Why Failing Med Students Fon't Get Failing Grades

[HalladayWeekend]

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http://well.blogs.nytimes.com/2013/02/28/why-failing-med-students-dont-get-failing-grades/

I think the biggest problem is that while grade inflation is widespread, it is not universal. As such, students who are given the appropriate score as prescribed by the rubric are left behind in the dust. For example, my school's rubric states that Honors should be reserved for the top 10% of students. In some clinical rotations at my school, upwards of 60% of students received Honors. This puts students who were graded according to the rubric as they should have been seem inferior, when in fact they were graded as they should have been. This is something that definitely should be addressed in the coming years.

 

[duckie99]

If there are national standards for grading implemented that must be followed then I may not be against that. The standards could be basic such as top x% are "honors", next y% are "high pass", next z% are "pass", etc. This leaves it up to the schools on how to assess such competencies. It doesn't address the subjective evaluation component of the grade but at least the grade itself is comparable (within that school anyway). I do think your MSPE letter sent to residencies breaks down the grades within each rotation. So if 70% of people get "honors" it doesn't really mean anything... except to hurt the 30% who did not (which is the way it should be really).

I do think grade inflation has become unfortunate. That's why many schools are just going to pass/fail. In any case I really do hope a student who deserves to fail will be failed. The article you post is sort of unfair to the student that is discussed because the writer believes a student should FAIL, yes FAIL, because she is uptight... we all are uptight to a degree. That is pretty ridiculous. The writer must have lost his understanding of what is involved with medical education and what third year students must endure (note the author is a physician) and so unless the student is absolutely abhorrent she should not fail for being a little uptight. However, the other problem is that the evaluators are not trained to evaluate and most of the time don't even care. It's all these issues that make me want a pass/fail system for the entirety of med school even more.

 

[Wordead]

I agree that the writer is silly for thinking that a hysterical girl that was just criticized should be failed....that's ridiculous.

I don't know about grades on the wards yet, but my school definitely did some serious acrobatics to pass some kids during M2. I thought it was very disturbing.

 

[Siggy]

The biggest issue is making sure that different rotation sites in the same field (say... IM) have the same standards. Using the cheesy "reporter-interpreter-manager-educator" framework, the community hospital I had IM at was more than happy to give high passes and honors for people who could do a good history and physical (reporter level). The county hospital expected us to walk in and start working at the manager level (great, you did a history and physical... now what's wrong? All 10 diagnosis with a differential for the first... and now what are you going to do?") the first day. Otherwise, it's a "pass." I'll definitely say I learned more at the county hospital and did 10 times the work... but my grades paint a different picture between the two.

 

[KnuxNole]

If there are national standards for grading implemented that must be followed then I may not be against that. The standards could be basic such as top x% are "honors", next y% are "high pass", next z% are "pass", etc. This leaves it up to the schools on how to assess such competencies. It doesn't address the subjective evaluation component of the grade but at least the grade itself is comparable (within that school anyway). I do think your MSPE letter sent to residencies breaks down the grades within each rotation. So if 70% of people get "honors" it doesn't really mean anything... except to hurt the 30% who did not (which is the way it should be really).

I do think grade inflation has become unfortunate. That's why many schools are just going to pass/fail. In any case I really do hope a student who deserves to fail will be failed. The article you post is sort of unfair to the student that is discussed because the writer believes a student should FAIL, yes FAIL, because she is uptight... we all are uptight to a degree. That is pretty ridiculous. The writer must have lost his understanding of what is involved with medical education and what third year students must endure (note the author is a physician) and so unless the student is absolutely abhorrent she should not fail for being a little uptight. However, the other problem is that the evaluators are not trained to evaluate and most of the time don't even care. It's all these issues that make me want a pass/fail system for the entirety of med school even more.

I'm not uptight D:

I think the student was wrong to outwardly yell at the attending. Just cause she is stressed doesn't mean she had to take it out on them, and give them more fuel. There is some bias because the writer could have exaggerated the reaction, thus making it not a big a deal as portrayed. However, any medical student who storms off after being critiqued(or arguing over it) makes no sense whatsoever. Especially arguing with anyone...keep it classy. 3rd year isn't meant to be the most stressful time ever.

With that said, I agree, the thought of failing her for that one small incident is blowing it out of proportion.

 

[mvenus929]

The writer must have lost his understanding of what is involved with medical education and what third year students must endure (note the author is a physician) and so unless the student is absolutely abhorrent she should not fail for being a little uptight.

While I'm not sure if she's currently on faculty at UCLA, Pauline Chen is an academic physician.

http://www.rhspeakers.com/speaker/pauline-chen/?v=about

I agree that the specific examples don't seem to be grounds for failing, but I also can't say that they're not. It's hard to know without seeing the student interact with others on a daily basis. Maybe they were isolated instances, maybe no one has addressed them with her, maybe she acts like that all the time and has been since the beginning of medical school despite interventions. I do know of students who act extremely unprofessionally, and should receive a failing grade for such conduct. I certainly don't want them acting that way as practicing physicians.

 

[J ROD]

My school does not curve......period.

You get a 70 or higher.

Can make 1 D with an overall 2.0 and still continue IF they think it was just a one time thing and you can handle it.

Sent 4 home last semester and looks like more are going this round.

 

[link2swim06]

The biggest issue is making sure that different rotation sites in the same field (say... IM) have the same standards. Using the cheesy "reporter-interpreter-manager-educator" framework, the community hospital I had IM at was more than happy to give high passes and honors for people who could do a good history and physical (reporter level). The county hospital expected us to walk in and start working at the manager level (great, you did a history and physical... now what's wrong? All 10 diagnosis with a differential for the first... and now what are you going to do?") the first day. Otherwise, it's a "pass." I'll definitely say I learned more at the county hospital and did 10 times the work... but my grades paint a different picture between the two.

👍👍👍👍

It's not a problem with evaluators per se, it's more an issue with expectations of those various evaluators.

This is true at my school for sure (and likely everywhere).

 

[Bryan O’Blivion]

While I recognize the author's frustration, it seems like the issue could be solved with some direct communication between the attending and the student. Nowhere in the article does the author reveal a one on one conversation with the student, which would be appropriate if there was a professionalism concern.

Personally, as a medical student, I appreciate direct feedback. As an example: One rotation was a particular struggle for me, I worked hard, and studied, but did have some difficulty making the material stick. I began the rotation really enjoying it, volunteering for procedures and often staying late to be present in any ward activity. I did this with a few attendings whom I enjoyed working with, and who praised me while I worked with them, but in evaluation with the clerkship preceptor, recommended that I fail the clerkship. This was revealed to me in a mid clerkship evaluation. I was taken aback, since I had really enjoyed the learning experience, and received compliments from them, at the time of the interaction. This made me mistrustful of them, and hesitant to ask questions or work with them. I wanted to broach the subject with them, but felt like I would only be worsening my position, as our previous instructor/student relationship seemed disingenuous.

In the case of the student in the article, I think that stamping one's feet and yelling is pretty poor form (totally unacceptable), but the student should really be corrected, which might take some assertiveness from the attending.

In my own case, a little direct feedback would have been welcome as well. I think that addressing specific issues with "problem" med students does not necessarily require having more power to fail them, but rather requires leadership in correcting unsatisfactory behavior.

 

[normtheniner]

I'm not uptight D:

I think the student was wrong to outwardly yell at the attending. Just cause she is stressed doesn't mean she had to take it out on them, and give them more fuel. There is some bias because the writer could have exaggerated the reaction, thus making it not a big a deal as portrayed. However, any medical student who storms off after being critiqued(or arguing over it) makes no sense whatsoever. Especially arguing with anyone...keep it classy. 3rd year isn't meant to be the most stressful time ever.

With that said, I agree, the thought of failing her for that one small incident is blowing it out of proportion.

I get the feeling that this is just one event in that students time at that school. When I read this I actually pictured the people in my class I could see doing this. Even now in second year I've seen them talk back to professors in class and tell them when they're wrong in what I'd consider a disrespectful tone.

I think there is a basic level of respect that every professor/clinician deserves from us regardless of how terrible we think they are... While I don't think this girl should fail the course, I certainly hope this showed up in her evals....

 

[Textbookversion]

failing med students definitely get failing grades. it's very possible to fail a class or rotation at my school dunno what this person is on about.

 

[KnuxNole]

I get the feeling that this is just one event in that students time at that school. When I read this I actually pictured the people in my class I could see doing this. Even now in second year I've seen them talk back to professors in class and tell them when they're wrong in what I'd consider a disrespectful tone.

I think there is a basic level of respect that every professor/clinician deserves from us regardless of how terrible we think they are... While I don't think this girl should fail the course, I certainly hope this showed up in her evals....

Those kids need to get slapped with rulers ala catholic school style

 

[Wordead]

failing med students definitely get failing grades. it's very possible to fail a class or rotation at my school dunno what this person is on about.

It really varies school to school...I know a school where 10% of the class had to repeat M2. My school I think hasn't a repeat in years.

 

[Thyroxine]

I get the feeling that this is just one event in that students time at that school. When I read this I actually pictured the people in my class I could see doing this. Even now in second year I've seen them talk back to professors in class and tell them when they're wrong in what I'd consider a disrespectful tone.

At my med school these kind of people don't usually tend to get failing grades...but many of them tend to also be gunners.

 

[NickNaylor]

At my med school these kind of people don't usually tend to get failing grades...but many of them tend to also be gunners.

Some people also just simply don't know how to respond to criticism or critique in any other way other than negatively.

 

[Stellar Clouds]

failing med students definitely get failing grades. it's very possible to fail a class or rotation at my school dunno what this person is on about.

At my school people do fail classes, but it is very difficult to fail a rotation. I've seen some monumental f**k-ups go through and pass rotations. The sad thing is, these people should have failed, but attendings are more likely to just pass someone. Failing a student requires a significant amount of paperwork, and on some rotations, working with that student again for 4-6 weeks.

 

[tobi44]

http://well.blogs.nytimes.com/2013/02/28/why-failing-med-students-dont-get-failing-grades/

I think the biggest problem is that while grade inflation is widespread, it is not universal. As such, students who are given the appropriate score as prescribed by the rubric are left behind in the dust. For example, my school's rubric states that Honors should be reserved for the top 10% of students. In some clinical rotations at my school, upwards of 60% of students received Honors. This puts students who were graded according to the rubric as they should have been seem inferior, when in fact they were graded as they should have been. This is something that definitely should be addressed in the coming years.

Its hard for third year students to fail rotations because third year rotations don't necessarily test whether you will be a good doctor. As a third year you essentially don't have a job description and you only have a few weeks to get acclimated to your co-workers and expectations before you are switched to something else. Add that to the fact that most third year medical student have not had the experience of a full time job so they don't really know how to work with people in a professional setting and I'm sure a lot of students flounder. It would be cruel to have a student go through all that work and effort to become a MSIII only to be failed at third year rotations because the expectations were unnecessarily high.

 

[DoctwoB]

What was interesting was reading the comments, including some from attendings, talking about how if they fail or give low grades to students, we raise a huge stink and give them poor evals, which hurts their career.

I know at my school we eval our attendings before we get grades back, but it's interesting to know that our feedback actually carries that kind of weight. We should exercise it with the same deliberation that we hope they give our grade.

 

[Procyon]

Yeah, I read this article, and I didn't really understand why she's a "failing medical student" just because she responded negatively to criticism. It seemed kind of silly to huff and puff like that, but I don't see how it warrants a failing grade.

The article also discussed the idea of the "intangibles" of being a doctor. At this stage in the game, aren't med students kind of still learning the best way to talk to patients, bedside manner, how to get good H&P's, etc? It seems unfair to fail a third year if they don't perform at an attending's skill level in that regard, which is what it seemed like the article was implying to me.

 

[HalladayWeekend]

Yeah, I read this article, and I didn't really understand why she's a "failing medical student" just because she responded negatively to criticism. It seemed kind of silly to huff and puff like that, but I don't see how it warrants a failing grade.

The article also discussed the idea of the "intangibles" of being a doctor. At this stage in the game, aren't med students kind of still learning the best way to talk to patients, bedside manner, how to get good H&P's, etc? It seems unfair to fail a third year if they don't perform at an attending's skill level in that regard, which is what it seemed like the article was implying to me.

The point is there should be a series of objective criteria for each clerkship that a student must accomplish before passing. Nobody is saying that students must be at an attending level, but there should be a minimal standard that medical students are held to. Whether this is in the form of an OSCE or being observed by specifically trained faculty (and given an opportunity to re-take if not passing), it should exist. Evaluations should exist on the wards for comments from residents/attendings for deans letter purposes, without the comical Honors-High Pass-Pass system that is a complete and utter joke. Pre-clinical grades get a bad rap on these forums, but they serve as a fair comparison amongst all students from a class (all students take the same exams), something that clinical grades don't come close to.
The point that the article makes is that clinical grades, as currently given, are essentially worthless. I agree that it is tough for a clinician to fail a student for any number of reasons in the current system, but there clearly are students who don't deserve to move forward. By taking this decision out of their hands (despite the obvious drawbacks with OSCE's, at least they are objective.), struggling students will get the extra help that they need to work on their skills. Excluding someone from a specific residency program because they did not get "Honors" in a specific rotation as grades are currently given is a farce, just as passing a student who doesn't deserve to pass.

 

[normtheniner]

At my med school these kind of people don't usually tend to get failing grades...but many of them tend to also be gunners.

Oh no... they definitely are. Our professor in micro actually gave us several years of old exams... several of the questions were repeated on our exam...

Those same students complained that the repeated questions "rewarded" those who just memorized test questions.... subsequent tests didn't have nearly as many repeats...

Some people are literally obsessed with being correct all the time.

 

[Thyroxine]

Oh no... they definitely are. Our professor in micro actually gave us several years of old exams... several of the questions were repeated on our exam...

Those same students complained that the repeated questions "rewarded" those who just memorized test questions.... subsequent tests didn't have nearly as many repeats...

Some people are literally obsessed with being correct all the time.

People like that make me wish that pre-clinical medicine could be a distance learning course 🙄

 

[Perrotfish]

Some people also just simply don't know how to respond to criticism or critique in any other way other than negatively.

To be fair, the criticism in third year is pretty much completely random. Its was obnoxious even for those of us in the middle of the pack, and if you're a top student fighting for a competitive specialty I imagine you have every reason to be losing your mind.

 

[SpecterGT260]

I really should be studying so I am just gunna drop this and apologize in advance if it has been covered.

1) the author had no understanding of the stress (extrinsic or intrinsix) of clinical clerkships. Technically, I don't either yet, but I have had enough conversations with senior students and residents to feel confident saying that this period can be killer, and people adapt at different rates. I know that some departments strive to "crack" a student as described in the article to see if they are "cut from the right stuff". If you do, you won't get any letters from the department and can kill that specialty goodbye if that is what you wanted. It happens.

2) They quoted a dude from Harvard saying "satisfactory is the kiss of death". yeah, ok 👍 Your clinical grades definitely matter. Step1 gets you in the door to interview, your demeanor on interview is huge, and then they want to see that the people you worked with in pertinent areas think you are capable. It's all spelled out in the PD survey. None of this adds up to grade inflation. If your school likes to give out honors it is a good thing that honors means nearly nothing to most PDs and they will skim over your Deans letter instead.

3) some people can't deal with any criticism. I know a few like this where the slightest correction is met with resistance making something that would have otherwise been a non issue a sudden problem. But not failing a student due to something like this doesn't exactly equal grade inflation either. The school in question in this article isn't the norm by anything that I have heard. My school's grades are highly dependent on your interactions. You won't fail a clerkship necessarily unless professionalism is a problem (and tantrums like this would certainly get you there), but you also cannot honor a clerkship without the blessing of the coordinator and staff.

People like to write critical editorial pieces about medicine and healthcare personnel. It's just a thing. Maybe there needs to be a little more transparency and PR work done to educate the average person on what actually goes on in medical school, because we currently have a flood of people (usually the ones who aren't sick yet) who think you basically read through an anatomy book and buy a stethoscope and then have an exclusive pass to job security and pill writing.

 

[NickNaylor]

3) some people can't deal with any criticism. I know a few like this where the slightest correction is met with resistance making something that would have otherwise been a non issue a sudden problem. But not failing a student due to something like this doesn't exactly equal grade inflation either. The school in question in this article isn't the norm by anything that I have heard. My school's grades are highly dependent on your interactions. You won't fail a clerkship necessarily unless professionalism is a problem (and tantrums like this would certainly get you there), but you also cannot honor a clerkship without the blessing of the coordinator and staff.

I'll admit that I've been extremely surprised at the way some people respond to criticism and critique. Obviously no one likes having their flaws pointed out, but there are some people that respond in a way that make me cringe - they get very defensive, etc..

You've been MIA for a bit Specter... step 1 studying doing you hard?

 

[NickNaylor]

To be fair, the criticism in third year is pretty much completely random. Its was obnoxious even for those of us in the middle of the pack, and if you're a top student fighting for a competitive specialty I imagine you have every reason to be losing your mind.

Yeah, I don't doubt that that happens. I suppose I have a different perspective as I don't have my heart set on one of those competitive specialties, but I just don't see ever being in a situation when I would act that way - even if it hurt my chances for residency. I just don't get that worked up about stuff. And there are some things that are inappropriate no matter what brought on the response.

 

[StIGMA]

I really should be studying so I am just gunna drop this and apologize in advance if it has been covered.

1) the author had no understanding of the stress (extrinsic or intrinsix) of clinical clerkships.

The author is an MD (surgeon in liver transplant / surg onc).

 

[SpecterGT260]

The author is an MD (surgeon in liver transplant / surg onc).

Hmmm missed that.

Sent from my DROID RAZR using SDN Mobile

 

[SpecterGT260]

I'll admit that I've been extremely surprised at the way some people respond to criticism and critique. Obviously no one likes having their flaws pointed out, but there are some people that respond in a way that make me cringe - they get very defensive, etc..

You've been MIA for a bit Specter... step 1 studying doing you hard?

Something like that 😀

Sent from my DROID RAZR using SDN Mobile

 

[normtheniner]

I'll admit that I've been extremely surprised at the way some people respond to criticism and critique. Obviously no one likes having their flaws pointed out, but there are some people that respond in a way that make me cringe - they get very defensive, etc..

You've been MIA for a bit Specter... step 1 studying doing you hard?

I know I'm exaggerating a bit, but this type of behavior (which happens at my school as well) reminds me of how our psych professors described personality disorders. These people's personalities are so rigid that some of them can't even realize that their interactions are usually what give them the negative response back from the environment.

Its a viscous cycle... and its been so bad this year that I feel like the faculty views the whole class as ultra gunners when its really just a few that behave this way (they just happen to be the ones that go to class).

 

[KnuxNole]

I disagree that the stress of 3rd year clerkships can explain her behavior. It's a 3rd year clerkship, not a PGY1 in a residency. There are some students that adapt at different rates, but they should never outwardly express it during the rotation. Express your anger after you leave the hospital or clinic. Plus, every medical student will be critiqued positively and negatively on their presentations. If someone gets mad with every "negative" comment, they will have ulcers by the time 3rd year is done. Remember, you aren't supposed to be flawless in your first rotation, people learn from their mistakes!

 

[SpecterGT260]

I disagree that the stress of 3rd year clerkships can explain her behavior. It's a 3rd year clerkship, not a PGY1 in a residency. There are some students that adapt at different rates, but they should never outwardly express it during the rotation. Express your anger after you leave the hospital or clinic. Plus, every medical student will be critiqued positively and negatively on their presentations. If someone gets mad with every "negative" comment, they will have ulcers by the time 3rd year is done. Remember, you aren't supposed to be flawless in your first rotation, people learn from their mistakes!

I don't think anyone is saying that her behavior is justified. It absolutely isn't. 3rd year can be a shock from what I have heard and I fully expect it to be as I become more and more aware of how little I know but no, yelling at a nurse or freaking out due to correction isn't at all appropriate. It also, however, doesn't imply grade inflation when she is not failed for such behavior as is implied by the author.

 

[goofball]

Am I the only person who thinks it's wrong to fail students on the suggestion of a nurse?

 

[Thyroxine]

Am I the only person who thinks it's wrong to fail students on the suggestion of a nurse?

Nope - I'd also be very surprised if it was actually a mainstream occurrence. Still wrong though.

 

[KnuxNole]

Am I the only person who thinks it's wrong to fail students on the suggestion of a nurse?

Imagine a world where that happens


Ms. Nurselady: Why don't you just fail him?
Dr. Attending: I really don't want to fail this guy, but he is doing pretty poorly. What do you think Ms. Nurselady?
Ms. Nurselady: Girl, lemme tell ya, he needs a wake up call. Just the other day, I was at the nurses station hard at work trying to find this good deal on cars on Criagslist, when this student comes up to me. He has the nerve to ask me where the chart for the patient in Room 411 is. I mean really? You don't know it's obviously on the third shelf from the right? What a dunce. I don't want my doctor to be this stupid!
Dr. Attending: Mm-hmm...you make a compelling case.

 

[Donald Juan]

Imagine a world where that happens


Ms. Nurselady: Why don't you just fail him?
Dr. Attending: I really don't want to fail this guy, but he is doing pretty poorly. What do you think Ms. Nurselady?
Ms. Nurselady: Girl, lemme tell ya, he needs a wake up call. Just the other day, I was at the nurses station hard at work trying to find this good deal on cars on Criagslist, when this student comes up to me. He has the nerve to ask me where the chart for the patient in Room 411 is. I mean really? You don't know it's obviously on the third shelf from the right? What a dunce. I don't want my doctor to be this stupid!
Dr. Attending: Mm-hmm...you make a compelling case.

Really?