Stress over grades in M1 and M2

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So I wanted to get some community thoughts on this. I'm still trying to understand the inner workings of all the grade implications for M1 and M2 years. I'm an M1 at a US MD school that does A,B,C,F grading (not pass-fail). I don't think that there is a competitive environment at my school to make top grades, it's more of a camaraderie-type atmosphere, which is great. I have read all the residency reports as to how much grades matter from the first 2 years.. aka not that much.. and that there are way more valuable things to do well on (step 1, clerkships, etc.).

HOWEVER, here is where my questions come in. Class rank has to matter somewhat, being in the top 25% in your class if you're shooting for AOA is a must as well. So why do people that go to pass-fail schools seem to not care at all about grades and go out 3-4 times a week, etc. You still get put into a class rank at a pass-fail school, do you not? Being in the bottom 25% of your class on your CV also seems to have bad implications. When it comes to residency, is every school required to put your GPA/rank even if they were pass-fail? (I heard rumors that Stanford med does not release the class-rank of any students as long as they're passing, true?).

I know the ultimate goal is to do well on boards and come out as a well-trained doctor.. and I understand that people have different goals for themselves. But I don't understand how some people just seem not to care. I've heard that being in AOA is a giant leg-up for applying to competitive residencies in rads, onc, derm, surg.. so why do people not seem concerned with being in the top 25% of their class?

Thoughts?

Why do you care what people at other schools do? Even schools that are pass-fail have percentages associated with their grades, so it's not like there's no reference to how they performed.

Originally Posted by tco

Why do you care what people at other schools do? Even schools that are pass-fail have percentages associated with their grades, so it's not like there's no reference to how they performed.

That was exactly my question. I stated in the post that I know schools that are pass-fail still have associated percentages and class rank. Therefore my question is why don't people at pass-fail schools seem concerned with their grades at all. This question also goes to people at my school or schools like mine. I'm not concerned with the performance of others, just trying to understand why there is a general 'grades in M1-M2 don't matter' sentiment across the forums.

I agree. I think it is important to to do well no matter what your grading system is because there are benefits, even if M1 and M2 grades themselves are not important themselves. (And like you, I still don't really get why people freak out about the thought of attending a non-P/F school).

It is in your best interest to do the best you can without burning out. Period. At least at my school (and I'm sure it's true at most), Step 1 scores correlate with grades. If you work harder for better grades, it just makes sense that you will do better on Step 1. You don't have to kill yourself for honors on everything, but just barely passing won't help you either.

And you are right about being in the top 25% of your class. If you are looking into competitive residencies, that is something you should shoot for.

I don't really get it either. I know that M1 and M2 grades themselves aren't important, but it seems to be very important to do well for the benefits beyond the grades themselves. I don't get stressed out about grades, I'm not burnt out, but I try and get the best grades I can. Why wouldn't you?

Originally Posted by MedBound1

That was exactly my question. I stated in the post that I know schools that are pass-fail still have associated percentages and class rank. Therefore my question is why don't people at pass-fail schools seem concerned with their grades at all. This question also goes to people at my school or schools like mine. I'm not concerned with the performance of others, just trying to understand why there is a general 'grades in M1-M2 don't matter' sentiment across the forums.

That's where you're wrong and where the phrase "true pass/fail" comes from: many schools that are P/F (mine included) do not rank and, at least for the pre-clinical years, the administration receives no information about your performance other than a P or F.

Beyond that, there's a well-known study (at least on SDN) that reported the results of a survey of PDs in all specialties asking what factors were most important to their decision to rank applicants. Class rank is almost universally near the bottom of importance, even in super competitive fields. Things like clinical grades, LORs, step 1, and to some extent research are the most important. Obviously doing well in the pre-clinical years is helpful (if for nothing else than you might be more prepared for step 1), but the data suggests that it's not a "game-changer" in terms of importance.

Originally Posted by NickNaylor

That's where you're wrong and where the phrase "true pass/fail" comes from: many schools that are P/F (mine included) do not rank and, at least for the pre-clinical years, the administration receives no information about your performance other than a P or F.

Beyond that, there's a well-known study (at least on SDN) that reported the results of a survey of PDs in all specialties asking what factors were most important to their decision to rank applicants. Class rank is almost universally near the bottom of importance, even in super competitive fields. Things like clinical grades, LORs, step 1, and to some extent research are the most important. Obviously doing well in the pre-clinical years is helpful, but the data suggests that it's not a "game-changer" in terms of importance.

Thanks for the reply Nick. What are your thoughts on societies like the AOA? We recently had a radiologist come in and talk who made the comment that if you wanted to go to a competitive residency in rads you needed to be in AOA (he was on the residency board for a long time and it was one of the factors that used to make initials 'cuts'). I'm guessing even at 'True P/F' schools like yours, the AOA will still receive a list of the top 25% of your class upon request, even though that is hidden information when it comes to residency apps.

Originally Posted by NickNaylor

That's where you're wrong and where the phrase "true pass/fail" comes from: many schools that are P/F (mine included) do not rank and, at least for the pre-clinical years, the administration receives no information about your performance other than a P or F.

Beyond that, there's a well-known study (at least on SDN) that reported the results of a survey of PDs in all specialties asking what factors were most important to their decision to rank applicants. Class rank is almost universally near the bottom of importance, even in super competitive fields. Things like clinical grades, LORs, step 1, and to some extent research are the most important. Obviously doing well in the pre-clinical years is helpful (if for nothing else than you might be more prepared for step 1), but the data suggests that it's not a "game-changer" in terms of importance.

It's hilarious that the more objective of the grades (pre-clinical vs clinical) matters less than the extremely subjective grading of third year.

BTW, I'm under the impression that all schools rank according to quartile. Are you saying that yours does not? If it does, they keep track of your percentage scores whether you know it or not...

Originally Posted by tco

It's hilarious that the more objective of the grades (pre-clinical vs clinical) matters less than the extremely subjective grading of third year.

BTW, I'm under the impression that all schools rank according to quartile. Are you saying that yours does not? If it does, they keep track of your percentage scores whether you know it or not...

That's not true - Yale is an example of this (how do they rank you when they don't even grade you for 3 out of 4 years?). A few schools don't rank at all, some are P/F and rank broadly (e.g., quartiles or quintiles; Cornell is an example of this), and some (most?) do actual ranks. It is untrue that "all schools rank according to quartile." This may be true at your school, but it certainly isn't true at all of them.

Originally Posted by NickNaylor

That's not true - Yale is an example of this (how do they rank you when they don't even grade you for 3 out of 4 years?). A few schools don't rank at all, some are P/F and rank broadly (e.g., quartiles or quintiles; Cornell is an example of this), and some (most?) do actual ranks. It is untrue that "all schools rank according to quartile." This may be true at your school, but it certainly isn't true at all of them.

I don't know how I feel about not ranking students. There is a significant difference between the type of student that is at the top quartile vs the bottom quartile, even at elite schools. I feel that it's invaluable information to PDs to know where the student ranks before ranking them in the match.

Originally Posted by MedBound1

Thanks for the reply Nick. What are your thoughts on societies like the AOA? We recently had a radiologist come in and talk who made the comment that if you wanted to go to a competitive residency in rads you needed to be in AOA (he was on the residency board for a long time and it was one of the factors that used to make initials 'cuts'). I'm guessing even at 'True P/F' schools like yours, the AOA will still receive a list of the top 25% of your class upon request, even though that is hidden information when it comes to residency apps.

I have no idea as I haven't been through the process; you'd be better off talking to older students. However, based on what I've heard and read, AOA can be extremely important for the more competitive residencies, but it seems to be PD-dependent (i.e., some PDs see AOA as extremely important while others not so much). I think this is more a result of step 1 scores and clinical grades being very important in those fields, and obviously the best students in those categories are also likely to be AOA since those are also usually the criteria used for AOA selection. You're right in that AOA does discriminate among the class to some extent, but if you're NOT AOA my understanding is that it doesn't really matter if the rest of your app is strong. All it says is that you're in the bottom 75-90% of your class, which doesn't really say anything.

Originally Posted by tco

I don't know how I feel about not ranking students. There is a significant difference between the type of student that is at the top quartile vs the bottom quartile, even at elite schools. I feel that it's invaluable information to PDs to know where the student ranks before ranking them in the match.

When the average GPA of a class at an "elite" school is 3.8+ and the average MCAT is 36+, I'm not sure that there's that much value in discriminating among medical students. To get into a top school you have to have a strong work ethic and be academically proficient. Just the fact that you go to Harvard, Yale, etc. says something about you - whether that something is deserved or not. Sure, there's some benefit to ranking students I suppose, but I think many schools are beginning to realize that those "benefits" may not actually be worth their costs. I will freely admit that those costs may or may not be overstated or actually exist - I'm not sure what going to a graded school is like since I don't go to one.

Originally Posted by NickNaylor

When the average GPA of a class at an "elite" school is 3.8+ and the average MCAT is 36+, I'm not sure that there's that much value in discriminating among medical students. To get into a top school you have to have a strong work ethic and be academically proficient. Just the fact that you go to Harvard, Yale, etc. says something about you - whether that something is deserved or not. Sure, there's some benefit to ranking students I suppose, but I think many schools are beginning to realize that those "benefits" may not actually be worth their costs. I will freely admit that those costs may or may not be overstated or actually exist - I'm not sure what going to a graded school is like since I don't go to one.

unless ur mexican or black ... then u get in with a 3.3 and 30

Originally Posted by tco

It's hilarious that the more objective of the grades (pre-clinical vs clinical) matters less than the extremely subjective grading of third year.

BTW, I'm under the impression that all schools rank according to quartile. Are you saying that yours does not? If it does, they keep track of your percentage scores whether you know it or not...

M1/M2 grades are more objective, but they are just not that highly correlated with who makes a good clinician. While you might get screwed over on some evals during M3/M4, the overall picture painted by those grades is useful, as are the comments from those evals which go into the MSPE.

Originally Posted by PrideNeverDie

unless ur mexican or black ... then u get in with a 3.3 and 30

Lol, username relevant.

Originally Posted by MedBound1

So I wanted to get some community thoughts on this. I'm still trying to understand the inner workings of all the grade implications for M1 and M2 years. I'm an M1 at a US MD school that does A,B,C,F grading (not pass-fail). I don't think that there is a competitive environment at my school to make top grades, it's more of a camaraderie-type atmosphere, which is great. I have read all the residency reports as to how much grades matter from the first 2 years.. aka not that much.. and that there are way more valuable things to do well on (step 1, clerkships, etc.).

HOWEVER, here is where my questions come in. Class rank has to matter somewhat, being in the top 25% in your class if you're shooting for AOA is a must as well. So why do people that go to pass-fail schools seem to not care at all about grades and go out 3-4 times a week, etc. You still get put into a class rank at a pass-fail school, do you not? Being in the bottom 25% of your class on your CV also seems to have bad implications. When it comes to residency, is every school required to put your GPA/rank even if they were pass-fail? (I heard rumors that Stanford med does not release the class-rank of any students as long as they're passing, true?).

I know the ultimate goal is to do well on boards and come out as a well-trained doctor.. and I understand that people have different goals for themselves. But I don't understand how some people just seem not to care. I've heard that being in AOA is a giant leg-up for applying to competitive residencies in rads, onc, derm, surg.. so why do people not seem concerned with being in the top 25% of their class?

Thoughts?

Because many schools don't have grades or ranks. Furthermore, when concerned with residencies, many of us aren't even interested in ROADs.

If you have 2 applicants, one from a school with a traditional ABCDF grading system, and one from a pure pass/fail school, how are you as a PD going to compare the grades of the two? This is why board scores are so gosh darned important-they provide a metric by which everyone can be compared, since the grading systems (and even the curriculum in general) are not standardized well.

Originally Posted by NickNaylor

When the average GPA of a class at an "elite" school is 3.8+ and the average MCAT is 36+, I'm not sure that there's that much value in discriminating among medical students. To get into a top school you have to have a strong work ethic and be academically proficient. Just the fact that you go to Harvard, Yale, etc. says something about you - whether that something is deserved or not. Sure, there's some benefit to ranking students I suppose, but I think many schools are beginning to realize that those "benefits" may not actually be worth their costs. I will freely admit that those costs may or may not be overstated or actually exist - I'm not sure what going to a graded school is like since I don't go to one.

I wholeheartedly disagree. I've seen quite a few students with 30+ MCAT scores, 3.7+ GPAs with terrible work ethic. Also, as you said, those schools have average MCAT scores and GPAs that approach those numbers, but the average is greatly skewed by persons who score extremely high applying exclusively to top tier schools. Ranking is important, and it would take an extremely thorough and thought-provoking post for me to consider otherwise.

Originally Posted by tco

I wholeheartedly disagree. I've seen quite a few students with 30+ MCAT scores, 3.7+ GPAs with terrible work ethic. Also, as you said, those schools have average MCAT scores and GPAs that approach those numbers, but the average is greatly skewed by persons who score extremely high applying exclusively to top tier schools. Ranking is important, and it would take an extremely thorough and thought-provoking post for me to consider otherwise.

But in the context of other information, what does ranking add? Does it matter if a Harvard grad is in the bottom 5% of the class? What does that even mean? I'm not sure that performance in the classroom means anything about the the kind of physician you're going to be. It's naive and asinine to think that being at the top of your class means you're going to be the best physician among your classmates. Given that's true, and given that there are plenty of measured to evaluate you by, what's the point?

Originally Posted by MedBound1

So I wanted to get some community thoughts on this. I'm still trying to understand the inner workings of all the grade implications for M1 and M2 years. I'm an M1 at a US MD school that does A,B,C,F grading (not pass-fail). I don't think that there is a competitive environment at my school to make top grades, it's more of a camaraderie-type atmosphere, which is great. I have read all the residency reports as to how much grades matter from the first 2 years.. aka not that much.. and that there are way more valuable things to do well on (step 1, clerkships, etc.).

HOWEVER, here is where my questions come in. Class rank has to matter somewhat, being in the top 25% in your class if you're shooting for AOA is a must as well. So why do people that go to pass-fail schools seem to not care at all about grades and go out 3-4 times a week, etc. You still get put into a class rank at a pass-fail school, do you not? Being in the bottom 25% of your class on your CV also seems to have bad implications. When it comes to residency, is every school required to put your GPA/rank even if they were pass-fail? (I heard rumors that Stanford med does not release the class-rank of any students as long as they're passing, true?).

I know the ultimate goal is to do well on boards and come out as a well-trained doctor.. and I understand that people have different goals for themselves. But I don't understand how some people just seem not to care. I've heard that being in AOA is a giant leg-up for applying to competitive residencies in rads, onc, derm, surg.. so why do people not seem concerned with being in the top 25% of their class?

Thoughts?

"Pride is essentially competitive-is competitive by its very nature... pride gets no pleasure out of having something, only having more than the next man. We say people are proud of being rich, or clever, or good looking but they are not. They are proud of being richer, or cleverer, or better looking than others."

Sort of related. Despite comparisons of pre-clinical grading systems and their utility to applications, clinical grades between schools also vary wildly and DO matter. Just looking at this thread, you can see the distribution of clinical grades at different schools (self-reported, obviously): http://forums.studentdoctor.net/showthread.php?t=945649

H-HP-P/F

35-55-10
15-15-70
10-40-50
10-10-80

So there's the already subjective grading of third year in addition to any grading caps the school has in place. Basically just adds another layer of complexity for the PD, if they even care.

Originally Posted by NickNaylor

But in the context of other information, what does ranking add? Does it matter if a Harvard grad is in the bottom 5% of the class? What does that even mean? I'm not sure that performance in the classroom means anything about the the kind of physician you're going to be. It's naive and asinine to think that being at the top of your class means you're going to be the best physician among your classmates. Given that's true, and given that there are plenty of measured to evaluate you by, what's the point?

I agree with nick.

I don't think there is a consensus answer to this question because everyone is different. Also on SDN, many people are obsessed with boosting their ego via career accolades, in hopes that their specialty or class rank or board score will define them as a person or justify their existence.

I think the best strategy is to work hard, do your best, retain balance, and detach yourself from the results. Many think this leads to poor results but it doesn't. Enjoy the work for what it is rather than enjoying it because you have more or did better than others.

Originally Posted by MCAT guy

"Pride is essentially competitive-is competitive by its very nature... pride gets no pleasure out of having something, only having more than the next man. We say people are proud of being rich, or clever, or good looking but they are not. They are proud of being richer, or cleverer, or better looking than others."

I think many people reading my original post are missing its intent. If it weren't for steadfast markers in place like entrance to the AOA who's cut-off is defined by a measuring stick between classmates, I would not care at all how I feel within the class. Like many medical students, I have a wife and many other obligations outside of medical school. I do not like the idea of pushing myself so far to the brink that I lose site of what's really important in life.. most of which have nothing to do with my career. I'm wondering what other peoples thoughts are on the importance of such honor societies, class rank and grades, etc. because I want to do the best I can but at a reasonable rate. I don't want to slide by in my first 2 years so I can go out and drink 3-4 nights a week, I want to do well in school while not sacrificing things in life that are more important to me (a work-life balance). You can't have it all.. and I don't want it all..

Originally Posted by DrSnips

M1/M2 grades are more objective, but they are just not that highly correlated with who makes a good clinician. While you might get screwed over on some evals during M3/M4, the overall picture painted by those grades is useful, as are the comments from those evals which go into the MSPE.

This. A trend of strong grades in third year gives a far more complete picture of who's going to be an effective resident than the single domain of memorizing stuff does in M1/M2.

AOA is a bit of a wild card. Anecdotes aside, its not all that valuable because many schools don't have it, and many that do don't award junior AOA, thus preventing your election from making any difference for interview season. It's way down the list of priorities for residency apps, even for most competitive specialties. People who get AOA (or would have gotten it) already have good grades, which is what the programs are after, anyway.

I attend a school that has H/P/F grading all four years. We aren't ranked, not by quartile, not by anything. There's no "secret list" of the top 25%. I guess if you were a PD you could try to read the tea leaves in the adjectives they use in our MSPEs, but that sounds pretty soft to me. They'll go off my clerkship grades, my Step scores, and my letters. Honestly that's the first 90% of the application for 90% of applicants.

Originally Posted by wololololololo

Sort of related. Despite comparisons of pre-clinical grading systems and their utility to applications, clinical grades between schools also vary wildly and DO matter. Just looking at this thread, you can see the distribution of clinical grades at different schools (self-reported, obviously): http://forums.studentdoctor.net/showthread.php?t=945649

H-HP-P/F

35-55-10
15-15-70
10-40-50
10-10-80

So there's the already subjective grading of third year in addition to any grading caps the school has in place. Basically just adds another layer of complexity for the PD, if they even care.

Right but this is the kind of info that's in the MSPE, grade intervals and such. Again, here the split is 25-75, and that's stated clearly to everyone who wants to know.

If third year grading is so subjective, then how do some people honor everything? Individual evals are somewhat subjective I agree, but you need a bunch of them in order to do well. Plus there's a Shelf. Saying third year grades are subjective is like the people in Pre-Allo talking about how random admissions is. They're both blown way out of proportion.

Originally Posted by MedBound1

I think many people reading my original post are missing its intent. If it weren't for steadfast markers in place like entrance to the AOA who's cut-off is defined by a measuring stick between classmates, I would not care at all how I feel within the class. Like many medical students, I have a wife and many other obligations outside of medical school. I do not like the idea of pushing myself so far to the brink that I lose site of what's really important in life.. most of which have nothing to do with my career. I'm wondering what other peoples thoughts are on the importance of such honor societies, class rank and grades, etc. because I want to do the best I can but at a reasonable rate. I don't want to slide by in my first 2 years so I can go out and drink 3-4 nights a week, I want to do well in school while not sacrificing things in life that are more important to me (a work-life balance). You can't have it all.. and I don't want it all..

What does it matter what others think about these things. As you said, you want work life balance. Decide how hard you want to work and give it your all and retain balance. That's all you can do regardless of others opinions on class rank and honors.

What would be bad is working really hard if others told you it's important or slacking off if others told you to slack off. Do your best everyday and take time off when needed. You won't lose sight of what's important if you work hard when its work time and schedule time for other important things (exercise, time with wife and friends). You said you want to do your best at a reasonable rate, well that's achievable in the absence of what random med students think.

Originally Posted by gravitywave

Right but this is the kind of info that's in the MSPE, grade intervals and such. Again, here the split is 25-75, and that's stated clearly to everyone who wants to know.

If third year grading is so subjective, then how do some people honor everything? Individual evals are somewhat subjective I agree, but you need a bunch of them in order to do well. Plus there's a Shelf. Saying third year grades are subjective is like the people in Pre-Allo talking about how random admissions is. They're both blown way out of proportion.

Exactly. My neuro rotation third year was 30% shelf, 30% oral exam (harder than shelf), 10% case reports and the remainder attending evals. If a clerkship director wanted to limit the subjective portion of the grade, they could absolutely devise a grading scheme to do so.

Originally Posted by DrSnips

Exactly. My neuro rotation third year was 30% shelf, 30% oral exam (harder than shelf), 10% case reports and the remainder attending evals. If a clerkship director wanted to limit the subjective portion of the grade, they could absolutely devise a grading scheme to do so.

But that's the bull**** part of this. Every school does 3rd year grades differently. Some are more subjective than others. Yet students at different schools are compared by the number of honors they get in clinical rotations, or if they did get honors in a rotation relevant to a residency.

My school makes it so you need a certain cutoff score on evals AND a certain cutoff percentile on the shelf exam to qualify for honors. If you had a 99th percentile exam score and had above average evals but just barely missed the cutoff score, then you can only pass. It feels like a 100% subjective system since no matter how well you do on the objective part of the rotation, the only thing that matters is if you could get the surgeon to give you above average on every eval category. You can easily get screwed by being assigned a few notorious hard asses who give nothing but average marks in the best case scenario.

Originally Posted by MedBound1

So I wanted to get some community thoughts on this. I'm still trying to understand the inner workings of all the grade implications for M1 and M2 years. I'm an M1 at a US MD school that does A,B,C,F grading (not pass-fail). I don't think that there is a competitive environment at my school to make top grades, it's more of a camaraderie-type atmosphere, which is great. I have read all the residency reports as to how much grades matter from the first 2 years.. aka not that much.. and that there are way more valuable things to do well on (step 1, clerkships, etc.).

HOWEVER, here is where my questions come in. Class rank has to matter somewhat, being in the top 25% in your class if you're shooting for AOA is a must as well. So why do people that go to pass-fail schools seem to not care at all about grades and go out 3-4 times a week, etc. You still get put into a class rank at a pass-fail school, do you not? Being in the bottom 25% of your class on your CV also seems to have bad implications. When it comes to residency, is every school required to put your GPA/rank even if they were pass-fail? (I heard rumors that Stanford med does not release the class-rank of any students as long as they're passing, true?).

I know the ultimate goal is to do well on boards and come out as a well-trained doctor.. and I understand that people have different goals for themselves. But I don't understand how some people just seem not to care. I've heard that being in AOA is a giant leg-up for applying to competitive residencies in rads, onc, derm, surg.. so why do people not seem concerned with being in the top 25% of their class?

Thoughts?

How does one "rock step 1?" By learning the material. How is learning the material rewarded? Good grades. How does one obtain "stellar third years grades"? Answering the residents' and attendings' questions thoughtfully and intelligently and having enough knowledge to recommend reasonable treatment plans. All this is based on what you learn during the first two years. So although grades during the first two years did not explicitly make to the top of the PD survey, it is the foundation. You will be hard pressed to find a student who struggled/didn't care the first two years rock step 1 and impress the hell out of the residents and attendings with their broad font of knowledge. Those students, at least at my school, who preach how unimportant the first two years are are usually doing this to make themselves feel ok with marginal performance. Don't know the first line drugs and mechanism of action for treating diabetes? Good luck impressing the FM attending. You get the point.

Originally Posted by NickNaylor

But in the context of other information, what does ranking add? Does it matter if a Harvard grad is in the bottom 5% of the class? What does that even mean? I'm not sure that performance in the classroom means anything about the the kind of physician you're going to be. It's naive and asinine to think that being at the top of your class means you're going to be the best physician among your classmates. Given that's true, and given that there are plenty of measured to evaluate you by, what's the point?

You're assuming I'm only mentioning ranking to separate the poor performers from everyone else. What if you (I know it could never happen to you) have a bad day on Step 1 and score a 225? You want to match into something highly competitive. If your program ranks quartlies, and you're in the top quartile, it tells the PD that you legitimately had a bad day. We put so much stock in our lives into one test day. First the MCAT, then Step 1...If your rebuttal is that you should still be considered for the same residency position as Joe Sixpack who went to Third Tier Medical School but is ranked in the top quartile, scored a 240, and has research published in the field, my question becomes, "Why do we score Step 1? Shouldn't it be P/F?"

Originally Posted by mustang1

How does one "rock step 1?" By learning the material. How is learning the material rewarded? Good grades. How does one obtain "stellar third years grades"? Answering the residents' and attendings' questions thoughtfully and intelligently and having enough knowledge to recommend reasonable treatment plans. All this is based on what you learn during the first two years. So although grades during the first two years did not explicitly make to the top of the PD survey, it is the foundation. You will be hard pressed to find a student who struggled/didn't care the first two years rock step 1 and impress the hell out of the residents and attendings with their broad font of knowledge. Those students, at least at my school, who preach how unimportant the first two years are are usually doing this to make themselves feel ok with marginal performance. Don't know the first line drugs and mechanism of action for treating diabetes? Good luck impressing the FM attending. You get the point.

That assessment of third year isn't exactly accurate. For the most part, attendings don't care about your assessment and plan. They're going to mark you as average no matter what you say and do. That's just how it goes. You will have a few that give you legitimate feedback and care about what you have to say, but those are few and far between.

Originally Posted by DrSnips

Exactly. My neuro rotation third year was 30% shelf, 30% oral exam (harder than shelf), 10% case reports and the remainder attending evals. If a clerkship director wanted to limit the subjective portion of the grade, they could absolutely devise a grading scheme to do so.

Ours was similar, attending/resident evals counted for less on Neuro than on any other rotation. The OSCE is worth a lot; the director put a high value on being able to perform and interpret the exam.

Originally Posted by ijn

But that's the bull**** part of this. Every school does 3rd year grades differently. Some are more subjective than others. Yet students at different schools are compared by the number of honors they get in clinical rotations, or if they did get honors in a rotation relevant to a residency.

My school makes it so you need a certain cutoff score on evals AND a certain cutoff percentile on the shelf exam to qualify for honors. If you had a 99th percentile exam score and had above average evals but just barely missed the cutoff score, then you can only pass. It feels like a 100% subjective system since no matter how well you do on the objective part of the rotation, the only thing that matters is if you could get the surgeon to give you above average on every eval category. You can easily get screwed by being assigned a few notorious hard asses who give nothing but average marks in the best case scenario.

I hear what you're saying, and it's true that we do depend on those reading our applications to read between the lines a little bit. I have heard that it can be difficult to get ranked by a program that's never had a student from your school before, because they don't have as good an idea of what your file represents.

Our school has a similar cutoff system. Do you think people should be honoring rotations on which they barely passed the Shelf? That used to be possible here. Some evaluators are tough but I think that just averages out for everyone over the course of the year.

Originally Posted by tco

That assessment of third year isn't exactly accurate. For the most part, attendings don't care about your assessment and plan. They're going to mark you as average no matter what you say and do. That's just how it goes. You will have a few that give you legitimate feedback and care about what you have to say, but those are few and far between.

That's not been my experience here. mustang makes some good points. Most of the body of knowledge for which you're held responsible during third year comes from stuff you first saw M1/M2.

Originally Posted by mustang1

How does one "rock step 1?" By learning the material. How is learning the material rewarded? Good grades. How does one obtain "stellar third years grades"? Answering the residents' and attendings' questions thoughtfully and intelligently and having enough knowledge to recommend reasonable treatment plans. All this is based on what you learn during the first two years. So although grades during the first two years did not explicitly make to the top of the PD survey, it is the foundation. You will be hard pressed to find a student who struggled/didn't care the first two years rock step 1 and impress the hell out of the residents and attendings with their broad font of knowledge. Those students, at least at my school, who preach how unimportant the first two years are are usually doing this to make themselves feel ok with marginal performance. Don't know the first line drugs and mechanism of action for treating diabetes? Good luck impressing the FM attending. You get the point.

You are assuming that everything learned during the first two years is boards-relevant. I don't know about you, but my experience has been FAR from that. We are taught WAY more material than we EVER need to know for the boards. Using grades as a proxy for work ethic, I would agree with you. However I disagree that you can't be a weak student during M1/M2 and then do well on the boards.

Originally Posted by tco

You're assuming I'm only mentioning ranking to separate the poor performers from everyone else. What if you (I know it could never happen to you) have a bad day on Step 1 and score a 225? You want to match into something highly competitive. If your program ranks quartlies, and you're in the top quartile, it tells the PD that you legitimately had a bad day. We put so much stock in our lives into one test day. First the MCAT, then Step 1...If your rebuttal is that you should still be considered for the same residency position as Joe Sixpack who went to Third Tier Medical School but is ranked in the top quartile, scored a 240, and has research published in the field, my question becomes, "Why do we score Step 1? Shouldn't it be P/F?"

Well, first, 225 is a respectable score (still above average). I see what you're saying, but I don't think it's true. I would agree with you if curricula were standardized and performance at one school could be meaningfully compared to performance at another. But they can't. I am usually just below the mean/median on our test scores, so in theory I would be in the third quartile. However, even if I maintain that relative performance among my peers, that would put me almost one standard deviation above the average on step 1 based on our school's past boards performance. That's why rankings are useless. Maybe they have some value for intra-institutional awards and competitive selection for stuff (e.g., AOA), but beyond that there just isn't much value there. Using your logic, does that just mean my performance on step 1 was a fluke?

Originally Posted by NickNaylor

You are assuming that everything learned during the first two years is boards-relevant. I don't know about you, but my experience has been FAR from that. We are taught WAY more material than we EVER need to know for the boards. Using grades as a proxy for work ethic, I would agree with you. However I disagree that you can't be a weak student during M1/M2 and then do well on the boards.

Nick, I don't think that's the baseline assumption to this viewpoint at all. Certainly there's plenty of minutiae that gets stressed in M1/M2 that people then walk away from and remain "good students." But the fact remains that the broader your knowledge base, the better prepared you are for Step 1 and clerkships. Preclinical courses are the foundation. Plenty of students with average basic science grades then go on to do well on Steps and clerkships, but a weaker student will find that much more difficult.

The reason preclinical grades aren't stressed by PDs is because they have more proximal and reliable ways of determining an applicants knowledge base.

Originally Posted by NickNaylor

Well, first, 225 is a respectable score (still above average). I see what you're saying, but I don't think it's true. I would agree with you if curricula were standardized and performance at one school could be meaningfully compared to performance at another. But they can't. I am usually just below the mean/median on our test scores, so in theory I would be in the third quartile. However, even if I maintain that relative performance among my peers, that would put me almost one standard deviation above the average on step 1 based on our school's past boards performance. That's why rankings are useless. Maybe they have some value for intra-institutional awards and competitive selection for stuff (e.g., AOA), but beyond that there just isn't much value there. Using your logic, does that just mean my performance on step 1 was a fluke?

not any more it ain't. Step 1 average for the first nine months of 2012 was 227.

I mentioned before that we aren't ranked here. There are some people who feel that we should be. You would be surprised who these people are (ie, not just the ones who would be at the very top of the class)

Originally Posted by gravitywave

Nick, I don't think that's the baseline assumption to this viewpoint at all. Certainly there's plenty of minutiae that gets stressed in M1/M2 that people then walk away from and remain "good students." But the fact remains that the broader your knowledge base, the better prepared you are for Step 1 and clerkships. Preclinical courses are the foundation. Plenty of students with average basic science grades then go on to do well on Steps and clerkships, but a weaker student will find that much more difficult.

The reason preclinical grades aren't stressed by PDs is because they have more proximal and reliable ways of determining an applicants knowledge base.

Definitely agree - however it can (unfortunately) be difficult to discern what is actually relevant or not when we're learning it. My guess is that I will never see a not insignificant portion of the material we were taught ever again. That's unfortunate, because it would really better to be presented with less material that is actually helpful than diluting out the important info with worthless trivia. Perhaps this is just my institution, but that has been my greatest frustration with the pre-clinical curriculum thus far.

Originally Posted by NickNaylor

Well, first, 225 is a respectable score (still above average). I see what you're saying, but I don't think it's true. I would agree with you if curricula were standardized and performance at one school could be meaningfully compared to performance at another. But they can't. I am usually just below the mean/median on our test scores, so in theory I would be in the third quartile. However, even if I maintain that relative performance among my peers, that would put me almost one standard deviation above the average on step 1 based on our school's past boards performance. That's why rankings are useless. Maybe they have some value for intra-institutional awards and competitive selection for stuff (e.g., AOA), but beyond that there just isn't much value there. Using your logic, does that just mean my performance on step 1 was a fluke?

You, Nick, scoring consistently below the mean/median? Either my esteem for you is unwarranted, or medical school is full of straight beasts.

Originally Posted by gravitywave

not any more it ain't. Step 1 average for the first nine months of 2012 was 227.

I mentioned before that we aren't ranked here. There are some people who feel that we should be. You would be surprised who these people are (ie, not just the ones who would be at the very top of the class)

Where'd you see 227?

I took it in early June of 2012 and my score report said the average was 224.

The point I've heard stressed on here is preclinical grades don't matter much but don't be in the bottom quintile or quarter, and don't fail anything. This often gets shortened on here to preclinical grades don't matter, but not always, and I agree, aim not to be in the bottom for the reasons you stated.

And as those residency director surveys show, though preclinical grades don't matter much, their importance increases for the more competitive residencies, so those who want something like radonc, derm, etc. do need to somewhat focus on grades, though I'd argue that time is better spent doing research.

Originally Posted by punkedoutriffs

You, Nick, scoring consistently below the mean/median? Either my esteem for you is unwarranted, or medical school is full of straight beasts.

He's expounded upon his approach to the preclinical years before... basically he doesn't try to kill himself with the material for classes.

Instead of going crazy trying to rank in the top 10%, he studies enough to pass, enjoys life, and preps early to rock step 1.

Originally Posted by punkedoutriffs

You, Nick, scoring consistently below the mean/median? Either my esteem for you is unwarranted, or medical school is full of straight beasts.

Yup, this is my approach.

Originally Posted by Blais

He's expounded upon his approach to the preclinical years before... basically he doesn't try to kill himself with the material for classes.

Instead of going crazy trying to rank in the top 10%, he studies enough to pass, enjoys life, and preps early to rock step 1.

Originally Posted by MedBound1

Thanks for the reply Nick. What are your thoughts on societies like the AOA? We recently had a radiologist come in and talk who made the comment that if you wanted to go to a competitive residency in rads you needed to be in AOA (he was on the residency board for a long time and it was one of the factors that used to make initials 'cuts'). I'm guessing even at 'True P/F' schools like yours, the AOA will still receive a list of the top 25% of your class upon request, even though that is hidden information when it comes to residency apps.

I think he was saying if you want to go to an upper tier residency in radiology or some other ROAD specialty you should be AOA (I was at the meeting haha).

Originally Posted by NickNaylor

Definitely agree - however it can (unfortunately) be difficult to discern what is actually relevant or not when we're learning it. My guess is that I will never see a not insignificant portion of the material we were taught ever again. That's unfortunate, because it would really better to be presented with less material that is actually helpful than diluting out the important info with worthless trivia. Perhaps this is just my institution, but that has been my greatest frustration with the pre-clinical curriculum thus far.

it's not just your institution. I think part of the reason to have this useless trivia is to differentiate between top students and everyone else on tests, and also to a large extent it's because they just don't know any better or just don't care.

Originally Posted by FIREitUP

it's not just your institution. I think part of the reason to have this useless trivia is to differentiate between top students and everyone else on tests, and also to a large extent it's because they just don't know any better or just don't care.

Agree with both of you. Hard to know what's important unless you use board review books the entire time. Add in group work nonsense and we're saturated with unimportant and low yield time wasters. Not sure why most schools do this. I guess there's no competition, in that these schools are in high enough demand that they can put out a ****ty product and still fill the class. Not much different from First Aid consistently having 20 pages of errata even though the book changes minimally (~<10%) each year.

Years of mediocrity is going to bite us in the ass when mid levels train in half the time and can do 80% of the job requirements. You can't be inefficient for decades without it eventually catching up with you.

I figured I would rant this on here... since my entire class seems to be preoccupied with grades right now. I think once we realize that the difference between a 75 and a 95 on a transcript doesn't exist, then people will simmer down. Right now though, people are still pretty intense.

My school is a pure pass/fail, however they do give out awards for the top mark in a class. Otherwise, our transcripts and our MSPR do not reflect any percentiles/ranking.

A lot of the material we are learning is basic science... with some clinical pearls mixed in. We get a lot of facts thrown at us and we're expected to assimilate.

But I know from talking to upper years and residents that what you learn in the classroom isn't going to help you treat patients all that much.

For those that are not on a pass fail system, I am truly sorry. Because that's not what medicine should be about.

You will be hard pressed to find a student who struggled/didn't care the first two years rock step 1 and impress the hell out of the residents and attendings with their broad font of knowledge.

I won't say I didn't care during the first two years, but my grades certainly weren't exemplary. I studied hard enough to pass comfortably, and then set about trying to dominate Step 1. While that didn't go as planned, I was still fairly well above average, and I've never had any issues with my knowledge base. I pretty well cruised through M3 and wound up with more anesthesia interviews than I could realistically attend. Maybe I'm a rare case, but I know at least a few other people from UAMS who did the same. How strongly effort, grades, and functional knowledge predict each other depends heavily on how relevant/useful your school's test questions are. That, I think, is a big reason why PDs don't tend to concern themselves as much with M1-2 grades. Why med schools haven't figured out this same concept as it applies to college GPAs is beyond me.

Originally Posted by MCAT guy

Agree with both of you. Hard to know what's important unless you use board review books the entire time. Add in group work nonsense and we're saturated with unimportant and low yield time wasters. Not sure why most schools do this. I guess there's no competition, in that these schools are in high enough demand that they can put out a ****ty product and still fill the class. Not much different from First Aid consistently having 20 pages of errata even though the book changes minimally (~<10%) each year.

Years of mediocrity is going to bite us in the ass when mid levels train in half the time and can do 80% of the job requirements. You can't be inefficient for decades without it eventually catching up with you.

And journal club. 1.5 hr group presentation on a topic

I'll go ahead and add my own input about how meaningful grades are in pre-clinical years. My school has 7 centers with different approaches to studying/grading/tests. You look at the center campus in Indy and you'll see the grade distribution is vastly different than ours for pre-clinical courses. Anatomy had over 70% of the students getting HP/Honors in Indy. Our center had 0 (Yes, ZERO) honors, 3 High Passes and the rest Pass. Sure, we only had 16 students at our center, but the idea that we were less intelligent/capable wasn't the case. We all take the same board-based final and our center got the highest score. It didn't change our distribution/grades at all despite how well we did. Take what I say for whatever worth it is, but I've seen that the percentiles/grades people are getting are essentially meaningless because each school is different in their approach in terms of grades/scales/etc. Another example is my second year Clinical Medicine course. We have exams that aren't even remotely representative of board exams, are taught by volunteer faculty that don't even know what the exams are. And then we have exams with short essays/TnF/etc. Some schools would laugh at that approach. In the end - I could go on about my grades but they're not going to help me if I don't do well on Step 1. That's essentially what matters.


And, also, just because you score "average" doesn't mean "average". Our grading scale in Pathology has an average of 90%. Is that bad? **** no. The only course where the average was "average" was in Anatomy where it was 75-80. And then you realize that some classes scale their grades according to that, and you might get a Pass in a class despite getting an 85%. And then you'll be in another class where an 85 is Honors. It's completely weird/arbitrary. The Step 1 is where it all differentiates/matters.

Correct me if I'm wrong.

There are a few (good) schools that do not have AOA: Harvard, Stanford, Yale, UCSD. In addition, Hopkins' determination of AOA occurs after residency match, so it doesn't matter for residency applications.

Many (good) schools do not internally track percentage/letter grades during the preclinical years for rank/AOA purposes. These include UCSF, Columbia, Duke, UVA.

Some schools have grades for a part of the preclinical years (Penn, WashU, U Washington, Vanderbilt, UTSW, UNC) but do not track more discriminating grades for the pass/fail portion. At my institution, first year performance factors as 10% of your eventual class rank (thirds). However, if you pass all your classes, you get all that 10%. If you fail a class, obviously your rank should drop.

To the best of my knowledge, Hopkins, Northwestern, Baylor internally track discriminating grades during the preclinical years (="false" pass/fail).

I don't know, but would like to find out, what the AOA/ranking policies with regard to the pass/fail years are at Michigan, Chicago, UCLA, Pitt, Cornell, Mt Sinai, and Emory.

Where do we make the cutoff as to what the "good schools" are that can be P/F but still produce "hard working students?" Who makes that decision? Where do we stop? Yale? Harvard? Hopkins? Penn? Stanford? UVA? U of Boston? Maryland? WVU? USF? Caribbean schools?

Originally Posted by chronicidal

Correct me if I'm wrong.

There are a few (good) schools that do not have AOA: Harvard, Stanford, Yale, UCSD. In addition, Hopkins' determination of AOA occurs after residency match, so it doesn't matter for residency applications.

Many (good) schools do not internally track percentage/letter grades during the preclinical years for rank/AOA purposes. These include UCSF, Columbia, Duke, UVA.

Some schools have grades for a part of the preclinical years (Penn, WashU, U Washington, Vanderbilt, UTSW, UNC) but do not track more discriminating grades for the pass/fail portion. At my institution, first year performance factors as 10% of your eventual class rank (thirds). However, if you pass all your classes, you get all that 10%. If you fail a class, obviously your rank should drop.

To the best of my knowledge, Hopkins, Northwestern, Baylor internally track discriminating grades during the preclinical years (="false" pass/fail).

I don't know, but would like to find out, what the AOA/ranking policies with regard to the pass/fail years are at Michigan, Chicago, UCLA, Pitt, Cornell, Mt Sinai, and Emory.

Why?