Tuesday, March 1, 2011

The Clerkship Lottery

During second year of med school, most schools have a lottery to decide on what the third year rotations will be.

Prior to our 3rd year clerkship lottery, we voted on special considerations for the clerkship lottery. Basically, students emailed in their special needs, such as people who had kids requested to have all their rotations at the university hospital rather than satellite hospitals over an hour away. Other people had requests to take an elective month at a certain time due to getting married, their wife's due date, a parent with recently diagnosed cancer having surgery, etc. Most requests were pretty reasonable, I thought.

Out of our class of 100+ students, 12 anonymously asked for special considerations. Out of the 12, 10 passed through our class vote.

Anyway, the day after we found out which requests passed, one woman in our class sent out the following email:

This is ridiculous! Many of those reasons were absolutely silly. What was the percent of votes needed to pass this anyway? I can't believe the votes passed with those stupid reasons these students gave.

Because for one thing, if your parents are ill, get a visiting nurse, since there is nothing you can do while you are studying anyway. Secondly, all these people that want to take care of their family or assist with their wife's pregnancy or take care of the children or see your children and all that... well, we all have loved ones we would like to see as often as possible, but because we chose such a demanding profession, we simply don't necessarily have that luxury. We just make it work without having to subject our colleagues to it. If it matters so much, have your family member move to where you are or you can commute or hire a baby sitter that can pick your children up from school.

I easily could have said something equally lame, but I sacrificed and let people with more important reasons have their say. But all these crazy reasons, I tell you, is unfair to the class as a whole and it is especially unfair to people that had good reasons but took the initiative to find solutions to their issues.

We all just kind of thought she was a crazy bitch. What do you think?


  1. I agree with the crazy bitch. Same issue happened at my school... really it comes down to people having vastly different thresholds for what justifies special consideration.

    "Crazy bitch" was just on the I'll-look-after-myself side (as I generally am), and was understandably a bit upset over it all. Not saying that the others were wrong for applying, just that the process obviously has flaws.

    My school came to a much fairer determination, by laying out fairly specifically what could be considered special consideration. A.k.a. planned wedding, spouse's work, were no, as you could change them. Children enrolled in school were allowed, as (the thought was) you're disrupting their lives without their say otherwise.

  2. Brady: I thought all the considerations were reasonable. I mean, what if your wedding was a few months away and you couldn't change it? And that's an incredibly reasonable request, considering it doesn't really *hurt* anyone if you have your elective in July. Another one that came up was wanting to take an elective when someone's dad having surgery for cancer, which I thought was reasonable. Nobody asked for consideration over a spouse.

    Even though there were a couple of things I wanted in the lottery, nothing was *that* important to me. Why would it be? There was just one rotation I really wanted to avoid and it was pretty easy to do so. So I was happy to let other people who had important reasons get priority.

  3. Crazy bitch.
    Illiterate, too, eh?

  4. I don't know about crazy, but bitch for sure.

  5. One of the medical schools I interviewed at had a similar lottery - but with a worse "prize"(10% of students would be randomly chosen to have to complete the entire 3rd and 4th years in a city over 200 miles away, giving up their family, friends, and houses for those 2 years).

    The students I talked to were very proud of the fact that the school DID NOT accept ANY special considerations, on the basis of exactly what this woman stated in her e-mail - it's unfair for people with families to get a free pass.

    Needless to say, I didn't go there.

  6. She actually was a crazy bitch, not so much because of this but there was a lot of other evidence.

    apotential: That really sucks to be at that school. The worst thing we could get was a rotation about an hour and a half drive away, where they provided free housing. I didn't think any of our hospitals was necessarily "bad" to be at. All had pros and cons.

    And I totally think it's fair for people with kids to get the option to stay in one place! I didn't have kids at the time, so I was more flexible and didn't care. And people who got to have all their rotations at the university hospital got zero choice of order, so it balanced out. Order was actually more important to me.

  7. I think I went to the school apotential is talking about. There were no exceptions except for the lotteried person getting ongoing medical treatment. I was lotteried to the "good" campus but when a friend got lotteried to the campus on the other side of the state but had a husband in a tenured track job, I switched with her. It wasn't unfair though. You knew when you interviewed at the program that you might be moving for the clinical years so it wasn't like it was an unfair surprise.

    I was single at the time, so it was easy to change, and it was my decision. In retrospect, I do not think it's fair to treat those without families as second class. Some sacrifice having families so they can concentrate on their work and it's not fair to make them sacrifice more.

    Granted, I'm not a nice person at all. I've had residents and students try to get out of work because they have kids when I was their senior resident and my answer was "I'm a single father and I'm here before you and leave after you and take half the days off you do, so suck it up. I won't have you slacking and blaming it on your families because then you give the rest of us with families a bad name. This isn't about your family; it's about your work ethic."

    She might be a bitch, but mostly for spam emailing and poor grammar. I agree with her point, so maybe we're both bitches.

    And it turned out that I'm glad I did switch. The "bad" campus turned out to be much better.

  8. Nuclear Fire: It's annoying when people use their kids to justify their bad work ethic. You're absolutely right: people who take advantage ruin it for everyone else.

    I think in the case of your med school, you're right that when you went to the school you knew what you were getting into. And a spouse isn't a good reason to get special treatment. But I do think in that particular situation, people with kids should get priority... because really, if they don't, it's the kids that end up suffering most for it.

  9. My response to her (and people who have made the same argument) is that yes, we picked careers that are demanding on our time and will result us in missing time with our families. All the most reason why we should take advantage of opportunities while we're in our training to enjoy ourselves and spend time with our families/friends/pets/household appliances as needed. [This is also my argument for any time I go drinking].

    Our clerkship lottery was nuts, but for another reason. You see, rather than a normal lottery (names drawn one by one, highest available preference given), we had a bizarro system. How it worked was that people ranked their preferences 1-16. Once the lottery was closed, they would go down each rotation (1-16) and see how many people ranked it first. If there were more people ranking it first than spots available, there was a lottery within that section to see who would get that spot. The same thing was done in every other section simultaneously, so the result was 90% of our class got their first selection and 10% were shunted to whatever spots were left (usually their last selection). As a result of this system, people were rapidly changing back and forth up to the deadline as an attempt to slot themselves into a spot that wasn't overfull to avoid the whole lottery process. I kid you not when I say friendships were almost lost over some of the mind games played.

  10. "I kid you not when I say friendships were almost lost over some of the mind games played."

    Oh, hell yeah. This brought out the worst character deficiencies in our class.

  11. iamnothouse: That is so dumb. Our lottery was actually pretty civilized, aside from that one obnoxious email and the replies it generated. We got one lottery number that would determine pick for the order of rotations. Then we would go in reverse order for picking location for our first 2 clerkships, then reverse order again, etc. So depending on what you wanted, there was no "good" lottery number. People were allowed to trade so if order was really important to you, you could trade with someone who was more interested in locations. I got every single choice I wanted with an OK number and it wasn't even a close call.

    And ultimately, there was a ton of switching around during third year, when some people in the class seemed to just disappear into thin air.

  12. Wow...what a snatch.

    Seriously, though, how DARE those student's parents get cancer and mess up HER choice of a rotation. The nerve of some people.

  13. What a Bitch!

    Though here in India it's kinda strange knowing that people have a choice in their clinical rotations. We have a fixed schedule of clinical postings depending on which alphabet our name starts with :P

    then again, we start med school pretty young (straight after high school, no premed--last two years of school are the preparatory phase) so having kids and ailing parents is not something that happens while still in med school. Usually.

    btw, I love your blog!

  14. we haven't "had" a lottery in the last few years. we just figure it out amongst ourselves and turn the list in. we have sites that are 5-7 hours apart so if you own a house, have kids, spouse has a good job, it's not even close to being reasonable to be sent clear across the state for 2 years if someone would rather be out there anyways. Not everyone is always completely happy, but a few people always come out the hero sacrificing a bit to help other people out.

  15. I betcha that one of those requests not passed was hers....

  16. Haha, anonymousrn, that's EXACTLY what I was gonna say!! Maybe she just had her panties in a twist because they wouldn't accomodate her cat's rigorous diet/exercise/spa regimen. *grin*

  17. Well, she *claimed* in her email that she didn't submit a request, but we can't prove that.

    The upshot of her email was a bunch of the anonymous people came forward and said things like, "Hey, I was the one with three kids under age 5 and wanted to stay at the university hospital. Thanks to everyone who made that possible."

  18. You're right she's horrible.

  19. Okay, at the risk of being flamed, I somewhat agree with her. The exceptions that resulted from personal choices (ie, to have children, to get married) should not result in exceptions in my opinion. No one forced you to get pregnant. I'm not sure I should have to drive an extra three hours each day because I'm choosing to not have children right now.

    But for illness of the family, something that is obviously not a choice, she is out of line.

  20. I think it's reasonable to ask for exemptions if you have kids at home. Some of the comments are saying that you shouldn't ask for special exemptions just for having kids, but I think that if you have a family you've got way more responsibilities and work at home than your colleagues, and it's fine to ask for a little help. That said, it is incredibly annoying when someone pulls out "I have kids" every single frickin' day when they leave early. (No, I don't have kids, but I'm planning starting soon)

  21. Fizzy:

    Talking about my school was a bit of distraction from the point, that I think she is right to be upset.

    The other students are also right to have applied for special consideration.

    The problem isn't an easy one to solve, as (in my experience) students generally have vastly different positions on how much "consideration" you should be given for any particular set of circumstances.

    Glad to hear your med lottery was generally amiable. Ours was a bit cut-throat, as some of our clerkship spots are > 100km away from the main centre.

  22. When we started our third year rotations I was single and childless so I told the woman in charge of assigning locations that I was fine with going wherever and to please stick me in the far away spots no one else wanted to go to because I really didn't mind.

    She hugged me.

    Anyway, it worked out great for me. I was on one rotation where i got every Thursday off, I got to be first assist at an open hemicolectomy my first week of gen surg, I started seeing patients on my own without my attending supervising, most places had free food, I got more efficient at rounding, a lot of times I didn't have to go to lecture, and i got away from all the OMG!DRAMA at my school. It was totally the best way of doing everything and if I could do it over again, I'd do the same thing. I felt bad for the students who had to stay at my school the whole time and be med student #5 on rounds and sixteenth assist in the OR and had to spend long periods of time waiting for the attending. For the most part, I didn't have to deal with any of that stuff.

  23. Threehills: Wasn't it your personal choice to go to a med school with rotations that required 3 hours of driving then? Most things in life come down to choice and it irks me when people call having kids a choice when procreation is the only reason the human race even exists. Anyway, all our rotations that were that far away provided free housing. I just can't imagine any reason I'd have for wanting one hospital over another to be more important than a one year old baby getting to have both parents living in the home. So as a single person with no kids, I deferred to people who had special requests and wasn't upset about it in the slightest. I'm glad (most of) my classmates were compassionate enough to do the same, even if it caused them some tiny inconvenience.

    Melissa: I find that annoying too and I have kids.

    JessJess: In retrospect, I had a way better experience at the community hospitals than the university hospitals and learned more. I was miserable at the university most of the time. If people wanted those rotations to be near their kids, they could have 'em.

  24. "Because for one, if your parents are ill, get a visiting nurse, there is nothing you can do while you are studying anyway."

    That's heartless :( Obviously if a busy med student is willing to take time out of their schedules to spend with ailing family, it's NOT something puny like a cold or sore throat. I think a bitter comment like that reflects her poor character and I'd hate to come across a doc like her in the future.

    As for the whole kids issue...taking time off or requiring special consideration due to children or children in need is probably not an enjoyable topic for any employer in any profession. The fact is, the majority of those 100+ classmates felt like 10/12 of the requests were reasonable, whether it was because they were compassionate or plain indifferent, so in HER case, she should suck it up.

    I like the idea of free housing though, so I am biased in the sense that I wouldn't mind relocating ESPECIALLY if housing was free.

  25. @Threehills

    Yes, technically kids/family is a choice, but I don't think it's unreasonable to ask for an exception to be given so you're not HOURS away from your spouse/kids.

  26. Wow, what a bitch... that's so heartless. Thank god most of your classmates were nice enough to let people with kids and special circumstances get spots to allow for their needs.
    We have our lottery in a couple weeks... I'm curious how that's going to go down.

  27. FYI: I remember one of the special requests that didn't pass was this woman who wanted all her rotations at one place because she only had one car and wanted to carpool with her husband (not a med student). That was a little bullshit.

  28. Crazy bitch. We have had one in my class ... but then she took a forced medical leave of absence and is now in the class behind us. My mom has been a guest lecturer at my school for years and the day she came ... this girl went batshit crazy yelling at my mom. And then the next day she told an attending to f off. The full version. I can't believe they didn't completely kick her to the curb but she had 2 kids and was divorced and apparently they told her to get a better support system in place before she came back. her support system ... get knocked up by another guy and get married again. How in the world did she even get accepted? Long rant ... sorry!

  29. Crazy illiterate bitch, definitely. Your class DEMOCRATICALLY voted for these considerations to pass, so obviously she was in the minority. I think children, weddings, surgeries, etc. are perfectly reasonable.

  30. Crazy bitch.

    OMG, people procreate and have responsibilities outside of medicine...gasp! Some people have lives outside of the hospital...people without them shouldn't be so hateful. It doesn't mean people who choose to have kids/families should get off easy or have less work, but when scheduling, it makes sense to make considerations for those issues when possible...especially when the majority finds it acceptable.

  31. Grammatically challenged, slightly bitchy.

    We're going through this process right now in my program and yep the claws have come out. Ours is a black box though, the school is not transparent AT ALL about how they will assign us our placements. They simply said, email us if you have a concern (i.e. children, ailing parents) and we will try to accommodate.

    I'm happy to separate myself from the gunners and be put out into the medical pastures for now. I've often found that rural settings allow for much more hands-on experience anyhow.

  32. what i can't believe is how much her writing sucks. seriously? forget about bitch or crayzee, how'd she get into med school? she writes like she's as smart as a sack of potatoes.

  33. I like that it was a vote of the whole class.
    As far as having kids, yes, you can "choose" to have them in medical school, or residency, or even later. (There are no really good choices). If you have children, you're going to be sacrificing a lot of time for them-- and still will manage to miss a lot. Not only do your kids lose out if you have a 3 hr commute, but also what limited study time you do have goes down the tubes (good luck studying on the weekend!).
    Being a doctor and a parent means trying to find balance; part of that is negotiating fair trades with your colleagues.
    (stepping off soapbox)

  34. She sounds like she was bitter. Maybe she was one of the two whose request didn't pass? Or, she should have put her request in, but didn't? I vote for crazy!

  35. Way late:

    Sounds like she's bitter that she doesn't have anyone in her life for whom she might need to make accommodations. I can imagine her life: estranged family, no partner, no kids. The people who have those things also get first dibs on the best stuff (or at least the stuff they want most) because they have people who love them, so their lives just keep getting better and better and hers just keeps sucking along.

    I can sympathize with the feeling. It's bad enough to be lonely, but to feel that you don't have the "right" to ask for anything because other people aren't lonely? You get to put up with inconvenient or undesirable options, and be grateful, because your wants and needs as an individual don't matter? Talk about salt in the wound.

    I'm not saying she was right to share these feelings with the world -- when you find yourself sending mass emails, you are automatically in the wrong, forever. I also don't doubt you, Fizzy, when you say she was generally a crazy bitch; in fact, that supports my theory about her loneliness, as people like that often have trouble keeping others in their lives. Still, I get why she's hurting and resentful, and I kind of feel for her. There but for the grace of God, and so on.

    1. She did other things that were crazy bordering on vicious. A lot of people in the class were thinking similar things about the lottery, but to email the whole class and to phrase it that way is a demonstration of the crazy. It was pretty hard to feel sorry for her.