if you have to ask, then you don't have it
By Guest on Wednesday, 02 March 2005
Posted in Match Center
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I started this thread as a spin-off from postings on this thread:

http://www.orthogate.com/index.php?name ... pic&t=2293

The thread seemed to be digressing, and I wanted to maintain the spirit of that post (which was to get info about away electives) in order to keep it useful for its intended purpose. At the same time, I feel like this is an interesting topic to just discuss ... so here goes ...

you know it's funny, some of my fellow residents were discussing yesterday what makes some med students better than others. assuming that your intelligence/knowledge base is suffice, what is that quality that makes you a star on an away rotation. we talked it over and came up with this answer.

if you have to ask then you don't have it.

where do you learn this "skill"??? on the playground when you are 4 years old. if you help others, share, don't fight, don't talk back, listen you are pretty much better than most medical students. i hate to simplify it that much, but now being on the resident side, it's amazing how many socially inept MDs there are, which is probably a function of a number of things. hyperfocusing their whole lives and becoming too high strung. many but not all have been spoiled by our parents so we could focus on school. a host of other personality disorders that medicine self selects run rumpant in hospitals. wait until you are residents and i promise some of you will agree!


I see what you're saying, but vehemently believe that you are oversimplifyinng way too much. You yourself make my point ... "it's amazing how many socially inept MDs there are." The problem is that our grades in 3rd year are largely based on the opinions of those doctors who may be socially inept, as well as very human in many many other ways. While I am in adamant agreement that "if you have to ask, you don't have it" in *some* way -- knowing what you need to get good grades in 3rd year is vastly different from knowing what you need to be a good person (which is what i equate with being a good med student and doctor -- share, help people, listen, work hard, etc etc).

Your point is well taken in some cases ... for example, classmates of mine who complain "there's just no way to honor these rotations," while at the same time *not* reading ahead, *not* asking questions, *not* going the extra mile, *not* staying late. But I also see many classmates who are amazing with patients, stay late to do extra work that no one will ever know about, read like crazy, and then get shafted by toxic residents, oblivious resident, or residents who are out to prove they're the bomb by setting unrealistic expectations.

I'm sure students who ask on this forum how one can honor rotations, are really asking how they can maximize the chances that the hard work they planned on doing anyway will be noticed.

There are *very* few residents I have met this year whom I want to be like ... when *I'm* a resident (as you said), I will do as they did. They made it clear up front what I need to do to do well, and then what they felt was the "extra mile". Then they showed that they were as enthusiastic about teaching me as I was about learning. Then they took time to notice what I did well, and where I could improve, and they let me know every step of the way. When things are laid out that clearly ... the good students will meet and then exceed whatever is laid out ... the bad ones, even having been told how to excel, simply won't.

I am an MS3 so my opinion is, quite frankly, worthless. However, I have a fundamental problem with some of the tactics in this game we play for residency.

1. Hiding behind a big step 1 sore......My thinking is if you rocked it once, why not just take it and rock it again. It has to look impressive if someone kills both Step 1 and 2 before interview time. I see it as refusing a rematch against an opponent you have already beaten.....

2. This whole away busisness about the risk benefit. I plan on rotating at places I want to match. So for me an away is a chance for me to show these people why they want me. I mean a big score is nice, but hard work is just as important. If you have a great away, then they have some much more than an application. I think that if you don't do any away rotations -- this might send the message you are hiding something. An away tests your character and qualities that cannot be measured numerically --- like the same ones that differentiate between good and bad doctors.

I know that every one will say why take the risk.....but I dont think I should change my tactics now.


You could look at it that way if you think the boards are excellent measures of your potential ... if that were the case, residencies would just base their choices on those scores. I view them as very rough measures of how well you represent your potential on one single day. If you just happened to have a bad day when you took step 1, you would expect that you should be able to make up for it by doing well on step 2. It seems unfair then that people who did well on step 1 should have to take a second test, where the best they can do is "the same", and where there are many more ways to do "worse". I worked my butt off to do well on step 1 ... you're telling me that I should risk having a bad day to take a second test, where the best I can do is "not bad"? Why should I take that gamble with my hard work?

As far as aways ... my questions came about because you can only do so many aways ... usually about 2-3 ... which means the vast majority of places where you apply will be places where you didn't rotate. In that sense, the "you should rotate to prove yourself" theory doesn't hold up. In addition, as I mentioned before ... my issue is that the whole 3rd year grading system blows ... I'm not sure how to make it better, but fact is, we might as well draw straws (not quite that bad, but pretty bad).

Anyway ... sorry if I'm pissy today. I just stayed 2 hours late today doing what should have been a 10-minute job, because the resident screwed up and didn't do what she should have done ... and then got scolded by her because it took me so long ... even though I could have just gone home because I *volunteered* to do it. See what I'm saying?

Oh well ...
The key to 3rd year is that there is no key. There is a delicate balance between work and personality. No one knows who will react to what, who will be impressed by what, who will be annoyed by what. Of course you need to know your stuff, you need to study hard, learn the material, and prove what you know on the floors and on oral/written exams. On the other hand, you need to do all of this in a way that doesn't irritate everyone else. Answering questions asked of other students makes you look knowledgeable, but also makes you look like an jackass. Getting up early to pre-round is great, as long as you don't show up everyone you work with. Kissing up is great, but can also really turn off people.

The bottom line is whether you make your team better when you're there. The more you try to be a valuable member of the team, then you'll likely do well. Yes, this has a lot to do with personality. It kind of sucks, but it also kind of makes sense -- no one wants to work with a genius jackass (of course they won't want to work with a stupid kid with lots of personality). On ortho aways, personality means even more. Showing your ability to work hard, learn material quickly, and utilize the information well/intelligently is very important. But, no department is going to rank someone highly is they're a complete tool and no one can work with them -- they don't like the ones that steal others thunder, upstage their colleagues, and backstab others. Work hard, work well, learn your stuff, and do the right thing -- if you're not socially inept, you'll do well.
Guest
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21 years ago
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I want to go on record saying that my comments were not directed at anyone --- I just see these as particular themes that seem to surface.

As for third year grades, yes -- its totally nuts how these are constructed. I just always try to rock the SHELF and that way at least in my heart of hearts --I KNOW THAT I KNOW THIS STUFF. You are so right-- I have no F-ING clue how they come up with some of these evals. I mean an attending who sees me for 2 hours a day on rounds and never even sees me talk to patients -- grades me on history and physical taking -- it blows my mind. My school only has honors and pass... and a near honors which is almost impossible to get. They give honors to the top 10-20% depending on the clerkship. So basically if you are in the top 25% you get the same pass that the very last dead beat gets that gets the 10% on the SHELF and does sub-par work. where is the justice in that? They use the narrative evaluatins--- but they dont count crap for AOA. I know some schools have 4-5 differnt grading levels...and this seems much more fair than our all or nothing system.

As for step 1 being only one day -- yes this is true. However, almost every other contest / exam in sports and academics is only one day. And the great ones rise above and come through in the clutch.
If you complain about the subjectivity of third year grading.....then smoke step 2 and show everyone that you know your third year stuff very well.
I see the step exams as justice --- no egos, no personality conflicts, no favoritism -- just me and what I know against the same test that everyone else takes.
Guest
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21 years ago
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Of course you need to know your stuff, you need to study hard, learn the material, and prove what you know on the floors and on oral/written exams. On the other hand, you need to do all of this in a way that doesn't irritate everyone else.


I'd agree that can definitely help, but not always, and not even most of the time ... simply because, as I said, the graders are human. It also speaks to the fact that yes, if you have to ask, you don't have it ... because it's nothing you can learn quickly ... it's a personality you have to have, of being able to work hard, be smart, and at the same time not look like a tool. Over time, it can (and should) be learned ... but it's not like book smarts where someone can say "read this book and you'll ace your rotation."

Still, like I said, it seems to me that in 3rd year, you make a lot of great decisions and work your butt off, just so your chances of doing well vs. poorly is slightly better than 50% ... and you can't really do much more than that ... which is why away rotations scare me.

The bottom line is whether you make your team better when you're there.


This is the thing that perhaps will make 4th year better than 3rd year ... my issue up to now has been that a lot of people don't *allow* you to make your team better. Students can only do so much to help out ... residents also have to provide the opportunities. My feeling is that residents should provide us ample opportunity to step in and help out ... and then the good and bad students will weed themselves out.

Similarly, as 3rd years, we simply need time and space to work hard. One of my biggest peeves with one of my least favorite residents was that she would send me to the ER to admit a patient, then show up 15 minutes later and jump in. Worse yet, she would sometimes forget to page me until after she had started interviewing the patient ... and since my histories obviously will take longer, she would leave to start entering orders and writing notes before I finished. This would happen in almost every aspect of that rotation ... no time or space. You could argue that maybe I was too slow, but the attending sure didn't think so, and luckily for me, he was one of the few attendings who wrote student evals.

I want to go on record saying that my comments were not directed at anyone --- I just see these as particular themes that seem to surface.


I didn't think they were, don't worry ...

... I just always try to rock the SHELF and that way at least in my heart of hearts --I KNOW THAT I KNOW THIS STUFF. You are so right-- I have no F-ING clue how they come up with some of these evals.


Yeah well, so far 2/4 of my rotations have only used the shelf as swing grades in case you're borderline ... and worth 10% and 20% of the other 2 rotations.

... I know some schools have 4-5 differnt grading levels...and this seems much more fair than our all or nothing system.


I beg to differ ... there's no way in hell that they can gauge to that fine a level. It's so subjective and rotten of a system, that the true resolution is really black and white ... pass/fail. It's akin to using a webcam to examine path slides. I'm of the opinion that it should all be pass/fail ... plus, the grades detract so much from the learning. I love being in medicine, I love the OR, and I'm willing to work ... but worrying about grades that don't even reflect any reality just takes all the fun out of it.

... However, almost every other contest / exam in sports and academics is only one day. And the great ones rise above and come through in the clutch.

... I see the step exams as justice --- no egos, no personality conflicts, no favoritism -- just me and what I know against the same test that everyone else takes.


Justice ... well, if you want to use that analogy, then having to take Step 2 even though you aced Step 1 is akin to double jeopardy. As far as sports ... the great ones *don't* always come through ... remember the jordan nike commercial where he talks about all his failures. Except here, if you don't come through, you can never play ball again. It ain't a game ... it's your life. Screwing up on Step 2 is likely to be worse than screwing up on Step 1 then making up for it on Step 2.
Guest
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21 years ago
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Damn blue, you need to chill on the long ass posts. Nobody wants to read and re-read posts that long!! Anyway, don't start stressing out so much now. It sounds like you are a strong applicant and you know what you want, so do 1 or 2 aways at places you might want to match at, don't take step 2 if you did well on step 1, work hard, be yourself, and you'll be fine.
Guest
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21 years ago
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Damn blue, you need to chill on the long ass posts. Nobody wants to read and re-read posts that long!! Anyway, don't start stressing out so much now. It sounds like you are a strong applicant and you know what you want, so do 1 or 2 aways at places you might want to match at, don't take step 2 if you did well on step 1, work hard, be yourself, and you'll be fine.


Who says long ass posts indicate unchillness? My long-ass posts are just because I thought this was an interesting topic, and I like to think about how things are ... and perhaps how things could be better.

My non-chill posts are the shorter ones where I ask specific questions in an effort to address my worries. This thread is just a philosophical diversion. If you don't want to read it or discuss it, you don't have to ... which is why I split this topic from the original thread ... I didn't want the important questions in the original thread to be missed in the midst of this discussion.

I appreciate your words of encouragement ... although as I'm sure is the case with all us surgical types, I don't like to leave things up to chance and think what I'm doing is enough.
Guest
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21 years ago
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Blue, I am impressed with your forum quoting skills. You must be one of those "computer whizzes" I have heard about. Maybe I need to sign up for a computer class at the local community college so I can spruce up my posts.

Seriously though, I have to second Raven in that you sound a little stressed about the process and it is very early. If you continue down this road you are going to be ready to hang yourself by december. Your stats look great and many of the people I know would be willing to sell their soul to start the process with that kind of record. There are plenty of programs in the region you are wanting. In the end, it looks like your record has the potential for getting plenty of interviews. If you decide not to do an away rotation, it probably wont hurt you, but it also wont help you in getting an interview, bumping you up on a rank list, or in deciding your own rank list--nothing ventured nothing gained. Good luck and try to enjoy your last year.
Guest
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21 years ago
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Blue, I am impressed with


your forum quoting skills.


You must be


one of those


"computer whizzes" I have heard about.


Why thank you, in fact I am. Not really, but I'd be willing to teach you how to quote for a small fee ... say, a recommendation letter saying how amazing a quoter I am. Will that help?

Well, I appreciate the concern, but like I said, you gotta separate my career concerns (other thread) from the fact that I think 3rd year sucks majorly in many ways, many of which are fixable ... and many of which are simply due to human nature. It's a paradox that it's also the best year of school I've ever had in terms of the cool things I've learned and seen, and joining a really cool club, even if it's at the absolute bottom.

And ... since when did this become the psychoanalyze me thread? My psych rotation preceptors told me I'm the most well-adjusted med student they've met in a long time ... so it's official and verifiable. So there.
Guest
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21 years ago
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Dude, are you a tool, or just reallyl bored ?
If you're not just really bored, you probably should go into medicine, b/c no orthopod I know is gonna want to be around somebody who talks so damn much.
Guest
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21 years ago
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the only response i can really give to that is ... thanks, OrthoOverhaul, for your kind private message ... and thanks to everyone else who had something constructive to provide, in the true spirit of orthopods.

OrthoOverhaul made some suggestions/observations that were like an epiphany to me, and "solved" my away issue as much as it could be solved. i'll post it for others to benefit from after i scrub this nasty feeling off me.

thanks
Guest
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21 years ago
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2b. Personally, I would rather not work with a prick like yourself. This guy is just concerned like all of us were at some point. How easy we all forget how much this process sucks.
Guest
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21 years ago
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ps. when the heck did this forum digress to that of bigsoccer.com or an aol chat room? I thought we were all professionals in here trying to throw in a little moral support rather than putting people and other fields down just to feel better about ourselves. Grow up.
Guest
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21 years ago
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thanks, bonehead ... i do apologize for the rambling, but i really appreciate how considerate and helpful people have been.

b
Guest
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21 years ago
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I'd be more than happy to work with any of you long winded or thoughtless pricks because that would mean that I matched. I prefer short posts; along with hot women lying, dancing, or surfing naked on a beach.

End of digression, I am bored and waiting until the 14th, but not that bored...

Crackbone
Guest
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21 years ago
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