The underlined sentence here highlights the importance of communication of what your evaluation actually is which
@efle and
@quickjab1212 @Thesimplelifeofamyloid have already emphasized. The bolded may be true in the context you're using it in, but isn't necessarily as true as I thought it was as a medical student. When I was a medical student, I used to lament that residents/attendings don't understand how much our evaluations mean, etc. Now I can see it's more than that. Unless your attendings/residents are IMGs, most AMGs grading you actually know the stakes but still give you vanilla grades, etc. and I wanted to make a few points now from a former resident's perspective that may be helpful.
Reasons for this:
1.) Culture. It starts from the top with the organizational workflow and is reinforced by the attending. Some places and attendings regard medical students as a caricature or side show who're supposed to regurgitate step 1 minutiae. It's very hard as a resident to take a medical student under their wing and work against the established culture.
Typically the most compassionate residents aren't the best ones either which then begs the question, why is Resident B breaking the mold and doing all this stuff for medical students when they can hardly do their own job?
2.) From the resident's perspective, I have observed that there is an approximate 80:20 split in performance where there's 80% of students who are nice enough, but mediocre. These are the types that ask what else they can do 2-3 times during the day and are mostly in the way and then somehow are absent when something actually shows up. Then there's that 20% that somehow know or anticipate what residents will struggle with and pitch in which wasn't me. These are the medical students we immediately latch onto and take under our wing.
3.) Evaluations are set up by your school poorly. There is such a thing as evaluation fatigue. As a resident, I just want one form with 10 likert score boxes with competencies with an open ended area where I can give my overall impression. Having boxes after each competency and likert score is an acceptable alternative. What makes it difficult is when the system deviates from this. Sometimes, there's some sort of patient attached to each evaluation. I'm not going to go digging into the EMR to retrospectively assess the performance of the medical student. If this happens to you, hand the resident a printed copy of whatever your work on that patient is and ask them if they can submit the eval but the end of a reasonable time period (ex. end of the week).
4.) There's a gross disconnect between the residency program and the clerkship director. Sadly, medical education is not always the priority or on the mind of the residency program director. On half the residency interviews I attended there was an emphasis on the so called "RAT" -Residents as Teachers that never panned out in real life. As residents, we don't actually have a session (or anything with regularity) where we meet with people above us and they tell us how to assess/evaluate medical students. One way to assess how good the connection between your residency and medical school is, is to look at the clerkship director and see how much residents respect him/her. If he or she is just a pushover or residents don't really know them, that's a sign the clerkship director's not really doing much to advocate for student education.
Things to do as a medical student:
1.) Be present. UWorld is not a priority during work hours. Rotations should have hours and you should follow them. If they're not explicitly stated, expect them to be resident hours. Now, that doesn't mean stay if the resident dismisses you but if the workflow isn't busy, don't try to ask "is there anything else I can do" before disappearing to the library or whatever. Stay where your resident can see you. There's a bajillion medical students who don't do this.
2.) This is easier said than done but don't ask the resident what you can do. Just watch what the resident does and do what they do the next time. Without stepping on toes, do the things they would have done. This level of proactivity is something students come in either having or not. Things I have noticed are those with prior life experience/jobs especially in the healthcare field usually latch onto this while the premed who went straight through (used to be me) were more dependent on being told what to do.
3.) When we ask questions, we're doing it for the same reason UWorld is doing it. When you get a UWorld question right, you don't disregard the block of text that follows. Similarly when we ask a question, sometimes students (including myself) saw it as a power trip or pimp and focused their energy on getting the question right and ignore the explanation. Some get defensive to and try to explain why they gave a different answer when we're just trying to teach a clinical pearl.
4.) Direct the resident's attention to what part of the evaluation needs to be completed just like
@efle and
@Thesimplelifeofamyloid point out. I remember an orientation where we were given a syllabi that on one page had a screenshot of the evaluation page as well as what each benchmark meant and someone in my med student cohort lied to a resident that "we were required to show them that page" which I thought was ludicrous at first but it was effective and now I can at least see the sentiment behind their action. As residents, we sometimes don't know which form means what. At my residency, there were two evaluations generated and one counts for very little while the other counts for nothing. We did not have any sessions where faculty came in to tell us what the medical students expectations/grading was like which would have been helpful. If your school is one that asks residents to assess the competency of a medical student on a particular patient, print out your work for that patient and ask the resident to submit an evaluation on that within etc. time period (end of the week).
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I didn't write this to point a finger at medical students or stand on a soapbox but to inform students about the reality of the situation. I'm someone who loves to mentor and give medical students the feedback/evaluations they deserve but I just wanted to educate ya'll about some of the hesitances/barriers from the resident's perspective.
Also, students sometimes lament about why they were given average marks in the likert score portion but outstanding superlatives. At least from my perspective, it was because they student was truly average clinically but put in a lot of work so I tried to highlight those positives while trying to be fair and stick the my internal grading scale. I used to be one of those people who just gave straight 5s but after my experiences, I feel it's honestly best to give the honest evaluation to the student. The one thing I don't include in evaluations are editorials on why a student isn't good. If a student is not exceptional, I just mark them that way and prefer not to give school admins/clerkship directors more fuel for a fire to speculate about things that aren't their business. I will, however, make that my honest impression clear to the student before they're done rotating.
Though I didn't address it,
@efle 's take that it's "who you ask" more than "how you do" sadly isn't far from the truth. There are clerkship directors or sometimes a committee who discuss each honor or failing clerkship grade at each school to combat grade inflation but most times asking the right resident is the easiest path to success.
