Sunday, July 13, 2014

So You Got a High Pass

So You Got a High Pass....

This time each year, I hear from many students that they are devastated by their grade on their first EM rotation. There appears to be a common misconception that a High Pass is a death knell. This is far from the case, we are frequently swayed to interview students who receive High Pass on their first EM endeavor. 

So why you ask, do we get excited for those who weren’t rock stars from day one? The answer is simple: If you could choice to train one of two runners, they both run the 100 in 12 seconds one with perfect form, and the other with horrible form, who do you choose? We choose the second, if you teach her good form she will beat the first.  The student who gets a High Pass on their first rotation, and Honors on the second will outdistance the rock star every time. Our great search in residency is for the teachable student. 

So what can you do to become this sought after teachable candidate? You need to improve in each aspect of EM. This is the time to be proactive; call or write the clerkship director at your first rotation, and get the specifics you need to address. 

For most this falls into two categories: 
  1. Approach
  2. Application
The approach for EM that is successful is proactive, energetic, and enthused. You want to go in, and light the place on fire. Be forceful, everywhere, and ahead. Run to action, put gloves on, and think what they will need next, and supply it. Never pass up an opportunity to get involved, or do even a menial task. You will be noticed and given more. Being reserved, quiet, or contemplative is likely to result in evaluations below your ability. Be willing to put your thoughts out there, and show how you can apply yourself. 

The application is realizing there are discrete skills in EM, you need to have them. The first is the EM presentation, read The Three Minute EM Presentation learn it, and do it. The second is the weighted differential, keep it wide, focused on the worst possible diagnoses, that could present like your patient, the probable reasons for this presentation, and the interesting (Zebra) that could present like this. Have this ready before your presentation, so you can amend your presentation to include the pertinent positive, and negatives for this differential. Review common EM core content, by reading texts, review books, or listen to EM basic or FOAMcast. The Plan is the last step, come up with how you will address your differential. Less is often more, don’t forget to start with your interventions for the patient, and then go to ancillary testing, that helps discriminate your differential. Now make it happen, be the first to recheck the patient, check test results, and think what you will do with the positive or negative result. 

Turn your disappointment into determination. Show us you can and will learn the form, and beat the natural. 


  1. Couldn't agree more! Give me a B+ student with motivation, interest and a desire to improve any day.

    STUDENTS- Don't let this grade inflation thing get you down. A SLOE with a HP grade and a narrative that says, "with more time and experience this hard-working, motivated, caring student will blossom into an excellent young physician" is music to a program directors ears. Work hard and strive for steady improvement...the chips will fall into place.

    JaxEM CD/APD

  2. Tom,
    Thank you so much. Students as you can see program leadership throughout the country view a High Pass as an opportunity for you to show your ability to grow as a clinician. Dr Morrissey is right grade inflation hurts everyone, so accept where you are now and show us who you can be.

  3. Postus Resurrectus! I just found this blog so sorry for getting this question in so late.

    This sounds weird but should I be worried if I end up getting Honors in all three rotations?

    1. No reason to worry. A High Pass in a competitive rotation is not a bad thing... but Honors is always going to be better.