Will a Negative Evaluation Ruin My Residency Options?

Question

How should I deal with negative evaluations, especially ones that are written by attendings and may end up in my dean's letter?

Response from Sara Cohen, MD Polytrauma and Brain Injury Fellow, Boston Veteran's Administration Hospital, Jamaica Plain, Massachusetts

The best way to deal with a negative evaluation is the same as the best approach to any medical condition: prevention, prevention, prevention! If you're having problems during a rotation, the first time you hear about it shouldn't be while reading your evaluation. If you feel that your attending doesn't think you're performing up to speed, ask him or her what you can do to improve. Even if you think you're doing well during a rotation, it's always a good idea to schedule a mid-rotation evaluation, just to see what areas of your performance need improvement. If nothing else, the attending will likely applaud your initiative and appreciate the efforts you make to become a better clinician.

That said, if it's too late and a negative evaluation is already staring you in the face, read it carefully and be honest with yourself: Are the criticisms justified? Ask your fellow med students and supervising residents if they feel that the evaluation was fair. Sometimes personalities can clash and an attending may write an overly harsh evaluation that isn't indicative of your performance. If you feel that this is the case, it's usually a good idea to speak with the clerkship director and express your concerns. At some institutions, the burden of proof lies with the attending to demonstrate that he or she gave the student constructive feedback and allowed for a chance to improve. If the evaluation is determined to be unjust, it may be removed from your record.

However, if the clerkship director does a thorough investigation and strongly feels that the evaluation is accurate, it's usually a good idea to stop there; you might earn yourself some enemies by persisting in your attempts to have the evaluation removed. Try to remember that evaluations serve a purpose: This is constructive feedback that should be used to improve your performance and become a better physician. It's better to discover your weak areas early rather than when you're farther along in your training and it's harder to change. Use the negative evaluation as a guide for the things that you must change in order to do well on future rotations in the same field. If you are interested in matching in internal medicine and you did poorly on your medicine clerkship, this will likely be outweighed by a stellar performance on your medicine subinternship.

As for how this negative evaluation will affect your dean's letter, remember that the dean is on your side. Although the dean's letter (also known as the Medical School Performance Evaluation) must accurately convey your performance in medical school, the dean has an interest in helping you and your classmates land the residencies of your choice. Every comment from every evaluation cannot possibly be included in the letter, so the dean usually will focus only on negative issues that arise repeatedly. Therefore, a single poor evaluation likely will be downplayed. Furthermore, if you can prove to the dean that you've made an effort to improve your performance in the areas where you received repeated negative evaluations, this can be emphasized in your letter.

For example, a good friend of mine had trouble waking up on time for his ob/gyn rotation, and his tardiness was noted in his evaluation. He subsequently made a special effort to show up early every morning and even was complimented in a later evaluation for his punctuality. Because he made an effort to change, the dean told him that he would emphasize in his letter that he took the negative criticism in an earlier evaluation and used it to become a better student.

Unfortunately, sometimes there's nothing you can do about a bad evaluation. Perhaps it came late in the year or it's not possible to improve on the particular criticisms. At that point, it's important to know that the evaluation may be included in your dean's letter and so you should be prepared to give an articulate explanation if asked about it during an interview. Acknowledge the criticisms and explain what you will do to improve in the future in order to make you a better physician.

The most important thing to remember is not to panic. Few medical students have an absolutely spotless application, and one negative evaluation likely isn't going to destroy your chances of matching at the residency of your choice.