It was relatively rare that an attending actually took the time to watch me take a history or do a procedure, yet they were asked to rate (and routinely DID rate) my abiities in those realms. Given how busy they are, I think most attendings just come to a gestalt impression of students based on a few minutes of interaction. Giving a lukewarm impression in those crucial moments can wipe out the impact (on your grade) of hours of work on the wards.

If you’re good at impressing people in brief interactions, then you’re golden for third year.

My 3rd year while it was traumatic in two subjects because I kind of unfortunately ended up in the toughest “base” hospital by random selection (or maybe simply because the guy at my university in chrage of doing the selection simply dislikes me). But, other teachers knew how tough we had it and made our lives easier by demanding less of us than students from the easier base hospitals. I got a 9.7 in Medical Genetics and I’m still not fully sure how I did it. Students from a different base hospital that had the same teacher got on average 8.4 or something.

Save for a few subjects, most of my subjects were in the base hospital and so while I had different rotations that lasted a couple weeks each, they were all in the same hospital. It’s now in my 4th year that we’re running all over the place. I’ve had days where I had to be in two hospitals in two very different parts of the city plus another trip to my university faculty for another non clinical class. Without a car.

In my experience, unless you’re rotating with the head honcho doctor of that specific clerkship subject, you can do crappily on a rotation and it won’t matter much at all in your final grade. As long as you show up (or maybe just skip the rotation half of the time and just show up once for the signature that you at least kind of showed up), that’s all that matters. I never sucked up to any doctor, I was just polite, knew when I didn’t know the answer to something and participative because I felt like it. Only once has a resident complained about me and the guy was a jerk to everyone (plus his opinions never afected my grade in the subject). In mexico showing up for rotations is more because YOU WANT TO LEARN, rather than sucking up for grades. Your numeric grades comes from the exams of that specific subject. You won’t have many chances in the future to do pelvic exams unless you dedicate to OB/GYN, so use the chance while you still can to have a taste of every medical field even if you won’t dedicate yourself to it as a resident. I’ll never become a surgeon but still volunteered to help in operations anytime I could. I took out a placenta just a few weeks ago and would have caught the baby had I washed my hands just 30 second quicker. >_< Stuff like that just can’t be learned from a book.

Of course, mexican med schools don’t have USMLE equivalent exams, just the final professional exams that are done after you finish your internship year. You’d think then that becomming a resident was easy but it isn’t. Your sole chances of getting into a residency depends on your scores on the national residency exam which they say is tough as hell to pass with flying colors; much less to pass, period. It’s an exam designed to screw people and require book knowledge above all, and to know how to answer those kinds of exams.

Therefore, over here as long as you pass the subjects, your rotations don’t matter much academically in a direct way, but skipping rotations means you learn less which will affect your performance later on.

#2 Can you imagine if a PD admitted to #1 above? It would undermine the very philosophy of undergraduate medical education.

Seriously, tell me that is not messed up. I am proud of my E in medicine but if any PD looks into me eyes and tell me that my E is not good enough for them, then I am better off in a different program and they can shove the H. Literally.

I must mention this: if I ever become a program director, I will probably not take a second glance at clerkship grades. Yes, an H looks fantastic…but there is no information about the site, workload, the attending, organization etc (and I don’t/won’t bother to ask). After straight 52 weeks of requires and electives in private, county and independent nonprofit healthcare facilities, I have slowly realized that your clerkship grade may say a lot OR nothing at all but you are the only soul who holds the answer to that.

So, let’s face it: while step 1 scores may not be the best predictor for overall performance, it’s the best tool in initial application strength. I don’t care what the PDs say–their secretaries do the screening while they are in the OR (they really don’t have time to screen 400 applicants for, let’s say 4 positions in ENT). Plus, if you can do well on step 1 & 2 enough to distinguish you from peers, then you either worked really hard like most medical students or you are just gifted in taking exams such as these.

So, if I become a PD, yes, step 1 would be important. More than clerkship grades. In surgery, I busted my a$$ on the floor, carrying more than 5 patients at once and practically present in all surgeries and trauma call. Studied everyday. Aced the oral…average on shelf (I actually thought I was going to fail) and ended up with an E…primarily because of a surgeon. In OB, I paid more attention to taking histories, and doing pelvic floor surgeries. LDR was boring, csections were interesting. And I definitely had a great time raiding the surgery lounge refrigerator while looking forward to my ‘S” (at this point, I was a fustrated third year medical student—I was really pi$$ed off with the bureaucracy and unethical nature of clerkship grading). But I got an H. And guess what? PDs have no clue how I got those grade.

So, for the PDs that love clerkship grades, goodluck in perpetuating your delusions. I’d rather focus on step 1, research and community involvement. Back to my wine…

just…wow.

you guys are neurotic. do you really think that there’s a secret formula out there that everyone uses to determine which residency you get? do you really think that a number (whether it’s your awesomely awesome board scores or your honor society membership or your 3rd year grades) is going to be the sole determinant of where you end up?

lemme break down some knowledge for you: there is no single thing that will gaurantee/disqualify you from the bestest residency evah. we know you all like, totally rawk and each of you is unique and special. that’s why med school and residency applications leave only a few lines for your academic acheivements. b/c you’ve all already shown you’re the smartest dawg out there. now all you have to do is show what other tricks you can do.

did you ever join the student government and ry to actually help out your school or student body? work with faculty, not to get a letter out of them, but to get some meaningful work done? ever volunteer at a shelter in medical school? ever stay late to help out your intern (w/o then trying to weasel your way into a higher grade)? have you ever done anything for others that you haven’t put down on your resume? because if you have, then you wouldn’t be worrying if your board scores were just 10 points above the national average, or if you only high passed your biochemistry class. because you’d realize that there is no one field out there that will make you the happiest, or one program where all your dreams would be realized. you’d finally wake up and realize you’ve already made it.

a common problem among medical students is that we’re always racing to the next place. basically, you’ve spent your life going to infinity and beyond. and when you reach infinity, there’s really nowhere else for you to go but . . . beyond.

so calm down.