Third year a peculiar phenomenon occurs. Some of your normally reliable and friendly classmates become transmogrified into unrecognizable people. Previously quick to lend a hand and share notes, they now read up on your patients, pimp you in front of the attending, and don't pass along messages from the intern. Unable to cope, some of you may question if you need to descend to those depths to compete, or stay the high road. Rest assured, any and all gunning that you do should be directed at optimizing patient care and studying for the shelf exam as much as possible.
Clinical evaluations are arbitrary
If you are a normal, well-adjusted human being with a modicum of work experience your clinical evaluations will be completely fine. Adhere to basic professional standards like showing up on time, wearing clean clothes, and showering, and your residents and attendings will sing your praises. Although once in a while you may be stuck with someone who is a stickler and gives you straight competents (my institution’s equivalent of “average”), it’s more than likely you will also have other evaluators who are more loosey goosey with their advanced scores (my institution’s equivalent of “honors”). In the end, unless you are someone who is severely skewed to one end of the autistic spectrum or actively trying to sabotage your medical career you’ll end up with a blend between competent and advanced. This is a good thing that at least someone thinks your competent at something because I sure felt grossly incompetent for 85% of the time in each rotation.
Subjective evaluations are not necessarily bad
Many will decry that such subjectivity is “unfair’. Schools seem to agree somewhat and attempt to objectify these evaluations by using discrete numbers because numbers are supposedly less subjective because they are numbers. We all see the folly in this as superlatives and mediocrities are just replaced by numbers. Standardized criteria across evaluators is an unachievable ideal.
However - this is not a bad thing. As much as fragile gentle-hearted M3s may complain the thing to realize is that the world is not fair. Additionally you will be evaluated forever in your professional career based on some quantitative data (i.e. how many surgeries you performed, what your patient’s A1c scores are, what percentage of your hypertensive patients are adhering to their medications etc) but also largely on how your supervisors, peers, team members and patients perceive you. It’s not inherently bad or unfair...it just is. Experiencing this earlier in your professional training should help you realize how you need to behave to create and strengthen those relationships.
Focus on the patient and being a good team member and not what your gunner med student colleague is doing
Your time on wards is about learning the language and culture of medicine. When on wards take notice of the follow ups for each patient. Outstanding labs, consult notes, missing charts, etc. are all things you can help your team with by keeping an eye on. Actively look for ways to contribute. If there's a clinical question, offer to look up the answer and give a short 1-2 min explanation. Even little things help. On surgery rotations if you are holding the dressing supply bucket that will help your team round more efficiently so they can see all their patients on time before going to cases.
If your goal is to provide the best care possible for your patients, your residents and attendings will notice that and your clinical evaluations will be excellent.
Practice makes Perfect Presentations
The most significant interactions you have with your attendings and residents will be the 3-5 minutes you spend each morning presenting and discussing your patients. This gives an opportunity for your attending to assess how well you can reconnoiter data, interpret said data, and create a plan. With that said, how you present this information is as important as what you say. There's a certain amount of theater involved in promoting, arguing, and defending your point.
Speak with confidence and fluidity.
The only way to achieve that is to practice. Figure out if your attending likes full presentations or more focused ones. Round on your patients half an hour earlier and spend some time rehearsing the important points and how you will say those points. If you can master giving good presentations, I guarantee you will see more advances / honors in your clinical evaluations.
Exam grades are important
When the resident / attending tells you to go home...you go home. Repeat, go home when your resident tells you to go home. Don't stay especially if it is not busy. Instead, go home and study. Since most students will receive decent clinical evaluations, the main differentiator will be your exam scores. Every rotation that I did not get an A in was because of my exam grade.
Use UWorld as a staple. Pretest questions also help. Stick with one or two review books. Try to read and do some questions every day. 1 chapter + 20 questions every day. Over 4 weeks that's almost 600 questions.
Third year is the most challenging and rewarding time in medical school. You'll be pushed beyond what you thought you were capable of, but also find that you'll rise to the challenge. Work your butt off but also enjoy yourself. You'll look back and be astonished by your transformation over that year. As always, believe in yourself and keep on hustling.