Can those who started from the bottom end up at top?

[DermViser]

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lol just realized that telling the doctor I do my clinical stuff with(who is FM) that I want to go into rads probably wasn't the best idea

Ya think? Good job! Did he actually ask you?

 

[DermViser]

Maybe. My perception of that story is student 1 learned the material while student 2 blew off the assignment and studied review material before even learning the material the first time. I think this attitude gets people in trouble in third year and beyond. Get the actual assignment done first, then focus on additional things.

Often, these students like student 2 above are the ones in clinical years who are first out the door so they can go do UWorld questions or whatever they're using for shelf prep. They're always so focused on the "high yield" that they don't really learn anything in much depth. Student 1, on the other hand, has already put the time in learning in depth during m1/m2 and really knows and remembers the information; he can get by doing a few World questions when he gets home after busting his tail in the hospital and really learning clinical medicine, getting to know his patients, etc. He can devote himself to the clinical side because he knows he'll ace the shelf without much effort. He doesn't need Step Up to Medicine because he already stepped up months ago.

That said, your student 2 who's right on the edge may be one who's able to step it up and do well clinically. 85 on class exams is not bad and probably pretty near the class average. He's not necessarily poised to jump into superstar territory, but probably has enough medical knowledge to do well if he gets there early and reads like a fiend on his patients. Again, people looking for the 'high yield' shortcuts are not always the people willing to do that.

THIS. It's no different that the people who ONLY study and read the information from review books and then are shocked they didn't get the 250/260 or even 240 they're looking for.

I swear Student 2 that you describe in your 2nd paragraph are the ones that actually carry Step Up to Medicine and Case Files with them during the actual clerkship. I don't know whether it's bc they think it impresses the intern/resident that they're reading during the clerkship or what.

 

[PL198]

Bingo. Yes, ichthyosis vulgaris. I knew you'd get it, GWDS!!

knew it just wanted you derm guys to revel in your excellence

 

[DermViser]

knew it just wanted you derm guys to revel in your excellence

LOL. No, I was just happy that GWDS got it so quickly on the first shot as you can't really zoom in to high power on the image to see it and he still got it.

 

[PL198]

LOL. No, I was just happy that GWDS got it so quickly on the first shot as you can't really zoom in to high power on the image to see it and he still got it.

That's just OP

and I don't mean original poster

 

[DermViser]

That's just OP

and I don't mean original poster

Well the only other OP I know is this:

 

[PL198]

Well the only other OP I know is this:

overpowered, like when something in a game is too good relative to other stuff.

 

[notbobtrustme]

3rd year is bull****. It comes down to random luck. I was unlucky to rotate at a site for OB/Gyn where the site director doesn't give out honors. So despite having the 3rd highest score on the Ob/Gyn shelf while rotating at the most intense Ob/gyn site, I ended up with a HP just because of her political stance on honors. Others were able to scrape by on the shelf, get the minimum score for honors while rotating at easier sites with easier hours (their toughest day was a single overnight while I had 6 days in a row working 12 hour shifts overnight) and end up with honors.

3rd year rarely comes down to how much medical knowledge you have. Any idiot who passed Step 1 has most of the knowledge needed to do well in patient care; no one cares that you know where the complement binding site for IgG is except for Step 1. It really comes down to site selection and who you work with.

 

[operaman]

3rd year is bull****. It comes down to random luck. I was unlucky to rotate at a site for OB/Gyn where the site director doesn't give out honors. So despite having the 3rd highest score on the Ob/Gyn shelf while rotating at the most intense Ob/gyn site, I ended up with a HP just because of her political stance on honors. Others were able to scrape by on the shelf, get the minimum score for honors while rotating at easier sites with easier hours (their toughest day was a single overnight while I had 6 days in a row working 12 hour shifts overnight) and end up with honors.

3rd year rarely comes down to how much medical knowledge you have. Any idiot who passed Step 1 has most of the knowledge needed to do well in patient care; no one cares that you know where the complement binding site for IgG is except for Step 1. It really comes down to site selection and who you work with.

I'm sure some people do get burned like this, but I personally rotated with a number of attendings who were notorious for torpedoing honors, don't believe in them, etc. The kind of people you would tell your friends you were with and they'd look at you pitifully saying, "we'll, you don't need to honor EVERYTHING." In every case, I told the attendings to their faces that I planned to be the exception. I was. Busted my arse and read like a fiend, but never met anyone who couldn't be won over with hard work, extremely strong knowledge base, and great attitude. 3rd year honors is about how much people like you, period. For some, you have to be a rock star for them to like you. Others it's easier.

Wholeheartedly disagree about the medical knowledge. Never seen a low step score who didn't struggle mightily both clinically and obviously on shelves.

 

[tdram]

Your grade sounds consistent with your description of your performance.

It is consistent, I'm not complaining. I was just responding to DermViser who said that I must be incompetent in order to not get anything more than a Pass. Maybe at other schools, if you have a pulse you get a High Pass, but I don't have that sort of luck here.

 

[Psai]

THIS. It's no different that the people who ONLY study and read the information from review books and then are shocked they didn't get the 250/260 or even 240 they're looking for.

I swear Student 2 that you describe in your 2nd paragraph are the ones that actually carry Step Up to Medicine and Case Files with them during the actual clerkship. I don't know whether it's bc they think it impresses the intern/resident that they're reading during the clerkship or what.

I do it because there's a ton of downtime at times and when I get home I'm tired and don't feel like studying

 

[DaTruMD]

To OP: unlikely.

 

[KnuxNole]

THIS. It's no different that the people who ONLY study and read the information from review books and then are shocked they didn't get the 250/260 or even 240 they're looking for.

I swear Student 2 that you describe in your 2nd paragraph are the ones that actually carry Step Up to Medicine and Case Files with them during the actual clerkship. I don't know whether it's bc they think it impresses the intern/resident that they're reading during the clerkship or what.

I carried case files cause it was small and fit in my lab coat for the lots of downtime. For some rotations, it was the main book I read.

 

[DermViser]

I do it because there's a ton of downtime at times and when I get home I'm tired and don't feel like studying

I carried case files cause it was small and fit in my lab coat for the lots of downtime. For some rotations, it was the main book I read.

I'm talking about the people who don't do anything and are mainly shadowers on rotations.

 

[eablackwell]

I think it depends on your school (as grade distribution in 3rd yr varies widely), but I imagine it's extremely difficult to go from the bottom to the top. I started out middle of the 2nd quartile at the end of 2nd yr, my 3rd yr overall average was in the top 5 in the class and I still didn't manage to make it out of the 2nd quartile. Sure, all the honors will look fantastic on my app, but it still doesn't qualify me for AOA 😉

 

[DermViser]

It is consistent, I'm not complaining. I was just responding to DermViser who said that I must be incompetent in order to not get anything more than a Pass. Maybe at other schools, if you have a pulse you get a High Pass, but I don't have that sort of luck here.

Never said you were incompetent and never said just having a pulse (in other words showing up) gives you a High Pass.

 

[DermViser]

I think it depends on your school (as grade distribution in 3rd yr varies widely), but I imagine it's extremely difficult to go from the bottom to the top. I started out middle of the 2nd quartile at the end of 2nd yr, my 3rd yr overall average was in the top 5 in the class and I still didn't manage to make it out of the 2nd quartile. Sure, all the honors will look fantastic on my app, but it still doesn't qualify me for AOA 😉

Is your first 2 years quartile ranking by grades H/HP/P/etc. or is it by actual points on exams? I think it also depends highly on how your class rank is calculated.

 

[Slack3r]

Based on comments, I have always been doing as expected for an average MS3, except I always get a Pass.

Average being the key word here.

 

[KnuxNole]

I'm talking about the people who don't do anything and are mainly shadowers on rotations.

If they aren't allowed to do anything/are just shadowing, then maybe they figure "Shoot, I'm not gaining anything here. Might as well try to squeeze some shelf reading time in.". Which, if they are doing that between seeing patients, nothing wrong with that. I doubt the residents/attending would be "impressed" to see someone reading. There is just so little time to study for some people, and doing what they can to survive is key.

 

[DermViser]

If they aren't allowed to do anything/are just shadowing, then maybe they figure "Shoot, I'm not gaining anything here. Might as well try to squeeze some shelf reading time in.". Which, if they are doing that between seeing patients, nothing wrong with that. I doubt the residents/attending would be "impressed" to see someone reading. There is just so little time to study for some people, and doing what they can to survive is key.

Yes, residents/attendings wouldn't be impressed. Students don't always see that. Esp. on something like OB-Gyn where things can change fast, reading and doing USMLEWorld questions when things suddenly change and you aren't there, isn't a good impression.

 

[Kaustikos]

Ya think? Good job! Did he actually ask you?

Well,
At first I didn't think it was a good idea. But midway I didn't have a problem because I didn't avoid doing things in other services. Like Psych: i told them I wanted to do Surgery but it didn't make any difference on how I managed patients and worked with staff.
It's another thing to say what you wanna do and belittle other specialties or insult them.

 

[eablackwell]

Is your first 2 years quartile ranking by grades H/HP/P/etc. or is it by actual points on exams? I think it also depends highly on how your class rank is calculated.

My school is on a pt system for M1-M3 (with H/NH/P/F for M3 only, although Honors don't actually boost your class rank) and P/F for M4. Many of the senior AOA people from our last class didn't even have any honors in 3rd year, but they had high numbers, it's a weird grading system. 😉 M1 & M2 really matter most in both jr and sr AOA.

 

[DermViser]

My school is on a pt system for M1-M3 (with H/NH/P/F for M3 only, although Honors don't actually boost your class rank) and P/F for M4. Many of the senior AOA people from our last class didn't even have any honors in 3rd year, but they had high numbers, it's a weird grading system. 😉 M1 & M2 really matter most in both jr and sr AOA.

Weird that an "H" in M3 wouldn't affect your class rank. It wouldn't shock me that M1/M2 have a higher effect in getting AOA, bc most students in clerkships are getting HP an H on their clerkships so the ranks don't move much.

 

[eablackwell]

Weird that an "H" in M3 wouldn't affect your class rank. It wouldn't shock me that M1/M2 have a higher effect in getting AOA, bc most students in clerkships are getting HP an H on their clerkships so the ranks don't move much.

I've heard it's like that at many schools, but at ours it's not with H at least, the goal is 10% H and the next 15% NH, and they often have to bump people up from the top of NH and P to hit their goal for H and NH at my school. The dean's letters are full of graphs to show distributions like that for the school, but I doubt people actually read all those distributions. 😉

 

[HLxDrummer]

Really? Honors is capped at 12% at my school high pass at 25%. Are there schools where, say, more than half the class gets letters or honors?

Man I wish mine was like that. Ours is top 15% for honors and that is it. No high pass. So you can work hard, get 16th percentile and a pass or do nothing and pass.

 

[LostinLift]

Weird that an "H" in M3 wouldn't affect your class rank. It wouldn't shock me that M1/M2 have a higher effect in getting AOA, bc most students in clerkships are getting HP an H on their clerkships so the ranks don't move much.

3rd year at my school is 70% of AOA, 1 and 2 are 15% each. No junior/senior distinction only one group. But yeah grades only get you nominated, you need research/leaderhip/EC to get elected.

 

[DermViser]

3rd year at my school is 70% of AOA, 1 and 2 are 15% each. No junior/senior distinction only one group. But yeah grades only get you nominated, you need research/leaderhip/EC to get elected.

Depends on school. It may be part of the AOA chapter to include those other things, but as far as how much they contribute in reality can be a different story vs. grades and Step scores.

 

[username456789]

Depends on school.

He was commenting specifically on his own school . . .

 

[DermViser]

He was commenting specifically on his own school . . .

I thought when he said "But yeah grades only get you nominated, you need research/leaderhip/EC to get elected", he was referring to getting elected to AOA in general.

What I was saying is that that may be the company line but it's not necessarily followed by any means with respect to election. I do agree with him that grades in the top quarter get you nominated in the first place.

 

[mcloaf]

I'm not sure if this is just my school but that hasn't always been my experience. Take pulm for example. Two students take the same pulm pathophysiology in-house final worth 60% of the final grade, each with an equal amount of basic science and clinical knowledge of pulmonary disease. The first student pours over the lectures time and again, memorizing everything he can including the professor's in depth 3 hour lecture of his research on PPHN. The second student spends an equal amount of time and effort pouring over Kaplan, First Aid, UWorld, Goljan, and Pathoma. Before the test, each student has an EQUAL AMOUNT of knowledge, slightly differing in content. The first student scores a 97 on the final and ends up in the top five percent. The second student scores an 85 and is straddling the 2nd and 3rd quartiles. I see this happen ALL THE TIME.
To really reach the top of the class it takes a dedicated effort to evaluate each professor's specific interests and predilections, and probably won't pay off in the clinical years.

Yea I recognize this description. In our last (first of M2) sequence I focused mostly on outside resources and blew off some of our in class stuff. Walking into the exam I knew a lot more than a lot of my classmates about stuff that I assume is boards relevant since it was in all these other resources but not really covered in class. Didn't really help me though. It's really frustrating to be explaining path and pharm to kids before you take a test together and then walk out with the same score because they memorized a few extra things off a professor's slides, but that's life. I don't plan on letting it happen again if I can help it. My approach for our second sequence was to get through all of my outside stuff as fast as possible to leave myself time to memorize/learn all the extra class stuff in the last few days before the test. I like this approach if only because it helps a lot to get a conceptual framework from something like Pathoma/RR and review with Rx before I get into our poorly organized lectures because I can worry less about not understanding what's going on and more about picking out the random factoids that are easily testable.

 

[eablackwell]

Sr AOA at each school is done differently (from what I've been told). The admins at my school are very basic-science grade driven, and 1st, 2nd, and 3rd year count equally. They simply put it all together to determine the 1st quartile eligibiliy for AOA. I wish my school was like yours, because then the fact that I did maybe 5-6 pts lower than usual in 2 M2 classes (while I was 9 months pregnant and having a kid) wouldn't have just knicked my chances at sr AOA. That being said, I'd much rather have my son than AOA. 😉


Edit: Oops, I was referring to LostinLift's post. For some reason it didn't quote, and I'm currently too lazy to delete and repost.

 

[Serous Demilune]

Sr AOA at each school is done differently (from what I've been told). The admins at my school are very basic-science grade driven, and 1st, 2nd, and 3rd year count equally. They simply put it all together to determine the 1st quartile eligibiliy for AOA. I wish my school was like yours, because then the fact that I did maybe 5-6 pts lower than usual in 2 M2 classes (while I was 9 months pregnant and having a kid) wouldn't have just knicked my chances at sr AOA. That being said, I'd much rather have my son than AOA. 😉


Edit: Oops, I was referring to LostinLift's post. For some reason it didn't quote, and I'm currently too lazy to delete and repost.

Get your priorities sorted or get off SDN. We don't tolerate your kind around here.

 

[FIREitUP]

I'm curious how likely it is for a below average student (in 1st and 2nd year) to "shine" during rotations? Maybe not such a good test taker, but knows the material and is great in social situations? I'm asking because I wasn't doing as well as I am now in school, and to make myself feel adequate, I thought to myself, "I'll do much better on rotations since I'm great socially and am very passionate about people." Was this foolish of me to think? I would say I'm about average as a student now and have fixed my test taking skills but I do realize that clinical grades account for more and I want to excel, and not appear as if i'm completely clueless. Any thoughts or personal experiences?

it happens. i was the same in preclinicals (figuring myself out so to speak). did well on step 1, did well on clerkships. just make sure you have a solid foundation of knowledge for step 1 since this will carry you throughout your shelf exams. i don't think this is the norm, however.

 

[giantswing]

It's possible, but you'd be the exception rather than the rule.

I was below ave first year, average second, and honored third; my class counselor was amazed. Now, third year at my school has more honors (~25% of the class vs 15% for years 1 and 2), but it's not easy to get HP/H in all the classes you need to honor the year. They're super stingy with HP/H in surgery and peds at my school, and for some reason, the "easier" the reputation (psych, family), the harder the attendings grade clinically.

 

[DermViser]

It's possible, but you'd be the exception rather than the rule.

I was below ave first year, average second, and honored third; my class counselor was amazed. Now, third year at my school has more honors (~25% of the class vs 15% for years 1 and 2), but it's not easy to get HP/H in all the classes you need to honor the year. They're super stingy with HP/H in surgery and peds at my school, and for some reason, the "easier" the reputation (psych, family), the harder the attendings grade clinically.

Your performance is definitely an exception, that's probably why she was surprised. No one is saying it can't happen. But all too often people rely on it like it's the rule, esp. when certain clerkships as you noted are very stingy with giving H/HP for rotations in the first place.

 

[EMDO2018]

.Yeah by the time most people get to med school, they have discovered their biological limit for how intelligent they are. The climbing from the bottom to the top can only really happen in HS or college when the kids who are really smart but underperforming realize how smart they actually are. Everybody in med school is smart, so transcending the academic ladder is less likely. My HS gpa=2.0, College gpa= 3.6, I'll be lucky if I pass in med school.

 

[DermViser]

.Yeah by the time most people get to med school, they have discovered their biological limit for how intelligent they are. The climbing from the bottom to the top can only really happen in HS or college when the kids who are really smart but underperforming realize how smart they actually are. Everybody in med school is smart, so transcending the academic ladder is less likely. My HS gpa=2.0, College gpa= 3.6, I'll be lucky if I pass in med school.

I don't think the limit is biological, but more environmental. If a student let's say goes to elite private schools from elementary onwards, likely he will be pushed much farther as far as their limits vs. say a student who goes to public schools (esp. low performing ones), although there are very high performing public schools as well (usuallly in affluent districts). Same for college - some colleges push you very hard, others are a cinch when it comes to getting an "A". Really, by the time you enter your first year of college, your study skills, thinking skills, etc. are pretty set and engrained although it can be modified slightly.

A lot of studying is getting used to the stamina and endurance of doing it for long periods of time. If your first time doing that is in medical school, then yes, it will be tough.

 

[KnuxNole]

I agree with the above. Was a public school kid all throughout. Basically if you didn't smoke crack and injected meth, you made it through high school. College, you had to legit learn how to study, but nothing extreme in terms of time/length. Plus plenty of allnighters 😛

However, med school was the first time I had to learn what studying truly meant. It's worlds different :O

 

[Mass Effect]

To be fair, you have to try REALLY REALLY hard to get a "Pass" on a rotation. If you come to work on time, do your work, don't complain, get along with the team, stay calm w/out losing your cool and take criticism constructively, you'll at least get a "High Pass". There is a LOT of grade inflation when it comes to clinical clerkships at most medical schools. In fact the literature has shown that many med students who should have received a "Fail", actually get a "Pass" for many reasons, by medical school faculty.

As has been stated by others, this was not the case at my school either. We had a cap of 10% for HP and Honors. Everyone else got Pass (unless they failed or something, but I imagine that's rare). Also, ranking was set at the end of 2nd year. Third-year grades didn't affect rank.

 

[DermViser]

As has been stated by others, this was not the case at my school either. We had a cap of 10% for HP and Honors. Everyone else got Pass (unless they failed or something, but I imagine that's rare). Also, ranking was set at the end of 2nd year. Third-year grades didn't affect rank.

Never heard of this happening at any allopathic school.

 

[Mass Effect]

Never heard of this happening at any allopathic school.

Regardless, the main point was that there are med schools out there that don't inflate third-year grades. Several of us can vouch for that.

 

[username456789]

Regardless, the main point was that there are med schools out there that don't inflate third-year grades. Several of us can vouch for that.

My medical school counted 3rd year grades for class rank. That said, a max of 10% of students could receive Honors (both clinically and pre-clinically). Which meant Honors was an actual honor.