This is a question as old as medical education itself, and still very relevant. The first thing I’ll say (perhaps controversially) is that clinical evaluations are subjective and often imperfect. They can feel validating when you’re labeled “excellent,” and disproportionately discouraging when you’re not. That said, they do carry real consequences for your future, so it’s reasonable to want to understand how to excel. What follows is one resident’s perspective, offered with the goal of helping you put your best foot forward and maximize your chances of earning honors.
Before clinical rotations even begin, know your school’s grading structure. At my medical school, clinical evaluations could make up anywhere from 20–70% of a rotation grade, with additional requirements such as OSCEs or shelf exam cutoffs needed to qualify for honors. Those latter components are far more objective (and controllable) so they deserve deliberate preparation. For example, I made it a habit to complete all relevant UWorld questions during each rotation and then redo my incorrects. That strategy consistently helped me score above the 80th percentile on shelf exams and removed a major source of stress from the equation.
Because evaluations are inherently subjective, your assigned preceptors can heavily influence your final grade. Some evaluators are generous with 5/5’s while others are notoriously stringent. When possible, be thoughtful about rotation sites and preceptors. Word of mouth from upperclassmen is often surprisingly accurate and worth listening to!
When it comes to the rotation itself, I won’t offer the usual “just be yourself” or “be normal.” The reality is that the wards come with unspoken expectations, whether or not anyone actually states them. Instead, here are some general principles to keep in mind.
● Be on time and be prepared. Showing up reliably and knowing your patients earns trust quickly. While you’re still a learner, preparation allows you to take on real responsibility. For example, I am happy to let a student suture (even with awkward knots and all) if that student has clearly read and practiced the basics.

● Have a good attitude. Ask genuine, thoughtful questions. Try not to ask things that can be answered with a quick search unless they’re contextual (“Why do you do it this way?” is very different from “What is X?”). Remember that we choose our specialty because we care deeply about it, so showing sincere interest and respect goes a long way.

● Understand hospital social norms. Be kind and respectful to everyone—nurses, techs, attendings alike. Avoid taboo or overly personal topics (drinking, drugs, gossip), even if the vibe feels casual. Be hygienic, wear appropriate and clean attire, and don’t distract busy residents or attendings when they’re managing urgent clinical tasks.

● Know when to leave and when to stay. If you’re told to go home, take that permission graciously. Sometimes having a student around can genuinely slow things down. That said, if you want to stay and help, make your offer concrete. Everyone knows that “Can I help with anything else?” often means “Can I leave?”—which is fine. But if you actually want to contribute, offer something actionable: “I can call that consult,” “I’m happy to write the note,” or “I can walk the patient to imaging.”

Remember that being an “honors” student is less about perfection and more about being reliable, prepared, curious, respectful, and easy to work with. If residents feel that you make their day even slightly easier, and attendings feel they can trust you with patients, you’re already doing everything you can. I wish you the best of luck during your clinical rotations!

Andrew Lee, MD, PGY2