We were asked to describe the most notable instance of harsh criticism
experienced in our professional careers, and to say whether it was
helpful or harmful.
Naturally, most of us are our own harshest critics, so my harshest
criticism came from myself.
What is odd, is the way this came about and affected me.
During one of the first rotations in my second year of residency, at
the end, the attending gave me an assessment form. It
appeared to be a form for me to use to describe my experience in the
I dutifully filled it out, have gotten used to doing paperwork that
seemed pointless. On the form, I was asked to describe what i
thought my strong points were, and to name some areas where I though I
needed some improvement. I turned it in, and forgot about it.
At the end of my second year, as usual, I was called in to meet with
the residency director. It was a routine thing. She
was going to review my experience, go over my evaluations, see if I had
any questions, things like that.
She pulled out a stack of papers, and immediately got a very concerned
look on her face. She said that one of my supervisors had
mentioned several areas that he thought needed improvement.
I was shocked. In general, my evaluations had been positive.
To have a list of things that "need improvement" was
unprecedented, in my experience. I felt awful.
She asked what I thought of it.
I did think about it, for a bit. Then I realized: all those
supposed criticisms were things I had written myself,
several months ago.
What my supervisor had done, was to ask me to criticize myself, then
pass on those criticisms as his own. Plagiarism, in a sense.
He was new there, and I had had the privilege of being the first
resident he'd supervised. So the residency director was not
on to his method, yet.
So I regained my composure, which I don't think had been lost, from the
perspective of an external observer, anyway, and said, in a
matter-of-fact way, that those were all criticisms had I written
myself. I did not know if they represented actual deficits
that would be apparent to others. I explained about the form
I had filled out. She nodded, put the paper aside, and that
was the end of it.
I was, frankly, pissed off at the supervisor who had done that.
But I never had to work with him again. The whole
thing passed with no particular consequence.
Did it have any effect on my, positive or negative?
Well, it taught me to keep my mouth shut. I've never been a
big proponent of self-disclosure, and this experience prompted me to be
even more reticent about my self-criticisms.
I'm still my harshest critic, but now I keep it to myself.
I can smell self-evaluations from a couple miles away so I avoid them like the plague. Why? Because I'm my own worst critic.
Med students have similarly learned we have nothing to gain from writing down our self-complaints for the view of others. Which isn't to say that we're not baited fairly often.
Attendings now put so little effort into writing comments (unless they actually hate you) that 96% of them (p=0.12) write "needs to read more" in the needed improvement section. Unfortunately, our grades are actually based on the completely arbitrary numbers assigned to us with a series of comparative questions above the comments section.
For example, on my last general medicine sub-internship, I had "straight 7s" from both my attending and my chief resident, owing mostly the fact that they were swell guys and not to say anything either way of my own ability. 7 = top 10% of med students I have worked with. 8 is something like top 5 med students I have ever worked with, or something like that.
Point being, getting "straight 7s," meaning top 10% of ppl they'd ever worked with, only earned me a high pass. There is no other source of evaluation or grading in the course, but there you have it. These arbitrary numbers, that don't even mean what they mean, determine our grades, and thus don't earn a lot of respect from students.
When asked to evaluate our attendings and residents, a few of us have been reduced to writing "needs to read more" in our comment section, as an inside joke. They probably do. But what relevance that has to their performance is as questionable as it is for a bunch of obsessive-compulsive low self-esteem med students who would gladly read more if not for that sleep requirement some of us have.
I think that in many cases, the only way to get honors is for an attending, probably one of the more senior ones, to take a personal interest in you and speak to the education director about you. That is extremely rare. I know there are some attendings who have the attitude that nobody ever deserves honors, no matter what.
And of course, the majority of medical students would read more, if they could stay awake.
One of the things to consider is that, among all the various things one never gets taught in medical school, there is nothing to teach us how to mentor someone, and consequently mentoring is a sorely lacking skill. So we see self assessments as an alternative.
We can certainly recall some teachers/mentors who were able to tell us where we needed to work on skills in medical care without berating or embarrassing. But my experience with the generic rounds format we went through in clinical years and postgraduate training all too frequently was more a fault-finding exercise.
Many years ago, I was interviewing for a job I didn't really want but had been pressured into pursuing. The interviewer, who struck me as fatuous, asked me what my faults were. In reality, my faults are too many to list in the space of an hour or whatever time we had set aside, and so I told him that my biggest fault was that I was not a keen observer of myself, and so I was unaware of what my faults might be. I asked him to tell me what his faults were, since the point of the exercise was that I might end up working for him. He declined, and the interview ended shortly thereafter. Just to add to the kafkaesque plotline, he offered me the job, but I didn't accept the position.