When you're a resident, how will you grade your students?

[KnuxNole]

I don't think it's a competition at all, and tend to roll my eyes at losers who treat it as such. I remember one attending believed this, and I did try so hard not to laugh at him when he said he's surprised students are helping each other these days since he expected us to throw each other under the bus. I prefer to remember that I'm still a normal sane human being and not some nasty freak of life(aka gunners and people who compete against others). I'm the type of students that collaborates with others. Since, I have the mindset that I want every student to get an A on this test alongside me, and I want every student to get an A/Honors in this rotation alongside me. It's absolutely NOT a competition, it's simply just medical school, that's it. Not cutthroat at all, and doesn't need to be overly competitive, since life is WAY too short to always compete against others. Maybe that's why I find it awesome when being around non-med students(granted the ones I'm friends with are VERY chill, so being around med students is not a problem) because there's never a sense of entitlement, competitive nature, and smug "I'm better than people, take notice". Because dude, if you ARE better than the other 5 students, I as a resident won't give a **** or pat you on the back so easily.

I would never think "HAHA, I'm better than this person." cause that feels like a lame stinky POS type attitude. I'm more of the nice guy

I would NOT want a douche taking care of me. I would be annoyed having a freak like that take my history, and send that crappy student/resident away to see the "main doctor"

I probably would end up getting chewed alive if igap was my attending D:
But, the attendings in two rotations gave me honors for the reasons he stated "Being laid back, getting along well, being a team player" as the main comments. Granted I did present patients, but those comments were the main things stated.

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[Phyozo]

Unfortunately, I don't think that's the case. People tend to want doctors they get along with and don't seem to care much what their education was like. If you don't have a medical education, it's basically impossible to evaluate how competent your doctor is unless he's just completely botching everything. In other words, yes, everyone wants a doctor who's motivated, smart, AND friendly, but since most patients don't have any way to tell whether you're good at your job or not, they rely mainly on personality.

I think we're setting up a false situation where students who get feedback and graded according to how they meet expectations turn out to be better physicians, grades be damned. You can have situations where you get regular feedback and constructive criticism of your work but are still guaranteed honors. Med students are generally conscientious enough to do their best to live up to expectations, regardless of whether there's a grade at stake or not. (Incidentally, I agree that, while I'll probably go pretty easy on my students, the feedback-->performance-->grade model is probably best for education.)

You may be right in that patients generally cannot tell whether a doctor is competent or not, save for gross incompetence, and patients tend to judge docs based on bedside manner rather than clinical acumen -- however, docs can easily tell who's competent vs not and at the end of the day, I wouldn't trust a less-than-competent doc to take care of anyone under my watch.

I disagree with the bolded statement above - I think we all strive for that in an idealistic sense, but I can name classmates off the top of my head who would get away with murder if their grade wasn't at stake...and that scares the crap out of me knowing they'll be interns next year (thank goodness none of them are practicing where I have friends/family).

igap - great post, btw.

 

[MilkmanAl]

I can name classmates off the top of my head who would get away with murder if their grade wasn't at stake...

So can I, and I've certainly been among them more than once (neurology and geriatrics come to mind...). Still, those students are very much in the minority. Most med students fall into that subset of people who give 110% effort at all times, whether they act like they are or not. In other words, I think it's generally a safe approach to simply give people your expectations knowing that they'll step in line. It won't work all the time, but you can deal with those cases as necessary.

 

[ArcGurren]

I realize that I will incur the wrath of many self-righteous medical students, but after having read the posts in this thread I am taken aback and am motivated to share my perspective.

First, the criteria for grades in the clinical years is actually well-documented at most institutions. Ask to see one of the evaluation forms to get a clear idea of what is being evaluated. Granted, it is not as clear-cut as a multiple choice examination, but here's a little secret.... nothing in real life is.

I notice a recurring theme in posts by medical students that students should be given the highest clinical grade just for "trying their best" regardless of fund of knowledge, or how they actually perform in relation to their peers. This notion is unfortunately a result of years of being told that you are all special snowflakes, and more years probably, of getting trophies and ribbons for 8th place finishes in the swim meet.

Since most students have never had a real job, and had to exist in the real world and see how "unfair" that cold, hard, world can be, they still cling to the notion that they are special and by right deserve a participation medal for just showing up and being their relaxing, laid-back, chill, selves.

For those of you who do not think that medical school should be a competition... I have no idea where you get that idea. Medical school is absolutely a competition. Not everyone gets the same grades, and the smartest, hardest-working, most professional students will get the best grades.

I think SLUser has it right that we all believe that we are perfect little snowflakes, and a non-honors eval simply cannot be deserved. I have given out hundreds of evaluations, and I have had the privilege of teaching some amazing medical students. These guys/girls don't just show up to get their participation medals. They know more than the other students, they work harder to perfect their presentation/rounding skills, are highly organized, do not need to be spoon-fed what to do, and are always with the team when the team stays late. They never complain, and they are always positive. If this sounds like a "gunner douche" to the medical students in this forum, then I suggest you engage in some introspection.

Competition is good. It pushes good people to great heights. One day when I am sick, I do not want a "chill", "laid-back", "non-douchey", "got honors for showing up" doctor taking care of me. I want a smart, extremeley motivated, extremely well-read, highly knowledgable, and highly professional doctor to take care of me. I daresay all patients want this type of doctor, and not someone who was rubber-stamped through the process by evaluators who thought "being chill", and not a "douche" were the main criteria for handing out honors.

I hear the cries, and wails, of entitled medical students already...

Does it smell like feces up there on your pedestal?

I really hope you're one of the older crowd, because everything about this is pure nonsense. People get along much better with doctors who are nice, caring, and have a good rapport with their patients. By and large except for the very, very small fields nobody cares where you got your degree or where you did your residency. As long as my general surgeon is a nice, competent doctor (and I'm pretty sure if he got through a general surgery residency he's 99% likely to be competent) then I'd have no issue with him doing my emergent appendectomy or chole whether he's from Harvard or from Podunk.

 

[ArcGurren]

So can I, and I've certainly been among them more than once (neurology and geriatrics come to mind...). Still, those students are very much in the minority. Most med students fall into that subset of people who give 110% effort at all times, whether they act like they are or not. In other words, I think it's generally a safe approach to simply give people your expectations knowing that they'll step in line. It won't work all the time, but you can deal with those cases as necessary.

I agree, aside from a few bad eggs I can't think of anyone who is that miserably lazy.

 

[SocialistMD]

I must be in a bad mood...

That's why I would discuss it in the evaluation comments when they need help or need to correct something that's seriously lacking instead of marking them down. My school has a separate section for constructive criticism that does not go on the MSPE on each evaluation. I don't think it's fair to tank their grade based on (in your case) what seems like somewhat unreasonable expectations requiring a very rare combination of things to coincide in a medical student.

Where I went to med school, honors was reserved for the top 10% of the class. That is my expectation, still. As SLUser has said, not everyone is an honors student, or, as you call it, a person in whom "a very rare combination of things coincides." That's the point of differentiating honors. Some people are just better than others at clinical medicine. That should be acknowledged and rewarded just as much as (if not more than) someone who can memorize a test and ace a shelf..

The third and fourth year are clinical rotations. Your clinical aptitude is being developed and tested. That is why evaluations should matter. Will 100% of your patients like you? No. Will their opinion of you be based on how well you know the Krebs Cycle or Ranson's criteria? Absolutely not. It will be based on how you interact with them. As a result, your clinical evaluations are a social experiment and some sink while others swim.

The thing is, grading med students really isn't arbitrary to the evaluators. We have expectations, and if you asked the residents in any given program, I bet their expectations would be the same. We tell you those expectations up front. Meeting those expectations doesn't mean honors, because our expectations are based on how hard you work. I can't say I expect you to come up with the correct diagnosis in 2 guesses or play 20 questions. I can say I expect you to work hard, follow x patients, give y presentations, etc... However, doing those tasks doesn't give you an honors, as those are my baseline things to earn a pass. You can move to a high pass if you do them well. What differs between residents isn't expectations, it is how much they actually care about teaching students. Those who care will "make you earn it," whereas those who don't will give everyone an honors, even those who don't meet their expectations, because it isn't worth the hassle for them to try.

As a surgery resident, I every student up front that surgery is a team sport. Those who honor are those who figure out how to make the team function better. Those who have the next patient's dressing down when I walk into the room, those who have read ahead for the case they are doing and those who can articulate a plan on the patients they follow, showing me they have synthesized what I've been teaching, are the ones who are honors students. Just showing up doesn't cut it.

they'll get that honor if they try to learn, show up on time, and don't complain.

I DO believe that someone simply working hard should get honors, since rotations, all you REALLY need to do, is be nice, work hard, show up on time, and try as learners.

Don't you find it sad that you will accept what is basically mediocrity and give it a gold star? You are expected to show up; it is your god-dam*ed job. Do you think businesses consider it "honors form" if their employees just show up and try hard? Absolutely not. You have to contribute. A medical degree is not thepurple participation ribbon you got for placing 6th in the 3-legged race in elementary school.

I have also seen residents who were jealous of really good students give critical evals because the students wanted to go into derm or radiology or some other competitive field

No, you haven't, you just want to see it that way. Residents have far more important things to worry about than how much smarter than them the student on their team is. Trust me, a first day intern knows more about his/her field than the 3rd year student on the service.

I don't like the idea of clinical grades because they are so subjective and the student is not really in control of them.

This isn't true. You control the effort you put into your rotation. It is an excuse to say it is too subjective to even try.

 

[KnuxNole]

Do you guys actually fail students? It seems universal that it's almost impossible to fail rotations, as someone who skips early and sees/presents 0 patients or does 0 procedures still passes.

And I guess I see rotations as not a job, but a "play doctor" sorta thing. Yes, we can help out the team. But we pay to be there, so students taking an hour to eat is fine, and leave to go to lectures/other duties. And if they need a day off or two for non-school problems, it's fine. The main objective is to learn how to do an HPI, how to present in a coherent fashion, how to think of some differentials and possible workups and plans, and to follow patients and get along with the team/be nice.

I also find it interesting that it's the surgery residents that seem to be contributing. But what about all the other specialties? Especially there are way more students that would never want to do surgery ever.

 

[jcu]

Do you think businesses consider it "honors form" if their employees just show up and try hard?

Employees get paid. Students pay to learn. Big difference.

 

[Phyozo]

Employees get paid. Students pay to learn. Big difference.

Paying to learn doesn't mean "deserving of honors". Students who just show up and do the bare minimum do deserve to pass, but it doesn't mean they're the top 10-25% of all MS3s.

I'm not a surgical resident nor am I going into a surgical specialty, but I do agree with most of the above.

 

[jcu]

Paying to learn doesn't mean "deserving of honors".

Didn't imply that. Was just pointing out that his analogy was a poor one.

 

[Perrotfish]

So can I, and I've certainly been among them more than once (neurology and geriatrics come to mind...). Still, those students are very much in the minority. Most med students fall into that subset of people who give 110% effort at all times, whether they act like they are or not. In other words, I think it's generally a safe approach to simply give people your expectations knowing that they'll step in line. It won't work all the time, but you can deal with those cases as necessary.

Are most of your classmates working as hard during fourth year as they were during third?

 

[dpmd]

Do you guys actually fail students?

The main objective is to learn how to do an HPI, how to present in a coherent fashion, how to think of some differentials and possible workups and plans, and to follow patients and get along with the team/be nice.

I also find it interesting that it's the surgery residents that seem to be contributing. But what about all the other specialties? Especially there are way more students that would never want to do surgery ever.

Wanted to address a few things you brought up

1. I have never failed a student, but that has more to do with the fact that I don't tolerate any behavior which would lead to failing. A student gets on the spot correction for failures in clinical knowledge, presentation skills, etc. Being late without calling me or not coming in due to illness without calling me (not the other students, but me since I am the one that is responsible for you) also gets correction in terms that is not at all vague. I tell students on the first day what I expect them to do, how I expect certain things done, and things they can expect to get in trouble for (such as lying). I also let them know that when they are not doing something correct, that they will know immediately but that I won't hold it against them unless they don't learn from it. Have not had to deal with anyone that couldn't get it together enough to pass, even if I hated their personality.

2. Perhaps I am unduly influenced by my medical school, but from the first week of first year we were learning how to take a history, how to present, and how to create a differential diagnosis (at the very least how to find info that would help you do so). I considered third and fourth year as an opportunity to refine those skills, and advance my clinical knowledge and skills in a variety of fields (not just the one I cared about-I would kill myself before going into psych but I read up about every patient I or my team saw so that I could anticipate what we might do or what the patient might do next). I guess for those at schools that did not do this I can see how you might be more useless on the wards with a busy team that can't sit down with you and go through how to do a complete H+P (I do teach my students how to better focus an H+P for the kind of surgical patient they are seeing-r/o appy is not the same as painless jaundice for example)

3. SLUser happened to mention this thread in a thread in the surgery forum so I guess a few of us wandered over

 

[KnuxNole]

Are most of your classmates working as hard during fourth year as they were during third?

4th years are working hard at airports for the first half and happy hour in the second half



DPMD: You do bring up a good point. What I meant to say was what you described, fine tuning the HPI and presenting and tailoring it to different specialties. Especially since in MS1, you don't know that much compared to MS3 in terms of pathology, pharm, physio, etc. And in MS1-MS2, it's a shift from the science mindset to the clinical mindset.

The reason why I mentioned that last sentence in my last post is cause I've noticed that out of my rotations, surgery seems to be the only one that is a bit harder on the students and has a more "hardass" mentality compared to the rest. None of the other rotations cared that students go for breakfast/coffee before rounds(or in OB/surg, a case) and take an hour for lunch or leave for lectures without getting asked a bunch of defensive questions. There are probably tons of exceptions, but from anecdotal evidence, it seems they tend to be harder to please and not tolerating "chill" or "less douchey" students and labeling them incompetent.

 

[AlexMorph]

I also find it interesting that it's the surgery residents that seem to be contributing. But what about all the other specialties? Especially there are way more students that would never want to do surgery ever.

Hit on a key point here

 

[SocialistMD]

Employees get paid. Students pay to learn. Big difference.

Yeah, but you are there to learn how not to let a person die. That isn't something that comes exclusively from books. Not only do you need to see things clinically, but you also need to be able to develop a rapport with your patients and they need to trust you to divulge that one critical piece of information that can be the difference in life and death. Coasting while under the guise of "learning" in this environment is even more unacceptable.

Hit on a key point here

Ah, so it is okay to accept mediocrity in the non-surgical fields? That explains why the gastroenterology fellows have no problem saying "we'll scope them in the morning, consult surgery" for gi bleeds that occur between the hours of 4:30 pm and 7:00 am.

 

[KnuxNole]

Med students indeed are learning how to not let someone die, but you DO realize med students have little responsibilities compared to a resident. Should they have responsibilites? Yes. Is it the same level as an intern? Hell no. They aren't the same as interns, and I don't think any rational person would look at them as such. As a resident, I wouldn't, I would be questionable if a student says he thinks he is on the same level as a resident/real doctor.

You can't learn all of clinical medicine in just 2 years, especially since you rotate through different specialties, some will be in things you'll never encounter again in life(like surgery), so you get a broad overview of each part. I'm not a resident, but I'm assuming residency is where you hone in on the speciality you choose, and using the clinical skills you learn and the knowledge of the diseases from MS1-3 to take care of patients.

Honestly, rapport for patients is a KEY thing, but for someone who isn't adept at it, can they change in 2 years? It's like in basic science with the eye rolling touchy-feely common sense classes.

 

[smq123]

The main objective is to learn how to do an HPI, how to present in a coherent fashion, how to think of some differentials and possible workups and plans, and to follow patients and get along with the team/be nice.

You should already know how to do an HPI, and how to think of differentials/workups/plans.

The main objective is to learn how to be a physician and, more immediately, how to be a resident. Which is hard to do when your mindset is "This is all that ought to be expected of me...."

Most med students fall into that subset of people who give 110% effort at all times, whether they act like they are or not. In other words, I think it's generally a safe approach to simply give people your expectations knowing that they'll step in line. It won't work all the time, but you can deal with those cases as necessary.

Most med students are not as good as they (and their peers) think that they are.

You may think that you're giving 110% effort, but chances are that that is not how you're coming across to others.

 

[SocialistMD]

Med students indeed are learning how to not let someone die, but you DO realize med students have little responsibilities compared to a resident. Should they have responsibilites? Yes. Is it the same level as an intern? Hell no. They aren't the same as interns, and I don't think any rational person would look at them as such. As a resident, I wouldn't, I would be questionable if a student says he thinks he is on the same level as a resident/real doctor.

I never said students have the responsibility of interns or residents. What they do have is a duty to their patient and any future patient they have to make the most of their "learning," no matter what it is. That way, when they are medicine residents with a patient who develops abdominal pain, they aren't just calling surgery without first ordering at least an abdominal film or <gasp> a CBC (circa this weekend).

You can't learn all of clinical medicine in just 2 years, especially since you rotate through different specialties, some will be in things you'll never encounter again in life(like surgery), so you get a broad overview of each part. I'm not a resident, but I'm assuming residency is where you hone in on the speciality you choose, and using the clinical skills you learn and the knowledge of the diseases from MS1-3 to take care of patients.

Absolutely agree, which is again why I don't expect my med students to have the clinical knowledge of my residents and I don't expect my interns to know as much as my junior residents. However, it doesn't mean you don't need to maximize your education while on those services you won't see again and it doesn't excuse a lackadaisical attitude. Ever.

Honestly, rapport for patients is a KEY thing, but for someone who isn't adept at it, can they change in 2 years? It's like in basic science with the eye rolling touchy-feely common sense classes.

That is why it takes practice and that is why not everyone is an honor student. I don't expect med students to have polished presentation skills, but I expect them to improve on the rotation, as I talk with them once a week (at least) about how to improve their presentations. I don't expect them to tie a perfect square knot at first, but I expect them to practice and gradually improve, as I make them tie 50 knots a night and give them to me in the morning. I know not everyone will come in knowing the difference between biliary colic and acute cholecystitis, but they better by the end of the rotation because it is something I discuss with every one of them, even if I'm not on a service that does that operation. The grade isn't determined on day one, but on day 28, and is based on improvement and effort throughout the month. That said, not everyone deserves an honors, just like not everyone will ace the test despite studying just as hard (or harder) as their honors classmate. It isn't a slight on the individual, it just is what it is.

 

[HalladayWeekend]

The purpose of MS 3/MS 4 is to begin to learn to apply the concepts/knowledge learned in MS1/MS 2 to patient care. If a medical student is ever in a position to make a decision on life/death care, there are some residents/attendings who would probably looking for a new line of work.

Again, the theme of this thread is that there different opinions/styles of grading. That is the problem with the system. I can accept not getting an Honors if students in my class are graded consistently (because clinical grades exist as a comparison amongst students). It is difficult to swallow that someone is getting a better grade merely because of who they worked with.

As I said earlier in this thread, this is why I think pre-clinical grades are a better comparison amongst students (all students in a class take the same exams and are held to the same standards). I think clinical performance is obviously more important, but I really feel this should be summarized in writing (and a single number doesn't do any justice). I think these honor grades in clinical years actually do more harm to students than good (in that the deserving students aren't always getting them).

 

[AlexMorph]

Ah, so it is okay to accept mediocrity in the non-surgical fields? That explains why the gastroenterology fellows have no problem saying "we'll scope them in the morning, consult surgery" for gi bleeds that occur between the hours of 4:30 pm and 7:00 am.

It's hard to have a reasonable discussion if all you people (surgeons) do is put yourselves on a pedestal and think everyone else is inferior. Different people value different things in life. Please do not try to insinuate now that all GI people care about is making money and that only surgeons do "God's work" (whatever that means).

 

[SocialistMD]

It's hard to have a reasonable discussion if all you people (surgeons) do is put yourselves on a pedestal and think everyone else is inferior. Different people value different things in life. Please do not try to insinuate now that all GI people care about is making money and that only surgeons do "God's work" (whatever that means).

I'm insinuating that if you are on call for gi problems, the answer isn't to pass the buck, but to at least evaluate the patient. Surgery is the last point on the gi bleed algorithm. I am the first to admit there are other specialties that do things I can't or have no desire to do. That said, if you are on call for certain emergencies, you had better take appropriate care of them, value differences or not.

 

[dpmd]

The reason why I mentioned that last sentence in my last post is cause I've noticed that out of my rotations, surgery seems to be the only one that is a bit harder on the students and has a more "hardass" mentality compared to the rest. None of the other rotations cared that students go for breakfast/coffee before rounds(or in OB/surg, a case) and take an hour for lunch or leave for lectures without getting asked a bunch of defensive questions. There are probably tons of exceptions, but from anecdotal evidence, it seems they tend to be harder to please and not tolerating "chill" or "less douchey" students and labeling them incompetent.

I can't speak for everyone, but I know that I am responsible for knowing where my people are (residents and students) so that if help is needed in the OR or on the floor/unit I can make good decisions about how to send. So I will ask where you were if you didn't tell me you were going somewhere or if you don't check in after finishing lecture (when I clearly see other students who were in lecture with you. I am also a bit of an exception because I am all about eating. I have even cut bedside rounding short so we can hit the caf quickly prior to a case (and just do a quick table round with a plan to see any patients I missed later). I will get a little testy if things get busy and we need every hand on deck but you are gone for a hour getting lunch, particularly if I end up not getting anything for hours. A better strategy if you really want to be able to eat right now would be to offer to grab stuff for the team (not pay-we have money on our badges and if the caf is closed I would pay). Not a requirement, but don't fault me for thinking higher of the student that stays to help over the one that bails.

 

[SLUser11]

I also find it interesting that it's the surgery residents that seem to be contributing. But what about all the other specialties? Especially there are way more students that would never want to do surgery ever.

There's surgery residents in this thread because I referenced it in a surgical forums thread, and they followed the link.

However, I think you're missing the point. If surgery residents were evil, out-of-touch jerks who don't care about students, then we wouldn't be spending our time in this thread. We're spending our time here because we actually care about student education. You may think that we're being bullies, but really we're the only ones who care enough to give an experienced opinion.

We're trying to give you our perspective and lay out our expectations. Earlier in the thread, several students mentioned that feedback and expectations are severely lacking...so why are we met with such derision when we share these things that you supposedly desire? Is it because it's not what you want to hear?

Take a step back and re-read some of the posts in this thread. It's ridiculous to think that all med students are created equally. Talent, work ethic, and level of interest vary among students, and their grades vary accordingly. If there's a general feeling that evaluations are random, it's probably because not enough residents have been as transparent as the ones in this thread.

 

[dpmd]

I wonder if the people who think everyone should get honors unless they screw up would push as hard for a strict pass/fail system? At my school the first two years were supposed to be pass/fail (they ended up ranking people anyway, just kept it sort of secret and used it for dean's recognition and something else I can't remember-bothered me because I didn't get either thing, not that I would have if I had known). I don't know if they plan to move to pass fail for clinicals though. Something tells me that people would rather just have everyone get honors because it sounds better.

 

[SocialistMD]

The purpose of MS 3/MS 4 is to begin to learn to apply the concepts/knowledge learned in MS1/MS 2 to patient care.

Exactly. And some students can do that and others can't. No test can identify that as fairly as the residents or faculty with whom the student interacts. That is why clinical evaluations are so important.

Again, the theme of this thread is that there different opinions/styles of grading. That is the problem with the system. I can accept not getting an Honors if students in my class are graded consistently (because clinical grades exist as a comparison amongst students). It is difficult to swallow that someone is getting a better grade merely because of who they worked with.

As I said, my classmates and I all pretty much agree as to who deserves honors, high pass and pass, so it isn't as arbitrary as you want to believe.

I think these honor grades in clinical years actually do more harm to students than good (in that the deserving students aren't always getting them).

That is because you have never evaluated students. It is easy to identify which are good, which are coasting and which are stars. I know you think you know better, and if there were a test you would probably beat me on it, but I am going to say that in my 7 years of evaluating students, I've never given an undeserved grade, high or low. You get what you earn. You mean to tell me a completely socially awkward person who can't hold a conversation with a colleague let alone a patient deserves an honors simply because s/he can fill in the correct box when evaluating a standard patient stem?

One of the biggest problems students have is figuring out how to do a focused h&p because it requires they think through a problem and figure out how to get to the answer. Everyone is so used to having the stem in exams they don't know how to get the stem from the patient. Clinical time is real-world practice time, and if you don't know the questions to ask or how to ask them, you are as worthless as an umbrella in a hurricane, and your clinical grade should reflect that.

 

[officedepot]

.

 

[KnuxNole]

I don't think people here believe you unfairly grade students. Sure in your mind you are fair and the student get what he/she deserves. But what about the student on the other team who gets "honors" and does all the things you hate simply because the resident doesn't really care or is very lenient? Or what about the student with another resident who gets "pass" but does all the things you love and would have given "honors" for? This is the main gripe with the system. Each resident is probably generally consistent individually. And maybe at your particular program all are generally consistent and you all sit down and talk about how each student has performed and work together to put together an informative fair eval..................yeah..... But across all other fields and all the other schools the scores will vary widely. This is especially annoying when the rotation director just makes that 3 or 4/5 a number grade. Some students get super lucky and all their evaluations are 5/5 while others are not so lucky and get 3/5s despite essentially similar performances. It's not that big of a deal what the "grade" by a resident is when the director will adjust the grade based on that resident's tendencies. But not all rotation directors do this.

Thus the reasoning why a grade on a clinical eval shouldn't really matter/count/hurt a decent student. There should only be a problem if the student was extraordinarily deficient in some manner. Comments should be the main source of evaluation with the best students getting the best comments for the dean's letter.



But hey, to each their own. In my experience surgeons tend to love this evaluation stuff. Their whole field is based on power egos and this little extra control over students gets them wet. Can't tell you how annoying most surgeons are imo. Like the other day on my rads rotation when they walk into the reading room and pretty much say radiologists are useless... no joke.

I'd rather stab myself in the eye with a scalpel than spend one day being a surgeon. I don't think surgery is bad(cause SOMEONE has to do the job!) or think less of them. But, I definitely don't hold them to a higher standard than any other doctor.

I would at people in your last statement.

 

[MeRLin443]

The brief summary of the two sides to this argument (please excuse the reductionism);

1) The best performers should receive the rewards, otherwise there is no incentive to pursue excellence;

vs.

2) Everyone should get the same result regardless of performance and ability because the starting conditions are inherently 'unfair'.

For some reason this argument seems familiar to me...

 

[officedepot]

.

 

[MeRLin443]

we think the grade should be as objective as possible and the best students rewarded with the most praising comments.

Removing the only element of clinical evaluation that attempts to be objective, the grading rubric, and shifting focus to the most subjective aspect, the comments, will make the process more objective.

 

[HalladayWeekend]

Removing the only element of clinical evaluation that attempts to be objective, the grading rubric, and shifting focus to the most subjective aspect, the comments, will make the process more objective.

As evidenced by this discussion, despite the presence of a grading rubric, the use and/or interpretation of such a rubric is anything but objective.

 

[MilkmanAl]

Are most of your classmates working as hard during fourth year as they were during third?

Actually, during the first semester, I'd say I and most people I know worked harder than during third year. I know a few people who are still doing rotations, and they're putting forth honest effort while they're working. For a lot of people, it's a pride thing. Granted, expectations of a soon-to-be anesthesia intern in a family practice rotation after match are pretty minimal, but that particular friend still works hard.

Most med students are not as good as they (and their peers) think that they are.

You may think that you're giving 110% effort, but chances are that that is not how you're coming across to others.

Fair enough, but I wasn't trying to get into how effectively they'd do their work. I know that I worked my freaking ass off during my plastics rotation at the beginning of third year, and while I know I got a whole bunch of stuff wrong and probably ended up creating a bunch of extra work for our already beleaguered intern, I was still trying my best to keep up with what needed to be done. That's where we jump into the feedback-->improvement part of this discussion.

 

[cofcemt]

I tell students on the first day what I expect them to do, how I expect certain things done, and things they can expect to get in trouble for (such as lying). I also let them know that when they are not doing something correct, that they will know immediately but that I won't hold it against them unless they don't learn from it. Have not had to deal with anyone that couldn't get it together enough to pass, even if I hated their personality.

This right here would put you in the top 1% of surgical residents/fellows I have ever dealt with during my 2 surgical rotations. This is what I wish would be the standard, but sadly it is not at my institution. Hopefully others are learning from your example and this attitude will permeate across your specialty.

 

[Neuronix]

I wonder if the people who think everyone should get honors unless they screw up would push as hard for a strict pass/fail system?

Absolutely. I did while I was in med school.

 

[KnuxNole]

Absolutely. I did while I was in med school.

Pass/Fail is fine. I loved that in MS1-MS2, cause the freaky losers who care a lot about competition can STFU and realize noone would care to compete with them and learn people who help others and not care that the 10s of people they helped got a HIGHER score than them.

Same with rotations. If you helped your struggling classmates in the same rotation, and EVERYONE gets honors, it should not matter at ALL, unless you are one of "those" competitive gunners who are lame at life. Cause who gives a **** if you do the same or better than someone else? I sure don't.

School is definitely a relaxing comforting environment, where people can care about about their learning, and their life outside of school which for almost everyone matters greatly.

 

[officedepot]

.

 

[ArcGurren]

Yeah, but you are there to learn how not to let a person die. That isn't something that comes exclusively from books. Not only do you need to see things clinically, but you also need to be able to develop a rapport with your patients and they need to trust you to divulge that one critical piece of information that can be the difference in life and death. Coasting while under the guise of "learning" in this environment is even more unacceptable.


Ah, so it is okay to accept mediocrity in the non-surgical fields? That explains why the gastroenterology fellows have no problem saying "we'll scope them in the morning, consult surgery" for gi bleeds that occur between the hours of 4:30 pm and 7:00 am.

Because when in doubt, insult another field. Classy. Especially considering my institution has night float for GI fellows and they are called to do bedside scopes all the time.

 

[SocialistMD]

Because when in doubt, insult another field. Classy. Especially considering my institution has night float for GI fellows and they are called to do bedside scopes all the time.

My comment was made in reply to what AlexMorph implied in his/her previous post, namely that it is the surgeons who seem to be the most critical evaluators and have the highest expectations (his/her reply to my post about different "values" seems to confirm the implication). My example was to show that there may be a correlation between easy graders and people who don't take their duty to patients seriously. If your institution has GI fellows on night float, more power to you and your institution. Mine does not, but GI is still the first call for GI bleeds. I can tell you my example was based on several gi bleed consults that came to the surgical service "after-hours" after GI replied verbatim what I said in my quote. If you don't like the truth in that, I'm sorry.

 

[ArcGurren]

My comment was made in reply to what AlexMorph implied in his/her previous post, namely that it is the surgeons who seem to be the most critical evaluators and have the highest expectations (his/her reply to my post about different "values" seems to confirm the implication). My example was to show that there may be a correlation between easy graders and people who don't take their duty to patients seriously. If your institution has GI fellows on night float, more power to you and your institution. Mine does not, but GI is still the first call for GI bleeds. I can tell you my example was based on several gi bleed consults that came to the surgical service "after-hours" after GI replied verbatim what I said in my quote. If you don't like the truth in that, I'm sorry.

The fact that they don't get up and run to the hospital because someone is stable and can wait a few hours after being resucitated (and is not a clear emergency) is a mark of poor patient care? What? That's a pretty poor metric to judge someone, let alone an entire profession (not to mention one of my harshest grades was given by a GI doctor). I'm fairly sure psychiatrists care about their patients but they don't run in just because the guy is developing NMS - they tell the staff on call what to do and they do it.

Usually when someone with a GIB has a surgical problem it's immediately taken care by a surgical team... there's not much a GI doctor can do for a perforated ulcer or a peritonitis. Most other GIB's don't need absolute immediate attention. I'm sorry if you think your own GI service is somehow mismanaging patients (which it doesn't really sound like is the case...) but you can't make blanket statements like that and not expect people to think of surgeons as egocentric (which is yet another blanket statement).

 

[mwsurg]

The fact that they don't get up and run to the hospital because someone is stable and can wait a few hours after being resucitated (and is not a clear emergency) is a mark of poor patient care? What? That's a pretty poor metric to judge someone, let alone an entire profession (not to mention one of my harshest grades was given by a GI doctor). I'm fairly sure psychiatrists care about their patients but they don't run in just because the guy is developing NMS - they tell the staff on call what to do and they do it.

Usually when someone with a GIB has a surgical problem it's immediately taken care by a surgical team... there's not much a GI doctor can do for a perforated ulcer or a peritonitis. Most other GIB's don't need absolute immediate attention. I'm sorry if you think your own GI service is somehow mismanaging patients (which it doesn't really sound like is the case...) but you can't make blanket statements like that and not expect people to think of surgeons as egocentric (which is yet another blanket statement).

Isn't this exactly SocialistMD's point? You can't know whether the problem is medical or surgical until you come in and evaluate the patient.

 

[SLUser11]

The fact that they don't get up and run to the hospital because someone is stable and can wait a few hours after being resucitated (and is not a clear emergency) is a mark of poor patient care?

That's an awfully big assumption based on the story Socialist told.

Usually when someone with a GIB has a surgical problem it's immediately taken care by a surgical team... there's not much a GI doctor can do for a perforated ulcer or a peritonitis. Most other GIB's don't need absolute immediate attention.

You're really off-base here....for several reasons...it's sort of hard to read. I think you need a good dedicated surgical resident to come down off his pedestal and lecture you on the basics of GI emergencies. It's not the laid-back, chillaxed thing to do, but it may save one of your future patients from a bad outcome.

In a nutshell, GI bleeds don't perforate. Perforation and bleeding are two different entities (both can be caused by PUD if involving the stomach or duodenum...diverticulosis of the colon bleeds....diverticulitis perforates....) There are many life-threatening GI bleeds that require emergent intervention. Only a small fraction of either upper or lower GI bleeds require surgical intervention...however, many require emergent endoscopic intervention (e.g. esophageal variceal banding, injection/cautery of bleeding ulcers).

While general surgeons can do EGDs and colonoscopies, I feel gastroenterologists are more suited for therapeutic upper endoscopy, and likely better for therapeutic colonoscopies as well in most academic centers.

 

[SocialistMD]

The fact that they don't get up and run to the hospital because someone is stable and can wait a few hours after being resucitated (and is not a clear emergency) is a mark of poor patient care? What? That's a pretty poor metric to judge someone, let alone an entire profession (not to mention one of my harshest grades was given by a GI doctor). I'm fairly sure psychiatrists care about their patients but they don't run in just because the guy is developing NMS - they tell the staff on call what to do and they do it.

Usually when someone with a GIB has a surgical problem it's immediately taken care by a surgical team... there's not much a GI doctor can do for a perforated ulcer or a peritonitis. Most other GIB's don't need absolute immediate attention. I'm sorry if you think your own GI service is somehow mismanaging patients (which it doesn't really sound like is the case...) but you can't make blanket statements like that and not expect people to think of surgeons as egocentric (which is yet another blanket statement).

1. Perforated ulcers don't present as gi bleeds.
2. The intervention needed for a gi bleed is an endoscopy. At our hospital, that is done by gi. They are expected to evaluate those patients and treat accordingly. What they are not expected to do is defer seeing the patient and recommend consulting another service, especially one that is not at all necessary in the first several steps of the management. It is equivalent to cardiology getting a consult for EKG changes and recommending a CT surgery consult without seeing the patient.

 

[Skinceutical]

Isn't this exactly SocialistMD's point? You can't know whether the problem is medical or surgical until you come in and evaluate the patient.

No, SocialistMD was making a blanket statement about the alleged culture of mediocrity in an entire specialty based on his experiences at his home institution.

When I was an intern, our GI fellows weren't in house overnight. However, they covered an emergent endoscopy pager, and routinely came in to scope our unstable GIBs. Yes, they grumbled a bit when you called them, but then again, I don't think anyone is going to be happy about having to drive back to the hospital at 2AM.

 

[Deferoxamine]

I realize that I will incur the wrath of many self-righteous medical students, but after having read the posts in this thread I am taken aback and am motivated to share my perspective.

First, the criteria for grades in the clinical years is actually well-documented at most institutions. Ask to see one of the evaluation forms to get a clear idea of what is being evaluated. Granted, it is not as clear-cut as a multiple choice examination, but here's a little secret.... nothing in real life is.

I notice a recurring theme in posts by medical students that students should be given the highest clinical grade just for "trying their best" regardless of fund of knowledge, or how they actually perform in relation to their peers. This notion is unfortunately a result of years of being told that you are all special snowflakes, and more years probably, of getting trophies and ribbons for 8th place finishes in the swim meet.

Since most students have never had a real job, and had to exist in the real world and see how "unfair" that cold, hard, world can be, they still cling to the notion that they are special and by right deserve a participation medal for just showing up and being their relaxing, laid-back, chill, selves.

For those of you who do not think that medical school should be a competition... I have no idea where you get that idea. Medical school is absolutely a competition. Not everyone gets the same grades, and the smartest, hardest-working, most professional students will get the best grades.

I think SLUser has it right that we all believe that we are perfect little snowflakes, and a non-honors eval simply cannot be deserved. I have given out hundreds of evaluations, and I have had the privilege of teaching some amazing medical students. These guys/girls don't just show up to get their participation medals. They know more than the other students, they work harder to perfect their presentation/rounding skills, are highly organized, do not need to be spoon-fed what to do, and are always with the team when the team stays late. They never complain, and they are always positive. If this sounds like a "gunner douche" to the medical students in this forum, then I suggest you engage in some introspection.

Competition is good. It pushes good people to great heights. One day when I am sick, I do not want a "chill", "laid-back", "non-douchey", "got honors for showing up" doctor taking care of me. I want a smart, extremeley motivated, extremely well-read, highly knowledgable, and highly professional doctor to take care of me. I daresay all patients want this type of doctor, and not someone who was rubber-stamped through the process by evaluators who thought "being chill", and not a "douche" were the main criteria for handing out honors.

I hear the cries, and wails, of entitled medical students already...

Hey actually this is pretty good. You nailed it.

Thank you.

 

[igap]

Hey actually this is pretty good. You nailed it.

Thank you.

My pleasure.

 

[Gastrapathy]

So surgical residents complain about GI in the medical student forums. Classy.

GI bleeding is rarely rapid enough to justify endoscopy before adequate resuscitation. There are absolutely no studies that show any benefit to endoscopy in the first few hours of presentation (actually the contrary). Trying to scope an under-resuscitated patient is a mistake nearly every time.

Someone needs to admit the patient and do that work. The only place that is ever a gastroenterologist is at a training institution. Most places the IM hospitalists/intensivists handle it. I'd prefer it wasn't a surgeon but thats not my fight. In general, I want you guys as far from my patients as possible. I've seen a surgical R2 decide that a routine LGIB = opportunity for a hemicolectomy and manages to sell it, scoop the patient off to the OR and take out colon in the middle of the night. I will say that I enjoyed that M&M.

The evidence-based guidelines (readily available for review at the ASGE website) support endoscopy within 24 hours of admission for nonvariceal hemorrhage. There are a few exceptions but repeated studies that were designed to demonstrate benefit from a faster interval were negative.

True emergencies that require after-hours procedures:

food-bolus impactions
suspected variceal hemorrhage
-lavage with BRB that fails to clear
-hx of cirrhosis
-prior variceal hemorrhage
ongoing brisk nonvariceal hemorrhage (really rare)
cholangitis (controversial, studies seem to support ERCP in <12 hours but probably not much more quickly than that, abx and fluids are good for infected people).


Surgeons "doing" endoscopy is a topic for another thread but let me just say that if you can't interpret the findings, you shouldn't scope. Can you tell the difference between PHG and GAVE? Are you familiar with the management of SSAs or will you simply tell the patient they had a hyperplastic polyp? What is your adenoma detection rate? If you biopsy a hiatal hernia and get "Barrett's", is it really Barrett's? Why in the world are you doing a colonoscopy for LGIB when you don't even have the equipment for hemostasis on your cart? Do you really still think a patient needs a "clearing ERCP" before lap chole with normal LFTs and imaging? All of these are things that I've encountered from surgeon endoscopists in the last 6 months.

/end threadjack

Clinical rotation evaluations are very subjective. Guess what, so is every evaluation you will receive for the remainder of your career. Patient evals, nurse evals, administration evals are all in your future. They aren't even capable of understanding what you do. Its an important part of 3rd and 4th year, particularly for people who were never in the workforce before, to learn how to be likable.

 

[Gastrapathy]

.

 

[SocialistMD]

Here we go...

So surgical residents complain about GI in the medical student forums. Classy.

My explanation is here. Either you like it or don't, but I don't think I was complaining about any other specialty other than citing laziness (albeit based on a single institution's division) to demonstrate why we may "make you earn" your honors more than other specialties.

GI bleeding is rarely rapid enough to justify endoscopy before adequate resuscitation. There are absolutely no studies that show any benefit to endoscopy in the first few hours of presentation (actually the contrary). Trying to scope an under-resuscitated patient is a mistake nearly every time.

Agreed. However, there is no reason to involve a surgical service at this time. End of story. My beef is that the GI service's default response was to not see the patient yet recommend surgery sees it. That is inappropriate patient care and abuse of another service. And, again, it only happened after hours, so take from that what you will.

Surgeons "doing" endoscopy is a topic for another thread but let me just say that if you can't interpret the findings, you shouldn't scope. Can you tell the difference between PHG and GAVE? Are you familiar with the management of SSAs or will you simply tell the patient they had a hyperplastic polyp? What is your adenoma detection rate? If you biopsy a hiatal hernia and get "Barrett's", is it really Barrett's? Why in the world are you doing a colonoscopy for LGIB when you don't even have the equipment for hemostasis on your cart? Do you really still think a patient needs a "clearing ERCP" before lap chole with normal LFTs and imaging? All of these are things that I've encountered from surgeon endoscopists in the last 6 months.

I completely agree. That is why the answer for a consult is not to refuse to see the consult until the morning while recommending a surgical consult.

 

[SLUser11]

So surgical residents complain about GI in the medical student forums. Classy.

GI bleeding is rarely rapid enough to justify endoscopy before adequate resuscitation. There are absolutely no studies that show any benefit to endoscopy in the first few hours of presentation (actually the contrary). Trying to scope an under-resuscitated patient is a mistake nearly every time.

Someone needs to admit the patient and do that work. The only place that is ever a gastroenterologist is at a training institution. Most places the IM hospitalists/intensivists handle it. I'd prefer it wasn't a surgeon but thats not my fight. In general, I want you guys as far from my patients as possible. I've seen a surgical R2 decide that a routine LGIB = opportunity for a hemicolectomy and manages to sell it, scoop the patient off to the OR and take out colon in the middle of the night. I will say that I enjoyed that M&M.

The evidence-based guidelines (readily available for review at the ASGE website) support endoscopy within 24 hours of admission for nonvariceal hemorrhage. There are a few exceptions but repeated studies that were designed to demonstrate benefit from a faster interval were negative.

True emergencies that require after-hours procedures:

food-bolus impactions
suspected variceal hemorrhage
-lavage with BRB that fails to clear
-hx of cirrhosis
-prior variceal hemorrhage
ongoing brisk nonvariceal hemorrhage (really rare)
cholangitis (controversial, studies seem to support ERCP in <12 hours but probably not much more quickly than that, abx and fluids are good for infected people).


Surgeons "doing" endoscopy is a topic for another thread but let me just say that if you can't interpret the findings, you shouldn't scope. Can you tell the difference between PHG and GAVE? Are you familiar with the management of SSAs or will you simply tell the patient they had a hyperplastic polyp? What is your adenoma detection rate? If you biopsy a hiatal hernia and get "Barrett's", is it really Barrett's? Why in the world are you doing a colonoscopy for LGIB when you don't even have the equipment for hemostasis on your cart? Do you really still think a patient needs a "clearing ERCP" before lap chole with normal LFTs and imaging? All of these are things that I've encountered from surgeon endoscopists in the last 6 months.

/end threadjack

Clinical rotation evaluations are very subjective. Guess what, so is every evaluation you will receive for the remainder of your career. Patient evals, nurse evals, administration evals are all in your future. They aren't even capable of understanding what you do. Its an important part of 3rd and 4th year, particularly for people who were never in the workforce before, to learn how to be likable.

I'm not surprised that you found your way into a forum to bash on surgery, since you've done it before. Socialist probably shouldn't have singled out your beloved specialty, but you're no better when you lash out in response. Saying, "I want you guys as far away from my patients as possible" is extremely insulting, and probably inaccurate.

Any consultant, as part of the nature of their practice, can produce several anecdotal stories that make another specialty look inept. I know that I can produce multiple stories about dumb gastroenterologists, but I don't do it because I know that there's idiots in every specialty, and there's great doctors in every specialty.

As I finish my colon and rectal surgery fellowship, I would love to hear why you think I shouldn't be doing colonoscopies.....fire away.

 

[HalladayWeekend]

Clinical rotation evaluations are very subjective. Guess what, so is every evaluation you will receive for the remainder of your career. Patient evals, nurse evals, administration evals are all in your future. They aren't even capable of understanding what you do. Its an important part of 3rd and 4th year, particularly for people who were never in the workforce before, to learn how to be likable.

These evaluations, however, are for the most part not subjectively putting a number on your performance, a single number that could determine the rest of your career. Also, a "meets expectations" (rather than going well beyond) in everywhere other than 3rd year evaluations is certainly not something to be upset about.