Can anyone give a good explanation for why Clinical Grades are considered more important for PDs than preclinical grades?

[gergles]

I'll try to clarify what exactly it is I'm asking. From what I understood the logic people put forth most of the time for why preclinical grades are unimportant to PDs is that they're not standardized across medical schools and PDs can just use Step 1 to ascertain basic sciences knowledge. However, this same exact logic in terms of the lack of standardization between medical schools can be said about clinical grades as well. So i'll start by beating a dead horse and saying grades received from clerkship preceptors are subjective and some hand out honors like there's no tomorrow and others are picky about it. Additionally schools use different grading systems some only having P/F (how the hell are you gonna compare that to a system that has Honors and High Pass). Most importantly, though schools have entirely different breakdowns for what influences your final grade in a rotation. At my school for instance the breakdown is (70% preceptor grade and 30% shelf). That means you cannot get honors even if you score 100th percentile on shelf unless your preceptor gives you honors. You only have to HP the shelf to receive honors if you received honors from your preceptor. Students from different schools can receive exact same grades from the same preceptor, but it can be the difference between one or the other not getting the same grade because the shelf exam is worth more/less. I'm also sure that at most schools not every student has the same exact preceptor for the same rotation which also makes it more subjective because one can get a preceptor who rarely gives honors while another doesn't.

To add to that the same issue can be said for class rank. Some schools only consider clinical grades for class rank while others consider overall performance in first 3 years meaning that preclinical grades can actually matter a lot.

So again I'm really asking why clinical grades are more important if they suffer from literally all of the same limitations that preclinical grades do in addition to being entirely subjective.

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[deleted103644]

The answer should be fairly self-evident - because they’re more relevant.

Subjective? Sure. But your future program director cares about how well you will work with others on the wards, less how well you’ve memorized biochemical pathways/etc.

Step 1 scores are a proxy for odds of passing tests for your specialty, clinical grades are a proxy for how well you will work with others on a clinical service.

 

[ciestar]

The fact that you’re going to be a CLINICIAN not a student is a big giveaway. It is more important because they want to know what you’re like on the floors and working with patients. Not how good you are at taking tests. Step 1 can answer that question. That, and a lot of schools are P/F preclinical.

My school grades similarly. Only if you dont hit the shelf cutoff, you don’t get honors or HP even if your eval is perfect.

 

[gyjlp1]

*eval.

 

[gergles]

The answer should be fairly self-evident - because they’re more relevant.

Subjective? Sure. But your future program director cares about how well you will work with others on the wards, less how well you’ve memorized biochemical pathways/etc.

Step 1 scores are a proxy for odds of passing tests for your specialty, clinical grades are a proxy for how well you will work with others on a clinical service.

Referring to my original point are there not schools where the shelf exams weigh far more heavily than preceptor evaluations such that your clinical years are graded practically the same way as your preclinical years. Again I'm talking about using it as a parameter for comparison. The fact that preceptor grades are subjective in themselves was only a minor point (and a continuously rehashed one at that hence why I said mentioning it is beating a dead horse) in comparison to my larger point: you can't compare grades between schools for the same exact reason preclinical grades are so easily dismissed. You are correct to state that they're more relevant, but the fact that they are not standardized among medical schools make them far more useless than their subjectivity ever will. I'm using standardized very loosely here, but essentially at the very least if every school was on the same grading system (starting at least M3), rewarded the same proportions of their class each grade [eg only 10% of any med school class can receive honors], and had an agreed upon percentages of how much preceptor eval vs shelf exam determined student's grades then clinical grades could better serve as a means of comparison....

 

[deleted103644]

Referring to my original point are there not schools where the shelf exams weigh far more heavily than preceptor evaluations such that your clinical years are graded practically the same way as your preclinical years. Again I'm talking about using it as a parameter for comparison. The fact that preceptor grades are subjective in themselves was only a minor point (and a continuously rehashed one at that hence why I said mentioning it is beating a dead horse) in comparison to my larger point: you can't compare grades between schools for the same exact reason preclinical grades are so easily dismissed. You are correct to state that they're more relevant, but the fact that they are not standardized among medical schools make them far more useless than their subjectivity ever will. I'm using standardized very loosely here, but essentially at the very least if every school was on the same grading system (starting at least M3), rewarded the same proportions of their class each grade [eg only 10% of any med school class can receive honors], and had an agreed upon percentages of how much preceptor eval vs shelf exam determined student's grades then clinical grades could better serve as a means of comparison....

I’m not sure if it’s universal, but many schools send not only your clinical grades, but also the distribution of those grades for your class (percent getting each grade).

So if everyone honors, your future PD will be able to discount accordingly.

 

[deleted480308]

Clinical evals are subjective and flawed but “do other attendings want to work with you” is potentially more important to some attendings than 5% on an exam.

 

[siliso]

In reviewing residency apps, all the transcripts I’ve seen do have breakdowns/bar graphs showing how many people got which grade with this candidate’s grade highlighted. Makes for easier comparisons. Yes, evaluations are subjective, and so will people’s experience of working with you in residency be to some extent subjective. Subjective doesn’t mean random. The predictive value is in the overall pattern.

Most of them also report what percentile was your shelf score, and some commentaries. It’s much more detailed than a report card with a list of grades.

 

[redpanda]

As others have mentioned, ability to interact with others, patients, families, attendings, residents, and staff alike is a major component of your ability to be a successful physician. Medical school and residency have already selected you as a decent test taker. While clinical evaluations are subjective, the constellation of results (e.g. this guy sucks to work with) is rarely wrong.