What is your threshold to appeal a clerkship grade?

[PremedSurvivor]

Hi y'all,

Could really use your advice, as I really do feel like I got screwed over. Long story short, my 3rd year grades are: 2 Passes, 1 Honors and 3 High Passes.

Because I received a High Pass in medicine, I worked my ass off for the medicine subinternship 4th year to get an Honoes. I solicited specific feedback multiple times on absolutely everything- fund of knowledge, presentations, bedside manner. I would also would follow-up with them to get their assessment on how I had incorporated their feedback. I was told i was "working at a resident level" and that "they had full confidence sending me to internship-- no concerns whatsoever". The attending who was with me the longest gave me full numerical marks (5/5). Howeverrrr, 2 people who sang me praises to my face, gave me 3s or 4s out of 5 for some of the categories; they also didn't bother to write any comments so there was no explanation for why I had received 4s or 5s. That apparently is enough to preclude you from Honors.

I was slapped with a High Pass and contacted the course director; when pushed to explain the numerical marks (what specific reason is there for getting a 4 instead of a 5); Director had no reason. Director basically was like "erm, I'm not sure since I just saw numbers, but if we allow YOU to change your grade all the students will" which is ridiculous bull****.

I am considering formally appealing the grade, but the course director stressed that " most students do not send an appeal after speaking with the course director". So now I'm weighing getting screwed out of my specialty of choice-- which is competitive-- due to an arbitrary and bull**** grading system, vs pissing off the administration.

Thoughts?

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[Osteoth]

Normally I would say leave it alone but its your SubI as a 4th year. I would appeal it.

 

[Redpancreas]

Coming from an institution where H’s aren’t just handed out, I don’t really see the issue. Who even cares about the Sub-I at this point? The main purpose is to make mistakes and take risks to challenge yourself so you can be somewhat more prepared for internship. Most interviews have gone out and an Honors on a Medicine SubI which is 100% based of subjective feedback (which you’d now probably agree with) would carry little weight in my eyes considering everyone is probably doing their best to kiss ass.

Edit: Applying to a competitive specialty doesn’t entitle you to sympathy Honors. It’s one thing if subjectivity was needed even for HP and those evals bumped you from H to P, but in this case you still have HP which is fine. Also, why is what the PD said BS? Do you really think you’re the first person to appeal your subjective grades to a CD asking for Honors? Just improve and come back better.

 

[IlDestriero]

HP is a good score. Honors wasn’t easy to get where I was a student either. It would be nice if they gave you useful constructive criticism, but all they really owe you is a grade. One can be too eager, and that can be quite annoying.
You can appeal, but that may backfire on you more than you think. The annoying don’t get many superlatives on their LORs.


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Il Destriero

 

[Osteoth]

Coming from an institution where H’s aren’t just handed out, I don’t really see the issue. Who even cares about the Sub-I at this point? The main purpose is to make mistakes and take risks to challenge yourself so you can be somewhat more prepared for internship. Most interviews have gone out and an Honors on a Medicine SubI which is 100% based of subjective feedback (which you’d now probably agree with) would carry little weight in my eyes considering everyone is probably doing their best to kiss ass.

Edit: Applying to a competitive specialty doesn’t entitle you to sympathy Honors. It’s one thing if subjectivity was needed even for HP and those evals bumped you from H to P, but in this case you still have HP which is fine. Also, why is what the PD said BS? Do you really think you’re the first person to appeal your subjective grades to a CD asking for Honors? Just improve and come back better.

HP is a good score. Honors wasn’t easy to get where I was a student either. It would be nice if they gave you useful constructive criticism, but all they really owe you is a grade. One can be too eager, and that can be quite annoying.
You can appeal, but that may backfire on you more than you think. The annoying don’t get many superlatives on their LORs.

I understand you guys' points, but what do you want the guy to do, just take his medicine even though he feels as though he got a grade that he didn't deserve?

 

[Goro]

I understand you guys' points, but what do you want the guy to do, just take his medicine even though he feels as though he got a grade that he didn't deserve?

I feel for the OP, but I wonder if t there's more to the story than meets the eye. I suggest that OP contact recent grads to see if they had any luck with appeals.

 

[ActinicKeratosis]

Literally the same story on my Medicine subi. The attending gave me perfect scores, the residents gave me average scores. I received a pass. I appealed the grade and no dice. You can try to appeal but at least at my school these tend to barely be successful except for “extenuating circumstances.”


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[sliceofbread136]

Your school seems to have a crappy appeal system. Do the people who wrote your evaluation know that the 3s and 4s they gave are keeping you from honors? If not I would ask the course director to relay that info to them and see if that changes their decision. If that doesn’t pan out logistically I would just do a formal appeal.

At least you won’t have to deal with these bs grades much longer, there is a light at the end of the tunnel!

 

[IslandStyle808]

Coming from an institution where H’s aren’t just handed out, I don’t really see the issue. Who even cares about the Sub-I at this point? The main purpose is to make mistakes and take risks to challenge yourself so you can be somewhat more prepared for internship. Most interviews have gone out and an Honors on a Medicine SubI which is 100% based of subjective feedback (which you’d now probably agree with) would carry little weight in my eyes considering everyone is probably doing their best to kiss ass.

Edit: Applying to a competitive specialty doesn’t entitle you to sympathy Honors. It’s one thing if subjectivity was needed even for HP and those evals bumped you from H to P, but in this case you still have HP which is fine. Also, why is what the PD said BS? Do you really think you’re the first person to appeal your subjective grades to a CD asking for Honors? Just improve and come back better.

How does he improve when there is a blank comment section on the eval and nobody is telling him what to work on to his face? This is why he is upset.

 

[IlDestriero]

How does he improve when there is a blank comment section on the eval and nobody is telling him what to work on to his face? This is why he is upset.

No he seems upset because he thinks he deserved honors and only got a high pass. Was his performance really better than 90% of the class? I guess not. Lots of people work hard and think they’re way way above average, but they’re not. You can do a great job and not get honors. You can know more than most, come early, stay late, be proactive about things, etc. You can be very strong, better than all your peers in that block, and still not be at the honors level.
Such is life. No Harvard for you.



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Il Destriero

 

[Redpancreas]

How does he improve when there is a blank comment section on the eval and nobody is telling him what to work on to his face? This is why he is upset.

He or she wouldn’t say a peep or be posting on SDN if it was straight 5’s on his evals. Even with 5s, there’s room to improve. Full disclosure, these “injustices” were how all my evaluations worked and frankly it just annoys me when people complain about it. “Oh I got a 3 on presentations but this attending never saw me present, wahhh” What is really happening is opportunistic students see their grades, realize that it’s possible to honor if they just make a case that hinges on XYZ stipulation, and then throw smokebombs to distract from the issue that they did not do well enough to receive a 5. The grading system is subjective and people only start to care so much about it when they receive a bad grade. Now if we’re talking about ways to make the evaluation system more accurate and fairer for the future, I’m listening. The only extenuating cases are if you really didn’t work with someone who evaluated you or that person and you had an established history before the rotation (but even that’s kinda on the student for not voicing it).

 

[PremedSurvivor]

Coming from an institution where H’s aren’t just handed out, I don’t really see the issue. Who even cares about the Sub-I at this point? The main purpose is to make mistakes and take risks to challenge yourself so you can be somewhat more prepared for internship. Most interviews have gone out and an Honors on a Medicine SubI which is 100% based of subjective feedback (which you’d now probably agree with) would carry little weight in my eyes considering everyone is probably doing their best to kiss ass.

Edit: Applying to a competitive specialty doesn’t entitle you to sympathy Honors. It’s one thing if subjectivity was needed even for HP and those evals bumped you from H to P, but in this case you still have HP which is fine. Also, why is what the PD said BS? Do you really think you’re the first person to appeal your subjective grades to a CD asking for Honors? Just improve and come back better.

And how are you supposed to improve if you aren't given any specific feedback from the people who give you a 4? I worked my ass off for this rotation and my comments can attest to that; if there was a single thing in there from the people who gave me 4s (presentations were too long, didn't complete tasks) then believe me I would understand. But to ask for feedback from these people about a thousand times, improve on what your told, get praised for that in the comments and then arbitrarily not get an H because of 2 people who didn't bother explaining themselves is ridiculous. If 2 different commenters are saying that a student is operating at a resident level then why the hell would you not give them an H? And if you don't, at least have a better excuse then, "Oh well, 2 people gave you 4/5s and didn't explain why, so somehow this matters more than the 5/5s."

What do I have to do, sell an organ? And I haven't applied yet, so this very much matters for me.

** TO be clear: the 2 people who gave me 4s did not bother commenting. The ones who gave me 5/5s were the ones who gave detailed context.

 

[Redpancreas]

And how are you supposed to improve if you aren't given any specific feedback? I worked my ass off for this rotation and my comments can attest to that; if there was a single thing in there (presentations were too long, didn't complete tasks) then believe me I would understand. But to ask for feedback about a thousand times, improve on what your told, get praised for that in the comments and then arbitrarily not get an H is ridiculous. If multiple people are saying a student is operating at a resident level (2 different commenters), then why the hell would you not give them an H?

What do I have to do, sell an organ? And I haven't applied yet, so this very much matters for me.

If you worked your tush off for the rotation, you should be happy with what you learnt as a result. Such is medicine. When was any of this fair?

 

[PremedSurvivor]

No he seems upset because he thinks he deserved honors and only got a high pass. Was his performance really better than 90% of the class? I guess not. Lots of people work hard and think they’re way way above average, but they’re not. You can do a great job and not get honors. You can know more than most, come early, stay late, be proactive about things, etc. You can be very strong, better than all your peers in that block, and still not be at the honors level.
Such is life. No Harvard for you.



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Il Destriero

I appreciate what you are saying, but no, I am furious because the grading system is subjective; you need to have a damn good reason to give someone the grade you do. Again, if those people who gave me 4/5s bothered explaining why, one freaking word, then I wouldn't have made this thread. Fine. But the fact that subjective numbers preclude you from an honors-- over people who gave top marks and detailed comments-- is utter bull****.

 

[PremedSurvivor]

If you worked your tush off for the rotation, you should be happy with what you learnt as a result. Such is medicine. When was any of this fair?

Because it's not a light decision; it's something that impacts my career. As I said, this was an important rotation.

 

[PremedSurvivor]

How does he improve when there is a blank comment section on the eval and nobody is telling him what to work on to his face? This is why he is upset.

YES. YOU UNDERSTAND. THANK YOU.

 

[PremedSurvivor]

Literally the same story on my Medicine subi. The attending gave me perfect scores, the residents gave me average scores. I received a pass. I appealed the grade and no dice. You can try to appeal but at least at my school these tend to barely be successful except for “extenuating circumstances.”


Sent from my iPhone using SDN mobile

Ugh, I'm sorry! That's ridiculous. I love how we are taught as a profession that experimental design with subjective reporting is completely biased, and yet that's exactly the grading system we use.

 

[IlDestriero]

So, are you really better than 90% of your classmates? Hard work only gets you so far.
We work with residents from a few different programs. One is elite the others are very average. The hardest working guy from the average programs is still behind the average guy at the elite program. You can usually tell who is from where without asking. Of course they have their duds as well, and some people are just afraid of kids.


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Il Destriero

 

[Dwan]

And how are you supposed to improve if you aren't given any specific feedback from the people who give you a 4? I worked my ass off for this rotation and my comments can attest to that; if there was a single thing in there from the people who gave me 4s (presentations were too long, didn't complete tasks) then believe me I would understand. But to ask for feedback from these people about a thousand times, improve on what your told, get praised for that in the comments and then arbitrarily not get an H because of 2 people who didn't bother explaining themselves is ridiculous. If 2 different commenters are saying that a student is operating at a resident level then why the hell would you not give them an H? And if you don't, at least have a better excuse then, "Oh well, 2 people gave you 4/5s and didn't explain why, so somehow this matters more than the 5/5s."

What do I have to do, sell an organ? And I haven't applied yet, so this very much matters for me.

** TO be clear: the 2 people who gave me 4s did not bother commenting. The ones who gave me 5/5s were the ones who gave detailed context.

I believe you that you likely didn't do anything blatantly wrong that would be worthy of comment. I'm sure you performed an excellent job in all categories, perhaps even above expectations for a typical m4. The hard part of getting honors, however, is that you have to be better than almost all other students. No one in the top 1/2 of the class is making mistakes like didn't complete tasks, etc, but many in the top 1/2 still aren't getting honors. If the grade is valid, then your only "mistake" would be that you weren't as impressive as some other students (Do you think the people who had AOA/all or mostly H from m3 did worse than you?) Unfortunately for the sake of residency applications, many other schools hand out honors like candy, and that I agree is unfair, but it's not something we can control at this point.

 

[Psai]

Everyone says nice things to everyone. Very few people will tell someone they sucked to their face. I had the worst medical student ever the other day and because I was nice to them they probably went home thinking they were some sort of superstar. It should be difficult to get honors and it shouldn't go to everyone who goes whining to the course director because their grade is "important".

 

[neoexile]

Everyone says nice things to everyone. Very few people will tell someone they sucked to their face. I had the worst medical student ever the other day and because I was nice to them they probably went home thinking they were some sort of superstar. It should be difficult to get honors and it shouldn't go to everyone who goes whining to the course director because their grade is "important".

...He's complaining because on marks which weren't perfect, he didnt receive feedback on how to improve. If he "sucked" or wasn't "perfect", then he should receive feedback to understand how he wasn't.

I understand that not everyone is Harvard material, but everyone should at least get the benefit of getting candid feedback. I'd argue is bad to be mean, but it is much, much, much (multiplied by a hundred) worse for someone to be nice without being truthful.

The latter does more damage in the long run.

 

[kb1900]

Everyone says nice things to everyone. Very few people will tell someone they sucked to their face. I had the worst medical student ever the other day and because I was nice to them they probably went home thinking they were some sort of superstar. It should be difficult to get honors and it shouldn't go to everyone who goes whining to the course director because their grade is "important".

Did you give the med student feedback? Otherwise what you're doing (knowingly giving the med student a skewed perception of his performance by absence of critique) is just as disingenuous as the med student appealing his bad performance...how would he she know better?

Obviously I'm assuming a lot from a little, but if everyone treats bad rotation students nicely and then gives no feedback just poor scores, you can't be surprised that the med student didn't see it coming and wants to appeal

 

[Redpancreas]

Did you give the med student feedback? Otherwise what you're doing (knowingly giving the med student a skewed perception of his performance by absence of critique) is just as disingenuous as the med student appealing his bad performance...how would he she know better?

Obviously I'm assuming a lot from a little, but if everyone treats bad rotation students nicely and then gives no feedback just poor scores, you can't be surprised that the med student didn't see it coming and wants to appeal

No one’s saying the evaluation-system’s fair or that residents uphold their end although most of us on SDN probably try because we like to talk about this stuff. A lot of residents at this point though are just burnt out and could care less about teaching students. OP’s post to me just sounds like it’s first time he’s ever had something unfair happen to him.

 

[Psai]

Yes the medical student got feedback. A lot of it is common sense stuff, like not being in the way when **** is going down or not putting your hands all over things that are going into a patient's body.

When you're a resident, you'll see that some medical students just have it and others don't. One person will be executing plans, calling consults, updating families while another won't even do assigned work in a timely basis. No amount of feedback will make a crappy student into a great one. Pay attention to what your residents are doing, learn how to do it, don't be annoying. Ask for honest feedback, ask good questions at proper times, be a team player.

Also, high pass is a good grade.

 

[Jamie561]

And how are you supposed to improve if you aren't given any specific feedback from the people who give you a 4? I worked my ass off for this rotation and my comments can attest to that; if there was a single thing in there from the people who gave me 4s (presentations were too long, didn't complete tasks) then believe me I would understand. But to ask for feedback from these people about a thousand times, improve on what your told, get praised for that in the comments and then arbitrarily not get an H because of 2 people who didn't bother explaining themselves is ridiculous. If 2 different commenters are saying that a student is operating at a resident level then why the hell would you not give them an H? And if you don't, at least have a better excuse then, "Oh well, 2 people gave you 4/5s and didn't explain why, so somehow this matters more than the 5/5s."

What do I have to do, sell an organ? And I haven't applied yet, so this very much matters for me.

** TO be clear: the 2 people who gave me 4s did not bother commenting. The ones who gave me 5/5s were the ones who gave detailed context.

since its all about the feedback, instead of appealing grade, just ask for narrative feedback from those 2 people. it is probable that they will give you pointers on how to improve the 3s to 5s.


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[deleted103644]

Literally the same story on my Medicine subi. The attending gave me perfect scores, the residents gave me average scores. I received a pass. I appealed the grade and no dice. You can try to appeal but at least at my school these tend to barely be successful except for “extenuating circumstances.”


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If the residents who had to work with you gave you average scores and the attending gave you perfect scores, you must have been a real pleasure to work with...

 

[Southplains]

I was slapped with a High Pass and contacted the course director; when pushed to explain the numerical marks (what specific reason is there for getting a 4 instead of a 5); Director had no reason. Director basically was like "erm, I'm not sure since I just saw numbers, but if we allow YOU to change your grade all the students will" which is ridiculous bull****.

That’s not the least bit ridiculous, it’s entirely accurate. I understand your frustration but you’re not special and entitled to a grade change. I’ve never really heard about grade changes in clinicals.

 

[ActinicKeratosis]

If the residents who had to work with you gave you average scores and the attending gave you perfect scores, you must have been a real pleasure to work with...

What’s your problem? Attacking someone on an anonymous online forum...classy.


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[neoexile]

Yes the medical student got feedback. A lot of it is common sense stuff, like not being in the way when **** is going down or not putting your hands all over things that are going into a patient's body.

When you're a resident, you'll see that some medical students just have it and others don't. One person will be executing plans, calling consults, updating families while another won't even do assigned work in a timely basis. No amount of feedback will make a crappy student into a great one. Pay attention to what your residents are doing, learn how to do it, don't be annoying. Ask for honest feedback, ask good questions at proper times, be a team player.

Also, high pass is a good grade.

I just feel like this sort of talk is why a lot of medical students become jaded third year. When you have residents that have a high probability of viewing you as "in the way" rather than "wanting to be actively learning", regardless of whether it is true or not, it's not out of the question to become cynical and bitter at the process. The reason I'm typing this is that this is type of experience that a lot of my friends had going into third year.

The question I have is why would it be out of the question then if medical students are "in the way" to tell them to go read for their shelves? If a resident feels like people are in the way, why would they want them there? And if there is the continued experience of not knowing who will evaluate you next month or not knowing what eggshells to step on.

I think my idea is that medical students want to be of help, but often they don't know how. And when the resident/attending is asked how they can be of help, there might be several times where they get the answer "use your common sense".

Not saying that medical students are angels, but there ARE problems with the system.

 

[SterlingMaloryArcher]

It's weird having to rate someone like that, and being rated like that. For one of my memberships I had to get 3 references from people who knew me well which included a questionnaire of certain personal qualities 1 being labeled as "poor" 5 being "the best I have ever seen" or something silly like that. Most people didn't put 5's all the way down because that just looks like B.S.

but

I always thought these subjective evaluations people try to put numbers on were dumb so whenever highschoolers interned at my job, as long as they met expectations I would just give whatever the highest point score for each quality was, all the way down the line on the forms they take back to their school for a grade. Some of the other managers would nitpick.

I assume residents are the same way in that there are really nitpicky ones and ones who are "satisfied enough" and know how important it is so are liberal with the grading and it comes down to luck who you get - and that really sucks!

 

[NickNaylor]

Didn’t read most of the thread, but as a resident I’m frequently asked to provide supplementary feedback for students that appeal their clerkship grade.

What I can tell you from my experience is that rarely has an appeal worked in their favor, at least in terms of the comments that I provide to the clerkship director. At best, the comments I provide support the grade they received. At worst I provide damning comments that may support a grade lower than what they received. With very few exceptions, most of the students I’ve provided supplementary feedback about seem pretty oblivious to their shortcomings, even when provided direct feedback by me or the attending during the rotation. They fail to incorporate the feedback into their practice, thus they get dumped on when they get their evaluation.

Personally, I think the whole idea of requesting a grade appeal is ludicrous from the get-go - I had never heard of this until I got into residency, and the students here request them like nothing else. Unless something completely egregious happened, I don’t think engaging in the appeal process is worth your while, and it potentially demonstrates lack of insight into your own performance. By “egregious” I don’t mean “I didn’t receive the grade I thought I should” - that’s evident, and clearly you weren’t performing at the whatever level (reasonable or not) the attending expected you to.

In terms of your comments, @neoexile, the problem is that a lot of what playing this “game” successfully about is being able to understand a situation and figuring out what to do in that situation, asking your residents/attendings what is expected of you, and doing every single one of those things to the best your ability. I completely agree with what @Psai said: watch what your residents are doing, do that, and figure out how to be useful to your team. As absurd as it seems, I can’t tell you how many students fail to do even basic tasks that I clearly explain to them and outline as expectations. It’s incredible. As an example, on an inpatient rotation we had a list of the patients with basic clinical info (diagnoses, current medications, overnight events, vitals, etc.) that was distributed to the team in the morning. The medical students were expected to keep this list up to date. I would spend about half an hour explaining to them what was expected, where to find the information, etc. at the start of the rotation and provide feedback each day if things were missing, information was incorrect, etc.. In spite of this, a good half of the students were incapable of performing this basic task correctly. Many of the students completely ignored feedback that I would give them. This happens all the time in a variety of situations.

Apart from doing these tasks myself, I don’t know how else I can possibly do everything I can to help students succeed. I’m quite empathetic to medical students because I remember going through this bull**** and I want the clerkship experience to be as non-stressful and useful as possible. Some students are seemingly incapable of doing this for themselves. I do everything I can to help make the students look good, teach as much as I possibly can, and provide tips to doing well. Again, despite me giving this information, a surprising number of students seemingly refuse to use this information and do their own thing. I have no idea why the f they do this, but it happens all the time.

Don’t be one of those students.

 

[Stagg737]

[QUOTE="neoexile, post: 19476673, member: 766557
I understand that not everyone is Harvard material, but everyone should at least get the benefit of getting candid feedback. I'd argue is bad to be mean, but it is much, much, much (multiplied by a hundred) worse for someone to be nice without being truthful.

The latter does more damage in the long run.[/QUOTE]

This x100. My favorite attendings and professors have always been the ones who are honest and blunt, as having advisors who blew sunshine up my *** about my application was a major factor as to why I had to re-apply to medical school.

 

[Goro]

In terms of your comments, @neoexile, the problem is that a lot of what playing this “game” successfully about is being able to understand a situation and figuring out what to do in that situation, asking your residents/attendings what is expected of you, and doing every single one of those things to the best your ability. I completely agree with what @Psai said: watch what your residents are doing, do that, and figure out how to be useful to your team. As absurd as it seems, I can’t tell you how many students fail to do even basic tasks that I clearly explain to them and outline as expectations. It’s incredible. As an example, on an inpatient rotation we had a list of the patients with basic clinical info (diagnoses, current medications, overnight events, vitals, etc.) that was distributed to the team in the morning. The medical students were expected to keep this list up to date. I would spend about half an hour explaining to them what was expected, where to find the information, etc. at the start of the rotation and provide feedback each day if things were missing, information was incorrect, etc.. In spite of this, a good half of the students were incapable of performing this basic task correctly. Many of the students completely ignored feedback that I would give them. This happens all the time in a variety of situations.

Don’t be one of those students.

This is fascinating to read, Nick. Is there anything common to these students that would explain these deficits? Poor work ethic? Lack of interest in that particular rotation? Students from a particular school?

 

[VincentAdultman]

Get feedback from the people who gave you 3s, apply it, and move on with your life.

Med students man....

 

[Psai]

Didn’t read most of the thread, but as a resident I’m frequently asked to provide supplementary feedback for students that appeal their clerkship grade.

What I can tell you from my experience is that rarely has an appeal worked in their favor, at least in terms of the comments that I provide to the clerkship director. At best, the comments I provide support the grade they received. At worst I provide damning comments that may support a grade lower than what they received. With very few exceptions, most of the students I’ve provided supplementary feedback about seem pretty oblivious to their shortcomings, even when provided direct feedback by me or the attending during the rotation. They fail to incorporate the feedback into their practice, thus they get dumped on when they get their evaluation.

Personally, I think the whole idea of requesting a grade appeal is ludicrous from the get-go - I had never heard of this until I got into residency, and the students here request them like nothing else. Unless something completely egregious happened, I don’t think engaging in the appeal process is worth your while, and it potentially demonstrates lack of insight into your own performance. By “egregious” I don’t mean “I didn’t receive the grade I thought I should” - that’s evident, and clearly you weren’t performing at the whatever level (reasonable or not) the attending expected you to.

In terms of your comments, @neoexile, the problem is that a lot of what playing this “game” successfully about is being able to understand a situation and figuring out what to do in that situation, asking your residents/attendings what is expected of you, and doing every single one of those things to the best your ability. I completely agree with what @Psai said: watch what your residents are doing, do that, and figure out how to be useful to your team. As absurd as it seems, I can’t tell you how many students fail to do even basic tasks that I clearly explain to them and outline as expectations. It’s incredible. As an example, on an inpatient rotation we had a list of the patients with basic clinical info (diagnoses, current medications, overnight events, vitals, etc.) that was distributed to the team in the morning. The medical students were expected to keep this list up to date. I would spend about half an hour explaining to them what was expected, where to find the information, etc. at the start of the rotation and provide feedback each day if things were missing, information was incorrect, etc.. In spite of this, a good half of the students were incapable of performing this basic task correctly. Many of the students completely ignored feedback that I would give them. This happens all the time in a variety of situations.

Apart from doing these tasks myself, I don’t know how else I can possibly do everything I can to help students succeed. I’m quite empathetic to medical students because I remember going through this bull**** and I want the clerkship experience to be as non-stressful and useful as possible. Some students are seemingly incapable of doing this for themselves. I do everything I can to help make the students look good, teach as much as I possibly can, and provide tips to doing well. Again, despite me giving this information, a surprising number of students seemingly refuse to use this information and do their own thing. I have no idea why the f they do this, but it happens all the time.

Don’t be one of those students.

To be fair, I remember trying to keep a list straight as a medical student and I didn't really get it until I was an intern. Even then, it took me a few rotations to really get it straight and I wouldn't expect a medical student to be able to keep up with the whole list or even their own patients. It's a lot easier to keep information straight about patients when you are experienced and know what you're looking for and care about. Then again, when I was a student the residents didn't really explain to me how to do it properly so there's that.

To the medical students

Shelves are important for your grade but basically useless for life. You should be seeing as many patients as you can and learning as much as possible on the wards. Watching someone get an mri might be boring as hell but at least you will understand why someone with acute chf may not be the best candidate for laying down in an mri scanner. People don't seem to care to find out how the hospital works. I've been to the lab to see how they process samples and run tests. So I don't sit there twiddling my thumbs wondering why something is taking forever to come back since I know the process. I doubt that most of my students do or even care.

If expectations aren't clear, get them clarified. Your job is to learn patient care, not just pass tests. No one cares about your 260 when they're actively trying to die on you. Don't obsess about stupid things. Instead of being offended and whining about being called useless, try to figure out how to become useful.

 

[deleted103644]

What’s your problem? Attacking someone on an anonymous online forum...classy.


Sent from my iPhone using SDN mobile

That was far from an attack. More of a gentle suggestion that you might want to work on how you interact with those who are not necessarily your superiors on the wards.

You might know all the answers, but that’s not enough.

You need to also be a good team member.

Your attending on a rotation will often have less of a sense of that than the residents, so maybe instead of getting defensive you should reflect on what you might have done or not done to get those evaluations.

 

[valid username]

You can appeal, but that may backfire on you more than you think. The annoying don’t get many superlatives on their LORs.

Threshold to appeal is extremely high. For one of my clinicals my scanned pdf indicates honors. Somehow it got entered into the system as a high pass.

I asked about appealing but decided not to when informed that the most likely outcome would be a lower grade.

It is irritating to look at that grade on my mspe? Hell yeah. But it's better than a fail.

 

[ActinicKeratosis]

That was far from an attack. More of a gentle suggestion that you might want to work on how you interact with those who are not necessarily your superiors on the wards.

You might know all the answers, but that’s not enough.

You need to also be a good team member.

Your attending on a rotation will often have less of a sense of that than the residents, so maybe instead of getting defensive you should reflect on what you might have done or not done to get those evaluations.

You made a sarcastic comment suggesting that I didn't perform well because residents rated me average and the attending gave me good marks. You don't know the full story so why are you judging? Come on you know very well that you wrote that comment to take a jab at me. Let's not kid ourselves.

 

[valid username]

I just feel like this sort of talk is why a lot of medical students become jaded third year. When you have residents that have a high probability of viewing you as "in the way" rather than "wanting to be actively learning", regardless of whether it is true or not, it's not out of the question to become cynical and bitter at the process. The reason I'm typing this is that this is type of experience that a lot of my friends had going into third year.

The question I have is why would it be out of the question then if medical students are "in the way" to tell them to go read for their shelves? If a resident feels like people are in the way, why would they want them there? And if there is the continued experience of not knowing who will evaluate you next month or not knowing what eggshells to step on.

I see your point. But seriously, we ARE in the way. It doesn't need to make as cynical. When stuff is going down, just be a fly on the wall and learn something. There's a lot to learn, it just needs to be done in a way that doesn't harm patients. Write your thoughts asap, research your questions that night, ask the lowest ranking qualified person for clarification (if needed) the next day at the best possible time.

 

[neoexile]

To be fair, I remember trying to keep a list straight as a medical student and I didn't really get it until I was an intern. Even then, it took me a few rotations to really get it straight and I wouldn't expect a medical student to be able to keep up with the whole list or even their own patients. It's a lot easier to keep information straight about patients when you are experienced and know what you're looking for and care about. Then again, when I was a student the residents didn't really explain to me how to do it properly so there's that.

To the medical students

Shelves are important for your grade but basically useless for life. You should be seeing as many patients as you can and learning as much as possible on the wards. Watching someone get an mri might be boring as hell but at least you will understand why someone with acute chf may not be the best candidate for laying down in an mri scanner. People don't seem to care to find out how the hospital works. I've been to the lab to see how they process samples and run tests. So I don't sit there twiddling my thumbs wondering why something is taking forever to come back since I know the process. I doubt that most of my students do or even care.

If expectations aren't clear, get them clarified. Your job is to learn patient care, not just pass tests. No one cares about your 260 when they're actively trying to die on you. Don't obsess about stupid things. Instead of being offended and whining about being called useless, try to figure out how to become useful.

I just feel that this statement patronizes the whole crowd of the medical students and equating any sort of work without direction with "learning patient care". A student could see 15 patients in a day and still learn very little about the care of the patient or about how the hospital works. And at the point where you are still a student, people WILL care about 260 or whatever board score up until you match into residency and fellowship. To your other example, I also don't see how watching someone get a MRI would teach why patients with acute CHF are not the best candidates for getting the MRI. This is much like saying watching a pilot fly a plane would teach someone how trim systems free up a pilot from maintaining constant pressure on the controls.

If done right, the boards CAN help you prepare for the wards as a student should have mental pathways from how someone comes in with a complaint to what the management and complications should be. To a medical student who is prioritizing their career, the shelves and boards WILL be important as it seems more and more program directors will not give a damn about too much else other than the scores. Everything else becomes secondary to that.

Do I still think clinical exposure is important? A thousand times yes. However, only after someone has a mental idea of how someone with a specific complaint should be evaluated and treated. The logic has to be there in some fashion or else very little will make sense. Otherwise, all that will be done is that students will be asked to work without knowing what the purpose of anything at all is. You need to have a sort of map in your mind as to where a patient should be based on their care. If the student doesn't then he or she should go read up and internalize it asap. And btw, I'm gonna that an educated guess that you already do this for all your students Psai.

I guess let me just add some nuisance to this perspective. There is a difference between a student who is working hard and failing vs a student who is not even trying. I think my comments are more to defend students that try hard but still come up short. I will not give any defense to someone who doesn't even put forth an effort to make themselves better.

 

[PremedSurvivor]

Get feedback from the people who gave you 3s, apply it, and move on with your life.

Med students man....

.... That's exactly my point. I ASKED them for feedback and they told me I was doing fantastic. When I pushed for things to work on, one of them encouraged me to "keep exploring" to see what specialty appeals to me. This is AFTER I stated I was interested in this field.

Honestly, I think the resident was just burned out and not paying attention-- not that I blame them. But if there this burnt out, then this shouldn't be what your grade is contingent on.

 

[PremedSurvivor]

Threshold to appeal is extremely high. For one of my clinicals my scanned pdf indicates honors. Somehow it got entered into the system as a high pass.

I asked about appealing but decided not to when informed that the most likely outcome would be a lower grade.

It is irritating to look at that grade on my mspe? Hell yeah. But it's better than a fail.

Geez I'm so sorry! You have better self control than I do-- I would have been furious.

Sorry, but after the amount we take out in loans to pay for medical school/ Step 1/ prep material, the least the registrar can do is do their job properly. At my school, we get skewered for inefficiency and yet it just slides when it comes from someone in a position of authority.

 

[PremedSurvivor]

Didn’t read most of the thread, but as a resident I’m frequently asked to provide supplementary feedback for students that appeal their clerkship grade.

What I can tell you from my experience is that rarely has an appeal worked in their favor, at least in terms of the comments that I provide to the clerkship director. At best, the comments I provide support the grade they received. At worst I provide damning comments that may support a grade lower than what they received. With very few exceptions, most of the students I’ve provided supplementary feedback about seem pretty oblivious to their shortcomings, even when provided direct feedback by me or the attending during the rotation. They fail to incorporate the feedback into their practice, thus they get dumped on when they get their evaluation.

Personally, I think the whole idea of requesting a grade appeal is ludicrous from the get-go - I had never heard of this until I got into residency, and the students here request them like nothing else. Unless something completely egregious happened, I don’t think engaging in the appeal process is worth your while, and it potentially demonstrates lack of insight into your own performance. By “egregious” I don’t mean “I didn’t receive the grade I thought I should” - that’s evident, and clearly you weren’t performing at the whatever level (reasonable or not) the attending expected you to.

In terms of your comments, @neoexile, the problem is that a lot of what playing this “game” successfully about is being able to understand a situation and figuring out what to do in that situation, asking your residents/attendings what is expected of you, and doing every single one of those things to the best your ability. I completely agree with what @Psai said: watch what your residents are doing, do that, and figure out how to be useful to your team. As absurd as it seems, I can’t tell you how many students fail to do even basic tasks that I clearly explain to them and outline as expectations. It’s incredible. As an example, on an inpatient rotation we had a list of the patients with basic clinical info (diagnoses, current medications, overnight events, vitals, etc.) that was distributed to the team in the morning. The medical students were expected to keep this list up to date. I would spend about half an hour explaining to them what was expected, where to find the information, etc. at the start of the rotation and provide feedback each day if things were missing, information was incorrect, etc.. In spite of this, a good half of the students were incapable of performing this basic task correctly. Many of the students completely ignored feedback that I would give them. This happens all the time in a variety of situations.

Apart from doing these tasks myself, I don’t know how else I can possibly do everything I can to help students succeed. I’m quite empathetic to medical students because I remember going through this bull**** and I want the clerkship experience to be as non-stressful and useful as possible. Some students are seemingly incapable of doing this for themselves. I do everything I can to help make the students look good, teach as much as I possibly can, and provide tips to doing well. Again, despite me giving this information, a surprising number of students seemingly refuse to use this information and do their own thing. I have no idea why the f they do this, but it happens all the time.

Don’t be one of those students.

I can completely understand where you are coming from; let me just thank you for actually explaining that to your medical students. At least you bothered to explain things to them. At our institution, we are very much sort of unleashed which is why I painstakingly tried to define what my resident wanted from me, did that and then followed up to make sure it had been done to their satisfaction. Literally, there is nothing else I could have done.

I apologize for the rant but it kills me that I feel like I got screwed over. Again, I didn't feel this way about every rotation; for some, I thought my grades made sense, no matter where they were. This rotation was really just unlucky enough to be blessed with a Course Director who really does not give a damn.

 

[PremedSurvivor]

[QUOTE="neoexile, post: 19476673, member: 766557
I understand that not everyone is Harvard material, but everyone should at least get the benefit of getting candid feedback. I'd argue is bad to be mean, but it is much, much, much (multiplied by a hundred) worse for someone to be nice without being truthful.

The latter does more damage in the long run.

This x100. My favorite attendings and professors have always been the ones who are honest and blunt, as having advisors who blew sunshine up my *** about my application was a major factor as to why I had to re-apply to medical school.[/QUOTE]
I agree. For one of my rotations, my attending tore me apart but gave me advice and instruction that helped me rock the other rotations. THAT is true education, and it's so rare given how jaded and overworked everyone in the hospital is.

 

[VincentAdultman]

.... That's exactly my point. I ASKED them for feedback and they told me I was doing fantastic. When I pushed for things to work on, one of them encouraged me to "keep exploring" to see what specialty appeals to me. This is AFTER I stated I was interested in this field.

Honestly, I think the resident was just burned out and not paying attention-- not that I blame them. But if there this burnt out, then this shouldn't be what your grade is contingent on.

Ok. Then move on with your life.

 

[neoexile]

Ok. Then move on with your life.

This is basically saying shut up and deal with it. No wonder medical students get super jaded. Lol.

 

[VincentAdultman]

This is basically saying shut up and deal with it. No wonder medical students get super jaded. Lol.

I mean, there's not much other recourse.

I suppose OP could go back to the residents and ask why he got threes. At least that way he's got something to go with moving forward.

But I've heard stories like this for years and I hate to be That Guy or sound jaded myself but a lot of times it comes down to

1. Part of the story isn't being told to us or...

2. Poor insight.

 

[neoexile]

I mean, there's not much other recourse.

I suppose OP could go back to the residents and ask why he got threes. At least that way he's got something to go with moving forward.

But I've heard stories like this for years and I hate to be That Guy or sound jaded myself but a lot of times it comes down to

1. Part of the story isn't being told to us or...

2. Poor insight.

Guilty before proven innocent seems to be the new norm. . Not denying many cases are the above two, but there should be some charity given to the person who is complaining rather than presuming guilt on the outset.

To the OP, what is your next rotation? It might be helpful to start reading up.

And for everyone, I found this big think video. I really think it's probably relevant for everyone here:

 

[PremedSurvivor]

Ok. Then move on with your life.

If medical school wasn't a major investment of my time and finances, and if this grade didn't impact my career choice, then yeah, I would move on. But that's not the case, now is it?

 

[PremedSurvivor]

Guilty before proven innocent seems to be the new norm. . Not denying many cases are the above two, but there should be some charity given to the person who is complaining rather than presuming guilt on the outset.

To the OP, what is your next rotation? It might be helpful to start reading up.

And for everyone, I found this big think video. I really think it's probably relevant for everyone here:

I appreciate you approaching this fairly. My next rotation is something I'm just taking for credits, so not gunning for that H like I was for this one. Will watch this!