How important are preclinical grades?

[Jabbed]

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I'm an incoming MS1 in a US MD program with a graded curriculum. I'm hoping to match into a competitive residency.

Is it a terrible idea to treat my examinations as P/F and focus on step-relevant material and important info at the expense of minutia? I've always heard that preclinical grades "don't matter" and that due to the sheer volume of information I'll end up forgetting everything that I learned within a few weeks of studying it anyway. I always intuitively thought that it would make far more sense to focus on the important/relevant information and consistently refresh it instead of binging and purging on whatever I need to make the A on any given block exam.

 

[ChEMD]

You have to decide how important it is to you to be in the top quartile (or whatever) of your class, which is a more important factor in terms of residency selection (as is AOA). Yeah, getting a high step 1 score a more important factor than a high class rank/AOA, but you have to remember that there will be PLENTY of people that will do both.

 

[Psai]

Do the best you can and don't take it too hard if you're not number one. Learn as much as you can. Doing well on step one is important for sure but don't forget that you're studying to be a doctor, not a test taker

 

[Porfirio]

Rule #1 of Medical School

Figure out what you want to do then try as hard as you have to - to reach that goal.

Rule #2 of Medical School

P=MD for most students

Rule #3 of Medical School

Work hard, play harder

Rule #4 of Medical School

The only point to the first two years of medical school is Step 1.

Rule #5 of Medical School

3rd and 4th year is why we pay tuition for medical school.

 

[Packman2003]

I would ask more people who have taken Step 1 within the last year. It seems to have changed quite a bit. You might find it to be counterproductive to blow off your classes to rely on board review resources. The actual exam goes beyond what you will find in First Aid, Pathoma, etc. If you want to score highly you need a really solid foundation.

 

[DermViser]

I'm an incoming MS1 in a US MD program with a graded curriculum. I'm hoping to match into a competitive residency.

Is it a terrible idea to treat my examinations as P/F and focus on step-relevant material and important info at the expense of minutia? I've always heard that preclinical grades "don't matter" and that due to the sheer volume of information I'll end up forgetting everything that I learned within a few weeks of studying it anyway. I always intuitively thought that it would make far more sense to focus on the important/relevant information and consistently refresh it instead of binging and purging on whatever I need to make the A on any given block exam.

You heard wrong. It's SDN folklore that keeps getting repeated again, and again, and again. If you go to a "true" P/F school the first 2 years, then you're lucky. If not, then preclinical grades will contribute to your class rank. How important class rank is depends on the specialty you are aiming to match in.

 

[DermViser]

I would ask more people who have taken Step 1 within the last year. It seems to have changed quite a bit. You might find it to be counterproductive to blow off your classes to rely on board review resources. The actual exam goes beyond what you will find in First Aid, Pathoma, etc. If you want to score highly you need a really solid foundation.

In what way has Step 1 changed? Are review books no longer enough? What assurance do you have that your class covered it?

 

[sazerac]

In what way has Step 1 changed? Are review books no longer enough? What assurance do you have that your class covered it?

And as a followup question, if there was a significant change to the Step 1 style / format / content / emphasis, who do you think would pick up on the changes first... a review book updated annually, or a medical school curriculum?

 

[Jabbed]

You heard wrong. It's SDN folklore that keeps getting repeated again, and again, and again. If you go to a "true" P/F school the first 2 years, then you're lucky. If not, then preclinical grades will contribute to your class rank. How important class rank is depends on the specialty you are aiming to match in.

If I knock a 250 on step 1 but have average/low-average class rank, will that bottleneck my chances at a competitive residency?

 

[Ugen]

Being AOA is a major boost. It's very important to matching competitive specialties ("Competitive specialties" means anything like Derm, Ophtalmology, Rad Onc, Anesthesia, Ortho, Plastics or anything like IM at a top hospital) as most of the people going to these places will be AOA.

90% of schools factor pre clinical grades heavily when selecting AOA. Find out about your schools criteria but keep in mind they may change in 2 years.

Doing well in pre-clinical classes will boost your chances of getting a high step 1 score simply because you will know more. Hopefully you don't have to be schooled on how important step 1 is

 

[J ROD]

only important if you want to do something competitive.

 

[VisionaryTics]

only important if you want to do something competitive.

But you don't want to be in the position late 3rd year when you realize you really want to do ortho or derm, and can't, because you never thought you'd be interested in those fields as an M1.

 

[J ROD]

But you don't want to be in the position late 3rd year when you realize you really want to do ortho or derm, and can't, because you never thought you'd be interested in those fields as an M1.

Or you do enough shadowing before and during school to have a good idea. Because you do not get to see if all while on rotations. I spent over 100 hrs looking at derm and I hate it. I find it boring no matter the lifestyle or money. Surgery, you should have a clue if you want to cut or not. Looked at Plastics since I was offered. I am not a cutter....lol

I already know the end game is to get into the residency you want and play the game accordingly. If you do not, know then you have to prepare for the hardest. I am amazed at how many folks even after 3rd yr have no clue what they want to do. Ultimately, that is the main reason you are here. Pick a field and get into residency. Get a job. Med school is just the means to get there.

I stress this to my younger classmates all the time. All they care about is grades since that is all they had to worry about all their lives. Once you get into the real world and have a job, nobody cares about your GPA. Only that you can do your job and not make their job harder.

Of course, you do not want to limit yourself if you truly do not know and need to figure it out, but I advise to start preparing and looking into that well before you get to 3rd yr. Just can't see if all in a year and a few months. Or at least where I am.

 

[username456789]

But you don't want to be in the position late 3rd year when you realize you really want to do ortho or derm, and can't, because you never thought you'd be interested in those fields as an M1.

Yup. My approach in medical school was "work exceptionally hard and do well so I don't close any doors." Even if I ended up applying to [insert whatever noncompetitive field of your choice] instead of Derm, I would've been in a great position to write my ticket.

 

[VisionaryTics]

Or you do enough shadowing before and during school to have a good idea. Because you do not get to see if all while on rotations. I spent over 100 hrs looking at derm and I hate it. I find it boring no matter the lifestyle or money. Surgery, you should have a clue if you want to cut or not. Looked at Plastics since I was offered. I am not a cutter....lol

I already know the end game is to get into the residency you want and play the game accordingly. If you do not, know then you have to prepare for the hardest. I am amazed at how many folks even after 3rd yr have no clue what they want to do. Ultimately, that is the main reason you are here. Pick a field and get into residency. Get a job. Med school is just the means to get there.

I stress this to my younger classmates all the time. All they care about is grades since that is all they had to worry about all their lives. Once you get into the real world and have a job, nobody cares about your GPA. Only that you can do your job and not make their job harder.

Of course, you do not want to limit yourself if you truly do not know and need to figure it out, but I advise to start preparing and looking into that well before you get to 3rd yr. Just can't see if all in a year and a few months. Or at least where I am.

As an example: I matched to otolaryngology. I talked to plenty of med students in my class who discovered "late" (mid/end of 3rd year) that they were interested in ENT when they were previously interested in gen surg or IM or whatever. Crappy preclincial grades/no research/no AOA? Good luck. Not impossible, but you'll be the odd man out.

If you do not, know then you have to prepare for the hardest.

Even if you think you know, still prepare for the hardest. You may surprise yourself.

 

[operaman]

They are very important for many reasons, the biggest of which are already mentioned here: AOA and Step 1. The scope of step 1 is well beyond the review materials, and review materials by definition were never intended to be primary/only sources. I busted my tail for 2 years, studied 2 weeks for step 1, and rocked it. Never bought First Aid either. In my class alone, of people who earned straight As/Honors/whatever, not one of them scored below 250. So, the first 2 years can be huge when it comes to this and future tests (shelves, step 2 ck, etc).

The other side is that M1/M2 are where you begin learning the language of medicine. If you've really learned your stuff, it makes 3rd year SOOOO much easier because your knowledge base is totally solid and you're just building on top of things you already know. I answered a LOT of shelf questions based on things I learned in the first 2 years.

Finally, the idea that they don't matter is absolute bunk. If someone had subpar preclinical grades but a 250+ on step 1, I think I would wonder what was going on. (Granted, I'd rather have a 250 with low grades than perfect grades with a 220.) I would personally be very uncomfortable ranking someone with a major discrepancy like that in their application because it would make me think they weren't that interested in their classes and blew them off in favor of some test they thought would benefit them. How is that person going to handle the parts of residency they aren't that interested in? Are they just going to blow off everything that isn't going to directly help them land a big fellowship? What kind of colleague will they be? If it's a surgical specialty, how would you feel ranking someone with below average anatomy grades?

Preclinical grades are not as important as other things, but they do tell part of your story.

 

[J ROD]

To each their own. Knock yourself out. I enjoyed doing solid work and not killing myself like some of my classmates. I do not need a 4.0 that bad.

 

[FIREitUP]

Being AOA is a major boost. It's very important to matching competitive specialties ("Competitive specialties" means anything like Derm, Ophtalmology, Rad Onc, Anesthesia, Ortho, Plastics or anything like IM at a top hospital) as most of the people going to these places will be AOA.

90% of schools factor pre clinical grades heavily when selecting AOA. Find out about your schools criteria but keep in mind they may change in 2 years.

Doing well in pre-clinical classes will boost your chances of getting a high step 1 score simply because you will know more. Hopefully you don't have to be schooled on how important step 1 is

most is not true. even in derm 50% don't have AOA.

 

[username456789]

To each their own. Knock yourself out. I enjoyed doing solid work and not killing myself like some of my classmates. I do not need a 4.0 that bad.

Everyone's different. For me, 2-3 years of busting my ass was worth 2-3 decades (or more) of loving life. Small investment up front for huge payout.

 

[J ROD]

Everyone's different. For me, 2-3 years of busting my ass was worth 2-3 decades (or more) of loving life. Small investment up front for huge payout.

I do not want a competitive field. I know that do not think it. I will be loving life in my poor field.

Like I said it is all about what you want to do. Play the game to your advantage. Mine is not competitive so I can just be solid and still have a life. I am not saying get a 2.2 GPA.....but a 3.0-3.5 is not bad and not the end of the world. Might be on here but on average.....there is about half the class below that. I do not even know my class rank.......😱

 

[cs24]

I would ask more people who have taken Step 1 within the last year. It seems to have changed quite a bit. You might find it to be counterproductive to blow off your classes to rely on board review resources. The actual exam goes beyond what you will find in First Aid, Pathoma, etc. If you want to score highly you need a really solid foundation.

Not at all what I've heard. Everyone is still swearing by the holy trinity of UWorld, first aid, and pathoma. And this is from people who did well.

 

[DermViser]

Not at all what I've heard. Everyone is still swearing by the holy trinity of UWorld, first aid, and pathoma. And this is from people who did well.

Everyone thinks THEIR exam is nothing that has been ever seen before. This happens year after year. Also, I guarantee you the ones who did well did not just use FA, UWorld, and Pathoma only. If so, it was bc they were already strong in other areas.

 

[DermViser]

Everyone's different. For me, 2-3 years of busting my ass was worth 2-3 decades (or more) of loving life. Small investment up front for huge payout.

👍👍

 

[EMDO2018]

AOA is top 10% of class right? Honestly, im too old to stress about being in the top 10%. I want to finish med school with hair, and not 300 pounds. I highly doubt ill want anything competitive, if I do ill just accept my losses.

 

[DermViser]

AOA is top 10% of class right? Honestly, im too old to stress about being in the top 10%. I want to finish med school with hair, and not 300 pounds. I highly doubt ill want anything competitive, if I do ill just accept my losses.

No. Those in the top 25% of the class are eligible to be inducted into AOA. How that calculation to be inducted varies. A lot. The problem is you'll have no idea where you fall so the game plan of slacking off bc "I highly doubt ill want anything competitive" is not a good idea.

 

[DermViser]

Finally, the idea that they don't matter is absolute bunk. If someone had subpar preclinical grades but a 250+ on step 1, I think I would wonder what was going on. (Granted, I'd rather have a 250 with low grades than perfect grades with a 220.) I would personally be very uncomfortable ranking someone with a major discrepancy like that in their application because it would make me think they weren't that interested in their classes and blew them off in favor of some test they thought would benefit them. How is that person going to handle the parts of residency they aren't that interested in? Are they just going to blow off everything that isn't going to directly help them land a big fellowship? What kind of colleague will they be? If it's a surgical specialty, how would you feel ranking someone with below average anatomy grades?

Preclinical grades are not as important as other things, but they do tell part of your story.

THIS. PDs know that there will be a LOT in residency that you won't like doing. Someone who comes in believing that working hard in preclinical courses is irrelevant and all that matters is Step 1 (as if they are mutually exclusive) is really seeing things as black-and-white, when it's actually gray.

That being said, there are people who've done really well when it comes to preclinical grades but don't do as well when the exam is standardized. So one doesn't necessarily guarantee another.

 

[dadaddadaBATMAN]

THIS. PDs know that there will be a LOT in residency that you won't like doing. Someone who comes in believing that working hard in preclinical courses is irrelevant and all that matters is Step 1 (as if they are mutually exclusive) is really seeing things as black-and-white, when it's actually gray.

That being said, there are people who've done really well when it comes to preclinical grades but don't do as well when the exam is standardized. So one doesn't necessarily guarantee another.

I would say you're correct, grades and step 1 aren't mutually exclusive. But they do seem to require different skill sets and preparation, and a lot of people seem to get very focused on one or the other. (this comment comes from an incoming M2 who has not taken the step, and deserves a heavy grain of salt)

My personal take is to not focus overly hard on either metric, but to learn as much as you can without destroying your personal life. If you must focus on one metric, step 1 is the more important of the two. If you are receiving poor pre-C grades, that should be a warning you that you may not understand material (and so you're probably not going to do well on step 1 either).

I'm not going to stress about the classes where I fell 1-2% short of honors. However, I think that if you're barely passing classes and claim to be "focused on step 1" then you're kidding yourself.

 

[DermViser]

I would say you're correct, grades and step 1 aren't mutually exclusive. But they do seem to require different skill sets and preparation, and a lot of people seem to get very focused on one or the other. (this comment comes from an incoming M2 who has not taken the step, and deserves a heavy grain of salt)

My personal take is to not focus overly hard on either metric, but to learn as much as you can without destroying your personal life. If you must focus on one metric, step 1 is the more important of the two. If you are receiving poor pre-C grades, that should be a warning you that you may not understand material (and so you're probably not going to do well on step 1 either).

I'm not going to stress about the classes where I fell 1-2% short of honors. However, I think that if you're barely passing classes and claim to be "focused on step 1" then you're kidding yourself.

I agree. However, again it depends on what specialty you're going for, as to whether racking up "Honors" is important, or not.

 

[J ROD]

I agree. However, again it depends on what specialty you're going for, as to whether racking up "Honors" is important, or not.

My point exactly. Mine does not so I will be very strong for what I want. Which is just slightly average or above the mean.

 

[DermViser]

My point exactly. Mine does not so I will be very strong for what I want. Which is just slightly average or above the mean.

Again, you're not going to know what average is. You'll see in general that the average for a medical school course is quite high.

 

[operaman]

I agree. However, again it depends on what specialty you're going for, as to whether racking up "Honors" is important, or not.

Exactly.

PD: So why do you want to be a surgeon?
M4: Well, it all started in first year when I really liked anatomy...
PD: Ah, I see, but your anatomy grade would suggest otherwise...
M4: .....

Fail.

 

[DermViser]

Exactly.

PD: So why do you want to be a surgeon?
M4: Well, it all started in first year when I really liked anatomy...
PD: Ah, I see, but your anatomy grade would suggest otherwise...
M4: .....

Fail.

Yup. A little hard to recover from.

 

[cs24]

Also, I guarantee you the ones who did well did not just use FA, UWorld, and Pathoma only. If so, it was bc they were already strong in other areas.

Classic DermViser 🙄. I guarantee that I know exactly what one of the people who scored very well was studying. But please, do tell me more about how my significant other prepared for boards, I have no idea.

 

[DermViser]

Classic DermViser 🙄. I guarantee that I know exactly what one of the people who scored very well was studying. But please, do tell me more about how my significant other prepared for boards, I have no idea.

You are free to copycat and test out the study habits of your significant other (how that is relevant is beyond me), and ONLY use FA, UWorld, and Pathoma. Like I said, the ones who ONLY used those resources were likely already strong in their basic sciences foundation, in general. Let me know how it works out. 🙄

 

[Mehd School]

Exactly.

PD: So why do you want to be a surgeon?
M4: Well, it all started in first year when I really liked anatomy...
PD: Ah, I see, but your anatomy grade would suggest otherwise...
M4: .....

Fail.

Blah Blah ... rough transition to the increased load in medical school ... blah blah honored all of the relevant rotations.... scored at a competitive level on the boards, etc.

 

[BurghStudent]

They are very important for many reasons, the biggest of which are already mentioned here: AOA and Step 1. The scope of step 1 is well beyond the review materials, and review materials by definition were never intended to be primary/only sources. I busted my tail for 2 years, studied 2 weeks for step 1, and rocked it. Never bought First Aid either. In my class alone, of people who earned straight As/Honors/whatever, not one of them scored below 250. So, the first 2 years can be huge when it comes to this and future tests (shelves, step 2 ck, etc).

The other side is that M1/M2 are where you begin learning the language of medicine. If you've really learned your stuff, it makes 3rd year SOOOO much easier because your knowledge base is totally solid and you're just building on top of things you already know. I answered a LOT of shelf questions based on things I learned in the first 2 years.

Finally, the idea that they don't matter is absolute bunk. If someone had subpar preclinical grades but a 250+ on step 1, I think I would wonder what was going on. (Granted, I'd rather have a 250 with low grades than perfect grades with a 220.) I would personally be very uncomfortable ranking someone with a major discrepancy like that in their application because it would make me think they weren't that interested in their classes and blew them off in favor of some test they thought would benefit them. How is that person going to handle the parts of residency they aren't that interested in? Are they just going to blow off everything that isn't going to directly help them land a big fellowship? What kind of colleague will they be? If it's a surgical specialty, how would you feel ranking someone with below average anatomy grades?

Preclinical grades are not as important as other things, but they do tell part of your story.

Or, or, they have a 250+, mediocre grades, and wow, a ton of awesome research. I wonder where they found the time to do that?

 

[operaman]

It's absolutely a balancing act, no doubt about it. Don't forget that the most competitive people have all of it: perfect grades, perfect boards, awesome research. That isn't always possible for everyone and some do have to triage and put effort where it can make a difference, but coming in with the idea that one thing or the other isn't that important seems like a recipe for trouble.

I don't think anyone will really buy the "had to adjust to the increased workload" line; no applicant is a good enough actor to sell it and no PD is stupid enough to buy it. Maybe if it was just the first semester of first year, but after that I would expect people to know what they needed to do to succeed.

The other consideration is the increasing competitiveness across the board. Many attendings will tell you that they would have a hard time getting a spot in their field today with the grades/boards they had back then.

 

[DermViser]

It's absolutely a balancing act, no doubt about it. Don't forget that the most competitive people have all of it: perfect grades, perfect boards, awesome research. That isn't always possible for everyone and some do have to triage and put effort where it can make a difference, but coming in with the idea that one thing or the other isn't that important seems like a recipe for trouble.

I don't think anyone will really buy the "had to adjust to the increased workload" line; no applicant is a good enough actor to sell it and no PD is stupid enough to buy it. Maybe if it was just the first semester of first year, but after that I would expect people to know what they needed to do to succeed.

The other consideration is the increasing competitiveness across the board. Many attendings will tell you that they would have a hard time getting a spot in their field today with the grades/boards they had back then.

Yeah, the I had to "adjust" line doesn't really work well anymore. Why? Bc there is another applicant right next to you who didn't have to adjust and did just fine.

 

[cs24]

You are free to copycat and test out the study habits of your significant other (how that is relevant is beyond me), and ONLY use FA, UWorld, and Pathoma. Like I said, the ones who ONLY used those resources were likely already strong in their basic sciences foundation, in general. Let me know how it works out. 🙄

What I personally will do to prepare for boards is irrelevant to this current conversation. I was just calling you out on one of your dramatic blanket generalizations you love to make with such authority.

 

[DermViser]

What I personally will do to prepare for boards is irrelevant to this current conversation. I was just calling you out on one of your dramatic blanket generalizations you love to make with such authority.

You are free to be naive as you'd like. But FA, Pathoma, and USMLEWorld only are not enough to cover entirely what you need to know, unless your basic science foundation is ALREADY strong beforehand. Nothing generalized about that. It's just fact (whether you choose to accept it or not, doesn't change that).

 

[operaman]

FA, Pathoma, and UWorld are more than sufficient REVIEW sources to use for step 1. They are not sufficient as your only sources from which to learn. I think that's the big distinction.

 

[cs24]

You are free to be naive as you'd like. But FA, Pathoma, and USMLEWorld only are not enough to cover entirely what you need to know, unless your basic science foundation is ALREADY strong beforehand. Nothing generalized about that. It's just fact (whether you choose to accept it or not, doesn't change that).

Ah I think I see the problem. My first post in this thread was a response to the "STEP 1 has changed quite a bit" remark in the comment I quoted, not the "you need a solid foundation to score high part". I was simply pointing out that I think Uworld, FA, and Pathoma are still the most important core review resources you need for boards. I will have a strong foundation by the time I start studying for step, and wouldn't tell anyone to blow off their classes to focus on board prep.

 

[dadaddadaBATMAN]

You are free to be naive as you'd like. But FA, Pathoma, and USMLEWorld only are not enough to cover entirely what you need to know, unless your basic science foundation is ALREADY strong beforehand. Nothing generalized about that. It's just fact (whether you choose to accept it or not, doesn't change that).

FA, Pathoma, and UWorld are more than sufficient REVIEW sources to use for step 1. They are not sufficient as your only sources from which to learn. I think that's the big distinction.

I think I was confused by the wording. What I thought was being said was that to do well on boards, we would have to use extensive resources beyond those ones (Pathoma, FA and UW) in addition to doing exceedingly well in our courses.

What you both seem to mean by this is that if someone went into med. school, did barely enough to pass, then used these resources, that would not be enough to do well on step 1.

However, in conjunction with hard work during the first two years during the actual coursework , they should review a significant portion of what we learned (other sources like various BRS, other qbanks and goljan are gravy on top).

Does this accurately express your experiences? Or am I still misinterpreting?

 

[operaman]

Spot on.

 

[Psai]

FA, Pathoma, and UWorld are more than sufficient REVIEW sources to use for step 1. They are not sufficient as your only sources from which to learn. I think that's the big distinction.

I was impressed with your long posts but your short posts are very valuable too. Nice

 

[DermViser]

I think I was confused by the wording. What I thought was being said was that to do well on boards, we would have to use extensive resources beyond those ones (Pathoma, FA and UW) in addition to doing exceedingly well in our courses.

What you both seem to mean by this is that if someone went into med. school, did barely enough to pass, then used these resources, that would not be enough to do well on step 1.

However, in conjunction with hard work during the first two years during the actual coursework though, they should review a significant portion of what we learned (other sources like various BRS, other qbanks and goljan are gravy on top).

Does this accurately express your experiences? Or am I still misinterpreting?

Yes, exactly. Thank you.

 

[ketosisevangelist]

What I personally will do to prepare for boards is irrelevant to this current conversation. I was just calling you out on one of your dramatic blanket generalizations you love to make with such authority.

Who can argue with you?

We have all seen it in med school. The couple that "invented love."

Hayyyy.

 

[ketosisevangelist]

Ah I think I see the problem. My first post in this thread was a response to the "STEP 1 has changed quite a bit" remark in the comment I quoted, not the "you need a solid foundation to score high part". I was simply pointing out that I think Uworld, FA, and Pathoma are still the most important core review resources you need for boards. I will have a strong foundation by the time I start studying for step, and wouldn't tell anyone to blow off their classes to focus on board prep.

DermViser owned you. Admit it.

 

[ketosisevangelist]

Yes... Hello...this is cs24. My significant other (SO) and I formally apologize to the SDN user known as DermViser.

Thank you.

Sincerely,
cs24 & my SO

 

[cs24]

Yes... Hello...this cs24. My significant other (SO) and I formally apologize to the SDN user known as DermViser.

Thank you.

Sincerely,
cs24 & my SO

Hilarious. Thank you for your strong contribution to the thread.