« Enough Whining About Primary Care | Main | My First Autopsy »

Tell Me What You Want!

Kendracampbell572x723Kendra Campbell -- I’ve been contemplating writing this blog post for a few days now. I wanted to write it, but thought I should wait until I had calmed down a bit, so that it didn’t sound like a huge ranting session. I guess I might as well just tell the story. I think it might help release some of the stress.

Let me begin with some background. I have no idea how to say this without sounding conceited, so I’ll just say it anyway. Echoing the thoughts of Jeff Wonoprabowo in his recent post, I have also always struggled to be the best. I have always maintained a very high GPA. I have always excelled in my exams. I am a bit of a perfectionist. I am a natural leader, and I always try to do everything to the best of my ability. I am generally not lazy, and I am good at “getting things done.” Okay, I hope I don’t sound too full of myself. I am certainly “not good” at many things (singing is an excellent example), but there are some things that I’m really good at, and making good grades has always been one of those things (as is common with most med students).

I did very well during the basic science years of medical school. I maintained a high GPA and performed well on both written and oral exams. I also did very well during my first two clinical rotations. My third and fourth clinical rotations, however, have been a bit different.

Okay, so now I’m going to come right out and say what I’ve been beating around the bush about. I received a “B” in my surgery rotation. Now, I know there are probably many people out there who are thinking, “seriously, SERIOUSLY, she’s complaining about getting a 'B?!' What’s wrong with this girl?!” But I’m hoping that many of you are still reading, and maybe there are even a few of you out there thinking, “hey, I understand!”

Here’s the thing. My surgery rotation was very tough. The hours were grueling, and the work was at times quite challenging. But I rose to the challenges. I stayed late when no one else would. I offered to do consults and other non-required tasks. I scrubbed in when no one else wanted to. I went out of my way to help my patients. I spent more time with them then I had to. I got along well with “most” of the nurses, residents, and attendings. I always did what my residents asked of me, and tried to always go above and beyond their expectations. I also did comparatively well on all the exams and quizzes. I can honestly say that I think I deserved an “A.”

I think the main problem with the surgery rotation was that we were never really told how we were being evaluated. Unlike my first two rotations, which provided clear guidelines on how students were graded, we were basically in the dark. When I got my grade, I didn’t even know who actually gave it to me. I also don’t know what I could have done better to earn an “A.” I certainly can’t think of anything shy of actually performing the surgeries myself.

Unfortunately, my current internal medicine rotation seems to be going similarly. I don’t really feel like I know what is expected of me. And this time, I really don’t know if I’m even doing a good job because I’m not sure what a good job is!

So, that’s my rant. I know it seems like such a silly thing to be upset about, but I just don’t like the feeling of “not knowing,” I guess.

I’m wondering if this lack of information about expectations has to do with the hospital, or the rotations, or the attendings, or something else. I’m actually very interested to know if anyone out there has experienced anything similar. Do you always know how you’re being graded during your clinical rotations? Or have any of you also experienced what I’m going through? Also, have you ever received a grade on a rotation that you thought was not a true reflection of your performance?

December 30, 2008 in Kendra Campbell | Permalink

Comments

Every grade, Kendra. Every grade. Remember that assigning grades has many things to do with personal biases of the grader. I have several stories from my 10 years as a student and staff member of a large university I could tell you about grading.

Cheers,

-j

Posted by: Jared | Dec 30, 2008 1:59:19 PM

Your evaluation has little correlation with the amount of work that you put into it. . .welcome to the real world! Realize that the clinical years are much more like a real job, where your performance is evaluated by a lot of factors, with more emphasis on social interactions. My advice is the following:

1. Talk more - you know that annoying gunner that seems to be talking a lot? well he/she's probably getting A's. I don't suggest talking your mouth off, but the students who generally speak up more are noticed.

2. Be personable - sure, your resident probably thinks you're ok, but do they REALLY like you? that is they should love you. Make them love you. Enough so that they will actually think of writing a good eval at the end.

3. Identify your key evaluators - sure, every single scrub tech, nurse, and resident may think you're a superstar, but if your preceptor/attending gets a funny feeling from you because you wore scrubs to his meeting, then you're screwed.

4. Realize this is how real life works and that it's all arbitrary - in the end, you could have done everything you can, but it's just arbitrary. But really, who cares? This is your LIFE, and i hope for your sake that good grades isn't the be all end all. It may be disappointing to get a 'B', but it will unlikely prevent you from pursuing and practicing your chosen specialty.


Overall, have fun. Unlike the academic years, sometimes the good fortune doesn't come until you let go.

Posted by: cardsbound | Dec 30, 2008 2:24:30 PM

yup...thats clinicals for you...
I got a "B" in radiology..LOL go figure...not like i could've done anything to get an A except kiss ***. The attending said she didn't feel like students in radiology can achieve an "A" b/c all we do is "observe" lol...

Posted by: Brian C | Dec 30, 2008 3:50:10 PM

Hi Kendra,

Since we are at the same school, I think they are using the same eval form. Have you had a chance to look at it? Down here in ATL most of the preceptors give us a copy of it and what I have found is there is not a lot on it. In addition to only ranking you on 5 areas, the instructions state list a number 1-5 of how you think the person did with 1 being equivelant to an F and 5 an A. That being said I have found some preceptors don't think about giving half numbers like 4.5 and some of those same doctors also don't belive in giving 5's. I had one doc tell me -
"if you got a 5 it would be the equivelant of being a resident" However one of the categories is professionalism. So tell me how I deserve a 4 vs a 5 if I am approprialy well dressed and act professional. I don't know.

But yeah - sometimes it sucks. I got a B+ in pediatrics just because the doc didn't want to give A's, even though I thought I went the extra mile like you did in Surgery.

I have found these tips help though: about half way through ask for feedback about what you can improve upon. I usually phrase it like - "do you have any constructive critisim you could give me..." Then of course act on their suggestions.
Also about a week before the end of the rotation - or sooner for the 12 week cores, go through the objectives that Ross has and see what if anything you haven't covered. Then ask if you can have a brief session with the doc to discuss. That helps you have a focused conversation with them right at the end and bonus gets some material covered for step 2.
Good Luck - and remember it goes by so fast. I can't believe I am already a 4th year who graduates in '09
p.s thanks for posting - it is fun to read your articles.

Posted by: Irene | Dec 30, 2008 3:59:05 PM

Hi Kendra,

I'm a PA student on my clinical rotations and know exactly how you feel. We also have evals, but we have copies of them to know what we are "actually" being graded on. With that said, it doesn't always matter. Some people don't like students, don't feel that any of us deserve an "A", the list goes on. After 4 rotations here is the best advice I can give: practice medicine the way you were taught. Be kind to your patients, go out of your way to do extra things (like you did on your surgery rotation) and be the best you were trained to be. At the end of the day, it should be more important that you had patients walk away feeling pleased with the treatment you gave them than getting an A.
Also, ask your preceptor what they expect from you and what they think you can do to improve. Not everyone will like you or give you an A. But they can all give some advice to help you in the future!

Posted by: PA student | Dec 30, 2008 5:56:35 PM

Keep in mind that most of your attendings in surgery don't even WANT to take the time to fill out your evals. So some just circle 3s and 4s and it has nothing to do with you.

The reality is that unfortunately-grades matter a bit for residency-along with your step score. So, i agree with the other comments, maybe you should ask your attendings what else you should be doing.

You're going to be evaluated for the rest of your career, so get used to it! And maybe when you're a resident, you'll make your expectations to med students clear when you do the evaluating-that has been my goal. Because I remember what a random process evaluations can actually be!

Posted by: | Dec 30, 2008 7:27:58 PM

In the end, grades in your last 2 years of med school have something to do with what you know and how hard you work, but also have a lot to do with the personality of the grader, your personality, and your looks. I overheard some of the surgery residents and attendings at my med school talking about how they were going to give so-and-so a better grade because of her looks. It's unfortunate, but it's just the way of life in med school. People who met you only for a few hours will evaluate you, others with whom you work a lot do not evaluate you, and there is little transparency in terms of how grading is done.

In the end, you'll be a physician, and you just have to do what's best for your learning and move out of the mode of perfectionism where you think it's possible to get perfect grades if you just try a little harder. It's just not the reality and it's not the way the game works. Fortunately, when you learn to let go of it, you'll find that you finally have time to focus on what is important to you, and to seek guidance and advice from people who really know you and whose opinions you value.

Posted by: Family Med Resident | Dec 30, 2008 9:08:52 PM

Hi Kendra,

I also attend the same school as you. I went through the same thing as you too.. but it was AICM. I haven't started rotations yet but my frustrations began at AICM. Exactly the same problem as you. I worked so hard and I aced the presentations, papers and PE but was never told that the final grade was only based on final MCQ and final PE exam. So, the rest of my hard work for the whole semester basically accumulated to nothing. Then it makes me wonder sometimes why do I even work so hard if it does not reflect my accomplishment - worse, why do I get lower grades than people who have poor work ethics (who don't show up to classes and or always late to rotations)?

I can just only tell myself that at least I am doing it for myself and for the patients because of what I stand for - that I have good work ethics and so on.

It is frustrating - the unfairness. I understand.. but I have no doubt you'll be a great physician because of what you stand for despite the injustice.

Keep up the good work!

Posted by: | Dec 31, 2008 1:04:19 AM

bahh, I don't pay attention to grades in clinical rotations anymore.

I have gotten A's in rotations I thought I deserved a little bit less, and I've got B's in rotations I worked my ass off... seriously, it's just a subjective process largely depending on whether your attending residents likes you, so my theory is that if you still intend to get A's you just have to kiss asses so everybody would like you.

Posted by: Diego Nova | Dec 31, 2008 9:50:10 AM

Hey Kendra,

I understand the feeling but I think you just have to live with it. Rotation grades are very subjective (depending on your grader). As you've admitted, it's pretty silly to just beat yourself up over it.

But I always found the following useful in consoling myself:

Because there are no rules / no exam scope to begin with, don't take it like an exam! Hey, no exams for a change!

Go the extra mile, because you want to and because you think your patients deserve it

Socialize and more socializing. Sure, it may get you into the good books of some folks (hence good grades or some people may think of you as a kiss ***) More importantly, rotations are for you to make friends who are potentially going to be your colleagues / consults. These people can help you in your later path as an aspiring doctor (if you let them). It pays to want to get to know more about them outside of work.

Posted by: ihlunn | Jan 2, 2009 12:19:47 AM

you had a tough rotation and got a B....suck it up and move on. Welcome to the real world

Posted by: | Jan 3, 2009 12:35:20 PM

well Kendra,, grades don't matter here in Indonesia, either a B or an A,,who cares??with all the uncertainty of medical profession here(it's who's son are you that counts), we tend to take it lightly(since i'm not the staff's offspring),,i've had my shares of Surgery, and im so full of it!It's depressing,,

despite all the nepotisms, Indonesia(Jogja) produces fine surgeons. a couple of years ago, after hit by an 5,9 Richter scale earthquake with over 3000 victims, more than 1000 surgeries, the number of post surgery septic events were low, , you could say that's very good knowing that there were only 1 big hospital in town..
So, i wouldnt say to suck it up,,but, keep movin on, the real test is when you become a doctor, in here you're judged by the crowdedness of your office during practice hours, grades?don't matter!!

regards,

gunawan

Posted by: gunawan | Jan 3, 2009 9:32:45 PM

Grades are extremely frustrating in clinicals. It's surprising, but as it turns out, many attendings have NO idea how their evals equate to letter grades, or assume a 5 means perfect, or performing at the level of a resident, etc. We had a few chief residents who actually talked to attendings after they raved about how great a student was, then gave them 3s and 4s on their evals. One even went back and changed their evaluations after that chat.

Posted by: Kristie | Jan 6, 2009 2:37:39 PM

Your patients won't usually tell you how they're "evaluating" you either. They may stop showing up for appointments, or not comply with treatment, all after smiling and nodding through their consultation.

At some point we have to be able to evaluate ourselves, whether we've done everything within the reach of our abilities, and behave accordingly. The real world is a lot more gray than the academic background we've spent our whole lives in - few clear expectations once you're out of school.

And don't confuse the need for clear guidelines with the need for approval. Check yourself, and if what you really need is frequent approval, try getting a dog.

Posted by: carolynann | Jan 6, 2009 2:50:25 PM

Sounds like a hospital problem to me and it should be addressed. You should know what you are going to be graded on and who is going to be responsible for grading you. You obviously are serious about striving to be the best you can and deserve to have someone explain how they arrived at the B grade. And by the way, congratulations on getting the B!

Posted by: Patricia Brown | Jan 6, 2009 3:02:38 PM

Looking back upon my third year of medical school, I now realize that grades are a crapshoot. I have received much excellent feedback from patients and have been asked for business cards from them . . . that is all the feedback I need.

I'm going into a competitive specialty that I love, have completed residency interviews at places I really want to end up, and feel that the B's I've received haven't limited me in any way.

Surgery and Medicine are the toughest rotations during your third year and it is all downhill from there.
I hope you maintain a positive attitude, learn to take good care of patients and find a specialty that you love. And when you become an attending remember your present feelings when dealing with "your" medical students and try not to be passive aggressive.

I wish you the best and hope that you can place your grades in the context of the big picture.

Posted by: Luke K. | Jan 6, 2009 4:18:01 PM

The B that you got is still a good grade in reality. I wouldn't beat yourself up over it - there are just too many other things to contend with, as you'll find out as you proceed forward into your clinical year. Want a true "horror story" to let you know how good a B is? Well here is mine: I got a C on one of my core rotations. During the rotation, I had worked very hard, like you, and tried to do everything that I thought was expected of me (even though no one gave strict guidelines as to what we were being evaluated on or what we were to accomplish during the rotation as medical students). I seemed to get along with the attendings well (there were no residents), and no one ever seemed to have any complaints about my performance or suggestions for improvement.

Well, a couple of months after the rotation I get the grade, and I see that I had gotten a C - and to top it off, I had missed a B by one stinking point. I requested a copy of the original evaluation form to see what had been written. Perhaps they had written why I had gotten a C. Well, I happened across more disappointment. The form had no comments on it whatsoever (even though there were specific sections on the form to be filled out with comments) - no comments about what I did right, no comments about what I needed to work on. Just a bunch of numbers carelessly circled, with two of the head attendings' signatures signed at the bottom of the form - and sadly enough, these were the attendings that I had really not spent a whole lot of time with. I had spent much more time with the other attendings.

So....not only was I annoyed at the grade, but I was also annoyed that the grade wasn't explained, especially when there was ample opportunity on the form to do so. I attempted to call the doctors a couple of times - simply to find out what I had done wrong, and how I could improve for future rotations. Interestingly enough, I was always told that the doctor had left for the day, or that they were too busy to come to the phone and that they would call back later. Well, they never called back, and I gave up on my repeated attempts to get in touch with them so that I wouldn't come across as an annoying grade-seeker. The very fact that they couldn't be bothered to take the time to tell me about what things I needed to work on as a student for the future, especially while giving me an unfavorable grade in the process, suggests unprofessional behavior and a poor attitude. And it turns out I was one of the lucky ones - I found out that they had almost failed other students for no apparent good reason.

I am a 4th year going through the craziness of the interview season at this time. All of my clerkship grades have been good, with the exception of that one C. And unfortunately, each and every single place that I have interviewed at has requested an explanation for that one C. Especially since it happens to be the grade for the rotation that I ended up wanting to specialize in. Talk about a slap in the face right there. Of all the grades, it had to be the one for the rotation that I decided to dedicate my career to. But oh well, such is reality. I pretty much had to suck it up and just calmly and professionally explain what had happened.

Fortunately, there are many residency programs out there that understand that clerkship evaluations are very subjective, and that things can go wrong despite your best efforts. They will certainly take this into consideration as they consider all of the other merits on your residency application.

My story has a happy ending, however: To redeem myself, I ended up doing another rotation in the same specialty at one of the top university hospitals in the country. I worked as hard as I could, and tried to learn as much as I could. I also made every effort to be a team player and focus on being an essential asset to the team, and to really work alongside the residents and attendings. Fortunately, it all paid off, and I ended up getting a good grade for the rotation. This very much helped to add to my application during residency interviews, and certainly put the pains of the former "C" rotation behind me.

So, Kendra, don't get down on your B. You still did excellent in my eyes, as well as the eyes of your patients. A B is still a good grade - you just aren't used to getting them, that is all. Don't let that B stop you from doing a good job for your patients, as well as for yourself. Focus on being the best doctor you can be. There is more to life than getting perfect grades. Just because your grade isn't perfect doesn't mean that you lack the competency to become an excellent physician.

Posted by: janine | Jan 6, 2009 5:17:21 PM

I suggest you find out who evaluated you and talk to them directly about why you got a B. Maybe ask them for some constructive criticism and grow from it. If you don't know what you did or rather, did not do, then you won't be able to change or improve. Also, I would try to find out ASAP what is expected of you in your current rotation or you might end up disappointed again.

Posted by: Heather | Jan 6, 2009 7:12:39 PM

Even as a first year, I can really understand your frustration. I've been having the same feeling since I started med school in the early fall. My grades are just not even close to what I feel I should be getting based on the time I put in and even my understanding of the material.

Then again, maybe I'm just bad at taking tests...

Posted by: Michael | Jan 6, 2009 7:26:57 PM

Hi Kendra,
I know exactly how you feel. I am like you who did way more than other students during surgery rotation. I even had a good eval from bitchy chief (every one surprise) but when it came to final grade, it had to do with final attending grade. I even got along with attending due to being only student scrubbing in during overnight calls. The attending told me that he gave me a good grade (a "B"), good grade? I was so upset because I worked hard and I got a "good" grade which was a "B," while other students, in different hospitals or with different attending, were slacking off and still got a "B."
I was interested in surgery but I ended up applying for medicine. I am the one who usually do well on exams and school. With my good "B" grade in surgery rotation on my transcript, I still have to answer why I got an B on that rotation to some interviewers.

-t

Posted by: T | Jan 6, 2009 8:47:42 PM

The first time I got my clerkship grades back (months after the clerkship, and we get our grades in batches), I had the same feelings as you did. I did all the work I was given and more, stayed late, did scut work without being asked, read on my patients, got along really well with my residents, worked hard to be a team player, etc. I didn't do any activities including working out, and often just skipped dinner and went to sleep instead once I got home. I thought, "I could have done a lot less work if all I was going to get was a B!"

I sought out advice from 4th year's as well as friends where were now residents. I talked to friends that were attendings (not my attendings). The overall response I got was don't worry about it. A "B" is still a good grade. Residency programs don't like that seriously on your grades. The amount of effort and work you put in has no correlation with your grade. It has a lot more to do with chance and having the right person take a liking to you. As an attending pointed out, doctors are doctors and not teachers. Sure teaching might be part of their job, but its not how they are evaluated by their boss. How well they do in teaching does not lead to more compensation, promotions, etc. Doctors are not trained on how to teach or how to evaluate medical students. Evaluation of medical students is not consistent among attendings. Many attendings don't think it's worth their time, and many of the ones that do don't have the time they wold like to put into it since they spend more time teaching and have the same patient responsibility as the attendings who don't stop to teach their students.

I was still frustrated, upset, mad, even after hearing the same words from many people. But at some point, I let it go. Now I do things to help my patients and learn. Sometimes that means staying late, but sometimes that means leaving early and going to read or catch up on sleep. I haven't gotten my next batch of grades yet, but I doubt it will be worse than the first. My gut feeling is that it will be the same, but I will be better rested and perhaps will have learned more.

Posted by: Elizabeth | Jan 6, 2009 8:53:18 PM

Maybe you got a B because everyone got a B in your rotation. I've just done my first clinical rotation and our consultant gave everyone the same grade. He didnt take the time to really assess us properly. Given your lack of goals and instructions at the beginning, it sounds like whoever was marking you doesn't care in the slightest.

Posted by: Lorna | Jan 7, 2009 10:51:04 AM

Its really pandemic.don't be worry.you should increase your self confidence so that none of these happenings would ruin that.

Posted by: | Jan 7, 2009 11:02:05 AM

Hey Kendra, don't get too disheartened by your 'B'. The thing about attachment evaluations is that it's all very subjective, it's really up to the person giving the grade. It is not a true reflection of your abilities or your performance. It's about playing the game well and making the right impression on the grader, unfortunately. I've realised that after 2 years of clinical attachments, and I was like you too... not every consultant really cares about giving you the grade appropriate to the level of your work input, and sometimes the grader could be a random person who doesn't know who you are and gives a safe grade (like a 'B') to everybody. Honestly, it's not worth losing sleep over. Been there, done that. Well, that's my 2 cents' worth anyway.

Posted by: YK | Jan 7, 2009 11:22:38 AM

I got a B in Peds. I didn't even look until just before graduation because the Attending told me I had done well and would get a high grade. I found out later that certain ethnic and religious components went into his process; Only members of a particular religion got As. Seriously. Who would have thought something like that would actually happen? But talking with others from my school....well there it was. I just chalked it up to a learning experience. It made zero difference in interviews. You need to chill a little and realize that these things happen to everyone. In the long view, well attendings and directors remember when they were students as well. BTW my chief in Surgery got a B in his core rotation in Surg.

Posted by: stuart | Jan 7, 2009 11:24:01 AM

The comments to this entry are closed.