Tag: evaluation

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The Radiology Residency Exit Interview- Why Should You Care?

exit interview

You’re finally about to hang in the towel. You’ve taken and passed your core exam, completed all your overnights, given your last tumor board, and finished your final residency dictation. Suddenly, you receive a call from the program coordinator. He says the residency program director wants you to come to her office for your last exit interview. Why even bother? What’s the point of a final discussion when heading out of Dodge anyway? Well, let me give you some reasons why this interview is the most important of your residency from a program director’s perspective.

Want A Recommendation?

Believe it or not, even after you leave your residency, faculty still receive phone calls from your employers if you are looking for a job or decide to change to a new one. And the last thing that you want your residency program director to say is, “That darn resident, he didn’t even care to give an exit interview.”

These folks that call for you from your subsequent practices are serious. And any bit of bad news about you can derail your next great job. Especially when the job market may or may not be the same as it is now!

No Holds Barred Summary Of Residency Issues

After residency, you feel you have no more obligations to the program. Anything you say now is not encumbered by your desire to impress or achieve. You can now have a heart-to-heart with your program director without any of the “BS.” It’s a great time to give the real lowdown on the residency, both good and bad. This interview is the best time to get a reality check on your program from the program director’s perspective.

The Exit Interview– A Last Chance For Great Residency Advice

For the resident, now is the time to ask any burning questions about how the world works, what you need to do to become great, or other residency-based training tidbits you can use for the rest of your career. So, residents will usually ask excellent questions at this time, right before they leave. Residency is usually a once-in-a-lifetime experience. And becoming an attending is so different. Subsequently, residents will often ask inspired questions to learn what they need to succeed in their next radiology life!

Maintaining Contact Information

Not everyone will remain in the same institution forever, and the same goes for your residency faculty. This interview is an excellent last opportunity to cull the contacts from your residency. Get those phone numbers, linked-in addresses, and social media connections finalized. You never know when you will need to contact your faculty again. It may be to consult on an interesting case, recommend a new job, or just to say hi. In any case, keeping this information safe and sound is critical!

Making Sure Everything Is In Order For Future Jobs- They Do Check!

Procedure logs, iodine treatments, and the number of cases completed are critical statistics that your next employer may need. So, ensure you have all the information you will require before you leave. To get hired, you need to back up your previous experiences. Also, make sure that your learning portfolio is all squared away and that you have records of all the academic research, presentations, and posters safe and sound. Often, you will continue to need all this information well into the future. This interview is your last shot at getting all of this straight!

The Radiology Exit Interview- A Critical Component

Between all these factors, including recommendations, giving the real low down on residency, getting some quality advice, garnering contacts, and ensuring everything is in order for your future career, the radiology exit interview is an integral but final component of the residency process. So, it has many more uses than you may have thought. You are not just paying homage to your residency program. Instead, you are providing a genuine service to your future career and helping out your program director. Therefore, you should take the interview seriously. During residency, it is your last chance to help out your program and ensure a great future for yourself in your radiology career!

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The Dean’s Letter Dilemma: A Rogue Evaluation

dean's letter

Within the application, few sources give as much information to the residency application committees as the Dean’s Letter. Yet, the Dean’s Letter also exposes a large crack in our system for deciding upon applicants. And today, I will talk about one of them- the rogue evaluation.

Here is an example of the sort of rotations comments that you may come across in a Deans Letter with a rogue evaluation:

Evaluations

Surgery- A, Excellent. Received glowing evaluations from all residents and attendings.

Psychiatry- A, Fantastic student, Able to empathize well with patients, acts as an intern (above his level of training!)

Family Medicine- A, Actively participated and gave excellent concise, and helpful histories

Radiology- A. Incredible eye, Great talk on Histiocytosis X/eosinophilic granuloma.

Medicine- A-, Worked hard, good scores on the shelf exam.

Ob/Gyn- B, Unable to do an appropriate pelvic exam, forgot to take a good history on several patients, and would not scrub in on many of the cases because he didn’t think it was necessary.

The Dilemma

Whoa. Look at that last rotation. Notice how it does not fit in with all the others. So, what are the possibilities behind the poor Ob/Gyn Deans Letter evaluation? What do admission committees do with this information? And, how does a Deans letter such as this one affect the applicant?

Why Did This Student Get Such A Horrible OB/GYN Evaluation?

Well, it could have been the medical student’s first rotation. Sometimes, in this situation, you have a medical student who initially had no clue how clinical rotations worked and just messed up. Or, maybe, one resident or attending had a vendetta against this medical student and wanted to stick it to him. And finally, perhaps, this medical student indeed did not function well in a rotation that did not interest him.

Regardless of the cause, this resident has been screwed (for lack of a better term!). What do you do when you have scores of applications without a significant blemish, and then you run into this one rogue Deans Letter? Well, you run it by your team, the admissions committee!

The Next Step: The Admissions Committee

So, how does the Admissions Committee deal with a Deans letter like this? And let’s assume that all the other factors, such as board scores, recommendations, personal statements, and extracurricular activities, were just fine.

Well, you can probably imagine the discussions at an admissions committee meeting. First, half the committee says we should give this candidate a shot at an interview because everything else on the applications sounded OK. And the other half wants to dump this application since it has a blemish. Moreover, this year has such stiff competition. In the real world, these are the discussions that take place.

As a program director, if the candidate makes it to the interview process, then the interview needs to proceed with this issue in mind. Typically, we need to press the medical student on this question. If he responds to the problem with a reasonable answer, we will then place the application in a separate pile where we need to confirm the candidate with another well-placed phone call to some of the faculty. On the other hand, if he evades the question or gives a vague answer, we put the application in the DNR (Do Not Rank) pile. The whole process can hinge on this one comment.

The Moral Of The Deans Letter

All this brings us back to the double point of this blog. First of all, as you can see, some schools do not filter the Dean’s Letter at all. And its comments can change the whole disposition of the applicant because often it is the only negative piece of information on the entire application. Is it fair? Sometimes, the alleged student misconduct is actual. But, often, a poorly edited/written Deans Letter is merely a function of the negligence of the institution delivering it. Vengeful comments do not belong in a Deans Letter. Truthful and objective statements do. But, most institutions will allow any old phrase to go into the Dean’s Letter. I see that as a significant issue with the system.

And lastly, all medical students must look at their Deans letter if they can. For one, they should try to edit it if they can. Or, at the very least, they need to know to address it if they make it to the interview stage. You are better off learning about the issues on the Dean’s Letter before starting your first interviews (if you are fortunate enough to get one).

Deans Letter Woes

My relationship with the Dean’s Letter is a love/hate one. Why? Primarily because it does help to ferret out differences among the candidates so that you can rank residents appropriately. At the same time, I am aware that it is an imperfect evaluation tool that can cause the demise of many applications of suitable candidates—bottom line. We need to find a better way to evaluate our medical students. Medical schools should take a second look to re-evaluate how they create the Dean’s Letter. It may lead to better selection criteria and improved treatment of their students!

 

 

 

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Gaining Recognition When The Odds Are Stacked Against You

recognition

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.