WTF is the point of clinic grades?

[LadyJubilee8_18]

My first attending: "You're not working up to the standards I'd expect from a second year medical student", My second attending: "You're so great with the patients! You are so thorough, and knowledgeable, are you sure you don't want to be a psychiatrist?" My FIS pedi attending: "You're making the team work well, you help the interns, you have great relationships with the patients and their families, etc. However, I don't believe in giving honors unless you go above and beyond" My neuro pedi attending: "I'm so glad you came on rounds with us because you're much more of an asset than the fellows." My pedi upper level: "You're doing so well, I assumed you were a third or fourth year" But guess who grades me? My FIS attending who doesn't believe in giving honors. I'm getting so frustrated with how subjective clinic grades are. On my psych rotation, you'd think the two attendings were grading different students. What is the point of this? It feels like it doesn't matter how hard you work, if you get an attending who doesn't like giving honors, you're not going to get honors. If you get an attending who gives out honors like candy, you're gonna get one.

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[Tired]

It feels like it doesn't matter how hard you work, if you get an attending who doesn't like giving honors, you're not going to get honors. If you get an attending who gives out honors like candy, you're gonna get one.

The point is that most attendings fall somewhere between these two extremes. That's why most excellent students end up with a substantial amount of honors, while most crappy students do not. There is an element of capriciousness, but in general most of my clinical faculty were reasonable people and their grades reflected it.

What the hell are you doing in clinicals as an MSII anyway?

 

[LadyJubilee8_18]

The point is that most attendings fall somewhere between these two extremes. That's why most excellent students end up with a substantial amount of honors, while most crappy students do not. There is an element of capriciousness, but in general most of my clinical faculty were reasonable people and their grades reflected it.

What the hell are you doing in clinicals as an MSII anyway?

I guess I've only had two rotations and ended up with people on either side of the spectrum. My school starts rotations in MSII. This is the hardest time for us in clinics because most attendings are used to having MSIIIs or MSIVs. Also, we are taking the shelf exams when most of the people across the country have more clinical experience than we do this time of year.

Anyway, my pedi attending made really good comments about me on the eval, but just gave me a pass because he says he just doesn't want to give out hp or honors unless you researched the treatment options and taught him how to better treat the patients. I read up on my patients, but I guess I never came up with novel treatments. It's hard being judged against people who aren't spending time and energy trying to learn the basics.

 

[Ypo.]

What the hell is the level of a second year student? I wouldn't expect you to be able to do much of anything. If you can take a history and get along with the patients, you're doing great.

The point of clinical grades is to get us to live in constant fear that we won't get into our residency of choice. Also, to break down any semblance of self confidence. Ok, i kid. But only sort of.


I don't know, jubes. You just have to take it with a grain of salt.

By the end of third year, you will have learned just the right way to do the minimum amount of work and experience the least amount of stress and still get the best evaluations possible. I don't work any harder now than I did in the beginning of third year; I just work smarter (or actually, not smarter-I've just learned to play the game).

For example, I do:
1)put a lot of effort into my presentations at morning report and into my SOAP notes.
2)read up on my patients and contribute my two cents to what I think their treatment plan will be, and I don't do it in a know it all way.
3) act enthusiastic or at least neutral (this is harder to do than it looks, especially after 6 hours of shadowing).
4) Tell people I am undecided of what I want to go into (true) and/or that I am interested in learning all I can from the rotation because of how it can apply towards the careers I am thinking of pursuing (also true).
5) Focus on my strengths (for example, I know pharmacology well and I contribute that info to the team).
6) let it be known how much it is important to me to do well in the rotation.
7) realize that residents talk about the students amongst each other. If you can make a great impression with one of them, word travels.
8) Try to hang around the residents/attendings who I feel I have a good connection with.
9) Maximize my points (for my school; it's the shelf exam that weighs most towards our final grade, so I make sure to not neglect studying for the sake of clinical evaluations.

I try to not:
1) Stress about attendings/residents from who I am not likely to get a great eval (talk to other students who have done the rotation and see who is a stickler).


Last tip I have is to maintain a close working relationship with your clerkship director; they pull a lot of weight and can really steer your grade towards the honor designation by talking with the residents/attendings if you let them know you want it and show them you are working hard. For example, I almost didn't honor my last rotation because only 3 residents filled out evals. One resident in particular filled out a mediocre eval without comments, but I KNOW she was impressed with me at the time; I just think she got lazy and wasn't thinking about it when she filled it out. So I wrote a tactful email to my director and told him my concerns. He told me that while he can't 'technically' promise anything, he knows people were impressed with me and that I shouldn't worry about it because he carries a lot of weight with the final grade. Two days later I have two new glowing evals in my box. Squeaky wheels get the grease (as long as they don't squeak too much.

Hope some of that helps. Again, try not to stress. I'm sure you are a hard worker and deserve the honor designation; it's just that you haven't learned all the tricks of the game yet and/or you got f'ed with stickler attendings.

Good luck.

 

[smq123]

My first attending: "You're not working up to the standards I'd expect from a second year medical student"

My school starts rotations in MSII. This is the hardest time for us in clinics because most attendings are used to having MSIIIs or MSIVs. Also, we are taking the shelf exams when most of the people across the country have more clinical experience than we do this time of year.

I understand your frustrations - I really do. But (and I'm sorry if this sounds mean), there is a time to vent, and a time to suck it up.

* If your school has been scheduling clinicals to start in the second half of MS2 for some time now, then, in fact, your attendings ARE used to working with MS2s. And if this is your 2nd rotation, then you should have a better idea of how to do well on rotations - good enough to not be quite so frustrated.

I mean, sure - you're frustrated because you're just starting out on clinicals. ALL of us were frustrated when we started out on clinicals. You're not alone in being frustrated. But a lot of third year students manage to get honors during their first or second rotation - you can too. Being a second year isn't going to preclude that.

My FIS pedi attending: "You're making the team work well, you help the interns, you have great relationships with the patients and their families, etc. However, I don't believe in giving honors unless you go above and beyond"

If you get an attending who gives out honors like candy, you're gonna get one.

Anyway, my pedi attending made really good comments about me on the eval, but just gave me a pass because he says he just doesn't want to give out hp or honors unless you researched the treatment options and taught him how to better treat the patients. I read up on my patients, but I guess I never came up with novel treatments. It's hard being judged against people who aren't spending time and energy trying to learn the basics.

Wait - I'm confused. You make it sound like your pedi attending gave you mid-rotation feedback, and basically told you, to your face, what he wanted in an honors level student. He told you, and it doesn't sound like you did what he asked. So, no, he's not going to give you a high pass or honors. Maybe I'm just misunderstanding?

My residents NEVER told me what to do in order to get honors. I had to read a LOT of old SDN threads to learn what an honors level student does. I had to spend a lot of time figuring out what an intern does, and then trying to copy that.

I mean, your pedi attending is right - what differentiates an intern from a med student? Both the intern and the med student can make a diagnosis (sort of) but the intern knows what to do with that diagnosis. An intern is self-reliant, and med students sometimes aren't.

By reading up on treatment plans, and trying to come up with YOUR OWN treatment plans, not only will rotations be more fun, but you'll impress your attendings and residents more. By being self-reliant, and seeing patients/doing scut work without being told, you'll impress your attendings even more.

And saying that "some attendings give out honors like candy" is kind of mildly insulting to those med students who DID get honors by working their asses off. I've had some really demanding attendings and residents who were NOT pushovers, by any stretch of the imagination, but I worked very, very hard to get as good a grade as I could.

 

[Kubed]

At my school, clinical grades really don't count for anything. They're not factored into GPA or class rank. They only serve as a means for making people repeat rotations.

 

[Ypo.]

And saying that "some attendings give out honors like candy" is kind of mildly insulting to those med students who DID get honors by working their asses off. I've had some really demanding attendings and residents who were NOT pushovers, by any stretch of the imagination, but I worked very, very hard to get as good a grade as I could.

On the other hand, acknowledging that there is a lot of subjectivity in the process is part and parcel of not going insane.

I always think it's best not to congratulate yourself too much on a good eval and conversely not be too down on yourself for a bad one.


It is important to try and learn from them. But it's also important to decide what is important for you. A lot of those evals are going to be more a reflection of the particular person's pet peeves, which you may not agree with. It's our part to pick out the good advice.


I think the best place for fair and balanced advice is to read a chapter from a book of your choosing regarding clinical skills/note writing/history taking for that rotation. Also to read tips about how to do well in the rotation. And do it before you start the rotation. If you follow all that advice, you can be assured that you are getting the most out of the rotation, and that you are a pretty good student. Other people will usually agree.

I wish I had done the above advice for my first few rotations. I was too used to relying on my school telling me what I was supposed to be doing all the time.

 

[Law2Doc]

The point is that most attendings fall somewhere between these two extremes. That's why most excellent students end up with a substantial amount of honors, while most crappy students do not. There is an element of capriciousness, but in general most of my clinical faculty were reasonable people and their grades reflected it.

In a perfect world/school what you say should be true. But I gotta go with Lady J here -- most of the attendings I and my peers have come across are at one or the other extreme, it is the rare attending who is in the middle. Which means the same student can be outstanding and getting honors one month and portrayed as a royal screw up the next.

Attendings really ought to be audited by administration for some consistency, and those who have unrealistic expectations (in either direction, too lax/generous vs too demanding in terms of expectations) should be removed from the process, to create the middle of the road you suggest where you have to be really good or really bad to end up at an extreme. I know of no med schools that actually do this though.

 

[Brian Griffin]

I really believe that I do those things that Ypo listed out above on rotations. The thing is, I'm over halfway through 3rd year, haven't gotten a single honors (have gotten a bunch of "excellents" which is the grade right below honors), but I've gotten great comments on my evals. It seems like the great comments just aren't really producing a corresponding great grade. I've been thinking about what I have and haven't done on these rotations, and I think one of the biggest secrets to getting honors is (in addition to what Ypo said above, which is all great advice), is to bring in and present research articles on interesting, relevant subjects, and "educate the team". Just basically something that shows how interested you are and how you're willing to go the extra mile, outside of just treating your patients well and being helpful to the team.

I know there's no magic formula to honors, but looking back, I think that while I definitely interact well with patients, residents, and attendings, I haven't really done anything like present reseach articles (outside the times that we are assigned to), and that's probably one of the reasons I haven't gotten honors. And I don't know if I will start doing these things. I'm sorry but I really enjoy going home at night and not having to worry constantly about doing extra work (like we did in 1st and 2nd years). Sure I read when something's going on with a patient that I don't know about, but I really love going home at night and spending most of my time relaxing. I know how hard residency is going to be, and we'll have to read because people will be depending on us to know the latest research, but that's even more reason for me to enjoy my free time now, while I have it. I'm not going into a competitive specialty, and I am basically sick of being a giant overachiever.

I think as someone said above... honors really aren't thrown out like candy, you do have to earn them, but it's a choice...are you willing to go the extra mile.

 

[smq123]

On the other hand, acknowledging that there is a lot of subjectivity in the process is part and parcel of not going insane.

Of course there's a lot of subjectivity. And you can either accept it and move on, or focus on it and get depressed.

But, despite the subjectivity, there are quite a few students who manage to get a number of HPs and Hs on their third year rotation evals. You could say that they were extraordinarily lucky and managed to get a string of residents/attendings who were lax and gave out honors like candy - but (as Tired alluded to), that would be too much of a coincidence.

And I'm not saying that ALL attendings are reasonable - sure, some ask for the weirdest things. But saying that all attendings are capricious when it comes to grading isn't quite true either.

I always think it's best not to congratulate yourself too much on a good eval and conversely not be too down on yourself for a bad one.

Sorry if I sounded arrogant. I was just really happy with my grades - and grateful to the many threads on SDN that gave out such good advice.

It is important to try and learn from them. But it's also important to decide what is important for you. A lot of those evals are going to be more a reflection of the particular person's pet peeves, which you may not agree with. It's our part to pick out the good advice.

Right - but what I've noticed from some people is that they're so fixated on the subjectivity of clinical grades that they can't read their evals objectively. All they focus on is the attending's pet peeves (admittedly, a number of those pet peeves are kind of dumb) that they totally bypass the real advice that will help them in their next rotation.

Granted, it doesn't help that sometimes your evals don't get processed by the registrar until AFTER you've completed the following two rotations....grr....

I think the best place for fair and balanced advice is to read a chapter from a book of your choosing regarding clinical skills/note writing/history taking for that rotation. Also to read tips about how to do well in the rotation. And do it before you start the rotation. If you follow all that advice, you can be assured that you are getting the most out of the rotation, and that you are a pretty good student. Other people will usually agree.

There are also some good threads on SDN - which is a great resource because actual residents and attendings (i.e. like the ones who will be grading you!) can share tips on what kind of students they would give honors to.

 

[Mariah246]

As subjective as they are, most residency programs rely very heavily on clinical grades.

My advice would be this: stop worrying.

After nearly ripping out all my hair because I couldn't acquire honors, there comes a point when you just have to give up.

Always be on time, work hard, smile, and smack the @#$ out of Step 1 when you finally have to take it. Armed with a high Step 1 score, all HP's (nothing lower, nothing higher), excellent written evaluations, and even a couple of offers of 3rd year LORs, I'm not sweating getting into residency. (Yes, even the ultracompetitive ones. Like derm/plastics/ortho/uro/ophtho)

 

[LadyJubilee8_18]

I understand your frustrations - I really do. But (and I'm sorry if this sounds mean), there is a time to vent, and a time to suck it up.

* If your school has been scheduling clinicals to start in the second half of MS2 for some time now, then, in fact, your attendings ARE used to working with MS2s. And if this is your 2nd rotation, then you should have a better idea of how to do well on rotations - good enough to not be quite so frustrated.

Right now second years are just starting rotations along with third and fourth years. On my previous rotation, the attending was in her first year of working with students, and had never worked with second years before. On this rotation, there were only two second years on the whole rotation, and we were working along with third and fourth years. My difficulty with clinical rotations is that I feel like I am doing well, and working hard, but my grades don't always reflect that. On my first rotation, my first attending gave everyone a pass. My second attending gave me an honors, and I honored the exam. I ended up with a HP, but I feel I could have gotten an honor had I not had the first attending.

I mean, sure - you're frustrated because you're just starting out on clinicals. ALL of us were frustrated when we started out on clinicals. You're not alone in being frustrated. But a lot of third year students manage to get honors during their first or second rotation - you can too. Being a second year isn't going to preclude that.

Wait - I'm confused. You make it sound like your pedi attending gave you mid-rotation feedback, and basically told you, to your face, what he wanted in an honors level student. He told you, and it doesn't sound like you did what he asked. So, no, he's not going to give you a high pass or honors. Maybe I'm just misunderstanding?

We have a certain attending for a given month, and then switch. I asked this attending what I could do better two weeks into the rotation, and he told me I was doing a great job, and that the others who were working with me were giving him really good feedback. His only advice was, "Try to expand your fund of knowledge, but everyone could stand to read more." I felt like I was on the right track from that feedback. Then at the end of our time with him, he told us how everyone was doing well and doing what was asked of us, but he doesn't like to give out honors unless we're going the extra mile. He then proceeded to explain what going the extra mile meant to him--for the first time despite the fact that I asked two weeks into the rotation. He then went off on a tangent about how where he trained, students had to take over night call on their pedi rotations, and how he thought we should also have to do this. How he felt we didn't learn as much as they did where he trained because our school was too easy on the students. He thought we weren't carrying enough patients at a time (even though all the patients on the service were split among the medical students), and how he saw more where he trained, etc.

My residents NEVER told me what to do in order to get honors. I had to read a LOT of old SDN threads to learn what an honors level student does. I had to spend a lot of time figuring out what an intern does, and then trying to copy that.

I mean, your pedi attending is right - what differentiates an intern from a med student? Both the intern and the med student can make a diagnosis (sort of) but the intern knows what to do with that diagnosis. An intern is self-reliant, and med students sometimes aren't.

By reading up on treatment plans, and trying to come up with YOUR OWN treatment plans, not only will rotations be more fun, but you'll impress your attendings and residents more. By being self-reliant, and seeing patients/doing scut work without being told, you'll impress your attendings even more.

I'm sure you're a great student and deserve every honors you get, but I'm just trying to figure this thing out. I felt like I was reading up on the treatment plans, and coming up with the same assessment and plan that my intern came up with. What I wasn't doing was using novel research to suggest a novel treatment plan, I only came up with plans that were part of the current standard of care. I just wish I knew this was what was expected before it was time to write the eval. I always did scut work without being told (I filled out a TON of forms), and I had the nurses page me when procedures were being done so I could learn how to do them. I went down to radiology frequently to go over my patients' imaging, and to learn how to read images better, etc. I'm not a lazy student; I felt like I was going "above and beyond". It was surprising to learn that I wasn't at the end of my time with this attending.

And saying that "some attendings give out honors like candy" is kind of mildly insulting to those med students who DID get honors by working their asses off. I've had some really demanding attendings and residents who were NOT pushovers, by any stretch of the imagination, but I worked very, very hard to get as good a grade as I could.

You are more than entitled to feel proud of your grades, I'm just explaining my observations. One fourth year told me that she got a hp in a rotation that she didn't even take! She dropped the rotation, but somehow the message didn't get through and she ended up with a hp on her eval. This whole system is very subjective, and I think most people are able to recognize that.

 

[smq123]

Right now second years are just starting rotations along with third and fourth years. On my previous rotation, the attending was in her first year of working with students, and had never worked with second years before.

Ah, I see.

That makes it difficult, and it's annoying to work with inexperienced attendings.

My difficulty with clinical rotations is that I feel like I am doing well, and working hard, but my grades don't always reflect that. On my first rotation, my first attending gave everyone a pass. My second attending gave me an honors, and I honored the exam. I ended up with a HP, but I feel I could have gotten an honor had I not had the first attending.

Well, your grade technically DID reflect that. You got an HP - which is a very good grade. You're not going to honor everything, but that's okay. An HP, particularly in your first rotation, is fantastic, and shows that you've got potential to be a real superstar on your rotations once you've got some more experience under your belt.

We have a certain attending for a given month, and then switch. I asked this attending what I could do better two weeks into the rotation, and he told me I was doing a great job, and that the others who were working with me were giving him really good feedback. His only advice was, "Try to expand your fund of knowledge, but everyone could stand to read more." I felt like I was on the right track from that feedback. Then at the end of our time with him, he told us how everyone was doing well and doing what was asked of us, but he doesn't like to give out honors unless we're going the extra mile.

I think the asking for feedback is really tough. And if people don't give you tips on how to ask for feedback, you won't get the right feedback that you need.

For me, asking people "what can I do better" was remarkably unhelpful. I'd always get a vague answer like, "Oh, you're doing fine, and just read more."

Asking focused questions was much more fruitful. Asking something like "What can I do to be more like a 4th year student? What do I need to start doing to prepare myself for the higher standards required of sub-Is?" can give you more useful information.

I'm just trying to figure this thing out. I felt like I was reading up on the treatment plans, and coming up with the same assessment and plan that my intern came up with. What I wasn't doing was using novel research to suggest a novel treatment plan, I only came up with plans that were part of the current standard of care. I just wish I knew this was what was expected before it was time to write the eval. I always did scut work without being told (I filled out a TON of forms), and I had the nurses page me when procedures were being done so I could learn how to do them. I went down to radiology frequently to go over my patients' imaging, and to learn how to read images better, etc. I'm not a lazy student; I felt like I was going "above and beyond". It was surprising to learn that I wasn't at the end of my time with this attending.

It doesn't sound like you're a lazy student either - that's not what I was saying.

I know, I know - the rotations "game" is annoying and frustrating. But it's early for you - you'll start to learn how to ask your interns for what the attendings want, and you'll intuitively start to know how to make yourself stand out. And it sounds like you ARE doing a lot of good things - and you're well on your way to shining during third and fourth year. It'll get easier with time.

This whole system is very subjective, and I think most people are able to recognize that.

It is very subjective, which is why I stopped worrying too much about it after my first rotation.

All that anyone can do is barrel forward and try to do the best job we can, without thinking about the grade too much. Eventually all your hard work will be rewarded.

 

[getunconcsious]

My first attending: "You're not working up to the standards I'd expect from a second year medical student", My second attending: "You're so great with the patients! You are so thorough, and knowledgeable, are you sure you don't want to be a psychiatrist?" My FIS pedi attending: "You're making the team work well, you help the interns, you have great relationships with the patients and their families, etc. However, I don't believe in giving honors unless you go above and beyond" My neuro pedi attending: "I'm so glad you came on rounds with us because you're much more of an asset than the fellows." My pedi upper level: "You're doing so well, I assumed you were a third or fourth year" But guess who grades me? My FIS attending who doesn't believe in giving honors. I'm getting so frustrated with how subjective clinic grades are. On my psych rotation, you'd think the two attendings were grading different students. What is the point of this? It feels like it doesn't matter how hard you work, if you get an attending who doesn't like giving honors, you're not going to get honors. If you get an attending who gives out honors like candy, you're gonna get one.

Hey! Try not to worry too much hon, I was there too back in August. My second rotation was Psych and was by far the most likely specialty for me out of the core MS3 rotations, so I really wanted an honors in it. But remember how I had that dumb attending kind of like your peds attending that told me how great I was then didn't give me a great grade? These things happen, but more importantly you can still get an honors overall if you work your butt off on the other half/parts of the rotation and also if you blow the shelf away. Also I would not hesitate to talk to the clerkship director--I mean this is your future career on the line. You want to do Peds, right? So this is really important! I've gotten what I felt were unfair grades on other rotations but I only ever talked to the clerkship director on Psych b/c I thought it was fairly likely that I would go into that specialty so NEEDED to have a good grade for all the freaking work I put in! Another note, part of the reason the clerkship director took me seriously was because I blew away the shelf. So study HARD for the Pedi shelf, it's not one of the easier ones. Like someone said already, one of the biggest mistakes students make is getting "caught up in the moment" of the rotation and spending tons of time trying to impress housestaff and attendings while meanwhile neglecting the shelf, which, if you run the numbers, is almost always worth more than any one person's eval of you.

This kind of crap will happen to you again and again in MS2/3 and you'll learn ways to get around it. I had 2 pedi attendings, one of whom was furious to be a ward attending in January (hates RSV babies, etc) and took it out on all of our evals. But I had a much more reasonable attending for February and blasted the shelf out of the water, so got an Honors. Don't give up on Honoring peds, especially if it's what you want to do!

One final point: from what I've seen of MS3 thus far (and with only one rotation left to go), the opposite phenomenon (think "bank error in your favor") happens to everyone at least once. Like you mentioned, someone HP'ed a rotation they dropped. For me it was Neurology. I'm sure you remember how much I freakin' hated Neuro, thought it was incredibly depressing, etc. I showed up and was very nice to everyone but certainly didn't go out of my way to "go the extra mile" or anything. I gossiped a lot with my chief residents, and they gave me honors. I got lucky on the shelf. Result? Honors in Neurology, one of my least favorite rotations. So don't despair, it will go the other way eventually!

The problem is it seems nearly everyone gets an uphill climb trying to honor the one rotation that actually matters, the one they want to do!

 

[Ypo.]

Sorry if I sounded arrogant. I was just really happy with my grades - and grateful to the many threads on SDN that gave out such good advice.

No, not at all. I was just providing my insight on what's helped me to not go insane and still maintain a positive attitude.

Right - but what I've noticed from some people is that they're so fixated on the subjectivity of clinical grades that they can't read their evals objectively. All they focus on is the attending's pet peeves (admittedly, a number of those pet peeves are kind of dumb) that they totally bypass the real advice that will help them in their next rotation.

Agreed. I've had to learn to not get so pissed i miss the good advice. But I've also learned how to pick out some of the less useful advice and just ignore it if need be. And strangely that has made my year a lot better.

There are also some good threads on SDN - which is a great resource because actual residents and attendings (i.e. like the ones who will be grading you!) can share tips on what kind of students they would give honors to.

True. I did this as well. But personally for me reading books/websites has been more helpful. I read all the threads I could around here but I didn't really start to get the hang of it until I started using other sources. The ACOG website has a great handbook for students on their ObGyn rotation...it has helpful examples of H&Ps, pp notes, etc...

 

[CorpusERdoc]

My first attending: "You're not working up to the standards I'd expect from a second year medical student", My second attending: "You're so great with the patients! You are so thorough, and knowledgeable, are you sure you don't want to be a psychiatrist?" My FIS pedi attending: "You're making the team work well, you help the interns, you have great relationships with the patients and their families, etc. However, I don't believe in giving honors unless you go above and beyond" My neuro pedi attending: "I'm so glad you came on rounds with us because you're much more of an asset than the fellows." My pedi upper level: "You're doing so well, I assumed you were a third or fourth year" But guess who grades me? My FIS attending who doesn't believe in giving honors. I'm getting so frustrated with how subjective clinic grades are. On my psych rotation, you'd think the two attendings were grading different students. What is the point of this? It feels like it doesn't matter how hard you work, if you get an attending who doesn't like giving honors, you're not going to get honors. If you get an attending who gives out honors like candy, you're gonna get one.

Why do you care about honors so much?

The only rotation grade that is important is the one in your specialty....

 

[riverie]

Why do you care about honors so much?

The only rotation grade that is important is the one in your specialty....

It just so happens that Lady J is interested in pediatrics.

 

[CorpusERdoc]

It just so happens that Lady J is interested in pediatrics.

It sounds like she needs to do better--whatever it takes, because she won't be getting in if there are people who don't get along with her...

 

[LadyJubilee8_18]

It sounds like she needs to do better--whatever it takes, because she won't be getting in if there are people who don't get along with her...

Ok, I was being a cry baby because I was really frustrated when I posted this thread. I actually got along well with everyone on the team, and the attending until the last day. I'm not having difficulty on the team...which was why I was so confused.

 

[riverie]

It sounds like she needs to do better--whatever it takes, because she won't be getting in if there are people who don't get along with her...

It didn't sound like a personality conflict so much as high expectations on the part of the attending for a student just starting out on clinics.

 

[Mariah246]

Why do you care about honors so much?

The only rotation grade that is important is the one in your specialty....

I'm pretty sure that's false for any of the competitive specialties. See: integrated plastics, ENT, uro, ophtho, ortho, derm, rads, etc... etc...

 

[CorpusERdoc]

I'm pretty sure that's false for any of the competitive specialties. See: integrated plastics, ENT, uro, ophtho, ortho, derm, rads, etc... etc...

I would have to say that getting pass vs. honors in family medicine or pediatrics is not going to alter your competitiveness in an orthopedic residency as much as board scores and performance in the orthopedic rotation.

 

[Mariah246]

I would have to say that getting pass vs. honors in family medicine or pediatrics is not going to alter your competitiveness in an orthopedic residency as much as board scores and performance in the orthopedic rotation.

That's certainly true.

But if we're talking about key clinical clerkships like medicine or surgery, then it might prove problematic.

 

[Tired]

In a perfect world/school what you say should be true. But I gotta go with Lady J here -- most of the attendings I and my peers have come across are at one or the other extreme, it is the rare attending who is in the middle. Which means the same student can be outstanding and getting honors one month and portrayed as a royal screw up the next.

Obviously I can only speak from my own experiences, and I did only go to one medical school, but just on its face, this doesn't make sense to me.

Ask yourself this: Are there a couple students in your class who consistently get honors? Are there a couple students who consistently get low pass or fail several rotations? Are most students somewhere in the middle, getting mostly pass or high pass, maybe 1 or 2 honors? Because that's how it's supposed to be, and that's what most people experience in med school.

Honestly, if you're doing really well once in a while, and not so hot the rest of the time (but still passing), then you're probably an average med student. Everyone gets portrayed as a royal screwup as med student, and most people get a passing grade, not a high grade. It's kind of a shock to the premed set who is used to being #1 all the time. But that's just what happens when you take a bunch of high-achieving people, put them all in the same class, and judge them against each other.

 

[Ypo.]

Obviously I can only speak from my own experiences, and I did only go to one medical school, but just on its face, this doesn't make sense to me.

Ask yourself this: Are there a couple students in your class who consistently get honors? Are there a couple students who consistently get low pass or fail several rotations? Are most students somewhere in the middle, getting mostly pass or high pass, maybe 1 or 2 honors? Because that's how it's supposed to be, and that's what most people experience in med school.

Honestly, if you're doing really well once in a while, and not so hot the rest of the time (but still passing), then you're probably an average med student. Everyone gets portrayed as a royal screwup as med student, and most people get a passing grade, not a high grade. It's kind of a shock to the premed set who is used to being #1 all the time. But that's just what happens when you take a bunch of high-achieving people, put them all in the same class, and judge them against each other.

I believe this is true for the objective component, but not for the subjective.

That said, no point in bitching over what you can't control. Do your best, rock the shelf, and let the rest roll of your back.

 

[DarthNeurology]

Anyway, my pedi attending made really good comments about me on the eval, but just gave me a pass because he says he just doesn't want to give out hp or honors unless you researched the treatment options and taught him how to better treat the patients. I read up on my patients, but I guess I never came up with novel treatments. It's hard being judged against people who aren't spending time and energy trying to learn the basics.

I think that is a little ridiculous. Getting honors depends on how well of a connection you make with an attending, i.e. laugh at their jokes, be interested as they talk about all of their life stories, and do busy work like running around quickly getting supplies, seriously, I have getting honors down to a fine art. Your attending who didn't want to give you honors has to give a legitimate reason that might sound plausible, if he/she didn't tell you to research various treatment options, then I don't think that should be part of the grade. It is the old Catch 22, i.e. "You should have done x,y and z while you were busy doing a,b, and c if you wanted honors, sorry we didn't tell you about that at the begining [snicker] . . ." Ask people who did honor this rotation and you will find out that they weren't doing this without being asked, but they will say that the attending liked them. No one teaches or instruct attendings to grade fairly in clinicals, you have to adore them and they give you a good grade. It might help some to do a lot of reading as someone who hates you will be impressed with your fund of knowledge and maybe you can turn them to your side. Sounds a lot like this attending was down on students who didn't go to medical school when students were made to work 7 days a week and 20 hours a day (yeah right), . . . so they feel a whole lot better about their career and life about smacking down students on a regular basis and telling them they don't go the extra-mile, . . . I think an attending who goes the extra-mile would be up to date with the latest research. That is really great that you came up with treatment plans as a second year, a lot of third years have trouble doing that so when you get to third year you will ace it. Although this sounds cynical, when your attending was talking about seeing more patients in the past you should have said, "Wow, what sort of interesting cases did you see?" or when talking about being up late at night ask him, "How in the world did you manage your personal life?" This gives him a chance to talk about what is bothering him, . . . being a good third year is being a good psychiatrist for your attending, . . . on the rotations where I took great to excellent care of patients I got slammed because I wasn't around enough to listen to the attending whine, . . . but remember that as a third or fourth year your "sickiest patient" is your attending, pay attention to everything they do and say. I have honored all cores and electives when using this strategy. I should write a FAQ or a book!

 

[LadyJubilee8_18]

I think that is a little ridiculous. Getting honors depends on how well of a connection you make with an attending, i.e. laugh at their jokes, be interested as they talk about all of their life stories, and do busy work like running around quickly getting supplies, seriously, I have getting honors down to a fine art. Your attending who didn't want to give you honors has to give a legitimate reason that might sound plausible, if he/she didn't tell you to research various treatment options, then I don't think that should be part of the grade. It is the old Catch 22, i.e. "You should have done x,y and z while you were busy doing a,b, and c if you wanted honors, sorry we didn't tell you about that at the begining [snicker] . . ." Ask people who did honor this rotation and you will find out that they weren't doing this without being asked, but they will say that the attending liked them. No one teaches or instruct attendings to grade fairly in clinicals, you have to adore them and they give you a good grade. It might help some to do a lot of reading as someone who hates you will be impressed with your fund of knowledge and maybe you can turn them to your side. Sounds a lot like this attending was down on students who didn't go to medical school when students were made to work 7 days a week and 20 hours a day (yeah right), . . . so they feel a whole lot better about their career and life about smacking down students on a regular basis and telling them they don't go the extra-mile, . . . I think an attending who goes the extra-mile would be up to date with the latest research. That is really great that you came up with treatment plans as a second year, a lot of third years have trouble doing that so when you get to third year you will ace it. Although this sounds cynical, when your attending was talking about seeing more patients in the past you should have said, "Wow, what sort of interesting cases did you see?" or when talking about being up late at night ask him, "How in the world did you manage your personal life?" This gives him a chance to talk about what is bothering him, . . . being a good third year is being a good psychiatrist for your attending, . . . on the rotations where I took great to excellent care of patients I got slammed because I wasn't around enough to listen to the attending whine, . . . but remember that as a third or fourth year your "sickiest patient" is your attending, pay attention to everything they do and say. I have honored all cores and electives when using this strategy. I should write a FAQ or a book!

Wow, I ran this advice by some other students who have honored courses, and they felt it was the most true on the page. Now I know what I've been doing wrong...caring for the patients! I spent my free time playing play station karaoke with my neuro patient, or putting together a birthday surprise for my NMS patient, when I should have been there for my attending. *sigh* I guess I'll do it if that's what will get me further, but I'd really prefer to get to know my patients better.

 

[Ypo.]

Wow, I ran this advice by some other students who have honored courses, and they felt it was the most true on the page. Now I know what I've been doing wrong...caring for the patients! I spent my free time playing play station karaoke with my neuro patient, or putting together a birthday surprise for my NMS patient, when I should have been there for my attending. *sigh* I guess I'll do it if that's what will get me further, but I'd really prefer to get to know my patients better.

Seriously? Getting to know your patients is good, but you are there to learn.

Anyways, I don't think just doing scutwork cuts it either. You should know each patient, their lab values, their disease, their treatment plan, what tests to order, differential diagnoses. If you read a few articles to share with the team, that makes it even better. Sure, grabbing charts and running errands here and there is good, because you are the least busy person on the team, but not to the exclusion of all the rest.

We had this guy from Nepal rotating with us and all he did every day was get the lab values for each and every patient. I thought it was kind of lame.

 

[LadyJubilee8_18]

Seriously? Getting to know your patients is good, but you are there to learn.

Anyways, I don't think just doing scutwork cuts it either. You should know each patient, their lab values, their disease, their treatment plan, what tests to order, differential diagnoses. If you read a few articles to share with the team, that makes it even better. Sure, grabbing charts and running errands here and there is good, because you are the least busy person on the team, but not to the exclusion of all the rest.

We had this guy from Nepal rotating with us and all he did every day was get the lab values for each and every patient. I thought it was kind of lame.

Yeah, I stayed after I was dismissed to do this stuff, I didn't do it on normal rotation time. I really enjoy spending time with kids, and trying to make their hospital stays a little more fun. Who wants to spend their 13th birthday shaking like crazy in a hospital bed due to NMS?

 

[Ypo.]

Yeah, I stayed after I was dismissed to do this stuff, I didn't do it on normal rotation time. I really enjoy spending time with kids, and trying to make their hospital stays a little more fun. Who wants to spend their 13th birthday shaking like crazy in a hospital bed due to NMS?

Oh, my bad then. Like you said, unfortunately you don't get credit for this. (unless you make sure to do it in front of the attending).

 

[LadyJubilee8_18]

Oh, my bad then. Like you said, unfortunately you don't get credit for this. (unless you make sure to do it in front of the attending).

That would just make me feel incredibly disingenuous. "Playing the game" just seems wrong and degrading...maybe I'll just do the best I can and hope. Luckily pediatrics isn't the most competitive field. I'd rather not jump through hoops and kiss *** for 2.5 years.

 

[Ypo.]

That would just make me feel incredibly disingenuous. "Playing the game" just seems wrong and degrading...maybe I'll just do the best I can and hope. Luckily pediatrics isn't the most competitive field. I'd rather not jump through hoops and kiss *** for 2.5 years.

Of course it would, and truthfully you probably wouldn't get any "points" for it anyways. The fact that you don't strategize every action in mind of your clinical grade just means you are a normal person.

But you know what WOULD get you points? Using the information you learned during your playstation sessions to improve the patients care. Ie-"yesterday in the afternoon, pt's fever had gone down. I also met patient's parents and discussed insurance issues-they cannot afford such and such medicine. Could we prescribe this generic medicine instead?" Your patient interactions can be valuable to the team, but only if you bring them up.

 

[DarthNeurology]

Wow, I ran this advice by some other students who have honored courses, and they felt it was the most true on the page. Now I know what I've been doing wrong...caring for the patients! I spent my free time playing play station karaoke with my neuro patient, or putting together a birthday surprise for my NMS patient, when I should have been there for my attending. *sigh* I guess I'll do it if that's what will get me further, but I'd really prefer to get to know my patients better.

There are ways to have your patient time too, just do it outside of clinicals, really, I got a volunteer job at a children's hospital so I could do *exactly* what you did on a rotation i.e. play with kids, talk to parents, and overally try to be supportive. This will help I think during clinicals even having a sort of release where you can be the kind and caring person you want to be, . . . the kind and caring person you ARE . . . but have to be more "hard" and "clinically focused" on rotations with attendings and residents.

If you feel the need to do this on a rotation, do it after you have signed out for the day and go back to a patient's room. You have to realize that most pediatricians are not putting together birthday parties for their patients, while that makes you a hero in my book, you have to do the whole "professional" approach which means focusing on diagnosis, treatment, and being super attentive to the attending. Attendings don't view such soft activities such as spending extra-time talking to patients positively, they don't, on all my wards rotations it is usually 5-10 minutes with each patient per day, and even that seems to be too much for them especially with 30 patients. . . they won't give you accollades for doing something they don't value or do themselves.

 

[Ypo.]

they won't give you accollades for doing something they don't value or do themselves.

Or be able to reasonably do in the future as a practicing doctor...


Sigh. Third year is so different from years 1 & 2. All they cared about at my school was the touchy feely stuff. Then after only teaching us how to "care" about the patients, they threw us to the shark tank that is the hospital. Suddenly we were expected to do more than just care about our patients.

The trick is not letting yourself get jaded. When you have those really bad days where you get dumped on... sometimes when you are feeling so rotten, it's hard to care as much about the patients. Scary, but true. Everyone needs a little kindness in their life.

 

[DarthNeurology]

Sigh. Third year is so different from years 1 & 2.

Right, in the hospital everyone it seems quotes from the "House of God" and is focused on doing the least amount of work, and getting into a cush specialty . . . at least some of the nastier residents and attendings. Being nice to patients gets you in trouble. And apparently being a medical student gives others a license to defecate on you, from the nurses to the residents to the attendings. . . that is why you have to be an enthusiastic cheerleader to win this game, . . . if you try to act too "adult" about your patients someone will tear you down and explain to you that you don't know enough and to go do x, y and z . . . nobody gets mad at cute demented monkey who works his *** off, which is what I aim to be on all my rotations!

 

[LadyJubilee8_18]

Right, in the hospital everyone it seems quotes from the "House of God" and is focused on doing the least amount of work, and getting into a cush specialty . . . at least some of the nastier residents and attendings. Being nice to patients gets you in trouble. And apparently being a medical student gives others a license to defecate on you, from the nurses to the residents to the attendings. . . that is why you have to be an enthusiastic cheerleader to win this game, . . . if you try to act too "adult" about your patients someone will tear you down and explain to you that you don't know enough and to go do x, y and z . . . nobody gets mad at cute demented monkey who works his *** off, which is what I aim to be on all my rotations!

Ok, now I feel like a total whiny baby. My attending showed me my actual eval today, and it was really good. He totally lead me to believe I was getting a pass. All the "You guys really could have done X to go the extra mile" and "I expect you to come up with novel treatment plans" and "Where I went to school, students learned so much more" and what not. Umm....disregard the insecure brat at the start of this thread

 

[tacrum43]

My first attending: "You're not working up to the standards I'd expect from a second year medical student", My second attending: "You're so great with the patients! You are so thorough, and knowledgeable, are you sure you don't want to be a psychiatrist?"

...

On my psych rotation, you'd think the two attendings were grading different students. What is the point of this? It feels like it doesn't matter how hard you work, if you get an attending who doesn't like giving honors, you're not going to get honors. If you get an attending who gives out honors like candy, you're gonna get one.

Thank goodness it's not just me! I am FREAKING OUT because my psych attending basically just told me she is ready to fail me (after only one week!) because apparently she thinks I'm lazy and incompetent. However, my psych attending for the first half of the rotation (different hospital) said he's giving me Honors and kept trying to convince me I should be a psychiatrist. WTF???

 

[45408]

Thank goodness it's not just me! I am FREAKING OUT because my psych attending basically just told me she is ready to fail me (after only one week!) because apparently she thinks I'm lazy and incompetent. However, my psych attending for the first half of the rotation (different hospital) said he's giving me Honors and kept trying to convince me I should be a psychiatrist. WTF???

actually said "lazy and incompetent"? I know what I think of when I think "incompetent," and it's pretty brutal. Ouch. Try to seek constructive criticism so it seems like you're interested in improving.

 

[tacrum43]

actually said "lazy and incompetent"? I know what I think of when I think "incompetent," and it's pretty brutal. Ouch. Try to seek constructive criticism so it seems like you're interested in improving.

No, those exact words weren't used, but they were implied. Actually, the attending didn't talk to me herself, but rather had a fellow do it (which I didn't think was very fair).

Anyways, I'm definitely working to improve and seeking additional feedback. I was so glad that my first half of the rotation went so well, but now I guess I can kiss "Honors" for the rotation goodbye. Now just a "Pass" sounds pretty good.

edit: And for the record, I don't agree that I am lazy or incompetent.

 

[getunconcsious]

No, those exact words weren't used, but they were implied. Actually, the attending didn't talk to me herself, but rather had a fellow do it (which I didn't think was very fair).

Anyways, I'm definitely working to improve and seeking additional feedback. I was so glad that my first half of the rotation went so well, but now I guess I can kiss "Honors" for the rotation goodbye. Now just a "Pass" sounds pretty good.

edit: And for the record, I don't agree that I am lazy or incompetent.

Hey Tacrum,
I don't know that I would plan on taking this lying down, especially if you really are thinking about psychiatry. Do your best on the rest of the rotation but if the eval comes out and is unfair you can try to fight it. If you got honors from one attending and rocked the shelf the clerkship director will probably buy that this other eval of you is unfair.

People need to stop taking this crap lying down. This is your career on the line here, people!

FIGHT THE REAL ENEMY! (tears up picture of Dr. Perry Cox)

 

[Acherona]

Wow, I ran this advice by some other students who have honored courses, and they felt it was the most true on the page. Now I know what I've been doing wrong...caring for the patients! I spent my free time playing play station karaoke with my neuro patient, or putting together a birthday surprise for my NMS patient, when I should have been there for my attending. *sigh* I guess I'll do it if that's what will get me further, but I'd really prefer to get to know my patients better.

uhh clerkship 101, grades are inversely correlated with how much time you spend with each patient.

 

[lilzelda2]

uhh clerkship 101, grades are inversely correlated with how much time you spend with each patient.

so true.......


Am I the only one sick of having to constantly please the attending or resident, its annoying as hell

 

[187502]

Seems like a very frustrating situation. Is your school aware of the grading discrepancy? Most schools I know tend to try and enforce consistent grading across various residents/attendings.

 

[tacrum43]

Hey Tacrum,
I don't know that I would plan on taking this lying down, especially if you really are thinking about psychiatry. Do your best on the rest of the rotation but if the eval comes out and is unfair you can try to fight it. If you got honors from one attending and rocked the shelf the clerkship director will probably buy that this other eval of you is unfair.

People need to stop taking this crap lying down. This is your career on the line here, people!

Just to update, it came out fine in the end. A new attending came onto the team, I proved I could indeed hack it, and all was well. But I would echo getunconcsious' advice about not taking a situation like this lying down. To be a 3rd year, that means you've worked your butt off and that you are also very likely highly in debt. Don't let one attending ruin your life.

I'm also pretty sure I won't be going into Psych as I am loving my Medicine rotation.

 

[vtucci]

It is easy to complain about having to please the attending/resident/fellow etc. and about their being arbitrary. No doubt the grading policy is not always fair or consistent and that is the most frustrating thing about clinical years. However, regardless of specialty and profession, everyone has someone to please (their boss) and most people try to garner the admiration of their peers. Medicine is not unique in this regard.

At the end of the day, the opinion that matters most is your own. Have you learned what you need to? Are you practicing the kind of medicine that you want to? Sometimes, this will require a trade off between your grade (and at later points in training/career, even your job) and your sanity. It is worth some introspection.

 

[crazylegs]

I agree with the posters that say "don't stress about your evals". 95% of the time they simply don't reflect what your evaluator really thinks of your performance on your rotations.

That being said, I never once read a written eval that was done for me on my 3rd/4th year clerkships. It wasn't worth the stress of reading into what was written or wondering why they didn't comment on a certain aspect of my performance that I really felt I was strong in. Instead, at the end of every rotation I personally asked my attendings/residents for a quick and candid critique of my performance and specifically asked what they thought I should improve on. I got much better feedback that way, as it was easier for them to simply tell me details of their critiques as opposed to writing them all down on an evaluation. It was also an excellent launching point for LORs - most of the time they were offered to me without me having to even ask for them.

At the end of it all, my clinical grades were excellent (which really brought my gpa up as I was less than mediocre with regards to basic sciences grades), my deans letter was nothing short of glowing, I got into my #1 choice for residency, I spent 3rd/4th actually learning for myself (and not for my grades), and I just simply enjoyed 3rd/4th year a lot more than my classmates who were sticklers about their evals. I'm okay with never knowing what was written on my evals because I always got the feedback I wanted anyway.

In the long run, the grades really don't matter .. but the 'true' feedback does. Blow off the subjectivity of your written evals, and you will be a much happier and more successful medical student.

 

[45408]

just my experience - with 2 of my 3 attendings in medicine, at the end of my rotation with them, they sat me down, gave me specific feedback, and they told me what grade they were going to give me. My final grade in medicine has their comments, and they both said in the comments "I recommend this grade."