this is an easy and impossible question to answer.

easy: work hard, be on time, make the interns/residents lives easier, ask smart questions that show interest--NOT questions that try to make you look smart (if that makes sense), don't complain about the work (as the residents and interns are 9/10 working harder than you).

impossible: you could do all of the above and still not get honors for one or more of the following reasons:
1) You are a jerk, and no matter how hard you work, all they will see is that you are a jerk
2) You come across a-hole residents or interns who grade you poorly because they can
3) You are at a site which is slow and unchallenging, not allowing you the opportunity to show you know anything (as was my peds rotation--all RSV and rota)
4) If the only person who grades you is an attending, whom you only see once a day for 1 hour, it is hard to demonstrate anything good about yourself

All you can do is your best.

Good luck

I agree whole-heartedly with Soudes.

Another school/rotation specific area is shelf exams. Some rotations place a high/unfair percentage of your grade on the shelf exam and what it often comes down to is everyone gets tightly packed clinical evals, unless you are a jerk or an absolute star, and the shelf separates the rest. I personally found reading early in the rotation more helpful than cramming in the end, especially for Gen Surg and Medicine. It might feel impossible to read at all during third year, but you'd be surprised how far a little reading can go. Search past threads about what books are good and ask around your school what is helpful, but try to read a little every day in the beginning and do more focused cases/questions towards the end or your rotation. Good Luck!!!

appropriate ass-kissing never hurts either!

Beware the dreaded question, "So what kind of doctor are you thinking of becoming?" Just about every resident and attending will ask you at some point in the process. If you are HONEST, like I was, and say "Orthopaedic Surgeon", then be prepared for some raised eyebrows and the need to bust your ass even harder to prove that you are still somewhat "interested" in whatever service you are currently rotating on.

I know some people have felt like they were prematurely dismissed by the attending/housestaff by declaring their intended field of interest. A much safer route is "I'm still uncertain" or "[insert rotation that you are on]" but you run the risk of looking either wishy-washy or a kiss-@$$.

Also, you will run into your past residents around the hospital throughout the year and I have to say it did feel good when I could honestly say, "Yep, still want ortho."

just a warning to those that feel the need to tell residents on your cores that you're interested in that field, they can see right through you. in the beginning i told just about everyone othat i was thinking about something surgical. once i knew it was ortho, i just told them that. most appreciated my honesty and told me that they were impressed with how hard i worked and how much i wanted to learn, even though in knew that "peds" (for example) wasn't my life's calling.

so i agree with the "work hard and show up on time" folks b/c no matter what your doing during your third year, those two things will get you far. but when they ask what you're interested in, the answer..."well i'm thinking about child psych, ob/gyn, or ortho" will clearly get you found out to be a pure b*llsh*t artist...unless you are generally interested in those three things...but i highly doubt that is possible.

the "i don't know" route also works if in an ortho/surgery hostile environment.

peace

i had good luck with following "i don't know" or "ortho" (both of which were true at the time) with "how did you make the decision when you were in my position". consistantly a GREAT conversation starter and a segue into a chance to get some solid advice about career choices. never be afraid to get to know these people - you NEVER know what you may have in common.

do your best to give credit, compliments, and attention to your fellow classmates, especially the quiet/shy ones. i know this sounds counterintuitive at some of the hypercompetitive programs, but believe me it works if you are sincere. besides, everyone complains about those programs being so competitive in the first place, so you can be a breath of fresh air and part of the solution. most folks will read this as "team player, confident, deferential", etc. this also puts you in a position to be protected/spoken well of when not around but your classmates are. assuming of course that you have not been a jackarse for the first two years, and that your classmates give you something to honestly praise them for. it goes without saying that these gestures should be genuine. avoid publicly displaying negativity as though your life depends on it, because it does. who likes to hang out with malcontents? also, actively solicit feedback continually, and make it clear to residents/attendings that you are not afraid of being wrong, but that you just want to be sure you are getting it right.

aaahhh, the wisdom of hindsight...

Agree with much of what has been said. I've tried both tacks; "I'm not sure yet" and "ortho!" I've gotten mixed results. Most of the medicine, peds, psych types seem a little put off--but not all--and the surgical types (ob/gyn, surg, er) seem to get it and say "good for you." I think my final advice would be at the minimum to tread cautiously. By this I mean if you have the feeling that coming out with it will hurt your grade/eval then don't go there. But some people feel this is the equivalent of selling out which I guess comes down to a personal decision.

As for getting good evals, it truly is a lottery in some ways. However, I've found that asking good questions, reading on your patients, and just showing interest go a long way. Don't be a tool and if you're going to kiss ass, do so tactfully. I personally enjoy shelf exams and look at them as an opportunity to separate myself from the ass-kissers and others who perhaps unjustly got too good of an eval. I encourage you to look at it this way because it's the one thing you have the most control over. You can't control whether you get a schmuck for a resident who's bent on screwing students over or who can't see through the slackers and ass kissers for what they are. I think the wash generally comes out in the end on average so consistency pays off in the end. Anyway, just my $.02 and good luck in finding your own way.

i got to evaluate med students this year on several rotations during my intern year. Yes, part of it is how smart you are, but dont be fooled. There were a couple of students i had that could not stop telling me how good their board scores were and that they had gotten all honors SO FAR and they really hoped that they could get one in gen surg (my rotation at the time). When i asked these guys questions, they generally did pretty well, but they just had the biggest sense of entitlement and poor attitude i have run across yet. They would NEVER try to pitch in and help out other students on the team. example: joe(false names) gets creamed on call the night before and is gonna have 8-10 patients to round on in the morning. Bob isnt on call for two more days and he only has 2 patients (got lucky on call). So i asked bob if he would mind picking up a few of joe's patients. His response? "I am only supposed to see patients i admit on call or go to the OR with. Besides, that is joes problem." It does not take a genious to figure out what kinda grade i gave him. He complained to the rotation director who asked me why i graded him so poorly and when i told him that story he agreed that bob did not deserve honors even though he got the highest grade on the shelf. In short, be the guy that you would like to be on a team with....

Well said bonedoc. I think it is better to be honest and tell them that ortho is for you. If you work you butt off, seem generally interested in the rotation, and are a team player, you will likely have a better shot at honoring with honesty than trying to suck up and tell them that you are interested in peds or IM.