grades during M3

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medicinehopeful

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how important are your grades as you rotate through the year 3 clerkships? are they as important as step 1? or more important? less important?
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medicinehopeful said:
how important are your grades as you rotate through the year 3 clerkships? are they as important as step 1? or more important? less important?
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Clinical grades are at least as important as the boards esp if you can get AOA. But is it worth your soul??? :scared: It's a rough field out there, as evidenced by some of the other posts.
 
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Hard24Get said:
Clinical grades are at least as important as the boards esp if you can get AOA. But is it worth your soul??? :scared: It's a rough field out there, as evidenced by some of the other posts.
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I think it is worthwhile to try to honor or high pass the rotation of whatever field you want to go into, because during residency application this may give you a leg up. However, by no means if you don't honor say medicine, and you want to do internal medicine does this destroy your chances. You can always do a sub-I in medicine, honor it, and then have a good shot at getting a prestigious residency. There is so much that goes into a third year clinical evals, including subjective comments, that it can be more of a popularity contest then relfect whow will actually be a better pracitcioner. Many people who don't honor third year become excellent practicioners, and likewise many who do honor third year don't become excellent practicioners. Some programs directors I have talked to realize that third year rotations are very subjective, and may not reflect important attributes of a good resident and do look at the whole application.
 
Definitely try to honor the specialty you are wanting to go in to. The rest are not as improtant as step 1 UNLESS you bomb a rotation, then it is very improtant!
 
ChildNeuro said:
I think it is worthwhile to try to honor or high pass the rotation of whatever field you want to go into, because during residency application this may give you a leg up. However, by no means if you don't honor say medicine, and you want to do internal medicine does this destroy your chances. You can always do a sub-I in medicine, honor it, and then have a good shot at getting a prestigious residency. There is so much that goes into a third year clinical evals, including subjective comments, that it can be more of a popularity contest then relfect whow will actually be a better pracitcioner. Many people who don't honor third year become excellent practicioners, and likewise many who do honor third year don't become excellent practicioners. Some programs directors I have talked to realize that third year rotations are very subjective, and may not reflect important attributes of a good resident and do look at the whole application.
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In addition, it depends on your school. I have friends at other schools where nearly half of the rotating students will get honors or high pass. Then my school, for example, strictly adheres to a policy where only the top 10% of the class overall gets honors. That means at the end of third year, my school looks back at all the students who honored a clerkship during third year and ideally they like this number to be approximately 10% of the class (i.e. 12-15 people max). That means about 100 people "only pass." Oh, and there is no high pass. So, at my school, you kind of have to be content to just pass unless you're in the top 10%... which I am not - and frankly, I don't think you need to be in the top 10% of your class to get a good residency. So yes grades are important but comments are probably a bit more important, imho, since they are a bit more specific (ideally) and many many many students will receive the same grade (pass, high pass, whatever).
 
Third year grades are so subjective, I've heard real horror stories and almost everyone I know has at least one. :scared:
There are the interns, residents and attendings from He*l out there, and it's all luck of the draw...

Of course you'll have great ones too, but it's all a craps shoot.
Fun, huh?
:mad:

Man am I happy to be done w/ 3rd year!:hardy:
 
I still remember meeting with a faculty member at one of the residency programs I was applying to and asking for advice. Said faculty member took a look at my record and commented, "Oh, very good, your boards are strong.... However," and they took a look at my transcript which had straight P's and said, "Your grades are admittedly weak. Why is that?"

Third year clinical rotation grades are important. If for example your school has a H/P/F system the residency applications people will review your transcript and they will like to see those H grades.

The response I got at the place that I mentioned above to my transcript full of straight P's and no H's was probably not universal (in fact, I would be surprised if it was a typical response). You can get plenty of interviews, maybe even at top residency programs if your application is otherwise strong, with straight passes and no honors. (I did.) But honors grades in clinical rotations are looked well upon, and you can probably expect that highly competitive residencies want to see them and will need other excuses (i.e. a strong application otherwise) to hire you if you don't have them. But if they want you because they like you, they will find reasons to hire you. (Nobody tells you, but that's what the residency application process really is about -- programs find the people they like, then make excuses with grades/boards/papers/whatever to hire them.)

For the most part, other than showing honesty and sincere effort, you cannot control the evaluations you get from residents and attendings for your clinical rotations. There is one part you can control. That is the shelf exam. At my school, most of the clinical grade was based on how well you did on the shelf exam (which is highly objective), NOT what the residents wrote about you (which is highly subjective). We had people barely even show up for rotations who spent all their time studying and they rocked the shelf exam and got honors in the rotations. Work hard on that exam and don't worry about what the residents think of you, other than to be polite.
 
jennyboo said:
For the most part, other than showing honesty and sincere effort, you cannot control the evaluations you get from residents and attendings for your clinical rotations. There is one part you can control. That is the shelf exam. At my school, most of the clinical grade was based on how well you did on the shelf exam (which is highly objective), NOT what the residents wrote about you (which is highly subjective). We had people barely even show up for rotations who spent all their time studying and they rocked the shelf exam and got honors in the rotations. Work hard on that exam and don't worry about what the residents think of you, other than to be polite.
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Just make sure you know your school/rotation policy. Our shelf exam is only worth like 30%, so grades are all random. Also, keep in mind that the dean's letter will usually spell out what percentage people get honors, etc, in a particular subject, so they can tell whether you are an outlier or not.
 
I agree with what has been written. On medicine, OBGYN and peds, evaluations accounted for 2/3 of the grade, while the shelf was 1/3. For surgery it was 1/2 and 1/2.

You need to understand that contrary to what you or other students here think, you are NOT that important, and the likelihood that you will make a big enough impression to elicit a strongly positive or negative evaluation is slim. You are more likely to get a decent evaluations (say a 3 or 4 on a 5 point scale) and so are your classmates. So in the end, the shelf matters the most because with the exception of the outliers, most people get the same evaluations.

So on that medicine shelf, you will almost have to break that 90th percentile to honor because everybody is likely to have decent evaluations or better.
 
jennyboo said:
There is one part you can control. That is the shelf exam. At my school, most of the clinical grade was based on how well you did on the shelf exam (which is highly objective), NOT what the residents wrote about you (which is highly subjective). We had people barely even show up for rotations who spent all their time studying and they rocked the shelf exam and got honors in the rotations. Work hard on that exam and don't worry about what the residents think of you, other than to be polite.
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Alot of times the hardest working students on a rotation, in terms of helping out residents and doing extras for patients, are not given the honors and high pass. Attendings, obviously, only give your grade based on a small amount of interaction time with them, and is based on *alot* of subjective factors unrelated to medicine. I have seen students who could barely present a patient, didn't care what was going on in the rotation get an honors because they were all "smoozy" with the attending and residents, but behind their backs didn't like them, and told me this. On the other hand, I have seen students cut down who, obvious to the group, are doing quite well in terms of learning medicine and seeing patients, but the attending has a personal problem with them, maybe jealousy. Looking back, I have honored rotations recently, but I would have studied more for shelfs for earlier rotations I just passed, instead of coming in early, as that is how you learn medicine. Honoring a rotation is really just a salesperson of the year where you were able to promote yourself well to the team and attending, real world skill learned? None.
 
My school is terrible about subjectivity. The shelf is only 10% of our grade, the rest is based on our ability to shake hands, make good eye contact, and kiss ***.
 
Hi...

Your grades during the 3rd year clerkships are important... but less so than your STEP scores. The reason is that the STEP scores are the great equalizer. Grade requirements vary by school, and are actually quite subjective due to different teachers/ reading requirements/ questions/ grade cutoffs. Having a great STEP 1 score shows how you fare in general to all applying medical students, rather than to simply the rest of your particular school class.

Great STEP score/ fair-poor grades = your classes were relatively harder
Fair-poor STEP score/ great grades = your classes were relatively easier

Hope that helps.
 
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there's actually a publication which surveyed program directors about what's important for residency applicants. it's somewhere on this board (no time for me to look it up now)... anyway, 3rd year grades are considered more important than step scores by most programs.
 
i talked to a residency director in anesthesia. He told me they use grades, letters, boards, to decide who they interview. They use the interview to rule out the crazies, then just rank based on board scores. He told me that is true of most programs not all.
 
werd said:
there's actually a publication which surveyed program directors about what's important for residency applicants. it's somewhere on this board (no time for me to look it up now)... anyway, 3rd year grades are considered more important than step scores by most programs.
Click to expand...

There have been publications like that for a number of specialties. The ones I've seen have been in EM, ortho, IM (I think), OB/GYN, and plastics, but there are probably others. They don't all say the same thing but certainly most agree that 3rd year grades and Step I are more important. If someone wants, I can find citations.
 
I think the general consensus for most (i.e. NOT derm, plastics, ortho) specialties is Step 1 is most important, with clinical rotation in your specialty and Step 2 being close behind. After those 3 come research and other intangibles.

One question, where do LOR's fit into this scheme? Are they more important than clinical grades/step 1? I'd imagine they can attract a program to you the way a good performance on an away rotation can...
 
jennyboo said:
I still remember meeting with a faculty member at one of the residency programs I was applying to and asking for advice. Said faculty member took a look at my record and commented, "Oh, very good, your boards are strong.... However," and they took a look at my transcript which had straight P's and said, "Your grades are admittedly weak. Why is that?"

Third year clinical rotation grades are important. If for example your school has a H/P/F system the residency applications people will review your transcript and they will like to see those H grades.

The response I got at the place that I mentioned above to my transcript full of straight P's and no H's was probably not universal (in fact, I would be surprised if it was a typical response). You can get plenty of interviews, maybe even at top residency programs if your application is otherwise strong, with straight passes and no honors. (I did.) But honors grades in clinical rotations are looked well upon, and you can probably expect that highly competitive residencies want to see them and will need other excuses (i.e. a strong application otherwise) to hire you if you don't have them. But if they want you because they like you, they will find reasons to hire you. (Nobody tells you, but that's what the residency application process really is about -- programs find the people they like, then make excuses with grades/boards/papers/whatever to hire them.)

For the most part, other than showing honesty and sincere effort, you cannot control the evaluations you get from residents and attendings for your clinical rotations. There is one part you can control. That is the shelf exam. At my school, most of the clinical grade was based on how well you did on the shelf exam (which is highly objective), NOT what the residents wrote about you (which is highly subjective). We had people barely even show up for rotations who spent all their time studying and they rocked the shelf exam and got honors in the rotations. Work hard on that exam and don't worry about what the residents think of you, other than to be polite.
Click to expand...

In that case your lucky, because at my school the grades were based mainly on the evaluations, which were 100% subjective BS.
 
yeah man!

clinical grades are such bullsh*.

it seems everyone around me is getting a 90+
why should they even look at this crap...........
 
Dr McSteamy said:
it seems everyone around me is getting a 90+
why should they even look at this crap...........
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if ur talking about shelf scores, then they should look at them b/c they are indicative of clinical knowledge. i think that most people on this thread agree that the subjectivity of evaluations is the major culprit behind why clinical grades are such a complicated game to play. so i think that incorporating an objective (and standardized) measure of clinical knowledge into the clinical grade will make it easier to plan and "work towards" a certain grade.
 
medicinehopeful said:
how important are your grades as you rotate through the year 3 clerkships? are they as important as step 1? or more important? less important?
Click to expand...

The most important thing is the grade in the rotation of your specialty

then boards

then recommendation letters

then other clinical grades
 
relative importance of grades, board scores, research, etc vary with specialty--but on balance (except for those few surgical sub-specialties that value step 1 score above all else) I'd say 3rd year grades are the most important part of your application.

#1 Surveys of program directors consistently rank "clerkship grade in specialty of interest" as the most important part of your application--i.e. it can really hurt you not to have honored what you want to do. If you didn't as a 3rd year, you better go back as a 4th year and get honors.

#2 Clerkship performance/grades not only affect your GPA, but the comments from you clerkship evaluations are the meat of your Dean's Letter. Programs want a stellar Dean's Letter and the only way to get one is to rock 3rd year.

#3 3rd year grades are always weighted most heavily so they are the biggest factor in determining your class rank

#4 see #3, they also largely determine AOA (if your school doesn't do Jr AOA, or you didn't make it)

#5 Good performance during 3rd year often sets you up for good letters of rec.

So I'd say 3rd year grades are, all things considered, the most important single thing you can do well on to improve your chances in the match.
 
RockfordWF said:
The most important thing is the grade in the rotation of your specialty

then boards

then recommendation letters

then other clinical grades
Click to expand...

yes, there are surveys of program directors to back this up
 
velo said:
relative importance of grades, board scores, research, etc vary with specialty--but on balance (except for those few surgical sub-specialties that value step 1 score above all else) I'd say 3rd year grades are the most important part of your application.

#1 Surveys of program directors consistently rank "clerkship grade in specialty of interest" as the most important part of your application--i.e. it can really hurt you not to have honored what you want to do. If you didn't as a 3rd year, you better go back as a 4th year and get honors.

#2 Clerkship performance/grades not only affect your GPA, but the comments from you clerkship evaluations are the meat of your Dean's Letter. Programs want a stellar Dean's Letter and the only way to get one is to rock 3rd year.

#3 3rd year grades are always weighted most heavily so they are the biggest factor in determining your class rank

#4 see #3, they also largely determine AOA (if your school doesn't do Jr AOA, or you didn't make it)

#5 Good performance during 3rd year often sets you up for good letters of rec.

So I'd say 3rd year grades are, all things considered, the most important single thing you can do well on to improve your chances in the match.
Click to expand...

For emergency medicine, it is as I described before, with 3rd year grades being down the list (with the exception of the EM rotation.) This is according to the SAEM research.
 
RockfordWF said:
For emergency medicine, it is as I described before, with 3rd year grades being down the list (with the exception of the EM rotation.) This is according to the SAEM research.
Click to expand...

Emergency medicine places a higher value on letters of recommendation than some other specialties. My recollection for ortho, for example, is that letters are well down the list, certainly below 3rd year grades. Apparently in plastics, according to a recent paper, AOA status is valued more even than Step I score, which was pretty surprising to me.

I think the trends are pretty clear overall, but you really can't make absolute statements about the relative importance of X vs Y criterion without qualifying them by specialty (and even then, individual programs will vary!).
 
RockfordWF said:
For emergency medicine, it is as I described before, with 3rd year grades being down the list (with the exception of the EM rotation.) This is according to the SAEM research.
Click to expand...

Actually I just looked up the paper on this for EM, and it looks like 3rd year grades are indeed more important than anything else besides the EM grade and the interview:

http://www.ncbi.nlm.nih.gov/pubmed/10894243
Acad Emerg Med. 2000 Jan;7(1):54-60.
Selection criteria for emergency medicine residency applicants.

From the abstract:
Items ranking as most important (4.0-5.0) in the selection process included: EM rotation grade (mean +/- SD = 4.79 +/- 0.50), interview (4.62 +/- 0.63), clinical grades (4.36 +/- 0.70), and recommendations (4.11 +/- 0.85). Moderate emphasis (3.0-4.0) was placed on: elective done at program director's institution (3.75 +/- 1.25), U.S. Medical Licensing Examination (USMLE) step II (3.34 +/- 0.93), interest expressed in program director's institution (3.30 +/- 1.19), USMLE step I (3.28 +/- 0.86), and awards/achievements (3.16 +/- 0.88).
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How does getting AOA exactly work?

Can you get AOA for your clinical grades w/o getting AOA in the basic science courses?
 
doctorperez said:
How does getting AOA exactly work?

Can you get AOA for your clinical grades w/o getting AOA in the basic science courses?
Click to expand...

At my school, it goes to the top 8% after the first two years (based on grades and Step I) and then 2/3 of the top 25% after the first three years (based on grades, Step I, and also subjective measures such as research, leadership, and community service).

You can google AOA to find out the national standards. I think that in general you have to be in the top 25% of your class to be eligible. If your school is P/F for the first two years, then presumably they would only use your 3rd year grades to determine class rank and thus AOA eligibility.
 
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