, don’t talk back, don’t be confrontational, and take initiative... only to potentially have their impression of you sullied by one person who can’t take 2 seconds to think “wait, maybe it’s ME who is wrong.”
I cannot refute this comment and rating with my evaluator because then it’d seem like I peeked when I shouldn’t have.

To those in residency and beyond, seriously, wtf can I learn from this so that it happens less often, if at all? And any advice that is basically “just move on” isn’t helpful; you’re making it easier for this thing to repeat itself.

And to all the PDs out there: how many of you actually want applicants rotating through your program to be non-confrontational to a fault? If I’m >99% certain that I’m right (especially on something this basic) why is it so bad for me to correct, even politely, my preceptor? Because that seems to be the mindset with all students doing an away or a Sub-I. Why should I just take the hit to my chin, get back up with broken teeth, only to be spat it in the face with a “you’re incompetent” loogie because I’m not allowed to defend my answer against theirs?

I just hope to God that whoever writes my LOR omits that part.

First thing, if it makes you feel any better, Obyn peeps are rough. I was in fact discussing this exact point with my fiance recently. They have a rough life, and tend to take it out on others. Ob was by far my worst ever rotation as a med student. I couldn't do anything right. If i showed too much initiative, I was pushy and overstepped my boundaries. If I didn't show enough initiative, I was uninterested. Meh. They literally made me cry and I was such a mess that I got into an accident that same day. One of the residents in the program I was rotating at also was made to cry because she got pimped so badly and brutally - on her birthday. Sadly they tend to be rough graders and they will nit pick everything if they don't like you. In my experience, I don't know anyone who has had a good Ob gyne rotation. With that said if you are a solid med student, and it's just a random eval in your non-clinical area of choice - particularly given that this is a known thing for Ob- I woudln't sweat it. A lot of stuff in med school/rotations/residency is subjective. Yes you can put in the work and do everything right and one off day can put a damper into the whole thing. It happens to everyone. Being combative sadly won't work - or even being right. Attendings dont like to be corrected - even if they are wrong. You can dispute it (I have disputed nonsense that I thought was wrong). For example, I had gotten all excellents/outstandings on one rotation - then I worked with one attending guy who literally worked with me for a few days and he gave me an average or something. Because the other peeps hadn't turned it my evals or they had gotten lost who knows they gave me an average. I was like what? I disputed this and eventually my grade got changed.

Overall though as someone else pointed out, as long as you are solid overall, I wouldn't worry too much.

 

[Iamnew2]

Maybe this is a stupid question, but why couldn’t you appeal that? Something similar happened to me with an attending I barely worked with who wrote that my clinical knowledge was lacking despite not asking me anything except for one resident level question. I went to my rotation’s site director and told them why I thought that was bull**** and they had it changed.

I did the same thing. Grade was changed from "average" to "outstanding." As one random attending who worked with me for a few days said I needed more "geriatric knowledge." Lol.

 

[Iamnew2]

Happens all the time. Vent and then forget about it.

I got a bad review comment from a nurse on surgery rotation because she told me I should be squirting water on skin as I removed some duoderm. She was bent because I didn't listen to her (spoiler: The duoderm came off fine). As an aside: Fast forward to intern year. If the ICU nurses told me to run around the room and honk like a goose before I took off the duoderm, I would do it. lol

I can think of a few other rando things off the top of my head that resulted in bad reviews. You're going to be caught on bad days but you'll also catch other people on bad days. And sometimes it's neither and you just have to play the game.

Don't most med schools let you remove one negative thing from your Dean's letter? Just remove hers, rant in private a few times about the incident, then move on.

Also nurses take out their anger against residents. I personally don't think nurses should be rating residents.

 

[mvenus929]

I thought I read on here in the past that some schools do. Maybe not most. Mine (UVA) didn't.

Though the clerkship director has control over what is put in the final evaluation. You can get a bunch of evaluations, and the clerkship director is the one who collates them and provides the narrative that is put in the Dean's letter. If there is one comment that doesn't jive with the rest of them, that comment can be omitted.

 

[IonClaws]

Rant, but also looking for advice.

Me: MS-4, away rotation, FM
Had end of rotation feedback, felt everything was pretty good during.
Evaluator had monitor with comments somewhat faced towards me.
He turns away for a minute, addresses MA's problem.
I take opportunity, lean in to see feedback on monitor.
Most feedback was “Beyond Satisfactory” and “Great.”
One was “Unsatisfactory” Comment: “Lacks basic scie-” Preceptor: ObGyn
I remember this day vividly: Saw the preceptor for less than 1 hour. Other time was with residents.
Was asked 4 “pimp” questions: Got 3 right.
Question I got “wrong”: “How does aspirin work?”
Me: “Irreversibly blocks COX-1”
Her: “What enzyme is affected?”
Me: “COX-1”
Her: “... the enzyme is cyclooxygenase. Different pathway”
Me: “Isn’t that COX-1 cyclo-oxygenase?”
Her: “Different pathway”
It should feel like a small thing, but I got a “below average” rating from her because I didn’t say the full name of an enzyme, and she was too far removed from med school to even recognize the enzyme by its shortened name. I could’ve corrected her, but she probably would’ve doubled down further.
It's frustrating because she’s apparently well-respected and everyone loves her, so her words probably hold weight in my eval and chances of a good LOR.
I’m just frustrated that my f-----g future might be in the hands of someone like this.
Feels like there are things you just cannot win no matter what you do. You can go in early, put in the work, show your happy face, show eagerness, show enthusiasm, hide the pain, don’t talk back, don’t be confrontational, and take initiative... only to potentially have their impression of you sullied by one person who can’t take 2 seconds to think “wait, maybe it’s ME who is wrong.”
I cannot refute this comment and rating with my evaluator because then it’d seem like I peeked when I shouldn’t have.

To those in residency and beyond, seriously, wtf can I learn from this so that it happens less often, if at all? And any advice that is basically “just move on” isn’t helpful; you’re making it easier for this thing to repeat itself.

And to all the PDs out there: how many of you actually want applicants rotating through your program to be non-confrontational to a fault? If I’m >99% certain that I’m right (especially on something this basic) why is it so bad for me to correct, even politely, my preceptor? Because that seems to be the mindset with all students doing an away or a Sub-I. Why should I just take the hit to my chin, get back up with broken teeth, only to be spat it in the face with a “you’re incompetent” loogie because I’m not allowed to defend my answer against theirs?

I just hope to God that whoever writes my LOR omits that part.

I am scratching my head OP, but wtf did your preceptor mean by "different pathway" ? Your response was correct AFAIK.

 

[killerleaf]

Unless you are going into OB/GYN, don't sweat it. Unless you have a ton more comments like that, from different areas, don't sweat it. In my experience, selection committees are going to look at that, say "O, it's OB/GYN, they always do that" and they will move to the rest of your Dean's letter.