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Rotation eval venting

Discussion in 'Clinical Rotations' started by mrp, May 28, 2002.

  1. mrp

    mrp Member

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    I have steam literally shooting from my ears right now, so I thought I'd vent on this board.

    Got my pediatrics eval today. It turns out that the attending who seemed so friendly while I was on the ward ACTUALLY thought I was doing a bad job. She wrote in my eval that I showed limited interest and effort in learning pediatrics. Additionally, she wrote that I didn't make an extra effort to learn about other patients on the ward.

    I sure wish she could have mentioned her thoughts to my face BEFORE the rotation ended. This totally came out of left field--I previously had thought I was doing great, and that I had a shot at honoring the course.

    Anyone else have similar stories?

    <img border="0" alt="[Pity]" title="" src="graemlins/pity.gif" />

    -mrp
     
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  3. md03

    md03 Senior Member

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    OH Yes,I know exactly how you feel. I had a similar experience on surgery and am still reeling from it (I have done very well in all other rotations, so now surgery is my lowest clinical grade...and that's what I'm going to do!)

    This is acutally not uncommon at my school. I know several people who had good midmonth evaluations (usually the only criticism anyone gets is "read more") only to be stunned to get a less than stellar final evaluation. Everyone who I know that had this experience would have been perfectly willing to change any criticized behaviour...if we had only known it needed changing!!! AAARRRGGGHHHH!!!

    Alas, the only recourse I have now is to figure out how to answer the inevitible interview question, "What happened in surgery?" and bust my butt even harder on my surgery electives so as to get excellent letters.

    I know that in the long run it probably wont matter very much, but it is extremely annoying.
     
  4. Dr JPH

    Dr JPH Banned
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    Does anyone find that the clinical instructors are honest when you ask them about your performance?

    I attended a small university and I was lucky. If I asked a professor a question, I got an honest answer. Sometimes too honest, but it motivated me to work harder or to alter my focus towards a particular problem/issue.

    It would bug the hell out of me if I asked a clinical instructor if he/she thought I was performing well and they couldn't be honest about it.

    Comments?
     
  5. Sevo

    Sevo Senior Member
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by mrp:
    <strong>I have steam literally shooting from my ears right now, so I thought I'd vent on this board.

    -mrp</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Not too surprising. I had the same experience, as did a number of people in my med school class.

    I'm not a big fan of pediatricians. I'm going to get flamed for this, but I've always felt that most peds people have serious problems maintaining relationships with anyone older than 12.

    I mean, there has to be something wrong with people who appear to be perpetually happy 24/7, right? The peds residents I worked with made backstabbing an art and furthering the gossip about each other the central point of their days -- all of that with big s*it-eating grins on their faces.
     
  6. Mad Scientist

    Mad Scientist Member

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    I say that there are two kinds of attendings...those that will say "Great Job!" and give you straight 10's on your eval, and those who say "Great Job!" and give you straight 5's (and single-handedly ruin your chance of doing any better than passing the course).

    I won't go nearly as far as Sevo about pediatrics, but I did have some problems in that rotation. They seem to want to do everything "by the book" and, at least at my school, were the most competitive people I've been around. I got called on the carpet for disagreeing with an attending during rounds (by the upper-level...the attending didn't care). Then on Internal Medicine I was criticized for not arguing my opinions strongly enough. Sheesh.

    There's no predicting evaluations...it drives me crazy but I don't know how to make it better. The other day at our end-of-rotation feedback session in IM we griped at the chief resident about it for a whole hour. I felt bad for her, since there wasn't anything she could do about it.
     
  7. gassman

    gassman Junior Member

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    Sevo--did you and I unknowingly have the same peds rotation at the same time?? :) Your comments really hit home. My inpatient peds experience was, hands down, the worst 4 weeks of medical school. The residents were, without question, the biggest collection of judgemental, passive-aggressive, back-stabbing whiners I have ever been around. To add to the fun, my intern hated me-- so basically anything I did was wrong. She told me within a four day period that 1)I needed to show more interest in peds, and 2)I was asking too many questions (...that she didn't know the answer to). So, which is it? Am I not interested, or am I too interested? :mad: :mad: :mad: Let's just say that it was a FUN 4 weeks.

    Just remember -- children are not small adults...pediatricians are. <img border="0" title="" alt="[Wink]" src="wink.gif" /> <img border="0" title="" alt="[Wink]" src="wink.gif" />

    Thank god for anesthesia. <img border="0" alt="[Clappy]" title="" src="graemlins/clappy.gif" />
     
  8. tussy

    tussy Senior Member

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    This is a common occurance and the only way to prevent it is to ask for an informal half way evaluation. No one wants criticism, but if you ask for it part way through, then you can correct any problems that have been identified. If they tell you you're doing a great job, then they can't give you a horrible eval at the end (or if they do then you have good grounds to contest it)
     
  9. njbmd

    njbmd Guest
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by mrp:
    <strong>I have steam literally shooting from my ears right now, so I thought I'd vent on this board.

    Got my pediatrics eval today. It turns out that the attending who seemed so friendly while I was on the ward ACTUALLY thought I was doing a bad job. She wrote in my eval that I showed limited interest and effort in learning pediatrics. Additionally, she wrote that I didn't make an extra effort to learn about other patients on the ward.

    I sure wish she could have mentioned her thoughts to my face BEFORE the rotation ended. This totally came out of left field--I previously had thought I was doing great, and that I had a shot at honoring the course.

    Anyone else have similar stories?

    <img border="0" alt="[Pity]" title="" src="graemlins/pity.gif" />

    -mrp</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Hi there,
    Attendings get much of their evaluation material from residents so make sure you are communicating well with your residents and interns. Sometimes not asking questions is interpreted as not being interested in the patients or the rotation. I really tried to benefit from my attendings' and chief resident's experiences in patient care. I always read about every patient on the service especially those that I was not taking care of. I also made it a point to ask for good references for conditions that were not commonly seen in my rotation location such as pediatric oncology.

    Some attendings are touchy about you asking about grades and focusing on your grade too soon. Instead, focus on making sure that you have covered the major pathology of a particular rotation. Great questions would be: Why did you handle this problem at this point in this manner? How much of so and so are you seeing? What do you find most interesting about peds etc? Would treatment X be a better alternative than treatment Y if the patient had presented with ...? Make your attending give you the benefit of his or her experiences in patient care. Try to discuss some cases that are confusing to you.Pull some out of a review book i you have to. Try to tie each rotation into broadening your clinical knowledge base as a physician.

    Take care of any personal disagreements on the spot. While your grade is your business, it can quickly become a personal item for a resident or attending that you have a personality conflict with. I can't tell you how many little cynical comments by a medical student translated into poor evaluations by residents/attendings. You may not have made the comment but the attending might have heard it from your direction. This is a lousy system but it is a hoop that you have to jump through. Needless to say, do very well on the shelf exam even if your clinical evaluation is not stellar. This can be a good leverage point if you have to appeal your grade. If you really feel like you deserved a better evaluation, discuss this with the resident first, then the attending and then the department chair. Do this from the standpoint that you want learn from your mistakes and not repeat them in the future. Ask that attending to elaborate on what you could have done to show more interest.

    If all else fails and you are interested in said specialty, do a couple of early outside electives during fourth year and have a good relationship with the department chairman. You can always explain a poor third-year grade to learning the ropes after shining in fourth year.

    I learned that there was a certain amount of "kissing up" on some rotations. Find out what you have to do early (from students who just left the rotation) and make sure you touch all bases. Our class was very good about getting the word out about poor residents and poor teaching. Always talk with your classmates to find out the scoop on their rotation experiences. Talk to folks who did well and talk to folks who had difficulty. You can learn from both.

    Finally, if you are having a bad time on a rotation, try to find some good and hang on.If you are very determined to get the best out of a bad situation, you will. Most interns and residents don't have the energy to keep hammering you if you don't yield early. They can abuse you but they can't stop the clock. Eventually, the rotation will end and you will cut your losses and move on. Just document every poor situation and have this documentation ready for the appeal.
     
  10. vhl

    vhl Member

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    OK, in defense of pediatricians, not all of them are backstabbers who can't have relationships with people over 12! I can't speak for other institutions, but here the pediatricians and residents really play nice in the sandbox, and share their toys (knowledge and time). Students tend to enjoy the rotation, and we have a high match rate in pediatrics, and many residents who stay at the hospital or in the community when they finish.
     
  11. md03

    md03 Senior Member

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    Personally, I had a very good peds rotation. The residents in my group were very nice, super sharp and genrally good teachers as well. The worst experience I had with residents was OB..they were the nasty backstabbers where I'm at. However, ultimately I got a good evaluation from them.

    I don't know if it is possible to get an honest midmonth evaluation. Regarding the surgery situation I described above, my fellow students and I asked the residents how we were doing midway through, and were told something to the effect of "you guys are exactly how med students should be". My written midpoint evaluation from the attending gave no indication of any problem, just "read more", as the only suggestion for improvement.

    Further, it is typical (at my school anyway) for evaluations to take several weeks to a month to be completed after the rotation is over. None of the evaluations have ever been done at the time we take the exam.

    So several students have been lead to believe that they were doing fine, only to have a nasty surprise weeks to months later, when they go look at their grade.
     
  12. entropy

    entropy Senior Member

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    In my experience in medical school, surgeons were
    the most honest and straitforward people,
    whereas pediatricians were the most two-faced
    back-stabbing, passive-aggressive people I ever
    worked with.

    I personally perfer people who are strait shooters, and I don't really care how polite they
    are....

    I think pediatricians end up hating all grown-ups;
    they somehow want to protect children from all the evil in the world, and in the process end up
    hating everyone else, ie. students, nurses,
    other pediatricians, residents, etc....

    Do-gooders, passive-aggressive, touchy-feely,
    and two-faced people really get on my nerves...

    I also think that before any evaluation goes into
    a students file, it should be reviewed by the student, and unless the student signs it, it should not be considered a legal document that can come back to haunt someone.....

    ------------

    anyways, my 2 cents worth...
     
  13. Winged Scapula

    Winged Scapula Cougariffic!
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    An earlier comment made me think about the following:

    despite popular student opinion that appearing interested in a subject is the best way to do well on a rotation I would venture that attitude and behavior are also great predictors.

    I cannot tell you the times I have heard (both as a student and as a resident) complaints about students "not knowing their place" or being "too familiar" or "show-offs, know-it-alls."

    One might say, "well that's imperious surgeons for ya, wanting the students to kiss their arse." Not really. The comments were made about students who were too socially friendly with residents, almost unprofessional or students who acted like the attendings were their best buddy. I don't know exactly how to describe it, except to say that we "know it when we see it."

    It was about students, especially those with allied health experience, talking about their previous work as if they could skip a certain learning experience because they'd done it before or had nothing to learn about it. A corollary to this behavior is the student who belittles his classmates or tries to 1 up them - I have seen very little of that here but worked with a 4th year student who would pre-round on my patients, always answer resident's questions about them before I could, etc. Believe me, several of the residents told me (without being prompted) how they were wise to his behavior and even apologized for it. So don't kiss arse or knock others down just to make you look better - it has the opposite effect.

    Just my two cents...
     
  14. Firebird

    Firebird 1K Member

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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by md03:
    <strong>Everyone who I know that had this experience would have been perfectly willing to change any criticized behaviour...if we had only known it needed changing!!! AAARRRGGGHHHH!!!

    Alas, the only recourse I have now is to figure out how to answer the inevitible interview question, "What happened in surgery?" and bust my butt even harder on my surgery electives so as to get excellent letters.

    </strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Maybe you should have asked.
     

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