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When your preceptors say you are where you are supposed to be... does that mean they are not impressed?

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Ha - this is one of the big problems with medicine - highly intelligent, hard working people really doing the job can be "average" in the pack. That isn't bad - it is just often relatively a new experience for many. The problem (and ha there is literature on this!) is that suddenly average people forget effectively how good they really are and can eventually stop advancing as well. That is a mistake which can be best combated if you know the effect exists. 

The opposite would be for reference if you were put in another environment where by virtue of your skills, work ethic, and the intelligence you are gifted with you are a super performer - and everyone constantly tells you how amazing you are, and comes to with new things to do and so on. Big fish in a small pond sort of effect. 

Being where you are suppose be is exactly that - you are doing just fine. One of the reasons I avoid that term is some people can read it wrong. 

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It's vague and sometimes I think clinicians use it defensively when they don't feel like giving specific statements on someone's performance. Maybe they are busy, maybe they don't like teaching, or maybe they just want to get home that day. They should instead tell you explicitly if you are below, meet or exceed expectations. I feel a lot of clinicians aren't sure what to expect of a medical student (or a resident for that fact) unless they are very involved with teaching or curriculum development. Sometimes you have to remind them that you haven't done your core rotation, or you just began clerkship, or that you aren't an off service resident!

There is no escaping of the anxiety trying to get "above expectations" for CaRMS because the residency system is screwed up. The only thing I can say is that you don't need to wow every attending to match, you just have to find 4-5 that you feel really good about that can go bat for you. If your goal is IM I would find someone that you've worked with for at least 1 week, and ask them if they feel "comfortable" giving you recommendation. It is a good sign when they say they are "comfortable" recommending you.

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Unfortunately, not all preceptors choose to work with trainees, nor do they enjoy it. So don't take it personally - most will tell you directly or indirectly if you are NOT meeting expectations. Otherwise don't read too much into it if you're getting vague "keep on reading and working hard" comments.  Especially if you're only working a few times/week with a preceptor. 

This continues from medical school into residency; unless you end up working with the same preceptor for longer periods of time, or in a smaller speciality with alot of 1:1 contact.

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I don't put down outright negative comments (unless it was for something flagrant, which I've never had to do) because I don't want comments from a 2 week elective to affect a medical student's future CaRMS match in case somehow it ends up on their MSPR .

For me generally vague comments mean you're average, mildly below average, or just someone I haven't worked with closely but have to help evaluate.

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