Hello everyone. I will be entering my second year soon and I wanted to hear from you guys as to whether it is true that some students who do not do well in the preclinical sciences (i.e., in bottom 1/4 of the class) can turn it around and shine in 3rd and 4th year if they have excellent interpersonal skills. That is what a number of people have told me and I am hoping it is true but thought I would get some more opinions on this.

Good people skills will win you points on the wards and with most attendings (may not work with the narcissitic personality disorders), but if you don't do well on tests now, chances are you won't miraculously get better at it and blow away your shelf exams and Step 2. There are always outliers, but most people tend to perform about the same as they performed in years one and two test-wise.

Very few people get lower than a B on any rotation, and lots of people do well, so being a stand-out is not easy, but you also have to try really really hard to fail.

Don't worry. Learn all you can. Do your best. Play nice. You'll be fine.

Hello everyone. I will be entering my second year soon and I wanted to hear from you guys as to whether it is true that some students who do not do well in the preclinical sciences (i.e., in bottom 1/4 of the class) can turn it around and shine in 3rd and 4th year if they have excellent interpersonal skills. That is what a number of people have told me and I am hoping it is true but thought I would get some more opinions on this.

Yes, I know of cases like that. The most telling is a that of a person that failed Step 1 three times before passing on the 4th attempt. This person (whom I know but won't name to protect privacy) now has a prestigious residency because he rotated at the place as a student, worked his butt off and was really well liked. On the other hand, I also know classmates that were at the top of the class in the first 2 years that struggled with post rotation exams in the clinical years. So there are no guarantees that any pattern established in the pre-clinical years will play itself out during the clinical years. The best thing to do is relax, do the best you can and don't obsess over where your class standing is. That's one question that your patients are unlikely to ever ask about!

A friend of mine failed biochem her first year due to some extraordinary circumstances. She was working so hard to make up for a crappy biochem grade that she almost failed a couple of other courses. I know that her situation may be different than the original poster's due to her circumstances, however I want to offer some words of encouragement. She did really well in her second year. This year, she is a star on all of the clinical rotations. Attendings and patients love her. Attendings are always telling her that she needs to go into their respective fields. She doesn't do that well on written exams, but she can answer almost any pimp question thrown at her and shows remarkable clinical judgement for a third year student. She hopes to be heading for a career in ENT.

I was asking an attending yesterday about what factors are important for a residency in IM. She told me that it is a combination of factors, including test scores, grades, etc. However, she said that the most important thing that a person can do to get a good residency is to do well in the clinical rotations. She also said that comments from evaluations are weighted very heavily.

I can attest that this can be true - I didn't do too well in first year, did a little better in third year, did better then I ever hoped to on the boards and have gotten good grades and evals in third year.

If you didn't do well first year, reflect on how you studied and try to find a different study pattern/habit. Study really hard for the boards b/c most residency directors and interns that I talked to this year said that while first year grades do matter, doing well on the boards proves you can master the material.

I suck at memorizing things in a limited amount of time-- I will retain things I do learn longer than many of my classmates though. The dean of student affairs coined a term that I think is hysterical-- intellectual bullemia-- and many of us have it really badly.

It seems like a lot of my 1st year faculty test us on really random things. I don't miss the clinical vignettes. I miss what I suspect are "gimme" questions for some people (ex. the fiber type for GTO is which of the following Ia, Ib, II etc). Either way, I still am in the low 70s in these classes. I did so much better on the NBME section tests than any of my class exams (even getting above the class average in anatomy) but am just scraping by in memory-intensive subjects (i.e., anatomy, neuro, physio and am really worried about pharm next year for this reason).

I have no problem with the non-memory intensive subjects like behavioral (currently 97 average), imaging, ethics (99 average for the course) but these classes are not nearly weighted as much as the others. This is such a divergence between my performance that it concerns me.

I was not a science major (I was a history/polisci undergrad and law grad) and realize that I do not have the best background for a lot of this stuff. If anyone has a suggestion, I would love to hear it. I always feel like I am running out of time and have a really hard time looking at things like the fiber type of GTO, with the obvious question popping up in my mind-- and why do I care?

I love doing differentials though and solving puzzles. I am also very comfortable with public speaking and taking H&Ps so my professors have told me not to worry that I'll probably do much better in clinical years (with the caution of shelf exams).

Granted, you utilize a slightly different skill-set during the clinical years. However, if you don't know any "medicine", you won't ask the patient the right questions, do the right physical exam, or come up with a reasonable differential and diagnostic/treatment plan - no matter how good your interpersonal or whatever skills are.

Not that they're not important. Just wait until you get a teenage girl with belly pain and need to get her sexual history, or a 75-year-old patient with frequent falls and need to screen for dementia, etc.

But knowledge counts too.

It just seems to be a different kind of knowledge at least from what I am seeing in my clinical experience.

I agree that you need to assimilate a lot of information in forming a differential. I seem to be able to do that pretty well for a first year- developing a list of potential causes then dismissing items (or reducing the likely candidates) based the H&P and tests. Or at least my professors (yes, more than one has said something) have thought it was amusing enough to mention/comment on it to me-- inquiring why I could do that but do so badly on the in class tests. Anyone else have this happen to them? Maybe it is my legal background and building a case?

For example, I have no problem with concepts that are used clinically (e.g., a unilateral lesion of the motor fibers of the trigeminal nerve will result in a deviation of the jaw on protrusion toward the side of the lesion). My issue is more the minutae- like the name of the fiber type for golgi tendon organs. If there is a disease process associated with the information, I am much more likely to remember it. I am hoping pathology will work well for me.

I think you'll do better 2nd and 3rd year. I was also a humanities major (religion) and it galled me how much better my science major classmates did in those classes. I thought I was so stupid. It was kind of ego-crushing.

Second year, depending on your curriculum, is a more integrative picture. I can't lie to you and say it's not ridiculously random-detail oriented. You have to recognize pathology microscopically, you have to regurgitate the genetic translocations associated with this or that cancer, know which arm of which chromosome etc. But you have a better framework to hang it on, especially if your school teaches by organ system. It doesn't sound like they do--mine didn't either, but it worked fine. It's easier to memorize things in big categories--ok, so you're learning pulmonary pathology, and with it you learn pulmonary drugs etc.

I did ok my first year, I rocked my 2nd year, have done great 3rd year. You'll be fine. The ability to use information and reason will make you shine on the wards. Especially if you have a reasonable personality. If you're fun to work with and like learning, they'll love you.

It just seems to be a different kind of knowledge at least from what I am seeing in my clinical experience.

I agree that you need to assimilate a lot of information in forming a differential. I seem to be able to do that pretty well for a first year- developing a list of potential causes then dismissing items (or reducing the likely candidates) based the H&P and tests. Or at least my professors (yes, more than one has said something) have thought it was amusing enough to mention/comment on it to me-- inquiring why I could do that but do so badly on the in class tests. Anyone else have this happen to them? Maybe it is my legal background and building a case?

For example, I have no problem with concepts that are used clinically (e.g., a unilateral lesion of the motor fibers of the trigeminal nerve will result in a deviation of the jaw on protrusion toward the side of the lesion). My issue is more the minutae- like the name of the fiber type for golgi tendon organs. If there is a disease process associated with the information, I am much more likely to remember it. I am hoping pathology will work well for me.

I think that your background as an attorney may make it more difficult for you in the typical multiple choice question testing format (whereas you would probably rock something that was a written test). You other profession makes you instinctively much more language sensitive than people coming in from scientific backgrounds and this can be a disadvantage in MCQ tests because your language skills enable you to see many more variables. However, don't give up. The subject matter does not get easier as you go through med school, but you do seem to get a better handle on studying and testing as time goes on. Hang in there!

I suck at memorizing things in a limited amount of time-- I will retain things I do learn longer than many of my classmates though. The dean of student affairs coined a term that I think is hysterical-- intellectual bullemia-- and many of us have it really badly.


HAAA!!! :laugh: :barf: :laugh:

I love it. I want a t-shirt.

And you are right, you will retain better. Just like you retain those adipose cells when you DON'T throw up those two Krispy Kremes....

I think that your background as an attorney may make it more difficult for you in the typical multiple choice question testing format (whereas you would probably rock something that was a written test). You other profession makes you instinctively much more language sensitive than people coming in from scientific backgrounds and this can be a disadvantage in MCQ tests because your language skills enable you to see many more variables. However, don't give up. The subject matter does not get easier as you go through med school, but you do seem to get a better handle on studying and testing as time goes on. Hang in there!

You definitely nailed part of my problem. I am very nitpicky with language (I do this unconsciously) and the questions are written so badly in some cases that it is distracting (not to mention, grammatically incorrect, which can affect interpretation of the question).

I never have a problem finishing my tests as my reading is very fast (I typically finish my test in 1/2 hour or 45 minutes when 2 1/2 hours are alloted and spend the rest of the time checking my answers and rationalizing choices). Unfortunately, I can argue almost any choice and that has been problematic as you guessed.

Thanks for the words of encouragement guys. I appreciate it.

You definitely nailed part of my problem. I am very nitpicky with language (I do this unconsciously) and the questions are written so badly in some cases that it is distracting (not to mention, grammatically incorrect, which can affect interpretation of the question).

I never have a problem finishing my tests as my reading is very fast (I typically finish my test in 1/2 hour or 45 minutes when 2 1/2 hours are alloted and spend the rest of the time checking my answers and rationalizing choices). Unfortunately, I can argue almost any choice and that has been problematic as you guessed.

I am exactly the same way. Believe me, you will learn how to do this. It's a skill, it's about knowing what they want, and it just takes practice. Some people do this really well--I think the people who don't rationalize but just memorize.

I promise you it will pay off. You may not get to the top of the class or get all As from now on, but you will improve your test talking skills, and you will be very impressive on the wards with good verbal and problem-solving skills.

I also think that there are lots of ppl who do well on tests but will be a walking disaster on the wards. You can't learn everything out of a book, and people who can't use logic and whose minds are just storage lockers will be in trouble.

-MJB

I often wonder about this particular mindset. I find that there is a (small) subculture in M1/M2 who seem to think that exactly BECAUSE they aren't doing well in their pre-clinical years they will certainly be a star on the wards. As if good grades and interpersonal skills are mutually exclusive. I kid you not, I once heard a guy ask during a review session, "do you have any questions for a student who struggles in anatomy but is going to be a star in clinics?"

To the OP, you sound alot like me when I was going through med school. I didn't do so hot the first year, even though I studied alot and was able to read though questions quickly to finish the test with more than enough time. I ended up doing much better 2nd year and during clinical rotations, and I think it has to do with the fact the material was much more INTERESTING. 1st year stuff was so boring, I'd rather even now, poke with my eyes out with a pencil than have to study that crap again. Your clinical shelf exams and pimp questions will come from 2nd year mostly, noone going to ask you about golgi complexes and ribosomes after this year, (except for step 1, but not that much.)

I often wonder about this particular mindset. I find that there is a (small) subculture in M1/M2 who seem to think that exactly BECAUSE they aren't doing well in their pre-clinical years they will certainly be a star on the wards. As if good grades and interpersonal skills are mutually exclusive. I kid you not, I once heard a guy ask during a review session, "do you have any questions for a student who struggles in anatomy but is going to be a star in clinics?"

While I don't think that vtucci falls into this category, I agree...there was one person in particular that I'm thinking of that nearly failed some of our classes and passed Step I by a small margin, so she touts her clinical successes more than most. Overcompensating? There is a lot--a LOT--to be said for interpersonal skills and analytical thinking, but personally, I found that studying my butt off 2nd year gave me a knowledge base without which I couldn't begin to think critically. And yeah, first year stuff is hard to learn because it's miserably dull.

While I don't think that vtucci falls into this category, I agree...there was one person in particular that I'm thinking of that nearly failed some of our classes and passed Step I by a small margin, so she touts her clinical successes more than most. Overcompensating? There is a lot--a LOT--to be said for interpersonal skills and analytical thinking, but personally, I found that studying my butt off 2nd year gave me a knowledge base without which I couldn't begin to think critically. And yeah, first year stuff is hard to learn because it's miserably dull.


I wasn't trying to accuse vtucci of anything :)
There's a big difference between admitting you struggle with parts of pre-clin (I sure did) and trying to say that that automatically = a great M3.

I wasn't trying to accuse vtucci of anything :)
There's a big difference between admitting you struggle with parts of pre-clin (I sure did) and trying to say that that automatically = a great M3.


I'm sure that it is only people hoping they will do better in third year and using positive thinking. I agree that you can't totally slack off first and second year and expect to shine during clinicals however, some of the people who really do well first and second year might not have the people skills that third year demands (not saying that as a general statement).

Like I said before I struggled through first year - mainly b/c I hated memorizing stuff that really didn't seem applicable (like all the amino acids or the molecular structure of DNA). Second year was a little better but, we were still taught by a lot of PhD's who wanted us to remember the biosynthesis of a medicine (which is of little clinical importance).

Third year was so much better for me b/c I got out of my study hibernation and was interacting with people almost all day - then going home and reinforcing what I learned at the hospital. It is just a different type of learning that might work better for some.

Interesting thread.

It seems that everyone seems to think s/he is stronger clinically than academically. Is anyone here willing to admit that s/he was stronger in the first two years and is now struggling? What sort of students end up like this? How can it be avoided?

Me! I was in the top of my class first and second year and did well on step 1, but now that I'm entering 3rd year (I've taken a year off for research), I'm so nervous that I'll be a total failure! It's not that I don't like people or anything, it's just that my strength has always been filling in little bubble sheets rather than being friendly and energetic when I'm actually tired and hungry. Anyway, I don't really have any advise since I'm just now anticipating the problem, but I'll keep you updated on my third year experience!

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QUOTE=Callogician]Interesting thread.

It seems that everyone seems to think s/he is stronger clinically than academically. Is anyone here willing to admit that s/he was stronger in the first two years and is now struggling? What sort of students end up like this? How can it be avoided?[/QUOTE]

We had a kid years ago who was bottom of the barrel, literally pass line + 1% preclinically (we don't have preclin grades though which was nice for him I guess) who did well on the wards, is fun to be around. He ended up at Hopkins IM.

Interesting thread.

It seems that everyone seems to think s/he is stronger clinically than academically. Is anyone here willing to admit that s/he was stronger in the first two years and is now struggling? What sort of students end up like this? How can it be avoided?

There was a medical student who was in with the ob/gyn resident during a prenatal checkup. He said in front of the patient during an U/S that the image looked like a "dog." If nothing else, think 2x-3x about what you're about to say before you say it. Statements which may seem to be innocuous may not be.

Also, whatever you do, don't make stuff up. I once inadvertently charted that pedal pulses were 2+ in a patient with bilateral BKAs just because it's part of the template in my brain that I usually write. I just wasn't thinking. It doesn't look that great (thankfully I lined it out before anyway really saw it).

Showing up somewhat on time, being nice to people is half the battle (for me anyway).

Interesting thread.

It seems that everyone seems to think s/he is stronger clinically than academically. Is anyone here willing to admit that s/he was stronger in the first two years and is now struggling? What sort of students end up like this? How can it be avoided?

Depends on how you mean struggling. I flew through years one and two with minimal effort, drank and partied more than I did in undergrad and killed the boards but my clinical grades are pretty flat. For me its more of an effort problem. I day-dream through clinic days, I have worn a tie once, I shave every 4 days or so, I never look up research papers, I've done one presentation, I don't answer pimp questions unless they are directed RIGHT at me [or I feel precious moments of my youth slipping away while another student stammers for 15+ minutes trying to think through a question that everyone should know], I don't ask questions or look interested. My saving grace is that people who are forced to spend any amount of time with me invariably figure out that I do inded know what Im doing, so my evals are a mix of "Very intelligent, will be good at any thing he does" and [I quote] "disinterested, unmotivated and distant from the material, barely passable performance"

So if you are looking for advice on what to do to avoid this...I will tell you: I want to be a surgeon, so the above description of me applies to all rotations except surgery. While on surgery I:
1. Looked nice every day (shaved, wore a tie if not in scrubs and actually learned that I did indeed have an iron somewhere in my closet), no one commented but no one complained about my appearance either, which had happened on other rotations.
2. Answered pimp questions like a mad man, they asked, I answered..no pause, sometimes I let a little time in for another student to get the answer wrong first. Several people pulled me aside including the director of the course and commented on my "strong fund of knowledge"
3. I picked up more patients and I even looked up research papers and presented them without being prompted. (I feel great shame and loss of dignity for this ass kissing...I normally feel that this sort of behavior is unacceptable). Several positive comments on my "initiative", how being someone elses secretary and reading a paper for them constitutes initiative I'll never know but it seems to be the standard perception.
4. I asked questions, and yes, I knew the answers before hand, in fact I knew some extra information so I could throw in a "OHHHH!!! is that related to this...[mechanism/pathophysiology etc, etc...]", again several positive comments...I feel so dirty.
In other words I was a total jack-ass...and it works.

In all my other rotations I saw students doing this and I thought that the attendings and residents would see right through it, but they don't. Med school is a game of the lowest common denominator, your classmates will be tools and look up random crappy research papers, your classmates will shout out answers like they have tourettes, your classmates will nod and smile and make the attending feel like the smartest person on earth while he tells them all about something they allready know. So your options are, roll your eyes and try not to doze off, or dive into the mud with them.

So my advice, if you care enough, is play the game. Im not sure its necessary however. With high enough grades your first 2 years you can still be in the top 25% of your class (or at least I can) with mostly passes 3rd year, and board scores carry a lot of weight.

None of this will work however if you really are a social retard.

On the flip side, is not getting honors in any rotation a sign of poor quality? My problem is that at least everyone likes me enough and I do well enough to get A's, but never honors.

On the flip side, is not getting honors in any rotation a sign of poor quality? My problem is that at least everyone likes me enough and I do well enough to get A's, but never honors.

In schools with real grades isn't an "A"=Honors?

I don't know how much of a disaster I was the first two years, but I never went to class, hovered right around the average, didn't care too much. I think how well you do 3rd year is, of course, partly your shining personality, but it's also partly how disciplined you're capable of being and how much room you have to turn it up a notch. I have a much better correlation between Step 1 and my performance on the NBME shelf exams during the clincal years than between Step 1 and the...questionably...written block exams from first and second year. At our school, it's top 10% honors only, so you have to have something special to get up there; luckily I have the shelf.

In schools with real grades isn't an "A"=Honors?

It actually isn't at my school--they have a separate "Honors" designation.
Go figure.