When you try really hard and still get an average evaluation

[The_Sunny_Doc]

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Just finished a rotation in the field I want to specialize in, and was miffed to see straight threes with a four for professionalism and a couple of meaningless comments (“keep studying hard throughout your rotations” “good job with patients”) in my evaluation. This was the rotation I busted my a** for, showing up 20 minutes early, churning out notes like a machine, going back to spend extra time each day talking to a couple of patients who were having a tough time. I asked questions about topics in the field and offered to present papers. We didn’t get pimped much, so I’ve no idea which info the preceptor used to grade us! I did far better in surgery (almost straight 5s) a field in which I have zero interest. Haven’t been frustrated during third year till now.

Surely there have been tons of threads created by third years complaining about their grade, so I know this is nothing new. Just feeling the sting now.

 

[curiousneuro]

Just finished a rotation in the field I want to specialize in, and was miffed to straight threes with a four for professionalism and a couple of meaningless comments (“keep studying hard throughout your rotations” “good job with patients”). This was the rotation I busted my a** for, showing up 20 minutes early, churning out notes like a machine, going back to spend extra time each day talking to a couple of patients who were having a tough time. I asked questions about topics in the field and offered to present papers. We didn’t get pimped much, so I’ve no idea which info the preceptor use to grade us! I did far better in surgery (almost straight 5s) a field in which I have zero interest. Haven’t been frustrated during third year till now.

Surely there have been tons of threads created by third years complaining about their grade, so I know this is nothing new. Just feeling the sting now.

Story of 3rd year...it sucks. Try not to let it tarnish your view of the field, though.

 

[deleted480308]

Just finished a rotation in the field I want to specialize in, and was miffed to straight threes with a four for professionalism and a couple of meaningless comments (“keep studying hard throughout your rotations” “good job with patients”). This was the rotation I busted my a** for, showing up 20 minutes early, churning out notes like a machine, going back to spend extra time each day talking to a couple of patients who were having a tough time. I asked questions about topics in the field and offered to present papers. We didn’t get pimped much, so I’ve no idea which info the preceptor use to grade us! I did far better in surgery (almost straight 5s) a field in which I have zero interest. Haven’t been frustrated during third year till now.

Surely there have been tons of threads created by third years complaining about their grade, so I know this is nothing new. Just feeling the sting now.

talk to one of your upperclassmen about that dept at your site......particularly someone who matched in your desired field.

sometimes they can help you navigate a doc better.....

Also, if you can do it quickly....ask to meet with the doc for a few minutes. Explain how you love the field and really want to make sure you perform well on your auditions. Then note your evaluation was basically an "avg" and you'd like to know if they can give you some tips on things to improve so your future residency directors view you as a more desirable candidate when you audition there.......it could get you some specific tips you didn't know you need, it alerts them they only called you avg in case they don't know how bad a particular schools' eval forms are, and could potentially get you some future mentorship

 

[The_Sunny_Doc]

talk to one of your upperclassmen about that dept at your site......particularly someone who matched in your desired field.

sometimes they can help you navigate a doc better.....

Also, if you can do it quickly....ask to meet with the doc for a few minutes. Explain how you love the field and really want to make sure you perform well on your auditions. Then note your evaluation was basically an "avg" and you'd like to know if they can give you some tips on things to improve so your future residency directors view you as a more desirable candidate when you audition there.......it could get you some specific tips you didn't know you need, it alerts them they only called you avg in case they don't know how bad a particular schools' eval forms are, and could potentially get you some future mentorship

Thanks, SB! That’s a good strategy. This doctor actually left the hospital for good at the end of our rotation, but I’ll contact the resident we worked with to see if I can get in touch with the physician via cell phone.

I’ll talk to some upperclassmen who matched to hear how their evaluations turned out.

 

[NeurologyHopeful2018]

Just finished a rotation in the field I want to specialize in, and was miffed to see straight threes with a four for professionalism and a couple of meaningless comments (“keep studying hard throughout your rotations” “good job with patients”) in my evaluation. This was the rotation I busted my a** for, showing up 20 minutes early, churning out notes like a machine, going back to spend extra time each day talking to a couple of patients who were having a tough time. I asked questions about topics in the field and offered to present papers. We didn’t get pimped much, so I’ve no idea which info the preceptor use to grade us! I did far better in surgery (almost straight 5s) a field in which I have zero interest. Haven’t been frustrated during third year till now.

Surely there have been tons of threads created by third years complaining about their grade, so I know this is nothing new. Just feeling the sting now.

Everyone...I do mean literally everyone have gotten average evaluations. Some attendings believe that is where you are supposed to be at...

I have gotten a few 2/5 evals too...

 

[Oso]

That sucks, sorry. Sounds about right for third year though. Not sure what field you're going into, but I hope this doesn’t discourage you too much. Same thing happened to me in my field of choice. Things will work out.

Also, if you’ve made it to the end of third year and are just now getting really frustrated at the arbitrary nature of it all... then hot damn you must have had a fabulous year. Good for you.

 

[SilverCat]

I found it helpful to ask about how to improve in the middle of the rotation, which helps you make improvements before they write the evals. Also, if you have an attending or resident who’s easy to talk to, asking about expectations of how to achieve 5s on presentation skills, knowledge, etc. May be useful.

Then again, you may be lucky to be placed with that one attending who you rub the wrong way. It’s life—just accept that not every patient you treat in future will treat you fairly.

 

[Redpancreas]

Just finished a rotation in the field I want to specialize in, and was miffed to see straight threes with a four for professionalism and a couple of meaningless comments (“keep studying hard throughout your rotations” “good job with patients”) in my evaluation. This was the rotation I busted my a** for, showing up 20 minutes early, churning out notes like a machine, going back to spend extra time each day talking to a couple of patients who were having a tough time. I asked questions about topics in the field and offered to present papers. We didn’t get pimped much, so I’ve no idea which info the preceptor use to grade us! I did far better in surgery (almost straight 5s) a field in which I have zero interest. Haven’t been frustrated during third year till now.

Surely there have been tons of threads created by third years complaining about their grade, so I know this is nothing new. Just feeling the sting now.

Honestly, the bolded is very low yield for getting 5s. All it serves to do is signal that to them that you're trying to make it look like you're trying hard. When I was on my subI my third year was gunning so hard (preparing topics and being aggressive in general). She would prepare presentations (basically watching OnlineMedEd videos and copying them) and then would present them identically to make herself look smart. It came off as extremely annoying and she did not even want to go into the field. OP, I'm not saying you were annoying, but for third years, developing a sense of how to help QUIETLY is a very useful skill and won't go unnoticed. Again OP, nothing to do with you and the notes were probably helpful and it sucks that you did not clinically honor :/

 

[NeurologyHopeful2018]

Honestly, the bolded is very low yield for getting 5s. All it serves to do is signal that to them that you're trying to make it look like you're trying hard. When I was on my subI my third year was gunning so hard (preparing topics and being aggressive in general). She would prepare presentations (basically watching OnlineMedEd videos and copying them) and then would present them identically to make herself look smart. It came off as extremely annoying and she did not even want to go into the field. OP, I'm not saying you were annoying, but for third years, developing a sense of how to help QUIETLY is a very useful skill and won't go unnoticed. Again OP, nothing to do with you and the notes were probably helpful and it sucks that you did not clinically honor :/

I dont think what she did was unreasonable. A lot of time - you really have to make an effort to stand out. Taking initiative to present topics related to patient care is excellent way to be noticed. You must give attendings reasons to give you 5s.

 

[Lawpy]

Story of 3rd year...it sucks. Try not to let it tarnish your view of the field, though.

That sucks, sorry. Sounds about right for third year though. Not sure what field you're going into, but I hope this doesn’t discourage you too much. Same thing happened to me in my field of choice. Things will work out.

Also, if you’ve made it to the end of third year and are just now getting really frustrated at the arbitrary nature of it all... then hot damn you must have had a fabulous year. Good for you.

Now I'm curious to know how some people manage to pan honor M3 and get strong evaluations across rotations if grading is so arbitrary and subjective.

 

[DokterMom]

If you think this is an area you'd like to specialize in, it almost never hurts to say so up front and to make your interest and enthusiasm known. It's a rare bird who will knowingly sabotage your career at this stage.

 

[The_Sunny_Doc]

That sucks, sorry. Sounds about right for third year though. Not sure what field you're going into, but I hope this doesn’t discourage you too much. Same thing happened to me in my field of choice. Things will work out.

Also, if you’ve made it to the end of third year and are just now getting really frustrated at the arbitrary nature of it all... then hot damn you must have had a fabulous year. Good for you.

Your comment cracks me up. I’ve been pretty lucky so far. Thanks for the sympathy.

Should go back to not being so invested in the outcome because that’s what has worked well till the last rotation. I couldn’t get a read on this preceptor. Perhaps my enthusiasm came off as fake to him. He was a rather cynical man.

 

[The_Sunny_Doc]

Honestly, the bolded is very low yield for getting 5s. All it serves to do is signal that to them that you're trying to make it look like you're trying hard. When I was on my subI my third year was gunning so hard (preparing topics and being aggressive in general). She would prepare presentations (basically watching OnlineMedEd videos and copying them) and then would present them identically to make herself look smart. It came off as extremely annoying and she did not even want to go into the field. OP, I'm not saying you were annoying, but for third years, developing a sense of how to help QUIETLY is a very useful skill and won't go unnoticed. Again OP, nothing to do with you and the notes were probably helpful and it sucks that you did not clinically honor :/

Thanks for the feedback and the sympathy. You’re probably right that it came off as too much. I feel like I have a good sense of how to navigate social situations, but sometimes we don’t know how we’re coming off. The above approach worked well enough for IM, surgery, and obstetrics, but those preceptors seem to enjoy going back and forth about semi-related topics. I likely read the situation wrong.

Oh, well. Over it. No regrets.

 

[sliceofbread136]

Honestly, the bolded is very low yield for getting 5s. All it serves to do is signal that to them that you're trying to make it look like you're trying hard. When I was on my subI my third year was gunning so hard (preparing topics and being aggressive in general). She would prepare presentations (basically watching OnlineMedEd videos and copying them) and then would present them identically to make herself look smart. It came off as extremely annoying and she did not even want to go into the field. OP, I'm not saying you were annoying, but for third years, developing a sense of how to help QUIETLY is a very useful skill and won't go unnoticed. Again OP, nothing to do with you and the notes were probably helpful and it sucks that you did not clinically honor :/

Lol, you see OP you just can’t win. Some will say you are too quiet, some say you aren’t quiet enough. It’s really just a crap shoot and will remain so until we try to implement at least some sort of standardization to our evaluation strategy...

 

[Oso]

Honestly, the bolded is very low yield for getting 5s. All it serves to do is signal that to them that you're trying to make it look like you're trying hard. When I was on my subI my third year was gunning so hard (preparing topics and being aggressive in general). She would prepare presentations (basically watching OnlineMedEd videos and copying them) and then would present them identically to make herself look smart. It came off as extremely annoying and she did not even want to go into the field. OP, I'm not saying you were annoying, but for third years, developing a sense of how to help QUIETLY is a very useful skill and won't go unnoticed. Again OP, nothing to do with you and the notes were probably helpful and it sucks that you did not clinically honor :/

I dont think what she did was unreasonable. A lot of time - you really have to make an effort to stand out. Taking initiative to present topics related to patient care is excellent way to be noticed. You must give attendings reasons to give you 5s.

Discussing this a bit more, and deviating from the OP's post ...

I think presenting papers can be a good thing when the material is relevant and the presentation is quick, to the point, and smooth. For example, during your plan: and for [problem or organ system], we should consider doing [intervention], as I found this retrospective study on whatever that showed benefits X, Y, and Z. Then you move on. If they want to ask questions about the study then they can do so afterwards. You can also offer to send the paper to the team.

What I found extremely annoying when I was a sub-I was the third years doing something like: "I found this really interesting paper from 2014. It's not really relevant to our patient anymore since our [test] did not show [disease], but just for kicks, it's a retrospective study with a sample size of x ..." Then 4 minutes describing the study objective, design, and results. THEN they state how it would have affected the management of the patient, IF the patient had the disease, which they do not. I kid you not, this happened a lot. The worst was someone walking us through the steps of performing a muscle biopsy and what we would have seen on histology ... had we been concerned the patient had a neuromuscular disease ... which they absolutely did not ... I just remember standing there thinking "I am hungry and I hate you" for delaying rounds.

 

[LuciusVorenus]

The problem with med school evaluations is they are kind of inflated. As a third year medical student you really SHOULD be getting all 3s. No one at that level is an expert at Reporting/Interpreting and DEFINITELY not at Managing/Education. Unfortunately everyone has fallen into the habit of giving all 5s and then putting "read more", so when an attending actually honestly evaluates you it ends up hurting you. Kind of makes the whole evaluation thing useless in the first place. I think the only real way to fix it is to make evaluations voluntary and recommend people only fill them out for students they want to argue on behalf of / believe are deserving of an honors (kind of like letters of recs). But that would be crazy because it would turn into a "WILL YOU FILL OUT MY EVALUATION" debacle at the end of every rotation. Alternatively, some of our rotations allowed us to pick 3 residents or attendings we wanted to be evaluated by and that kind of helped.

 

[sunshinefl]

The problem with med school evaluations is they are kind of inflated. As a third year medical student you really SHOULD be getting all 3s. No one at that level is an expert at Reporting/Interpreting and DEFINITELY not at Managing/Education. Unfortunately everyone has fallen into the habit of giving all 5s and then putting "read more", so when an attending actually honestly evaluates you it ends up hurting you. Kind of makes the whole evaluation thing useless in the first place. I think the only real way to fix it is to make evaluations voluntary and recommend people only fill them out of students they want to argue on behalf of / believe are deserving of an honors (kind of like letters of recs). But that would be crazy because it would turn into a "WILL YOU FILL OUT MY EVALUATION" debacle at the end of every rotation. Alternatively, some of our rotations allowed us to pick 3 residents or attendings we wanted to be evaluated by and that kind of helped.

I think this posts illustrates the situation. There are 2 standards, evaluate you from some total physician competence scale, or evaluate you at your level.

I only just finished first year, so I don’t know if this is the same for later, but we did have a community preceptor we worked with all year this year. They had to evaluate us. On the form our school specifically states to evaluate us against the expected capacity for a FIRST year student, not a whole complete attending physician. This is the standard I think is appropriate and makes more sense. At any year or level of training.

 

[LuciusVorenus]

I think this posts illustrates the situation. There are 2 standards, evaluate you from some total physician competence scale, or evaluate you at your level.

I only just finished first year, so I don’t know if this is the same for later, but we did have a community preceptor we worked with all year this year. They had to evaluate us. On the form our school specifically states to evaluate us against the expected capacity for a FIRST year student, not a whole complete attending physician. This is the standard I think is appropriate and makes more sense. At any year or level of training.

I think RIMES is part of the problem. I don't know what scale the community preceptor evaluates you with, but I do agree that being evaluated at your own level is the right way to go. Unfortunately, the RIMES scale is designed specifically to evaluate you against an expert (i.e. a senior resident/attending). I think this was partly to allow you to see improvement as you go from med school to residency, but it hasn't worked out that way.

 

[Oso]

The problem with med school evaluations is they are kind of inflated. As a third year medical student you really SHOULD be getting all 3s. No one at that level is an expert at Reporting/Interpreting and DEFINITELY not at Managing/Education. Unfortunately everyone has fallen into the habit of giving all 5s and then putting "read more", so when an attending actually honestly evaluates you it ends up hurting you. Kind of makes the whole evaluation thing useless in the first place. I think the only real way to fix it is to make evaluations voluntary and recommend people only fill them out of students they want to argue on behalf of / believe are deserving of an honors (kind of like letters of recs). But that would be crazy because it would turn into a "WILL YOU FILL OUT MY EVALUATION" debacle at the end of every rotation. Alternatively, some of our rotations allowed us to pick 3 residents or attendings we wanted to be evaluated by and that kind of helped.

I think this posts illustrates the situation. There are 2 standards, evaluate you from some total physician competence scale, or evaluate you at your level.
I only just finished first year, so I don’t know if this is the same for later, but we did have a community preceptor we worked with all year this year. They had to evaluate us. On the form our school specifically states to evaluate us against the expected capacity for a FIRST year student, not a whole complete attending physician. This is the standard I think is appropriate and makes more sense. At any year or level of training.

I think RIMES is part of the problem. I don't know what scale the community preceptor evaluates you with, but I do agree that being evaluated at your own level is the right way to go. Unfortunately, the RIMES scale is designed specifically to evaluate you against an expert (i.e. a senior resident/attending). I think this was partly to allow you to see improvement as you go from med school to residency, but it hasn't worked out that way.

I agree completely.

Perhaps this is slightly unrelated, but another pet peeve of mine was being expected to be a 'manager/expert' during the first week of a rotation, especially if you have a different attending each week. For example, my first week of neurology (which I had after 8 weeks of surgery) was rough because I knew absolutely nothing about the brain/nervous system. My attending told me I was "stuck" in the interpreter stage, which is behind for a 3rd year, because I was having trouble coming up with solid work ups and plans. I was on the consult service, would see a patient with my resident, and then immediately afterwards I would present to the rest of the team, with no time to think or look stuff up. Sure enough my evaluation from this attending said I had "trouble generating appropriate management plans" ... it's like, hello, what do you expect from a third year student after 4 days on service (first day was an orientation)???

 

[IMApplicant18]

I agree completely.

Perhaps this is slightly unrelated, but another pet peeve of mine was being expected to be a 'manager/expert' during the first week of a rotation, especially if you have a different attending each week. For example, my first week of neurology (which I had after 8 weeks of surgery) was rough because I knew absolutely nothing about the brain/nervous system. My attending told me I was "stuck" in the interpreter stage, which is behind for a 3rd year, because I was having trouble coming up with solid work ups and plans. I was on the consult service, would see a patient with my resident, and then immediately afterwards I would present to the rest of the team, with no time to think or look stuff up. Sure enough my evaluation from this attending said I had "trouble generating appropriate management plans" ... it's like, hello, what do you expect from a third year student after 4 days on service (first day was an orientation)???

That comment implies you have no clinical acumen and is a red flag - did it go on your MSPE?

 

[Oso]

That comment implies you have no clinical acumen and is a red flag - did it go on your MSPE?

The comment was given to me as feedback but was not on my official neurology evaluation and therefore not on my MSPE. I got a high pass in the clerkship overall.

 

[Tenk]

Yeah clinical grades are pretty stupid. One trick I learned pretty early on is to avoid trying to impress your attendings/residents with medical knowledge but instead trying to talk about stuff outside of medicine. Whether that’s sports, a hobby, cars, whiskey, doesn’t matter. Finding common interests always helps people like you and if people like you they will have a much harder time giving you a bad score. If all you do is show up and do your job and focus on medicine you’ll just become another face in an endless sea of MS3s.

 

[IMApplicant18]

Yeah clinical grades are pretty stupid. One trick I learned pretty early on is to avoid trying to impress your attendings/residents with medical knowledge but instead trying to talk about stuff outside of medicine. Whether that’s sports, a hobby, cars, whiskey, doesn’t matter. Finding common interests always helps people like you and if people like you they will have a much harder time giving you a bad score. If all you do is show up and do your job and focus on medicine you’ll just become another face in an endless sea of MS3s.

Truth. Clinical grades is a reflection of how well you are liked. No more no less. Really no one expects you to really know anything.

I once rotated w 2 students on EM. One guy was super chill, had adrenaline junkie hobbies, easy to get along with - and he got mostly HP and H for evals. Another girl was top of class, very high clinical knowledge and acumen - but had a uptight intense personality with very formal presentations. I can tell despite her knowledge and work ethics - nobody liked her and she got mostly middling evals.

 

[NachoPlatter]

Just finished a rotation in the field I want to specialize in, and was miffed to see straight threes with a four for professionalism and a couple of meaningless comments (“keep studying hard throughout your rotations” “good job with patients”) in my evaluation. This was the rotation I busted my a** for, showing up 20 minutes early, churning out notes like a machine, going back to spend extra time each day talking to a couple of patients who were having a tough time. I asked questions about topics in the field and offered to present papers. We didn’t get pimped much, so I’ve no idea which info the preceptor use to grade us! I did far better in surgery (almost straight 5s) a field in which I have zero interest. Haven’t been frustrated during third year till now.

Surely there have been tons of threads created by third years complaining about their grade, so I know this is nothing new. Just feeling the sting now.

To be honest, I think it almost hurts more when you get pan-positive comments ("Best student I've worked with, preforming at intern level..") and then the numbers are straight 3's. Those ones just make my head spin.

Just shake it off, take a deep breath, and remember in 30 years when you're an expert in this chosen field, nobody will remember or care about your third year grade/evaluations.

 

[GadRads]

Yeah clinical grades are pretty stupid. One trick I learned pretty early on is to avoid trying to impress your attendings/residents with medical knowledge but instead trying to talk about stuff outside of medicine. Whether that’s sports, a hobby, cars, whiskey, doesn’t matter. Finding common interests always helps people like you and if people like you they will have a much harder time giving you a bad score. If all you do is show up and do your job and focus on medicine you’ll just become another face in an endless sea of MS3s.

True, but there are times you won't be liked due to no fault of your own, and finding common interests won't even help. Not everyone will like you in real life, and some people will be terrible for a petty or absolutely no reason. I had such an experience with an attending in MS3 and another in intern year.

 

[Redpancreas]

Thanks for the feedback and the sympathy. You’re probably right that it came off as too much. I feel like I have a good sense of how to navigate social situations, but sometimes we don’t know how we’re coming off. The above approach worked well enough for IM, surgery, and obstetrics, but those preceptors seem to enjoy going back and forth about semi-related topics. I likely read the situation wrong.

Oh, well. Over it. No regrets.

No I didn’t mean you didn’t anything wrong. My tangent was moreso for others. The showing up 20 minutes early and seeing patients before you leave is a bit much but it’s not annoying. Just won’t get you 5s.

 

[LuciusVorenus]

To be honest, I think it almost hurts more when you get pan-positive comments ("Best student I've worked with, preforming at intern level..") and then the numbers are straight 3's. Those ones just make my head spin.

Just shake it off, take a deep breath, and remember in 30 years when you're an expert in this chosen field, nobody will remember or care about your third year grade/evaluations.

I worked SUPER hard on my surgery rotation, and in the end my evaluation was like a page long of the most positive stuff ever. It ended with "I can think of no student better deserving of an honors." High pass. Honestly I think sometimes people look at the scale and try to do it honestly, and it ends up hurting you when everyone else is mindlessly getting 5/5 with "good work."

On my IM interviews this year an interviewer actually pointed out the evaluation and grade and we had a laugh.

 

[jhamaican]

Sounds like typical medical school BS. Most of us on this board have been there. Keep your head down, do your best. You will be out in the real world soon. Just realize it is an artificial environment and u will be out relatively soon.

 

[Chillbo Baggins]

To be honest, I think it almost hurts more when you get pan-positive comments ("Best student I've worked with, preforming at intern level..") and then the numbers are straight 3's. Those ones just make my head spin.

Just shake it off, take a deep breath, and remember in 30 years when you're an expert in this chosen field, nobody will remember or care about your third year grade/evaluations.

True, but the stupid thing about this system is when these evals screw over people's chances for their desired field. (Not that I think that's the case in this situation, but in general)

 

[CherryRedDracul]

Yeah clinical grades are pretty stupid. One trick I learned pretty early on is to avoid trying to impress your attendings/residents with medical knowledge but instead trying to talk about stuff outside of medicine. Whether that’s sports, a hobby, cars, whiskey, doesn’t matter. Finding common interests always helps people like you and if people like you they will have a much harder time giving you a bad score. If all you do is show up and do your job and focus on medicine you’ll just become another face in an endless sea of MS3s.

This should be ****ing stickied.

This is good life advice in general.

 

[DrMcCoyDO]

Yeah clinical grades are pretty stupid. One trick I learned pretty early on is to avoid trying to impress your attendings/residents with medical knowledge but instead trying to talk about stuff outside of medicine. Whether that’s sports, a hobby, cars, whiskey, doesn’t matter. Finding common interests always helps people like you and if people like you they will have a much harder time giving you a bad score. If all you do is show up and do your job and focus on medicine you’ll just become another face in an endless sea of MS3s.

I swear, this is part of how I matched into my top program of those I interviewed at. I had a few hour down-time on interview day, so I shadowed the program director for a bit. We talked more about our mutual love of arcade games and sound systems than anything else. I’m definitely not the top when it comes to clinical knowledge, but you can bet that he remembered me after interview day.

 

[MediCane2006]

This is a rite of passage in med school. I will forever hold a grudge against the damn obgyn resident who gave me straight “average”’s after 6 weeks of showing up at 4am to have vitals ready and notes prewritten for the residents who arrived at 5.

This is why sub-internships and away rotations are so important.