Bottom of the class

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Murphy Brown

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I've heard all the cliches. P=MD and what do you call the person who graduates last in his med school class? Doctor.

But really how much does class rank matter in terms of residency when you're at the bottom? Say the bottom 10%?
 
Murphy Brown said:
I've heard all the cliches. P=MD and what do you call the person who graduates last in his med school class? Doctor.

But really how much does class rank matter in terms of residency when you're at the bottom? Say the bottom 10%?
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I think it really depends. If you're bottom of the class at Harvard, you're still in a great school. So, your choice of residencies isn't bad by most standards. If you're bottom of the class at St. George, you're in trouble.

It really depends more on your Step I score. If you're bottom of the class because you don't understand the material, you won't do well on the Step, and you're probably headed for a less competitive residency.

If you're bottom of the class because you're in a class of superstars and you score average on Step 1, you're probably okay for most residencies.
 
lets get one thing straight: earning an MD degree is a great accomplishment. think of all the thousands of people that couldn't even hack the pre-med courses, not to mention the people whose applications were rejected from medical school .

so you aren't learning at the rate of your peers (or have some other issue(s)). once you graduate you will continue to learn and hone your skills. 5 years out of residency you will likely have the same fund of knowledge as your peers that graduated at the top (assuming same specialty). entirely different characteristics will influence professional success, since no doctor sits on his ass in the library all day.

just because you are not amazing at med school does not mean you can't be a great doctor. find what you are good at and capitalize on it.
 
GoodmanBrown said:
I think it really depends. If you're bottom of the class at Harvard, you're still in a great school. So, your choice of residencies isn't bad by most standards. If you're bottom of the class at St. George, you're in trouble.

It really depends more on your Step I score. If you're bottom of the class because you don't understand the material, you won't do well on the Step, and you're probably headed for a less competitive residency.

If you're bottom of the class because you're in a class of superstars and you score average on Step 1, you're probably okay for most residencies.
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I'm definitely not at Harvard lol. I'm at a low-tier U.S. school and I end up scoring just below the average on everything. I've passed everything. I just can't get past a C. We had a mid-term exam at the end of January and the average was an 82 and I scored a 76. That's kind of how it's been all year. I pass, but I'm always below the average. I feel like I understand the material and can explain it and all, but I can't reach the class average.
 
reedman said:
lets get one thing straight: earning an MD degree is a great accomplishment. think of all the thousands of people that couldn't even hack the pre-med courses, not to mention the people whose applications were rejected from medical school .

so you aren't learning at the rate of your peers (or have some other issue(s)). once you graduate you will continue to learn and hone your skills. 5 years out of residency you will likely have the same fund of knowledge as your peers that graduated at the top (assuming same specialty). entirely different characteristics will influence professional success, since no doctor sits on his ass in the library all day.

just because you are not amazing at med school does not mean you can't be a great doctor. find what you are good at and capitalize on it.
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Thanks for the encouragement. But I'm just worried I won't match. If I can't meet the average at my own school, I don't know what will happen on boards. I'm really worried now that more schools are adding seats and residencies aren't adding slots. A lot of people will be left out in the cold and I fear I might be one of them.
 
Murphy Brown said:
Thanks for the encouragement. But I'm just worried I won't match. If I can't meet the average at my own school, I don't know what will happen on boards. I'm really worried now that more schools are adding seats and residencies aren't adding slots. A lot of people will be left out in the cold and I fear I might be one of them.
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keep in mind that your first two years grades matter little, if at all, for residencies. At my school our first two years aren't even factored in to our final class rank that goes to residency programs, since we have multiple campuses that run the basic science years differently (it's all based on step 1 score and third year NBME shelfs, which are standardized).

That being said, obviously being below average in your class grades makes it unlikely you'll get the highest step 1 in the class, but if you work hard and study the right stuff for the boards, you should be able to move your class rank up considerably, and third year grades matter a LOT more.

That being said, if you're still bottom 10% of the class by the time 4th year comes, that means that you had a low step 1 and you only passed (no HP/Honors) all of your third year rotations. That's a bad sign, and pretty much forces you into an 'uncompetitive specialty', although as long as you didn't outright fail the boards or failed a year and had to repeat, and you apply smartly, you will get a residency spot.

So, in sum, being in the bottom 10% as an M1 or M2 doesn't mean you'll be in the bottom 10% as an M4 (and vice versa, being a superstar M1 and M2 doesn't guarantee you'll get a 260 or honor all your rotations), but being that low by the time you apply for residencies will have a negative impact.
 
Thanks Sunset. This rank is based only on the first semester of school so I hope I can turn things around, but it's hard not to be discouraged when you find out how poorly you're doing compared to everyone else.
 
Murphy Brown said:
I'm definitely not at Harvard lol. I'm at a low-tier U.S. school and I end up scoring just below the average on everything. I've passed everything. I just can't get past a C. We had a mid-term exam at the end of January and the average was an 82 and I scored a 76. That's kind of how it's been all year. I pass, but I'm always below the average. I feel like I understand the material and can explain it and all, but I can't reach the class average.
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My friend was in your shoes. Just staying afloat. He actually failed one class. He passed the boards fine, well below average again. However, I was at a very competitive school where the average board score was quite strong. He went into a non competitive residency. His problem was pure laziness, and maybe too much alcohol. He would never have matched into a competitive field with his grades and scores. I'm sure the comments in his deans letter were all essentially "competent, but lazy". If you want a competitive residency lock onto the department like a guided missile, go to lectures, meetings, journal club, etc, study and work longer and harder than ever before on your audition months, and suck up more than a ....... on a Friday night after payday. It can be done.
 
IlDestriero said:
My friend was in your shoes. Just staying afloat. He actually failed one class. He passed the boards fine, well below average again. However, I was at a very competitive school where the average board score was quite strong. He went into a non competitive residency. His problem was pure laziness, and maybe too much alcohol. He would never have matched into a competitive field with his grades and scores. I'm sure the comments in his deans letter were all essentially "competent, but lazy". If you want a competitive residency lock onto the department like a guided missile, go to lectures, meetings, journal club, etc, study and work longer and harder than ever before on your audition months, and suck up more than a ....... on a Friday night after payday. It can be done.
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lol that made me laugh. I know I might change my mind but right now I don't want a competitive residency. I'd like to do IM or FM. I've been thinking about something like being a hospitalist in the future. The specialty isn't competitive but my family lives in Jersey / New York and that's where I'd like to end up and hopefully not at a malignant program. I don't have to be in the city. I'll be happy with upstate NY or MA, CT, RI, any of those places within reasonable commuting distance. But those places are saturated with much better applicants than I am right now and that's my fear.
 
Well, if my math is correct 10% of the class will be in the bottom 10% of the class. Everyone should at least prepare themselves for disappointment. It happens.
 
Even if you are in the bottom 10% of your class at an M.D school you still have options. You can go into Internal Medicine and specialize in whatever.
 
Brigade4Radiant said:
Even if you are in the bottom 10% of your class at an M.D school you still have options. You can go into Internal Medicine and specialize in whatever.
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It may be easy to get into an IM residency but that doesn't mean you'll get into the one you need to get into to specialize afterwards. And if you can't manage to be in top percentage in medical school what makes people think they can get into the top percentage in residency for fellowship application?
 
OncoticPressure said:
It may be easy to get into an IM residency but that doesn't mean you'll get into the one you need to get into to specialize afterwards. And if you can't manage to be in top percentage in medical school what makes people think they can get into the top percentage in residency for fellowship application?
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You can't judge how someone will do in residency by how they did in years one and two of med school. Some people are going to perform better in residency than they did in the basic science years.
 
Murphy Brown said:
This rank is based only on the first semester of school so I hope I can turn things around, but it's hard not to be discouraged when you find out how poorly you're doing compared to everyone else.
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Adjusting to the pace of med school is no small deal...it's only your first semester so cut yourself some slack. There's PLENTY of time left to improve...or fail (nah I kid).

Consider the following:

1) You are succeeding. You haven't failed anything and don't mention anything about hating school: both are terrific signs.

2) Med students tend to over-analyze things--that little bit (or a lot) of Type A is part of the reason why we got into med school and don't fail out. Don't let your class rank "define" you so early on in the game. Wait until you at least have your step 1 score before you consider ruling out options.

There's no reason to be a Negative Nancy right now. Do the best you can and try to have some fun along the way.
 
You have recognized that you need to raise your work ethic - the world is full of bellow average.
 
Murphy Brown said:
I've heard all the cliches. P=MD and what do you call the person who graduates last in his med school class? Doctor.

But really how much does class rank matter in terms of residency when you're at the bottom? Say the bottom 10%?
Click to expand...

Will anyone even know? Most schools won't tell anyone that you're in the bottom 10%. The Dean's letter just says you're in the bottom half of the class.
 
Grades are heavily correlated to Step 1 scores, so even if the grades don't necessarily matter, you're not likely to do well on the boards.
 
I've often felt that I'm in the bottom half of the class too... apparently my year at my med school is insane and the mean on most tests is slightly above 90% with the median well above that so if you get say a 86 or below... you're already looking at lowest quartile :scared:
 
bomgd3 said:
Grades are heavily correlated to Step 1 scores, so even if the grades don't necessarily matter, you're not likely to do well on the boards.
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I never understand the need some people have to kick someone when they're down. I just don't get it. I guess it's that gunneresque quality that most DECENT people try to avoid. Oh well. Karma's a boomerang.
 
reedman said:
define "well". what specialty does OP want anyway?
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A few posts up:

Murphy Brown said:
lol that made me laugh. I know I might change my mind but right now I don't want a competitive residency. I'd like to do IM or FM. I've been thinking about something like being a hospitalist in the future. The specialty isn't competitive but my family lives in Jersey / New York and that's where I'd like to end up and hopefully not at a malignant program. I don't have to be in the city. I'll be happy with upstate NY or MA, CT, RI, any of those places within reasonable commuting distance. But those places are saturated with much better applicants than I am right now and that's my fear.
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Study hard for Step 1 and improve during M3 and you should be able to get a decent IM spot.

If you are understanding the material that is good, just make sure you understand it WELL and go kick ass on Step 1. 3rd year is a much different ballgame - even if your grade is highly dependent on shelf exams, 3rd year shelf exams are quite different from preclinical in house class exams.
 
My experience has been:
First year: mostly Ps, couple HP (mostly average or just a little above)
Second year: mostly HP, one H, couple P (mostly a bit above average)
Third year so far: Straight H (obviously above average)

I'm not trying to toot my own horn (much), but you have to remember that you can always make the decision to do the extra work. Like today. Also, clinical grades are about four things: being pleasant, appearing to work hard, appearing to be intelligent, and appearing to be interested. At the end you will have to do decently on a shelf exam, but you have much more time to study for it than during the first two years.

As a word of caution, just because clinicals are more important doesn't mean you should wait till then to work hard. A big part of appearing intelligent is remembering stuff from the first two years. So study well for Step 1 and you'll be fine.
 
BigRedder said:
At the end you will have to do decently on a shelf exam, but you have much more time to study for it than during the first two years.
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I've always heard exactly the opposite -- that on rotations like IM, OB, and surg, you don't really have time to study because they're so busy and you work such late hours. Can you please clarify? Is that not true?
 
Just remember that a lot of people that are dynamite in basic science suck horrendously with their interpersonal skills. You'll jump some in the ranks in 3rd year just because of this fact.

What year are you?
 
tco said:
Just remember that a lot of people that are dynamite in basic science suck horrendously with their interpersonal skills. You'll jump some in the ranks in 3rd year just because of this fact.

What year are you?
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The poster said she's a first year.
 
tco said:
Just remember that a lot of people that are dynamite in basic science suck horrendously with their interpersonal skills. You'll jump some in the ranks in 3rd year just because of this fact.

What year are you?
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I love the fallacy of that "if you're good a basic science, you must be sociopath, and ergo, if you suck at MS1 and MS2, then by definition you aren't a sociopath and will succeed in MS3."

FALSE.

It is possible to be both nice and smart.

OP: I would change something in your studying. What you're doing is obviously not getting the results you want, so you need to change. Are the hours you're putting in real study hours, or are you wasting time on SDN and Facebook ? Do you need to study at a different time of day? Do you pre-read the material for lectures? Can you listen to an audio recording? do you re-write your notes? re-read and re-read and re-read the syllabus? pimp (nicely) your study mates and come up with potential questions? Can you identify the stuff that a lecturer think is important during a lecture? Odds are there are only 2-3 testable points per lecture, you need to be able to pick up what these are. Do you need to study alone more or with 1-2 other people? I think that study groups of >3 are worthless because they degenerate into socializing. Try some of these consistently until your next exam, then re-evaluate and change.

good luck. And remember not everyone at the top of your class is a douche.


Obviously you can't do all of these, but you need to be critical of what you're doing and ditch the stuff that isn't working.
 
MedStudentWanna said:
I've always heard exactly the opposite -- that on rotations like IM, OB, and surg, you don't really have time to study because they're so busy and you work such late hours. Can you please clarify? Is that not true?
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There is clearly not more time in the day to sit and study, but the exams come much more infrequently, as in every 6-12 weeks, maybe 4 depending on how your rotations are set up. This is more key than you understand. During the first two years, if you try to take a few days off after an exam you are already behind, and you have no idea what the test will be like. Meanwhile, shelf exams are defined entities with commercial review books and practice questions. You will get used to the format, and to a certain extent the content, while studying for Step 1. You can study at your own pace, focusing on whatever is relevant at the time.

Also, though there may be portions of various clerkships when you work long hours without free time, there will be many times when you have long stretches of the afternoon when there is nothing you can do other than study and maybe check up on a patient or two. Some clerkships may have built in study time.
 
Sorry, I guess I should answer the question more nicely. Grades are highly correlated to Step 1 scores, so yes, grades matter when it comes to residency! Don't mean to come across as tactless 😳
 
It really depend on what your exams are like. If they are NBME, then you should be more worried because those are more similar to what you'll get on step1. If they're not remotely close and just professor's own fantasies, then you're probably ok. If you really want to know how much you understand the material get a board prep Q bank and see how you do on it.
 
OP, I'm in the exact same position as you. Literally. Even our grades sound the same.

I don't want to put words in OP's mouth, but what worries me is that someone has to be in the bottom 10% at the end of med school and it could very well still be me. Similarly, these study tips are good and well, but again, someone has to be at the bottom, and sometimes all the study tips in the world don't make a difference.

So, I'd like to echo the OP's question - if you're interested in FM, etc. but are only particular on the general location -- given a below-avg step 1 score -- do the bottom 10% get slim pickings? More likely than not, rural hicktown and the like? Looking at the stats, it doesnt look all that likely to not match anywhere at all, so at least there's that.
 
RapplixGmed said:
I've often felt that I'm in the bottom half of the class too... apparently my year at my med school is insane and the mean on most tests is slightly above 90% with the median well above that so if you get say a 86 or below... you're already looking at lowest quartile :scared:
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What school has exam averages and medians in the 90s? We just took a final with an average of 74%.
 
mcgyver said:
It really depend on what your exams are like. If they are NBME, then you should be more worried because those are more similar to what you'll get on step1. If they're not remotely close and just professor's own fantasies, then you're probably ok. If you really want to know how much you understand the material get a board prep Q bank and see how you do on it.
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So, so true- if your school has PhDs teaching basic science that are writing bogus exams and you are doing below avg on them, it doesn't really correlate to how you'll do on Step1. I'd say path, physiology, anatomy, pharmacology will better predict than other classes too [in that order].
 
Gabby said:
What school has exam averages and medians in the 90s? We just took a final with an average of 74%.
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WashU 😵. Doesn't always happen but I don't think i've seen a test yet in 2nd year where the average wasn't >=85%. The administrators like to comment on how our class is way better than average too so I think theres just a ton of insanely smart people coming through with me.
 
RapplixGmed said:
WashU 😵. Doesn't always happen but I don't think i've seen a test yet in 2nd year where the average wasn't >=85%. The administrators like to comment on how our class is way better than average too so I think theres just a ton of insanely smart people coming through with me.
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I always figure when an exam average is in the 90s, it means the test was easy, not necessarily that the class is just that smart. Not saying you guys aren't. You had to be to get into one of the best med schools, but an average that high has some connection to easy tests, wouldn't you say?
 
RapplixGmed said:
I've often felt that I'm in the bottom half of the class too... apparently my year at my med school is insane and the mean on most tests is slightly above 90% with the median well above that so if you get say a 86 or below... you're already looking at lowest quartile :scared:
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Gabby said:
What school has exam averages and medians in the 90s? We just took a final with an average of 74%.
Click to expand...

RapplixGmed said:
WashU 😵. Doesn't always happen but I don't think i've seen a test yet in 2nd year where the average wasn't >=85%. The administrators like to comment on how our class is way better than average too so I think theres just a ton of insanely smart people coming through with me.
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MedStudentWanna said:
I always figure when an exam average is in the 90s, it means the test was easy, not necessarily that the class is just that smart. Not saying you guys aren't. You had to be to get into one of the best med schools, but an average that high has some connection to easy tests, wouldn't you say?
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aaaaaaaannd now we know why no one cares about preclinical grades 🙂
 
MedStudentWanna said:
I always figure when an exam average is in the 90s, it means the test was easy, not necessarily that the class is just that smart. Not saying you guys aren't. You had to be to get into one of the best med schools, but an average that high has some connection to easy tests, wouldn't you say?
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MedStudentWanna,

You do have a very good point and I do wonder about that sometimes. We don't do the shelf exams for the preclinical years either so theres no way to compare. Only problem is that they have thrown some tests at us that everybody seems to agree was brutal yet the average still turns out to be above 85% but again, this is a very subjective thing.

In any case, I've been mostly superficially studying for my classes anyways, which explains the lower score, and concentrating most of my time on board studying. As I often remind myself, I would trade all of my honors and high passes in for passes if I could get +10 to my board score.
 
My competitiveness is something that I question, and it is based almost entirely on my written scores.

So my first two years I was a below average student. I even failed a class and had to remediate. But I passed that. Then I did below average on Step 1. I passed the first time, but barely got above 200.

Fast forward to my MS3 year. I barely pass shelf exams, no matter how much I read or study. I get MUCH better marks on my evaluations from residents on attendings. So they think I know my stuff. But I worry.

I want to do Internal Medicine in the midwest.
 
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