“Nobody really pays attention to your clinical knowledge, just be normal and your preceptors will like you.”
Or at least we hoped, as we tried to comfort ourselves with the first day of clerkships looming closer and closer. Our cohort was entering a time that required not only knowledge but also application of it. If that were not enough, narrative evaluations of this exciting era would make their way to our medical school performance evaluation (MSPE) and among the sea of unblemished resumes, read by those deciding where we will or will not end up. I attend a program with pass/fail clerkships, so narrative evaluations hold even more significance, which sent me on a hunt for advice on how to do well in my clerkship year.
“I’ve figured you could show up to a rotation with minimal knowledge and if the people like you, it would go smoothly,” an intern said.
“Taking baked goods did wonders for me.”
“Don’t be a try-hard.”
“Read the room and be teachable.”
“Always say you’re interested in whatever specialty you’re rotating on or that you’re still deciding.”
An attending surgeon advised, “Know things. People notice that.”
“I don’t care about your medical knowledge. You probably don’t know much anyway,” a clinical skills coach reminded me and my classmate.
“Your personality is irrelevant to me. As long as you’re good at what you do, I’ll be happy working with you,” an attending physician volunteered.
I started my rotations on a cold, dark day in January. I showed up at 6 a.m. sharp to a work room lit by colorful fairy lights, where the night resident graciously clicked through what would be the first real-life head CT I would read. I was anxious, excited, and ready to learn and be helpful. Since then, I’ve had the distinct opportunity to see myself through the eyes of numerous interns, residents, and attending physicians. I’ve been called engaged, compassionate, and receptive to feedback, and advised to hone my clinical skills, improve my confidence, and, of course, keep reading.
Then on a warm Sunday afternoon in July, after much anticipation, I clicked on the freshly uploaded evaluation of my most recent clerkship. While most of the evaluators, much like prior clerkships, had positive things to say, one wrote that I was noticeably disengaged from the nonoperative part of medicine, needed to learn to have humility, and that my enthusiasm for the OR came off as being overly assertive and, again, uninterested in medical management.
There it was, a few lines in a gray box titled “Narrative Evaluations,” cautioning evaluators that their words may appear in the student’s MSPE. I had volunteered to see consults, triages, write notes, and help patients in any way needed, thinking I had built rapport with the mentioned preceptor. None of the words in that box were ever said to me when I solicited feedback in person, so I just stared at them dumbfounded, hitting the mental playback button for my weeks on the service.
Knowing the potential impact their comments may have, evaluators balance providing honest feedback and the risk of negatively impacting a student’s career. The widely understood solution to this dilemma is providing constructive criticism in person and making only the strengths of a student visible to residency programs on the narrative evaluation form. Typically, placing constructive criticism that was not previously discussed with the student in this evaluation is not recommended and is reserved for extreme cases, such as dishonesty and unprofessional behavior, rather than a perceived lack of interest. So, back to my evaluation: What prompted my preceptor to make this rather unconventional choice? Had I not “read the room”? Had I been the complete antithesis of the role-model medical student?
Friends, mentors, and even academic advisors told me not to take it personally, to just learn and move on from this sporadic evaluation, that I was not alone in this experience, and after all, the person filling in those evaluation forms is only a human being. They may have had a bad or unusually busy day, and a month after a medical student has rotated off-service, they receive yet another reminder email for an evaluation form. So, if I think there is some truth to it, I should modify my behavior, and if not, let it “roll off my back.” Ultimately, those comments did not make their way into my summative clerkship evaluation. I still could not help but wonder, why had this evaluator — whom I thought all had gone well with — consciously chosen to write something they knew could hurt my career?
In the subsequent weeks, I recovered from the aftershock of these comments. There was not much I could do except keep striving to become a capable, collaborative, and professional physician. I learned that given the choice, it is important to choose evaluators who have shown that through feedback, they aim to shape me toward becoming a better physician rather than using feedback as a tool to express their agreement or lack thereof with my presence and personality. I believe this is part of “reading the room,” recognizing that while professionalism and objectivity are ideal, human nature can sometimes lead to unexpected outcomes.
Once I am in the role of evaluator, I vow to be mindful of the power my written word holds, constantly assuring that the feedback I immortalize after I click submit is consistent with what I provided in person. I will be intentional with my words, recognize any personal biases as well as the fluctuations of my own mood, and not permit them to influence the evaluation I provide. When I see areas of potential improvement, I will prioritize prompt, private, face-to-face conversations that foster understanding and growth, rather than providing delayed written feedback that will be read by others and not necessarily have constructive impact.
How have you been impacted by evaluations? Share in the comments.
Helia is a third-year medical student at Yale School of Medicine. When not learning medicine, she can be found sketching, collecting rare books, and bouldering. She is a 2024–2025 Doximity Op-Med Fellow.
Animation by Jennifer Bogartz
