What if you don't honor anything!

[Lorraine]

I dunno...I'm scared because I haven't honored any rotations so far, and in fact, I'm really not sure what I want to go into yet either! But let's say that if I intend on going into something like derm, opth, radio, you know those ultra-competitive programs, would I be automatically overlooked? I scored high 90's on step 1, so i was thinking i might have a chance in those specialties, but let's just say that my shy nature translates into a lot of lukewarm evals 🙁

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[bobbyseal]

There's always a family practice residency in South Dakota available...

🙂

I wouldn't sweat the grades too much. Sure, derm, optho, and radiology are tough to match if you don't have the grades. Do some research, get to know your university program, and do a couple away rotations where you sparkle. But honestly, competition is what it is, and if you don't have the resume, it's going to be tough.

It seems like a lot of people lament on these forums that they're a great student, but just don't have the grades to match in these high paying/good lifestyle fields.

On another note, does anyone have any advice on how I can join an NBA team? I'm kind of slow, can't really jump high, but I would really like to be an NBA star. What can I do to get in?

 

[ckent]

It's OK, your still only half way through third year. Most programs would like to see students get honors or at least A's or high passes in at least a few of their rotations. A student with straight B's or passes is often interpreted as a student who may not be as successful during residency. You will have difficulty matching into the specialties that you mentioned with straight B's or passes and mediocre evaluations. My advise to you is to try to stop being so quiet. Speak up whenever you know something, as you obviously know a lot. Contribute to discussions whenever you can, and ask questions about whatever you don't understand. Go out of your way to present patients to your attendings and make extra presentations on topics to show that you are really interested. Actually, there was a study that suggested that when students just said "uh huh" or "I agree" more often, they were interpreted as less quiet and received better grades, so that's something that you can try too. Try to see your attending as just another person or perhaps even a friend, and you will feel more open to talk to them, try not to think about how you are being evaluated 24/7.

 

[Lorraine]

ckent,

I appreciate your advice. It's nice to be able to post here and get a response worth reading - who wants to waste their time?! 😀

 

[bobbyseal]

"It's nice to be able to post here and get a response worth reading - who wants to waste their time?!

Lorraine, are you saying that my posts are a waste of time?

C'mon now they're legitimate replies with a little wise ass sarcasm mixed in. What better to make medicine seem funny?

 

[irlandesa]

Originally posted by ckent
It's OK, your still only half way through third year. Most programs would like to see students get honors or at least A's or high passes in at least a few of their rotations. A student with straight B's or passes is often interpreted as a student who may not be as successful during residency. You will have difficulty matching into the specialties that you mentioned with straight B's or passes and mediocre evaluations. My advise to you is to try to stop being so quiet. Speak up whenever you know something, as you obviously know a lot. Contribute to discussions whenever you can, and ask questions about whatever you don't understand. Go out of your way to present patients to your attendings and make extra presentations on topics to show that you are really interested. Actually, there was a study that suggested that when students just said "uh huh" or "I agree" more often, they were interpreted as less quiet and received better grades, so that's something that you can try too. Try to see your attending as just another person or perhaps even a friend, and you will feel more open to talk to them, try not to think about how you are being evaluated 24/7.

hmm, I thought my earlier post went through but I guess not. anyway, I hope that HP grades are as equivalent to A's like ckent says, though that is not really the impression I get from my school. that aside, there is some good advice here; I would add 2 things as well. 1)Study for the shelf exam from the beginning of the rotation. I scored 2 points below the cutoff on the shelf to get Honors in Psychiatry even though my evals were quite good; I should have studied more. 2)Echoing ckent's advice, be sure to find a resident (or two) that you feel truly comfortable with and spend as much time working with them as possible. From personal experience, there is nothing worse for your grade than having a resident dislike you, even if it isn't really your fault. If you end up with free time to ask extra questions, go to lunch, or watch a baseball game for an hour while on call with your resident, be sure to do these things. I think this advice also applies to any attendings and other students on the rotation as well. I know that I felt way more comfortable participating in group discussions in Surgery b/c I liked the other students and knew they wouldn't mock me if I got an answer wrong (unlike the kids I had the misfortune to be with on inpatient Peds).

 

[kem]

Hi,

I didn't do well on my first rotation evals, and I went and talked to some of the professors to see how I could improve, and all of them said that I should do more reading. However, I WAS doing a lot of outside reading, they just couldn't tell because I was quiet and never talked about it. So on my next rotation I forced myself to say things like, "In my reading last night..." or "I read an article about..." even though I hate doing that because I feel like I'm bragging or something. It helped on the next rotation, but that could have also been because the people were nice. But it's a thought.

🙂 Kem

 

[ktat72]

i have the same problem with slightly weaker step 1 scores. I can say that on Sugery I only got a Satisfactory with a rating between a Satisfactory and a High Pass because some residents gave me a High Pass (2 out of the six) - the hospital I was at did not give anyone Honors - they usually have a reputation for not giving anyone honors (i know of one student on my team who did more work than the residents and everyone in our group was told we were not getting honors). Even the comments section was pretty bad - only one one liner in the good section and one one liner in the bad section.

Ob/GYN was kind of the same thing. One resident that filled out my eval only put check marks by the Satisfactory column and did not write any comments at all. I have no clue how the other residents evaluated me, but I hope I got at least a High Pass because I even did the extra presentation in rounds.

 

[Andrew_Doan]

Originally posted by Lorraine
I dunno...I'm scared because I haven't honored any rotations so far, and in fact, I'm really not sure what I want to go into yet either! But let's say that if I intend on going into something like derm, opth, radio, you know those ultra-competitive programs, would I be automatically overlooked? I scored high 90's on step 1, so i was thinking i might have a chance in those specialties, but let's just say that my shy nature translates into a lot of lukewarm evals 🙁

KEY---> OUTSTANDING LETTERS OF RECOMMENDATION

You'll be fine. The resident selection process is mult-factorial.

 

[ktat72]

i forgot to mention, on my surgery evaluation, there was only a one liner in each section of my evalation - one line for the positives of the rotation and one line for the negatives (i remember the positive was something that pointed to a statement about me that was made by a couple Surgery residents, and the negative was something mentioned by only one resident and the attending decided to include that in.

on OB/GYN I try to find out how each resident evaluates me and the secretary thinks I am weird doing things like that.

 

[24858]

Hello,
I am only a second year and all but I figured that the grades during 3rd and 4th year didnt mean squat compared to the grades received in the 1st two years. I mean there is so much subjectivity put into the grades received in years three and four. I would think that the grades you get in the first two years would mean a lot more b/c it objectively demonstrates how well you do in reasoning and how much effort you put into a project. I find it sad that you have to watch a ball game with a resident in order to get a high pass (maybe not exactly watch a ball game, but I think you can catch my drift). Personally from my vantage point if you did well in your first two years and did well on the boards, then dont sweat the fact that someone thinks you are shy, you should be competetive even with P's or B's in your third or fourth year.

 

[Hercules]

Actually 3rd year grades are more important than 1st and 2nd year grades at most, if not all schools. I know our 3rd year counts the same as our 1st and 2nd year combined. This is because even though it is subjective, how you perform clinically is so much more important than your ability to memorize the minutiae of the basic science years.

 

[kem]

Yes, even though 3rd year grades are more subjective than the first two years, as doctors we are going to be dealing with patients and other colleagues subjectively, not just memorizing facts and taking multiple choice exams.

After talking with several faculty, when they look at a residency applicant they don't think "wow, this person knows everything." Instead, the question is "do I want to work with this person?" Of course, having perfect grades and amazing 3rd year evals would be ideal, but few people do, and the rest of us have to fill up "leftover" residency spots. 🙂

kem

 

[Andrew_Doan]

Originally posted by Hercules
Actually 3rd year grades are more important than 1st and 2nd year grades at most, if not all schools. I know our 3rd year counts the same as our 1st and 2nd year combined. This is because even though it is subjective, how you perform clinically is so much more important than your ability to memorize the minutiae of the basic science years.

I wanted to concur. It was surprising to discover that my internal medicine clerkship was worth just as much as 1 year of pathophysiology and tons more than anatomy!

When applying for residency, you can count on the clinical grades being more important than the first two years.

 

[12R34Y]

Agreed with the above posters about how hugely important 3rd and 4th year grades are.

there was a study done that got responses from EM residency directors and basic science grades were i think like 7 or 8th on the list.
FIRST was EM rotation grade.......letters of rec.........clerkship grades . i think in that order.


this had like 80 residency programs responding so this isn't a minority.

I think it is pretty well established that 3rd and 4th year grades surpass most......letters of rec also hugely important..........basic sciences NOT important in the scheme of things.

later

 

[ktat72]

yeah, i would have to agree that the third year should count more, because it shows how hard you work to get things done - not just based on a numbers game. i wish more residents would, however, take more time into filling out the evaluation letter than just putting checkmarks down and giving a Satisfactory or mentioning just a one liner. I know there are many residents who just do not like to give a High Pass or Honors, but I wish more residents and attendings would spend more time in the comments section so this shows up next to the Satisfactory grade and will not make it look bad. I know the attending I usually have for Outpatient Medicine Clinic and my Medicine rotations does this - he almost never gives out Honors or a High Pass but has a couple really nice comments to say in the evaluation that will go in the transcript and make it look good. I was looking at my file and my family medicine preceptor from MS 2 said more things about me than my Surgery rotation coordinator (he only gave me a High Pass though, which the coordinator back at our school, who lost the evaluation form twice that i had an Incomplete in that section, only gave me a Satisfactory even though I got honors on the exam).

 

[24858]

ktat brings up a good point, which is the point I am making, 3rd year grades are based solely on one persons opinion of you and there own preconceived notions (some people like to be tough graders and some people like to be easy graders), I for one do not see how in the world something so subjective could count more than grades obtained through an objective system as in the first two years.

 

[Andrew_Doan]

Originally posted by MeaCulpa
ktat brings up a good point, which is the point I am making, 3rd year grades are based solely on one persons opinion of you and there own preconceived notions (some people like to be tough graders and some people like to be easy graders), I for one do not see how in the world something so subjective could count more than grades obtained through an objective system as in the first two years.

I see your points, but it's how medical training works. The evaluations are very subjective. If students are going to do well, then they need to learn what is expected during the rotation by different attendings.

 

[DireWolf]

Originally posted by MeaCulpa
I for one do not see how in the world something so subjective could count more than grades obtained through an objective system as in the first two years.

You better learn to see, quick. It is common knowledge that 3rd/4th year grades are more important than 1st/2nd year grades when it comes to residency selection. Deal with it.

 

[Hercules]

Originally posted by MeaCulpa
ktat brings up a good point, which is the point I am making, 3rd year grades are based solely on one persons opinion of you and there own preconceived notions (some people like to be tough graders and some people like to be easy graders), I for one do not see how in the world something so subjective could count more than grades obtained through an objective system as in the first two years.

Residency directors don't really care whether a grade is derived subjectively or objectively. They're more interested in what's being graded. Again, 1st and 2nd year grades reflect the ability to memorize and regurgitate information, much of which will never be used again. 3rd year grading basically come down to:
1) Works hard
2) Plays well with others
3) Knows the material
(not neccessarily in that order)

These 3 areas are incredibly important to residency directors, especially #'s 1 & 2. Your basic science grades don't incorporate #2 and may or may not incorporate #1.

 

[Lorraine]

as step 2 is a more objective way of assessing knowledge attained during the third year, i am hoping that an awesome step 2 score as well as good letters of rec will help because all of my evals have just been satisfactory/pass with all the comments talking about how i was too quiet for them to assess what i knew. My work ethic and ability to work well with others actually are my only "high marks" so I'm hoping during interviews I can explain the reason why my evals weren't glowing was just purely because my nature is to be quiet unless I need to give a presentation or something.

 

[irlandesa]

OK, I think the "well that's how 3rd year works" is now officially a well-beaten dead horse. I kind of see what Lorraine means, sometimes during group discussions or lectures on my current rotation it feels more like a competition to see who can scream their knowledge (or quite often, unfortunate lack thereof) the loudest rather than a fun learning experience. Unfortunately, if you are like me and prefer to wait until there is a good polite pause and you know something to jump in, you get kinda screwed and this PA student on my rotation even makes fun of me in front of the other students for being on the quiet side. I understand the importance of assertiveness, but good group facilitators or sufficiently small groups where rude people and those who insult other students are not tolerated would be really nice. But I know, this is "the real world" and "the way it is", please spare the lectures. I miss surgery where I got to be the only student in the OR with an attending or resident and they quizzed me if they wanted to find out what I knew.

 

[Andrew_Doan]

Originally posted by irlandesa
OK, I think the "well that's how 3rd year works" is now officially a well-beaten dead horse. I kind of see what Lorraine means, sometimes during group discussions or lectures on my current rotation it feels more like a competition to see who can scream their knowledge (or quite often, unfortunate lack thereof) the loudest rather than a fun learning experience. Unfortunately, if you are like me and prefer to wait until there is a good polite pause and you know something to jump in, you get kinda screwed and this PA student on my rotation even makes fun of me in front of the other students for being on the quiet side. I understand the importance of assertiveness, but good group facilitators or sufficiently small groups where rude people and those who insult other students are not tolerated would be really nice. But I know, this is "the real world" and "the way it is", please spare the lectures. I miss surgery where I got to be the only student in the OR with an attending or resident and they quizzed me if they wanted to find out what I knew.

Sorry if you felt like you were lectured. I didn't mean to come across like that.

Consider this... There's more to being a physician than memorization and regurgitation. To be a good physician requires: being able to relate to patients, working with the health care team (including nurses, techs, clerks, residents, fellows, medical students, etc...), applying medical knowledge to patient care, having effective communication skills, and being dedicated to patient care. All of these important qualities are best evaluated in a clinical setting during your clinical rotations. Thus, this is why program directors are most interested in your performance during these years. If you think the third and fourth years of medical school are 'subjective', then you'll love residency when you must deal with numerous faculty personality types.

No one likes to do anything the same way, and the evaluation process during residency is all subjective.

Best regards,
Andrew

 

[DOtobe]

As a DO student who receives letter grades for rotations, I am curious how letter grades compare to honors/high pass/pass. Is it A = honors, B = high pass, and C = pass?

 

[Andrew_Doan]

Originally posted by DOtobe
As a DO student who receives letter grades for rotations, I am curious how letter grades compare to honors/high pass/pass. Is it A = honors, B = high pass, and C = pass?

Pretty much. PASS/NO PASS is really letter grades in a disguise.

This is why some schools kept letter grades.

 

[irlandesa]

I don't mind outspoken personalities or people who are different from me at all, in fact the opposite. However, I do take issue with people who feel the need to talk right over other students and sometimes professors. This is not an effort to "get along" with others, their behavior is just plain rude. And I consider getting pimped in the OR, seeing a patient with a resident, answering and asking questions on rounds, etc. to all be appropriate clinical settings for learning. The attendings and residents that I've met are mostly great; it's just a few students who feel the need to put others down in front of residents and classmates who make life difficult at times. oh well, must keep learning to ignore them as much as possible.

Dr. Doan, I wasn't referring to you about the "lectures", you obviously know what you're talking about, so no hard feelings at all! I was referring to the people who are barely or not even third years yet, but feel the need to regurgitate what others say without adding anything of substance. gets old after a while..

 

[Andrew_Doan]

Originally posted by irlandesa

no hard feelings at all!

🙂

 

[scootad.]

I learned the hard way during my first rotation (medicine) that its not so much what you know, but how vocal you are (even if you dont have a clue what you're talking about) thats most important. And lets face it, thats the way the real world is unfortunately. Loud mouths win out. So after that rotation, whenever I've been in a small group situation with an attending and the attending asks a question, I make sure I'm the first one to answer, its a race to show off that you are not a mute.

This was a big adjustment for me as I'm a quiet guy by nature, and I've always firmly believed in the importance of speaking only when one has somethign of value to contribute. I've always been annoyed by people who talk for the sake of hearing their own voice. But now I've become one of those people and I've done much better on my rotations.

 

[puffy1]

3rd year grades aren't solely based on the subjective opinions of the attendings/residents doing the evaluations. I think in the majority of situations you have to perform well on the rotation-ending shelf exams in order to have a shot at honoring/high passing/passing. Some rotations weigh the written component heavily (surgery where I'm at counts it as 50%) while others don't weight it as heavily (psych counts the shelf as 30%).

However, if you don't make a particular cutoff score, you're not going to do as well as you did on your evals. So no matter how much knowledge you spout out during your rotations, you're not going to honor it if you stink up the shelf.

I hope the people who believe that 1st and 2nd year grades are more important than 3rd year grades realizes just how important 3rd year is.

 

[Galaxian]

What if you don't honor anything! Well...the sun will still rise tomorrow morning, so just keep on breathing. To get honors, I think the most important thing to do is to rock the shelf exam, no single thing will help more than this. To a certain degree, I agree with scootad in that you need to be more vocal, and definitely need to step up when something cool/onerous shows up. But you have to be careful not to look like a little lap dog yelping for treats like a coked out *****. Residents see through that crap pretty quick, and they aren't that far removed from a student's position. The best advice my advisor gave me was to always do your best, so that way you won't have any regrets if things don't go your way...

 

[huktonfonix]

Hey, whats wrong with coked out ******? Nah, actually agree with above even if its from Galaxian

 

[kd]

So I don't get why residents get so much input into our evals, anyway. Yes, I understand we spend lots more time working with them than with attendings. But these people are busy, overworked people who have ZERO training in teaching. On my OB rotation, I got a grand total of ONE attending evaluation- the other 5 came from residents, two of whom had barely even worked with me (one night on call with each). I ended up missing an A in OB by less than one point because of some BS crap one of the residents spread about me- apparently, I pissed her off by asking a simple question during a procedure and for whatever reason, she took it the wrong way and got revenge on my grade. All the other residents commented on this incident in my eval, even though they had previously told me I was doing well and nothing negative ever happened again. So I'm really pissed that my OB grade was ruined based on the whims of one lousy miserable resident.
Oh well, we're over halfway through 3rd year, thank God, so we're almost done with this BS. Hang in there!

 

[Andrew_Doan]

Originally posted by kd
But these people are busy, overworked people who have ZERO training in teaching.

Not completely true. The residency training program is full of teaching opportunities. We teach the other residents and other medical students throughout the year. This is part of a residency training program.

 

[Galaxian]

Some of the best teaching I've gotten has been from residents. In fact, I don't understand why their input matters so little...for pete's sake, we spend about 90% of our time on the wards with them anyways! Then again, I guess I never had a bad resident on the wards, so I guess I'm kinda lucky...

 

[huktonfonix]

Often times residents may be closer to having studied the material or may be up to date on the latest studies and are great sources of teaching. Never had a bad resident eh......were you on the same rotations I was on?

 

[GeddyLee]

I learned this the hard way. You don't get honors by being a hard worker and knowing the material. You get honors by showing that you are a hard worker and showing that you know the material.

You cannot be quiet like I was! Be in your face. Ask pertinent questions that you prepare the night before rounds/surgery. Be there...all the time...in the attendings presence as much as possible. Try to present information on a relevant topic...either formally, or off the cuff during rounds.

Something else I learned....do as many rotations during third year at "affiliate"" hospitals...community hospitals if possible. It's easier to get great evals from these places, compared to your academic institution.

Finally, if you didn't get many honors, crush the heck out of step II. I think that should show where you are academically. And as long as your deans letter doesn't say anything to the effect that you were a slacker, then you should fair pretty well.

Geddy

 

[ktat72]

originally posted by kd:

On my OB rotation, I got a grand total of ONE attending evaluation- the other 5 came from residents, two of whom had barely even worked with me (one night on call with each). I ended up missing an A in OB by less than one point because of some BS crap one of the residents spread about me- apparently, I pissed her off by asking a simple question during a procedure and for whatever reason, she took it the wrong way and got revenge on my grade. All the other residents commented on this incident in my eval, even though they had previously told me I was doing well and nothing negative ever happened again. So I'm really pissed that my OB grade was ruined based on the whims of one lousy miserable resident.

hey, at least the OB resident got to evaluate you. here I am putting down names of different residents for that rotation - residents i know i worked really hard for and they have seen me do the work for them - yet i know of two residents (I know they know me really well) who have turned in my evaluation saying "do not know student well enough to evaluate student" - you work the student like crazy and then you say this - this is BS.