Navigating Clinical Evaluations as an MS3

Chris Walsh, MSIII Sidney Kimmel Medical College
EMRA NE2 Representative, 2022-2023

The third year of medical school marked a dramatic change for me in a lot of ways. During my preclinical years, I used to wake up at my preferred hours and study at whichever time best fit my schedule. My mind palace was overflowing with Sketchy bugs, and Sketchy drugs. My guiding forces, Dr. Ryan and Dr. Sattar, laid the foundation, while the ever-present click of my space bar helped everything stick. In some ways, I knew more then than I know now. And I found comfort in taking multiple-choice exams to assess my understanding. But then came third year.

Grades in third year, you see, are determined in large part by the almighty clinical evaluation, an amalgamation of feedback from faculty and staff that you’ve worked with during a given rotation. Some of these staff may have worked with you longitudinally while others only a single shift. And so, while I still religiously tap away at my space bar, my focus has shifted on how to reliably receive good clinical evaluations.

To demystify and attempt to provide some concrete basis to this notoriously nebulous topic, I wanted to make this installment of the MSC Newsletter a pseudo-interview with a few participating Emergency Medicine residents and faculty at Thomas Jefferson University. My hope is to shed some light on ways in which to impress and succeed on your current or future Emergency Medicine rotations.

For this month’s Newsletter, I emailed residents at the Thomas Jefferson University Emergency Medicine residency program and asked participants to answer the following prompt: “What can a 3^rd year medical student can do on their EM rotation to convince you to provide them with an outstanding clinical evaluation?”

Dr. Gus Reynolds was happy to provide his perspective as a 1^st year resident in the program. He shared three pieces of advice. First, he says that it is important to him that you try to work well alongside the other staff in the ED. Whether it be other physicians, nurses, or technicians, if he hears from them that you are doing a good job, he says “there is a huge chance I think you’re an all-star.” Secondly, Dr. Reynolds finds it important for students to be proactive in asking for ways to help and be engaged with outstanding tasks. Although calling consults, in my experience, is the source of some anxiety, he assured me that it “really does help.” Lastly, Dr. Reynolds simply added “talk to me like I’m human…I’ll tell you if I’m super busy and can’t talk.” This last piece, for me, was important to hear. As a medical student, it is easy to feel annoying, or like a burden, and it is often difficult to navigate which conversations to participate in, but this was a good reminder that residents sometimes aren’t so far removed from your position and can be approached like any other person. In fact, many of the positives that I have experienced as a third-year student have stemmed from meaningful interactions with the residents that I have worked alongside.

Because evaluations can come from residents of all years, I thought it would be important and interesting to see what, if any, differing advice an upper-year resident could provide. Dr. Jennifer Dai, a second-year resident, was also kind enough to participate. Her input centered largely around the difference in presenting patients. She says the best approach to presentations is to “develop a focused and concise HPI that is relevant to the patient's chief complaint. Come up with a narrow differential of what you think the diagnosis could be and what your plan is; it doesn't matter if you're wrong! What we care about is hearing your reasoning, what labs and medications you want to give them, and disposition. Ultimately, your goal is also to determine disposition.” One thing I have had to reconcile with during my third year is that my patient presentation can go well up until the plan, which is when all bets are off. Sometimes the plan is good, other times I feel like I’m being laughed off the stage at a cheap open mic night. So, even though this sentiment has been said to me on other rotations, it is reassuring to hear that that is also the case in Emergency Medicine. Dr. Dai’s second piece of advice echoed Dr. Reynolds’ call for proactivity. She suggested to “Go and reassess your patient without asking (e.g. see how they are feeling after the treatments you proposed for them, recheck their vitals if they were initially abnormal).” Again, while this is another sentiment that has been echoed on other services, I think it bears mentioning given that it was reflected in both participant’s suggestions.

Lastly, Dr. Chaiya Laoteppitaks, the Emergency Medicine Clerkship Director at Sidney Kimmel Medical College, participated in answering the prompt. While he largely echoed the sentiments of Dr. Dai, he provided me with two additional resources that he believed were beneficial in helping students craft the ideal Emergency Medicine presentation. The first resource is a paper titled “The 3-minute Emergency Medicine Medical Student Presentation: A Variation on a Theme,” which is a brief article that outlines the approach to presenting and identifies common pitfalls that students may make. The second resource is an episode of the EM Basic podcast titled “How to Give a Good ED Patient Presentation” which also provides examples of presentations. Both resources, I have found, are easily digestible and have helped me start to think about how to approach this important skill for my upcoming EM rotation.

Navigating the transition between receiving a numerical score for a written exam and having your grade calculated based on feedback will surely continue to vex medical students for years to come, but I hope this article has helped provide some insight into the key elements on how to succeed on your EM rotations. I want to thank Dr. Reynolds, Dr. Dai, and Dr. Laoteppitaks for their willingness to participate in this month’s article. There are links below that will help you navigate to the resources discussed above. Good luck out there, everyone!