smile8888

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Hi guys,

I am an M2 at a top 20 school, and as you can imagine, the caliber of students in my class are quite ridiculous, insane and amazing. Recently, I started feeling extremely frustrated. I feel frustrated because of the expectations I have for myself coming into medical school. I have never felt so dumb in my life before because I've always been near the top of my class. Since medical school started, I have had exams where I am above average, but for the most part, I've in the bottom 1/3 or 1/4 of my class on exams. I am extremely grateful that my institution is P/F during the first two years, however, I am worried that this will translate to having a low board exam score (the M2's from the class above me have an avg STEP 1 of 239).

This is just getting really frustrating and it's bothering me a lot. It's gotten to the point that I feel discouraged because I feel that no matter how hard I study, I'll always be in the bottom of my class.... So I just want to hear any advice about what/how I should go about doing well for the boards, which is what really matters most? Also if anyone has been in similar situations where they aren't doing as well as they would like to in their class, but still manage to do well on the board exam?

Really appreciate any advice/responses!
 

bashwell

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If you can crush Step 1, and as long as you pass and don't fail, then it won't matter as much how you're doing as an M2 relative to your class. Just focus on crushing Step 1 rather than how you compare to your class.
 
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Someone has to be at the bottom. It's just how it is. You're at the bottom of presumably one of the brightest cohorts you can be a part of. I'm sure it doesn't feel good, as it's going to be natural to compare yourself with your peers, but you're still in a great place. How limited you'll be with regard to step performance depends somewhat on how rigorous your classes are. If they're step-geared and you're making low 70s, you're probably in a bad place. If they're incredibly minutiae driven and your making high 70's, you could be fine. All you can do is bust your ass and see what happens. Either way, your school name brand will have some degree of positive impact
 
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operaman

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Psai is spot on. There are typically a rash of posts like this at this point in the year. Most of it is just due to the phenomenon of piling 100-200 top students into one group where half of them will, by definition, become the bottom half of the class despite their earlier successes. This is only magnified at more elite institutions.

Unfortunately, high board scores are not as easy to get as SDN would make it appear. Reading the Step results threads make even 260s look a little passe! While your class standing does not doom you to a low score, it does make your odds of scoring high much longer. The steps are obviously a different exam and your ongoing prep and final dedicated study period can make a substantial difference. There's also the issue that class exams tend to reward brute memorization and regurgitation while step exams test long term retention and conceptual understanding.

Roughly speaking, based on your school's average and your class standing, a score in the 240s would be a reasonable goal with adequate prep.
 

Entadus

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Well, if your school typically has a step 1 average around 239, and you are scoring below average in most classes,

I think it's fair to expect a score somewhat below 239.

The national average will probably be a 230 for current M2's, maybe you should make 230+ your goal?
 
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The caliber of students in your class is probably not significantly better than the caliber of students at a not-top-20 school. As undergrads maybe, but as you've realized med school is completely different.

Study hard and do the best you can. Don't start freaking out about being in the bottom half.
 

MrChance2

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No idea about boards but from the match lists I see at top schools it seems pretty much everyone is matching really well.
 

ridethecliche

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What's the spread of the distributions where you're scoring in the 1/4- 1/3? If the spread isn't that high you're likely worrying about a few points. It seems that the spread isn't as insane as I'd have expected, i.e. SD's are pretty small so the difference in points vs percentile makes a small difference look like a huge one.

Point is, if the average is 239 and things are clustered pretty closely, you might never know.
 
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masaraksh

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What's the spread of the distributions where you're scoring in the 1/4- 1/3? If the spread isn't that high you're likely worrying about a few points. It seems that the spread isn't as insane as I'd have expected, i.e. SD's are pretty small so the difference in points vs percentile makes a small difference look like a huge one.

Point is, if the average is 239 and things are clustered pretty closely, you might never know.
brooo!

But yeah, sometimes our school reports average/median for tests but obviously the spread is important, but I doubt any schools report things like IQR which I imagine would be most helpful in figuring out how you stand in this instance.

As for your concerns about boards, I'd say don't worry right now. The thing is you can't start studying for boards staring in M1 because you need to learn what they are teaching you in class. So keep studying, find time for exercise, if you are struggling maybe find a resource/book that has some questions at the end of chapters or something. Maybe try flashcards/Anki as it seems to work for a lot of people and they say that it makes learning more 'active recall' than just passively reading.
 

Hemorrage

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Being an M2 as well, my strategy has been simply to learn the material as well as I possibly could. I owe it to my patient's and to myself. Whatever happens on the boards is what happens. I'll be content with it as long as i know i tried my hardest and did my best work possible. On the bright side, the specialties that really require high board scores are in the minority.
 
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Psai

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Being an M2 as well, my strategy has been simply to learn the material as well as I possibly could. I owe it to my patient's and to myself. Whatever happens on the boards is what happens. I'll be content with it as long as i know i tried my hardest and did my best work possible. On the bright side, the specialties that really require high board scores are in the minority.
You owe it to your patient's what
 
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Yes you can do well. I know people who were in the bottom 1/4 of their class get good scores on boards. One of my classmates was like in the bottom 10%. She just couldn't remember all the super little details that they put on our tests. But she was smart, realized that the USMLE isn't a pure memory test and got over 240. Do uworld questions, you will figure out pretty fast that it is not about details or memorization.

Always stay positive.
 

ridethecliche

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brooo!

But yeah, sometimes our school reports average/median for tests but obviously the spread is important, but I doubt any schools report things like IQR which I imagine would be most helpful in figuring out how you stand in this instance.

As for your concerns about boards, I'd say don't worry right now. The thing is you can't start studying for boards staring in M1 because you need to learn what they are teaching you in class. So keep studying, find time for exercise, if you are struggling maybe find a resource/book that has some questions at the end of chapters or something. Maybe try flashcards/Anki as it seems to work for a lot of people and they say that it makes learning more 'active recall' than just passively reading.
Honestly, just trying to pass right now as I settle into the swing of things. I've definitely been slacking on the workouts lately, but starting to get back into the swing of things. Not having a place to live for the first month of med school sucked (to put it lightly).

I rode my motorcycle up to your school over the last long weekend to visit our mutual friend. I totally forgot to hit you up. Next time! Might be doing it again over the long weekend next month!
Also, you should add me on fb haha.
 

Hemorrage

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You owe it to your patient's what
To learn the information as well as i can. Unlike first year, i feel much of the information i'm memorizing is practically useful.
 

Entadus

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To learn the information as well as i can. Unlike first year, i feel much of the information i'm memorizing is practically useful.
He was making fun of your grammar. You used an apostrophe despite the desire to express the simple plural form of the noun (patients)
 

Psai

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He was making fun of your grammar. You used an apostrophe despite the desire to express the simple plural form of the noun (patients)
It's incredible how many people get it wrong, especially on nursing boards and signs. I've seen an apostrophe in the word gets and I'm like wat
 

HIppoCamp

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Yes. First Aid + UWorld + Pathoma. You'll be fine. Pay attention in what you have left for classes.

Contrary to what others will tell you, Step 1 is about learning how to take a test / learning 'high yield' info, which is somewhat useless crap for actual patient care.

Have fun!
 

Cyal

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At the end of MS2, I was probably average at a low-tier MD school, but I broke 245. I read half of first aid in ms2. In my 6 weeks dedicated time I just did u-world and finished first aid. I think I would have broken 250 if I didn't take step 1 on 1 hr of sleep and high fatigue--I had a messed up sleep cycle in my 6 weeks dedicated study time. So your class rank doesn't doom your board scores. And if you believe in God, pray.