For medical students and residents, at times, it can be 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. 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 physician assigned us to review compelling cases that presented themselves the prior week. We were then to discuss the medical topics that arose from these cases.
First, 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 and delved into the physiology and management of patients with hypertension. It wasn’t a bad presentation. Unfortunately for me, the attending would not stop affectionately staring at the third medical student. It was a bit creepy.
Next off, it was my turn to present. I had a great case of a patient with Histiocytosis X/eosinophilic granuloma of the spine that I thoroughly researched. I knew the case and the topic cold. Therefore, I rehearsed the presentation many times at home. So, I was excited to present. What could be wrong about presenting a rare, fascinating case I knew well?
So, I began to present the case and then went through the process of coming up with the diagnosis with history and imaging. Again, I noticed the attending continuing to ogle the third-year medical student inappropriately. 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 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 different innovative ways of evaluation, bias can interfere with gaining recognition for your work. In the end, the final grade often comes down to the evaluators’ quality. (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 studies on the topic, I have used the information from that presentation for the betterment of my patients. And finally, the subject arose 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 get the attention of your evaluators about your quality work 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 them. Now, I am not asking you to be a brown-noser, but sometimes to garner the attention of our seniors, we have to find out what makes them tick. A person like this is more apt to listen to you when you are on the same wavelength. Admittedly, in my case above, if I had 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 might not have ended differently, even if I had 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 that 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 use the nuclear option, ensure 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 who can evaluate your work.
Gaining Recognition For Your Work
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 part of the real world. Most of us are somewhat sheltered from the real world through the beginning of medical school because our teachers’ primary evaluation method is exams. As we enter the clinical years and residency, evaluations become more subjective. So, learning how to successfully interact with difficult attendings who may unfairly evaluate your work is vital. Don’t be another technicality of a poor mentor. Be proactive in your education and obtain the recognition you deserve.
