Class rank ruining chances of residency

[AbruptioPlacentae]

Hi all!

First post here, and just wanted to hear feedback on my current situation as an MS3. As it stands, my preclinical class rank is currently at the bottom 10% of my class, however, my USMLE Step 1 score is in the mid 240's. I've recently become interested in some specialties such as ophtho, ENT, and urology and I was wondering how badly my class rank will hold me back when it comes to applying for residency. I've heard that good performance during 3rd year can erase many doubts about class rank, but I've also heard some PD's have a bias to only interview those who are top 2/3 of their class. I've also read the program director survey released in 2018 and I didn't know how to interpret the survey results. Any help would be appreciated!

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[Blanky]

Interested as well.

 

[Angus Avagadro]

I believe it is program dependent. Having said that, your Step score may keep you from getting screened. If your rotation evals are good and dont have any red flags, you should get a look from some programs. Some, although I think it's rare, will screen on class rank. Good luck and best wishes!

 

[Kardio]

Hi OP - I am, unfortunately, totally without an answer to your question.

I’m an just an incoming students and curious about your situation. Would you say that you chronically prioritized Step studying over your coursework - or did you just happen to prepare better for Step?

 

[Instatewaiter]

Hi all!

First post here, and just wanted to hear feedback on my current situation as an MS3. As it stands, my preclinical class rank is currently at the bottom 10% of my class, however, my USMLE Step 1 score is in the mid 240's. I've recently become interested in some specialties such as ophtho, ENT, and urology and I was wondering how badly my class rank will hold me back when it comes to applying for residency. I've heard that good performance during 3rd year can erase many doubts about class rank, but I've also heard some PD's have a bias to only interview those who are top 2/3 of their class. I've also read the program director survey released in 2018 and I didn't know how to interpret the survey results. Any help would be appreciated!

if your pre-clinical grades are discordant from your clinical grades then it won't hurt you very much. However, if you don't absolutely rock third year, you're going to struggle to Match well.

 

[nimbus]

Depends on your school tier too. Bottom of the class at Columbia or Stanford still match at very competitive programs.

 

[Frogger27]

Similar situation as you, OP with a lower step 1 (high 230s). My plan is to get as many H as I can to move my class rank out of bottom quartile and hustle wrhba bunch of research/good evals

Hopefully it’ll be enough to match into one of those competitive fields. I think you’ll be okay with a Step in mid 240s as long as you do well third year

 

[Cornfed101]

Your Step 1 score is definitely more important than your class ranking. Only 68% of PDs in ENT said that class ranking mattered and of those that said it was a factor the average importance was a 3.8/5. Not nothing, but that means 32% of PDs don't even look at your class ranking at all to invite you for an interview.

 

[7331poas]

I'm an M0 so I will only chime in about the data you were having trouble interpreting.

Your Step 1 score is definitely more important than your class ranking. Only 68% of PDs in ENT said that class ranking mattered and of those that said it was a factor the average importance was a 3.8/5. Not nothing, but that means 32% of PDs don't even look at your class ranking at all to invite you for an interview.

Why do "M0's" even comment if you have no knowledge of the situation.

That graph is essentially meaningless, since if 68% of PDs ostensibly "care" about your class rank then your chance of matching is dramatically hindered.

Just sit this one out.

 

[Cornfed101]

Why do "M0's" even comment if you have no knowledge of the situation.

That graph is essentially meaningless, since if 68% of PDs ostensibly "care" about your class rank then your chance of matching is dramatically hindered.

Just sit this one out.

OPs question was purely data-driven, and OP specifically asked how to interpret the survey results. I don't need to be in med school to know how to read a graph.

I was wondering how badly my class rank will hold me back when it comes to applying for residency. I've heard that good performance during 3rd year can erase many doubts about class rank, but I've also heard some PD's have a bias to only interview those who are top 2/3 of their class. I've also read the program director survey released in 2018 and I didn't know how to interpret the survey results. Any help would be appreciated!

The graph is only meaningless if you look at each half separately. Of the 68% of PDs that said it was important, the average importance was 3.8/5. Yeah OP is hindered, but obviously they just need to try and improve the rank and if they can't then they aren't dead in the water.

 

[ScreamingInternally]

I'm matching IM so take everything about what I say here with a BIG grain of salt. I'm going based almost entirely from things I've read as well as several close friends who are going into optho, uro, vascular surg, and ortho coming out of a mid-tier MD med school. No one I know if going ENT so I have no info there, but I'm assuming its similar.

There's tons of things at play here including multiple factors which will occur primarily in third year. You'd need to get an even higher score on Step 2, obviously get first pass on CS. You'd need to perform well in most if not all rotations (looking for Honors across the board but a couple high sats wont kill you as much as some other stuff), and excellent letters of rec in late 3rd/ early 4th year from within that specialty. And then there's research/publications/presentations, which you'd also certainly need, short of taking a year off to do some research and get some publications (especially prevalent from what I understand in optho and uro). Class rank won't hurt as much as pretty much any of the things I've listed above, and your class rank should skyrocket in clinical years if you're getting the honors in rotations which you'd need regardless in order to have a better chance at matching.

I know 3 people matching ortho, 1 going for vascular, 2 going optho, and 1 going uro. Each of them have 250+ step 1s with similar or somewhat higher step 2. They all have high class rank, and met honors for pretty much every rotation across the board. They all have at least 3+ publications, with a couple of them hitting 10 pubs (most of which is fluff, but numbers count nearly as much as quality here). I obviously dont know about their letters of rec, but I'm sure they're good as well. None of them are expecting to take a year off, but I know that one going into optho has been talking about it as a backup in case he doesnt match. I think only one of them is really looking for top-tier places, the rest are just hoping to match but idk if that's based on stats. or just them being nervous.

Coming into 3rd year with a low pre-clinical rank and a 240 (solid but not amazing) Step 1 means that it's not impossible, but it'll be difficult for sure. Don't know your research/publications though, which might be useful to post at least the numbers in case someone with more knowledge stops by.

You could also peruse the specialty spreadsheets for this years match to get a better idea.

 

[Blanky]

What about other specialties like middle of the road in competitiveness?

 

[operaman]

Hard to say. Some schools don’t even report class rank. If it’s one of those then it may not even be an issue.

The PD survey simply says that 2/3s of PDs say it matters and to that group it matters a lot. You can see how it compares to other factors as well. Bottom line is that it matters.

If you want competitive fields then you have serious work to do. Your step 1 is decent and shouldn’t close many doors. Figuring out why you’re in the lower class ranks is important or else you’ll be banging out solid Ps in clerkship as well.

In general I would say a low rank but slightly above average step 1 (but below average for competitive fields) is likely someone who prioritized step 1 over all else because AOA was clearly off the table. This approach tends to be time intensive and they may not have done much research either. Low grades and below average steps plus scant research is not a recipe for success. Now is the time to step it up big time.

 

[efle]

Depends on your school tier too. Bottom of the class at Columbia or Stanford still match at very competitive programs.

Stanford and Columbia (and peers like them) generally refuse to identify their bottom end students as such. If their MSPE explicitly stated they were bottom 10% or rank 140/150 or something like that, could be a different story.

 

[7331poas]

OPs question was purely data-driven, and OP specifically asked how to interpret the survey results. I don't need to be in med school to know how to read a graph.

Okay lets break down your sentences and show exactly why what you are arguing is pure BS.

Of the 68% of PDs that said it was important, the average importance was 3.8/5. Yeah OP is hindered, but obviously they just need to try and improve the rank and if they can't then they aren't dead in the water.

The average importance is 3.8/5.

What does that mean? Is 3.8/5 high? Seems pretty high to me considering that is only 0.3 below the average importance of Step 1. Or is it low? You (and I) have no concept of what 3.8/5 means in this graph.

When people just blindly post this picture from the charting outcomes it shows they haven't bothered to read what it says.

Yeah OP is hindered, but obviously they just need to try and improve the rank and if they can't then they aren't dead in the water.

Brilliant deduction. But it hasn't answered the question. If a person with a high step 1, multiple publications, and good clerkship scores, but also has a low class rank then what is their chance of matching? Is a low class rank alone enough to hinder an applicant?

The answer, if we go off "data-driven" M0 analysis, is that 68% of PDs think it is only "0.3 points" less important than Step 1. Therefore, an applicant with a stellar Step 1 and poor class rank is immediately dead-on-arrival at "68%" of residency programs.

Now of course everyone reading that knows it is bull****. They also can see that this graph is a very poor question choice to ask PDs.

This isn't data driven. This is a "M0" looking at the only information they know about in residency admissions, the charting outcomes.

 

[Iz_FtB]

Okay lets break down your sentences and show exactly why what you are arguing is pure BS.



The average importance is 3.8/5.

What does that mean? Is 3.8/5 high? Seems pretty high to me considering that is only 0.3 below the average importance of Step 1. Or is it low? You (and I) have no concept of what 3.8/5 means in this graph.

When people just blindly post this picture from the charting outcomes it shows they haven't bothered to read what it says.



Brilliant deduction. But it hasn't answered the question. If a person with a high step 1, multiple publications, and good clerkship scores, but also has a low class rank then what is their chance of matching? Is a low class rank alone enough to hinder an applicant?

The answer, if we go off "data-driven" M0 analysis, is that 68% of PDs think it is only "0.3 points" less important than Step 1. Therefore, an applicant with a stellar Step 1 and poor class rank is immediately dead-on-arrival at "68%" of residency programs.

Now of course everyone reading that knows it is bull****. They also can see that this graph is a very poor question choice to ask PDs.

This isn't data driven. This is a "M0" looking at the only information they know about in residency admissions, the charting outcomes.

Relax with the M0 talk, man.

 

[WedgeDawg]

It’s not gonna matter that much at most programs. There will probably be a few programs that will care and you’ll probably lose out on some interviews, but if you apply broadly enough, assuming the rest of your app is up to snuff (step scores, clinical grades, letters, research), you’ll probably get enough interviews to comfortably match.

 

[DokterMom]

A "bottom 10%" is going to be a bit conspicuous in highly-competitive fields. Your job is to get your class rank OUT of the gutter with top clinical marks before anyone sees it.

If you've got a lot of research, paid employment or public service hours to indicate that your time was spent productively in other ways, that will mitigate. But best to pour your efforts into doing well clinically. (If any of your future preceptors think you're a slacker based off your preclincal performance, now would be a great time for a visible turnaround.)

 

[akuko2]

Applying uro now and this year is especially competitive. From my experience as well as my co-applicants, no one really asks about class rank specifically but they do ask about AOA. Research is critically important if you are interested in urology so get on that ASAP and apply broadly to programs which have a lower percentage of matched candidates who are AOA (urology match spreadsheet has this data); do away rotations at programs that match their away rotators and you maximize your chance at success.

 

[Detective SnowBucket]

I know we have adcoms on SDN but are there any residency PD's that we know of on here?

 

[DoctwoB]

There are; APD is a well known one. There are others. But they can’t always give you a clear answer because there is no one answer. Your app is made up of several factors. Grades, steps, letters, research, mspe, etc.

The very top applicants will have all of the above. But most applicants will have relative areas of strength and weakness. Every PD will value the aforementioned factors slightly differently. Some may treat step as the biggest factor, some may use it as a cutoff, some may ignore it. Likewise poor research will be a nonstarter for some programs and irrelevant at others. For some in small fields especially like urology or ENT, letters from people known to the PD may be the biggest factor.

So for OP. Your grades aren’t great. Not ideal obviously, but your step is decent and If you improve your grades in clinicals, add research, good letters, etc. and apply broadly you should be fine.

 

[ndafife]

Class rank is an easy way to get yourself ranked vs your classmates also applying in the same specialty. Everyone else in your class applying to the specialties you listed are going to have similarly wrong Step Scores. If your going to apply to something as the 6th best person in your class applying, id expect to be treated as such

But really, applying to something competitive like ENT as a bottom 10% student is going to be seen as a major red flag. Bring that rank up this year

 

[mistafab]

One issue with interpreting the perceived importance rankings from the data set, is that it does not tell us in which direction a factor is important.

A really, really bad score could tank your ranking. But maybe a really, really good score doesn’t really change your ranking. Either way the importance factor would be the same if the direction was flipped. The data just does not tell us.

Edit: I wouldn’t spend too much time interpreting the data. Just do the best you can.