Evaluating medical students: Beware misleading first impressions

I showed up that morning on the inpatient service as a part of my elective. Surprisingly, I found three other medical students present: 1 third year, 2 second years.

The fourth year of medical school has many perks as I have been told by those senior to me. Once the application process gets underway, I have been advised to live every day as though it were my last. Personally, I liked the opportunity to share my experiences with those junior to me as they adjusted to an unfamiliar setting outside of the classroom.

That morning though I didn’t feel like teaching; one of the students really irked me. Each time we convened to discuss a patient, this individual proceeded to pace back and forth outside the huddle while checking his phone and yawning.

When we walked in the room, the student would proceed to sit down. I told his counterpart, “A lot of evaluations as a third year comes down to picking up on social cues. Unless someone sits, don’t sit.”

His attire didn’t help his case either: white coat, collared shirt, no tie, rumpled pants, sneakers.

Each detail annoyed me more and more. He is asking for a professionalism violation, I thought. Sensing an impending train wreck, I had to say something.

“Are you OK?’

“Yeah, I’m just in a lot of pain.”

“Really?”

“Yeah, I have flat feet. That’s why I have to wear these orthotic sneakers.”

“No kidding. Just make it clear when you do your rotations to avoid any miscommunication that might mess up your grade.”

One of the greatest fears I had through third year was the unfair evaluation. The thought of a subjective assessment comprising a large part of my final grade for each rotation invoked anxiety, but after getting a few unfair ones, I felt that I had overcome the shock of being blindsided and vowed to not contribute to this practice as a resident.

What accounted for my mistake?

Asymmetric insight.

In 2001, Emily Pronin and Lee Ross at Stanford, Justin Kruger at the University of Illinois, and Kenneth Savitsky at Williams College, administered questionnaires to 125 college students as part of their studies of this principle. The questionnaires asked participants to think of their best friend and assess how well they knew this friend and vice versa. One question asked them to “indicate the degree to which their friend’s essential nature was observable to them versus hidden beneath the surface,” using a graphical scale consisting of icebergs (shown below). This same question was then asked about them, “the degree to which their essential nature was observable to their friend versus hidden beneath the surface.”

iceberg key

Interestingly enough, there was a statistically significant difference in perception: Participants felt they observed much more of their best friend than the other way around.

Having endured the evaluations of third year, this principle accounted for much of the anguish and angst I felt, especially when the comments written about me conflicted with how I felt. As I learned in this case, the conclusions I generate of others should be done with care; the tragic tale resulting from the misjudgment of an iceberg a case in point.

Rushil Patel is a medical student who blogs at his self-titled site, Rushil Patel.

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