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Does it really matter if it is P/F?

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bora

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Dudes and dudettes,
I am kind of curious if going to a medical school that grades P/F in pre-clinicals is really an advantage. From outside it looks and sounds pretty good, but most of the P/F schools I'm considering have a "hidden" ranking systems that are just like grade-scales, and I am sure they bring on the competitive environment as if the P/F system was not there to begin with. These hidden scales are reported on your transcripts on most of the schools I looked at. Also, I am considering a competitive specialty and am sure that distinguishing myself from others would only help me out, and I think a grade scale would only help me out (that is if I kill it). Obviously, many of you will debate preclinical vs. clinical grades and all I am concerned about is pre-clinical STEP 1 stuff. Would you guys say that a P/F system with hidden ranking and a grade scale system are pretty much the same thing? Or would you guys just say, "Dude relax, let the dice roll, and pick the school that is the best fit w/o considering their grading system?" Thank you very muchooo for the insight pepzz!
 

SunsFun

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I still prefer P/F over grades even with hidden ranking. Even if someone is aiming for a competitive specialty, it is much easier to tailor the content you learn in class to STEP preparation when you don't have to worry as much about getting an A in every class. And STEP is obviously much more important.
 
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mcloaf

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Let me tell you what's going to happen in this thread: People who go somewhere with P/F are going to tell you it's awesome, while people who go somewhere without P/F are going to tell you it doesn't matter.

As someone who goes somewhere with unranked P/F, it is awesome. I'm not sure I'd consider ranked P/F much different than just having grades, but others will disagree.
 
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tantacles

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Let me tell you what's going to happen in this thread: People who go somewhere with P/F are going to tell you it's awesome, while people who go somewhere without P/F are going to tell you it doesn't matter.

As someone who goes somewhere with unranked P/F, it is awesome. I'm not sure I'd consider ranked P/F much different than just having grades, but others will disagree.

I go to a school with grades, and it definitely matters; residency programs don't particularly care, so in that respect it's pretty unimportant, but students spend a whole lot of time talking about grades and worrying about whether they received an A, B, or C in their courses.

I'm lucky in that I have completely ignored grades and treated our school like a pass/fail school, but had I been accepted to a P/F school, I definitely would have gone there.
 
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Goro

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I have been told that residency directors like having some differential other than P/F, and that's why some programs metastasized the convention to H, HP, P and F. But this info was some time ago, so I'll have to see what our Clinical Deans have to say now on the subject. Stay tuned!

I go to a school with grades, and it definitely matters; residency programs don't particularly care, so in that respect it's pretty unimportant, but students spend a whole lot of time talking about grades and worrying about whether they received an A, B, or C in their courses.

I'm lucky in that I have completely ignored grades and treated our school like a pass/fail school, but had I been accepted to a P/F school, I definitely would have gone there.
 

Espadaleader

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You'll see the difference when you interview if you haven't already interviewed. Students are way less stressed. My PI was a residency committee member at a top 10 back in the mid 00's and when I tell her that pretty much every top 20 school is P/F now she kinda scoffs. Most of the schools at the forefront of medical education are P/F so I don't think residency directors have a choice. Like are the directors at Harvard, Yale, Hopkins, Duke, Sinai, Penn, Brown etc. gonna say we prefer having a differential when all of their students are P/F?
 
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DermViser

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Dudes and dudettes,
I am kind of curious if going to a medical school that grades P/F in pre-clinicals is really an advantage. From outside it looks and sounds pretty good, but most of the P/F schools I'm considering have a "hidden" ranking systems that are just like grade-scales, and I am sure they bring on the competitive environment as if the P/F system was not there to begin with. These hidden scales are reported on your transcripts on most of the schools I looked at. Also, I am considering a competitive specialty and am sure that distinguishing myself from others would only help me out, and I think a grade scale would only help me out (that is if I kill it). Obviously, many of you will debate preclinical vs. clinical grades and all I am concerned about is pre-clinical STEP 1 stuff. Would you guys say that a P/F system with hidden ranking and a grade scale system are pretty much the same thing? Or would you guys just say, "Dude relax, let the dice roll, and pick the school that is the best fit w/o considering their grading system?" Thank you very muchooo for the insight pepzz!

Program Directors don't care about the actual grades in preclinical courses. This is because your grade in Biochemistry has no bearing on how you'll do in residency training. When schools grade preclinicals - this directly lends itself to your overall class rank, hence why it's still an issue for students. But yes, I think P/F with internal ranking (meaning grades are still kept on hand for ranking) pretty much defeats the whole purpose of P/F in the first place, but I guess it's better than letter grades - which make students ridiculously neurotic.

IMHO, I think P/F grading allows you to concentrate more on studying and acing USMLE Step 1 - which will truly decide which specialties are effectively closed off to you, and which fields are still possibilities.
 
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DermViser

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I have been told that residency directors like having some differential other than P/F, and that's why some programs metastasized the convention to H, HP, P and F. But this info was some time ago, so I'll have to see what our Clinical Deans have to say now on the subject. Stay tuned!

For clinical rotations yes (which is why very few schools are P/F in the third year). For preclinical courses, no, bc they have a much better marker than your professor made multiple choice exams, USMLE Step 1.
 

BABSstudent

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I go to a straight pass/fail school for the first two years and I will tell you that it eliminates a ton of stress. Like it is amazing how much less stress I have.

For example, in my biochem class I have one more test and a final left for this quarter. If I went to a school with letter grades, I would be worried about the upcoming test because I need a 90% or higher to get a B+ or A- on my quiz grades. I am right on the edge. It's unnerving how close I am. However, I go to a P/F school and will not need to worry about trivial details like that. I need a 17% on the quiz to pass the class. That means I will study to get a 70% so I can prepare for the final, but I am not worried about studying until I know EVERYTHING backwards and forwards. I will use the extra time focusing on other classes, exercising and being with my wife.

Which would you prefer?
 
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solitarius

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    My expectation is our performance during the ERAS process will ride on third-year and Step 1.

    So Third Year will be difficult at every school, while part of Fourth Year should be easy everywhere. The only differentiator is the pre-clinical years and whether there's a research requirement to graduate.

    In my humble and personal opinion, the Holy Grail is:
    • Pass / Fail
    • Internally unranked for the first two years (ranked for third year)
    • Block-scheduling (with one exam per block)
    • Half-day scheduling
    • Six weeks protected for Step I preparation
    • 2 year pre-clinical including Step I
    The absolute cherry on top would be no AOA, but this drastically shrinks the number of schools to less than one hand.

    As I understand it, there are less than three schools that have all this.
     
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    Itsame

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    UMass is pretty darn close! Though we generally have 2 classes per block (so two exams to study for). Typical day is 4 hrs of lecture (except Tuesdays), though you might have clinical stuff in the other half days, or anatomy lab when that's happening. 6 wks free to study for Step 1 (8/9 ish if you don't attend a series of board prep lectures)

    Still got the AOA though!
     
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    trino

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    My expectation is our performance during the ERAS process will ride on third-year and Step 1.

    So Third Year will be difficult at every school, while part of Fourth Year should be easy everywhere. The only differentiator is the pre-clinical years and whether there's a research requirement to graduate.

    In my humble and personal opinion, the Holy Grail is:
    • Pass / Fail
    • Internally unranked for the first two years (ranked for third year)
    • Block-scheduling (with one exam per block)
    • Half-day scheduling
    • Six weeks protected for Step I preparation
    • 2 year pre-clinical including Step I
    The absolute cherry on top would be no AOA, but this drastically shrinks the number of schools to less than one hand.

    As I understand it, there are less than three schools that have all this.
    Sounds like Case Western fits this bill exactly. Although mandatory lecture/PBL
     

    trino

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    IMO this is even worse than grades
    Well, there's only 6 hours of lecture a week. PBL is also set up differently (probably shouldn't be called PBL because that invokes a stigma). But to each their own, just wanted to clarify.
     
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    seeinghowitgoes

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    IMO this is even worse than grades

    Yea, both CCLCM and Case fit that bill with regard to schedule and mandatory classes (CCLCM continues the p/f into clinical years as well)...as @trino said, to each their own, but I'll take sitting in class for a few half days a week for that setup any day
     

    MilkIsGood

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    Yes. Way less stress, yet everyone still learns. My class's average grade on the last test was high 80s.
     

    Microglia

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    Dudes and dudettes,
    I am kind of curious if going to a medical school that grades P/F in pre-clinicals is really an advantage. From outside it looks and sounds pretty good, but most of the P/F schools I'm considering have a "hidden" ranking systems that are just like grade-scales, and I am sure they bring on the competitive environment as if the P/F system was not there to begin with. These hidden scales are reported on your transcripts on most of the schools I looked at. Also, I am considering a competitive specialty and am sure that distinguishing myself from others would only help me out, and I think a grade scale would only help me out (that is if I kill it). Obviously, many of you will debate preclinical vs. clinical grades and all I am concerned about is pre-clinical STEP 1 stuff. Would you guys say that a P/F system with hidden ranking and a grade scale system are pretty much the same thing? Or would you guys just say, "Dude relax, let the dice roll, and pick the school that is the best fit w/o considering their grading system?" Thank you very muchooo for the insight pepzz!

    If there is hidden ranking it doesn't matter as much. Some schools have p/f with absolutely no preclinical rankings, and they rock. Ya know, not that I'm super biased or anything..
     

    darkjedi

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    • 2 year pre-clinical including Step I
    I'm a bit biased, but I think having a 1.5 year curriculum is better in the long run, especially if you get to take your Step 1 after your clinical rotations. Schools that have switched to the 1.5 year curriculum + Step 1 after a clinical year have been shown to increase their Step 1 scores, mine included. Plus you get to work in the hospital and see patients earlier, which is presumably why you are pursuing med school.
     
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    Lucca

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    I'm a bit biased, but I think having a 1.5 year curriculum is better in the long run, especially if you get to take your Step 1 after your clinical rotations. School's that have switched to the 1.5 year curriculum + Step 1 after a clinical year have been shown to increase their Step 1 scores, mine included. Plus you get to work in the hospital and see patients earlier, which is presumably why you are pursuing med school.

    Do schools with 1.5yr curricula also test more often? Is there a bigger rush to push all of the information on the students than in 2 yr curriculum or is it just structured in such a way that isn't a problem?
     

    darkjedi

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    Do schools with 1.5yr curricula also test more often? Is there a bigger rush to push all of the information on the students than in 2 yr curriculum or is it just structured in such a way that isn't a problem?
    Not from my experience. When we were on block schedule, we had tests about once a month. One of my friends at UChicago is on a 2 year schedule, but had tests ~8 days.
     

    Lucca

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    Not from my experience. When we were on block schedule, we had tests about once a month. One of my friends at UChicago is on a 2 year schedule, but had tests ~8 days.

    Wow, it sounds like you really hit the jackpot there. Given your location and your past posts I can probably guess where you are, hopefully I'll have the chance to apply.
     

    scarletgirl777

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    Dudes and dudettes,
    I am kind of curious if going to a medical school that grades P/F in pre-clinicals is really an advantage. From outside it looks and sounds pretty good, but most of the P/F schools I'm considering have a "hidden" ranking systems that are just like grade-scales, and I am sure they bring on the competitive environment as if the P/F system was not there to begin with. These hidden scales are reported on your transcripts on most of the schools I looked at. Also, I am considering a competitive specialty and am sure that distinguishing myself from others would only help me out, and I think a grade scale would only help me out (that is if I kill it). Obviously, many of you will debate preclinical vs. clinical grades and all I am concerned about is pre-clinical STEP 1 stuff. Would you guys say that a P/F system with hidden ranking and a grade scale system are pretty much the same thing? Or would you guys just say, "Dude relax, let the dice roll, and pick the school that is the best fit w/o considering their grading system?" Thank you very muchooo for the insight pepzz!
    You should absolutely not let this matter. It is true that students at schools with grades in pre-clinicals spend a lot of time stressing about exams. They will all try to make it seem like it's this great collaborative environment in interviews and everyone's so relaxed, but it's not true. However, since residency directors absolutely do not care about pre-clinical grades, you should not allow yourself to be sucked in.

    I had not heard of schools using preclinical grades as a major component of the class rank that gets reported to residency directors. That would be very stupid because residency directors care about clinical performance, not memorization of esoteric minutiae that will never appear on a standardized exam. There were some schools that used it as a tiebreaker for AOA or chose the top 5 or so students to be junior AOA but for the vast majority of students preclinical performance had no effect. But if there was a school that did make preclinical grades central, I would have considered that a major turn-off. Preclinicals were a time for me to relax, make friends, and enjoy my fading youth :)

    You are right about schools misleading about P/F though. In some schools some percentage of people must fail or it's only P/F for a semester or there is internal ranking...etc etc. And the administrators/admissions people are not above deliberately misleading you/lying so you'll come.
     

    JJMrK

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    At the risk of sounding like a broken record: it depends on your goals. IMO P/F grading systems are a disadvantage for students who intend to apply for competitive specialties. Each "H" on your transcript is one piece of a large puzzle, and the more you get the brighter your application will shine. While it is probably true that P/F grading allows for more of a focus on step 1, there are plenty of students who manage to honor courses and do well on the test. I have the same opinion of systems that severely limit the number of "H/A" grades that are given out during clinical clerkships. In the same vien, AOA isn't everything, but it is extremely helpful to have.

    If you are interested in a less competitive field and attend a school with some type of grading scale, you are always free to choose to be content with passing.
     
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    seeinghowitgoes

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    At the risk of sounding like a broken record: it depends on your goals. IMO P/F grading systems are a disadvantage for students who intend to apply for competitive specialties. Each "H" on your transcript is one piece of a large puzzle, and the more you get the brighter your application will shine. While it is probably true that P/F grading allows for more of a focus on step 1, there are plenty of students who manage to honor courses and do well on the test. I have the same opinion of systems that severely limit the number of "H/A" grades that are given out during clinical clerkships. In the same vien, AOA isn't everything, but it is extremely helpful to have. I

    If you are interested in a less competitive field and attend a school with some type of grading scale, you are always free to choose to be content with passing.

    I know you prefaced that with it's your opinion, but I don't know if there is much to back it up…I suppose it depends on the school, but it seems many highly ranked schools have true P/F (and it may be that many P/F schools are more highly ranked, though I haven't really looked into it), and I don't think they have any problems getting people into competitive residencies. Tangentially, according to the survey of residency directors, perceived prestige ("highly regarded") of a medical school ranks as more important than Honors in basic sciences. Everybody on SDN loves saying how unless you're going into academic medicine/policy, school doesn't matter, so if school usually only matters at the margins, and it's considered "more important" than honors, then being able to get a lot of honors probably isn't all that impactful anyway.

    Also, the idea that each "H" will help you shine assumes residency directors are comparing an "H" on one transcript directly to the transcript of somebody who didn't even have the possibility to prove they have "H" level of knowledge in the preclinical years; my guess is that isn't necessarily the case, especially when Step 1 and clinical grades can be taken into account (schools like CCLCM that don't have clinical grades I'm less sure about, but again looking at the match list of at least that one institution, they seem to make it work). Of course, as it's been said before, residency directors don't value preclinical grades nearly as much as multiple other factors, so it's questionable how big a piece of the larger puzzle they really comprise anyway.

    Of course, I'm sure when comparing two similar candidates that both had the opportunity to get "H," it would clearly be beneficial to do well. I just don't know how much they matter outside of that situation when it comes to getting into residencies.

    As for how it impacts the class dynamic, anecdotally my friends at schools with grades and/or schools with more tests are much (both observationally and admittedly) more stressed than my friends that just have one exam at the end of each block and/or true P/F grading. Other than that type of data, I imagine it'll be tough for anybody to compare because each person only has his or her experience and no control, and to be fair, grading system type (with a preference for P/F) was a large factor in my decision, so I am sure my analysis of the topic is a bit biased.

    But in the end, good, successful doctors have been coming from both types of programs for years, so to OP, regardless of the system, all will probably end well!
     
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    bora

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    thanks everyone for the valued insight! keep it coming...
     

    JJMrK

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    I know you prefaced that with it's your opinion, but I don't know if there is much to back it up…I suppose it depends on the school, but it seems many highly ranked schools have true P/F (and it may be that many P/F schools are more highly ranked, though I haven't really looked into it), and I don't think they have any problems getting people into competitive residencies. Tangentially, according to the survey of residency directors, perceived prestige ("highly regarded") of a medical school ranks as more important than Honors in basic sciences. Everybody on SDN loves saying how unless you're going into academic medicine/policy, school doesn't matter, so if school usually only matters at the margins, and it's considered "more important" than honors, then being able to get a lot of honors probably isn't all that impactful anyway.
    I didn't say that school name was less important than pre-clinical honors, and I don't think this is true. As an example, my opinion is that if the same institution were to have "H" grades one year and not the next, the students in the first year are at a very slight advantage to those in the second. Personally, I would take a slight advantage in this process every single time.

    Also, the idea that each "H" will help you shine assumes residency directors are comparing an "H" on one transcript directly to the transcript of somebody who didn't even have the possibility to prove they have "H" level of knowledge in the preclinical years; my guess is that isn't necessarily the case, especially when Step 1 and clinical grades can be taken into account (schools like CCLCM that don't have clinical grades I'm less sure about, but again looking at the match list of at least that one institution, they seem to make it work). Of course, as it's been said before, residency directors don't value preclinical grades nearly as much as multiple other factors, so it's questionable how big a piece of the larger puzzle they really comprise anyway.

    Again, my statement had nothing to do with specific institutions and their ability to match well. It was strictly about comparing two different grading scales, one of which I think is slightly advantageous. Many times institutions with big names are able to maintain a P/F system because programs trust that students from those schools are at a certain level. It's not the grading system that is helping these students when they apply to residency though, it's the name. Again, IMO if those schools had "H" grading systems, the students' position would be improved. This is especially true during the clinical years, during which grades are used heavily for evaluation by PDs.

    Of course, I'm sure when comparing two similar candidates that both had the opportunity to get "H," it would clearly be beneficial to do well. I just don't know how much they matter outside of that situation when it comes to getting into residencies.


    Everything matters, it's just that some things are more important than others. You'll figure this out in medical school.

    As for how it impacts the class dynamic, anecdotally my friends at schools with grades and/or schools with more tests are much (both observationally and admittedly) more stressed than my friends that just have one exam at the end of each block and/or true P/F grading. Other than that type of data, I imagine it'll be tough for anybody to compare because each person only has his or her experience and no control, and to be fair, grading system type (with a preference for P/F) was a large factor in my decision, so I am sure my analysis of the topic is a bit biased.

    This is a huge, sweeping generalization, and is more dependent on the person than the school or grading system.
     

    NickNaylor

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    At the risk of sounding like a broken record: it depends on your goals. IMO P/F grading systems are a disadvantage for students who intend to apply for competitive specialties. Each "H" on your transcript is one piece of a large puzzle, and the more you get the brighter your application will shine. While it is probably true that P/F grading allows for more of a focus on step 1, there are plenty of students who manage to honor courses and do well on the test. I have the same opinion of systems that severely limit the number of "H/A" grades that are given out during clinical clerkships. In the same vien, AOA isn't everything, but it is extremely helpful to have. I

    If you are interested in a less competitive field and attend a school with some type of grading scale, you are always free to choose to be content with passing.

    I would agree with this. Unimportant though pre-clinical grades may be, if you're interested in a competitive specialty and can achieve at the level necessary to do so, then any opportunity to distinguish yourself is advantageous. I don't think it's all that important of a factor (as you imply later), and I definitely believe no one should make a school choice based on this. There are many more important things to consider.
     
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    BABSstudent

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    At the risk of sounding like a broken record: it depends on your goals. IMO P/F grading systems are a disadvantage for students who intend to apply for competitive specialties. Each "H" on your transcript is one piece of a large puzzle, and the more you get the brighter your application will shine. While it is probably true that P/F grading allows for more of a focus on step 1, there are plenty of students who manage to honor courses and do well on the test. I have the same opinion of systems that severely limit the number of "H/A" grades that are given out during clinical clerkships. In the same vien, AOA isn't everything, but it is extremely helpful to have. I

    If you are interested in a less competitive field and attend a school with some type of grading scale, you are always free to choose to be content with passing.
    My school has no problem matching into competitive specialties or residencies. But if you believe that, make sure you go to a school with grades and not P/F.

    In all actuality, it's step 1 scores and clinical grades that matter (along with research and ECs to a lesser extent). Step 1 equalizes everyone since each school has a different rigor in their classes and student population. I mean, think about it. Do you really want to have honors mean a lot when you could have honored everything at a school where you are the top medical student or gone to WashU and be incredibly smart but struggle to be average since their MCAT average is so high. Step 1 takes care of this disparity. Also, the first two years have a lot of trivial knowledge that doesn't need to be remembered to be a doctor.

    Clinical grades show what type of doctor you will be and how far you will go. Unfortunately it is also a buch of *** kissing.
     

    JJMrK

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    I would agree with this. Unimportant though pre-clinical grades may be, if you're interested in a competitive specialty and can achieve at the level necessary to do so, then any opportunity to distinguish yourself is advantageous. I don't think it's all that important of a factor (as you imply later), and I definitely believe no one should make a school choice based on this. There are many more important things to consider.

    Agree 100%.

    My school has no problem matching into competitive specialties or residencies. But if you believe that, make sure you go to a school with grades and not P/F.

    In all actuality, it's step 1 scores and clinical grades that matter (along with research and ECs to a lesser extent). Step 1 equalizes everyone since each school has a different rigor in their classes and student population. I mean, think about it. Do you really want to have honors mean a lot when you could have honored everything at a school where you are the top medical student or gone to WashU and be incredibly smart but struggle to be average since their MCAT average is so high. Step 1 takes care of this disparity. Also, the first two years have a lot of trivial knowledge that doesn't need to be remembered to be a doctor.

    Clinical grades show what type of doctor you will be and how far you will go. Unfortunately it is also a buch of *** kissing.

    See my second post in the thread. It's not about certain schools having problems. It's about one system that is slightly more advantageous, all other things being equal. I do NOT advocate choosing a school based on this issue. As an aside, it'd be too late anyway, as I graduate med school in 2 months.

    I have thought about it, and currently hold the opinion I have expressed. It's OK if you disagree.
     
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    bambam92

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    I think if you have the option to go straight P/F it would lead to less stressful preclinical years. And it can't be a disadvantage to go pass/fail in my opinion. Many of the top MD programs in the country are P/F --so I don't see how this could be disadvantageous. Students coming out of Harvard are still doing "alright" in the match last time I checked... despite their P/F grading. lol
     

    seeinghowitgoes

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    This is a huge, sweeping generalization, and is more dependent on the person than the school or grading system

    Just for the record, absolutely agree it's a generalization (though it could probably be a bit of a debate as to whether my personal observations in this instance are people or school/grading system driven, but ehhh), and that's why I mentioned in so many words that it was admittedly not scientific at all (I'm reporting correlations with no control at best).

    Again, my statement had nothing to do with specific institutions and their ability to match well. It was strictly about comparing two different grading scales, one of which I think is slightly advantageous. Many times institutions with big names are able to maintain a P/F system because programs trust that students from those schools are at a certain level. It's not the grading system that is helping these students when they apply to residency though, it's the name. Again, IMO if those schools had "H" grading systems, the students' position would be improved. This is especially true during the clinical years, during which grades are used heavily for evaluation by PDs.

    I do understand that every little bit helps (I don't know if it takes being in medical school to realize that haha), I guess I still just question the value add when one student couldn't get honors even if he or she wanted to.

    That being said, I understand your sentiment and appreciate the perspective, and your opinion creates an interesting hypothetical. I must admit I had never really thought about how much improvement their might be for some students if the "H" was an option at some schools currently P/F (I just assumed it was a non-factor if it didn't exist at a given school). I wonder if there is a school that made a change (one way or another) that reported some sort of data that could be looked at. Either way, one of us will have to carry out an RCT on it one day for the definitive answer :)
     
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    scarletgirl777

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    Agree 100%.



    See my second post in the thread. It's not about certain schools having problems. It's about one system that is slightly more advantageous, all other things being equal. I do NOT advocate choosing a school based on this issue. As an aside, it'd be too late anyway, as I graduate med school in 2 months.

    I have thought about it, and currently hold the opinion I have expressed. It's OK if you disagree.
    I have thought about this, and the stress of memorizing useless minutia would make ALL of med school a stressful experience and negate any gains of having that H in histology.
    Show me a PD that cares about this.
     
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    JJMrK

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    I have thought about this, and the stress of memorizing useless minutia would make ALL of med school a stressful experience and negate any gains of having that H in histology.
    Show me a PD that cares about this.

    They're out there, I've met them.

    Again, not the most important thing ever, but some people do use this in their overall assessment of a candidate.
     
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