Clerkship Grades all Passes

[bGMx]

What's the word on all passes on clerkships? I can't seem to get anything higher than a pass, being one point away from high pass on both so far. I like to sleep well at night, stay healthy, keep in touch with friends and family, hike, cook, create art; all the things that I value in my life as well as work hard. But I'm surrounded by students who seem to work harder at the sacrifice of these things I wrote above. The competition makes passing feel like failing, at least when stacked against peers and evaluated as a piece of paper on a PD's desk. I haven't taken psych yet, will definitely strive for an honors. All my qualitative evals on my MSPE so far have been glowing and I think fairly capture my attitude, that being friendly, diligent, and laid back. I wonder if I'm being myopic in caring that I'm getting only passes, as passes mean that I'm average, and I'm ok with that. My concern is also that perhaps I'm shooting myself in the foot.

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[Bartelby]

For a pass / high pass / honors system it would be good to avoid having almost all "pass" grades. Especially at more competitive programs many applicants will have a significant amount of high pass or honors. It also matters how your school grades. If a reviewer sees that 80% of your school gets high pass or honors for each rotation but you are consistently "pass," that will not look great. In contrast, if 80% of your school gets a "pass" on each rotation then it is much less of a concern.

If you don't get higher clerkship grades on most core clerkships, at least strive very hard for an honors in psychiatry and try to get honors in various elective of non-core clerkships (where it is typically easier to get higher grades).

All that said, if you apply widely and otherwise have a good record I don't think a transcript of mostly "pass" will hold you back.

 

[SmallBird]

What's the word on all passes on clerkships? I can't seem to get anything higher than a pass, being one point away from high pass on both so far. I like to sleep well at night, stay healthy, keep in touch with friends and family, hike, cook, create art; all the things that I value in my life as well as work hard. But I'm surrounded by students who seem to work harder at the sacrifice of these things I wrote above. The competition makes passing feel like failing, at least when stacked against peers and evaluated as a piece of paper on a PD's desk. I haven't taken psych yet, will definitely strive for an honors. All my qualitative evals on my MSPE so far have been glowing and I think fairly capture my attitude, that being friendly, diligent, and laid back. I wonder if I'm being myopic in caring that I'm getting only passes, as passes mean that I'm average, and I'm ok with that. My concern is also that perhaps I'm shooting myself in the foot.

It's important to be balanced, but you need to balance times of balance with times of unbalance too.

 

[splik]

It is very unlikely that passes make you "average". At most schools, passing grades are below average, and only passes across the board for core clerkships would usually put a student in the bottom quartile. It also probably is not a good thing if your MSPE comments focus on your friendliness or how laid back you are. Those are not positive comments in this context. other students will have comments reflecting their oustanding clinical skills, fund of knowledge, ability to integrate into the team, strong professional attributes, going above and beyond, and perfoming above expected for their level of training.

 

[bGMx]

Let me clarify; the gist of the MSPE said that I was well liked, had an excellent knowledge base, and was attentive to patients while being friendly, diligent and laid back.

 

[FlowRate]

It depends on the grade distribution of your school. There are a few schools that are F/P/H and H is heavily restricted. You're fine getting mostly P in that sort of setup. The average school is something like 0-5% F / 5-10% P / 50% HP / 35% H. In that sort of system, you're at the bottom of your class. Even worse in the sort of school that's 0% F / 3% P / 17% HP / 80% H.* We get your core clerkship grade distributions with your ERAS.

* This does exist. I once reviewed a student application who had all H and one HP who was bottom or second quartile because of getting one HP. The clerkship grade distributions were vast majority H with one clerkship being roughly 33/66 HP/H and the sole decider of class rank for that reason.

 

[Stagg737]

N=1, but I had all passes (system was F/P/H and clinical "grades" were based completely on shelf score) and had no problems getting interviews even with poor board scores. I also had a glowing MSPE and LORs.

It depends on the grade distribution of your school. There are a few schools that are F/P/H and H is heavily restricted. You're fine getting mostly P in that sort of setup. The average school is something like 0-5% F / 5-10% P / 50% HP / 35% H. In that sort of system, you're at the bottom of your class. Even worse in the sort of school that's 0% F / 3% P / 17% HP / 80% H.* We get your core clerkship grade distributions with your ERAS.

* This does exist. I once reviewed a student application who had all H and one HP who was bottom or second quartile because of getting one HP. The clerkship grade distributions were vast majority H with one clerkship being roughly 33/66 HP/H and the sole decider of class rank for that reason.

I can't imagine why a school would ever implement that last distribution. Seems like it only serves to punish lower rank students and does nothing to benefit those who are exceptional.

 

[Traveler2016]

It's not the end of the world, especially if the rest of your app is well-rounded

 

[mistafab]

Several points for you.

Getting all passes is no bueno.
You don't have to sacrifice a healthy/satisfying lifestyle to do well.
Getting good grades is not a competition. You doing better doesn't make other people do worse and vice versa.

A lot of times, good strategy is the difference between mediocre grades vs good grades in the clinical arena. Look at how grades are calculated. Look at all appropriate/necessary thresholds. Look at how evaluations, shelfs, etc all contribute to your grade. Develop a strategy and you will do better.

 

[bGMx]

I don't at all think I'm competing with people directly, I'm very non-zero sum minded. One example: I regularly defer pimping questions in the company of colleagues when we're together so we get equal opportunities to shine, allowing a 50/50 split in answering questions. I don't do all of the "to-do's" without first talking with my colleagues and seeing what they prefer to tackle.

I'm aware that if someone does what I am doing + more they deserve a higher grade. That's what I mean by the competition comment; it's an indirect competition. For example: If I was scoring passing marks and I attended a class of 1, then I wouldn't have this problem, because I would be doing everything required of me and then some. But when you put a student who is pretty satisfied with his/her own performance in the broader context of living a good life [me] in the same evaluative zone as others who are obviously and publicly striving for improvement and sacrificing well being for this, it seems like that may be the difference? Even though our outcomes are identical, that being patient satisfaction and high standard of care.

I'm a bit in a bind mentally here because I'm doing everything I should that makes me a good/above average medical student per oral feedback, but I'm scoring passes per the grading, and I'm being made aware that generally there is an unwritten understanding by recruiters that "pass = poor student performance" even when that is by no means the case. So what I'm worried about is having a PD think I'm some sort of gamble even though I'm about as well rounded as they come both personally and as an applicant, or at least that's how I perceive myself to be.

I appreciate all your feedback. It is frustrating and pretty broken that this part of medical education and the path towards physician-ship is based on something that is as arbitrary as letter grades stacked on someone's desk; all the while being compared to people who are potentially living less balanced, more chaotic lives. To me this tiered grading structure coupled to a residency selection process which is overflowing with applicants inspires self-esteem based on comparison to others which is the seed for self-indulgence, and this shift in mindset is something I need to decide whether or not an esteemed program is worth. I also need to think about the question of "if I can, should I?" and I want to continue making sure that that particular teeter-totter remains balanced, avoiding overworking and underworking, and ultimately-- at what cost? Thanks for adding your input.

 

[SmallBird]

I don't at all think I'm competing with people directly, I'm very non-zero sum minded. One example: I regularly defer pimping questions in the company of colleagues when we're together so we get equal opportunities to shine, allowing a 50/50 split in answering questions. I don't do all of the "to-do's" without first talking with my colleagues and seeing what they prefer to tackle.

I'm aware that if someone does what I am doing + more they deserve a higher grade. That's what I mean by the competition comment; it's an indirect competition. For example: If I was scoring passing marks and I attended a class of 1, then I wouldn't have this problem, because I would be doing everything required of me and then some. But when you put a student who is pretty satisfied with his/her own performance in the broader context of living a good life [me] in the same evaluative zone as others who are obviously and publicly striving for improvement and sacrificing well being for this, it seems like that may be the difference? Even though our outcomes are identical, that being patient satisfaction and high standard of care.

I'm a bit in a bind mentally here because I'm doing everything I should that makes me a good/above average medical student per oral feedback, but I'm scoring passes per the grading, and I'm being made aware that generally there is an unwritten understanding by recruiters that "pass = poor student performance" even when that is by no means the case. So what I'm worried about is having a PD think I'm some sort of gamble even though I'm about as well rounded as they come both personally and as an applicant, or at least that's how I perceive myself to be.

I appreciate all your feedback. It is frustrating and pretty broken that this part of medical education and the path towards physician-ship is based on something that is as arbitrary as letter grades stacked on someone's desk; all the while being compared to people who are potentially living less balanced, more chaotic lives. To me this tiered grading structure coupled to a residency selection process which is overflowing with applicants inspires self-esteem based on comparison to others which is the seed for self-indulgence, and this shift in mindset is something I need to decide whether or not an esteemed program is worth. I also need to think about the question of "if I can, should I?" and I want to continue making sure that that particular teeter-totter remains balanced, avoiding overworking and underworking, and ultimately-- at what cost? Thanks for adding your input.

Maybe, but it's not as bad as all that. As you state, you are going to medical school while maintaining a range of hobbies and work life balance, and you are going to be a doctor at the end of it. That is remarkable - most would never have it that good! If you would like to strengthen your position as you go into residency application, you may have to on certain occasions put in more effort, for which you will reap benefit. Whether or not you agree - you have the answers to the test, and you can't change it. If you want to reduce the risk of being perceived as mediocre according to some metrics you are going to have to work harder some of the time. Then when you have a few honors under your belt you can get back to your hobbies and other worthwhile things.

 

[ObsequiousAplomb]

I'm a little confused about the criteria you're talking about. Generally speaking there are rubrics for grading. People don't give their favorites the honors and the run-of-the-mill students passes. I mean, that happens, but it's usually because the evaluator uses the rubric slightly different depending on how much they like the student.

So what exactly makes up your grade? It's not a composite of shelf score, feedback forms filled out by residents and attendings, and some other factor? Because it usually is made up of that. People write down great feedback on the MSPE sections, but send a 4/7 or 5/7 or whatever the threshold is on some sub-components of the clinical evaluation form. That's usually how people who honor the shelf and get great feedback end up only passing a rotation.

 

[FlowRate]

Getting good grades is not a competition. You doing better doesn't make other people do worse and vice versa.

This isn't true everywhere. Our clinical grades WERE curved. We were the year at our institution that had the most strictly defined grade curve (15% get Pass) which really didn't help when other institutions historically thought of our school as grade inflated and this was slightly before universally adopted grade distributions on ERAS. (Even before the required 15% Pass, it was never actually grade inflated.)