Psychiatry Shelf Exam and Grades.

I have had today off to study for the psychiatry shelf exam which I have tomorrow. The shelf exams are national exams that most medical students in the USA are required to take at the end of their rotations. The can be pretty tough and have some obscure case scenarios. 

A lot of medical students complain about the grading during their 3rd and 4th year rotations. It can be very subjective and not as straight forward as the first 2 years of medical school courses. At my school you are evaluated on a clinical level and then on exam knowledge level as well. There are 6 categories that your attending physicians rank you on according to their opinion of your performance. We are ranked on Knowledge, patient care, professionalism, life long learning, inter-professional practice, communication. You can get an outstanding, good, adequate or inadequate for each of the categories. In order to get an A you need 3 of the 6 categories to be ranked as outstanding and you need to get .25 standard deviation above the national mean on the shelf exam. You have to meet both these requirements to get the A. If you get the outstandings but not .25 standard deviation above the mean you will not get the A. If you get .25 standard deviation above the mean but not 3 or more outstandings you will not get an A.

For the students who are very good at studying and taking exams usually have no problem getting the score on the shelf exam but they tend to not do as well on their evaluations so for the first time in their lives they get a B and are furious. Those students who are better on a social level tend to do well on the evaluations and get more outstandings but those students often have more difficulty on the shelf exam. The students who can succeed in both areas get the A. As you can imagine the evaluation aspect can really depend on the doctors giving you the evaluation. Some doctors refuse to give above a good for anyone and other doctors may mark all outstandings without much thought. All of the evaluations for a given rotation are averaged to determine your final evaluation. 

I have found it helpful to actually sit down with those doing my evaluation and explain the system to them and ask them to mark outstanding if they think I did "A" level work. This method has proven to be effective. You have to ask for the business. Your average medical student would never even think to do this. A little bit of life experience goes a long way in these kinds of situations. I am pretty sure for my psychiatry rotation I have the outstandings taken care of so now I just need to do well on the shelf exam to get the A.