What does it take to consistently honor clerkships? What differentiates someone who honors a clerkship vs someone who doesn't?

[aldol16]

Agree. Unless they tell you to leave. Then gtfo.

But never forget the dance we all do when that happens. "Go home." "Are you sure there's nothing else I can help you with?" "Yes, go home and enjoy you day."

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[efle]

@Matthew9Thirtyfive I agree with some of your points, but your school is definitely unique in how you are evaluated on clinical rotations. I also had to choose my evaluators when I did med student rotations way back in they day, and we definitely weren't evaluated by every single person we interacted with.

I don't think that it's totally a matter of getting lucky, since as an attending I do feel like I can tell the difference between an "honors" student from a "high pass" one. But from a student perspective, choosing the right people to evaluate you or performing to the expectations of whoever your specific attending happens to be is absolutely part of the "game" that realistically needs to be played.

It's good that you participate properly and use the whole grading scale and differentiate students. The more frequent experience I had especially from residents/fellows was to just click down a column uniformly giving all 3's, or all 5's, etc. I actually had one friend get all 3's from a fellow that cost him Honors, he reached out to the fellow to ask about it and the fellow was horrified to learn he'd essentially given failing marks, thinking "at the level of an intern" was generous for an MS3 when really it was a 60/100 for the grade book. He successfully got the eval revoked and his grade upgraded back to Honors so happy ending to the story, but man, I had zero faith in the grading system after seeing several things like that happen.

 

[Matthew9Thirtyfive]

It's good that you participate properly and use the whole grading scale and differentiate students. The more frequent experience I had especially from residents/fellows was to just click down a column uniformly giving all 3's, or all 5's, etc. I actually had one friend get all 3's from a fellow that cost him Honors, he reached out to the fellow to ask about it and the fellow was horrified to learn he'd essentially given failing marks, thinking "at the level of an intern" was generous for an MS3 when really it was a 60/100 for the grade book. He successfully got the eval revoked and his grade upgraded back to Honors so happy ending to the story, but man, I had zero faith in the grading system after seeing several things like that happen.

I’ve been fortunate to very rarely experience that. The one time I did, I was able to get it fixed. It is sad to hear that kind of **** happens on the reg.

 

[GoSpursGo]

It's good that you participate properly and use the whole grading scale and differentiate students. The more frequent experience I had especially from residents/fellows was to just click down a column uniformly giving all 3's, or all 5's, etc. I actually had one friend get all 3's from a fellow that cost him Honors, he reached out to the fellow to ask about it and the fellow was horrified to learn he'd essentially given failing marks, thinking "at the level of an intern" was generous for an MS3 when really it was a 60/100 for the grade book. He successfully got the eval revoked and his grade upgraded back to Honors so happy ending to the story, but man, I had zero faith in the grading system after seeing several things like that happen.

FWIW, I found it helpful when our students' eval forms actually spelled out what my eval would translate to as a grade. But that definitely isn't the case from every school.

 

[Maximus2020]

So if someone else gives advice that differs from yours, they are either lying or they are not top programs? Or both?

Not trying to get into an argument with you. You can be offended that I pointed out your book if you want, but I’m not going to get into a mud slinging match with you.

In this specific context when talking about how to earn spots at the top programs, absolutely yes. Your profile title lists you as a medical student so I would argue I have more experience to make such statements. Having interviewed at many top hospitals, been through the match, completed residency/fellowship, worked at a top 10 hospital, had ample time on residency admissions committees, and mentored/witnessed the journeys of many med studs, I think what I argue should hold more ground.

Again, I'm not getting anything out of this; you can choose what to believe and that's fine.

You trying to undermine what I am saying by insinuating I am exaggerating because I have published/am selling a book on the topic is where this got out of hand. Nothing is being exaggerated on my part.

 

[operaman]

In this specific context when talking about how to earn spots at the top programs, absolutely yes. Your profile title lists you as a medical student so I would argue I have more experience to make such statements. Having interviewed at many top hospitals, been through the match, completed residency/fellowship, worked at a top 10 hospital, had ample time on residency admissions committees, and mentored/witnessed the journeys of many med studs, I think what I argue should hold more ground.

Again, I'm not getting anything out of this; you can choose what to believe and that's fine.

You trying to undermine what I am saying by insinuating I am exaggerating because I have published/am selling a book on the topic is where this got out of hand. Nothing is being exaggerated on my part.

As another person who landed a spot in a top 10 program in a very competitive field in a very tough year (classmate with 260 step 1 didn’t match), I have to strongly agree that honors grades are important.

In reviewing apps for interviews, it seemed like everyone was either all honors or almost all honors. I know I never actually had to think about what rotations they did or didn’t honor - at most it was glancing at whichever one they didn’t. Even then, often their lone pass was on an elective that was straight p/f.

I think there’s definitely a different standard both between competitive fields and others as well as top programs and others. For students who want the best training, they have to know they are competing against the nations best students. There’s also the issue that faculty aren’t always completely honest with students about this sort of thing. Students these days are very fragile and a faculty member who told students the unvarnished truth about this would probably get reported for bullying and abuse right after the student had to leave and find a safe space. I wish I were being hyperbolic there but that’s actually true and I’ve seen it happen. Much easier to make someone feel better than crush them outright.

 

[Matthew9Thirtyfive]

In this specific context when talking about how to earn spots at the top programs, absolutely yes. Your profile title lists you as a medical student so I would argue I have more experience to make such statements. Having interviewed at many top hospitals, been through the match, completed residency/fellowship, worked at a top 10 hospital, had ample time on residency admissions committees, and mentored/witnessed the journeys of many med studs, I think what I argue should hold more ground.

That’s fine. I personally choose to listen to actual PDs and mentors I have met with in real life. And your appeal to authority doesn’t really work, as I was reporting what I’ve heard from actual PDs. My level of training is irrelevant, unless you’re claiming you know more about what PDs care about than PDs.

And as for the dig that they were just not going to tell me something negative to my face, I’ve honored all my rotations. So that wasn’t an issue.

 

[Ole_Toe]

In this specific context when talking about how to earn spots at the top programs, absolutely yes. Your profile title lists you as a medical student so I would argue I have more experience to make such statements. Having interviewed at many top hospitals, been through the match, completed residency/fellowship, worked at a top 10 hospital, had ample time on residency admissions committees, and mentored/witnessed the journeys of many med studs, I think what I argue should hold more ground.

Again, I'm not getting anything out of this; you can choose what to believe and that's fine.

You trying to undermine what I am saying by insinuating I am exaggerating because I have published/am selling a book on the topic is where this got out of hand. Nothing is being exaggerated on my part.

They were simply pointing out that you do have a financial interest in this specific advice which you can’t deny but seem very keen on obfuscating. Not that big of a deal, but you come off very defensive in this thread.

Edit to moderator who deleted my comment about the price of the book: the sales thread is locked for comments...

 

[Maximus2020]

They were simply pointing out that you do have a financial interest in this specific advice which you can’t deny but seem very keen on obfuscating. Not that big of a deal, but you come off very defensive in this thread.

Thank you for taking the time to post another comment irrelevant to this discussion. Please either provide your own advice to medical students pertinent to this discussion or do not post statements like this. Feel free to PM me if any specific comments about me personally - thanks!

 

[GoSpursGo]

ok the current discussion is entirely unhelpful to the OP. I think the main thread participants have made their points clear and have made fair points about biases. But at this point unless someone has new advice for the OP, please take personal bickering to PMs.

 

[calivianya]

I mean, we work with like 6-7+ attendings and at least as many residents on most rotations. The site director gets evals on us from all of them.

That's so lucky! We get a singular eval, from the preceptor we were assigned. And the really fun part is we are not allowed to talk to them about it. It all goes through HR. It would be rule breaking to talk about what I need for honors, how my school's grading works, etc. The HR person gives the eval to the preceptor, who sends it back to the hospital HR, who sends it to my class coordinator. I don't get to see it until my rotation grades are finalized and my class coordinator uploads the documentation into the rotation management software.

And going to a different person to get an eval from as was suggested above? LOL. How am I supposed to get an eval to affect my grades when it's against the rules to handle my evals, talk about my evals, or get an eval from anyone other than my primary preceptor... who I can't choose?

This is the kind of crap that should be on the pre-med forum, honestly. People talk a lot about location and rank, but knowing what I know now, how preceptors are selected and how clinical grades work would honestly be a factor worth considering when picking med schools to attend.

Reading through this thread, I can ultimately see how some people's grades are based on their own effort. But I'm going to maintain that for some of us, up to 80% of what's required to get honors is blind luck.

 

[efle]

And going to a different person to get an eval from as was suggested above? LOL. How am I supposed to get an eval to affect my grades when it's against the rules to handle my evals, talk about my evals, or get an eval from anyone other than my primary preceptor... who I can't choose?

You're pretty much locked in at your school, sounds like nothing you can influence. I will say it's also against the rules at my school to talk about grading with the evaluators, but that doesn't stop it from happening. E.g. someone explicitly asking their resident whether they'd give 5's if they ask them for an eval, someone emailing their grader about the inflated averages, and like I mentioned above even having an eval removed after the fact by going to their grader to talk about it. Having your fate decided by dice roll is probably the lesser evil in comparison.

 

[ChordaEpiphany]

In this specific context when talking about how to earn spots at the top programs, absolutely yes. Your profile title lists you as a medical student so I would argue I have more experience to make such statements. Having interviewed at many top hospitals, been through the match, completed residency/fellowship, worked at a top 10 hospital, had ample time on residency admissions committees, and mentored/witnessed the journeys of many med studs, I think what I argue should hold more ground.

Again, I'm not getting anything out of this; you can choose what to believe and that's fine.

You trying to undermine what I am saying by insinuating I am exaggerating because I have published/am selling a book on the topic is where this got out of hand. Nothing is being exaggerated on my part.

As another person who landed a spot in a top 10 program in a very competitive field in a very tough year (classmate with 260 step 1 didn’t match), I have to strongly agree that honors grades are important.

In reviewing apps for interviews, it seemed like everyone was either all honors or almost all honors. I know I never actually had to think about what rotations they did or didn’t honor - at most it was glancing at whichever one they didn’t. Even then, often their lone pass was on an elective that was straight p/f.

I think there’s definitely a different standard both between competitive fields and others as well as top programs and others. For students who want the best training, they have to know they are competing against the nations best students. There’s also the issue that faculty aren’t always completely honest with students about this sort of thing. Students these days are very fragile and a faculty member who told students the unvarnished truth about this would probably get reported for bullying and abuse right after the student had to leave and find a safe space. I wish I were being hyperbolic there but that’s actually true and I’ve seen it happen. Much easier to make someone feel better than crush them outright.

These two are absolutely spitting truth here. That's undeniable. If you want to match at a top residency in a competitive field, you need to have the best application. What's missing is context. "What are your goals and why are you doing this?"

There are basically two ways to land a top, top residency

1) Completely optimize your life around getting top step scores, shelf scores, evals, and brute force your way to the top.

2) Have an "X-factor" accomplishment that separates you from the crowd and identifies you as a future leader in the field. (Note 1: You still need great grades, but something like this gives you wiggle room for a few weaknesses; Note 2: this is not an extra degree or something along the "prescribed" path; Note 3: This advice is straight from the mouth of a chief at a top 5 subspecialty surgery department).

So while @operaman and @Maximus2020 are absolutely correct in saying this is what PDs are looking for at a top 10 residency in a competitive field, you should have a good reason for chasing that goal before internalizing their advice.

The reason for pursuing top, top residencies is to break free from the mold and create a whole career of "X-factor" accomplishments, usually through big risks and high uncertainty (and typically at a much lower salary on the professorship track at a low-paying academic center in a HCOL city). Meanwhile, the person who pursues pathway #1 above is typically not the kind of person who even wants that. Med students are optimizers who are often extremely risk-averse and prestige-driven. Most med students thrive on the mold.

Taking this one step further, the vast majority of people in medicine are primarily clinicians who change the world one patient and family at a time, even at high-powered academic centers. The vast majority are not carving a career of "X-factor" accomplishments, even with a golden, pure-Harvard line of training and employment. Very few people in medicine are actually utilizing a top 10 residency in a way that would be unavailable at a top 50 or even community program, and those very few are almost always on pathway #2.

So catering the advice above to #1 people using #1 strategy and then using top 10 residencies as a benchmark doesn't make much sense to me. They're going to use that residency the same way they'd use any halfway decent academic residency, so I say cater the advice to that level. If you're specifically aiming to match a top subspecialty at a top institution, you should probably be a #2-type person anyway. If you're a #1-type person, like most med students and practically all working physicians, you should understand that there is luck involved in this and factor it into your plans. Do your best. Absolutely follow the advice given here. However, understand that you'll probably wind up with a P or HP here or there, even if you do everything right. Then, understand that in all likelihood the biggest change to your career will be a smaller report length in whatever phallic measuring contests you get yourself wrapped up in.

tl;dr If you're the kind of person who wants/needs to be told how to optimize their application for surefire success, you probably don't need a top 10 residency anyway, so go find advice aimed at matching your specialty of choice. Focus on your clinical goals, and don't be disappointed if the top 10 dream doesn't come to fruition. You'll probably make the same or more than almost all of the top 10ers anyway while doing just about the same thing day-to-day.

 

[efle]

There are basically two ways to land a top, top residency

1) Completely optimize your life around getting top step scores, shelf scores, evals, and brute force your way to the top.

2) Have an "X-factor" accomplishment that separates you from the crowd and identifies you as a future leader in the field. (Note 1: You still need great grades, but something like this gives you wiggle room for a few weaknesses; Note 2: this is not an extra degree or something along the "prescribed" path; Note 3: This advice is straight from the mouth of a chief at a top 5 subspecialty surgery department).

Don't forget #3, the easiest way - go there for med school

 

[bGMx]

Don't forget #3, the easiest way - go there for med school

Now this is just a musing of mine, but I can conceptualize this as a liability. I think (doing a bit of self-justification here not just for my medical career but also my entire life) that going to several different places allows you to gain vastly different perspectives which can then be integrated powerfully. For a metaphor, going to a different residency from your medical school, which is different from your undergraduate, is almost like doing a learning meta-analysis.

 

[altblue]

Now this is just a musing of mine, but I can conceptualize this as a liability. I think (doing a bit of self-justification here not just for my medical career but also my entire life) that going to several different places allows you to gain vastly different perspectives which can then be integrated powerfully. For a metaphor, going to a different residency from your medical school, which is different from your undergraduate, is almost like doing a learning meta-analysis.

That's not the point, though. It'll be easier to get into a residency if you're already known to be a solid rotator there throughout M3/M4.

For the reasons you listed, I have no interest in staying with my med school's hospital, but I know that as long as I leave a decent impression with a program, that'd work in my favor if I were to apply.

 

[operaman]

Now this is just a musing of mine, but I can conceptualize this as a liability. I think (doing a bit of self-justification here not just for my medical career but also my entire life) that going to several different places allows you to gain vastly different perspectives which can then be integrated powerfully. For a metaphor, going to a different residency from your medical school, which is different from your undergraduate, is almost like doing a learning meta-analysis.

Since the roles of student and resident are so vastly different, I don’t think there is a huge added value in this regard. There probably is some value in expanding your own network, but you don’t spend enough time with any one dept as a student to even begin learning what you can learn from those faculty.

Contrast this with fellowship, especially in surgical fields, where I think you’re spot on and going elsewhere is incredibly beneficial. In this case, you will have spent 5-7 years with your staff and by the end you know exactly what they do and why they do it. Going to a new place for fellowship can open you to some entirely new ways of thinking and operating that you can incorporate into your future practice. It’s also nice for the residents to know you only as a fellow rather than as the person who was just their co resident. Makes it a little easier to assume that fellow/attending role rather than being a super chief resident.

 

[TelemarketingEnigma]

reading threads like this makes me really glad my school does not do honors of any kind for rotations

same as for preclinicals, we got P/F with a percentage. To this day I do not actually know how my clinical grades stacked up against my classmates because they never gave us any histograms like they did for preclinical. I think the grade distribution gets put in the MSPE but we didn't get to review that part of it, all i know is my class quartile stayed the same as it was for preclinicals.

 

[HemorrhagicShock]

Hate to say it but honors comes down to being likable and to some extent physical appearance coupled with whom you're assigned to work. If you get that hardass senior resident, or jerk off attending, you're screwed regardless of your actual ability.

I say this as an attending that works with medical students and residents, and I literally see this pattern from my own colleagues who write reviews.

Indeed it's a game!

 

[Lawpy]

Hate to say it but honors comes down to being likable and to some extent physical appearance coupled with whom you're assigned to work. If you get that hardass senior resident, or jerk off attending, you're screwed regardless of your actual ability.

I say this as an attending that works with medical students and residents, and I literally see this pattern from my own colleagues who write reviews.

Indeed it's a game!

Is there any way to change this at attending level?

 

[HemorrhagicShock]

Is there any way to change this at attending level?

Unfortunately, the answer is no.

This is simply a factor of human nature. The only control one has in these situations is to simply work hard, do the best you can, hustle hustle hustle, and let the cards fall where they may. You cannot change some of these immutable factors.

I do like the advice above to game the situation as much as you can before you are even being evaluated (pick rotations at places known for grade inflation, pick preceptors/residents/attendings that are known for giving high marks, pick rotation times when the attractive girl or tall athletic guy isn't rotating etc.)

Rather than let it be a defeating revelation, simply reframe it in one's mind that this is how the world works (not just medicine) and don't spend too much time fretting over it. I get that this is tough to sublimate into a day-to-day productive approach as a medical student!

 

[Deecee2DO]

I disagree that honoring clerkships is "mostly" luck. I think about 15-20% of it is luck. The rest is how you play the game.

I honored all my clerkships and it wasn't necessarily because I was smarter, more hardworking, or more likeable. I just played the game better.

1. Ace your shelf exams. Aim for 90th percentile and above on all shelf exams.

2. Figure out who will evaluate you, and make sure to look good in front of those people. No one cares if you suck up to the intern who isn't going to evaluate you anyways.

3. If you impressed someone, see if you can get the clerkship coordinator to have that person evaluate you also, if not already.

4. Make sure to ask your seniors and/or classmates who gives higher scores on average. Request those preceptors/attendings.

5. Let your preceptors know what the average score is and what score = honors. Some preceptors think 5/10 is average when in reality, the average score amongst your peers may be 7/10. If you got 5/10 you would be below average. I told some of my preceptors what the average score is and what score = honors. It definitely helped in my favor.

This is insanely important and very strategic. Definitely do this OP it pays dividends

 

[efle]

5. Let your preceptors know what the average score is and what score = honors. Some preceptors think 5/10 is average when in reality, the average score amongst your peers may be 7/10. If you got 5/10 you would be below average. I told some of my preceptors what the average score is and what score = honors. It definitely helped in my favor.

Gotta be careful doing this if it's against your school's academic honesty policy. One of my classmates did something like this via email once - big yikes, stick to mentioning it to them in person

 

[Matthew9Thirtyfive]

Gotta be careful doing this if it's against your school's academic honesty policy. One of my classmates did something like this via email once - big yikes, stick to mentioning it to them in person

Why would you do it in email anyway? That’s so weird lol.

 

[DrRiker]

I think I would have agreed with you when I was a Med student because at the time I didn’t feel like I was gunning per se or going too terribly beyond what seemed normal. I was open about my desire to earn honors but was never particularly manic about it.

Now getting to see if from the other side I’ve seen how mediocre and laissez faire most students are. They can easily just vanish into the paint and I’d have no clue who these people were when I’d get an eval request. I think my baseline level of working hard was just different than other students, so now I tend to overemphasize the level of effort required.

Is this actually the case? I've not been with many other students on rotations, so I have no idea where the baseline is set.

 

[hmockingbird]

As an attending this is what makes 3rd years stand out to me:
-IMPLEMENTS FEEDBACK. This is probably the biggest one. I don’t care if you’re a nervous wreck on day 1 but I care if you can show me you learned from that later in the rotation.
-Really knows their patient. Can identify trends over time.
-Subtle exam or historical finding
-Thorough differential that is well reasoned. Thorough plan. Having a differential/plan for every item on the problem list not just the main diagnosis.

Things that make you stand out negatively, besides being grossly behind (such as not able to present coherently by the end of the rotation) would mostly be professionalism issues. Eg leaving without permission, dress code (have literally seen a med stud wear a long sleeved body con dress… like it technically fit the dress code requirements but that is not business casual my friend), rudeness, making fun of patients, HIPAA violation.

ETA: our rotation has an assignment and we literally give you the rubric. So you can see exactly what you need to do to get a perfect score. Shocks me how many people don’t even follow the basic directions let alone take advantage of that.

 

[Maximus2020]

I love this thread.

Completely agree with hmockingbird's post above.

1) The feedback thing is so funny yet true. The honest truth is that many peeps could care less about feedback yet it really builds up the ego of an attending or resident to ask "what I can do to improve", do it, then mention how you hope you took that to heart at the end. I did this halfway through some rotations to meet with the attg and ask what it would take to get Honors, etc. Really works. Be humble with the phrase "I always can improve" plastered on your forehead.

2) Knowing the patients better than anyone is a huge plus. Family phone number? Outside records from 30 years ago? Favorite ice cream flavor? Once, I wished a patient Happy Birthday when the attg and I went to see the patient. Later that month, my evaluation mentioned how impressed the attg was that I knew that and made the patient happy. Kid you not.

3) The differential and A/P are the most impressive to me, showing a true inside look at the workings of the mind. Probably the only thing that cannot be game'd during 3rd year. Separates from the pack.

Agree with hemorrhagicshock's note as well. People are spot on here.

 

[psyspy]

As an attending this is what makes 3rd years stand out to me:
-IMPLEMENTS FEEDBACK. This is probably the biggest one. I don’t care if you’re a nervous wreck on day 1 but I care if you can show me you learned from that later in the rotation.
-Really knows their patient. Can identify trends over time.
-Subtle exam or historical finding
-Thorough differential that is well reasoned. Thorough plan. Having a differential/plan for every item on the problem list not just the main diagnosis.

Things that make you stand out negatively, besides being grossly behind (such as not able to present coherently by the end of the rotation) would mostly be professionalism issues. Eg leaving without permission, dress code (have literally seen a med stud wear a long sleeved body con dress… like it technically fit the dress code requirements but that is not business casual my friend), rudeness, making fun of patients, HIPAA violation.

ETA: our rotation has an assignment and we literally give you the rubric. So you can see exactly what you need to do to get a perfect score. Shocks me how many people don’t even follow the basic directions let alone take advantage of that.

Honestly all of that is “average” or “meets expectations” level where I am. And “really knowing the patient” can sometimes be limited, especially when residents themselves don’t even know certain things about the patients that the attending pimps them on. And getting everything right the first two days is probably one of the few ways students can truly stick out from the rest. Subtle historical or exam finding is another way, but oftentimes these just won’t be there.

Not implementing feedback would be grounds for a very bad evaluation. Implementing it will get you a good comment at best.

All in all those first 1-2 days and those obscure pimp questions that the residents struggle with are in fact the most important thing, but I’ve sadly never figured out how to ace them. Even for the some of questions residents don’t struggle with, med students just won’t have had enough context, experience, or background knowledge to answer them without guessing

There really are no participation trophies here unless you’re at a top 20 school. And so many of these “strategies” for the wards seem outdated since everyone does them now. Makes you think this career is generally as dismal as law now…

 

[psyspy]

I love this thread.

Completely agree with hmockingbird's post above.

1) The feedback thing is so funny yet true. The honest truth is that many peeps could care less about feedback yet it really builds up the ego of an attending or resident to ask "what I can do to improve", do it, then mention how you hope you took that to heart at the end. I did this halfway through some rotations to meet with the attg and ask what it would take to get Honors, etc. Really works. Be humble with the phrase "I always can improve" plastered on your forehead.

2) Knowing the patients better than anyone is a huge plus. Family phone number? Outside records from 30 years ago? Favorite ice cream flavor? Once, I wished a patient Happy Birthday when the attg and I went to see the patient. Later that month, my evaluation mentioned how impressed the attg was that I knew that and made the patient happy. Kid you not.

3) The differential and A/P are the most impressive to me, showing a true inside look at the workings of the mind. Probably the only thing that cannot be game'd during 3rd year. Separates from the pack.

Agree with hemorrhagicshock's note as well. People are spot on here.

1. Everyone at my school asks for feedback, or it’s given without asking.
2. You are likely not at a mid or high tier program, as all of that is honestly just fluff that might earn you good MSPE commentary at best, and will likely not even be acknowledged weeks later when it comes time to write evals.
3. Lol…most of that is going to come from assistance from the residents. M3s won’t know how to properly manage complex cases like residents do

 

[psyspy]

The biggest issue is that there are attendings that give honor evals like candy, and then there are others that won’t dare give any, so it’s significantly more of “the evals happen to you” than “you control what evals you get”, so the only way you can truly differentiate yourself is MSPE commentary

 

[HemorrhagicShock]

1. Everyone at my school asks for feedback, or it’s given without asking.
2. You are likely not at a mid or high tier program, as all of that is honestly just fluff that might earn you good MSPE commentary at best, and will likely not even be acknowledged weeks later when it comes time to write evals.
3. Lol…most of that is going to come from assistance from the residents. M3s won’t know how to properly manage complex cases like residents do

And thus you will eventually come to the conclusion that when everybody is hustling hard, doing these exact things, and doing them perfectly every time, it'll all come down to the immutable factors I listed in my post above:

1. Being assigned to the team/attending/resident that likes to hand out honors like candy
2. Your ability to interact with other people in a team-based setting (emotional intelligence stuff that can't be taught quickly)
3. Your physical appearance, which includes your physical attractiveness, height (if you're male), ethnicity, and to some extent how you groom yourself relative to the context (e.g a relaxed fashion/hairstyle approach as a California kid rotating in the NE... you're gonna look out of place and it'll subconsciously come out when your evaluator sits down to do your review)

FYI I am an attending that works with rotating medical students and residents (though I personally am not an academic attending, our hospital is just an affiliated community site where I happen to work), so I like to think my perspective comes from experience!

It's okay (in fact encouraged) to set high goals within medicine. BUT what is often forgotten is that you must have zero expectations that you'll ever achieve those goals despite doing everything correctly. This profession... actually this world... doesn't owe you anything. It's not fair, but it doesn't matter, you cannot change it. Have the grace to understand this, and you'll be better off in the long run.

 

[psyspy]

And thus you will eventually come to the conclusion that when everybody is hustling hard, doing these exact things, and doing them perfectly every time, it'll all come down to the immutable factors I listed in my post above:

1. Being assigned to the team/attending/resident that likes to hand out honors like candy
2. Your ability to interact with other people in a team-based setting (emotional intelligence stuff that can't be taught quickly)
3. Your physical appearance, which includes your physical attractiveness, height (if you're male), ethnicity, and to some extent how you groom yourself relative to the context (e.g a relaxed fashion/hairstyle approach as a California kid rotating in the NE... you're gonna look out of place and it'll subconsciously come out when your evaluator sits down to do your review)

FYI I am an attending that works with rotating medical students and residents (though I personally am not an academic attending, our hospital is just an affiliated community site where I happen to work), so I like to think my perspective comes from experience!

It's okay (in fact encouraged) to set high goals within medicine. BUT what is often forgotten is that you must have zero expectations that you'll ever achieve those goals despite doing everything correctly. This profession... actually this world... doesn't owe you anything. It's not fair, but it doesn't matter, you cannot change it. Have the grace to understand this, and you'll be better off in the long run.

I’m glad I’m not gunning for a competitive specialty. Not to mention covid/masks in the hospital (rules for which even vary from team to team) have made it that much harder to mesh well and mingle with the team

There is one last factor that hasn’t been mentioned, being extremely meticulous with whom you ask for an evaluation. Sometimes it’s better to get a neutral eval than risk an unnecessarily negative one, which is educationally counterproductive because then you can’t get effective feedback, but many specialties now seem like a race to the bottom anyhow, so it all fits

And being able to accept the final paragraph of what you wrote is quite liberating in my opinion. But most med students won’t really internalize that because of all they’ve invested into the profession

 

[Lawpy]

Your physical appearance, which includes your physical attractiveness, height (if you're male), ethnicity

Wait what?

 

[i-doctor]

I’m glad I’m not gunning for a competitive specialty. Not to mention covid/masks in the hospital (rules for which even vary from team to team) have made it that much harder to mesh well and mingle with the team

There is one last factor that hasn’t been mentioned, being extremely meticulous with whom you ask for an evaluation. Sometimes it’s better to get a neutral eval than risk an unnecessarily negative one, which is educationally counterproductive because then you can’t get effective feedback, but many specialties now seem like a race to the bottom anyhow, so it all fits

Talk about paranoid…When I applied to ophthalmology, letters of recommendation were sent directly to the residency program directors. I was able to obtain a couple of extra letters of recommendation more than required, so I only gave a partial list of my residency programs to each doctor who wrote my recommendation letter. So in effect each program received 3-4 letters, but each recommendation letter only went to 2/3 of the programs. I created a flow sheet of where each letter went. So if any given recommendation letter was a bad one, approx 1/3 of the programs wouldn’t have gotten it.
As an introverted person, I couldn’t always judge how I was perceived, so I decided to play defense.

 

[psyspy]

Talk about paranoid…When I applied to ophthalmology, letters of recommendation were sent directly to the residency program directors. I was able to obtain a couple of extra letters of recommendation more than required, so I only gave a partial list of my residency programs to each doctor who wrote my recommendation letter. So in effect each program received 3-4 letters, but each recommendation letter only went to 2/3 of the programs. So if any given recommendation letter was a bad one, approx 1/3 of the programs wouldn’t have gotten it.
As an introverted person, I couldn’t always judge how I was perceived, so I decided to play defense.

I guess that was a good strategy, but there wasn’t one you could bank on? Has me thinking I shouldn’t bank on any I get later

 

[i-doctor]

I guess that was a good strategy, but there wasn’t one you could bank on? Has me thinking I shouldn’t bank on any I get later

Yes there was one from the program director that was a must everywhere.
My recommendation is to always ask for a letter whenever you run across that sweet, gentle doctor who couldn’t hurt a fly. (The kind of person who couldn’t sleep at night if he/she wrote an unkind word about anyone.) Even if not remotely connected to your eventual field of interest. Those letters might be necessary later on to pad your application.

 

[Phloston]

Title sums it up. As I approach my third year as a student with a P/F STEP 1, clerkships seem to be everything when it comes to residency. I was wondering if anyone had any thoughts on this.

Memorize the Clinical Mastery Series forms for your shelves. These are the NBME subject-specific forms. And when I say memorize, do repeated passes of forms 1-6. Then make sure you do all of the UWorld questions, and even Rx Qs possibly.

Get as much time away from rotation as possible so you can do nothing but questions.

That's it.