Friday, March 25, 2011

Bummer of a day

It's been a down day--I know, I know, I'm on surgery and it's been a down few weeks. Today has really capped off this last month, though.

I'll start backwards first. We have this online system for evaluation of our clinical rotations. Basically, you log a patient, send it to your preceptor for evaluation, and whatever the sum of your evaluations says, that counts for 75% of your grade. The other 25% is your shelf exam.

I got the results of my shelf exams earlier this week. They aren't as good as I had hoped (I can always blame the raging shingles outbreak, I guess), but they aren't so bad that I'll be able to retake them and improve my score. It's basically at or just above the national mean for the disciplines--I'm assuming that is a passing grade for my medical school, but who knows. I had been in contact with my dean, and the understanding was that if I bombed the shelf exams, maybe we'd work out a plan B. Instead, I probably did enough to pass them, but the grades will prevent me from getting honors. I won't know for sure for a few weeks yet.

The other frustrating thing is that the evaluations/grades don't seem to mirror how hard I worked. I got really positive feedback from my family medicine people, and if my shelf exam had been better, I am pretty sure I would've gotten honors. On the other hand, less than half of my pediatric preceptors filled out evaluations. The ones that did maybe put in one or two general comments--nothing bad, but nothing that stands out. I got my rotation assessment, and it really seems bland to me. I got better feedback from neurology! So, despite the fact that all of my pediatric preceptors told me I did a great job, I was comfortable with kids, I should think about pediatrics, etc, it doesn't count for anything if they never responded to the evaluation form.

I still don't have my OB/gyn comments back, but the response rate on those was about 10%. So, 75% of my grade will be based on 10% of my performance. Not fair, but that is how the system works.

I am really frustrated by this. I worked especially hard in pediatrics and family medicine. Now it seems as though all of that work is for nothing. I could've worked much less hard for the same grade. The whole system seems arbitrary, and it is extremely frustrating.

Today has also been a frustrating day on my current rotation. The other med student on my team is a rock star (S, if you read this, you are totally a rock star!). She's great, and I'm glad she's on my team. It's tough for me to be the less preferred member, though. It didn't help today that the resident and I got our signals crossed. I had asked him three times about what he wanted taken care of--when I did it as we had discussed, it was obvious that I hadn't done it the way he wanted. There was no patient harm or anything--I'd never do anything if I was worried it wasn't in the patient's best interest--but it was frustrating. At least the other med student had heard the same thing I did, so I wasn't totally out of my mind. I could tell that the resident was annoyed with me, so I went and finished my to-do list out of his way for a little while.

I was definitely feeling like I could do no right, no matter how hard I tried. I was helping him change a patient's dressing a little later, and the patient looked at me and said, "You're pretty." I nearly cried. I was tired, my hair was back in a messy ponytail, I had no makeup on, and I was feeling down. (And let's not even touch the body image issues I've been battling lately). I looked at him and said, "Thank you. That's the nicest thing anyone has said to me today." Granted, he was on pain meds and probably said that to every person he saw that day, but it made me smile.

I'm just down because today I felt worse than invisible. Despite my best efforts, I feel like all my team sees are my shortcomings. I try hard to write thorough patient histories--I might've caught a colon cancer in a patient and prevented him from bleeding out during surgery--but that gets no notice. I do blood draws, I run scutwork, I do whatever needs to be done and am always willing to take on more. Instead, my low moments end up being the highlights. Today, for instance, even though the resident was busy and I had confirmed the plan multiple times, I should've asked him to show me what he wanted done. I know that doesn't save him any time, but then it would have been absolutely certain that we were on the same wavelength. I thought I was saving him trouble. I didn't want to seem like a pest. Next time, I'll be a pest.

I am glad my three weeks of vascular surgery are over. I really feel like I didn't learn much more than what I could've learned reading a textbook. The service is so busy that there really isn't time for teaching. My overnight call this week consisted of three (very stressful) emergency surgeries with an attending I had never met before. Thank goodness the helpful resident was also on call, as was another med student from the general surgery team. We had an abscess debridement (where the patient lost all of the skin from his anus to his scrotum), an emergency procedure where the patient was bleeding out into his abdomen (and lost most of his blood volume), and another exploratory procedure because the patient was though to have strangulated bowel. There was also a respiratory code on one of our patients on the floor. Thankfully, everything turned out ok, but we were so busy with emergencies (and then the usual night shift work) that there was no time for teaching.

I got to watch surgeries these last three weeks, but I didn't get to do much beyond retract and cut sutures. I did a few blood gas draws and one intubation with the anesthesiologist, but otherwise everything else I learned was from reading. I've been told there is more OR time on general surgery (I'm not sure that is good or bad). I'm not looking to become a surgeon, but I'd like to learn about how surgeons decide what is an appropriate clinical indication, when surgery is worth the risk in some of these high risk cases, how you manage patients post-operatively, etc. I feel like the clinical rotation is supposed to be seeing how the service works. I really feel like I was more of a minion than a member of the team--and questions about why we were doing something were absolutely not encouraged. I understand not answering a general question that can be researched. However, I sometimes had specific questions about why we were doing X in a patient instead of Y. Sometimes the chief resident would give me a one sentence answer, but generally everyone was so busy and overworked that they didn't have time for more than a few words.

Anyway, it was just a rough day. I felt like a piece of crap, and seeing how much the resident preferred my co-medical student was the nail in the coffin. It is absolutely not the other med student's fault--I am thrilled she is on my team--but favoritism hurts. I guess all I can do is try my best. All the hard work I do may never get noticed, but at least I know I am doing it. It's not like my online evaluations will get filled out anyway. Part of me feels like that if there is no chance to get an honors grade on this rotation, why try so hard? My sanity and sleep would probably benefit from me back things down a bit. Still, I feel like I need to do the best I can so that I know my non-honors grade wasn't from a lack of effort on my part.

Here's hoping medicine is a better fit for me...

1 comment:

  1. all i can say is . . PROMISE: it gets better! and try to focus less on grades/feedback and more on what you are learning :)