the first 2005 clerkship anxiety thread

[fang]

Many of us will be starting clerkships in a few months. While I'm really happy to be done with the bookwork and on to seeing patients, I'm also a little anxious about the new grading scheme. (I know it's not all about the grades, but still, I'd like to do well!) In the 1st 2 years, if you put in the work you can see results, but I think it might be different with clerkships where your personality and natural ability to interact with people might be more significant. There's really no way to improve yourself in that reguard.

So to you people who have done this already... any thoughts? Can you work hard to do better or should you just try to get enough sleep so you're not completely spaced out when you talk to patients? I'm more on the introvert side of the spectrum... I'm not shy and I speak up when I have something to say, but I'm not one of those center-of-the-party kinds of people. I'm wondering if I'm going to find this transition difficult.

(Any other clerkship anxieties or tips?)

 

[El Jefe]

Many of us will be starting clerkships in a few months. While I'm really happy to be done with the bookwork and on to seeing patients, I'm also a little anxious about the new grading scheme. (I know it's not all about the grades, but still, I'd like to do well!) In the 1st 2 years, if you put in the work you can see results, but I think it might be different with clerkships where your personality and natural ability to interact with people might be more significant. There's really no way to improve yourself in that reguard.

So to you people who have done this already... any thoughts? Can you work hard to do better or should you just try to get enough sleep so you're not completely spaced out when you talk to patients? I'm more on the introvert side of the spectrum... I'm not shy and I speak up when I have something to say, but I'm not one of those center-of-the-party kinds of people. I'm wondering if I'm going to find this transition difficult.

(Any other clerkship anxieties or tips?)

Your personality is extremely important depending on what residents you get teamed up with. Some of them will absolutely not give honors to anyone they don't adore. It's nice to know your book learning, but I think being a great people person will probably get you just as far with clerkship grading. You need to study for exams, but at our school, resident/attending evals are typically half your grade, and the "knowledge base" part of those evals is just a tiny part of the whole. Being shy is probably nearly as great a liability in clerkships as being "stupid".

 

[jennie 21]

Well, I think it's true that your personality and the way you interact with patients are very important in clerkships, but I disagree with you that you can't "improve" in those areas. You can. It's true that to some extent you have a natural personality and if you're a shy person you will probably never be the life of the party, but it's certainly possible to work on specific aspects of your patient interaction. For example--I'm a second-year like you, but at our school we have "practice" physical exams with trained patient-actors and after that the "patient" critiques your performance. I've gotten the comment a couple of times that I need to be more assertive, more take-charge with patients, so that's something I'm working on doing. I do think that as you interact more with patients you will naturally develop and evolve in your style of interacting with them and your bedside manner, and you naturally begin to develop that "physician-aura" of authority and reassurance. Everyone has their own style with patients and no two doctors are exactly the same, but your style does evolve over time; the way you approach a patient as a third-year med student will be very different from the way you will when you're a third-year resident. You will naturally find your own style and develop something that works for you. As long as you're conscientious and caring and not extremely shy, I don't think it matters much if you're not the most outgoing person in the world. You'll be fine! I also worked as an EMT for three years and found that my skills in interacting with patients and my overall comfort level with patients improved A LOT during that time. A lot of it's just practice and getting comfortable in the role

 

[fang]

A lot of it's just practice and getting comfortable in the role

That's good to hear. It's true that you can work on being more assertive and outgoing, and that's probably what I should focus on working on. We have standardized pt exams as well, and I've recieved very positive feedback so far at that, but I find that to be easier-- it's just you and the patient, so you're not competing with other people to be heard. Some of my more outgoing classmates seem to have adopted a "style" that I personally find very fake, both with patients and their preceptors. For instance, I might be moved to bake some cookies for a team when I'm leaving a preceptorship, but one of my classmates bought the attending a $50 bottle of scotch... over the top in my opinion! When I see that going on I start wondering, how much does that crap matter?

 

[Samir Desai]

That's good to hear. It's true that you can work on being more assertive and outgoing, and that's probably what I should focus on working on. We have standardized pt exams as well, and I've recieved very positive feedback so far at that, but I find that to be easier-- it's just you and the patient, so you're not competing with other people to be heard. Some of my more outgoing classmates seem to have adopted a "style" that I personally find very fake, both with patients and their preceptors. For instance, I might be moved to bake some cookies for a team when I'm leaving a preceptorship, but one of my classmates bought the attending a $50 bottle of scotch... over the top in my opinion! When I see that going on I start wondering, how much does that crap matter?

A $50 bottle of scotch? I don't let anything short of $ 100 influence me! Just kidding. Attending physicians generally don't expect gifts at the end of rotations. In the conversations I've had with other attendings, I've never come across anyone who said that a gift that they received from a student influenced the way they graded the student. It's not necessary to give a gift. A thank-you would be nice. I've had some students write me a very nice thank-you note, which is a nice touch and a fine way to end the rotation. I certainly don't penalize students who don't send me thank you notes or cards.

Having said that, I do think it's important to do your best to connect with the attending and the rest of the team. That's something that should be your focus throughout the time you are working with them. If you are well liked by the team, you might benefit from what's called the "halo effect." That's when one evaluation factor affects the ratings or grading of other factors. For example, if you are a great team player but have an average fund of knowledge, you may get higher ratings on fund of knowledge because you are such a great team player. It also works the opposite way - if you are late on a number of occasions, your poor attendance may lower your grades in other areas such as fund of knowledge.

Samir Desai, MD

 

[doc05]

I have to agree w/Dr. Desai. The likeability factor is huge. Getting a good clinical evaluation is about being on time; working hard; being personable; not antagonizing anyone; and knowing things (least important of all). After all this, just ace the shelf exam and you'll get a good grade. Good luck! 3rd year is fun.

 

[Samoa]

Dr. Desai, with all due respect, I thought that the halo effect was something that the people evaluating students should seek to avoid. But it sounds like you're advocating it as a legitimate method of grading. I have to say it's a little frustrating to know that your evaluation depends to such a great extent on image rather than substance. As someone who's both benefited and suffered on various occasions as a result of it, I don't feel like I was evaluated fairly in any of those situations. It's easier to deal with when the error is in your favor, but how do you handle a situation where you've gotten off to a bad start and you know it's working against you?

 

[Samir Desai]

Dr. Desai, with all due respect, I thought that the halo effect was something that the people evaluating students should seek to avoid. But it sounds like you're advocating it as a legitimate method of grading. I have to say it's a little frustrating to know that your evaluation depends to such a great extent on image rather than substance. As someone who's both benefited and suffered on various occasions as a result of it, I don't feel like I was evaluated fairly in any of those situations. It's easier to deal with when the error is in your favor, but how do you handle a situation where you've gotten off to a bad start and you know it's working against you?

Samoa, I'm not advocating it as a legitimate method of grading. What I am saying is that it does occur. Clerkship grading is far from perfect. It definitely needs to be improved. One thing that should be done is to have every evaluator (attending, resident, intern) go through a "how to evaluate students" course. This might help make things more fair. All I'm saying is that since it occurs, you should realize that. I am certainly not recommending image over substance.

 

[Febrifuge]

... any thoughts? Can you work hard to do better or should you just try to get enough sleep so you're not completely spaced out when you talk to patients? I'm more on the introvert side of the spectrum... I'm not shy and I speak up when I have something to say, but I'm not one of those center-of-the-party kinds of people. I'm wondering if I'm going to find this transition difficult. (Any other clerkship anxieties or tips?)

No need to cover the same ground as others re: paying attention to your style, in interacting and presenting. Plus, it sounds as though you already have an awareness of yourself, so I trust you'll be able to self-identify any problems you're having before too much time passes. You'll be surprised how well your training helps you, if you let it.

I will add that one factor in your overall "aura" as a student practitioner is how well you work on a team, and one huge advantage you can give yourself is to remember that the team includes nurses and techs (like myself) as well as the docs who are grading you. A student recently asked me to walk her through how to hang a bag of saline; I thought that was great (if kinda unnecessary) because with other students, I've been treated like I was invisible.

If you don't know where something is, or how something is done, ask -- and 9 times out of 10 I'll just take care of it, like I would for a staff doc, leaving you to concentrate on your "doctor thing." People on the team listen to one another, and they know when a student is particularly good, bad, or otherwise. I've seen 3rd-year residents, in the midst of filling out a comment card on a student, look around and ask for impressions from support staff.

In other words, there may be more people involved in grading than you might think. On the other hand, you have more allies than you know. Our lives are much easier if you are doing well, and some of us have the time and energy to spare in helping you out. Get your bearings, get a sense of how the work flows in the team, and swim with the current. You'll be fine.

 

[Dr.Evil1]

Factors stated above are all pertinent to getting a good clerkship grade, I agree with Desai about the halo effect as well.

What I think needs to be emphasized as a tactic for doing well on rotations is to ask pertinent and insightful questions to show you are interested and aware of what is happening. I do not think you should ask stupid questions (and believe me there ARE stupid questions) just to ask a question on rounds but if you are part of the team you should be involved during all of rounds. I'm not talking about pimping type questions but insightful questions especially about the treatment of your teams patients. I definetly think that this shows off your interest and dedication to the team much more than staying late to do scut work or giving gifts etc. I think that most attendings in the academic medical setting are there because they like to teach, if you are a good learner then it is an appreciated and valued trait.

Often these questions will be turned back at you and you will have the opportunity to do a little reading and reporting back to the group. This is a HIGH YEILD opportunity to put in a little extra work and get alot of respect in return.

 

[pwrpfgrl]

is any one else worried about their technical skills?? i feel like every one else picks things up 10x faster than I do (like drawing blood, putting in IV's, etc). We haven't even learned most of those things yet - and i already feel like i am SO bad at them. should i be getting extra practice? or are we expected to be bad at the technical side?

 

[Chisel]

If you are well liked by the team, you might benefit from what's called the "halo effect." That's when one evaluation factor affects the ratings or grading of other factors.

Samir Desai, MD

I thought the "halo effect" was only seen with Pneumopericardium, or is that the "halo sign"............

I'm sorry, I'm on Radiology rotation and I have CXR's on the brain.

I am wondering how significant these grades are in the process of getting a residency. I know that it is important to do well on rotations so that you know what you are doing when you are the Dr, but do these play as an important role as many people think.

I have heard from former DME's and from several "Getting a Residency" texts, that GPA and board scores are near the bottom of the list.

Any thoughts?

Chisel
PCOM MS III.5

 

[Blade28]

It's all about being on time, working hard, being enthusiastic, and aggressive/proactive/assertive about asking for more responsibilities or duties. Volunteer to help your team out whenever you can.

 

[LotaPower]

It's all about being on time, working hard, being enthusiastic, and aggressive/proactive/assertive about asking for more responsibilities or duties. Volunteer to help your team out whenever you can.

i wish it was all about that....

honestly dude, when it comes down to it...its all about rocking the shelf (unfortunately)

 

[fang]

i wish it was all about that....

honestly dude, when it comes down to it...its all about rocking the shelf (unfortunately)

At our school, the shelf is only 10% of the grade. To be honest, I wish it were more! At least that's something you can somewhat control. I feel like this is going to be a situation where I can try as hard as possible and still not do as well as I'd like-- and the horror stories from current 3rd year students are not helping. I'll just have to see how it is and do the best I can, but I'm trying to get used to the idea that it's going to be unpredictable and frustrating at times. I'm kind of a competative person by nature, so getting a mediocre score for something I put a lot of work in to will be difficult.

 

[klubguts]

I think you have more control then you think you do...just do the things previously mentioned (#1 being work hard) and the majority of the time you will be evaluated fairly. Everyone feels like they get academically "screwed" once or twice during third year, usually because you just don't mesh with your staff/ residents or their expectations of you are greater. Either way, not much you can do about it. This is just the nature of the beast...it is a very subjective process. Good luck.