Bencasey, thanks for your posts. While the bulk of your logic certainly makes sense, is this reasoning based on information gathered from interactions with program directors, or is it inferred based on your personal experiences in the match process? If it is the latter, then if I may, what is your specialty?
I do not doubt that preclinical grades, in general, do matter. They must matter to some extent. But because the variability of preclinical courses at LCME schools in terms of quality and structure is quite high, and because the worth of these courses (in terms of their contribution to your class rank) is different at each school, it would also make sense that programs even the very competitive ones would look at Step 1 scores and third year grades (but more importantly, third year EVALS) to formulate their rank lists. I do not doubt that in very competitive programs, there may often be applicant ties during the decision making process. However, in such cases, wouldnt PDs tend to regard things like the applicants interview performance and research accomplishments (in that specialty), as less subjective and far more relevant factors for making their final decisions?
According to the NRMP statistics, preclinical grades seem to be near the bottom of the list in terms of importance for virtually every specialty. While class rank tends to be of higher performance, the class rank equation differs widely across schools. I am sure that there are medical students out there that have had a few mediocre grades here and there but graduated at around the 50th percentile of their class.
There are plenty of medical students (myself included) that have a good idea about what specialty theyd like to pursue, or have at least narrowed it down, even as seemingly naïve first years. I have physicians in my family, including a general surgeon and an EM doc, and I believe that both would be a good fit for me. I do not think that I would enjoy academic medicine and would likely look towards community programs for residency. Such programs are only moderately competitive. Had I been the derm type, I probably would not have been in a position to create this thread in the first place.
Lastly, there is no kumbaya. Clearly getting an A is a lot better than a C. There is no reason to celebrate, but considering I did well in my other classes and PASSED everything, I am not going to lament over it either.