Consensus on Pre-Clinical Grades?

[Bones&Bourbon]

I'm curious to get everyone's feedback, as I've gotten mixed input ever since I started medical school regarding the true "weight" pre-clinical grades carry. I've been told things such as "PD's don't look at them," "PD's don't care as long as you pass," etc. In the "for what it's worth category" - my school uses a H/HP/P/F grading scale without bell curves (e.g. you get what you get regardless of how the class performed as a whole), and they don't use pre-clinical grades to determine class ranking. For additional context, I'm ℅ 2023 and will be taking Step 1 prior to the P/F change.

TLDR; do program directors ~really~ care about pre-clinical grades, or is it all about Step 1 and clinical grades?

Thanks in advance everyone, greatly appreciate your input.

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[Real McCoy]

See attached PD survey that @Goro has recently shared.

 

[Bones&Bourbon]

@Real McCoy and @Goro - thanks for your help.

So it seems that basic science/pre-clinical grades are fairly low on the totem pole, as they were given a relative importance of 3.2/5 by the 20% of PD's who cited it as a factor for selecting applicants to interview (Fig. 1) and a relative importance of 3.4/5 by the 10% of PD's who cited it as a factor for ranking interviewees (Fig. 2).

 

[MedDoc305]

@Real McCoy and @Goro - thanks for your help.

So it seems that basic science/pre-clinical grades are fairly low on the totem pole, as they were given a relative importance of 3.2/5 with only 20% of PD's citing it as a factor for selecting applicants to interview (Fig. 1) and a relative importance of 3.4/5 with only 10% of PD's citing it as a factor for ranking interviewees (Fig. 2).

View attachment 320787View attachment 320788

Does consistency of grades include preclinical?

 

[Lawpy]

I'm curious to see if preclinical grades would be more important (and more schools shifting from P/F to graded) with Step 1 P/F

 

[Goro]

Does consistency of grades include preclinical?

I'm curious to see if preclinical grades would be more important (and more schools shifting from P/F to graded) with Step 1 P/F

Stop thinking like pre-meds. PDs will simply use Step 2 as the screening tool, and also pay more attention to LORs, and clinical evals [MSTEs? Can't remember the exact name].

Pre-clinical grades are important to YOU, not PDs. They're the best predictors of Boards scores we have. It gets murky when you only have P/F grading or those students who decide to skate by and focus intensively on Board prep.

 

[slowthai]

The answer is no, they absolutely do not care. In your case, since preclinical grades aren't used to determine AOA or rank, they matter even less, lol

For the sake of completeness, the only thing I would say is, don't fail any courses. That's typically a red/orange flag.

 

[slowthai]

I'm curious to see if preclinical grades would be more important (and more schools shifting from P/F to graded) with Step 1 P/F

The consensus is that step 2, AOA, research, and school name will become more important. So indirectly, they will become more important, but only if you're gunning for AOA (if AOA is at least in part based on preclinical grades). AOA was never necessary for a successful match in any of the competitive fields though, so it's not really changing much of anything on that front.

 

[sloh]

I'm curious to see if preclinical grades would be more important (and more schools shifting from P/F to graded) with Step 1 P/F

Step 2 will be more important

https://www.nejm.org/doi/full/10.1056/NEJMp2004929

 

[Yhwach]

So glad I'm in unranked P/F preclinical.

I'll worry about the rank BS in rotations

 

[drducky.]

Focusing on preclinical grades in med school is like focusing on being the leader of clubs in undergrad when your mcat is 490 lol

 

[7331poas]

See attached PD survey that @Goro has recently shared.

This is always the most unhelpful comment on any thread this type of question arises. What am I supposed to do with the information that 20% of program directors like to see that I speak Spanish? Should I take that as a sign I should learn Spanish? How about 20% of PDs who think I should be interested in an academic career? Should I include that in my personal statement? Should I start an interest club for "academic physicians"?

That entire survey is not actionable.

 

[Real McCoy]

This is always the most unhelpful comment on any thread this type of question arises. What am I supposed to do with the information that 20% of program directors like to see that I speak Spanish? Should I take that as a sign I should learn Spanish? How about 20% of PDs who think I should be interested in an academic career? Should I include that in my personal statement? Should I start an interest club for "academic physicians"?

That entire survey is not actionable.

The OP asked about pre-clinical grades. There are figures/results in the survey that show how PDs rank pre-clinical grades/performance relative to many other factors. Although it's not perfect, actual numbers/data >> anecdotal conversations.

 

[Goro]

This is always the most unhelpful comment on any thread this type of question arises. What am I supposed to do with the information that 20% of program directors like to see that I speak Spanish? Should I take that as a sign I should learn Spanish? How about 20% of PDs who think I should be interested in an academic career? Should I include that in my personal statement? Should I start an interest club for "academic physicians"?

That entire survey is not actionable.

It's not meant to be a Lancet article. And Yes, the n's are small.

The survey gives you a snapshot if what program directors are thinking, and that's why it's valuable.

I suppose that there are Medical students who have not gotten over the idea of being pre-med, and as such, may still be at a loss to discover the news that preclinical grades are not important. It is time that they accept this

 

[7331poas]

It's not meant to be a Lancet article. And Yes, the n's are small.

The survey gives you a snapshot if what program directors are thinking, and that's why it's valuable.

I suppose that there are Medical students who have not gotten over the idea of being pre-med, and as such, may still be at a loss to discover the news that preclinical grades are not important. It is time that they accept this

Okay. How is thinking that preclinical grades will matter after step 1 becomes P/F more of a "premed mindset" than thinking that step 1 matters currently? (given that step 1 is a cumulative exam of preclinical content)

 

[COMMANDER CLOWN]

Okay. How is thinking that preclinical grades will matter after step 1 becomes P/F more of a "premed mindset" than thinking that step 1 matters currently? (given that step 1 is a cumulative exam of preclinical content)

Because you're assuming that preclinical classes effectively teach you on what's going to be on Step 1, which is hilariously wrong. Example: my school knows all about Sketchy/Zanki/Pathoma, and they specifically make exam questions that exclude information from those resources. Think about that, they are IGNORING RELEVANT MATERIAL because they have such big egos that they force students to watch their terrible lectures. I know what you're going to say, "well learning about the tiny details in medicine will help me become a better doctor, I can't just focus on one standardized exam". That's fine, the problem is that you won't have a chance to ever use your "valuable" knowledge when you have a step score of 200.

It seems like you've drank too much of the administrative kool-aid. I bet you believe them when they say that wellness lectures are useful for decreasing stress, TBLs are useful because doctors need to know groupwork, and that all you need to do to score well on Step 1 is to study their horrible lectures.

 

[slowthai]

Because you're assuming that preclinical classes effectively teach you on what's going to be on Step 1, which is hilariously wrong. Example: my school knows all about Sketchy/Zanki/Pathoma, and they specifically make exam questions that exclude information from those resources. Think about that, they are IGNORING RELEVANT MATERIAL because they have such big egos that they force students to watch their terrible lectures. I know what you're going to say, "well learning about the tiny details in medicine will help me become a better doctor, I can't just focus on one standardized exam". That's fine, the problem is that you won't have a chance to ever use your "valuable" knowledge when you have a step score of 200.

It seems like you've drank too much of the administrative kool-aid. I bet you believe them when they say that wellness lectures are useful for decreasing stress, TBLs are useful because doctors need to know groupwork, and that all you need to do to score well on Step 1 is to study their horrible lectures.

I agree with you 100% on this, and I'm pretty sure 7331poas does too. I think he's talking about something else entirely. Not really sure what he means when he says believing step 1 matters is a premed mindset though. I honestly don't see what's premed about it, other than the fact that it's just another round of box checking and hoop jumping that we have to endure to get what we want.

 

[slowthai]

One concern I've heard is that Step 2 is taken so much later that students won't really know what they're competitive for until its too late to tailor their apps significantly. Will schools adjust to this somehow?

I don't imagine so, at least for a while. You know schools move in slow motion when it comes to anything that benefits their students. The only thing that'll speed it up if it ever happens is if the big name schools make it trendy.

Like I've said before, the places best equipped to handle this are those with a 1 year preclinical and a 1 year clinical: basically, any curriculum that allows you to take step 2 at least a year before ERAS submission. This'll give you enough lead time to make any adjustments to your app or specialty choice.

 

[ready2go2]

A good chunk of schools do not even have pre clinical grades, in fact the best/top schools don’t (P/F + unranked). You can’t use it as a comparison tool even if your truly wanted to, hence why it’s ranked so low in terms of importance

 

[7331poas]

Because you're assuming that preclinical classes effectively teach you on what's going to be on Step 1, which is hilariously wrong. Example: my school knows all about Sketchy/Zanki/Pathoma, and they specifically make exam questions that exclude information from those resources. Think about that, they are IGNORING RELEVANT MATERIAL because they have such big egos that they force students to watch their terrible lectures. I know what you're going to say, "well learning about the tiny details in medicine will help me become a better doctor, I can't just focus on one standardized exam". That's fine, the problem is that you won't have a chance to ever use your "valuable" knowledge when you have a step score of 200.

It seems like you've drank too much of the administrative kool-aid. I bet you believe them when they say that wellness lectures are useful for decreasing stress, TBLs are useful because doctors need to know groupwork, and that all you need to do to score well on Step 1 is to study their horrible lectures.

what? I dont think that preclinical classes are representative of step 1. My point is that step 1 is just as irrelevant to the practice of medicine as your average pre-clinical curriculum. And even if you disagree with that assertion, I think we can all agree that step 2 is probably more relevant than step 1. And yet PDs overwhelmingly choose to emphasize step 1 in their selection. Clearly PDs have a "premed mindset" to an extent.

 

[Lawpy]

The consensus is that step 2, AOA, research, and school name will become more important. So indirectly, they will become more important, but only if you're gunning for AOA (if AOA is at least in part based on preclinical grades). AOA was never necessary for a successful match in any of the competitive fields though, so it's not really changing much of anything on that front.

Step 2 will be more important

https://www.nejm.org/doi/full/10.1056/NEJMp2004929

Ok but the factors that led to Step 1 being P/F will likely affect Step 2 and change that to P/F probably in few years. Considering the programs are desperate for having something concrete to compare, this could mean preclinical grades could be important. I realize this sounds ridiculous but we already have few programs requiring Casper

 

[slowthai]

Ok but the factors that led to Step 1 being P/F will likely affect Step 2 and change that to P/F probably in few years. Considering the programs are desperate for having something concrete to compare, this could mean preclinical grades could be important. I realize this sounds ridiculous but we already have few programs requiring Casper

Yeah, and they even started adding freaking secondaries to residency apps. It just keeps getting worse and worse.

But I don't think they'll ever start looking at preclinical grades. They're just gonna start looking at shelf scores or make up specialty specific exams (or use in-service exams).

 

[Lawpy]

Yeah, and they even started adding freaking secondaries to residency apps. It just keeps getting worse and worse.

But I don't think they'll ever start looking at preclinical grades. They're just gonna start looking at shelf scores or make up specialty specific exams (or use in-service exams).

Wait didn't ENT try out secondaries before and immediately got rid of them soon after? Hopefully that happens here. The covid 19 stuff + Step 1 P/F are making programs do some really bizarre stuff.

I agree preclinical grades won't really matter other than spotting red flags through failures.

 

[7331poas]

Yeah, and they even started adding freaking secondaries to residency apps. It just keeps getting worse and worse.

But I don't think they'll ever start looking at preclinical grades. They're just gonna start looking at shelf scores or make up specialty specific exams (or use in-service exams).

The amount of work it would take each specialty organization to make their own specific exam for medical students would be tremendous.

 

[slowthai]

Wait didn't ENT try out secondaries before and immediately got rid of them soon after? Hopefully that happens here. The covid 19 stuff + Step 1 P/F are making programs do some really bizarre stuff.

I agree preclinical grades won't really matter other than spotting red flags through failures.

Yes, ENT did that and they scrapped it. My hope is that these are just desperate, one-off acts of stupidity and that it's all because of what's been happening this year. But I'm not optimistic that they will go away. And I totally agree.

 

[slowthai]

The amount of work it would take each specialty organization to make their own specific exam for medical students would be tremendous.

I mean, only the ones without existing shelves would have to do it. But they've been working on them for a some time now because of the step 1 p/f thing.

 

[Bones&Bourbon]

It's not meant to be a Lancet article. And Yes, the n's are small.

The survey gives you a snapshot if what program directors are thinking, and that's why it's valuable.

I suppose that there are Medical students who have not gotten over the idea of being pre-med, and as such, may still be at a loss to discover the news that preclinical grades are not important. It is time that they accept this

Considering the exceptionally low value placed on pre-clinical grades by PD's, it's frustrating to hear that medical school administrators/basic science lecturers are still putting such a huge emphasis on our "need" to perform exceptionally well in our pre-clinical years, as if pre-clinical grades are on the same pedestal as Step 1. While I understand that pre-clinical grades are an indicator of Step 1 performance, the extent to which they over-emphasize pre-clinical grades seems like a bit of an attempt at self-validation seeing as the pre-clinical curriculum is the only thing within their "sphere of influence."

 

[Goro]

Considering the exceptionally low value placed on pre-clinical grades by PD's, it's frustrating to hear that medical school administrators/basic science lecturers are still putting such a huge emphasis on our "need" to perform exceptionally well in our pre-clinical years, as if pre-clinical grades are on the same pedestal as Step 1. While I understand that pre-clinical grades are an indicator of Step 1 performance, the extent to which they over-emphasize pre-clinical grades seems like a bit of an attempt at self-validation seeing as the pre-clinical curriculum is the only thing within their "sphere of influence."

I don't know what your school is telling you, and I sincerely doubt whatever message you're getting is parroted at all the other med schools, but the bolded is the message that's all they need to tell you, and for you to listen to on this subject.

 

[Bones&Bourbon]

I don't know what your school is telling you, and I sincerely doubt whatever message you're getting is parroted at all the other med schools, but the bolded is the message that's all they need to tell you, and for you to listen to on this subject.

Thankfully my school is seemingly ahead of the curve with their statements on pre-clinical grades and their value. However based on the comments above, it sounds like others haven't been as fortunate, hence why I posed the initial question..

 

[Captain_Falcon]

My school "studying for class is studying for boards. Our class average on the board exams and CAS and NBME tests are above average so that means our curriculum is strong."

They say this without acknowledging our class average on our neuro block exams so far has been like 68%. So that makes me think, maybe my class as a whole just does really well keeping up with outside resources and doing lots of practice questions. And THAT is why historically our students have rocked those tests. (Has nothing to do with your crap curriculum)

 

[slowthai]

My school "studying for class is studying for boards. Our class average on the board exams and CAS and NBME tests are above average so that means our curriculum is strong."

They say this without acknowledging our class average on our neuro block exams so far has been like 68%. So that makes me think, maybe my class as a whole just does really well keeping up with outside resources and doing lots of practice questions. And THAT is why historically our students have rocked those tests. (Has nothing to do with your crap curriculum)

Schools love to do this; just take all the credit for stuff they had no hand in and put all the blame on you for stuff that's specifically their fault. It's *****ic

 

[7331poas]

I mean, only the ones without existing shelves would have to do it. But they've been working on them for a some time now because of the step 1 p/f thing.

We should determine entrance to a profession based on a person's 3rd year shelf exam for that field? yikes

 

[slowthai]

We should determine entrance to a profession based on a person's 3rd year shelf exam for that field? yikes

Hey, it's better than using worthless preclinical grades based on crappy professor-written exams. They're just looking for an objective metric to cut down on the number of apps. Idk what they're going to do, but I'd much prefer some kind of objective metric than the number of low quality pubs you can pump out and spam at every conference or clerkship grades. You have way more control over your shelf scores than the subjective stuff.