“It was disappointing to see that you could get ahead in your clinical rotations just by sucking up to the doctors”, says Dino Gačević, now a doctor in intensive care. “A friend of mine really wanted to become a heart surgeon, and during that rotation he started mimicking and joining their banter and attitude. He ended up being favoured because of it.”
“You shouldn’t underestimate the racism or bias of some doctors during your medical internship. I’ve seen it myself”, says Jasper Klasen, a junior doctor currently pursuing a PhD at Erasmus MC. “Sometimes it’s just blatantly racist”, he explains. “I wasn’t a bad intern, but during a presentation it was obvious that my fellow student with a migrant background had worked much harder. She knew every answer, was incredibly empathetic with patients. But I got an 8, and she received feedback like: ‘You need to speak up more’, ‘how impressive that you speak Dutch so well’ – she was born here for crying out loud. She got a much lower mark, even though it was clear she’d done a better job than I had.”
Many interns and recent graduates recognise this. Gačević: “If you’re not 100 percent ethnically Dutch, it’s harder to connect with doctors and you’re often marked down. There was a doctor who kept calling me ‘Borat’, referring to my Montenegrin roots and the 2006 film Borat – which is actually set in Kazakhstan. That was really unpleasant. Fortunately, most doctors don’t go that far.”
A new way of assessing
These kinds of experiences motivated Klasen and other student council members to push for a change in the assessment system. When Klasen and Gačević were doing their clinical rotations, students would receive a single grade per rotation. Since September 2023, they now get more feedback forms and must have practical skills signed off by a supervising doctor. Grades have been scrapped, so a single doctor can no longer determine a student’s mark.
Searching for feedback
Klasen hopes the new assessment system will improve things, as he received only about two hundred words of feedback in two years of rotations. Stefan Monde is still in the middle of his medical internship and is being assessed under the new system. He’s just finished his surgery rotation and is about to begin paediatrics. Sometimes, he finds it hard to get meaningful feedback. “You get comments like: ‘pleasant to work with’, ‘shows willingness to learn’, ‘does well’. That could apply to any intern – it doesn’t say anything about how I actually performed.”
Still, he receives more assessments overall, and he’s ‘quite happy with that’. “During my first rotation, we had to submit three feedback forms a week – it felt like jumping through hoops. They could be from a doctor, or even from another intern commenting on your teamwork. In surgery, it’s just one form a week – there wasn’t time for more – and a total of eleven practical skills, like suturing or placing an IV.” Monde would appreciate more in-depth feedback, but given how busy doctors are, he’s not sure how the system could be improved.
It’s also up to students to actively seek feedback, says Pim den Boon, a junior doctor currently doing PhD research at the Erasmus School of Health Policy & Management. Handling feedback is tough, he adds. “Medical students are perfectionists – you’re being assessed and working with patients. You don’t want to make mistakes. But to learn, you have to be willing to make them – so you’ll never make them again. Ideally, you’d hear that you’re doing everything right, but my advice to students is: really ask for feedback and be open to criticism.”
Personal attention is everything
Being graded by a doctor who has never seen you – it happens, says Gačević. The doctor gets updates from the team, but that can go in an oddly way, Klasen explains. “Once, I was at a meeting where a doctor asked aloud about another intern: ‘Do you know him? Who’s that? The one with the strange face? I’m thinking an 8, anyone disagree?’ That’s how the mark was decided.”
The doctors who do take the time and offer personal feedback make a lasting impression, the students say. “At the Reinier de Graaf hospital in Delft, I worked a lot with junior doctors”, says Monde. “They often explain things in more detail than a specialist. When you’ve done certain procedures countless times, it becomes second nature – that a cut should be made a certain way, or why you’d order a particular blood test. For junior doctors, that’s less obvious and I appreciated that. It made me feel like I wasn’t expected to know everything straight away.”
Gačević had a great experience during his general practice rotation. “It was a one-on-one rotation. We’d go for a walk during lunch and have nice conversations on the way to house calls. This doctor really looked at who you were and what motivated you.”
The best feedback comes from doctors who try to see the person behind the intern, Den Boon also found. “After a great day in the outpatient clinic, the gynaecologist said: ‘I can see how much joy it brings you to have long conversations with patients – that’s not always possible here. I think you’ll be happier and get more out of your career if you choose a specialty where that time is available.’ I found that incredibly valuable. I felt seen and appreciated, and I hadn’t even realised that doctor had been observing me like that.”
