How important are 3rd year grades factor into the application process? I have always been told that it is the number one thing that programs look at, even more important than board scores, letters, etc. I think that I am a good student from a good school in the southeast. I did well my first two years >3.6 GPA and on the boards >240 with some research experience but am struggling this year on the wards and have been making Bs so far, even in medicine. I want to go to a good programs like UCLA, UCSD, Stanford, Yale, Colombia, Penn, etc. (not MGH/Hopkins/BWH) and am planning on doing aways at some of these places to improve my chances. Do residency programs understand that it is really hard to make As/Honors in 3rd year since there are obviously alot of subjectivity to grading and a really hard shelf exam that could really hurt your grade? I really do think that I am a good applicant but this year has put doubts into my mind and make me wonder if I am a good student and if I can really get into the really good programs out there that I want. Any help would be appreciated.