Rotations--to grade or not to grade?

[DoctorInSpace]

Hi everyone. I am currently at an osteopathic school, but we are considering having our third and fourth years graded. I believe we are currently pass/fail for all rotations. I do know that our class rank really can't change much after our 2nd year. None of the osteopathic schools have grades during their 3rd and 4th years.
I'm asking you guys at MD schools to please give me your opinions. How does your school work? Do you like that way it works? What would you change?

Any information is helpful. I know everyone will have their own opinion and I welcome that.

Thanks!!

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[DrMom]

None of the osteopathic schools have grades during their 3rd and 4th years.

Don't know where that tidbit came from, but we have grades 3rd & 4th years at my school for our 13 months of required rotations. The 8-9 elective months are pass/fail. I wouldn't want to have my class rank & GPA set solely by the pre-clinical years.

 

[DoctorInSpace]

Dr. Mom,

Someone PMd me and told me OSU had grades years 3 and 4......i had no idea! I was totally misinformed and glad to know the truth now. You said you wouldn't want to have class rank/GPA set solely by clinical years----lots of my classmates agree, because they will be better clinically than they are w/books and such.

Any more opinions?

 

[KyGrlDr2B]

Moving to clinical rotations forum.

 

[doc05]

in response to the original question:

yes, you should absolutely have grades during clinical years. it's not always fair, but how else will you be accurately evaluated for residency purposes?

 

[Yosh]

At WesternU/COMP...our 1st two tears are number grades...and rotations are ALL letter grades. I think it helps you shine so to speak, and having rotated with students from other DO schools, that only pass/fail....alot of times causes the graded students to work harder and allow the P/F students to slack.

 

[Harrie]

Our school has grades for the first 3 years, then 4th year is pass/fail. After we finished first and second year, there were a lot of people excited about finally starting third year because they figured that they would have better grades. Honestly, even though you are graded clinically, it seems that the shelf exam is still what determines your grade. You can be an awesome clinical student, but when the shelf exam accounts for 30-40% of your grade it really comes down to your grade on the test. Then there are the mediocre clinical students who pull off A's because they rock the test. It really isn't much different than the first two years!

 

[DoctorInSpace]

Our school has grades for the first 3 years, then 4th year is pass/fail. After we finished first and second year, there were a lot of people excited about finally starting third year because they figured that they would have better grades. Honestly, even though you are graded clinically, it seems that the shelf exam is still what determines your grade. You can be an awesome clinical student, but when the shelf exam accounts for 30-40% of your grade it really comes down to your grade on the test. Then there are the mediocre clinical students who pull off A's because they rock the test. It really isn't much different than the first two years!

As far as I know, we don't have Shelf Exams here, and there is no plan for that. I can understand how that would affect your grade on your rotations, and how that would be pretty similar to the first two years, and not an accurate account of your clinical ability. Thanks for the info.

Yosh and Doc05--thanks for your input too. I want to get as many opinions as possible on both sides of the coin so we can present this to our school in the most fair way possible.

Thanks again. I'd give Karma points if we were still diong that. Instead, I'll just send my thoughts of appreciation!

 

[kinetic]

Graded clinical years are lame.

They're totally subjective. First of all, many schools can have artificial grade inflation; I've heard of places where they hand out 50% honors. My own institution used to have a problem with the FP rotation because it was so incredibly easy to get honors that it was a joke - that has since been stopped (but now it's the reverse, which is also pretty lame). Second of all, clinical grading is why ass-kissers do so well. You get an honors for laughing at bad jokes, grinning like an ape, throwing around compliments, being a gopher ...oh, and sometimes actually knowing something. And if you're friends with the residents/attendings, that's an automatic honors. Whereas, if you're quiet and not as extroverted or just not an ass-kisser (especially if you are on the team with someone who is) you may eke out a pass.

I once was on a team for 2 weeks with one resident and then the teams rotated. I was paired up with a female and the first resident was a male. He fawned all over her, helped her with everything, prepared her for pimping sessions, and reviewed her progress notes. Meanwhile, I received no help, got stuck with mostly combative patients, and was generally on my own. Then the teams switched and the new resident was a female. We finished out the rotation and she gave me her evaluation. (Paraphrase, but this is the actual gist of it with no sarcasm): "I was surprised. The other resident told me that you were lazy and pretty stupid, but I didn't find that to be the case. However, since he gave you such a poor review for the first half of the rotation, I'm going to be forced to give you a pass."

That's why you worked so hard to get into medical school: so that you can get dicked over in some popularity contest. Or so you can watch some oversexed guy/gal try to hit on a medical student in exchange for grades. It makes you feel all warm and fuzzy inside.

 

[scootad.]

that is so very true kinetic

there's a similar topic on teh allopathic forum. but i dont think this is anything unique to medicine. hot people tend to be more successful in all fields regardless of merit.

 

[kinetic]

Graded clinical years are why:

Female medical students walk around in the halls and ask male residents, "you coming out to my party tonight?" (This happened a lot.) Of course, once you get your grade in you stop throwing out those invites ...coincidence, eh?

Male medical students would hand out cigars and bring in movies for the residents.

Female medical students wear revealing clothing and giggle brainlessly when they get noticed by loser male residents.

 

[Gauss]

Graded clinical years are why:

Female medical students walk around in the halls and ask male residents, "you coming out to my party tonight?" (This happened a lot.) Of course, once you get your grade in you stop throwing out those invites ...coincidence, eh?

Male medical students would hand out cigars and bring in movies for the residents.

Female medical students wear revealing clothing and giggle brainlessly when they get noticed by loser male residents.

this is why only attendings give out our clinical grades
residents can assist in evaluation and you can have them fill out optional evals, but it comes down to what the attending says.
Not perfect by any means but it cuts down on the crap you mentioned

what I hate are shelfs that amount to >40% of your grade

 

[kinetic]

this is why only attendings give out our clinical grades
residents can assist in evaluation and you can have them fill out optional evals, but it comes down to what the attending says.
Not perfect by any means but it cuts down on the crap you mentioned

what I hate are shelfs that amount to >40% of your grade

Yeah, but attendings get the ass-kissing treatment too. And looooove it!

 

[Gauss]

Yeah, but attendings get the ass-kissing treatment too. And looooove it!

Really???
you have some bizarre attendings then
MOst of mine can smell ass-kissing coming a mile a way and they crucify female med students that display the behavior you mentioned

 

[irlandesa]

this is why only attendings give out our clinical grades
residents can assist in evaluation and you can have them fill out optional evals, but it comes down to what the attending says.
Not perfect by any means but it cuts down on the crap you mentioned

what I hate are shelfs that amount to >40% of your grade

my school should adapt your school's policy! my medicine clerkship director told us that our residents have the most say in our grades b/c they spend the most time with us, and all the rotations are the same. The exception to this is the family medicine clerkship, where each student is paired with one attending. Interesting observations you guys have about female students getting better evals from male residents; I've also found this to be true even though most of the male residents I've met are married.. I find that I tend to get along better with male residents b/c they are less likely to be snotty and judgemental than many female residents, and the more mature ones are more likely to realize they are there to learn and teach, and not to gossip and act foolish. Pediatrics was awful for me b/c of the juvenile and judgemental behavior of the female residents, and I received not a single evaluation from an attending (male or female). I think grades should be replaced by narrative evaluations about strengths and weaknesses that provide specific feedback (not just some vague checkmark in a box), and the shelf exam scores should be reported only for the specialty the student wants to go into and/or other specialties the student would like reported. This sounds silly, but I think it would actually help the residency directors to select for people with the clinical skills and personal traits they are looking for instead of having to look through a bunch of diff. grading systems and graphs.

Oh yeah, I've seen male students engage in ridiculous behavior too, and they have not only the advantage of being able to flatter the female residents, but also to flatter the more sexist of male residents.

 

[DoctorInSpace]

Thank you all for your posts. I'm seeing that this will not be an easy topic for my school to decide on. Some people hate to have their grade and class rank determined by the first two years, but others say that the numbers don't matter too much unless you are going for an ultra competitive residency.

I'm not sure what will actually be proposed to our administration---if residents will be allowed to grade, or only the attendings, how the grading is done, etc. For our Simulated Patient exams, we have had problems with some faculty grading much harder than others. If we can't standardized a process in our own school, i'm not so sure we can standard a procedure among 12 hospitals.

Keep the opinions coming, from both sides.

 

[Harrie]

That's the point. There is no way to standardize grades in 3rd year. Some attendings hand out honors like candy, some will give one or two coveted honors per year, some won't ever give honors. Plus, there is no way to go back and standardize by attending either. If one attending gives out all honors to a group of three students and another gives out a near honors and two high passes, there is no way to actually standardize this because maybe that first attending's students were all really good. You just have to know that clinical grades aren't fair, life's not fair, and you have to just do the best you can and not get torn up by one or two evaluations. Honestly, I think this is why the shelf exam is weighted so heavily.

 

[DoctorInSpace]

Harrie,

Thanks for your input. I'm thinking pass/fail is the way to go, and in terms of landing the residency I want, it will depend on showing off my knowledge when I am at that rotation as well as getting to know those who will decide my fate.

Let the conversation continue...

 

[irlandesa]

That's the point. There is no way to standardize grades in 3rd year. Some attendings hand out honors like candy, some will give one or two coveted honors per year, some won't ever give honors. Plus, there is no way to go back and standardize by attending either. If one attending gives out all honors to a group of three students and another gives out a near honors and two high passes, there is no way to actually standardize this because maybe that first attending's students were all really good. You just have to know that clinical grades aren't fair, life's not fair, and you have to just do the best you can and not get torn up by one or two evaluations. Honestly, I think this is why the shelf exam is weighted so heavily.

this all sounds great until you realize that many of us have a 150K+ debt to pay off. If I end up not being able to get a decent residency in IM b/c of a few evals in a closely related specialty (Peds) and/or b/c I got 2 Passes this year (1 in Peds, 1 in Surg due to my shelf exam, decent written evals tho), and can't get a decent paying job after a residency b/c my residency program is not well regarded at all, this is a BIG problem. I don't want to end up in serious financial trouble or in a location that is completely unsatisfactory b/c the grading system blows. "Life's not fair, deal with it" just doesn't cut it when you can't pay back your debt and put food on the table for your family

 

[Harrie]

I'm not saying that its right, but I'm just saying that this is how it is done (at least at my school). It isn't fair. It is impossible to make it fair. So you can dwell on the injustices, but it won't make a bit of difference because that's just how the system works.

 

[Harrie]

BTW, I doubt that a few passes in third year is going to make you so financially insecure that you won't be able to put food on the table for your family. You may not match at your #1, but you won't be on welfare either. Come on, we need to put things into perspective here.