Does class rank actually matter (quartiles, quintiles, etc)?

[ERDOC555]

Yes being at the top and getting AOA obviously does matter, but how about just the top quartile/quintile but without AOA?

I've seen a lot of schools that internally rank and then at the end the Dean simply lists the quartile that the student was in, but often times in a coded way such as: good, great, excellent, exceptional, at the very end of the letter in literally one sentence.

For example:
"Student X will make a _______ (insert a bolded adjective here) resident."

It's hard to believe program directors would know enough to figure out the secret code for 100+ schools to try to figure out the exact quartile. Let's say it is even more direct and says Xth quartile, is this a big factor?

My logic is that taking a lower class rank by not going crazy to get the top scores on exams and using those hours to study for and reinforce Step 1 material is a much better use. I could be dead wrong though and would love other opinions.

Can anyone with experience in this area chime in? How important is this?

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[buonassezia]

Medical schools also have to include on the MKSAP a graphical representation of the breakdown of categories, and where you fall within the breakdown (using, for example, and arrow indicator to indicate which quartile). Even if the wording is elusive, everyone jumps to the graph at the end when they look at your MKSAP. This, unfortunately, matters more than we'd all like it to… perhaps more than anything else on the transcript. Write it off at your own peril.

 

[ERDOC555]

Medical schools also have to include on the MKSAP a graphical representation of the breakdown of categories, and where you fall within the breakdown (using, for example, and arrow indicator to indicate which quartile). Even if the wording is elusive, everyone jumps to the graph at the end when they look at your MKSAP. This, unfortunately, matters more than we'd all like it to… perhaps more than anything else on the transcript. Write it off at your own peril.

What exactly is the MKSAP (I think I get the letters, but not sure the function or content)?

 

[Pacna]

Can anyone with experience in this area chime in? How important is this?

Somewhat important. It's about 10th on a residency director's checklist. http://www.nrmp.org/wp-content/uploads/2014/09/PD-Survey-Report-2014.pdf

 

[joker2400]

What exactly is the MKSAP (I think I get the letters, but not sure the function or content)?

Mksap is a study tool for internal medicine. The Mspe or dean's letter is a document put together by your school that is supposed to summarize your time there.

 

[HooliganSnail]

Class rank doesn't really matter that much. Just make sure you pass all of your classes.

When it comes to a student's academic's, the important things are that they didn't fail any classes, and that they didn't fail the boards.

Of course doing better is always better, but I wouldn't fret just because you are in the 35th percentile or something.

Program's really want to know how a candidate works in real life, they know all the medical students are academically smart, they did get into med school after all. The mystery is the intangibles. Do they play well with others, do they create drama, or go with the flow. Do they arrive early and stay late? Most important, Will they develop into an independent functioning resident/attending, or will I have to hold their hand the whole time.

Board scores and class rank are very predictive of success on the in-service and board exams, but not much else. Some of the most incompetent doctors we've had in our program test very well.

Unfortunately, test scores are still the only objective measurement we have......

 

[FiveOClock]

Class rank doesn't really matter that much. Just make sure you pass all of your classes.

When it comes to a student's academic's, the important things are that they didn't fail any classes, and that they didn't fail the boards.

Of course doing better is always better, but I wouldn't fret just because you are in the 35th percentile or something.

Program's really want to know how a candidate works in real life, they know all the medical students are academically smart, they did get into med school after all. The mystery is the intangibles. Do they play well with others, do they create drama, or go with the flow. Do they arrive early and stay late? Most important, Will they develop into an independent functioning resident/attending, or will I have to hold their hand the whole time.

Board scores and class rank are very predictive of success on the in-service and board exams, but not much else. Some of the most incompetent doctors we've had in our program test very well.

Unfortunately, test scores are still the only objective measurement we have......

I definitely can see where you're coming from, the candidate themselves is the most important variable. But personality and work ethic won't get you passed Step 1 and class rank filters that nearly all competitive residencies have. There are simply too many good candidates that have it all.

 

[HelpPleaseMD]

don't let anyone tell you anything different. its all about class rank / steps / research.

 

[Mad Jack]

don't let anyone tell you anything different. its all about class rank / steps / research.

Probably depends on the field/competitiveness of the program.

 

[ERDOC555]

Mksap is a study tool for internal medicine. The Mspe or dean's letter is a document put together by your school that is supposed to summarize your time there.

Thanks!

I found this from Ohio State

"

• Summary Statement: Although the College of Medicine is a nonranking institution, students are clustered based on percentages assigned to their preclinical end-of-year and core clinical clerkship grades. The categories are: outstanding, excellent, very good, good and capable. Only Med 1-3 grades are include in the MSPE cluster statement. We do not feel it is fair to include July and August grades in Med 4 because of differences in student schedules and the relative weights of the clerkships.
  
• Appendices: These include graphic representations on “Preclinical Comparative Performance,” “Clinical Comparative Performance,” "Professionalism Comparative Performance," “Compartive Performance in Medical School” and an information page on the College of Medicine. "

It seems that the appendices will have your ranking in pretty clear terms. That makes a lot more sense than interpreting just the single words.

So in reality few schools in the US is actually true P/F or unranked?

 

[Jabbed]

So in reality few schools in the US is actually true P/F or unranked?

Correct.

 

[buonassezia]

What exactly is the MKSAP (I think I get the letters, but not sure the function or content)?

OMG, I must have been sooooo tired and typed the wrong acronym. MKSAP is not what I meant at all (a series of questions that helps you improve your IM knowledge)… I meant MSPE. This stands for Medical Student Performance Evaluation, and every student from an allopathic medical school gets one assembled for them by their Dean's Office. It used to be called the "Dean's Letter," and is a standardized assembly of comments, grades, rankings, and descriptions about your curriculum and program. These are very important for residency applications.

(Sorry, wrong acronym!)

 

[buonassezia]

Our school is true P/F in the preclinical years, but then the clinical years just matter a ton more for your ranking. I think Yale may still truly have no rankings overall, but I'm not positive. Most everywhere else does, and rankings may or may not factor in the first 2 years' performance.

 

[buonassezia]

Maybe what they mean above by saying a "non-ranking institution" has to do with not specifying the EXACT number you graduated in your class. Most places will still put you in a general category (quartile, quintile, etc.) to characterize your performance. So their "non ranking" phrase is a little misleading.

On the other hand, preclinical years are often not included in rankings at all ("true P/F"), but it varies by school. Sounds like your school does include all years 1-3 for rankings. Residencies tend to care less about your preclinical rankings than clinical year or overall ranks.

And no, splitting hairs between different percentages is not really warranted, but 1st v 2nd or 3rd quartile can definitely have some impact. When everything else about your app is great, and so is everybody else's, you may get screened based on this parameter. This will not exclude you from tons of great places, and you will match, but the significance is non-zero. Keep doing your best and things will work out.

 

[Instatewaiter]

don't let anyone tell you anything different. its all about class rank / steps / research.

Probably depends on the field/competitiveness of the program.

Not true at all. Even community PM&R in North Dakota requires their applicants to be in the top quartile of the class. If you are below the mean in a given medical school class, you're probably going to have to start thinking about psychiatry in Mongolia.

 

[buonassezia]

(Sorry for the excessive advice here):

I had the same questions as you about classes v Step I studying. Classes seemed, in many ways, kind of irrelevant to Step I, and I thought I might be better off just whizzing through them and getting to the boards studying.

I ultimately chose to bust on the courses and worry about Step I later, and, wooh! I'm so glad I did. After busting on classes, it turned out I had an incredibly strong foundation of knowledge going into Boards studying. A lot of the minuscule, seemingly-unimportant minutia of classes is stuff that they LOVE to throw in randomly on the Boards, and you never quite know what you're going to get. Take the time now to assemble the rich framework and puzzle through the "why" of everything you learn, even if it seems dumb. If you learn the whys and hows of those tiny ridiculous details now, it will pay off tenfold later.

This leads to better long term memory and ability to derive answers from shreds of memory even when the details get fuzzy again. It leads to having practiced the kind of reasoning they expect on Step I everyday. If the classes suck, complement your knowledge and understanding of the subjects by texts, audio, or online materials as you go. In second year, if you want, do the First Aid and/or Goljan Path texts alongside the material to make sure you're getting everything.

Second semester second year I started listening to Goljan and Lionel Raymon pharmacology as I walked to and from classes, prepared dinner, did my laundry, etc., over and over again. Watched a few Kaplan vids on the weekends and kept busting on my courses. Worked out very well. You need time and context to assimilate all the information, which you cannot effectively "study" or review for Step I until you've seen it once or a few times. You really will not be as effective if you try to study before you've really learned, and often the irrelevant-seeming things may be useful down the road. That said, there are truly poorly-taught classes worth skimming through or skipping…

In the end doing well on your school's tests probably is not very different from doing well on Boards, although it may seem that way now.

That's my way-more-than-2 cents. 🙂

 

[ERDOC555]

(Sorry for the excessive advice here):

I had the same questions as you about classes v Step I studying. Classes seemed, in many ways, kind of irrelevant to Step I, and I thought I might be better off just whizzing through them and getting to the boards studying.

I ultimately chose to bust on the courses and worry about Step I later, and, wooh! I'm so glad I did. After busting on classes, it turned out I had an incredibly strong foundation of knowledge going into Boards studying. A lot of the minuscule, seemingly-unimportant minutia of classes is stuff that they LOVE to throw in randomly on the Boards, and you never quite know what you're going to get. Take the time now to assemble the rich framework and puzzle through the "why" of everything you learn, even if it seems dumb. If you learn the whys and hows of those tiny ridiculous details now, it will pay off tenfold later.

This leads to better long term memory and ability to derive answers from shreds of memory even when the details get fuzzy again. It leads to having practiced the kind of reasoning they expect on Step I everyday. If the classes suck, complement your knowledge and understanding of the subjects by texts, audio, or online materials as you go. In second year, if you want, do the First Aid and/or Goljan Path texts alongside the material to make sure you're getting everything.

Second semester second year I started listening to Goljan and Lionel Raymon pharmacology as I walked to and from classes, prepared dinner, did my laundry, etc., over and over again. Watched a few Kaplan vids on the weekends and kept busting on my courses. Worked out very well. You need time and context to assimilate all the information, which you cannot effectively "study" or review for Step I until you've seen it once or a few times. You really will not be as effective if you try to study before you've really learned, and often the irrelevant-seeming things may be useful down the road. That said, there are truly poorly-taught classes worth skimming through or skipping…

In the end doing well on your school's tests probably is not very different from doing well on Boards, although it may seem that way now.

That's my way-more-than-2 cents. 🙂

Great advice! I appreciate the detailed post!

I have to agree with you about the minutia and deeper understanding benefiting the student. The MCAT was exponentially easier because I had a deeper understanding of most of the material from my coursework. Then when it came to the few actually tested topics, I did well because I could reason beyond the obvious.

Thanks everyone for all the information! I'll definitely try to do well in clinical years as well as master the Step 1 material.

 

[Brorthopedic]

Don't fail any classes, rank in the top half of your class and crush your step 1 and you'll be fine. Class rank starts to matter more and more as you go after extremely competitive specialties in desired locations/prestigious institutions, purely because applicants start to have similarly strong qualifications (step/research/LORs) and PDs need more metrics in order to differentiate between the applicants.

 

[operaman]

My usual thoughts whenever I see threads like this:

1) everything is important because it's all related. Students who ace classes tend to crush the steps and go on to do well clinically and on shelves. Sure, there are occasional exceptions, but overall, past performance is a pretty good indicator of future performance.

2) importance of different factors changes with your level in school. For an ms1, grades and class rank matter most because that's one of the only things you can work on at that time. Telling a preclinical student that xyz doesn't matter much is really doing them a disservice; it's an entirely different conversation than the similar sounding one had with an ms4 with a completed application. In the beginning, we can't really tell an individual student how much something will ultimately mean to them.

3) planning to make up for performing below average on all class exams by magically performing above the 90th percentile on a national exam doesn't seem like the best idea.

4) everyone who cites the PD survey needs to actually read it in its entirety and understand the methods behind it. It doesn't really say what everyone seems to think it says.

5) everyone should download that radiology journal article about the mspe code words and look up their school in the supplemental materials and see what theirs will actually say.

 

[ERDOC555]

My usual thoughts whenever I see threads like this:

1) everything is important because it's all related. Students who ace classes tend to crush the steps and go on to do well clinically and on shelves. Sure, there are occasional exceptions, but overall, past performance is a pretty good indicator of future performance.

2) importance of different factors changes with your level in school. For an ms1, grades and class rank matter most because that's one of the only things you can work on at that time. Telling a preclinical student that xyz doesn't matter much is really doing them a disservice; it's an entirely different conversation than the similar sounding one had with an ms4 with a completed application. In the beginning, we can't really tell an individual student how much something will ultimately mean to them.

3) planning to make up for performing below average on all class exams by magically performing above the 90th percentile on a national exam doesn't seem like the best idea.

4) everyone who cites the PD survey needs to actually read it in its entirety and understand the methods behind it. It doesn't really say what everyone seems to think it says.

5) everyone should download that radiology journal article about the mspe code words and look up their school in the supplemental materials and see what theirs will actually say.

Could you link to that radiology journal?

 

[Taddy Mason]

Could you link to that radiology journal?

http://www.jacr.org/article/S1546-1440(13)00767-9/abstract

 

[ERDOC555]

http://www.jacr.org/article/S1546-1440(13)00767-9/abstract

Thanks so much!

Do you think most PDs have read and are familiar with this article? I was surprised at how fuzzy some schools were as welll as how many lacked data all together.

 

[operaman]

Thanks so much!

Do you think most PDs have read and are familiar with this article? I was surprised at how fuzzy some schools were as welll as how many lacked data all together.

I'm sure the article got shared on all their email lists when it came out, though not sure how many use it in practice. They must get very familiar with the MSPEs coming from schools that frequently send them applicants and probably don't need it. There are also other ways to get similar info such as from your LORs, especially more summative letters like a chairman's letter.

Despite everything schools do to obscure it, it really isn't that hard to tell who the stars really are and anyone reading this could do it too. Give me 10 randomly chosen ERAS applications from the same school without any of the MSPE and I could put them in nearly perfect class rank order and so could anyone else. Take 10 apps from 10 different schools and I could still get pretty close.

 

[SurgeonOfLife]

So I was wondering if I interpreted this right for Perelman (Penn):

The eight highest ranking students are described in the summary paragraph as the Top students in the class. The hierarchy for the remainder of the class is Outstanding, Excellent to Outstanding, Excellent, Very Good to Excellent, and Very Good. This hierarchy is defined on the last page of the MSPE. Numerical boundaries are used for only the top 8 students.

Barring the rankings for students #1-8, everyone else is divided into quintiles? And these quintiles are based on the non-P/F classes & clinicals?

 

[HooliganSnail]

don't let anyone tell you anything different. its all about class rank / steps / research.

......If your applying for dermatology

I and my fellow residents have a significant say about the students we rank each year, and I can say that I never know anyone's class rank, their step scores are mentioned in passing, and I have absolutely no idea, nor do I care, if any of them do research.

I can't speak to any other program, or any other field. But at our shop, it is mostly about the candidate themselves.

 

[Slack3r]

Yes being at the top and getting AOA obviously does matter, but how about just the top quartile/quintile but without AOA?

I've seen a lot of schools that internally rank and then at the end the Dean simply lists the quartile that the student was in, but often times in a coded way such as: good, great, excellent, exceptional, at the very end of the letter in literally one sentence.

For example:
"Student X will make a _______ (insert a bolded adjective here) resident."

It's hard to believe program directors would know enough to figure out the secret code for 100+ schools to try to figure out the exact quartile. Let's say it is even more direct and says Xth quartile, is this a big factor?

My logic is that taking a lower class rank by not going crazy to get the top scores on exams and using those hours to study for and reinforce Step 1 material is a much better use. I could be dead wrong though and would love other opinions.

Can anyone with experience in this area chime in? How important is this?

Look, I know you're gunning for derm, but you're not even in school yet. The realistic answer to your numerous threads is: everything matters, especially for a competitive field like dermatology filled with number-grubbing automatons. Don't overthink this, just do your best.

 

[J ROD]

Something competitive........then yes. Otherwise, not really. Steps are most important.

 

[username456789]

......If your applying for dermatology

I and my fellow residents have a significant say about the students we rank each year, and I can say that I never know anyone's class rank, their step scores are mentioned in passing, and I have absolutely no idea, nor do I care, if any of them do research.

I can't speak to any other program, or any other field. But at our shop, it is mostly about the candidate themselves.

But you likely have little/no say about who is interviewed, and much of the Step score/class rank stuff is involved in that branch in the decision tree anyway.

 

[*brobro*]

In the first 2 years, there were a number of people who liked to talk about how they were just "ignoring all the bull**** from class and focusing on board studying." These were often the same students who were carrying around a copy of FirstAid in their first year of med school. Most of these people did not perform exceptionally on step 1. On the other hand, the junior AOA people and other top students focused on the blocks and then started studying for step 1 early on in second year...but not at the sacrifice of block grades. Learning everything in exhausting detail the first time will be the best thing you ever did for yourself. It will not only help on step 1, it will also continue to be helpful during third year clerkships and on shelf exams. There's nothing wrong with "gunning" for derm (and honestly being really prepared and working hard is not gunning...) and trying to be the best student possible. If you find yourself interested in some other "less competitive" field down the line, then you'll be happy you have a good app. Just because peds and IM are not all that competitive doesn't mean that the top programs in these fields are easy to get into. Always better to be the person shooting for derm who finds out they just LOVE family medicine than to be the guy planning on skating into a family med program who finds out they really want to do derm.

Bottom line: Do as well as you possibly can in class and find the people in the classes above you who did really well and ask them what they did.

 

[HelpPleaseMD]

......If your applying for dermatology

I and my fellow residents have a significant say about the students we rank each year, and I can say that I never know anyone's class rank, their step scores are mentioned in passing, and I have absolutely no idea, nor do I care, if any of them do research.

I can't speak to any other program, or any other field. But at our shop, it is mostly about the candidate themselves.

The question posed by the op was whether it mattered, not whether it is necessary to match to a particular field.

I know in my specialty, and I actually would assume all, that they would rather take someone with a higher class rank/steps/research unless there is something glaringly weird about them during interview day. Suggesting that rankings/scores don't matter much is doing the students a disservice. I am in IM, a relatively uncompetitive speciality, but at the topish programs you still need the aforementioned to match well.

just my 2 cents. feel free to disagree

 

[HelpPleaseMD]

In the first 2 years, there were a number of people who liked to talk about how they were just "ignoring all the bull**** from class and focusing on board studying." These were often the same students who were carrying around a copy of FirstAid in their first year of med school. Most of these people did not perform exceptionally on step 1. On the other hand, the junior AOA people and other top students focused on the blocks and then started studying for step 1 early on in second year...but not at the sacrifice of block grades. Learning everything in exhausting detail the first time will be the best thing you ever did for yourself. It will not only help on step 1, it will also continue to be helpful during third year clerkships and on shelf exams. There's nothing wrong with "gunning" for derm (and honestly being really prepared and working hard is not gunning...) and trying to be the best student possible. If you find yourself interested in some other "less competitive" field down the line, then you'll be happy you have a good app. Just because peds and IM are not all that competitive doesn't mean that the top programs in these fields are easy to get into. Always better to be the person shooting for derm who finds out they just LOVE family medicine than to be the guy planning on skating into a family med program who finds out they really want to do derm.

Bottom line: Do as well as you possibly can in class and find the people in the classes above you who did really well and ask them what they did.

in the grand scheme of things AOA matters more than boards, at least for IM from my experience

 

[*brobro*]

Right, I was just trying to point out that the people who make junior AOA have to do really well on class exams and then these people also typically go on to do well on boards and third year. At least that has been the experience with my cohort. It's not surprising that AOA becomes such an important factor with residency selection. It's not that if you don't have it, you aren't still a great applicant...but if you do have it, you must be, at the very least, a consistently hard worker.

 

[HooliganSnail]

The question posed by the op was whether it mattered, not whether it is necessary to match to a particular field.

I know in my specialty, and I actually would assume all, that they would rather take someone with a higher class rank/steps/research unless there is something glaringly weird about them during interview day. Suggesting that rankings/scores don't matter much is doing the students a disservice. I am in IM, a relatively uncompetitive speciality, but at the topish programs you still need the aforementioned to match well.

just my 2 cents. feel free to disagree

I don't disagree completely.... Of course, doing better is obviously......better. I do EM, so that is all I can speak too, but EM is pretty competitive.

The question in hand is how to evaluate your incoming students as possible residents and eventually doctors. There is a bunch of data at hand, but most of it is not especially indicative of what we are looking for

We Want:
1. Assertive - Can NOT be holding your hand. Interns get a short leash, but as you advance through the ranks, you really need to be independent. Nothing worse than a senior resident who still needs to be watched closely.
2. Communication - Effective communication on different levels that you can switch through rapidly, Communicate with other doctors, with the nurses, with the tech's/radiology, and with the patient. Clear. Concise.
3. Teachable - Do you play well with others. We do not expect our incoming interns to know a ton about actual patient management, but we NEED them to be able to learn.
4. Rapid integration of information - lots of sources of data, being able to pull it together in a timely fashion and make a damn decision (kinda relates to #1)

The problem with class rank, and board scores is that it tells us NOTHING about the skills mentioned above. And I can assure you, in the real world, the above attributes are far far far more important than "how smart you are"

We know that doing well in courses makes you more likely to do well on the Step(s). We know that people with high step scores do better on the in-service, and are more likely to pass the Board exam. That's it

We have had a ton of residents in the past who test well, but are not particularly effective ER physicians. So in the absence of any other objective measurement of the qualities we are looking for, the MOST Important Factor for my program is the actual Candidate Themselves.