How important, exactly, are 3rd year grades?

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Mar 7, 2008
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I'm finding it a bit frustrating the way grades are assigned during 3rd year. The subjective and whimsical nature of it can be ridiculous at times. One resident I had on service spent zero time on my eval. She just checked the middle box straight down the page and then wrote "Student did a good job." under the comments on the back. Then, another resident on the same service actually wrote a more meaningful eval with some real comments on the back. Then there was an attending that my classmate saw exactly 1 time during his time on the rotation. This attending went on vacation soon after, but had a reputation of giving very high marks to everyone regardless. And so my classmate naturally got a high grade in the rotation. Some attendings think that an "honors" performance is a student who does all of his work and completes assignments and tasks and performs appropriately, while other attendings will not give honors unless you simply amaze them or do something way out of the way impressive. (like curing cancer)

I guess my question is regarding how rad onc programs perceive 3rd year grades. How badly will it reflect on you to get all passes but with great comments and critiques? I felt like I worked my butt off in every rotation but the attending or residents don't fully understand how greatly the 1 page check marks and comments affect your grade. It's like they don't even bother remembering who you are sometimes. I don't want to give the impression of being incompetent or lazy or not caring on clinical rotations, but the method of grading just seems to be irrepresentative of performance. The shelf exam counts for a relatively small portion of our grade and I found out from upper classmen that my school is particularly stingy about handing out honors and near honors.

My understanding from one of the deans that I've spoken to is that the most important thing is to do well and impress on rad onc away rotations. Anyone have any thoughts?


And to think . . . I hesitated
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Apr 16, 2004
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You bring up some good points. However, third year grades are important there is no getting around it. Positive comments on your MPSE/Dean's letter also count for a lot so your grades are not the end all be all. I don't want to be put in a position to defend the objectivity of third year grading so I will just leave it at that.

There are other important aspects to impressing and securing an interview: Step I scores, research experiences/publications, away rotations, etc. So just because your third year grades may not be the best, don't limit your applications.

Bottom line: third year grades are important.


The Dude Abides
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Aug 8, 2005
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Yeah, I totally hear ya. I found out afterwards that only 2 people on my surgery rotation received honors, and there were 30+ people on that rotation!

How heavily are dean's letters weighed? I spoke to one rad onc director that said he didn't even read dean's letters because "deans are just cheerleaders for each of his students." I should hope that the comments in the dean's letter count for something!


I'd have to agree that 3rd year grades are an important part of your application. Certain clerkships are perhaps more important than others and the general consensus I get from talking to PDs and attendings is that Medicine in the most important. If you didn't do too hot in Medicine most places would expect to see an honors in a Medicine subI or equivalent. Doing well in Medicine becomes important for letters as I had one PD tell me in no uncertain terms that any application without a strong letter from the Dept. of Medicine was "severely lacking."

I completely agree that grades are apparently randomly assigned sometimes. Half of my Surgery grade was based on the report of an attending I worked with for exactly 2 hours in clinic. It doesn't seem fair, I agree, but we're all in the same boat. As far as what grades mean, I think that's very institution dependent. I remember being told repeatedly that "75% of students receive Pass as their grade" for any given clerkship. When I got my Dean's letter which included a handy graph of grade distributions among all the clerkships well over half of students were getting Honors/HP. There's a lot of grade inflation out there so while P may equal MD, in the crazy competitive world of Rad Onc you may stand out with too many on your record.

As far as Dean's letters, it is again institution dependent. My school writes these 9 page monstrosities that I've heard nobody ever reads because they're just too long. On the flip side I heard a PD at my school say he doesn't read other schools' letters because they're too short and don't cover enough. I remember as a first year shadowing my home program's PD as he was doing an initial screen of applications. He spent maybe 2 minutes tops with each one so obviously things were not read in detail. I would assume if you're invited for an interview they might look more carefully at the comments, but a lot of programs just see them as a regurgitation of your transcript/CV.