What is your threshold to appeal a clerkship grade?

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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.

I have no reason to withold anything from this forum, given that I am seeking advice on whether to appeal. And given that I have gone through a year of rotations, it really isn't a question of insight. It's just frustrating to play by the book, do everything you have to do as a student and get screwed for arbitrary reasons. Again, I don't approach every rotation like this, but in this case, it really was a question of evaluators not caring enough to be thorough. They should have given me explicit feedback when I asked them for it, rather then tell me everything was fantastic to my face and then surprise me with a 3-4/5 later. There is absolutely no excuse for them not having done that.

My only take away from this-- to myself and everyone else here-- is that unfortunately, it seems like you can do everything right and still get screwed over for no fault of your own, and appealing can hurt more than it helps. The only thing left to do for us is to become better residents/ attendings than what we had. Going forward, I hope that no matter how tired or burnt out I am, I'll at least spare a few minutes to be blunt with my students about what they can improve. Not give them this sunshine and rainbows bull**** to their face to get them off my back, and then inexplicably given them marks.

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You can work harder than most, come early, stay late, and do everything asked of you and still not be an honors level student. That’s the reality.
You can always know more, present better, be easier to work with. Unless you have a problem you’re probably not going to hear about it.
You doing everything right and being told you’re doing great doesn’ necessary mean you’re honors material.
Appeal or don’t. But that’s the answer.


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Il Destriero
 
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I’d give you examples, but you come off as a bit whiney and entitled.
PS. Your HP isn’t going to keep you out of your chosen career. It doesn't mean the system is broken and you got screwed over either. Maybe you should gun for killer LORs from those faculty instead of crying over spilled milk.



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Il Destriero
 
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Would program directors even be made aware of a fourth year sub-i grade? I was under the impression that pretty much all schools included only M1-3 grades in the MST, hence the M4 reputation of slacking off. If that's the case, then I don't see why your HP should matter.
 
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!

How about after?

So about that insight...

Ya. I'll at least agree on HP doesn't impact career choice. I'll just say that it's better to focus on the next rotation.
 
Would program directors even be made aware of a fourth year sub-i grade? I was under the impression that pretty much all schools included only M1-3 grades in the MST, hence the M4 reputation of slacking off. If that's the case, then I don't see why your HP should matter.
Nope. Our fourth year grades are definitely included.
 
So about that insight...

.... considering a medical school a major investment of my time/ resources is somehow not insightful? Being frustrated for being denied the opportunity to improve by people who won't take the time to voice their criticisms is not insightful? I'm not sure what you're getting at.
 
Nope. Our fourth year grades are definitely included.

Let me suggest this. There are a lot of people who are voice negative reactions to your post. The best way to get them to stfu is for you to get a 260-270+ on your Step 2 CK. Perhaps focus on that. That will matter a lot more than a stupid HP on your transcript.

As an aside, residency programs are also looking for people that they like to work with. As a general rule, whining makes you less likable. Doesn't mean that the whining is not justified. But it DOES make you less likable. People will look for an applicant with a good attitude as well as good boards to work with.

Last year, one of my friends matched a top tier program and had failed attempts on CK and CS. Another one of my friends had top board scores but has not matched for 2 years now. The difference between both was attitude. So therefore its best to focus on what you can do now and stop focusing on this stupid rotation with stupid people :p
 
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You can work harder than most, come early, stay late, and do everything asked of you and still not be an honors level student. That’s the reality.
You can always know more, present better, be easier to work with. Unless you have a problem you’re probably not going to hear about it.
You doing everything right and being told you’re doing great doesn’ necessary mean you’re honors material.
Appeal or don’t. But that’s the answer.


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Il Destriero

That is exactly the problem. Honors should not be this elusive mystery. There are some attendings who have been very up front with what counts as Honors and what doesn't make the cut. I absolutely love those people, because regardless of what grade I get, I feel the process is fair and sensible.

To tell someone they are doing fantastic-- when they are clearly pressing you for specific feedback on how to improve-- and then knock off points later is to fail your responsibility as an educator to that student. I'm not asking anyone to hand me an H on a silver platter; I'm just asking to be informed what exactly qualifies as an H. I'm not sure how that comes across as "whiny" or "entitled".
 
Let me suggest this. There are a lot of people who are voice negative reactions to your post. The best way to get them to stfu is for you to get a 260-270+ on your Step 2 CK. Perhaps focus on that. That will matter a lot more than a stupid HP on your transcript.

As an aside, residency programs are also looking for people that they like to work with. As a general rule, whining makes you less likable. Doesn't mean that the whining is not justified. But it DOES make you less likable. People will look for an applicant with a good attitude as well as good boards to work with.

Last year, one of my friends matched a top tier program and had failed attempts on CK and CS. Another one of my friends had top board scores but has not matched for 2 years now. The difference between both was attitude. So therefore its best to focus on what you can do now and stop focusing on this stupid rotation with stupid people :p

Wow! Well, that pretty inspiring; thank you for sharing. I appreciate your time and guidance.

Apologies for coming across as whiny; if anything, it stems from fear. I'm anxious that after having worked hard, I'll be denied the chance for my specialty of choice. But based off of what you told me, it's so relieving to hear that someone failed attempts on CK/CS and matched top tier.
 
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That is exactly the problem. Honors should not be this elusive mystery. There are some attendings who have been very up front with what counts as Honors and what doesn't make the cut. I absolutely love those people, because regardless of what grade I get, I feel the process is fair and sensible.

To tell someone they are doing fantastic-- when they are clearly pressing you for specific feedback on how to improve-- and then knock off points later is to fail your responsibility as an educator to that student. I'm not asking anyone to hand me an H on a silver platter; I'm just asking to be informed what exactly qualifies as an H. I'm not sure how that comes across as "whiny" or "entitled".

I'll say it like this. In the long run, one HP is not going to make or break you. Not for derm, plastics or being president of the US. There are gonna be jerks in every field who are not honest and in general are complete dinguses. The system in medicine IS broken. It is.

However, at the same time, this is much like someone complaining on SDN how they lost a game of Mario Party or a dude got a way with cheating in a casual game of basketball and won. This is how people are looking at this. What will hurt you is if you get into a protracted battle that will likely unwinnable as opposed to just getting a qbank or some ankis and studying some flash cards all the way.

Better to put this behind you OP. There is Step 2 CK that needs to be killed and you must kill it hard.
 
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I'll say it like this. In the long run, one HP is not going to make or break you. Not for derm, plastics or being president of the US. There are gonna be jerks in every field who are not honest and in general are complete dinguses. The system in medicine IS broken. It is.

However, at the same time, this is much like someone complaining on SDN how they lost a game of Mario Party or a dude got a way with cheating in a casual game of basketball and won. This is how people are looking at this. What will hurt you is if you get into a protracted battle that will likely unwinnable as opposed to just getting a qbank or some ankis and studying some flash cards all the way.

Better to put this behind you OP. There is Step 2 CK that needs to be killed and you must kill it hard.

... are you saying I shouldn't pick a fight with that dingus who cheated in our neighborhood basketball pick up game? Because I KNOW HE DID.

But in all seriousness, this was very relieving to read. I really do appreciate it, Neoexile. Step 2, here I come...
 
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... are you saying I shouldn't pick a fight with that dingus who cheated in our neighborhood basketball pick up game? Because I KNOW HE DID.

But in all seriousness, this was very relieving to read. I really do appreciate it, Neoexile. Step 2, here I come...

That's the spirit. Get a 260/270 and tell the rest of us to stfu! :D
 
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That is exactly the problem. Honors should not be this elusive mystery. There are some attendings who have been very up front with what counts as Honors and what doesn't make the cut. I absolutely love those people, because regardless of what grade I get, I feel the process is fair and sensible.

To tell someone they are doing fantastic-- when they are clearly pressing you for specific feedback on how to improve-- and then knock off points later is to fail your responsibility as an educator to that student. I'm not asking anyone to hand me an H on a silver platter; I'm just asking to be informed what exactly qualifies as an H. I'm not sure how that comes across as "whiny" or "entitled".

You are super whiny and entitled.
 
Is it bad to meet and ask the clerkship director about differences in comments vs. clinical grades WITHOUT complaining/being rude/asking for a grade change? Would that negatively affect you?
 
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Here you all complaining about evals not allowing someone to get honors, while I got honors on the shelf and the evals but didn't honor because someone gave me an arbitrary score on lectures that tanked my total score. Yes LECTURES; it wasn't like attendance based (I attended all), but they are being elusive about how we were graded for attending lectures lol, and the evaluations from lecturers from me were excellent.
 
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Here you all complaining about evals not allowing someone to get honors, while I got honors on the shelf and the evals but didn't honor because someone gave me an arbitrary score on lectures that tanked my total score. Yes LECTURES; it wasn't like attendance based (I attended all), but they are being elusive about how we were graded for attending lectures lol, and the evaluations from lecturers from me were excellent.

They probably have guidelines on what percent of the class can get Honors and HP. You have to draw lines somewhere. If 1/3 of the class gets Honors and another 1/2 get HP it devalues the grading system. Unless you’re at an Ivy, then it’s business as usual. Maybe that time you nodded off after call was noticed, or more than likely it’s just a feeling “he was better” and gets the H and you’re left with HP and they put the score in the lecture block so you wouldn’t become obsessed on the injustice of it all.


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Il Destriero
 
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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?

I don't really have much insight into it. I think part of it is certainly a lack of interest - I think we in psychiatry probably get that more than most services since psychiatry is the red-headed step-child of medicine and, unfortunately, many medical students see it as irrelevant (which really couldn't be further from the truth, but that's for another post). But that fact doesn't account for all this phenomenon because there are plenty of students who do extremely well but know what they're going into, and it isn't psychiatry.

The irony is that many of the students who ignore feedback and "do their own thing" actually have great worth ethics - at least in terms of doing the work and trying to work as hard as they can. I think this is actually part of the issue. I think some students overestimate their understanding of what it means to do well clinically such that they completely ignore feedback that is likely to help them but doesn't jive with their expectation of what an honors student should do. Some of it is probably hubris - perhaps they've done well on previous rotations and think they can just keep doing whatever it is they were doing before on psychiatry, which requires a different set of skills and which is much different than most other inpatient services. I'm really not sure. All I know is that it's something that I see quite often on our rotations, and for the life of me I can't understand why some students completely disregard tips that myself and other residents try to give them to help them perform well.
 
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They probably have guidelines on what percent of the class can get Honors and HP. You have to draw lines somewhere. If 1/3 of the class gets Honors and another 1/2 get HP it devalues the grading system. Unless you’re at an Ivy, then it’s business as usual. Maybe that time you nodded off after call was noticed, or more than likely it’s just a feeling “he was better” and gets the H and you’re left with HP and they put the score in the lecture block so you wouldn’t become obsessed on the injustice of it all.


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Il Destriero

1. Never nodded off; in fact the person giving the lectures helped connect me to residents outside my program in my field of interest, so if anything I was actively involved in answering questions and being attentive out of respect to that help.

2. We have H/P/F system, with 10% getting H; you have to reach a certain percentile on the shelf AND hit a certain overall average with evals to get H, the likelihood of both is already low as is. The line is already drawn pretty strictly.

3. The person evaluating us on the lectures is different from the attending evals and from the course director reviewing final grades (who I saw once, ie she didn't evaluate me herself).
 
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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.

LOL. I'm actually a med student at the school where you do residency. The reason the students don't give a f about clinical evaluations is because they have very little bearing on our final grades. Clinical evaluations used to matter alot, but prior classes complained about how subjective they are and as a result, the shelf and an "objective clinical skill" exam pretty much determine our grades now. You can get all average clinical grades and still recieve honors overall.

The grade is entirely determined by the shelf exams. Also, on rotations like Psych about 70-80% of the class gets an Honors. And at our school, appeals almost always seem to result in a higher grade being given. So those poor guys who don't do as well on the shelf have a lot of incentive to challenge grades. It's very commonly done at our school.
 
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Appealing a clerkship grade is like a private citizen taking on the IRS without a attorney to represent them. Every once in a while the IRS loses, but very rarely. You're probably correct that your clerkship grade is wrong, but that doesn't mean anyone cares to change it.
 
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Here you all complaining about evals not allowing someone to get honors, while I got honors on the shelf and the evals but didn't honor because someone gave me an arbitrary score on lectures that tanked my total score. Yes LECTURES; it wasn't like attendance based (I attended all), but they are being elusive about how we were graded for attending lectures lol, and the evaluations from lecturers from me were excellent.

That bites! I'm sorry. This is exactly the hand-waving sort of bull**** I find infuriating. Again, if we weren't paying an arm and a leg to be here, I suppose it wouldn't matter.
 
Appealing a clerkship grade is like a private citizen taking on the IRS without a attorney to represent them. Every once in a while the IRS loses, but very rarely. You're probably correct that your clerkship grade is wrong, but that doesn't mean anyone cares to change it.
Thanks for your honesty. Unfortunately, that seems to be the consensus. This experience was a good dose of what the real word looks like LOL
 
LOL. I'm actually a med student at the school where you do residency. The reason the students don't give a f about clinical evaluations is because they have very little bearing on our final grades. Clinical evaluations used to matter alot, but prior classes complained about how subjective they are and as a result, the shelf and an "objective clinical skill" exam pretty much determine our grades now. You can get all average clinical grades and still recieve honors overall.

The grade is entirely determined by the shelf exams. Also, on rotations like Psych about 70-80% of the class gets an Honors. And at our school, appeals almost always seem to result in a higher grade being given. So those poor guys who don't do as well on the shelf have a lot of incentive to challenge grades. It's very commonly done at our school.
Whoa, good to know. Our school is ridiculously stingy with the Honors; like maybe 10-20%. Even then, it seems arbitrary. You can meet the shelf cutoff and get stellar clinical comments, but if someone arbitrarily gives you a 4/5 instead of 5/5 there goes the H.
 
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Is it bad to meet and ask the clerkship director about differences in comments vs. clinical grades WITHOUT complaining/being rude/asking for a grade change? Would that negatively affect you?
Thank you for the suggestion; I already did.

When I pushed the Course Director for an explanation, he could not provide me with a concrete answer as to why I got an HP instead of an H. When I pointed out that I couldn't improve without specific feedback, he apologized and said it was out of his hands. He even admitted himself he wasn't sure what to make of the discrepancy. It was kind of a "Sucks to be you, but it's best to move on" situation.

The fact that he was unable to justify his decision tells you exactly what you need to know about the validity of the grading system lol.
 
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Here you all complaining about evals not allowing someone to get honors, while I got honors on the shelf and the evals but didn't honor because someone gave me an arbitrary score on lectures that tanked my total score. Yes LECTURES; it wasn't like attendance based (I attended all), but they are being elusive about how we were graded for attending lectures lol, and the evaluations from lecturers from me were excellent.

I know that feeling. I got 84 on Peds shelf - but got a 3/5 rating on clinical eval - and my final grade was Pass. A classmate got 74 on Shelf, but got 5/5 for clinical eval by a generous attending who gives everyone all 5s HPed the clerkship.

I feel you must make the shelf worth a TON to make the grades more fairer. No wonder residencies cares a lot of your USMLE board scores - while yes you are not defined by your board scores - it is the ONLY objective way to measure someone.
 
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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.
Actually I was furious, but I've been around long enough to know that sometimes in life you get screwed over. I often find it easier to move on than to try to force someone else to do the right thing. My way is not necessarily the right way. It's what works best for me. Thankfully not everyone is like me. People could run amok with no consequences. On the other hand, the slways punitive response is likely due to whining.
I agree with you that there should be more accountability from the registrar. The solution (as always) requires a middle ground. Systems that consistently blame only one side are broken.

Apologies for coming across as whiny; if anything, it stems from fear. I'm anxious that after having worked hard, I'll be denied the chance for my specialty of choice.
Your concern is real. I think most of us can appreciate that. I don't think you're coming off as whiney. The point is that if you fight for your grade you may get labelled as whiney. That isn't fair of course. It also isn't fair to get a grade based on someone's mood. Try to take comfort in the fact that there are plenty of grumpy people handing out subjective grades. And plenty of super nice, forgiving, accepting people handing out grades. Because of these things, grades have only limited utility.

The safest thing to do is trust that whoever evaluates your grades won't read much into them, but you aren't obligated to make the safest choice.
 
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Since someone else brought this up and I don't recall hearing it before:
What's the deal with acute CHF and MRI? Is this just a matter of not wanting them flat on their backs? Or avoiding contrast. Or something else?
 
MRI Contrast can induce kidney damage - patients with CHF are prone to renal problems (cardio-renal syndrome).
 
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As a student, I found the subjective clinical evaluations extremely frustrating. Some feedback could potentially ding your grade, and could come with seemingly no suggestions on how to improve. Clinical grades are important, which makes it suck even more.

As a resident, I'll say this: It's pretty easy to see who is really good, and who is not. Some people are just a cut above, independent of the things in everyone's control (show up early, stay late, act interested etc). It may not obvious to you as a student, but we can discern from how you act, what you say and even the questions you ask a basic level of understanding and aptitude. Just keep that in mind when things seem unfair or you get the middling evals for "no reason". We can also tell when you're being lazy, much more easily than you think.

That said, there are still frustrating things about it. Schemes vary wildly from school to school - although the MSPE does address this explicitly with an appendix which we DO look at; plus class rank is a thing. Some people could get to work with the dude who gives straight honors evals, while others with the bs "I never give honors cause nobody's perfect" dude (imo, they should not be working with students or should have their grading scheme examined by the clerkship director). There should always be specific feedback given too. Best thing you can do is find an honest resident, seek feedback, implement it and move on. Of course- read daily, know your patients, be early, be willing to stay late, don't complain, don't put others down, don't be annoying. Figure out what needs to be done and do it well.
 
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