Rotations and Clerckships - how are you graded

"Getting along well" does not necessarily equate to "kissing a**". When you are on a busy ward with your team -- and particularly if you are on a team with another medical student -- then teamwork becomes very important. You do your part -- nobody likes to see a medical student who complains about fetching too many radiographs or doing too many rectals. You help your teammates -- nobody likes to see a medical student who tries to make him/herself look good at the expense of the other medical students. And you learn to become a competent medical student -- and in the process, you make your interns and residents look good to the attending.

There are probably situations out there in which "getting along well" equates to "kissing a**" -- I certainly don't want to claim that it doesn't exist (grrr) -- but it might be helpful if you approached it from a different angle.

Cheers,
-a.

 

the "be a good team player and you'll get the Honors" cheer sounds well and good but simply isn't true (if it were, many more people would get the Honors). Teamwork and having a good attitude and learning to present patients well (at least in IM and Psych, most other specialties could give a $*** in my experience) is of course very important, but the system is still subjective enough that you can get screwed. First, what constitutes the criteria required for Honors or High Pass means different things to different evaluators. "Outstanding" vs. "excellent" interpersonal skills (H vs. HP) are far from objective (I still have no idea how to differentiate, and I'd bet many residents do not either). 15-20% of people in each rotation are supposed to get the happy H, but there is no way the actual distribution consistently comes close to this at my school b/c "they are just standards (via the Dean of Students)" And then there is the shelf exam, which can make or break the grade if you are on the H/HP or HP/P border at the end of the rotation. Many schools use the shelf exam as the swing grade if you're on the border, so if you happen to have a bad day, you can count on getting the lower grade. I have my share of complaints about the system as do most of my classmates; I've found that all you can do is focus on learning how to become a good doctor. If you're a pleasant person who learns to present patients and is reliable, etc., and you still get a bad eval from a resident for some reason, forget 'em.

 

Moving to clinical rotations.

 

The variables are the school and the specific clerkship:

In our school, for the Medicine Clerkship, the evaluations are 80% of your grade and the shelf exam is 20% of your grade. You get from 6-8 evaluations during your 2 month clerkship including from 2 attendings, 2 senior residents, and 2-4 interns. Each rates you on several factors including teamwork, fund of knowledge, use of literature, quality of presentations, proficiency with the H&P, etc.

The actual evaluators do not write their names, so everybody's evaluation counts equally.

 

The two canonical student views of grading during clerkships are the "learn a lot, get along, work hard and you'll get honors" sunshine view, and the "it's all arbitrary, and the residents screw you" dark cloud view. (Though that's obviously an unfair characterization of irlandsea's post above.)

In my opinion, the truth is somewhere in between. Here's my model of how clerkship grading works.

In general, I think most people actually can tell good medical students from mediocre ones; it's mostly a matter of the confidence the student projects. But good students also are the ones who do lots of learning, help their teammates, "go the extra mile", and all that. And the shelf exam adds a quantitative element as well. So that combination (confidence, enthusiasm, exam performance) sort of sets the range you're working in. If you do well in all of those, you're in the Honors/High Pass range; if you do most, you're in the Honors/High Pass/Pass range, and if you do almost none, you're in the High Pass/Pass range.

After that, weird interpersonal stuff kind of sets the final grade. If you're in a H/HP/P range, and you really got along great with an attending who actually communicates their enthusiasm for you to the clerkship director, you'll get the Honors. On the other hand, if you're in the H/HP range and you didn't get along well with the clerkship director, for whatever reason, you'll get the HP.

Yes, there is a definite element of injustice in this. I'd bet that virtually every medical student has a anecdote about grading that causes them to grind their teeth whenever they think about it (I know I do). But when you're actually on duty, you have to try and do the things you can actually control, which are the "Go team! Rah rah!" things already mentioned. And that's easier if you pretend you don't know about the arbitrariness.

It's a maddeningly imperfect system. But I think most of the people in the system are trying to make it work out right. You just have to do your best and have faith in that.

 

At my school:

Medicine is 50% objective (two quizzes and the NBME) and 50% subjective (30% attending eval and 20% resident eval).

Surgery, Peds, Psych, OB/Gyn are structured similarly, with like half the grade objective and half subjective (I don't know the details because I haven't rotated through them yet). Geriatrics is mostly subjective with an objective OSCE grade, and Neurology is simply pass/fail with evaluations. Surgical subspecialties and that junk are pass/fail with evals too.

As far as evaluations go, we're evaluated on 7-8 levels such as relationship with patients, fund of knowledge, teamwork, relationship with health care team, etc, and each level is rated from 1 to 10. I have no idea how they convert it to a "grade", but I'm sure an 8-10 will put you in the B+ to A+ range.