When I was a first and second year medical student, we had to attend a crappy â€œclinical medicineâ€ course. Ninety percent of the time, there was nothing about â€œclinical medicineâ€ to be found anywhere. Instead, we would sit around in a big circle with a group of 10 or so of my classmates and talk about pure shit.
Basically, hereâ€™s how it would work: Some goody-goody type question would be posed to the group. The question would usually be of the variety where you wouldâ€™ve sworn that a liberal tree-hugger just died and went to heaven. Something like â€œhow would that make you feel?â€ Or, better yet, â€œwhat scares you most about doing your first pelvic exam?â€ Holy shit, I didnâ€™t know if I was going to get out alive.
Then weâ€™d play musical chairs going around the room while everyone gave their two cents worth. After a week or two of this shit you could always predict which person would speak up first. Typically this was the student or two that was interested in family medicine, since the department usually organized this course at my school. Always gotta make a good impression, ya know.
Of course, I would always give some crap answer to just get by. At the end of first-year, we got our feedback about how we â€œperformedâ€ in our â€œclinical medicineâ€ course. My feedback was something along the lines of â€œneeds to participate moreâ€ and â€œdidnâ€™t show interest in participating in group discussions.â€
Oh really? No shit. Of course I â€œdidnâ€™t show interest.â€ I wasnâ€™t interested. Remember, I donâ€™t sell out. Didnâ€™t then, and still donâ€™t now. They could take their Dr. Feelgood shit somewhere else for all I care. What sucks about this course, and particularly the third and fourth year of medical school, is the subjectivity. This, in fact, was my first taste of subjective-based evaluations that would come to haunt me for years to come.
Subjective grading is rampant during your clinical years of medical school. There isnâ€™t really anything wrong with subjective grading per se, and it is a good model for evaluation if used properly. For example, most all jobs use subjective-based evaluations in some form or another. However Iâ€™ve found, based on my experiences, that jobs which utilize subjective evaluations do so on a more level playing field.
When non-medical work-based evaluations are given it is typically the same person that evaluates you each time. This provides a benchmark of thought on how well you are progressing. The turnover is very small and you could typically have the same person evaluating you for years to come. This is simply not true in medical training. For some reason what works for every under industry under the sun doesn’t apply to medicine.
Iâ€™ve had different attendings and residents for each of my rotations. Iâ€™ve even had new attendings and residents that come on board in the middle of a rotation. In fact, this is very common. Each has their own view of what is â€œgoodâ€ and what is â€œbad.â€ Very frequently, what is â€œbadâ€ to one attending might be â€œgoodâ€ to another. How hard would it be to coordinate student rotation schedules with resident schedules? Damn near impossible I would guess based on your stellar performance thus far.
How the fuck are you supposed to know what each new resident and/or attending wants? Well, thatâ€™s a really good question and one that I donâ€™t have a good answer for. Just when you think youâ€™ve got Dr. Joeblow attending figured out, some other tool comes in to take his place. Same thing with residents.
The best method I’ve found to deal with this problem is to not try and figure out what makes these guys tick. They each want something different, so I decided to offer them something different. Instead of brown nosing from me, they got just enough so that I would pass â€“ ass-kissing not included. This will lift a lot of weight from your shoulders, but you must be content with getting sub-par evals. I feel bad for the students that try to figure out what each attending and resident wants. Actually, I really donâ€™t feel bad – they could be like me and not give a fuck.