Failed an elective - what next?

[zgripflight 2]

I recently failed a visiting clerkship elective. I'm a new clerk, and was completely caught off guard with the grade as no preceptor indicated that I was on my way to a "deficiency." I thought I had a good rapport with the preceptors and patients, although they did point out that they expected me to have more knowledge in the sub specialty. Honestly, much of what they wanted me to know felt out of scope of my clinical education but I was fine with the somewhat unfair pimping. Otherwise, I thought the elective went fine; I was always early, read around patients, offered to stay late and help - and I often did.

The review said they expected better presentation skills and a stronger ability to create DD and plan, which is fair. But there were no residents during the rotation, an no one observed any exams/interviews which are normally my strong suit. My plan also evolved from the interview/exam which no one witnessed. And it was my first week of clerkship...

In any case, I'm wondering how screwed I am. Still have +1 year of clerkship. Is this considered a major red flag? Am I screwed for any specialty, even non competitive ones? I have to remediate the elective at the end of clerkship -  after interviews - if that makes any difference.

Thanks for any input.

[shady 39]

I've never heard of anything like this before, let alone one in the first week of clerkship. Speak to your school's elective coordinator and figure out where to go from here.

EDIT: I mean to say it's extremely unusual for a program to fail a visiting elective student. That thought never even crossed my mind as a possibility back when I did my clerkship electives.

[freewheeler 548]

Was there an attempt at the start of the elective to explicitly clarify expectations and inform them of where you are at in your education--ex. just started clerkship?

[zgripflight 2]

 

6 minutes ago, freewheeler said:

Was there an attempt at the start of the elective to explicitly clarify expectations and inform them of where you are at in your education--ex. just started clerkship?

I'm in a program where we start clerkship with electives, and we do basically 1 month of pre-clerk electives - so little hospital experience. I thought I made that clear to both preceptors, and they did mention it in the review - " this was ____________'s first clerkship rotation and should be taken into context with performance in future with increasing exposure to rotations."

 

9 minutes ago, shady said:

I've never heard of anything like this before, let alone one in the first week of clerkship. Speak to your school's elective coordinator and figure out where to go from here.

EDIT: I mean to say it's extremely unusual for a program to fail a visiting elective student. That thought never even crossed my mind as a possibility back when I did my clerkship electives.

Thanks for the input. That's my next step, although from what I understand from my school's policies, I don't think there is much in I can do when it's a visiting elective.  

[freewheeler 548]

Talk to your UME in person. 

Hard to know for sure as of course none of us were there to observe you/your staff on the elective, but it sounds like you just got screwed over by a staff who while they acknowledged your station in your medical training, hit the deficiencies button when honestly at your stage the expectations have to be pretty low.

Subspecialists can be pretty out of touch with that stuff, especially if not at your particular home program.

Just learn what you can from this experience, and if nothing else it gives you something to talk about when CaRMS interviews roll around and pretty much every program will ask you to tell them about a time you encountered some sort of difficulty or conflict during clerkship or how you deal with negative feedback.

CaRMS is such a blackbox with its subjectivity and inherent randomness it is difficult to say for sure what impact it will have on your application or how different programs may receive it, but honestly just keep shooting for whatever it is you want to do. You'll graduate and match to something somewhere as long as you don't accumulate many performance deficiencies.

Also keep in mind that on your MSPR it will only include comments from the ITER that are labelled as being on the MSPR and the last radio button selection of satisfactory/unsatisfactory, etc. not the entire thing.

[JohnGrisham 1,694]

Wow, sorry for your situation. Who fails a clerk on their very first rotation? And honestly, i get you're at Mac or Calgary - but starting your students off on a subspec rotation not at your home program is not the smartest organization. Did you choose to go OOP for this elective and in this specific specialty? 

 

42 minutes ago, zgripflight said:

I recently failed a visiting clerkship elective. I'm a new clerk, and was completely caught off guard with the grade as no preceptor indicated that I was on my way to a "deficiency." I thought I had a good rapport with the preceptors and patients, although they did point out that they expected me to have more knowledge in the sub specialty. Honestly, much of what they wanted me to know felt out of scope of my clinical education but I was fine with the somewhat unfair pimping. Otherwise, I thought the elective went fine; I was always early, read around patients, offered to stay late and help - and I often did.

The review said they expected better presentation skills and a stronger ability to create DD and plan, which is fair. But there were no residents during the rotation, an no one observed any exams/interviews which are normally my strong suit. My plan also evolved from the interview/exam which no one witnessed. And it was my first week of clerkship...

In any case, I'm wondering how screwed I am. Still have +1 year of clerkship. Is this considered a major red flag? Am I screwed for any specialty, even non competitive ones? I have to remediate the elective at the end of clerkship -  after interviews - if that makes any difference.

Thanks for any input.

 

[JohnGrisham 1,694]

Also, as a general rule at least in my experience - you can't receive a fail or "deficiency" unless you received Mid-rotation feedback to the effect that you were performing as such, and offered support on how to address deficiencies. I'm pretty sure this is a Accredidation standard. So talk to your UGME, and figure out what recourse you have. Pretty unacceptable, unless you completely slacked off and didnt show up (which doesnt sound at all what you did).

[indefatigable 648]

Unfortunately, starting clerkship with electives isn't advantageous.  At least with even slightly longer electives, it's easier to show improvement.  Elective are usually quite important for matching.    

For me, the electives I started my clerkship with have been really good at taking this training stage into consideration - although I had two week+ electives, with some shadowing experience.

But I agree with the comments above, in particular the last one by JohnGrisham re feedback - if there was nothing in the middle indicating you weren't performing adequately, then this seems somewhat unfair and not procedurally acceptable.

[zgripflight 2]

1 hour ago, JohnGrisham said:

Wow, sorry for your situation. Who fails a clerk on their very first rotation? And honestly, i get you're at Mac or Calgary - but starting your students off on a subspec rotation not at your home program is not the smartest organization. Did you choose to go OOP for this elective and in this specific specialty? 

 

 

Thanks. I stayed in province but maybe the sub specialty isn't too used to getting new clerks, although it seemed that they had several residents on other teams. Everyone there was lovely and professional as well.

I did get feedback that my knowledge + presentation needed work, but it was mixed. Some praise and some criticism/feedback. One preceptor definitely noted that I got better over the week. I honestly didn't get any indication that it was worthy of a fail, and they were understanding that it was my first week. Maybe they didn't quite understand the implication of a deficient rating. I'm ready to move on and do my best but I'm a little worried its a big red flag to programs. Oh well

[JohnGrisham 1,694]

3 hours ago, zgripflight said:

Thanks. I stayed in province but maybe the sub specialty isn't too used to getting new clerks, although it seemed that they had several residents on other teams. Everyone there was lovely and professional as well.

I did get feedback that my knowledge + presentation needed work, but it was mixed. Some praise and some criticism/feedback. One preceptor definitely noted that I got better over the week. I honestly didn't get any indication that it was worthy of a fail, and they were understanding that it was my first week. Maybe they didn't quite understand the implication of a deficient rating. I'm ready to move on and do my best but I'm a little worried its a big red flag to programs. Oh well

Was this a 2 week rotation?

Again, i would reach out your UGME and clarify procedures. Then have them liase with the program in question. Its not acceptable to give a student a deficient = fail for you, without documentation of poor progress at the mid-point, and an appropriate action/learning-plan/remediation steps. 

Again, very first rotation, non-core, and 2 weeks should be a sign for the program to have extremely little expectations of you.  Even as a end of year 3 clerk, the expectations are not very high at all.

[1D7 155]

I know of a few people this has happened to where out of touch attendings failed clerks rotating on their first 2 weeks on a medicine subspecialty. Terrible thing to happen to a new clerk.

My best advice is to speak to UGME to clarify whether or not this is a failure that will require remediation and if it will show on your transcript. Chances are it will have no bearing on your ability to match into any future specialty assuming you have no failures moving forward. However, if it does appear, try to find ways to appeal it (and work to excel at all your upcoming rotations).

Again, i would reach out your UGME and clarify procedures. Then have them liase with the program in question. Its not acceptable to give a student a deficient = fail for you, without documentation of poor progress at the mid-point, and an appropriate action/learning-plan/remediation steps. 



Again, very first rotation, non-core, and 2 weeks should be a sign for the program to have extremely little expectations of you.  Even as a end of year 3 clerk, the expectations are not very high at all. 

There are attendings who will fabricate something up to make the failure seem sound. It's still worth a shot, but only if this has ramifications on CaRMS. If it doesn't appear on the MSPR and no remediation is needed, walking away is probably a better use of time.

[NLengr 782]

Honest to God, what kind of douchebag blowhard academic physician fails a visiting clerk on their first rotation? Unless you walked in on them stabbing a patient to death, just give the kid a 5/10 (or some middle of the road grade) and a couple comments on areas to improve. 

[JohnGrisham 1,694]

12 hours ago, 1D7 said:

I know of a few people this has happened to where out of touch attendings failed clerks rotating on their first 2 weeks on a medicine subspecialty. Terrible thing to happen to a new clerk.

My best advice is to speak to UGME to clarify whether or not this is a failure that will require remediation and if it will show on your transcript. Chances are it will have no bearing on your ability to match into any future specialty assuming you have no failures moving forward. However, if it does appear, try to find ways to appeal it (and work to excel at all your upcoming rotations).

 

 

There are attendings who will fabricate something up to make the failure seem sound. It's still worth a shot, but only if this has ramifications on CaRMS. If it doesn't appear on the MSPR and no remediation is needed, walking away is probably a better use of time.

Sure but again unless I'm mistaken, there needs to be documented and documentation of communication of deficiencies. 

Simply stating "oh I told them" isn't good enough. Need a record. Cause then yes people will just make things up.

[blah1234 133]

2 hours ago, NLengr said:

Honest to God, what kind of douchebag blowhard academic physician fails a visiting clerk on their first rotation? Unless you walked in on them stabbing a patient to death, just give the kid a 5/10 (or some middle of the road grade) and a couple comments on areas to improve. 

I'm honestly surprised that failing even happens. It usually ends up being more work for the attending with stuff like paperwork, appeals, etc. I know that's why a lot of subpar clerks just get passed through because an average mark is easier to deal with administratively.

[NLengr 782]

46 minutes ago, blah1234 said:

I'm honestly surprised that failing even happens. It usually ends up being more work for the attending with stuff like paperwork, appeals, etc. I know that's why a lot of subpar clerks just get passed through because an average mark is easier to deal with administratively.

Oh I agree. My program has a clerk not show up at all for a 2 week rotation and it still was impossible to fail them. 

[Edict 674]

On 3/10/2019 at 5:15 PM, zgripflight said:

Thanks. I stayed in province but maybe the sub specialty isn't too used to getting new clerks, although it seemed that they had several residents on other teams. Everyone there was lovely and professional as well.

I did get feedback that my knowledge + presentation needed work, but it was mixed. Some praise and some criticism/feedback. One preceptor definitely noted that I got better over the week. I honestly didn't get any indication that it was worthy of a fail, and they were understanding that it was my first week. Maybe they didn't quite understand the implication of a deficient rating. I'm ready to move on and do my best but I'm a little worried its a big red flag to programs. Oh well

I would check to ensure this goes nowhere on your transcript or MSPR (which are different things btw). It is absolutely crucial that this does not show up for CaRMS. If it does, I would fight tooth and nail to have it changed or removed. It is unfair for this to happen and it is likely the subspecialty preceptor just expects elective clerks to be functioning at a 4th yr level and that is unfortunate. 

[End Poverty 153]

1 minute ago, Edict said:

I would check to ensure this goes nowhere on your transcript or MSPR (which are different things btw). It is absolutely crucial that this does not show up for CaRMS. If it does, I would fight tooth and nail to have it changed or removed. It is unfair for this to happen and it is likely the subspecialty preceptor just expects elective clerks to be functioning at a 4th yr level and that is unfortunate. 

If it's U of C, unfortunately, it shows up on the MSPR. All rewrites and remedial work done during clerkship is recorded on MSPR as well.

 

[Thunderbirds 19]

Yikes, I never understood Calgary's logic of making students do 8 out of 12 total weeks of electives (also, a very low total # to begin with) at beginning of clerkship. I can't imagine trying to make an impression/get letters week 1 of clerkship. I mean, they've always done well in the match in past years, but you can't help but think that it may have a slight impact on the 22 students who went unmatched at U of C this year compared to U of A (5 out of 162) and UBC (9 out of 290). 

[End Poverty 153]

13 minutes ago, Thunderbirds said:

Yikes, I never understood Calgary's logic of making students do 8 out of 12 total weeks of electives (also, a very low total # to begin with) at beginning of clerkship. I can't imagine trying to make an impression/get letters week 1 of clerkship. I mean, they've always done well in the match in past years, but you can't help but think that it may have a slight impact on the 22 students who went unmatched at U of C this year compared to U of A (5 out of 162) and UBC (9 out of 290). 

It is a big disadvantage of 3 year programs that a lot of students are not very aware of. I did not know about the fact that we do our electives at the beginning of our clerkship until few months ago.

[indefatigable 648]

3 minutes ago, End Poverty said:

It is a big disadvantage of 3 year programs that a lot of students are not very aware of. I did not know about the fact that we do our electives at the beginning of our clerkship until few months ago.

Sadly, my school has the same policy (despite being a four year school) - but they've changed it for future years.

[Tullius 30]

Just now, End Poverty said:

If it's U of C, unfortunately, it shows up on the MSPR. All rewrites and remedial work done during clerkship is recorded on MSPR as well.

 

I wonder what Calgary's rationale is here.  Do they want their students to do poorly in the match?

[Snowmen 587]

27 minutes ago, Tullius said:

I wonder what Calgary's rationale is here.  Do they want their students to do poorly in the match?

My school does the same thing and the reason is that they don't have quite enough clinical placements to have two classes of clerks overlap. By giving us electives at the beginning and end of clerkship, they can off-load some students and ensure that there isn't too many students at our teaching hospitals.

It still sucks, but at least there is some logic behind it.

Most students just end up doing their first elective within the Sherbrooke network where it's almost a running gag and expected that we will suck.

[Tullius 30]

Okay, good to know.  I guess I should spend more time on this forum.  I'm sometimes critical of the way my own medical school is set up, but it sounds like I should be thankful I'm not at some of these other places.

[Edict 674]

19 minutes ago, Snowmen said:

My school does the same thing and the reason is that they don't have quite enough clinical placements to have two classes of clerks overlap. By giving us electives at the beginning and end of clerkship, they can off-load some students and ensure that there isn't too many students at our teaching hospitals.

It still sucks, but at least there is some logic behind it.

Most students just end up doing their first elective within the Sherbrooke network where it's almost a running gag and expect that we will suck.

It may be the case for Sherbrooke but i'm not sure its exactly the same for Calgary. Sherbrooke has a worse student/population ratio than Calgary does. I think Calgary's issue could easily be solved with curriculum changes. 

[indefatigable 648]

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