For those of you that are medical students and residents, at times, it can be really tough to gain recognition for your work. I want to give you a little vignette of one uncomfortable experience with a difficult attending I had as a former medical student and then we will discuss how to counter a poor evaluation. Although your stories may differ from mine, many of you will experience something similar as you traverse through residency.

The Background Story

I was a fourth-year medical student subintern during a medicine rotation. And, my group consisted of myself, a pretty female third-year medical student, an intern, a resident, and a balding senior medicine attending in his late sixties or early seventies. The attending assigned us to go over interesting cases that presented themselves over the prior week. We were then to discuss the medical topics that arose from these cases.

First off, the 3rd year medical student began to discuss a patient with severe onset of hypertension. And, she went through an appropriate workup of the patient with hypertension as well as delved into the physiology and management of patients with hypertension. Not a bad presentation. Unfortunately for me, the attending would not stop affectionately staring at the third medical student. In fact, it was a bit creepy.

Next off, it was my turn to present. I had a great case of a patient Histiocytosis X/eosinophilic granuloma of the spine that I dutifully researched in depth. In fact, I knew the case and the topic cold. I rehearsed the presentation many times at home. So, I was excited to present. What could be bad about presenting a rare fascinating case that I knew well?

So, I began to present the case and then went through the process of how we came up with the diagnosis with history and imaging. Again, I noticed the attending continuing to inappropriately ogle the third year medical student. As soon as I started to discuss the topic, WHAM…. He shut me down by saying, “We don’t need to discuss this topic because it rarely occurs and you will probably never see another case like this in your lifetime. What a waste of everybody’s time!”

Problems With Gaining Recognition In Clinical Education

All too often, something similar to this scenario occurs in clinical medicine, whether you are in radiology or another field. Perhaps, you are a foreign medical student and the mentor won’t give you the time of day. Or, maybe, you are a little rough around the edges and your teacher doesn’t like your personality. In all these situations, favoritism for reasons other than merit and quality often trumps a great job.

No matter how you change the grading system to include milestones or other innovative ways of evaluation, bias can interfere with gaining recognition for your work. In the end, many times the final grade comes down to the quality of the evaluators themselves. (Don’t take it personally!)

At the same time, there are many positives about the experience of having learned about the topic of eosinophilic granuloma regardless of my evaluator. First of all, in my line of radiology work, the diagnosis of eosinophilic granuloma has come up in my experience several times. Second, from my own studies on the topic, I have used the information from that presentation to the betterment of my patients. And finally, the topic has arisen on some of my radiology board examinations and I knew all the answers to the topic cold. So yes, there was something educationally valuable from this experience.

How Can We Align The Evaluator With The Recognition Of a Good Job?

That brings us back to the crux of this post. What can you do to bring the attention of your quality work to your evaluators when they don’t want to give you the time of day? I do not claim it is going to be easy. It certainly isn’t. But, there are a few workarounds.

Get What Makes The Evaluator Tick

First, ask your evaluator what it is that interests him or her. Now, I am not asking you to be a brown-noser, but sometimes in order to garner the attention of our seniors, we have to find out what makes them tick. A person such as this is more apt to listen to you when you are on the same wavelength. Admittedly, in my case above, if I would have changed my topic I think it still would have been difficult to change this attending’s opinion of me. But, at least, I would have presented a case that would have been more likely to get his attention.

Defy Expectations

Next, go above and beyond the expectations of the evaluator. For instance, perhaps, I could have begun a quality initiative study to improve the outcomes of patients on his service and put his name on the paper. My story above may not have ended differently if I would have provided the “ogler” with something distinct and memorable. But, it would have increased my chances of garnering recognition for my work.

The Nuclear Option

And finally, sometimes you need to go to the top. Things can be on occasion so bad, where you cannot even fathom doing anything that will change the opinion of your senior. But be very careful. Heads of departments will often side with their staff before they side with a resident or medical student. So, if you are going to use the nuclear option, make sure you have objective evidence that this person is unfair to you without trying to get your evaluator into trouble. And, also make sure that the director is willing and able to help. Sometimes, they can pair you up with someone else that can evaluate you for your work.

Take Action>

We all encounter people in positions of authority who may not be “fair” to their subjects. It is part of what we experience in medical school and residency and it is part of the real world. Most of us are somewhat sheltered from the real world through the beginning of medical school because our teachers’ main method of evaluation is exams. Suddenly as we enter the clinical years and residency, evaluations become more subjective.

It is important to learn how to successfully interact with difficult attendings who may unfairly evaluate your work. Don’t be another technicality of a poor mentor. Be proactive in your education and obtain the recognition you deserve.