<p>I don’t really know. My guess is that the attending won’t bother to contact the residents. I usually provide my attending with my CV, personal statement, as well as a reflection paragraph of our time together (with what I think I did well) to help write the letter.</p>
<p>
</p>
<p>S’s experience has been very different with almost daily interaction with the attendings, much of it for extended periods. He’s actually had several attendings offer to write LORs for him.</p>
<p>He just had his meeting with the Dean to review his Dean’s letter. He was very pleased with the meeting and the letter. He managed to get Honors in all of his big rotations one of which was in his area of interest and every evaluation was absolutely stellar. The Dean said in his letter that it was one of the best overall group of evaluations he’s ever seen in his fifteen years as Dean.</p>
<p>He had a great third year and finished in the upper part of the first quartile. Since third year essentially counts double, it really makes him a very strong candidate for his proposed residency so he’s hoping that will help him match to one of his top choices. Sadly for EaMom and me, none of his top choices are anywhere close to home.</p>
<p>eadad,</p>
<p>May I ask you what your son’s STEP 1 scores were?
I expect he may have been amongst the top scorers in STEP1 as well.</p>
<p>Aside from the bedside manner and people skills, I am guessing that how well students perform in their rotations must be correlated with how well they understood their nonclinical material (as indicated by STEP1 score) and how well they are able to connect the dots to help diagnose.</p>
<p>Thank you.</p>
<p>One of his strengths has always been “connecting the dots” as you describe it. He is a conceptual learner and has always learned for learning’s sake, not for grades. Fortunately the grades usually followed but he has never been about competing with anyone but himself and has never cared about getting the top grades…he’s certainly anything but a gunner. </p>
<p>He knew that third year was going to be “his” year and it was.</p>
<p>He has asked me not to disclose his Step score but suffice it to say, it was good enough to make him very competitive for most of the desirable sub-specialties and highly competitive for a few of them. His class’s average score was over 232 and he scored well above that.</p>
<p>
</p>
<p>Eh, I would argue that there really isn’t as direct a correlation as you imply. The grading in the clinical years can be so subjective and more dependant on people skills. If you got a 270 on Step I, but can’t talk to patients, you’re not going to do so hot on rotations.</p>
<p>There are people who barely pass step I, but go on to honor all of third year, and of course the opposite.</p>
<p>
</p>
<p>Agree. S told me a story about another student who was in one of his rotations. Kid came right and said he had had zero trouble getting all A’s the first two years yet had not been able to get anything above a 3 (out of 5) on his rotations and in some cases was having trouble getting 3s.</p>
<p>Effective communication skills are very important and that also mean being a good listener. Lack of either of these will really bite you in a clinical setting especially when doing rounds.</p>
<p>
</p>
<p>I wish this were the case as I consider these things to be my strength. However, only 2 out of the 8 criteria that we’re evaluated on are “fund of knowledge” and clinical reasoning" so how good you are as a clinician doesn’t factor in a ton. Also, you are only going to be asked 1-2 questions per day and it’s highly dependent on luck whether you get those questions right. So, someone may very well prepare for a surgery, miss both of the pimp questions, and appear as if they don’t know jack squat. </p>
<p>
</p>
<p>I would say it has even less correlation with how well you talk to patients. I’ve done very well on the standardized patient encounters that we’re tested on at the end of each rotation. These are encounters on which you are judged on your history taking, physical exam skills, eye contact, empathy, listening skills. So, why are my clinical evaluations from attendings and residents so much more variable? Because they don’t observe me doing any of that! It’s rare for anyone to observe you take a focused history (maybe once per rotation). They have no idea how you interact with patients.</p>
<p>Instead, what I’ve found to be the biggest determinant of my grade is luck. There are a handful of students that are so charismatic and smart that you know they’re honors students within 10 minutes of meeting them. There are also a handful of very weak students. For the rest of us, whether we get honors or HP or pass really depends on the individual attending. I’ve had attendings give me straight 8’s or 9’s because they think that a student who does a good job deserves a 8/9. I’ve also heard of attendings give straight 5/9’s for a good job, not because they’re mean but because they thought a 5 was a good grade. Everytime I see an evaluation with the same score for every single criteria, I know the evaluator didn’t take a ton of time to think it through. And it’s frustrating to work so hard and then just get straight 5’s. Or even straight 8’s because you feel like the attending just gave you a random grade without much thought. For me, on the eight criteria on which I’m judged, getting 6’s and 7’s vs. 7’s and 8’s is basically the difference between a high pass and honors. But, there’s no standardization between attendings as to how they assign scores.</p>
<p>Appreciate all your input, folks. Third year sounds way too subjective even within a single medical school. Imagine the variability of these grades across various med schools then. </p>
<p>How do the Adcom-equivalent for residency spots weigh these grades from a wide range of med schools then?</p>
<p>
</p>
<p>Near as I can tell, they don’t. Grades are essentially accepted at face value. As for the “unfairness” of it, is it really any more or less subjective than the scrutiny residents face from their patients? As I see it, grading during the clinical years of medical school is no more or less fair than what physicians will deal with for the rest of their careers.</p>
<p>What I personally found very disturbing regarding clinical grading only became clear to me as I hit the interview trail. To put it bluntly, the more prestigious and/or desirable the residency program, the better looking the interviewees became. I assume that getting an interview spot at a great program means that you had the corresponding grades to match. What does that say about the way we grade? I refuse to believe that good-looking medical students are objectively better clinicians than their more average-looking classmates.</p>
<p>The difference is that the patients aren’t really grading the residents. Over the course of residency, you and any other doctor will **** off plenty of patients and often it’s not your fault. But, outside of a patient leaving AMA, what’s the consequence to you? I highly doubt your competitiveness for fellowships is dependent on how much your patients like you.</p>
<p>But, my grades are dependent on how much my attendings like me. When I apply, my grade in my radiology rotation as well as my six core rotations will be closely scrutinized. And those 7 or so grades will help determine what residency I get into. And scores from 1 attending can be enough to sink your entire rotation grade. I was talking to a friend today with a USMLE of 260 who received 1’s and 2’s (out of 9) from a surgery attending. There’s just no recovering from that. And I’ve done multiple rotations with this guy as my partner. There’s no way he (or anyone) deserve a 1 or a 2 (when a 5 is considered a “bad” grade).</p>
<p>
Male and female?</p>
<p>Just found out I got honors for my radiology rotation, which is good as it is almost a requirement to honor the radiology rotation if you want to get into anywhere good.</p>
<p>I’ve found this application process to be particularly stressful compared to applying for college and med school. Given that I’m not as competitive as in the past, I’ve needed to polish just about my entire application. Will be turning in my application in just about a month. Right now, I’m just trying to get as much of it done as possible since this month I have neuroradiology while next month I have my medicine sub-I where I will have considerably less time. Then it’s smooth sailing after October 1st. Fourth year is heavenly if not for the application process. It still is great compared to the workload of third year but there’s a different kind of stress.</p>
<p>I sure hope my kid gets good counseling, mentoring, whatever in this process. I believe that her plan is still to do a research year between MS2 and MS3 so maybe that will be a time to figure all this out.</p>
<p>The story about the dude getting the 2’s and 3’s just made me sick to my stomach. Two similar data points. In law school , our top student rubbed a prof the wrong way and he gave him a D in a 8 hour course. The other was my D who was torpedoed by a high school teacher in a college rec. Fortunately, the …uhhh… witch was clumsy and was found out before the torpedo hit the target. </p>
<p>I understand and respect the need for subjectivity in the process. I also understand that not everybody is good and true.</p>
<p>NCG, I’m relieved that your “Honors” came through for you. I know that has to be a relief. And thanks again for doing this thread. As much as it freaks me out, I need to start getting some sort of handle on this in case she looks to me for guidance. I dang sure won’t be offering this time.</p>
<p>
</p>
<p>Well done! :)</p>
<p>DD has enjoyed her rotations for the most part though she has little idea what area of medicine she wants to go into. She does seem to have figured out a few areas that don’t interest her at all in terms of a career so I guess that she is making progress.</p>
<p>Congrats, NCG! You should celebrate every victory in this arduous path! Way to go!</p>
<p>By the way, were you able to continue your research in MS3 or is this impossible due to your schedules?</p>
<p>Probably impossible as a M3. If you’re a motivated M2, you might have time to do some research although that’s pretty rare as well. Most people do research in the summer b/w their M1 and M2 years. It’s also possible to do a quick project as a M4 since your hours are generally better (although my comrades doing surgical specialties right now are working pretty hard). I actually just got involved in a project with a neuroradiology attending. Not really expecting a pub or anything. Just because I had some free time and maybe get a LOR.</p>
<p>I have heard that a lot of 4th year students have the option of doing a lot of traveling. Is this true? Can kids just leave for a month and go traveling during their 4th year of medical school? </p>
<p>Also why don’t kids do research during the summer b/w M2 and M3 or M3 and M4? Is there not enough time to get involved in a research project. One of my friends in med. school is currently aiming for orthoped. surgery residency and this kid never has any down time. If he isn’t studying, he is doing research or other activities that will boost his resume. Sorry if this question has been asked and answered many times but for competitive residency programs like ortho, does it matter where you went to medical school? (Top 20 versus top 50?) I understand that there a ton of other factors that come into play, but do top 20 med. schools give their applicants a boost in the application process?</p>
<p>Congrats, NCG. We are all cheering you on.</p>
<p>0701- I think the summers are MS2 are taken with school commitments, I know DDs tuition goes up for MS3/4 as they are year round schedules and assume other schools are similar.</p>
<p>
</p>
<p>I think what you’ve heard about is M4s doing away rotations at other institutions, frequently all over the country. So in that way, at least, you can do some traveling during fourth year - I suppose if you do an easy away rotation, you can slack off and consider it a vacation 
- but that would defeat the purpose of away rotations, which is generally to impress an institution that you hope to match at.</p>
<p>
</p>
<p>Between M2 and M3, you have to take USMLE Step I, which I can confirm from personal experience is a beast of a test to prepare for and take haha. Med students generally study for Step I for 4-8 weeks right after finishing M2 classes, and then relax or take a vacation with whatever precious time they have left before starting rotations. </p>
<p>And usually, you don’t get a break between M3 and M4 years. However, there is generally some vacation time built into M4. You also have to take Step II at some point in there. Some students take it early (i.e. during July/August/September) - others wait until Feb/March in order to keep it off their residency apps (if they think it might hurt them more than help). So every student makes their schedule to fit their goals.</p>
<p>As for your friend wanting to do ortho - well… most students wanting to match into ortho are gunners by necessity :D</p>