Saturday, November 17, 2007

Student, evaluate thyself

First of all, WHEW.

I'm done with inpatient pediatrics. One more month left in this rotation, which is a week of newborn nursery and three weeks of outpatient clinics. But the tough stuff is the inpatient, with longer hours, call and weekends.

So, how was it? Well, I am totally beat, but I really like peds for a bunch of reasons I won't go into here. In fact my liking of it is such a majority that it is easier to say what I don't like about it, which is:
1. Crazy adolescent patients
2. Crazy parents
3. 1 and 2 (they often go together)
4. Extremely depressing patients, such as victims of child abuse (shaken baby syndrome being possibly the most depressing) and those with profound CP and mental retardation

Still, even with the above, I could see myself really enjoying pediatrics. Because the vast majority of time, even in bad situations 1-4, you still leave feeling like you managed to help, even in the smallest way.

But that is not what I would like to talk about today. Today I would like to discuss (with my keyboard and my three readers) the idea of self-evaluation.

Most rotations do this in some respect, but peds does it more formally than others I've had so far. At the half-way point they give you a long questionnaire which you fill out in what is supposed to be an intensely self-searching and honest manner, and then you go over it with one of the attendings.

Now, as an oftentimes exorbitantly introspective (and, okay, insecure) person, I found this process both redundant and depressing. Basically, it allowed me to write down all the shortcomings I have been acutely aware of since day one on the wards, while at the same time introducing new and disturbing facets of inadequacy which I may now ruminate over at my leisure. When I finished the forms, and was feeling even more disappointing than usual, I started questioning the utility of this form of review. The way I see it, there are Three Main Classes of Student, and self-evaluation fails each of them, albeit for different reasons:

-The Egotistical Jackass: This is the person who sees most everything as beneath them and their superior level of function. The self-evaluation fails here because the egotistical jackass will never consciously acknowledge that they have room for improvement; if they do it tends to be something inane like "I will try not to make the other students as jealous of my awesomeness." (You think I am lying, but there are definitely students like this out there. Sometimes they actually are pretty good, and sometimes not. Sometimes their ego is kind of endearing, and sometimes it makes you want to tie their vulnerable appendages to your car bumper and drive off.)
-The Oblivious and Often Inappropriate Nutbar: Again, it is surprising how many there are. Most of these people, in my opinion, simply lack introspective prowesses. They say and do ridiculous things and don't seem to understand why they are wildly inappropriate. Example: one of my fellow students, who is so strange and inappropriate that it would not surprise me in the least to learn that he is actually a humanoid robot shell operated by alien beings, actually started pimping us, our interns and our senior resident in the middle of rounds. By name. As in, "(Senior Resident's name), why don't you tell us some metabolic derangements you might see with this disease." It would have been even funnier if it wasn't so sad. Asking them to figure out how they can improve is like asking an cow to derive the equations of motion.
-The Paranoid, Insecure Self-Torturer: I think I fall into this category, and I think the result of self-evaluation for most of us is as I described above. The last thing we need is more stuff to beat ourselves up about.

I think the main goal of this self-evaluation stuff is to come up with an "action plan"; that is, a way to address the areas you think need to be improved. Again, in light of the Three Major Types of Student, I think this step is not useful. The egotistical jackass has not come up with anything reasonable to improve, so it's kind of a moot point there. The Oblivious and Often Inappropriate Nutbar... well, it's best not to delve deeper into their psyche. And the Paranoid, Insecure Self-Torturer formulates about 20 action plans for their perceived areas of weakness every single day on their way home, so to ask them to do it formally is to risk pushing them into Generalized Insecurity Paralysis (GIP) which I think we can all agree is counter-productive.

All that being said, my session was somewhat helpful for me. For instance, my attending moved several areas of self-perceived weakness into the "strengths" category, which was honestly a load off of my mind. Example: my knowledge base. I always feel behind my peers, so having an attending tell me that wasn't true was frankly a load off of my mind. She also did point out that some things I perceived as deficits in my presentations were actually not an issue, but that my lack of confidence was; and as I had not realized my insecurity was so apparent, that was a helpful observation.

So, med school bigwigs, on behalf of my other equally though differently dysfunctional classmates, just tell us what we are good at, and what we suck at, so we can go back to being in denial, or insane, or self-deprecating. Thank you, and I hope I've given you a plan for improvement.


docmama said...

dear dr. vonb,

since we have had the good fortune of experiencing this rotation together, i can live through these insanities with you in REAL LIFE. sweet.
i HATED the survey and interview. plus, i was even more bitter when, on top of being the LAST interview scheduled on that friday afternoon, they didn't get around to me until an hour and 15mins past my scheduled time. all for this ridiculous "tell me what you don't like about yourself" ritual.
honestly, i'm with you - i think they do this for show and that people who haven't figured out how to recognize their weaknesses and come up with a plan to fix them by now are probably past hope.

i miss seeing you on the wards, but boy do i LOVE the outpatient hours (despite the utter boredom).

Old MD Girl said...

Oh God. What a pain. As if I didn't already know how much I suck. Bring on the paranoia!