What does it take to consistently honor clerkships? What differentiates someone who honors a clerkship vs someone who doesn't?

[CuriousMDStudent]

Title sums it up. As I approach my third year as a student with a P/F STEP 1, clerkships seem to be everything when it comes to residency. I was wondering if anyone had any thoughts on this.

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[Osteosaur]

It depends heavily on your school.

1) shelf exams are anywhere from 25% to 80% of clerkship grades. You need to nail them. Many schools have strict cutoffs to honor clerkships. This is the one element where you truly have control.

2) strategically pick your evaluator if you can. The PGY3 who loves teaching and wants to make your life easy? Pick them over the preceptor who who looks impatient every time a student presents and never acknowledges you. This is totally random since one person's 3/5 is another person's 4/5. Just find someone you click with and do your best to be helpful, responsive to feedback, etc. But this can be hard.

 

[Dr. Doctor MD]

Title sums it up. As I approach my third year as a student with a P/F STEP 1, clerkships seem to be everything when it comes to residency. I was wondering if anyone had any thoughts on this.

I strongly disagree with the statement that clerkships are everything, but they certainly are one important factor in residency selection.

To answer your question, honoring every clerkship takes a combination of 3 things:
30% being smart/hardworking
35% being likeable
35% being lucky

The first two things are in your control, the third is mostly out of your control, unless you can get information from upper classmen and request certain preceptors/rotations/evaluators.

 

[Chelsea FC]

Title sums it up. As I approach my third year as a student with a P/F STEP 1, clerkships seem to be everything when it comes to residency. I was wondering if anyone had any thoughts on this.

I think its 80% being a mix of likable and being hardworking. You dont have to enjoy doing it but if you always make yourself available and helpful to the team even if u hate the fact u will have to be in the hospital 4am for surgery or whatever rotation you dont really enjoy having a good attitude helps. THe other part is just being a sociable person who can shoot the shh**t with the residents and attendings. Some of it is also gaming the system like giving props to your residents in front of their superiors or just being really helpful and kind to the supporting staff (nurses, scrub techs CRNAs). I honored all my 3rd and 4th year rotations while at the same time almost dropping out of school during the first 2 years.

 

[IlDestriero]

You have to do significantly better than average on the exams.
You have to have a good attitude.
You have to work hard and be engaged without being asked.
You have to outperform your peers.
I looked at outperforming my peers as a game. It worked for me, and probably made me a better physician.
Watch out for attempted sabotage and friendly fire.

 

[calivianya]

Honoring clerkships is mostly luck, unless you are allowed to pick your preceptors - then you can pick ones that are known to give honors.

Tbh I had very nearly the exact same performance on all clerkships - worked hard, studied hard, stayed late, cracked 90th percentile on all COMATs except one - and I got everything from honors to barely passing.

At least the barely passing was only one eval, and that preceptor’s comments were so wildly different than everyone else’s that no one has asked me about it and I’ve still gotten plenty of interviews. I think PDs and residency selection committees can tell when someone’s just out to get you, especially when it’s incongruent with all of the other evals. I also think they can see through when you get a “pass” but you honored your COMAT/shelf and your preceptor said you’re one of the best students they’ve had and you’ll make a terrific doctor, so I wouldn’t get too wrapped up in pass vs. honors if you are unable to honor all of your rotations.

 

[Maximus2020]

Chelsea is spot on with the advice. Luck is a small part of the win. The shelf is about 30%, the game is the other 70%.

3rd year is a true social game. You can own Step 1 and know your stuff colder than Ice Cube, but if you do not recognize the game and learn to play it well, you will not win. It is a game. Basic thoughts are show up early, stay late, work hard, don't give a **** about your own life outside the hospital.

But it's more than that. You have to read people, learn their likes and dislikes, figure out what they are thinking, etc. It's similar to poker, meaning you need a poker face - i.e., calmess and professionalism. Not just with the attending - with other med studs, interns, nurses, pharmacists, patients, janitors, secretaries, the cat on the ledge, the mice in the call room - everyone. The mice better be as happy as those from Cinderella in singing your praises.

It is a double-edged sword though. Try too hard and be discovered - you're a gunner, game over. Try too little and be shamed - lazy med stud, game over. A MasterClass could be created on the game. It is tough - you will cry, curse, and complain. But through it all, smile like a pledge and say thank you sir, may I have another.

Godspeed and be strong.

 

[Konigstiger]

But it's more than that. You have to read people, learn their likes and dislikes, figure out what they are thinking, etc. It's similar to poker, meaning you need a poker face - i.e., calmess and professionalism in the fields of **** that are 3rd year. Not just with the attending - with other med studs, interns, nurses, pharmacists, patients, janitors, secretaries, the cat on the ledge, the mice in the call room - everyone. The mice better be as happy as those from Cinderella in singing your praises.

Lol trying to avoid this type of BS is exactly the reason I abandoned finance as a potential career and went into medicine. I was naive.

 

[Matthew9Thirtyfive]

You have to do significantly better than average on the exams.
You have to have a good attitude.
You have to work hard and be engaged without being asked.
You have to outperform your peers.
I looked at outperforming my peers as a game. It worked for me, and probably made me a better physician.
Watch out for attempted sabotage and friendly fire.

Mostly true. How much the shelf matters depends on the school and even rotation. For three of my rotations, your shelf score did not factor into honors except that you had to pass it. Getting a 100% or a 70% was the same thing. For the other three core rotations, the higher you scored, the better your chances at honors (and one had a strict cut off).

 

[Dral]

My experience is that there will be a baseline that involves your personality and how people perceive you. I believe this is honestly hard to change (and difficult to remember to alter when you have other stuff on your mind like presenting patients to a new attending). There is of course an element of luck based on who is evaluating you.

I think the objective parts like shelf exams are what you can change the most (assuming you're doing what others in the thread suggest such as 'reading the room' and being a positive hard worker.

I pretty much was consistent across my clerkship grades except one rotation. There was this take home portion that was basically a google search exam. I wasn't having much of it and got a D on it I think. Ended up with a B or B+ in the rotation. Oddly enough, it was the specialty I thought I would end up doing when I started med school. Noooooope!

 

[Lawpy]

Lol trying to avoid this type of BS is exactly the reason I abandoned finance as a potential career and went into medicine. I was naive.

Oof, kinda sucks with the private equity takeover and increased corporatization, medicine is increasingly heading the way of finance

 

[operaman]

As others have noted it’s mostly all about how much people like you. Your baseline knowledge is also key as this allows you more leeway in terms of time to be present on the wards while also studying for your shelf exams.

There’s definitely a balance and it tends to favor stronger students. Devote all your time to the shelf and you’ll have a harder time impressing on the wards and integrating with your team. I’ve seen plenty of Med students sitting apart from the team banging out shelf questions while others were actively engaged in patient care. I assume they are trying to do what they feel they must, but it’s hard to impress clinically when you’re staring at Uworld and anki all day. The opposite is also true - highly likable people who can’t seem to hit the honors level on the shelf. It’s all a balance, but your foundation of knowledge and inherent mental prowess are what allow some students that luxury.

Beyond that, the real key is how well you can present, and this means adapting to the norms of whatever team you’re on. This is really the crux of clinical medicine - the ability to gather relevant data and synthesize it and then concisely communicate your assessment and plan to others. Outside the OR, this is pretty much the heart of all I do every day even now.

 

[Banco]

Luck is often a big contributor. Luckily no one needs to get honors in everything even for the most competitive of specialties.

 

[mistafab]

I mostly agree with @Chelsea FC in their post. I also honored all my rotations.

My one thing is it isn’t necessarily how much they like you personally (though that is somewhat a factor), but how likable you are to work with.

Showing up on time. Good attitude. Not annoying. Finding something you can find authentic interest in - even in a specialty you wont eventually work in. Always follow through. Get the work done, then leave (if that’s kosher). Not making comments just for the purpose of making comments (common annoying extrovert habit). Don’t lie. That’s really it.

I definitely was not my attending’s or resident’s friend, but still honored everything. As a resident now, i’m not looking for buddies to give the honors to - just whoever is likable and doing a great job. When I talk with my attendings - that is what their eval comes down to as well.

 

[Rads4lyfe]

Honoring clerkships is mostly luck, unless you are allowed to pick your preceptors - then you can pick ones that are known to give honors.

Tbh I had very nearly the exact same performance on all clerkships - worked hard, studied hard, stayed late, cracked 90th percentile on all COMATs except one - and I got everything from honors to barely passing.

At least the barely passing was only one eval, and that preceptor’s comments were so wildly different than everyone else’s that no one has asked me about it and I’ve still gotten plenty of interviews. I think PDs and residency selection committees can tell when someone’s just out to get you, especially when it’s incongruent with all of the other evals. I also think they can see through when you get a “pass” but you honored your COMAT/shelf and your preceptor said you’re one of the best students they’ve had and you’ll make a terrific doctor, so I wouldn’t get too wrapped up in pass vs. honors if you are unable to honor all of your rotations.

I disagree that honoring clerkships is "mostly" luck. I think about 15-20% of it is luck. The rest is how you play the game.

I honored all my clerkships and it wasn't necessarily because I was smarter, more hardworking, or more likeable. I just played the game better.

1. Ace your shelf exams. Aim for 90th percentile and above on all shelf exams.

2. Figure out who will evaluate you, and make sure to look good in front of those people. No one cares if you suck up to the intern who isn't going to evaluate you anyways.

3. If you impressed someone, see if you can get the clerkship coordinator to have that person evaluate you also, if not already.

4. Make sure to ask your seniors and/or classmates who gives higher scores on average. Request those preceptors/attendings.

5. Let your preceptors know what the average score is and what score = honors. Some preceptors think 5/10 is average when in reality, the average score amongst your peers may be 7/10. If you got 5/10 you would be below average. I told some of my preceptors what the average score is and what score = honors. It definitely helped in my favor.

 

[Detailsmatter]

I agree with pretty much all of the other advice on here. My school doesn't have honors or other qualifiers like high pass etc but it does have quartiles and thats all that matters. One thing to put into perspective how much the shelfs matter is that even if it is "only" 25% of the grade, its the single thing that varies the most amongst students. Obviously there are extremes to both ends, but for the MOST part, most students do about the same on evals, OSCEs, and random clerkship specific assignments. So when looking at honors and your class ranking, the thing that'll have the most impact on determining your rank will likely end up being the shelf if your school has a similar system. All this to just say that no matter how little the shelf counts for your grade, make sure you do your best on it because it'll likely be what differentiates the class

 

[Matthew9Thirtyfive]

I’ll say it again. Read the policy for the rotation at your school. For half my rotations, my shelf score was irrelevant to my grade as long as I passed. Literally, getting a perfect score and barely passing would have contributed the same toward my final grade. Spending time trying to crush the exams for those rotations would have been a huge waste of time, and instead I focused on what actually went into the grading and honored.

 

[Osteosaur]

Showing up on time. Good attitude. Not annoying. Finding something you can find authentic interest in - even in a specialty you wont eventually work in. Always follow through. Get the work done, then leave (if that’s kosher). Not making comments just for the purpose of making comments (common annoying extrovert habit). Don’t lie. That’s really it.

I definitely was not my attending’s or resident’s friend, but still honored everything. As a resident now, i’m not looking for buddies to give the honors to - just whoever is likable and doing a great job. When I talk with my attendings - that is what their eval comes down to as well.

This is pretty much gold. Every rotation I didn't honor was due to slacking off on the shelf.

But honestly I think most of this advice, and similar, is stuff most medical students do. I feel like with the exception of a few people most of us show up, work hard, help when we can, and stay out of the way. You'll get a small handful acting inappropriate (chattering and giggling outside patient rooms, grumbling about going home) but that is really more the exception.

That is why I say it really depends on:
1) shelf
2) being nice to work with and common sense stuff
3) factors you have no control over like being on a team with jerks or people who don't have time for you

 

[RangerBob]

I'll just add in addition to what others, the impression that you're hardworking and care is what matters. You can be super efficient/hardworking and actually do more than others, but if you're asking to leave early, or can't always be reached, it creates the impression that you're not part of the team.

An attending taught me this as a med student:
Attendings grade you based on your fund of knowledge.
Residents grade you based on how helpful you are/how much you're a team player.

So study, don't be mean, don't ask to leave early, always be ready to help and think proactively what you can do.

As others point out, don't forget the luck factor--did you get an easier-grading attending, resident, intern, etc., did you get the sticklers. You can't do anything about it, but it might make you feel a little bit better when you get high pass instead of honors if you can attribute it to having the tougher graders. Or it just makes you that much more bitter about it!

 

[Maximus2020]

I know this may sounds gunnerific, but halfway through some of my rotations, I actually asked attendings and senior residents for feedback.

The word "feedback" makes me re-live nightmares as a 3rd year. I simply despise that word. But, for Honors, asking for feedback, and thereby elevating the egos of other people who think you actually give a care about their opinion, worked wonders for me. I was a straight shooter and told the attending I wanted to do whatever it took to earn Honors. Aggressive I know and probably not good advice to use for every attending, but those attendings who are more aloof, deer in the headlights clueless, or introverted tended to appreciate this tactic.

Funny thing is I often felt many attendings or residents didn't place as much value on Honors as I did. Whether it was being oblivious or just not knowing the game, I often felt like some people didn't think it mattered and so often gave HP rather than Honors to some superstars just out of trying to not give too many people Honors. YOLO - go after it, but delicately.

 

[calivianya]

Funny thing is I often felt many attendings or residents didn't place as much value on Honors as I did. Whether it was being oblivious or just not knowing the game, I often felt like some people didn't think it mattered and so often gave HP rather than Honors to some superstars just out of trying to not give too many people Honors. YOLO - go after it, but delicately.

I think they’re realistic about how much honors is going to do for you.

Honors is definitely overhyped on SDN. I got honors for 5/11 rotations and a straight pass for the rest of third year because my school doesn’t give out high pass as a grade. I was worried that so many “pass” grades would hurt me, but I shouldn’t have wasted my energy. I am applying to a very competitive subspecialty, and I have received >30 interviews between that, my backups, and prelim/TY years, including interviews at my #1 program.

People act like it is going to hold you back if you don’t get honors, and that has absolutely been 100% false for me. I think residency programs know how much BS goes into clinical grades and how much of the evaluation process is just smoke and mirrors tbh.

If you have good board scores, strong letters, and a well rounded app otherwise, I don’t think honors or lack thereof is going to do anything for you at most places.

 

[Matthew9Thirtyfive]

I think they’re realistic about how much honors is going to do for you.

Honors is definitely overhyped on SDN. I got honors for 5/11 rotations and a straight pass for the rest of third year because my school doesn’t give out high pass as a grade. I was worried that so many “pass” grades would hurt me, but I shouldn’t have wasted my energy. I am applying to a very competitive subspecialty, and I have received >30 interviews between that, my backups, and prelim/TY years, including interviews at my #1 program.

People act like it is going to hold you back if you don’t get honors, and that has absolutely been 100% false for me. I think residency programs know how much BS goes into clinical grades and how much of the evaluation process is just smoke and mirrors tbh.

If you have good board scores, strong letters, and a well rounded app otherwise, I don’t think honors or lack thereof is going to do anything for you at most places.

Agreed. I’ve literally been told by PDs that in third year, even a pass in the specialty you want to apply to is unlikely to hurt you since everyone knows how subjective those grades are.

 

[Maximus2020]

Different people will have different experiences on here and that's fine. But I would caution to believe anyone who thinks earning Honors does not matter. The clerkship grades and feedback feed the Dean's letter so if you want a great Dean's letter, you need Honors.

Different residencies/specialties also may place different value on clerkship grades (MD versus DO programs too).

Honors and Step scores trounce every other piece of your residency application. I have been on a residency adcom for multiple cycles and there is just no good feeling that comes out of seeing "Pass" when other applicants have "Honors". LORs often tend to all be the same and even when I see a really great one, it will not make me overlook a low Step score or not Honors.

Indeed, the grades are subjective, but they matter for AOA and the Dean's letter. If other candidates have Honors, I'm going to interview them and, more importantly, rank them higher, than those that do not.

 

[ChordaEpiphany]

Different people will have different experiences on here and that's fine. But I would caution to believe anyone who thinks earning Honors does not matter. The clerkship grades and feedback feed the Dean's letter so if you want a great Dean's letter, you need Honors.

Different residencies/specialties also may place different value on clerkship grades (MD versus DO programs too).

Honors and Step scores trounce every other piece of your residency application. I have been on a residency adcom for multiple cycles and there is just no good feeling that comes out of seeing "Pass" when other applicants have "Honors". LORs often tend to all be the same and even when I see a really great one, it will not make me overlook a low Step score or not Honors.

Indeed, the grades are subjective, but they matter for AOA and the Dean's letter. If other candidates have Honors, I'm going to interview them and, more importantly, rank them higher, than those that do not.

I'm curious how you look at overall performance vs. clerkship-specific performance. If a candidate has 8 core clerkships and a sub-I, for instance, I can understand not being thrilled with straight Ps. What about a student with mostly Hs but a P in the specialty of interest? It seems like you can influence your overall grade profile, but for individual clerkships at a certain point it's just stochastic, no?

 

[Maximus2020]

Great point. Overall versus specialty specific can be challenging. At minimum, you should get Honors in the specialty of interest but if you get a P there and all Honors otherwise, then the feedback/Deans letter becomes critical to understand why that happened (e.g., piece of crap attending, sick, life events, etc.). This can be explained in the interview.

The sub-I/AI is more meaningful to me than anything else. You should be at the level of an intern on this rotation so earning Honors here takes the cake.

Other scenarios:
- Honors in medicine and surgery, HP/P in fam med and peds, candidate gunning for ortho or IM/cards, no problem, would interview 10/10 times
- S in surgery, Honors all else; going into IM/non-surgical field; no problem, still look highly
- HP all around; look less highly than the 2 scenarios above

 

[operaman]

Great point. Overall versus specialty specific can be challenging. At minimum, you should get Honors in the specialty of interest but if you get a P there and all Honors otherwise, then the feedback/Deans letter becomes critical to understand why that happened (e.g., piece of crap attending, sick, life events, etc.). This can be explained in the interview.

The sub-I/AI is more meaningful to me than anything else. You should be at the level of an intern on this rotation so earning Honors here takes the cake.

Other scenarios:
- Honors in medicine and surgery, HP/P in fam med and peds, candidate gunning for ortho or IM/cards, no problem, would interview 10/10 times
- S in surgery, Honors all else; going into IM/non-surgical field; no problem, still look highly
- HP all around; look less highly than the 2 scenarios above

Can confirm. A pass on your sub-i in a competitive field is essentially a big DNR flag. Near impossible to overcome without some crazy extenuating circumstances and probably a few personal phone calls from well connected faculty.

Also agree 100% on the last part. Straight HPs suggests someone who simply can’t play the game well. Either they are meh clinically or they can’t balance a clinical workload with self study. Either way, that can spell problems as a resident where time is even more limited and self study is essential for your progress.

 

[ChordaEpiphany]

Great point. Overall versus specialty specific can be challenging. At minimum, you should get Honors in the specialty of interest but if you get a P there and all Honors otherwise, then the feedback/Deans letter becomes critical to understand why that happened (e.g., piece of crap attending, sick, life events, etc.). This can be explained in the interview.

The sub-I/AI is more meaningful to me than anything else. You should be at the level of an intern on this rotation so earning Honors here takes the cake.

Other scenarios:
- Honors in medicine and surgery, HP/P in fam med and peds, candidate gunning for ortho or IM/cards, no problem, would interview 10/10 times
- S in surgery, Honors all else; going into IM/non-surgical field; no problem, still look highly
- HP all around; look less highly than the 2 scenarios above

Can confirm. A pass on your sub-i in a competitive field is essentially a big DNR flag. Near impossible to overcome without some crazy extenuating circumstances and probably a few personal phone calls from well connected faculty.

Also agree 100% on the last part. Straight HPs suggests someone who simply can’t play the game well. Either they are meh clinically or they can’t balance a clinical workload with self study. Either way, that can spell problems as a resident where time is even more limited and self study is essential for your progress.

These comments both read like someone who hasn't experienced clerkship grading in the modern age, especially since COVID. Depending on the scenario/rotation it can be impossible to even make an impression at all.

I hope at the very least you're aware that some schools give out honors like candy while others reserve it for top 5%, and that P/HP/H can mean wildly different things at different schools. Also, some schools literally limit the number of honors attendings can give out. A lot of people then run into trouble if they do a key rotation late and the attendings have literally run out of honors.

I understand placing weight on these evals, but it is extremely subjective. I would think in medicine we'd know better than to look at one data point in a notoriously biased/subjective data set and draw conclusions from it.

Just from knowing the overall quality, intelligence, reliability, and work ethic of my peers, I know that many of the best get boned on evals. Yeah it's pretty rare for someone great to get straight passes, but some weird, almost random mix of P, HP, and H is the norm around here, and it happens for all kinds of reasons out of people's control.

Personally I think we should just separate shelf scores from evals. Also, schools should make some attempt at normalizing by evaluator. If Attending A gives straight Ps to everyone and Attending B gives H to everyone, someone should be taking that into consideration.

 

[Captain_Falcon]

I hope at the very least you're aware that some schools give out honors like candy while others reserve it for top 5%, and that P/HP/H can mean wildly different things at different schools. Also, some schools literally limit the number of honors attendings can give out. A lot of people then run into trouble if they do a key rotation late and the attendings have literally run out of honors.

Personally I think we should just separate shelf scores from evals. Also, schools should make some attempt at normalizing by evaluator. If Attending A gives straight Ps to everyone and Attending B gives H to everyone, someone should be taking that into consideration.

My school does 1/3 shelf exam and 2/3 clinical eval for our overall clerkship grades. But, they also factor in the clinical evaluator(s) and their history of assigning students P/HP/H. Essentially you get 1/3 shelf 2/3 clinical, and that gets a holistic review by administration at my school to give you your overall clerkship grade. So in theory, you could get an H on shelf and a HP on clinical eval, but if that physician has only ever given P and his comments on your eval actually reflect an honors-level student, then you should get an H for that clerkship. However, my school does not limit the % of students that gets honors.

 

[altblue]

These comments both read like someone who hasn't experienced clerkship grading in the modern age, especially since COVID. Depending on the scenario/rotation it can be impossible to even make an impression at all.

I hope at the very least you're aware that some schools give out honors like candy while others reserve it for top 5%, and that P/HP/H can mean wildly different things at different schools. Also, some schools literally limit the number of honors attendings can give out. A lot of people then run into trouble if they do a key rotation late and the attendings have literally run out of honors.

I understand placing weight on these evals, but it is extremely subjective. I would think in medicine we'd know better than to look at one data point in a notoriously biased/subjective data set and draw conclusions from it.

Just from knowing the overall quality, intelligence, reliability, and work ethic of my peers, I know that many of the best get boned on evals. Yeah it's pretty rare for someone great to get straight passes, but some weird, almost random mix of P, HP, and H is the norm around here, and it happens for all kinds of reasons out of people's control.

Personally I think we should just separate shelf scores from evals. Also, schools should make some attempt at normalizing by evaluator. If Attending A gives straight Ps to everyone and Attending B gives H to everyone, someone should be taking that into consideration.

I understand the frustration with subjective clinical grading, but the uncommon person who manages to beat the trend and consistently get strong clinical evals knows how to play the game. That itself demonstrates value, since in the future they're more likely to figure out how to fit in and be seen as competent by their patients, senior residents and attendings. In non-procedural specialties, your perceived worth is maybe 35% is how competent you actually are and 65% how well you fit the image of the confident well-liked doc with a certain gravitas.

Doesn't make it fair, since some opportunistic personalities can figure that out before kind and honest ones do, we all know the type, but it does matter.

 

[operaman]

These comments both read like someone who hasn't experienced clerkship grading in the modern age, especially since COVID. Depending on the scenario/rotation it can be impossible to even make an impression at all.

I hope at the very least you're aware that some schools give out honors like candy while others reserve it for top 5%, and that P/HP/H can mean wildly different things at different schools. Also, some schools literally limit the number of honors attendings can give out. A lot of people then run into trouble if they do a key rotation late and the attendings have literally run out of honors.

I understand placing weight on these evals, but it is extremely subjective. I would think in medicine we'd know better than to look at one data point in a notoriously biased/subjective data set and draw conclusions from it.

Just from knowing the overall quality, intelligence, reliability, and work ethic of my peers, I know that many of the best get boned on evals. Yeah it's pretty rare for someone great to get straight passes, but some weird, almost random mix of P, HP, and H is the norm around here, and it happens for all kinds of reasons out of people's control.

Personally I think we should just separate shelf scores from evals. Also, schools should make some attempt at normalizing by evaluator. If Attending A gives straight Ps to everyone and Attending B gives H to everyone, someone should be taking that into consideration.

Sadly the concerns from students about clerkship grading haven’t changed one iota since I went through. I’m sure you could search past threads and find the exact same discussion. Some things in medicine never change.

For whatever random subjectivity is built in to the system, plenty of students honor most/all of their clerkships, at least on the apps I’ve reviewed for a top program in a competitive subspecialty. It does seem that the superstars manage to come through the unfairness just fine.

I realize this means some diamonds in the rough may slip through the cracks, but frankly it isn’t up to those reviewing apps to control for schools’ poor grading systems. The best students still manage to distinguish themselves. Covid hasn’t changed that one bit.

 

[Maximus2020]

It is a game. Plain and simple. Just because you may have aced Step 1 and are book-smart does not mean you will auto-Honors clerkship. The more social skill you have, the higher your chances of Honors are.

It is always possible to make an impression no matter the rotation or length of time on said rotation. The same with an interview. Give me 5 minutes with someone and that person makes an impression on me.

Examples:
- I spent 1 week on a required Aging clerkship where other med studs told me it was impossible to impress this attending (take everything that people say as a grain of salt). I did what needed to be done and got a glowing recommendation. Think what can make someone else's life/job better/easier, do said thing, and boom. You made an impression.

- I got chewed out on a rotation by an aggressive attending who basically said I sucked to the clerkship director who called me and said she was really disappointed in me. I then went to other attendings and a group of nurses I had connected with, asked them to weigh in, and convinced the clerkship director the first attending was a bozo. Clerkship director then re-called me, apologized, and said I was doing a great job. I cried and laughed all in one day.

- I spent 1 day with an old neurologist. He had no weight in the final grade. We connected well so I asked for an eval from him anyway. Same thing on a family med rotation - spent 1 day with a different attending, connected with him, asked for an eval even though it was just 1 day. The more evals you collect that are glowing, the more ammunition you have to plead your case for Honors.

- I heard from a med stud that for an upcoming clerkship, only 1 attending gave Honors. The other never did. It was first come, first serve when an email came out asking med studs for site preferences. Obviously, I glued my eyes to my phone and hit refresh like a mad man til that email came through. I got the attending, got the Honors. Yeah, this is not fair, but this is just the game.

I think of it like the game of Survivor (I have watched the show since its inception). You have to be aggressive to get to the end for the $1 million, but you also need to get everyone to like/love/want to adopt you so they vote for you in the end.

 

[operaman]

I would also add: don’t be shy about expressing your desire to earn honors. When asking for feedback I would typically tell the person that I wanted to get to the level of an honors student and what could I improve to get there.

I did surgery as my first clerkship and the chief of my division told me on day one that it was too bad I was doing surgery first because I really needed to earn honors given my career goals but he had never given that grade to a student in their first clerkship before. I looked him square in the eye and told him I was going to be the first. And I was.

Don’t be afraid to ask for what you want and make it clear you are willing to work hard for it.

 

[Maximus2020]

"I looked him square in the eye and told him I was going to be the first. And I was."

I said a huge "Boom" when I read this. What a beast.

 

[efle]

+1 for picking the right evaluators/preceptors

At my school shelves were a tiny part (like 20%) and eval scores were not adjusted. So whether you get a 70 vs 90 ion the NBME doesn't really matter. Whether you get 5/5s or 3/5s can swing you from Honors down to Pass though.

So the best thing you could do for yourself was find out who gave 5/5s

 

[Matthew9Thirtyfive]

Where are you guys going where you can consistently pick who evaluates you? I was only able to do that for one rotation.

 

[cptsam]

Some of the stuff I'm reading above is so cringe lmao

I literally just show up on time, do what I'm told to do, joke/socialize when appropriate, and leave when I'm told to. Got honor-level evals on all my evaluations.

The fact that people call this a game where you're bending over backwards to get honors is just not it. In the grand scheme of things, meaning your life/ the rest of your decades-filled career, we'll look back on how trivial this all was.

 

[Matthew9Thirtyfive]

Some of the stuff I'm reading above is so cringe lmao

I literally just show up on time, do what I'm told to do, joke/socialize when appropriate, and leave when I'm told to. Got honor-level evals on all my evaluations.

The fact that people call this a game where you're bending over backwards to get honors is just not it. In the grand scheme of things, meaning your life/ the rest of your decades-filled career, we'll look back on how trivial this all was.

Yeah. I think it’s important to mention in the interest of full disclosure that the user really pushing that it’s so crucial to get all honors wrote and is selling a book on getting honors.

Helpful Book for 3rd Year of Medical School/Clinical Rotations

That doesn’t make the advice necessarily bad per se, but does provide some context.

 

[altblue]

Some of the stuff I'm reading above is so cringe lmao

I literally just show up on time, do what I'm told to do, joke/socialize when appropriate, and leave when I'm told to. Got honor-level evals on all my evaluations.

The fact that people call this a game where you're bending over backwards to get honors is just not it. In the grand scheme of things, meaning your life/ the rest of your decades-filled career, we'll look back on how trivial this all was.

You're probably more likable than you think, or you go to a program with easy honors, lol

Some people have to work harder to leave a good impression that others do. Maybe their social skills are underdeveloped in some way, or maybe they have underlying confidence issues/social anxiety. Either way, it can be fixed, but the process of doing so can feel like a game

It does matter if you're interested in something competitive

 

[operaman]

Some of the stuff I'm reading above is so cringe lmao

I literally just show up on time, do what I'm told to do, joke/socialize when appropriate, and leave when I'm told to. Got honor-level evals on all my evaluations.

The fact that people call this a game where you're bending over backwards to get honors is just not it. In the grand scheme of things, meaning your life/ the rest of your decades-filled career, we'll look back on how trivial this all was.

I think I would have agreed with you when I was a Med student because at the time I didn’t feel like I was gunning per se or going too terribly beyond what seemed normal. I was open about my desire to earn honors but was never particularly manic about it.

Now getting to see if from the other side I’ve seen how mediocre and laissez faire most students are. They can easily just vanish into the paint and I’d have no clue who these people were when I’d get an eval request. I think my baseline level of working hard was just different than other students, so now I tend to overemphasize the level of effort required.

 

[aldol16]

Depends on the team and the rotation. In general, showing up early (not just to be there but to actually do work/help getting the day started), staying late to help out, and being helpful to the team. Nothing is below you as a medical student. Late is also relative - this doesn't mean stay when your team is gone to hang out with the night team. This means be there whenever your team is there and leave whenever your team leaves. Being helpful is a learned skill. Nobody will tell you all the things that you should be doing. You kind of have to figure those out.

 

[Matthew9Thirtyfive]

This means be there whenever your team is there and leave whenever your team leaves.

Agree. Unless they tell you to leave. Then gtfo.

 

[Thesimplelifeofamyloid]

Some of the stuff I'm reading above is so cringe lmao

I literally just show up on time, do what I'm told to do, joke/socialize when appropriate, and leave when I'm told to. Got honor-level evals on all my evaluations.

The fact that people call this a game where you're bending over backwards to get honors is just not it. In the grand scheme of things, meaning your life/ the rest of your decades-filled career, we'll look back on how trivial this all was.

It really depends on your program. @Maximus2020 and @efle advice is the best in the thread. It's important to have a strategy, especially if you want to consistently get honors.

 

[efle]

^ yea unfortunately being hardworking and likeable doesnt matter if your evaluator is unfamiliar with the inflated system and doesnt know the median grade is 4.5+/5. When "performing at the level of experienced resident" is the norm for MS3 grading you can imagine how dangerous new evaluators are.

Surprised to hear most schools dont let you choose your site/evaluators, that must be really stressful if you get bad luck with your assignment for something critical. The sketchiest, most ethically gray area behaviors I saw related to grades were all from people going into competitive surgical fields trying to protect their Honors

 

[Maximus2020]

Yeah. I think it’s important to mention in the interest of full disclosure that the user really pushing that it’s so crucial to get all honors wrote and is selling a book on getting honors.

Helpful Book for 3rd Year of Medical School/Clinical Rotations

That doesn’t make the advice necessarily bad per se, but does provide some context.

Ok, truly, think whatever you want. Implying I am making this up? I spend time on here to help medical students like yourself gain insight into the extremely difficult and grueling process. No one was there for me or provided such advice.

I don't think it's just me who believes getting as many Honors as possible is important. You would be blind to believe otherwise.

Get yourself into a top 10 program competitive specialty without all or almost all Honors and then maybe I'll change my tune.

Earning Honors is not trivial. Earning a high ACT/SAT, A's in school, high MCAT and great USMLE score are not trivial. Yes, they mean nothing to me now, but I don't discount how important they were to get me into both a phenomenal residency/fellowship and a kick-ass amazing job/career. It's a domino effect and each has its important place.

"In the Interest of Full disclosure": What I make on royalties is about 0.001% of my annual income. Hope that provides some context.

 

[Matthew9Thirtyfive]

^ yea unfortunately being hardworking and likeable doesnt matter if your evaluator is unfamiliar with the inflated system and doesnt know the median grade is 4.5+/5. When "performing at the level of experienced resident" is the norm for MS3 grading you can imagine how dangerous new evaluators are.

Surprised to hear most schools dont let you choose your site/evaluators, that must be really stressful if you get bad luck with your assignment for something critical. The sketchiest, most ethically gray area behaviors I saw related to grades were all from people going into competitive surgical fields trying to protect their Honors

I mean, we work with like 6-7+ attendings and at least as many residents on most rotations. The site director gets evals on us from all of them.

 

[GoSpursGo]

I mean, we work with like 6-7+ attendings and at least as many residents on most rotations. The site director gets evals on us from all of them.

@Matthew9Thirtyfive I agree with some of your points, but your school is definitely unique in how you are evaluated on clinical rotations. I also had to choose my evaluators when I did med student rotations way back in they day, and we definitely weren't evaluated by every single person we interacted with.

I don't think that it's totally a matter of getting lucky, since as an attending I do feel like I can tell the difference between an "honors" student from a "high pass" one. But from a student perspective, choosing the right people to evaluate you or performing to the expectations of whoever your specific attending happens to be is absolutely part of the "game" that realistically needs to be played.

 

[Matthew9Thirtyfive]

@Matthew9Thirtyfive I agree with some of your points, but your school is definitely unique in how you are evaluated on clinical rotations. I also had to choose my evaluators when I did med student rotations way back in they day, and we definitely weren't evaluated by every single person we interacted with.

I don't think that it's totally a matter of getting lucky, since as an attending I do feel like I can tell the difference between an "honors" student from a "high pass" one. But from a student perspective, choosing the right people to evaluate you or performing to the expectations of whoever your specific attending happens to be is absolutely part of the "game" that realistically needs to be played.

Oh I wasn’t making any point about it. I was just shocked that most people get to pick their evaluators. We only did that on one rotation and it was really nice because if I didn’t have a great rapport with someone, I just didn’t ask them for an eval lol.

 

[Matthew9Thirtyfive]

Ok, truly, think whatever you want. Implying I am making this up? I spend time on here to help medical students like yourself gain insight into the extremely difficult and grueling process. No one was there for me or provided such advice.

I don't think it's just me who believes getting as many Honors as possible is important. You would be blind to believe otherwise.

Get yourself into a top 10 program competitive specialty without all or almost all Honors and then maybe I'll change my tune.

Earning Honors is not trivial. Earning a high ACT/SAT, A's in school, high MCAT and great USMLE score are not trivial. Yes, they mean nothing to me now, but I don't discount how important they were to get me into both a phenomenal residency/fellowship and a kick-ass amazing job/career. It's a domino effect and each has its important place.

"In the Interest of Full disclosure": What I make on royalties is about 0.001% of my annual income. Hope that provides some context.

No need to get defensive. Pointing out potential interests is important when giving out advice.

I don’t think your advice on getting honors is bad. I do think you are grossly overstating how important it is to honor every rotation though, and I say that as someone who has honored every rotation. I have had multiple PDs tell me that all honors in MS3 looks great but is not necessary at all. A surgery PD even told me that not honoring your third year surgery rotation wasn’t a deal breaker as long as you honored your subi.

So while I get you have a particular perspective, I think it is a bit much to say it is universal. Your personal preferences on what you look for in applicants is def not shared by everyone.

 

[Maximus2020]

No need to get defensive. Pointing out potential interests is important when giving out advice.

I don’t think your advice on getting honors is bad. I do think you are grossly overstating how important it is to honor every rotation though, and I say that as someone who has honored every rotation. I have had multiple PDs tell me that all honors in MS3 looks great but is not necessary at all. A surgery PD even told me that not honoring your third year surgery rotation wasn’t a deal breaker as long as you honored your subi.

So while I get you have a particular perspective, I think it is a bit much to say it is universal. Your personal preferences on what you look for in applicants is def not shared by everyone.

No, there is just no need to make a comment insinuating I am overstating things to financially gain. That's simply uncalled for.

PDs or really anyone in power are not going to say the truth to your face. The truth comes out behind closed doors in the adcom meetings. This is a marketing tactic. I would never tell an applicant that he or she is looked at badly because of a less than Honors grade. That would be suboptimal support/counseling. This is the same argument in discussing USMLE scores. The truth is that they matter a great deal, no matter what someone tells you.

Also, it is important to understand whether these PDs are at top 10 programs. If not, then of course Honors grades do not matter as much. Their applicants often don't have all Honors so it makes sense for them to say that. It's like the saying of the person with the worst grades graduating med school is still called doctor. Yeah, of course if you don't get all Honors, you can still match somewhere. It's all about your career/professional goals.

 

[Matthew9Thirtyfive]

No, there is just no need to make a comment insinuating I am overstating things to financially gain. That's simply uncalled for.

I didn’t. I said you are selling a book about getting honors. I explicitly said that doesn’t make your advice good or bad, but is necessary context. You’re getting defensive.

PDs or really anyone in power are not going to say the truth to your face. The truth comes out behind closed doors in the adcom meetings. This is a marketing tactic. I would never tell an applicant that he or she is looked at badly because of a less than Honors grade. That would be suboptimal support/counseling. This is the same argument in discussing USMLE scores. The truth is that they matter a great deal, no matter what someone tells you.

Also, it is important to understand whether these PDs are at top 10 programs. If not, then of course Honors grades do not matter as much. Their applicants often don't have all Honors so it makes sense for them to say that. It's like the saying of the person with the worst grades graduating med school is still called doctor. Yeah, of course if you don't get all Honors, you can still match somewhere. It's all about your career/professional goals.

So if someone else gives advice that differs from yours, they are either lying or they are not top programs? Or both?

Not trying to get into an argument with you. You can be offended that I pointed out your book if you want, but I’m not going to get into a mud slinging match with you.